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Abstract

Objective: To identify the symptoms of codependency and health issues in the codependent family members of drug users who called a toll-free telephone counseling service. In total, 505 family members participated in this cross-sectional study. Drug users' mothers and wives who had less than 8 years of education and those who were unemployed had a greater chance of high codependency. It was also determined that a high level of codependency imposed a significant burden on the physical and emotional well-being of those affected, resulting in poor health, reactivity, self-neglect and additional responsibilities. It was concluded that codependency has a negative impact on the family system and on the health of the family members of drug users.
ARTIGO ARTICLE
101
1 Departamento de
Farmacologia e Toxicologia,
Universidade Federal de
Ciências da Saúde de Porto
Alegre. R. Sarmento Leite
245, Centro. 90050-170
Porto Alegre RS Brasil.
cassandra.bortolon@
gmail.com
2 Grupo Hospitalar
Conceição.
Family functioning and health issues
associated with codependency in families of drug users
Funcionamento familiar e questões de saúde
associados com codependência em familiares de usuários de drogas
Resumo A dependência química atinge o usuá-
rio e o sistema familiar como um todo, todavia o
tratamento dessa condição é centrado no usuário,
o que deixa a família em segundo plano. Obje-
tivo: identificar os sintomas de codependência e
questões de saúde em familiares codependentes
de usuários de drogas que ligaram para um ser-
viço telefônico de aconselhamento. No total, 505
familiares participaram de um estudo transver-
sal. Mães e esposas de usuários de drogas que ti-
nham menos de 8 anos de estudo e que estavam
desempregadas apresentaram maior chance de
alta codependência. Além disso, foi identificado
que o nível alto de codependência interfere signi-
ficativamente no bem-estar físico e emocional dos
familiares, o que resultou em problemas de saúde,
reatividade, autonegligência e sobrecarga de ta-
refas. Foi concluído que a codependência tem um
impacto negativo no sistema familiar e na saúde
dos familiares de usuários de drogas.
Palavras-chave Dependência mimética, Família,
Usuários de drogas, Telefone
Abstract Substance abuse affects both the user
and the family system as a whole, yet substance
abuse treatment is centered on the user, leaving
the family in the background. Objective: To iden-
tify the symptoms of codependency and health is-
sues in the codependent family members of drug
users who called a toll-free telephone counseling
service. In total, 505 family members participated
in this cross-sectional study. Drug users’ mothers
and wives who had less than 8 years of education
and those who were unemployed had a greater
chance of high codependency. It was also deter-
mined that a high level of codependency imposed
a significant burden on the physical and emotion-
al well-being of those affected, resulting in poor
health, reactivity, self-neglect and additional re-
sponsibilities. It was concluded that codependency
has a negative impact on the family system and
on the health of the family members of drug users.
Key words Codependency, Family, Drug users,
Telephone
Cassandra Borges Bortolon 1
Luciana Signor 1
Taís de Campos Moreira 1
Luciana Rizzieri Figueiró 1
Mariana Canellas Benchaya 1
Cássio Andrade Machado 2
Maristela Ferigolo 1
Helena Maria Tannhauser Barros 1
DOI: 10.1590/1413-81232015211.20662014
102
Bortolon CB et al.
Introduction
Drug dependence affects not only drug users
themselves but all of the people in their social
context, especially their family1. The lives of ad-
dicts’ families usually focus on the family mem-
ber’s drug abuse, which can result in additional
psychological problems2-4. Codependency refers
to psychological behavioral problems that enable
drug users and their family members to engage
in mutually destructive habits and maladaptive
coping strategies to maintain a sense of balance
or homeostasis5. The wives of alcoholics report
enabling their partners’ use of alcohol and other
drugs6, and codependent family members display
an intense need to help compared with family
members without codependency7. Therefore,
codependency may also be defined as a multi-
dimensional problem influenced by a variety of
factors that may begin in childhood with a com-
pulsive need to assume a caretaker role and may
produce paradoxical affective links that reinforce
the drug user’s maladaptive behavior patterns.
Codependent people compulsively maintain
links with their children or partners despite the
suffering and lack of compensation that char-
acterize the relationships4. Codependent family
members often have difficulty setting bound-
aries and asserting their own needs because of
low self-esteem, poor emotional control and
self-blame. This not only allows the drug user to
continue their addiction but also prevents family
members from seeking help for themselves and
their loved ones4,8,9.
Known drug use within a family is an envi-
ronmental stressor, and codependency may arise
from these circumstances along with great psy-
chological suffering10,11. Wives’ descriptions of
their alcohol-dependent husbands reveal their
own physical and emotional overload in terms of
responsibility for children and household main-
tenance, the performance of multiple roles in the
family and financial worries12,13. The children of
drug users present a higher risk of developing
substance abuse and psychiatric disorders com-
pared with children from families without sub-
stance abuse14. In addition to the increased men-
tal health dysfunction15 associated with codepen-
dency, as seen in up to 59% of drug users’ wives,
there is an increased risk of physical disorders.
One-fourth of the young women who seek gener-
al medical care in Mexico present with codepen-
dent behaviors, usually within a relationship with
an alcohol-dependent partner4. Family members
who seek telemedical help to deal with a family
member who uses drugs present a poorer quality
of life in the psychological and physical domains
compared with the drug users themselves or with
the general population16.
The codependency model is frequently used
in health services for the joint treatment of drug
and/or alcohol users and their families2,17. How-
ever, the substance abuse treatment is centered
on the user, leaving the family in the background,
and more studies that identify the main charac-
teristics of the families of substance abusers are
needed10,17. Nonetheless, the families of substance
users need help, as family members present dis-
orders that deserve greater attention from treat-
ment programs12. This study aims to determine
whether there is an association between family
functioning and health issues and codependency
in the families of drug users.
Methods
We conducted a cross-sectional study of 505
family members of drug users who had requested
help with a drug user in the family by calling the
drug-prevention information service “VIVAVOZ
- call 132” and who requested information about
treatment sites for drug users between August
2008 and March 2010.
The study was applied to the population of
all five Brazilian regions. Parents, siblings, de-
scendants, second- and third-degree relatives
and spouses were included in this study (after
they contacted the service). They completed as-
sessments regarding codependency and family
functioning. Incomplete protocols (the call was
dropped, incomplete evaluation), family mem-
bers of those who used only tobacco, individuals
under 15 years of age and individuals who lacked
the cognitive ability to answer the questionnaire
were excluded. The research ethics committee of
the Federal University of Health Sciences of Por-
to Alegre approved the project.
The data were collected by college students
from different health areas who were trained
in substance abuse problems and motivational
interviewing (an intervention carried out in a
follow-up telephone call) and who worked un-
der the supervision of a licensed professional, as
described elsewhere18. During the phone calls,
the students collected sociodemographic data,
codependency index information and answers to
open-ended questions about family functioning.
103
Ciência & Saúde Coletiva, 21(1):101-107, 2016
Assessment of Codependency
The instrument used to evaluate codepen-
dency was the Holyoake Codependency Index
(HCI), a self-report instrument with 13-items
that are rated on a 5-point Likert scale. Each of
these 13 items falls into 1 of 3 themes (e.g., ex-
ternal focus, self-sacrifice and reactivity), and
the average scores of the items in each theme
are added to give a total score of 3 to 15 points2.
External focus is characterized by focusing atten-
tion on the behavior, opinions and expectations
of other people to gain their approval or affec-
tion; self-sacrifice refers to neglecting one’s own
needs to focus on meeting the needs of others;
and reactivity reflects a belief in one’s capacity to
solve other people’s problems and control their
behavior2. The main characteristic of the HCI is
that the self-report is based on the intensity of
the dysfunctional link with drug users. The HCI
was previously translated into Brazilian Portu-
guese, and scores higher than 9.7 determine high
codependency19.
Assessment of Family Functioning
Telephone interviews were used to under-
stand the individuals’ family functioning. The
interviews used strategies similar to those used
in the clinical setting10,20. Family functioning
was assessed using the participants’ spontaneous
self-responses to the prompt “Tell me how you
perceive your relationship with the family mem-
ber who uses drugs”, based on the transcripts of
telephone interviews with family members21.
The participants’ responses were analyzed by
a jury of two psychologists who received specific
training from a psychologist who specialized in
family psychology. The family specialist was also
responsible for the final decision (based on the
literature and experience with face-to-face inter-
ventions with the families of drug users) regard-
ing the correct categorization when the jurors’
opinions diverged. The answers were interpreted
as binary variables (yes or no) for the following
categories: 1- emotional/task overload, including
descriptions of stress, fatigue, excessive worry,
difficulty sleeping, loss of emotional control and
poor crisis management resulting from the user’s
behavior and the added burden of paying the us-
er’s debts, theft of personal property and the use
of drugs in the household; 2- self-neglect, focus-
ing on user’s need instead of one’s own, neglect
of personal and professional responsibilities,
covering for the user’s inappropriate behavior,
accepting drug use in the home and failing to es-
tablish boundaries and implement changes; and
3- personal health issues, based on descriptions
of seeking treatment for medical, psychological
and psychiatric conditions and participation in
self-help groups.
Data Analysis
Data analysis was conducted using the Statis-
tical Package for the Social Sciences (SPSS) pro-
gram, version 18.0. Initially, univariate analyses
of categorical variables were conducted using the
Chi-squared test, odds ratios (OR) and the con-
fidence interval (95% CI). The variables of the
respondent’s relationship with the drug user, sex,
profession, family income and education were
included in the logistic regression analysis. Sta-
tistical significance was set at p < 0.05.
Results
Among the 505 family members who were inter-
viewed, 64% showed high codependency accord-
ing to the HCI scale. The sample was composed
mainly of women who were the mothers or wives
of drug users. The sociodemographic characteris-
tics of the family members are presented in Table
1. Mothers and wives were unemployed and those
with less than 8 years of education were likely to
exhibit high codependency. The association be-
tween the sociodemographic variables and the
codependency level is presented in Table 2.
The most common Brazilian states from
which the families sought help were as follows:
Rio Grande do Sul (37.1%), São Paulo (15%),
Rio de Janeiro (9.9%), Minas Gerais (7.3%),
Bahia (5.9%), Paraná (5.5%), Distrito Federal
(3.6%), Santa Catarina (2.6%); and 13.1% came
from the remaining states.
A descriptive analysis of the 3 codependen-
cy themes of the HCI among family member
revealed that external focus occurred very in-
frequently, while self-sacrifice (52%) and reac-
tivity (59%) were relatively common. According
the HCI, the only element that predicted high
codependency was reactivity (OR 2.33, 95% CI
= 1.55-3.49). Self-sacrifice, on the other hand,
predicted low rather than high codependency
(OR 0.58, 95% CI = 0.39-0.86). A descriptive
analysis of family functioning showed that the
family members who called the hotline exhibited
emotional/task overload (88%) and self-neglect
(75%).
104
Bortolon CB et al.
A high proportion of the family members
who called to discuss how to help someone who
used drugs reported that their own medical con-
dition was unhealthy (47%). In particular, the
family members reported seeking medical treat-
ment for themselves (33%), using medication
(39%), participating in self-help groups (19%)
and enrolling in psychological or psychiatric
treatments (22%). Among the highly codepen-
dent participants, 69% reported that they were
receiving medical treatment, compared with 31%
of the low-codependency group. Medication was
used by 70% of the high-codependency partici-
pants and by 29% of the low-codependency par-
ticipants. Psychological/psychiatric treatments
were reported by 65% of the high-codependency
participants and by 35% of the low-codependen-
cy participants. Bivariate analysis showed that
high codependency (OR 1.57, 95% CI = 1.04-
2.35) was associated with medical treatment. The
only significant predictor of high codependency
in the family members of drug users after the lo-
gistical regression was medication use (OR 1.54,
95% CI = 1.01-2.35), as Table 3 shows.
Discussion
This study showed that the majority of the fami-
ly members who called the drug-related toll-free
number exhibited high levels of codependency.
Other studies have also revealed a high risk of
codependency among women whose husbands or
fathers had alcohol use problems2,4,19. These results
corroborate the reports that wives and mothers
who are bonded with a person who does little to
solve his/her own problems suffer from emotional
conflicts, tension and preoccupation with the us-
er’s excessive alcohol consumption and maladap-
tive behaviors4,22. This study also shows that the
family members of drug users with high codepen-
dency present dysfunctional behaviors and receive
more medical treatment, including more drug
prescriptions. In fact, a study of Mexican women
seeking primary health care showed a codepen-
dency rate of 25%, with a much higher likelihood
of codependency among women whose partners
or fathers presented alcohol dependence4. Both
studies reflect the need to better comprehend how
family relationships interconnect with mental and
physical health and how they relate to the diagno-
sis of codependency in women who are treated at
primary health care units.
In our study, the HCI characteristic of high
reactivity was associated with codependency. This
characteristic indicates that the wife or mother
takes on responsibilities that are not her own,
and consequently, the drug user never realizes
the consequences of his own addiction1,2,19. These
highly reactive family members have limited in-
sight into the effects of their attitudes toward the
drug user; hence, they engage in enabling behav-
iors that thwart any efforts to improve the drug
user’s condition6.
Using the spontaneous self-reports, it was
possible to gather further details about the family
functioning associated with high codependency.
Codependent family members exhibit a need to
care for and control the behavior of the drug
users, which leads to physical and emotional
overload and the neglect of their own needs1,19.
Self-neglect was almost three times more like-
ly to occur in family members with high code-
pendency than in those with low codependency.
Sociodemographic variables
Relationship (n = 505)
Mother
Wife
Sibling
Father
Other relative
Relative’s sex (n = 503)
Female
Male
Relative’s age (n = 471)
< 45
> 45
Marital status (n = 471)
Married
Single
Profession (n = 465)
Unemployed
Employed
Family income (n = 459)
5 minimal wages
> 5 wages
Education (n = 463)
8 years
> 8 years
Relative uses drugs - yes (n = 170)
Tob ac c o
Alcohol
Marijuana
Cocaine
n (%)
305 (60)
77 (16)
67 (13)
17 (3)
39 (8)
469 (93)
34 (7)
214 (45)
257 (55)
276 (59)
195 (41)
172 (37)
293 (63)
347 (75)
112 (25)
171 (37)
292 (63)
137 (80)
23 (14)
9 (5)
1 (1)
Table 1. Sociodemographic characteristics of family
members.
105
Ciência & Saúde Coletiva, 21(1):101-107, 2016
High-codependency individuals are controlled
by the user’s behavior; they allow it to affect their
personal and occupational lives by changing or
cancelling plans, hiding the user’s behavior from
the rest of the family, lying or excusing the user’s
behavior, and expressing a desire to change their
own behavior without managing to do so6.
Self-sacrifice is an important behavioral trait;
it reflects a tendency to place others’ needs above
one’s own. Self-sacrifice has been previously re-
ported as a common trait among Brazilian fam-
ily members regardless of their codependency
classification19; this finding is in contrary to the
findings of studies from the Northern hemi-
sphere, and the differences may be attributed to
cultural differences2. It is important to consider
cultural issues in the Brazilian population with
regard to traditional women’s roles and family
dedication, responsibility and “unconditional
love”, which may manifest as servile and self-sac-
rificing behaviors. Because of high reactivity and
self-neglect, emotional/task overload is common
among high-codependency family members and
may increase the risk of psychological and phys-
ical disorders.
The limitations of this study are mainly relat-
ed to the fact that family functioning was evalu-
ated using self-reports; the family members may
have underreported or minimized behavioral
outcomes that are considered normal within the
OR (95% IC)
Adjusted
1.90 (1.23 a 2.93)*
1.0
1.39 (0.60 a 3.21)
1.0
1.64 (1.07 a 2.52)*
1.0
1.29 (0.81 a 2.06)
1.0
1.72 (1.12 a 2.64)*
1.0
Sociodemographic data
Relationship (n = 505)
Parents and wives
Other
Relative’s sex (n = 503)
Female
Male
User’s sex (n = 503)
Male
Female
Relative’s age (n = 471)
45 years old
<45 years old
User’s age (n = 489)
45 years old
< 45 years old
Marital status (n = 471)
Married
Single
Profession (n = 465)
Unemployed
Employed
Family income (n = 459)
5 minimum wages
> 5 wages
Education (n = 463)
8 years
> 8 years
Relative uses drugs (n = 404)
Yes
No
High
codependency
n (%)
257 (80)
64 (20)
305 (96)
14 (4)
298 (93)
21 (7)
140 (48)
155 (52)
13 (4)
294 (96)
177 (59)
122 (41)
120 (41)
173 (59)
229 (79)
59 (21)
125 (43)
168 (57)
108 (34)
206 (66)
Table 2. Association between codependency level and sociodemographic variables.
Low
codependency
n (%)
125 (68)
59 (32)
164 (89)
20 (11)
172 (93)
12 (7)
74 (42)
102 (58)
7 (4)
175 (96)
99 (58)
73 (42)
52 (30)
120 (70)
118 (69)
53 (31)
46 (27)
124 (73)
62 (34)
118 (66)
OR (95% IC)
Bivariate
1.89 (1.25 a 2.86)*
1.0
2.65 (1.30 a 5.39)*
1.0
0.99 (0.47 a 2.06)
1.0
1.24 (0.85 a 1.81)
1.0
1.10 (0.43 a 2.82)
1.0
1.07 (0.73 a 1.56)
1.0
1.60 (1.07 a 2.38)*
1.0
1.74 (1.13 a 2.68)*
1.0
2.00 (1.33 a 3.02)*
1.0
0.99 (0.67 a 1.46)
1.0
Mothers (51.1%) and fathers (3.1%); wives (45.8%). Multivariate analysis: adjustment for relationship, profession, and education.
* p < 0.05.
106
Bortolon CB et al.
family setting. Additionally, the interview instru-
ment was developed internally and was not val-
idated. Some limitations regarding health issues
need to be considered; specifically, we did not
have access to the participants’ medical records
and relied on self-reports of the described prob-
lems. The classification of a family member as a
“drug user” was based only on the telephone ac-
counts of the informants themselves, who were
the family members of the user. Future research
should be planned to overcome these limitations.
This study described family functioning and
codependency and health issues in the family
members of drug users. The family scenario sur-
rounding substance abuse creates unnecessary
suffering for the family members as a result of
the effects of addiction16,23. These data may be
utilized in clinical settings, where codependency
should be diagnosed and treatment programs di-
rected toward the family members of drug users
should include medical and psychological inter-
ventions. In conclusion, there is an urgent need
to establish appropriate care and effective inter-
ventions for the family members of drug users.
Collaborations
CB Bortolon, HMT Barros and M Ferigolo par-
ticipated in the design of this study. CB Borto-
lon, MC Benchaya, CA Machado and L Signor.
conducted a literature review and discussion. CB
Bortolon, TC Moreira and LR Figueiró conduct-
ed a statistical analysis. All of authors participat-
ed in the review and reading in full of this article.
OR (95% IC)
Adjusted
1.79 (1.00 a 3.20)*
1.0
2.24 (1.41 a 3.54)*
1.0
1.31 (0.85 a 2.03)
1.0
1.54 (1.01 a 2.35)*
1.0
Family functioning
Emotional and chore overload
(n = 496)
Yes
No
Self-neglect (n = 480)
Yes
No
Health aspects
Medical treatment (n = 472)
Yes
No
Medication usage (n = 474)
Yes
No
Psychological/psychiatric care (n =
471)
Yes
No
High
codependency
n (%)
285 (90)
31 (10)
251 (82)
55 (18)
109 (37)
184 (63)
129 (44)
166 (56)
66 (22)
227 (78)
Table 3. Association between codependency level and aspects of family functioning and health issues.
Low
codependency
n (%)
149 (83)
31 (17)
111 (64)
63 (36)
49 (27)
130 (73)
55 (31)
124 (69)
35 (20)
143 (80)
OR (95% IC)
Bivariate
1.91 (1.11 a 3.26)*
1.0
2.59 (1.69 a 3.96)*
1.0
1.57 (1.04 a 2.35)*
1.0
1.75 (1.18 a 2.59)*
1.0
1.18 (0.75 a 1.88)
1.0
Multivariate analysis: adjustment for relationship, profession, and education. * p < 0.05.
107
Ciência & Saúde Coletiva, 21(1):101-107, 2016
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... Foram rastreados potenciais 55 arti gos, sendo incluídos nesta revisão 16 arti gos que preencheram os critérios de inclusão e exclusão mencionados para esta revisão 8,9,14,17,[30][31][32][33][34][35][36][37][38][39][40][41] 41 mostraram níveis significativamente maiores de sintomatologia psicológica entre os indivíduos que convivem com algum dependente de álcool e têm uma história familiar positiva de alcoolismo, os quais sugerem que os achados são parcialmente consistentes com a sintomatologia hipotética descrita para a codependência 31,41 . ...
... Foram rastreados potenciais 55 arti gos, sendo incluídos nesta revisão 16 arti gos que preencheram os critérios de inclusão e exclusão mencionados para esta revisão 8,9,14,17,[30][31][32][33][34][35][36][37][38][39][40][41] 41 mostraram níveis significativamente maiores de sintomatologia psicológica entre os indivíduos que convivem com algum dependente de álcool e têm uma história familiar positiva de alcoolismo, os quais sugerem que os achados são parcialmente consistentes com a sintomatologia hipotética descrita para a codependência 31,41 . ...
... Foram rastreados potenciais 55 arti gos, sendo incluídos nesta revisão 16 arti gos que preencheram os critérios de inclusão e exclusão mencionados para esta revisão 8,9,14,17,[30][31][32][33][34][35][36][37][38][39][40][41] 41 mostraram níveis significativamente maiores de sintomatologia psicológica entre os indivíduos que convivem com algum dependente de álcool e têm uma história familiar positiva de alcoolismo, os quais sugerem que os achados são parcialmente consistentes com a sintomatologia hipotética descrita para a codependência 31,41 . ...
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O conceito de codependência, embora muito popular no meio clínico do campo das dependências químicas, segue sendo considerado um constructo muito criticado e controverso no meio científico. Nosso objetivo foi avaliar o estado da arte sobre o constructo de codependência de familiares de usuários de álcool e outras drogas quanto à etiologia e outros possíveis fatores relacionados. Tratase de uma revisão da literatura através da busca de artigos indexados em bases de dados, publicados nos idiomas inglês, português e espanhol, utilizando-se os descritores codependência, transtornos relacionados ao uso de substâncias e família. Foram incluídos 16 artigos nesta revisão, os quais retratam que o conceito de codependência segue teorizado e pouco explorado de forma empírica. Tentativas de escalas de rastreio foram realizadas sem replicações de estudos de campo. De uma forma geral, aqueles que se autoidentificam como pessoas codependentes, uma vez que recebem suporte, relatam alguns benefícios positivos. O termo, mais do que um conceito psicológico de fato validado, parece representar um movimento social que deu empoderamento aos membros das famílias de usuários de álcool e outras drogas. Mais estudos de campo sobre a validação conceitual da codependência e os fatores a ela relacionados devem ser conduzidos, a fim de corroborar sua real utilidade clínica e ampliação de evidência da existência desse fenômeno.
... The mother is likely to get involved in this care taking role so to restore an equilibrium which portrays the image of the family as normal. This co-dependency leads to negative consequences for the family system from the perspective of alcoholism as the mother is unavailable for her children by tending to the needs of her alcoholic husband while other responsibilities like bonding with the children, are compromised (Bortolon, 2016). Another possible explanation perhaps for low scores on mothers' overprotectiveness for avoidant attachment can be due to the nature of such style of attachment (Ainsworth, 1985) as the findings for avoidant attachment on the given subscale for father were also the same. ...
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Background Alcoholism is a growing problem in Pakistan. Problems related to alcoholism affects the family members especially children of alcoholics who are likely to have biased perceptions of parental practices which in turn affects their attachment patterns. Objective To analyze the differences in perceptions of parental practices across three attachment styles namely avoidant, anxious/ambivalent, and secure attachments of the adults who are children of alcoholic parents. Method The study is a correlational research design with a sample of 330 participants selected through purposive sampling technique. The participants were adults who are children of alcoholics from nuclear family systems, whose fathers were admitted in a rehabilitation center for the treatment of alcoholism for the second time. Results MANOVA computed to examine differences in perception of parental practices across attachment styles was significant [F(12, 632) = 53.130, p < .001, Pillai's Trace = 1.003, partial eta squared = .501], indicating that those with different attachment styles perceive parental overprotectiveness, emotional warmth, and rejection differently. Conclusion Perceptions about parental practices for father can be linked with alcoholism, while for mother the perceptions about parental practices are a product of attachment mainly. Implications The findings can be used to devise counseling and therapeutic plans for adults who are children of alcoholics and help in educating them about the condition of alcoholism.
... Social exclusion resulting from the degradation of bonds in years of drug use is common in this population, especially among crack users (35) . The desire to want to be treated or even in situations when abstinence has already been achieved are not actions that can be more than enough for many users to restore their family relationships (36) . Thus, the Temporary House and Monitored ...
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Objective: to describe the evolution of the intervention and treatment models of the Reference Center for Alcohol, Tobacco and Other Drugs in the State of São Paulo, submitting production data for the last 6 years. Method: a cross-sectional and retrospective study, with data and records of the consultations carried out between 2013 and 2018 in different CRATOD sectors. Results: the service counted 204,933 service records in the last six years, 31,807 of which were new cases, 12,318 rapid tests for HIV, Syphilis, and Hepatitis B and C and served 69 patients in the Monitored Housing. Conclusion: the service’s line of care encompasses three premises: reception with qualified listening, outpatient/hospital treatment and social reintegration, in this context, the nursing professional appears as a fundamental part during all treatment phases. The consistency of this work in conjunction with the multi-professional team resulted in the consolidation and structuring of a service flow aimed at the constant motivation and care of the drug addict.
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Objetivo: conhecer como o familiar vivencia o cuidado da pessoa com dependência química. Método: História Oral Temática Híbrida, com quatro colaboradores, tendo como local um hospital psiquiátrico localizado na cidade de Curitiba, Paraná, Brasil. Coleta de dados entre os meses de outubro e novembro de 2020. Os dados foram analisados seguindo os passos de transcrição absoluta, textualização e transcriação. Resultados: revelaram-se dois temas: A vivência sofrida do familiar com o tratamento do dependente químico e Espiritualidade e religiosidade como suporte para lidar com os desafios da dependência. Conclusão:a dependência química causa impactos nos familiares, que sofrem em virtude do surgimento dessa doença, gerando sofrimento, frustação e, por vezes, desesperança por parte dos familiares. Experiências diversas sobre o mesmo evento podem servir como reflexão e alerta para todos sobre a importância do cuidado voltado aos familiares.
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Objetivo: averiguar de qué manera los familiares experimentan el cuidado de personas con adicciones a sustancias químicas. Método: Historia Oral Temática Híbrida con cuatro colaboradores, realizada en un hospital psiquiátrico situado en la ciudad de Curitiba, Paraná, Brasil. La recolección de datos tuvo lugar durante los meses de octubre y noviembre de 2020. Los datos se analizaron siguiendo los pasos de transcripción absoluta, textualización y transcripción. Resultados: se hicieron evidentes dos temas, a saber: La experiencia de los familiares con respecto al tratamiento de personas con adicciones a sustancias químicas; y Espiritualidad y religiosidad como apoyo para lidiar con los desafíos de la adicción. Conclusión: la adicción a sustancias químicas ejerce diversos efectos en los familiares, que sufren a raíz de la aparición de esta enfermedad, generando angustia, frustración y, en ocasiones, desesperanza en los integrantes de la familia. Diversas experiencias con respecto al mismo evento pueden servir como reflexión y alerta para todos los involucrados en relación a la importancia del cuidado dirigido a los familiares.
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Bu çalışma ile bağımlı bireylerle çalışan profesyonellerin gözlemlerinden yola çıkarak gençlerde madde kullanımının oluşumu ve tedavi süreçlerinde aile etkisinin etiyolojini ortaya çıkarabilmek ve bağımlılık öyküsü içerisinde aile deneyimlerini daha yakından inceleyebilmek amaçlanmıştır. Araştırma, nitel araştırma yöntemine ve fenomenolojik desene uygun olarak yürütülmüştür. Birbirinden farklı kurumlarda görev yapan, farklı mesleklere sahip ve madde bağımlısı bireylerle çalışan 15 kişiyle derinlemesine mülakat gerçekleştirilmiştir. Elde edilen veriler sonucunda; bağımlılığa evrilen aşamadan bağımlılık sonrası aşamalara kadarki her bir süreç içerisinde aile faktörünün farklı etki ve deneyimlere sahip olduğu tespit edilmiştir. Bağımlılık öncesi süreçte krizler, problemler, iletişimsizlikler, travmatik yaşam deneyimleri sıklıkla karşılaşılan aile özellikleri olurken; bağımlılık sürecinde madde kullanımından geç haberdar olma, şok-panik-öfke-gizleme gibi davranışsal tepkiler verme ve eş bağımlılık geliştirme gibi aile deneyimleri öne çıkmaktadır. Bağımlılığın tedavisi aşamasında ise sürecin başarılı olabilmesi için aile katılımı ve desteği en önemli unsurlardan biridir. Tedavi aşamasında hızlı ve kolay çözüm yolları talep eden veya var olan tedavinin aksaması durumunda hızlı şekilde motivasyon kaybı yaşayabilen aile deneyimleri tespit edilmiştir. Yine annelerin babalardan daha uzun süre ve daha aktif şekilde tedavi sürecine katıldıkları aileler çoğunluktadır. Sonuç olarak aile faktörü bağımlılığın her aşamasında kendi özel şartları içerisinde değerlendirilmeli ve tedavi sürecine dahil edilmelidir. Tedavi süreçleri sadece bağımlı bireylerle sınırlandırılmamalı, sosyal çevrenin ve özellikle ailelerin de tedaviye uyumu desteklenmelidir. (Based on the observations of professionals who work with addicted individuals, this study aims to reveal the etiological origins of the family effect in the formation and treatment processes of substance addiction in young people, and to understand family experiences in the addiction history better. The research was carried out in accordance with the qualitative research method and the phenomenological approach. In-depth interviews have been conducted with 15 people with different professions working in different institutions with drug addicts. As a result of the data that have been obtained, it has been determined that the family factor has different effects and experiences in each process from the stage that turns into addiction to the stages after addiction. While we see family problems, miscommunication, and traumatic life experiences occur in the pre-addiction process, during the addiction processes family members that become aware of the substance use later, that give behavioral responses like shock-panic-anger-hiding and develop co-dependence become prominent. During the treatment of addiction, the necessity and support of family participation is one of the most important elements for this process to be successful. Families that demand quick and easy solutions during the treatment or that can quickly lose motivation in case of disruption of the existing treatment have been identified. Likewise, it is far more frequent to see the mother participating in the treatment process longer and more actively than the father in a family. As a result, the family factor should be evaluated in its own special conditions at every stage of addiction and should be included in the treatment process. Treatment processes should not be limited only to addicted individuals, and the adaptation of the social environment and especially the families to treatment should be supported.)
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Background : The involvement of the husbands in the issue of drug addiction has impacted the wives’ livelihoods. Due to drug addiction amongst husbands, the wives experience stress and strain. The Stress Strain Coping Support Model (SSCS) was established to better comprehend how coping influences stress and strain. Thus, the purpose of this study was to determine the relationship between the stress which refers to family impact experienced by the wives of drug addicts, in terms of economic difficulties and marital conflict, and mental wellbeing. Furthermore, this study examines the role of coping as a mediating factor between family impact and mental wellbeing. Methods : This study involved 132 wives of low-income drug addicts in Malaysia, who were selected using a purposive sampling method. Economic Strain Scale (ESS) and Braiker-Kelly Marital Conflict Scale (BKMCS) were used to measure family impact. Coping and Adaptation Processing Scale Short Form (CAPS-SF) and Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) were used to measure coping and mental wellbeing of the respective respondents. Results : Path analysis using SmartPLS software version 3.3.7 showed that there is a direct association between family impact and coping, and between coping and mental wellbeing. The results also showed that family impact was associated indirectly with mental wellbeing through coping. Conclusions : The findings benefited drug addict wives and practitioners related to this field in terms of enhancing the use of coping mechanisms in managing family impact and improving mental wellbeing, specifically amongst low-income drug addict wives.
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Purpose The purpose of this exploratory study was to examine the caregiving burden (CB) and the determinants of burden among family members of substance-addicted people. Design and Methods The sample of this cross-sectional research was 128 informal family caregivers of substance-addicted people. We collected data by using the Zarit Burden Interview (ZBI) assessing subjective burden. Findings Mean ZBI score was 52.2. The regression analysis showed that ZBI mean score was higher in female caregivers and caregivers with lower education, poor economic status, and longer caregiving duration. There was an inverse relationship between the addict's age and the CB. Practice Implications The predictors of CB may assist in setting caregivers at greater risk of CB as targets for the intervention.
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Abstract. Dependence on psychoactive substances (chemical dependence) is defined as “a complex of physiological, behavioral and cognitive phenomena in which the use of a psychoactive substance or class of psychoactive substances be- gins to occupy a more important place in a person’s value system than other forms of behavior that were previously more significant for him”[1] . An effective factor in the treatment of chemical dependence is the environment, that is, relatives and friends that surround the sick person. However, often these people also need rehabilitation in order to know what to do, how to behave, and again to prevent the use of psychoactive substances by their relatives. The purpose of this work was to describe the changes in the relationship of relatives with loved ones with chemical dependence, before and during rehabil- itation and content analysis. The participants in the study were relatives (mothers) who had a chemically dependent close (sons). In the course of studying the experience of the relationship of relatives who have a chemical dependence during their use, the categories “search for close information about the situation”, “actions of relatives within the situation”, “actions of chemically dependent in relation to close people”, “search for help for addicts” were obtained loved ones ”,“problems in the family of chemically dependent”, “control over the use of chemically dependent relatives” and “establishing boundaries with the chemically dependent”. During the course of rehabilitation under the 12-step program, the situation changed and the experience consisted of “taking relatives as addicted as a disease,” “significant changes in relationships with the chemically dependent at the rehabilitation stage,” “helping relatives during the rehabilitation period”, “expanding the boundaries with chemically dependent during the rehabilitation period”, “actions close to a possible breakdown of chemically dependent”, “relations of relatives with other people”, “joint plans of relatives and chemically dependent for the future”, as well as “the transformation of the lives of relatives of loved ones suffering from chemical dependence”.
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RESUMO Introdução: A dependência de drogas é um fenômeno que atinge não somente o usuário, mas também o sistema familiar como um todo. Devido à complexidade dessa relação, a família pode desenvolver características conhecidas como codependência, entre elas: autoestima baixa, valorização das opiniões dos outros em detrimento das suas, dificuldade de identificar os sentimentos ou comportamentos que facilitam o uso de drogas. O objetivo deste estudo foi avaliar as crenças codependentes e o estágio de mudança em familiares de usuários de drogas que procuraram um serviço de teleatendimento. Métodos: Realizou-se um estudo transversal no VIVAVOZ Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas no período de junho a julho de 2007. A amostra incluiu 154 familiares de usuários de drogas. Os instrumentos utilizados foram as escalas Ladder, que avalia o estágio de mudança de comportamento frente ao familiar usuário e Holyoake Codependency Index. Esta avalia a codependência em 13 itens, sendo calculados pela soma de 3 elementos denominados: foco no outro, autosacrifício e reatividade. Resultados: 71% dos familiares apresentaram crenças codependentes. Dentre esses, 89% identificaram-se no estágio de contemplação, ou seja, percebiam a necessidade de mudança no seu comportamento em relação aos usuários. Conclusão: Este estudo reforça a importância de abordagens voltadas à família para motivar seus integrantes a diminuírem os comportamentos codependentes. ABSTRACT Introduction: Drug addiction is a phenomenon that affects not only the user but also the family system as a whole. Due to the complexity of this relationship, the family can develop characteristics known as codependency, including: low self-esteem, appreciation of others' opinions to the detriment of their own, and difficulty identifying feelings or behaviors that facilitate the use of drugs. The aim of this study was to evaluate the codependent beliefs and stage of change in family members of drug users who sought a helpline service. Methods: This was a cross-sectional study in the VIVAVOZ National Guidance and Information on Prevention of Drug Abuse in the period from June to July 2007. The sample included 154 families of drug users. The instruments used were the Ladder scale, which assesses the stages of changing behavior towards family-user, and the Holyoake Codependency Index, which assesses the codependence in 13 items, calculated from the sum of three elements, namely: Focus on the other, self-sacrifice, and reactivity. Results: 71% of relatives showed codependent beliefs. Among these, 89% identified themselves in the contemplation stage, i.e., they perceived the need for change in their behavior in relation to users. Conclusion: This study reinforces the importance of family-oriented approaches to motivate their members to lower co-dependent behaviors.
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This article describes and illustrates the ongoing development of a treatment for working with families and friends of drug users using harm reduction principles. The author was instrumental in applying harm reduction principles to substance abuse and has used these same principles to help families deal with the pessimism, pain, and grief that accompany their relationship to a person with an active substance abuse problem. The treatment involves learning decision-making processes based on both self-care and love for the substance abuser and is based on the values of harm reduction, caring, and incrementalism, rather than those of codependency, tough love, and abrupt behavior change. A long-term family therapy group and two family consultations illustrate the treatment and its applications.
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The objective of the study was to determine whether family profiles differ between patients with anorexia nervosa or drug dependence disorder. 25 families of patients with anorexia nervosa and 26 families of patients with drug dependence disorder responded to a battery of self-reports (Interpersonal Dependence Inventory, Family Adaptability and Cohesion Evaluation Scales, and Family Questionnaire). A lack of social self-confidence was observed in patients with anorexia nervosa or drug dependence disorder and their parents. Family disturbances characterized by low cohesion and emotional reliance on another person were observed in the families of patients with anorexia nervosa or drug dependence disorder. The present study suggests that there are differing levels of severity of family disturbances among fathers, mothers, and patients in both anorexia nervosa and drug dependence disorder.
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CONTEXTO: A dependência química tende a afetar a família como um todo. Filhos de dependentes químicos têm um risco aumentado para o desenvolvimento da dependência química, bem como para transtornos psiquiátricos, quando comparados com outras crianças. OBJETIVO: Investigar o perfil de crianças, adolescentes e familiares em um serviço de prevenção seletiva para filhos de dependentes químicos e discutir alternativas de intervenção e tratamento para essa população. Tipo de estudo: corte transversal. AMOSTRA: serviço de prevenção seletiva, situado em um bairro da periferia da cidade de São Paulo, com 63 familiares, 54 crianças e 45 adolescentes. INSTRUMENTOS: dados sócio-demográficos; Procedimento de Desenhos de Família com Estórias – DF-E; Drug Use Screening Inventory (DUSI); Critérios de investigação sobre situações de estresse psicossocial vividas pela criança (CID 10, 1993); Self-Report Questionnaire SRQ-20; CAGE familiar. RESULTADOS: com relação ao perfil familiar, 67% pertencem à categoria socioeconômica D; na maioria das famílias o pai é o dependente químico (67%), tendo como substância de escolha o álcool (75%). O SRQ-20 detectou, em 59% dos cônjuges que não eram dependentes químicos, risco de distúrbios em saúde mental. Nas crianças, foi observada timidez e sentimento de inferioridade, depressão, conflito familiar, carência afetiva e bom nível de energia, que é indicativo de equilíbrio emocional e mental. Nos adolescentes, foi observado maior índice de problemas nas seguintes áreas do DUSI: desordens psiquiátricas, sociabilidade, sistema familiar e lazer/recreação. CONCLUSÃO: o artigo concluiu a necessidade de um serviço especializado de prevenção seletiva, dirigido a crianças, adolescentes e familiares afetados pela dependência química, uma vez que filhos de dependentes químicos representam um grupo de risco para o desenvolvimento de problemas bio-psicossociais.
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Treatment programs geared toward Hispanic culture are extremely rare, and programs involving the entire Hispanic family are virtually nonexistent. Two prospective studies test the hypothesis that a family-centered intervention is as effective with Hispanic families as it is with non-Hispanic families. First, the program (Celebrating Families!) was presented in English to non-Hispanic and Hispanic families. Second, the program was translated into Spanish and adapted to Spanish culture (¡Celebrando Familias!). Hispanic families were compared with non-Hispanic families in both studies. These studies indicate that a family-centered treatment model can be an effective treatment intervention for Hispanic clients.
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This paper offers a conceptual overview of a neglected field. Evidence is presented to suggest that, globally, addiction is sufficiently stressful to cause pain and suffering to a large but uncounted number of adult affected family members (AFMs), possibly in the region of 100 million worldwide. A non-pathological stress-strain-coping-support model of the experience of AFMs is presented. The model is based on research in a number of different sociocultural groups in Mexico, England, Australia and Italy and aims to be sensitive to the circumstances of AFMs in low and middle income countries and in minority ethnic and indigenous groups as well to those of majorities in wealthier nations. It highlights the social and economic stressors of many kinds which AFMs face, their lack of information and social support, dilemmas about how to cope, and resulting high risk for ill-health. The public sector and personal costs are likely to be high. Attention is drawn to the relative lack of forms of help designed for AFMs in their own right. A 5-Step form of help aiming to fill that gap is briefly described. Family members affected by addiction have for too long been a group without a collective voice; research and action using the model and method described can make a contribution to changing that state of affairs.
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Codependent behaviors are associated with an unhealthy reliance on others for meeting emotional needs. This over-reliance on others often leads to dysfunctional interpersonal relationships. This article presents emotional stocks and bonds (ESB), a metaphorical model for use with clients who display codependent behaviors. Emotional stocks and bonds incorporates theoretical tenets from Bowen family systems and attachment theory and aids clients in understanding and changing unhealthy relationship behavior patterns. In addition to an overview of the model's key concepts and its use in clinical practice, we provide a case illustration and a discussion of practice implications and limitations.
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The purpose of the present study was to learn about the self-perception of women who live with alcohol-addicted partners. It was hoped that avoiding to label the women in advance as codependent would facilitate a better understanding of their lives and self-perceptions. The qualitative naturalist methodology used was based on a feminist framework. In-depth interviews with 10 women living with alcoholic partners were conducted and analyzed. The findings revealed 3 central dialogues around which the women’s self-perceptions evolved—with deviance, with strength, and with self-fulfillment. Findings are discussed relative to the ongoing discourse between the codependency approach and other social, psychological, and gender conceptions in this domain. Clinical implications and directions for future research are offered.