Beyond Codependency: And Getting Better All the Time

By Melody Beattie

Review By Neal J. Pollock (VA USA)

While I have not read Melody Beattie’s other works, I thought this a very valuable book in and of itself. It sheds much light on the topic and helped me to become sensitized to the obvious signs of codependency in people. By doing this, it enabled me to avoid situations where I could become codependent in a relationship.

I think that, as in the Diagnostic and Statistical Manual, there are levels of psychological situations and/or problems. Thus, there may be people inherently inclined towards codependency, but there may also be people who are thrust into it due to the demands of others. The latter may find this book incredibly helpful in avoiding such relationships and in helping their dependent person seek real help vs. codependency from another person. There are also a number of great quotes by the author in this book. A few are:

p. 70: “It’s hard to feel compassion for someone while that person is using or victimizing us.”

p. 71: “If everything looks black, we’ve probably got our eyes shut.”

p. 164: “Who we’re in a relationship with says as much about us as it does about them.” Earnie Tucker (quoted by Melody Beattie)

Codependency is not something to make light of, it’s as much (if not more) the codependent’s problem as the dependent’s. As Caroline Casey humorously noted in “Making the Gods Work for You” (Harmony Books NY 1998), on page 72:
“What do codependents see when they die? Someone else’s life flashes before their eyes.”

This is literally a life-changing book for codependents.

Reviewer: A reader

Once Melody Beattie’s Codependent No More has been “digested”, Beyond Codependency helps to move the recovering codependent past the hurt and on to the business of literally changing behaviors and making a better life. I absolutely recommend this book above any others to recovering codependents.

A 3-year study of addiction mutual-help group participation following intensive outpatient treatment

BACKGROUND: Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate.

Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit.

METHOD: Alcohol-dependent outpatients (N=227; 27% female; Mean age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years post discharge.

Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience.

Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes.

RESULTS: Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation.

Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement.

Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity.

CONCLUSIONS: Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful.

Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.

Kelly JF, Stout R, Zywiak W, Schneider R. A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcohol Clin Exp Res. 2006 Aug;30(8):1381-92.

Brief-TSF is designed to engage alcoholics in supportive therapy while attending Alcoholics Anonymous.

This study analyzed the Alcoholics Anonymous (AA) participation of 55 patients during the 3 months after their discharge from structured treatment, when dropout is high.

Three levels of meeting attendance were discerned:

• low,
• mid-level, and
• “90 meetings in 90 days.”

Of greatest interest, the mid-level group showed mixed interest in AA practices despite substantial meeting attendance, that is,

• they admitted powerlessness over alcohol, but had less enthusiasm for the higher power concept, and relapsed significantly;
• they were likely to have a sponsor, but were less involved with other AA members; and
• they reported working the 12 Steps, but were less interested in the AA literature.

Findings suggest that individuals who are attending AA but having difficulty embracing key aspects of the program need professional assistance that focuses more on AA practices and tenets and meeting attendance.

Barriers to affiliation can also serve as opportunities for furthering both counselling goals and affiliation.

Research; Paul Elliott Caldwell and Henry S.G. Cutter. Journal of Substance Abuse Treatment. Volume 15, Issue 3, May-June 1998, Pages 221-228

• See also:
• Twelve Step Facilitation
• Brief-TSF Description
• AA and Treatment Work Better Together
• Alcohol Related Brain Injury
• THE TWELVE REWARDS OF RECOVERY

What does the Brief-TSF model look like?

How does the Brief-TSF model work?

Defining the Brief-TSF processes

This model brings together three people to achieve sobriety in one of them. These are the;

• experiential contributor (AA Peer Sponsor) and
• professional care (Twelve Step Facilitator) to collaborate in facilitating self help recovery for the
• alcoholic (normally known as the patient or client).

Each of the three people brings to the intervention knowledge’s and functions known as ‘domains of praxes’. Within each domain are the constituents of experience, training, perceptions, goals and capabilities.

Functional Domain

The Brief Twelve Step Facilitator facilitates self-assessment by the patient, introduces them to a ‘Peer Sponsor’ and facilitates understanding of the ‘Program of Recovery’. In addition the healthcare worker assesses and addresses or refers the patient for any co-morbidities.

The Peer Sponsor shares their ‘experience, strength and hope’ with the patient, provides initial resources to attend meetings, introduces the ‘Newcomer’ to Alcoholics Anonymous members and explains the program of recovery from drinking.

The patient chooses what, when, and how they can use information, from each of the providers. This is true Self help within a paradigm of mutual help.

Additionally, the patient is supported in seeking professional treatment/therapy for other issues.

Recovery Domain

Each participant maintains their integrity and independence within their domain.

The primary goal of Brief-TSF is affiliation with Alcoholics Anonymous as described in the Stages of AA Affiliation.

Recovery includes attending AA meetings and other activities, stopping drinking, ‘working’ the program of recovery and consulting with a peer sponsor within an affiliation scheme.

The whole facilitated process producing a ‘Domain of Recovery’.

Disease Domain

Alcoholism is a primary, chronic, progressive three fold disease – mental, physical and spiritual. Alcohol dependence is fatal if not arrested by abstaining from alcohol.

Each participant has a hand in recovery

Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: findings from project MATCH.

OBJECTIVE: Although Alcoholics Anonymous (AA) is the largest mutual-help organization for alcoholics in the world, its specific mechanisms that mobilize and sustain behavior change are poorly understood. The purpose of this study is to examine prospectively the relationship between helping other alcoholics and relapse in the year following treatment for alcohol use disorders.

METHOD: Data were derived from Project MATCH, a longitudinal prospective investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence. Kaplan-Meier survival estimates were used to calculate probabilities of time to alcohol relapse. To identify the unique value of helping other alcoholics when controlling for the number of AA meetings attended, proportional hazards regressions were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics.

RESULTS: There were no demographic differences that distinguished participants in regard to involvement in helping other alcoholics, with the exception of age; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics.

Those who were helping were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended.

CONCLUSIONS: These findings provide compelling evidence that recovering alcoholics who help other alcoholics maintain long-term sobriety following formal treatment are themselves better able to maintain their own sobriety. Clinicians who treat persons with substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

Research; Pagano ME, Friend KB, Tonigan JS, Stout RL. Helping other alcoholics in alcoholics anonymous and drinking outcomes: findings from project MATCH. J Stud Alcohol. 2004 Nov;65(6):766-73.

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Helping other Alcoholics and Relapse

The specific mechanisms of Alcoholics Anonymous (AA) that mobilize and sustain behavior change are poorly understood.

This study examined the relationship between helping other alcoholics in AA and relapse in the year following treatment for alcohol use disorders. Data were derived from a longitudinal investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence (Project MATCH). Probabilities of time to alcohol relapse were calculated using Kaplan-Meier survival estimates. Proportional hazards regressions, with control for number of AA meetings attended, were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics.

those who were helping other alcoholics . . . were significantly less likely to relapse in the year following treatment

Age was the only demographic characteristic that distinguished participants involved in helping other alcoholics; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics and were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended.

Thus recovering alcoholics who help other alcoholics (mutual-help) maintain long-term sobriety after formal treatment are better able to maintain their own sobriety.

The authors conclude that clinicians who treat substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

Research report; Pagano ME, Friend KB, Tonigan JS, and Stout RL. Helping other alcoholics in alcoholics anonymous and drinking outcomes: Findings from Project MATCH. Journal of Studies on Alcohol 65(6):766-773, November 2004.

• 12-Step Recovery Theory And Application
• AA And Al-Anon
• AA And The Disease Concept Of Alcoholism
• Adolescent Children Of Alcoholics
• Al-Anon Offers New Life
• Alcohol Consumption In Patients Pancreatitis
• Alcohol Metabolization
• Alcohol Related Brain Injury
• Alcoholic Brain Damage And Thiamine
• Alcoholic Jealousy
• Alcoholics Anonymous
• Alcoholics Can Benefit From Al-Anon
• Alcoholism And Personality Disorders
• Alcoholism Is Also Genetic
• Alcoholism Myths
• Anti-Craving Naltrexone Injection Reduce
• Benefits Of Alcoholics Anonymous
• Beyond Codependency
• Brief-TSF Description
• Children With Alcohol Dependent Fathers
• Counselor Characteristics
• Craving Reduction
• Effective Professional Interventions
• Effects Of Gambling Addiction
• Free Inhalant Abuse Education
• Just For Today Card
• Mindfulness Can Help Recovery
• Prescription Drug Overdose Becomes Big Killer
• Process Of Recovery For Alcoholic Women
• Research Evidence For TSF  .
• Return To Drinking After Liver Transplantation For Alcoholic Liver Disease
• Role Of Significant Others
• Screening Can Decrease Teen Risk Behaviour
• Sleep Problems Affect Alcoholism Recover
• Spirituality And Helping In Alcoholics Anonymous
• Strategies For Dealing With Common Problems
• Strategies For Dealing With Denial
• Sweet Tooth And Alcoholism
• Symptoms Of Alcoholism
• Teen Drinking Leads To Risk Of Alcoholism And Social Exclusion
• The Aging Alcoholic
• The Classification Of Alcoholics
• The Dry Drunk
• Thyroid Function In Depression And Alcohol Abuse
• TSF Description
• Twelve Step Recovery Is Spiritual
• Twelve Steps To Recovery From Burnout
• What About Partners Of Alcoholics?

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Religiosity and participation in mutual-aid support groups for addiction

Mutual-aid support groups, such as the 12-Step fellowship Alcoholics Anonymous play a vital role in substance abuse treatment in the United States.  In 2005, The Walsh Group conducted a national survey of participants in mutual-aid support groups for addiction to identify key differences between participants in various recovery groups.  The survey was conducted with the assistance of The Center for Survey Research at the University of Virginia, Secular Organizations for Sobriety (SOS), SMART Recovery, and Women for Sobriety (WFS).  Extensive data was collected from survey respondents on many aspects of recovery.  This paper focuses on the impact of survey respondents’ level of religiosity on their recovery and their participation in mutual-aid support groups.

Key findings from the survey on mutual-aid support groups discussed in this paper include:

• Active involvement in groups significantly improves the chances of remaining clean and sober, regardless of the group (SOS, SMART, WFS, 12-step) in which one participates.
• Respondents whose individual beliefs better matched those of their primary support groups showed greater levels of group participation, resulting in better outcomes as measured by increased number of days clean and sober.
• Religious respondents were more likely to actively participate in 12-Step groups and WFS, both of which have spiritual components in their programs.
• Non-religious respondents were significantly less likely to participate in 12-Step groups. 
• Respondents with low levels of religiosity were more likely to actively participate in groups with secular programs, such as SOS and SMART Recovery.  

These results have important implications for treatment planning and implementation, indicating that matching clients to appropriate support groups according to their individual beliefs can have a positive impact on their program involvement and, ultimately, on their treatment outcomes.  When participants in recovery groups feel more comfortable with the philosophies of the groups they attend, they are more likely to become actively involved in these groups, which often results in longer periods of remaining abstinent from the use of alcohol and other drugs.

Research; Randolph G. Atkins, Jr, and James E. Hawdon. Religiosity and participation in mutual-aid support groups for addiction. Journal of Substance Abuse Treatment, Volume 33, Issue 3, October 2007, Pages 321-331

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism by AA Services Read more about this title…

Review of the book ’Alcoholics Anonymous’

From; The NEW ENGLAND JOURNAL OF MEDICINE, Vol. 221(15), October 12, 1939

ALCOHOLICS ANONYMOUS: The story of how more than one hundred men have recovered from alcoholism. 400 pp. New York Works Publishing Co., 1939, $3.50.

The psychological aspect of alcoholism taxes the entire skill and intuition of the therapist, and the authors of this book claim that in the long run the ex-alcoholic patient who is properly trained in psychological method is an extremely effective person to bring about the cure of the neurotic alcoholic individual.

The first part of the book discusses methods, with particular stress on twelve steps in the recovery program. This program includes the general principles of psychotherapy found in such books as those by Durfee and Peabody. There is, however, an essentially new note, namely, that the alcoholic individual should be helped to admit to God, to himself and to another human being (preferably an ex-alcoholic patient) the exact nature of his personality deficit Some will perhaps shy from the emphasis on God and religion until it is realized that the alcoholic patient is asked in this relation to believe sincerely in a power greater than himself. He then sees that his life is really unmanageable without this power.

The second part contains the stories of twenty-nine individuals who were cured by the method of working out their character problems in relation to God, themselves and another human being. All these individuals were "convinced by an ex-alcoholic therapist" Those who at some time must deal with the problem of alcoholism are urged to read this stimulating account

The authors have presented their case well, in fact, in such good style that it may be of considerable influence when read by alcoholic patients.

Bloggers note; Its now sold over 25 million copies and has helped over 100 million people recover from alcoholism and about 500 other maladies – not just alcoholism.

Combined Alcoholics Anonymous and professional care for addicted physicians

We surveyed 100 impaired physicians who were successfully treated in a substance abuse program that combined professionally directed treatment and peer-led self-help.

An average of 33.4 months after admission, subjects reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities.

Feelings of affiliativeness to AA, which were very high, were strong predictors of subjects perceived support for their recovery.

Three psychological variables were seen as influential to this process:

• shared belief,
• group cohesiveness, and
• mutual identification.

Feelings of affiliativeness and an identification with the role of care giver in addiction treatment appeared to be central to subjects recovery process.

Research report; Galanter, Marc; Talbott, Douglas; Gallegos, Karl; Rubenstone, Elizabeth. Combined Alcoholics Anonymous and professional care for addicted physicians. American Journal of Psychiatry. Vol 147(1), Jan 1990, 64-68.