The Meadows Logo

FE9D29B3-F346-4682-8D3C-A2B9B0FB6D7D Created with sketchtool.

Sharing the Disease

June 18, 2009

By Claudia Black, Ph.D., MSW

It has long been known by addiction professionals that, for every person addicted, approximately another four persons, usually immediate family members, are directly affected – husbands, wives, committed partners, mothers, fathers, siblings, and young and adult children.

Would the impact of addiction be reduced if four times the number of family members took part in recovery programs? Would the impact be reduced if educational and treatment programs addressed the confusion, fear, and pain families and children suffer when the addicted person enters treatment? How might the lives of family members be altered if interventions were directed at them?

As the addict deserves his or her recovery, so do codependent family members. When family members recognize their codependency and its similarities to the addict’s addiction, they can recognize the mutuality of their recovery processes.

The following, excerpted from my recently published Family Strategies: Practical Tools for Professionals Treating Families Impacted by Addiction, helps therapists working with family members to link the addict’s behaviors with similar behaviors experienced by the family. This approach allows family members to realize they also have issues from which to recover.

The following provides examples of each disease symptom as experienced by the addict and by the family member (codependent).



“I wonder if there’s enough booze at home or if my dealer will be home or if I have enough money for my drugs.”

“I will need to cover my bases with my family by …”

The addict repetitively focuses on behaviors connected to his/her acting out behavior. The codependent experiences the inability to focus on other things without intrusive thoughts about the addicted person and his or her behaviors.

Codependent Family Member

“I wonder where my husband is, who he is with and what I will say to him when he gets home.”

Increased Tolerance


“I used to get drunk on six beers. Now it takes a dozen.”

“I used to be satisfied with pornographic magazines; now I need contact with someone on the Internet who will interact with me.”

The addict needs to engage more frequently in the behavior or the substance to garner the desired effect, which is usually related to a neurochemical change.

The codependent displays an increase in psychological tolerance as he/she increases acceptance of inappropriate and/or hurtful behavior with lower expectations.

Codependent Family Member

“He used to be critical of me, and I would get really upset; now he calls me horrible names, and it’s no big deal to me.”

Loss of Control


“I told myself I was only going to spend 50 dollars at the casino and lost my whole paycheck before I left.”

“I told myself I would only have one glass of wine at the wedding, and I got drunk and passed out.”

The addict is no longer able to predict engaging or using behavior.

The codependent is also no longer able to predict his or her own behavior.

Codependent Family Member

“When I know that he will be late for dinner again, I plan to give him the cold shoulder and go about my business. On occasion, I’ll snap. Yesterday I planned on ignoring him, but I ended up screaming in front of the kids. I, not my husband, was out of control.”



“I don’t know where I was, what I did, or who I was with last night.”

Blackouts are the one symptom the addict experiences that is not an exact carryover to the codependent. The substance addict has a period of amnesia, usually lasting from hours to days. He/she is conscious and interacting, but the memory is not imprinted on the brain, so it cannot be recalled.

The codependent’s blackout, often referred to as a “brown-out,” is due to the stress of heightened emotions; there are too many emotionally charged stimuli for details of what occurred to be recorded. It may not be a well-delineated memory block as a substance abuse blackout. It is more of a sense of something occurring without clarity. This could be referred to as a trance-like or dissociative experience in which the memory may or may not be recorded and is not readily available for conscious memory. The process addict’s (gambler or sex addict) blackout is more similar to the codependent than the substance abuser.

Codependent Family Member

“We had a screaming fight the other night. I don’t remember exactly what I said.”



“I wanted cocaine so bad I could taste it.”

The addict has a severe physical or psychological urge or craving to reengage in the substance or behavior.

The codependent experiences a deep obsessive psychological urge or longing for the times when things were better. Frequently, the craving goes hand in hand with euphoric recall (romanticizing the good times).

Codependent Family Member

“I really miss him. When he is gone, I ache for him.”

Compulsive Behavior


“When I had a craving, I knew I shouldn’t drink, but I found myself in the bar last night anyway.”

Addicts begin engaging in the behavior in a manner that they feel driven and obsessed, and they do so repeatedly, which often reduces cravings or preoccupation.

Codependents may begin engaging in behaviors such as snooping, spending money, eating, having sex, etc. Codependents’ compulsivity may be acted out in perfectionistic tendencies.

Codependent Family Member

“My house is clean, with everything in its place. It makes up for how I feel inside.”

Decreased Tolerance


“I used to be able to stay out for hours using, and now I am in trouble shortly after I begin.”

Progressively the addict cannot engage or use to the extent he/she once did and begins to experience negative symptoms more quickly.

The codependent becomes less patient, is less likely to stay in denial, and may experience an emotional bottom. Usually, these symptoms transpire more in the latter stages of the addictive process.

Codependent Family Member

“I can’t take any more. Everything he does irritates me.”

Medical Problems

In the latter stages of addiction, particularly if the addict is a substance abuser, physical problems can run the gamut from heart and lung disease, brain disease, liver damage, and throat and mouth diseases to diabetes and digestive disorders.

Medical problems may also be related to unsafe sexual practices, accidents, and injury. Codependents are more apt to experience stress-related health problems ranging from headaches, stomach or digestive problems, hives, back problems, ulcers, depression, and/or anxiety. Many diseases codependents suffer are fueled and complicated by stress, most specifically autoimmune disorders.

Codependent Family Member

“I went to one doctor after another, thinking my problems were all physical, to find after months in a 12-Step program my physical ailments disappeared.”

In conclusion, it is important to continue to talk about disease-related behaviors such as lying, sneaking, etc., and the many feelings related to living with addiction. Understanding the addict’s process and then considering the family’s similar experiences helps family members understand that they are in need of recovery as well. Family Strategies offers various tools to assist families in their healing processes.

As family members share in the disease, they may now share in the recovery.

About the Author

Claudia Black, Ph.D., MSW, Clinical Consultant for The Meadows, is a lecturer, author, and trainer internationally recognized for her pioneering and contemporary work with family systems and addictive disorders. She serves on the Advisory Board for the National Association of Children of Alcoholics and has been a keynote speaker on Capitol Hill in Washington, DC. Claudia has been featured in numerous publications, appeared on many national television shows, and written several well-known books, including Changing Course, It Will Never Happen to Me, A Hole in the Sidewalk, Depression Strategies, Straight Talk, Relapse Toolkit, The Stamp Game: A Game of Feelings, and her latest book, Family Strategies.