The concept of codependency was initially used to define behaviors and relationships in family members of drug abusers and alcoholics. Similar patterns have been seen in family relationships involving chronically or mentally ill individuals. At one time, debates ignited about whether codependency was a dysfunctional relationship or a personality problem. Eventually, some studies contradicted the stereotypical view of a chemically-dependent spouse having a personality disorder responsible for these codependent behaviors. Instead, it was suggested in many cases, these behaviors were normal reactions to overwhelming stressors of living with an addict. Today, the term has been broadened to encompass codependent members of any dysfunctional family. Subsequent research has also uncovered different patterns in codependency, based on gender and other variables.1,2 Codependency is a learned behavior that can be passed down from one generation to the next. It is an emotional and behavioral condition impacting an individual\u2019s ability to have a healthy, mutually satisfying relationship. It typically involves mutually destructive habits and maladaptive coping strategies to maintain a sense of balance or status quo.3 A form of codependency known as relationship addiction is associated with people forming or maintaining one-sided, emotionally destructive and or abusive relationships.2 The primary difference between a supportive and codependent relationship is the former is constructive and mutually beneficial, while the latter has negative consequences. Codependency erodes family relationships and reinforces addictive, often dangerous behaviors. A dysfunctional family is one in which members experience fear, anger, pain or shame without acknowledging these problems exist. They avoid anything related to the problem, which leads to developing behaviors to facilitate denying, ignoring or avoiding painful emotions. The self-identity and emotional development in members of dysfunctional families are often inhibited. Codependents tend to have low self-esteem and seek solace to make them feel better, which may manifest in drug or substance use, workaholism, compulsive gambling or unsafe sexual activities.2 Characteristics of Codependents Understanding the common traits of codependency is the first step in recognizing you may have a problem requiring professional intervention.2 \tExaggerated sense of responsibility for the actions of others \tTendency to confuse love and pity, with the tendency to \u201clove\u201d people you can pity and feel you can rescue \tAssuming more than your \u201cfair share\u201d all the time \tBeing hurt when people don\u2019t recognize your efforts \tCompulsively maintaining links with children or partners despite suffering \tExtreme need for approval and recognition \tInability or unwillingness to express your needs \tFeeling guilty when asserting yourself \tA compelling need to control others \tLack of trust in self and or others \tFear of being abandoned or alone \tDifficulty identifying feelings \tRigidity\/difficulty adjusting to change \tProblems with intimacy \tDifficulty setting boundaries \tChronic anger \tLying\/dishonesty \tPoor communication skills \tDifficulty making decisions2,3 Codependency in Families of Drug Users The mutually destructive behaviors mentioned above enable a drug user to continue his or her addiction and also prevent family members from seeking help for themselves and loved ones. A Brazilian study analyzed 505 family members of drug users who requested help by calling a drug hotline. Mothers, spouses and second- and third-degree relatives were included in this study, although the vast majority were wives and mothers of addicts. Among the 505 family members who were interviewed, 64% showed high codependency based on the Holyoake Codependency Index, a self-reporting measure. Among the highly codependent participants, 69% reported receiving current medical treatment compared to 31% in the low-codependency group. Moreover, psychological\/psychiatric treatments were reported by 65% of the high-codependency participants compared to 35% in the low-codependency group. Mothers, unemployed wives and those with less than eight years of education were more prone to high levels of codependency. High reactivity, emotional\/task overload and self-neglect were prevalent among the participants. An analysis of these patterns revealed wives and mothers assumed the responsibilities of the drug user, oblivious their enabling behaviors were thwarting efforts to improve the family situation.3 In Brazil, traditional women\u2019s roles, family dedication and responsibility often manifest as \u201cunconditional love,\u201d which can result in servile and self-sacrificing behaviors. Although these cultural differences need to be taken into account, this study still provides useful insights on coexisting behavioral, medical and psychological traits in codependent women.3 Changing and Healing In order to transform codependent relationships into healthy ones, codependents must face their fears, then move beyond them to a place of strength and stability. With proper support and treatment, it is possible to prioritize one\u2019s own wellness, which signals self-respect and thereby elicits respect from others. Although it\u2019s difficult to enact change after years of ingrained behaviors, you can set limits and refuse to allow yourself to be emotionally \u201cblack mailed.\u201d When you set limits and say no or refuse to be pulled into another person\u2019s drama, it will scare and upset them, likely setting off a period of anger, rage and withdrawal. It\u2019s not uncommon for an addict to make irrational requests or threaten to hurt themselves or loved ones when those closest to them don\u2019t acquiesce to their demands. Learning how to stay the course in the face of negative backlash is incredibly challenging, but it is possible if you consistently stand your ground.4 Codependency Treatment Codependency is typically rooted in a person\u2019s childhood, therefore treatment often involves exploration of early childhood issues and their relationship to current destructive behavioral patterns. Treatment includes education, individual and group therapy and experiential therapy. The latter is a therapeutic approach to encourage individuals to identify and address hidden or subconscious issues through activities such as role-playing, guided imagery, the use of props and a range of other active experiences. The goal of therapy is to help codependents rediscover themselves and identify self-defeating behavioral patterns. Once an addict is stabilized in rehab, treatment focuses on helping them get in touch with feelings likely buried since childhood and reconstructing family dynamics.2 \tPanaghi L, Ahmadabadi Z, Khosravi N, Sadeghi MS, Madanipour A. Living with Addicted Men and Codependency: The Moderating Effect of Personality Traits. Addict Health. 2016;8(2):98-106. \tCo-Dependency. Mental Health America website. http:\/\/www.mentalhealthamerica.net\/co-dependency Accessed May 24, 2017. \tBortolon CB, Signor L, Moreira Tde C, et al. Family functioning and health issues associated with codependency in families of drug users. Cien Saude Colet. 2016 Jan;21(1):101-7. doi: 10.1590\/1413-81232015211.20662014. \tBeing Good vs. Being Codependent. Psych Central website. https:\/\/psychcentral.com\/lib\/being-good-vs-being-codependent\/ Updated July 17, 2016. Accessed May 24, 2017.