FILLING THE EMPTIED WELL: TREATING CO-DEPENDENCY AS A STRESS-RELATED DISORDER
Co-dependents have a bad rap! As family members of those with addictive disorders, we are often considered harder to treat than the addicts themselves. We are frequently angry, rigid, blaming, lying and self-righteous. We are also depressed, anxious, in pain and can’t sleep. We frequently develop our own addictive and compulsive behaviors to help us cope and we are subject to chronic or acute stress-related illnesses such as GI issues, back pain, allergies, headaches/migraines, heart disease, CFS or fibromyalgia and cancer.
We feel guilty about taking time for self-care, so resist any provider instructions to that end. We have forgotten how to play, relax and have fun, if we ever knew how in the first place! We are stuck in a downward spiral as devastating and lethal as addiction itself, and co-dependency is indeed usually considered to be a process addiction as well.
All of this frequently leads us to be the first in our families to seek help. Our providers, whether they be medical, psychotherapeutic, spiritual or chiropractic, have an amazing opportunity to intervene for health in an addicted family system, but often don’t make much headway. We can all agree that living with an active addict is usually very stressful! But we tend to focus on the emotional stress, and don’t pay enough attention to what typically happens in the bodies and brains of people caught in unrelentingly stressful, painful situations, with no visible way out.
I hope in this 3-part article to offer a different perspective that may open the door to more effective treatment for the whole family. In the first part, we will start by exploring the effects of ongoing stress on the physiology, brain chemistry and nutritional status of people experiencing it. I will then share simple but powerful nutritional and lifestyle interventions which might quickly stop this deadly downward spiral by improving sleep, reducing anxiety and depression, and supporting the brain towards more flexible, creative and effective problem-solving.
In the second part, I will explore the many reasons family members have trouble sleeping and will offer nutritional, psycho-social and spiritual tools to address stress-related insomnia.
In the third part, I will share a series of interventions, including hypnosis and EMDR, that have been effective in my practice in motivating family members towards self-care, and then supporting their own on-going recovery process.
So, what are the physiological results of ongoing stress? Briefly,they include adrenal down-regulation, often called adrenal fatigue.This leads to profound hormone and glandular dysregulation and impairment of the immune system. Unrelenting stress also severely depletes our bodies and brains of the key nutrients and neurotransmitters which allow us to cope with stress. We run out! These cascading issues explain many co-dependent symptoms,including resistance to change.
The adrenal glands are part of the Endocrine System and regulate our responses to stress in part by producing adrenaline and cortisol, which gives us our get up and go. For instance, cortisol is supposed to be high in the morning to get us up and low at bed-time so we can sleep. One of the effects of on-going stress isthat this normal cycle shifts so that cortisol is low in the morning, leading to a.m. grogginess and fatigue, and high at bedtime, leading to insomnia.
While much of the stress experienced by family members are out of our control- constant fear, lack of opportunities to relax and feel safe, and hypervigilance, certain behaviors within our control contribute to adrenal stress as well. These include poor food choices, using food and drinks as stimulants when tired instead of resting, staying up late even though fatigued, and constantly driving ourselves because of our belief that “being or appearing perfect” will somehow keep us safe. Dr. Wilson, in his book “Adrenal Fatigue”, discusses how constantly being in a position of powerlessness and staying in no-win situations, over time; also profoundly impact adrenal function. These are very familiar situations for many family members!
So, what actually happens in the body in response to a stressful situation? The adrenal glands release cortisol, adrenaline and norepinephrine and we move into arousal of the sympathetic nervous system. This increases blood pressure, heart rate, oxygen intake and blood flow to muscles. Muscles tense in readiness to fight or flee, stored glycogen is released to raiseblood sugar, and digestion shuts down, reducing the secretion
of digestive enzymes such as hydrochloric acid. (Functionalmedicine identifies most GERD as actually due to not enoughstomach acid production at the time of the meal, leading to rebound production after the esophageal sphincter has relaxed.)In the short term, this is fine, and the body returns to normal once the stressor is gone. However, in chronically stressful situations, these conditions persist and worsen. A chronic increase in stress hormones, which lead to metabolic syndrome, digestive problems and muscles aches and pains, is followed by cortisol depletion. By this time, family members are exhausted, have difficulty making decisions and thinking clearly, and have a slower recovery time from illness and infection. Their ability to handle stress is now severely compromised.
But adrenal depletion/down regulation is not the only issue. It is our brain’s job to allow us to cope with stress gracefully and effectively. But to its job, it must be fed optimally! It requires daily input from our diet of amino acids from protein, vitamins and minerals from fruits and vegetables, and fatty acids in order to function. Healthy eating is not optional! Our very lives, well-being and ability to creatively solve problems and overcome stress depends upon it. And ongoing stress both profoundly depletes the brain of these necessary nutrients and interferes with our ability to feed ourselves consistently, digest the food optimally and then absorb and utilizethese nutrients.
Thus, effective interventions would ideally include education and adequate nutrient replacement. Along with educating our family members about other types of self-care, we need to be teaching them about how crucial it is to feed the brain adequately and keep blood sugar levels very stable to reduce anxiety, anger and fatigue. This would mean teaching our clients and ourselves(!) about simple but healthy meal and snack planning. We should be helping our clients identify and overcome barriers to healthy eating and encouraging them to notice how much better they feel and function when they eat healthy food. I even believe in feeding my clients in the office if they have gone too long without eating. It’s amazing how much better they function during the therapy hour with a well-fed brain!
Finally, certain specific supplements found in any vitamin store may jump-start the entire system and can often help people feel better within 20 minutes! I tend to initially recommend a high dose vitamin and mineral formula from a reputable company along with fish oil and digestive support. This is then followed by specific amino acids such as tyrosine for energy, tryptophan and GABA for sleep, and theanine to help reduce the sense of overwhelm we often live with. These amino acids among others, have been shown to convert to neurotransmitters within 20 minutes, and relieve stress, anxiety and depression without negative side effects. Amino acids are anti-addictive! Rather than needing to take more and more over time to get the same effect, we get to take less and less because the brain’s stores of these crucial chemicals are being rebuilt and filled. Certain herbs and nutrients also have the ability to strengthen and support depleted adrenal function, leading to a reversal of all the above symptoms.
This approach lays the foundation for recovery from co- dependency/co-addiction. By feeding the brain first, we give ourselves and our clients the internal resources necessary to change our way of being in the world and to find creative solutions to the painful, challenging situations we find ourselves in. Stuck no longer, true recovery becomes a true possibility.
By: Christina Veselak, a licensed psychotherapist and mental health nutritionist in private practice at Garden Gate Counseling and Consulting near Denver, CO; is Program Director of St. Ephraim’s