The Relationship Model of Addiction (I) Codependency

One of the latest developments in the field of addiction is the Relationship Model of Addiction (RMA). The prevailing approach to addiction for the past 50 plus years has been a medical-based model. When the American Medical Association established that alcoholism (which later became interchangeable with chemical dependency as well as addiction) qualified as a disease-a "pathological dependence," only objective or science-based criteria applied. Addiction was understood strictly from a medical perspective and only genetic, biochemical and behavioral factors were considered. The subjective arena was never broached and mental, emotional, psychological and relationship factors were virtually ignored.

The RMA picks up where the disease concept leaves off. From the RMA perspective, "pathological dependency" implies a pathological relationship, one that can be most accurately understood by looking at the mental and emotional dynamics of a relationship. "Pathological" can be synonymous with an unhealthy, dysfunctional, "bad" relationship. The RMA broadens our understanding of addiction as being a relationship and extends the concept to activity-based and relationship addictions, not just to chemical dependency.

The relationship is with a means of relief, be it with a substance or an activity like gambling, porn or sex ("process" addictions) or with another person (codependency). The relationship is driven by pain and the need to relieve that pain. The pain is emotional in nature, the result of unconscious unmet emotional needs stemming from childhood, from relationships that failed to provide adequate emotional nourishment. Despite being unconscious, they remain active, never go away, and only get stronger over time. 

This 'pathologically dependent' relationship is a destructive and doomed one. It feeds on itself, creating a vicious cycle. While providing temporary relief, the net effect actually leaves the addict in more pain and emotional hunger than before. The level of pain and hunger driving the addiction increases over time as no real nourishment is ever provided. The energy spent keeping the relationship going zaps whatever internal resources existed prior to becoming addicted and further isolates the addict from relationships that might otherwise provide some nourishment. The relationship becomes overpowering, the number one relationship in the addict's life, coming at the expense of all other relationships and priorities, i.e. family, work, health and creative endeavors. This accounts for the progressive deterioration on all levels of functioning associated with this pathological dependency.  

In many ways, the relationship is akin to carrying on a secret love affair. Secrecy and deception are always involved. Imagination plays a key role, and denial is always operating.

Denial makes it virtually impossible for someone in the throes of an addiction to realistically and accurately assess the existence of the problem, as well as the severity of problems resulting from the relationship. The addict has no idea how desperately involved he or she is and the lengths he or she would go for relief, without considering the costs. For the addict illusion has replaced reality. In his or her deluded mind, no one sees or knows what is happening. Getting busted poses no threat.  Regret is no worry. Crashing and burning never enters the mind until he or she crashes and burns.      

The cause (etiology) of addiction is attributable to the backlog of pain associated with emotional hunger and deprivation. A basic premise of the RMA is: Where there is pain, there is the need to relieve that pain. The greater the pain, the greater the need is to relieve it.

The primary predisposing factor or condition is the presence of a relatively abundant amount, albeit subjective and impossible to measure, of emotional hunger and deprivation, which adds acuity and specificity to the prevailing genetic or biochemical explanations. The same logic applies: The greater the pain (subjective), the greater the susceptibility to becoming addicted.

The RMA also has profound treatment implications. It naturally follows that, if the lack of emotionally nourishing relationships and need for relief is the (primary) cause of addiction, then the development of nourishing relationships would reduce the need for relief, which could ultimately free the addict from his/her addiction. Rather than spending life fending off pain and depleting one's inner resources, one would tap into them, providing nourishment from within oneself and making it possible to continue growing and evolving.

It also follows that learning how to create healthy, emotionally nourishing relationships is an integral part of treatment and recovery. After a period of sustained stabilization, the next stage of recovery would be a period of intensive 'self-work'-developing the relationship with oneself - which could be the most abundant and enduring source of emotional and spiritual sustenance - where your higher self resides. Many consider your self tantamount to your higher power. It's where there is compassion, guiding wisdom, purpose and unrealized potential. 

After having developed a solid relationship with yourself, you act as a separate, autonomous entity, are self-aware, and are not seeking to fill holes or provide what's missing from external sources but rather looking to do so from within. The next stage of recovery would be a period of intensive 'relationship training' in which you gain the understanding and skills necessary to create healthy, intimate, emotionally nourishing relationships.


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  • Judith Toledo

    Judith Toledo

    21st Mar 2010

    Sounds informative, Supportive, and Powerful.

  • Debbue


    30th Oct 2015

    I'm not familiar with you or your work but I am interested in looking further into RMA. I trained as an addictions counsellor many years ago after completing 18 months of residential treatment for my own addictions. During my training I recall reading various articles which discussed the different types of addictions, relationships being one of them however RMA appears to suggest that the crux of any addiction is relationship based and I would have to agree. So while standard medical models of treatment look at approaching therapy via a number of various modalities I'm interested to know what modalities of treatment are suggested from the RMA perspective?? Debbie (NZ)

  • Hi Debbie (NZ), (10/30/2015)

    The first thing that popped into my mind when I think of modalities of treatment, I begin with education. I look at recovery as beyond sobriety; that recovery is a transitional journey out of unhealthy relationships and into healthy ones, and developing the relationship with one's Self is the turning point. Modalities of treatment include cognitive behavioral therapy, journal, other writing assignments, i.e. writing a "good-bye letter." and developing a creative outlet, meditation, communication and self-care practices, customizing a self-care program. I synthesized my schooling, clinical training, personal passion and life and recovery experience into a paradigm for understanding addiction, recovery and treatment that highlights the emotional, psychological, experiential and relationship aspects of addiction. I've culled basic principles of object relations and self psychology, existential, humanistic, phenomenological, systems, mindfulness and meditation, and developed relationship training to become more proficient in the art of relating and intimacy.

    I embrace the understanding of addiction as being a relationship, like any other, with a means of relief of pain from unmet emotional needs. And that any relationship with a means of relief, which includes, substances and activities like sex, porn and gambling and people as is the case with love addiction and codependency. Relationships that fail to provide adequate nourishment are the cause. Emotionally nourishing relationships therefore, may well be the cure. When nourished the addiction extinguishes itself, when the pain that drives the addiction is relieved. Your priorities change.

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About Daniel Linder, MFT

Daniel Linder

Relationships. I was born with a keen sense about relationships, was always assessing how close and intimate people are with each other. I had a knack for relationships. The importance of relationships cuts to the core of who I am. The combination of clinical training, 25 years of professional experience treating dysfunctional, non-intimate couples and families, as well as rigorous self analysis has given me a lot to work with. I put what seemed to come naturally to me under a microscope in an effort to break the process of building healthy relationships down to concrete essentials: Understanding of Basic Principles, Communication Skills, Self-realization and Intimacy.

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