Acceptance and Commitment Therapy (ACT)

Addiction fundamentally alters the brain’s reward and decision-making systems through well-documented neurobiological mechanisms. When substances like drugs (including alcohol and nicotine) are consumed, they trigger massive releases of dopamine in the brain’s reward circuit, particularly in areas like the nucleus accumbens and ventral tegmental area. With repeated exposure, the brain adapts by reducing natural dopamine production and decreasing the number of dopamine receptors, creating tolerance and requiring increasingly larger amounts of the substance to achieve the same effect. This neuroadaptation hijacks the brain’s natural reward system, making everyday activities less rewarding while the addictive substance becomes disproportionately important.

Over time, addiction also impairs the prefrontal cortex, the brain region responsible for executive functions like decision-making, impulse control, and weighing long-term consequences. This creates a neurological double-bind: the midbrain structures driving craving and drug-seeking behaviour become hyperactive, while the prefrontal systems that would normally regulate these impulses become weakened. Chronic substance use also disrupts stress response systems, making individuals more vulnerable to relapse during difficult periods. These changes help explain why addiction is recognised as a chronic brain disease rather than simply a matter of willpower – the neuroplastic changes can persist long after substance use stops, though the brain does have remarkable capacity for recovery with sustained abstinence and appropriate treatment.

The Challenge of Stopping

The challenge of stopping stems from the profound neurobiological changes addiction creates in the brain’s fundamental survival systems. The brain essentially learns to treat the addictive substance as necessary for survival, similar to food or water. When someone tries to quit, they face intense physical withdrawal symptoms as their neurochemistry struggles to return to homeostasis, combined with psychological cravings that can persist for months or years. The damaged prefrontal cortex makes it extremely difficult to override these powerful urges with rational decision-making, while stress, environmental cues, and emotional states can trigger automatic drug-seeking responses that feel almost involuntary. This creates a cycle where attempts to quit often lead to temporary success followed by relapse, which many interpret as personal failure rather than recognising it as part of the neurological reality of the condition.

Addiction appears progressive because tolerance drives escalating use over time, while the brain’s reward system becomes increasingly dysregulated. What begins as recreational use gradually shifts to compulsive use as natural dopamine production diminishes and neural pathways become more deeply entrenched. The condition typically follows a predictable pattern: initial experimentation leads to regular use, then to use despite negative consequences, and finally to compulsive use where the person continues despite severe impairment in major life areas. Additionally, chronic substance use often damages the brain regions responsible for insight and self-awareness, making it harder for individuals to recognise the severity of their condition. The progressive nature is also influenced by external factors – as addiction advances, people often lose social supports, employment, and housing, creating additional stressors that fuel continued use and make recovery more challenging.

Understanding addiction when you’re not “addicted” to alcohol or other drugs

The difficulty in understanding addiction, even among people with their own compulsive behaviors, stems from several key differences in how these conditions manifest and are perceived. While behaviors like sugar consumption, social media use, or shopping can indeed activate similar dopamine pathways, they typically don’t create the same level of neurobiological hijacking that occurs with substances like alcohol, opioids, or stimulants. Addictive drugs often produce dopamine surges 2-10 times greater than natural rewards, creating more profound and lasting changes to brain structure and function. Additionally, many behavioral compulsions allow people to maintain relatively normal functioning in major life areas, whereas substance addiction typically leads to progressive deterioration across multiple domains – relationships, work, health, and legal standing.

The social and cognitive factors also create barriers to understanding. Most people can relate to losing control occasionally – eating too much dessert or spending too much time scrolling their phone – but these experiences usually involve temporary lapses that can be corrected relatively easily through willpower or environmental changes. This creates a false sense of equivalency where people think “I can stop eating cookies when I want to, so why can’t they just stop drinking?” They don’t grasp that addiction involves a qualitatively different level of brain change where the substance has become neurobiologically essential, not just psychologically preferred. There’s also often a moral lens applied to addiction that doesn’t exist for other compulsive behaviours – society tends to view overconsumption of legal, socially acceptable things as personal quirks or minor character flaws, while addiction to illegal substances or excessive alcohol use carries heavy stigma and assumptions about moral failing, making it harder to see as a medical condition requiring treatment rather than simply better self-control.

A Word On Nicotine (Tobacco Products)

Yes, nicotine absolutely does release large amounts of dopamine, making it highly addictive despite being legal and socially accepted in many contexts. Nicotine causes an increase in dopamine levels in the brain’s reward pathways, creating feelings of satisfaction and pleasure.Research shows that nicotine, like opioids and cocaine, can cause dopamine to flood the reward pathway up to 10 times more than natural rewards.

This helps explain why nicotine addiction can be so powerful and difficult to overcome, even though people often view smoking or vaping as less serious than other forms of substance addiction. Repeated activation of dopamine neurons in the ventral tegmental area by nicotine leads not only to reinforcement but also to craving and lack of self-control over intake. The addiction develops through the same basic mechanisms as other substances – as people continue to smoke, the number of nicotine receptors in the brain increases, requiring more of the substance to achieve the same dopamine response.

What makes nicotine particularly insidious is its legal status and social acceptance, which can make people underestimate its addictive potential. The rapid delivery of nicotine to the brain (within 10-20 seconds when smoked) creates an almost immediate reward that strongly reinforces the behaviour. This is why many people who successfully quit other substances still struggle with nicotine, and why nicotine addiction often serves as a gateway that primes the brain’s reward system for addiction to other substances.

Low self-worth is one of those things almost everyone has heard of, but it’s often misunderstood. It’s not simply “not liking yourself” — it’s a deeper, often quiet belief that you’re somehow not enough: not good enough, not lovable enough, not worthy of good things. This belief can shape how a person thinks, feels, behaves, and connects with others, sometimes without them even realising it’s happening.

This article walks through what low self-worth can look like, how it tends to develop, why it’s not always the explanation for a behaviour it might seem to explain, and what genuinely helps.

What Does Low Self-Worth Actually Look Like?

Low self-worth doesn’t show up in just one way — it tends to ripple across several areas of a person’s life.

In the way someone thinks

• A harsh inner voice that’s quick to blame and slow to forgive
• Black-and-white thinking about their own worth (“I’m a failure” rather than “that didn’t go well”)
• Brushing off compliments or achievements (“I just got lucky”)
• Constantly comparing themselves to others, usually unfavourably

In how someone feels

• A background hum of shame or guilt that isn’t tied to anything specific
• Anxiety in situations where they feel judged or evaluated
• Taking criticism much harder than the moment probably warrants
• Struggling to feel like they deserve good things — joy, rest, success

In how someone behaves

• People-pleasing, and real trouble saying no
• Avoiding challenges for fear of failing in front of others
• Perfectionism, partly as a way to dodge criticism before it happens
• Overcompensating — bragging, chasing status, or over-achieving to cover up insecurity underneath
• Self-sabotage, like procrastinating or quitting before they can “fail properly”
• Over-apologising, even when nothing’s actually their fault

In relationships

• Putting up with disrespectful or unequal treatment
• Needing frequent reassurance from others
• Trouble setting or holding boundaries
• Pulling away from people to avoid the risk of being rejected

Physically

• Guarded body language, poor posture, avoiding eye contact
• Neglecting self-care, sometimes because they don’t feel “worth the effort”

Worth remembering: none of these signs are exclusive to low self-worth. They overlap with anxiety, depression, trauma responses, and other things going on for a person. It’s the overall pattern — and the story underneath it — that matters, not any single item on this list.

Where Does It Come From?

Low self-worth is very often learned rather than something a person is simply born with — which is actually good news, because what’s learned can also be unlearned.

Watching the adults around us Kids learn a lot about how to treat themselves by watching how the important adults in their life treat themselves. A parent who’s constantly self-critical or dismissive of their own needs is teaching a child a template, even without saying a word directly to them.

Love and attention that come with strings attached If approval or affection is only given for achievement, appearance, or good behaviour, a child can learn that their worth depends on ticking boxes — rather than being something they simply have, no strings attached.

Being told directly Repeated criticism, shaming, or put-downs from parents, teachers, or peers get absorbed, especially in childhood before a person has the tools to separate “someone said this about me” from “this is true about me.”

Early relationships with caregivers Inconsistent, neglectful, or dismissive caregiving is strongly linked to a shaky sense of self-worth in adulthood — the underlying logic often being something like, “if the people meant to care for me didn’t, maybe I’m not worth caring for.”

Peers and wider social environments Bullying, exclusion, and highly competitive or comparison-heavy environments — including social media — can teach the same lesson outside the family entirely.

Broader social messaging Cultural narratives around race, gender, body type, class, or ability can also send repeated messages of lesser worth, reinforced across many different settings over time.

Why It’s Not Always the Explanation

It’s tempting, once you’re aware of low self-worth as a concept, to see it everywhere. But plenty of behaviours that look like they’re about self-worth are actually about something else entirely — or several other things at once.

Take a few common examples:

• Substance use can be tangled up with self-worth (numbing shame or a harsh inner critic), but addiction is genuinely shaped by many factors — genetics, brain chemistry, trauma, mental health conditions, and environment all play a real part.
• Having few or no friends might reflect low self-worth (believing you’re not worth others’ time), but it could just as easily be social anxiety, depression, being naturally introverted, or simply preferring one’s own company. The key difference is usually the story underneath — does the person want connection and feel blocked by fear, or is being alone genuinely fine by them?
• Coming across as arrogant or superior is often assumed to be a mask for hidden insecurity — and sometimes it is. But it’s worth being cautious here, because this assumption can become impossible to disprove (“if they’re arrogant, they’re secretly insecure; if they’re humble, that confirms it too”). Sometimes confidence is just confidence.
• Frequent casual sex or a high number of partners doesn’t automatically point to low self-worth either. For many people, this is simply how they’ve chosen to structure their sex life, without any distress or underlying insecurity attached. What matters more is the function the behaviour seems to serve for that particular person — for example, someone who says they need to tell others about their experiences afterward specifically “to feel validated” is giving you a much clearer signal than the behaviour itself would.

The takeaway: self-worth is worth holding as a hypothesis to test with a person, rather than assumed from the outside based on how something looks.

What Actually Helps

If low self-worth is at the heart of things, here’s what tends to make a genuine difference — not overnight, but over time.

1. Notice and challenge the inner critic Pay attention to the specific language your mind uses about you. Often it’s harsher and more sweeping than how you’d ever speak to someone else. Try the “friend test”: would you say this to someone you cared about? If not, that’s a sign of distortion, not truth. It also helps to separate the behaviour from the self — “that didn’t go well” instead of “I’m hopeless.”

2. Loosen the strings attached to your worth Notice what your sense of worth currently depends on — achievement, appearance, being liked, being productive. Then start building small experiences of worth that aren’t tied to those things: resting without earning it, being liked without performing. This is slow, quiet work, but it’s often the real target.

3. Build evidence, not just insight Small, doable actions build a track record of competence over time — self-worth grows partly through lived proof, not just understanding. Avoiding challenges or social situations might feel safer, but it also blocks the very experiences that could prove the harsh self-view wrong.

4. Practise boundaries Struggling to say no, or putting up with poor treatment, is common with low self-worth. Practising small boundaries — even minor ones — can genuinely shift things, not just relieve symptoms temporarily. Pay attention to the fear beforehand versus what actually happens afterward; they’re often quite different.

5. Try self-compassion rather than self-esteem Self-compassion doesn’t require feeling good about yourself — it just means relating to yourself kindly, especially when things are hard. That’s often a far more achievable starting point than trying to force positive self-regard from a standing start. Remembering that struggling is part of being human (not a personal failing) is a big part of this.

6. Pay attention to relationships If low self-worth was shaped by relationships, it often needs relationships to help un-shape it too — this is part of why therapy, and a genuinely supportive relationship, tends to work better than self-help alone. Where possible, it also helps to reduce contact with people or environments that actively reinforce the negative self-view.

7. Shift from approval to values Instead of asking “what will make people think well of me,” try asking “what actually matters to me.” This shift — living by your own values rather than by anticipated approval — reduces the constant self-monitoring that keeps worth tied to outside opinion.

A Final Note

Self-worth work is rarely quick, and it’s rarely a straight line. It’s more like slowly rebuilding a belief system than fixing one single thought. Old patterns will likely resurface here and there — that’s not a sign the work isn’t working, it’s just part of how deeply learned beliefs unwind over time.

If this sounds familiar to you personally, it’s worth having a conversation with a psychologist or therapist — someone who can help you work out what’s underneath the patterns, and support you through actually shifting them.

By Mitchell Webb | Webb Therapy, Surry Hills Sydney

We all have moments in relationships where we give too much, worry too much, or lose ourselves a little in someone else. That is not codependency — that is being human. But when those moments become the architecture of the entire relationship, when your sense of self, your emotional stability, and your very identity become organised around another person’s needs, moods, and wellbeing, something more significant may be at play.

Codependency is one of the most misunderstood and underdiagnosed relational patterns in clinical practice. It is frequently mistaken for love, devotion, or simply being a caring person. Yet the research is consistent: left unaddressed, codependent patterns cause significant harm to both people involved — and they rarely improve on their own.

This article explores what codependency actually is, what the current evidence says about how to identify it, and — critically — what you can do if you recognise yourself in it.

What Is Codependency, Really?

The term “codependency” originated in the addiction treatment field in the 1970s and 1980s, used initially to describe the partners and family members of people with substance use disorders. Clinicians noticed that the people surrounding someone with addiction often developed their own set of dysfunctional patterns — enabling behaviour, emotional enmeshment, a compulsive need to control or fix the other person — that were distinct from, yet deeply intertwined with, the addiction itself.

Over the following decades, the concept broadened. Researchers and clinicians came to understand that codependency was not unique to addiction contexts. It appeared in relationships involving chronic illness, mental health conditions, emotional immaturity, narcissistic traits, and even in ostensibly “normal” relationships where one person had learnt, usually in childhood, that love was conditional on their usefulness or selflessness.

The American Psychological Association (2023) now broadly defines codependency as an emotional and behavioural pattern characterised by excessive reliance on others for approval, identity, and self-worth — typically at the expense of one’s own needs, boundaries, and sense of self.

Mental Health America describes it as a “relationship addiction”: a pattern where people form or maintain relationships that are one-sided, emotionally exhausting, and often damaging — yet feel compelled to stay because their sense of purpose and worth has become fused with the relationship itself.

Importantly, current research frames codependency not as a character flaw or a deliberate choice, but as a learned relational strategy — one that almost always has its roots in early experiences where a child learnt that to be loved, they needed to be needed.

The Difference Between Normal Relationship Behaviour and Codependency

This is perhaps the most important clinical question, and one that causes enormous confusion. Most people, at some point in a relationship, will:

• Put their partner’s needs before their own
• Worry excessively about someone they love
• Suppress their own feelings to keep the peace
• Feel their mood affected by their partner’s emotional state
• Struggle to maintain boundaries with someone they care about deeply

None of these, in isolation or temporarily, constitute codependency. Relationships involve genuine interdependence — research by Rusbult and Van Lange (2003) in the Annual Review of Psychology demonstrates that healthy mutual reliance is not only normal but essential to human flourishing. We are wired for attachment, and feeling affected by those we love is a feature of that, not a flaw.

The distinction lies in pattern, pervasiveness, proportion, and — critically — motivation.

In healthy relationships, care for another is chosen freely from a stable sense of self. You can be deeply affected by your partner’s pain without feeling responsible for fixing it. You can prioritise their needs without abandoning your own. You can be close without losing the thread of who you are.

In codependent relationships, the dynamic is structurally different. The table below outlines the key distinctions that clinicians look for:

That last row is one of the most clinically telling features of codependency. When a codependent person’s partner recovers, stabilises, or no longer needs them in the same way, it can trigger a profound identity crisis — because the caretaking role was not just something they did; it was who they were.

Evidence-Based Signs You May Be in a Codependent Relationship

The following indicators are drawn from validated clinical frameworks, including the work of Darlene Lancer (a leading researcher in codependency treatment), the Codependency Assessment Tool (CAT), and broader attachment and self-determination research.

1. Your emotional state is governed by the other person’s

You feel happy when they are happy, anxious when they are struggling, guilty when they are upset — regardless of whether you had any role in it. Their mood functions as the weather system you live inside. This is clinical enmeshment: a blurring of the emotional boundary between self and other.

2. You feel responsible for managing their emotions

Not just concerned — responsible. You find yourself working to regulate their feelings, prevent their distress, or shield them from the consequences of their behaviour. You walk on eggshells. You rehearse conversations. You adjust yourself to pre-empt their reactions.

3. Your self-worth is tied to being needed or useful

You feel most secure, most loveable, most like “yourself” when the other person is relying on you. When they don’t need you — when they are doing well, managing independently, or connecting with others — you feel vaguely anxious, unsettled, or unnecessary.

4. You have significant difficulty saying no

Not simply a preference for harmony, but a deep fear of what will happen if you assert a need, a limit, or a disagreement. Saying no feels dangerous — not mildly uncomfortable, but genuinely threatening to your sense of safety in the relationship.

5. Your own needs feel unimportant, illegitimate, or too much to ask

You consistently prioritise the other person’s needs, minimise your own, and feel guilty or ashamed for having them at all. Other people’s needs feel urgent and real; yours feel like an inconvenience.

6. You enable behaviour that harms the other person (or you)

You cover for them, make excuses, absorb consequences, or rescue them from situations they need to face. You know, somewhere, that this is not helping — but stopping feels impossible, cruel, or too frightening.

7. The relationship has become your primary source of identity

Outside of this relationship, you are not sure who you are, what you want, or what matters to you. Your social connections, interests, and sense of purpose have narrowed to the point where the relationship has become your whole world.

8. You experience disproportionate fear of the relationship ending

Beyond the normal grief of losing someone important, the prospect of this relationship ending feels like annihilation — as though without it, you would cease to exist in any meaningful sense.

What Causes Codependency? The Evidence

Current research strongly implicates early attachment experiences as the primary driver of codependent patterns. Studies in developmental psychology consistently show that children who grow up in environments characterised by:

• Emotional unpredictability or neglect
• A parent or caregiver with addiction, mental illness, or chronic instability
• Conditional love (affection given in exchange for performance, caretaking, or compliance)
• Parentification (being required to manage a parent’s emotional world)

…are significantly more likely to develop the relational strategies we now recognise as codependency. These children learn, at a pre-verbal and deeply embodied level, that love is not unconditional — that it must be earned through service, vigilance, or self-erasure.

Attachment theorists describe this as an anxious or disorganised attachment style: a chronic hypervigilance to the emotional states of others, combined with an unstable or underdeveloped sense of self.

Critically, Mental Health America notes that codependency is a multigenerational pattern — one that is modelled, transmitted, and reinforced across families and generations, often without anyone recognising it for what it is. This is why it so frequently feels normal. To the person in it, it simply feels like love.

How to Navigate a Codependent Relationship: What the Evidence Recommends

Recognising codependency is significant. What comes next matters enormously. The following steps reflect current evidence-based approaches, including schema therapy, attachment-focused therapy, and self-determination theory.

Step 1: Name it without shame

Codependency is not a character defect. It is a survival strategy that once served a purpose. The self-critical spiral of “why can’t I just stop?” is itself part of the pattern — a form of the same self-erasure that drives codependency in the first place. Begin by acknowledging what is true, with as much compassion as you can manage.

Step 2: Seek individual therapy — not couples therapy, at least not first

This is one of the most consistent recommendations in the clinical literature, and one of the most frequently ignored. The instinct in a codependent relationship is to focus on the relationship — to fix the dynamic, to work on “us.” But codependency is fundamentally an individual pattern that predates the current relationship. Individual therapy is the appropriate first step.

Evidence-based modalities with strong outcomes for codependency include:

• Schema Therapy: Identifies the early maladaptive schemas (core beliefs about self and relationships) that drive codependent behaviour, and systematically reworks them
• Attachment-focused therapy: Addresses the insecure attachment patterns at the root of codependency, building what attachment researchers call “earned security”
• Acceptance and Commitment Therapy (ACT): Builds psychological flexibility, value-based action, and a stable sense of self that does not depend on external validation
• Dialectical Behaviour Therapy (DBT): Particularly helpful where emotional dysregulation and enmeshment are prominent features

Step 3: Begin the work of differentiation

Differentiation — the developmental process of becoming a distinct self within a close relationship — is at the heart of codependency recovery. In practical terms, this means:

• Identifying your own feelings, needs, and values separately from the other person’s
• Practising sitting with the other person’s distress without rushing to fix it
• Rebuilding connections, interests, and a sense of identity outside the relationship
• Gradually practising the expression of needs and limits — starting small, building tolerance

This is not a process of becoming cold or detached. Research on interdependence consistently shows that the more securely differentiated a person is, the more genuinely intimate they can be. As The Bridge to Recovery notes, this is what attachment researchers call the “dependency paradox”: the more safely you can depend on someone, the freer and more authentically connected you become.

Step 4: Address enabling behaviours directly

If the relationship involves someone with an addiction, mental health condition, or chronic instability, the codependent person is almost certainly engaging in enabling — behaviours that, with the best of intentions, prevent the other person from experiencing the natural consequences that might otherwise motivate change.

This is extraordinarily difficult to stop, not because the person doesn’t understand it intellectually, but because it is underpinned by deep anxiety and a terror of what will happen if they don’t intervene. Therapeutic support is usually required to navigate this safely.

Step 5: Consider whether the relationship can become healthy

This is a question that must be held with honesty. Some relationships, with both parties doing meaningful work, can move from codependency toward genuine interdependence. This typically requires both people to be willing to acknowledge the dynamic, engage in individual therapeutic work, and — often — couples therapy once both have established some individual stability.

Other relationships cannot sustain that shift. If the other person has no interest in change, or if the dynamic is also characterised by coercive control, abuse, or sustained exploitation, the most honest clinical recommendation is that the healthiest path forward may be to leave.

This is not a failure. It is, in many cases, the most courageous and self-respecting act available.

Step 6: Build the life you paused

Recovery from codependency is not simply the removal of a problematic pattern. It is the construction of something new: a stable, internally anchored sense of self; relationships characterised by genuine reciprocity; a life in which your own needs, values, and wellbeing are not an afterthought but a foundation.

This takes time. It is not linear. But the research is clear that it is possible — and that the therapeutic work, while challenging, produces lasting and meaningful change.

A Note on Seeking Support in Australia

If you recognise yourself in this article, please know that you are not alone and that effective help is available. A number of pathways are worth considering:

• Individual therapy with a psychologist or psychotherapist experienced in attachment, schema, or relational trauma
• SANE Australia (sane.org) — mental health support and resources
• Beyond Blue (beyondblue.org.au) — resources and access to counselling
• Co-Dependents Anonymous (CoDA) Australia — a peer support programme based on the 12-step model, with meetings available nationally and online

The fact that you are asking these questions is already significant. Awareness is where change begins.

Mitchell Webb is a counsellor and psychotherapist based in Surry Hills, Sydney, with a focus on relational patterns, attachment, and identity. Webb Therapy offers individual counselling and psychotherapy for adults navigating complex relationship dynamics.

References

American Psychological Association. (2023). APA Dictionary of Psychology. apa.org

Mental Health America. Codependency. mhanational.org

Rusbult, C. E., & Van Lange, P. A. M. (2003). Interdependence, interaction, and relationships. Annual Review of Psychology, 54(1), 351–375.

Feeney, B. C., & Van Vleet, M. (2010). Growing through attachment: The interplay of attachment and exploration in adulthood. Journal of Social and Personal Relationships, 27(2), 226–234.

Lancer, D. (2014). Conquering shame and codependency. Hazelden Publishing.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.