Acceptance and Commitment Therapy (ACT)

1. Alcohol (ethanol) enters the body through the oral cavity (i.e., the mouth). The inner surface of the oral cavity is mucosal tissue to keep the cavity lubricated and it is capable of absorbing alcohol into the bloodstream. This absorption is considered “insignificant”.

2. Alcohol flows down the oesophagus to the stomach where 10-20% of ethanol will be absorbed into the bloodstream. Alcohol enters the bloodstream via the mucosal tissue of the stomach wall, and travels straight to the liver. Alcohol can take 5-10 minutes to reach the brain because of the ethanol absorbed via the stomach. If you drink alcohol on an empty stomach, the pyloric sphincter [gateway between the stomach and the small intestine] is going to be more open, and the alcohol is going to immediately enter the small intestine after reaching the stomach. If food is also present in the stomach, the sphincter will open and close at a rate that allows food to enter the small intestine gradually, therefore if alcohol is also in the stomach, it will gradually enter the small intestine.

3. Alcohol flows through the pyloric sphincter into the small intestines where most alcohol absorption occurs. Human intestines are attached the to the posterior abdominal wall by a fold of membrane called the mesentery. Alcohol is absorbed into the mesentery via veins and then travels to the liver.

4. One function of the liver is that it detoxifies toxic elements into non-toxic elements before passing it to the heart and then the rest of the body. The liver sustains considerable “abuse” from a variety of toxic elements and chemicals, and therefore it needs to be capable of full regeneration. NOTE: Many diseases and exposures can harm it beyond the point of repair. These include cancer, hepatitis, certain medication overdoses, and fatty liver disease.

In the liver, ethanol is met with an enzyme called alcohol dehydrogenase and converts ethanol into acetaldehyde [ass-eh-tal-de-hide]. This chemical is more toxic than ethanol, so the liver uses another enzyme to convert acetaldehyde into acetate, which is non-toxic to the human body. NOTE: the amount of alcohol consumed + the timeframe it is consumed [and a variety of other factors] will influence the ability of the liver to effectively convert acetaldehyde all the way into acetate. The liver can’t handle the entire workload effectively therefore ethanol (before being metabolised) will go straight from the liver to the bloodstream and make its way directly to the heart.

NOTE: Genetics will play a role! Certain people do not produce the liver enzymes in enough quantity to properly breakdown ethanol.

5. Blood leaves the liver through the hepatic veins. The hepatic veins carry blood to the inferior vena cava—the largest vein in the body—to the right side of the heart. The heart will beat and send the incoming blood to the lungs to oxygenate and expel carbon dioxide as we breath out. This is how ethanol can be on your breath. Inside the lungs, at the very end of the bronchioles, are hollow air sacs called alveoli where there is a gas exchange. Ethanol evaporates through capillaries into the air sacs and exhaled out of the body. Breathalysers can detect the quantity of ethanol in a person’s system based on the quantity of ethanol in our breath.

6. Not all the ethanol will expel from the body via the breath. The rest will flow back to the heart, with newly oxygenated blood, and then get pumped all the way up to the brain and around the body. NOTE: Ethanol is water soluble. It will be distributed to every cell in the body except bone and fatty tissue [some will enter fat cells but not easily]. Ethanol will interact with every other cell i.e., every organ, gland, nerve, muscle etc.

7. Ethanol will affect and compromise protein synthesis inside muscle tissue. Therefore, if you have been training at the gym, running, swimming etc., your muscles will not effectively be able to repair.

8. Once ethanol has reached the brain, it will cross the blood-brain barrier and begin to affect chemical messengers [neurotransmitters] in the grey matter of the brain. It affects serotonin, dopamine, gamma-amino-butyric-acid (aka GABA), glutamate, endorphins etc. The person will experience pleasure, euphoria, lowered inhibitions [related to dopamine], lowered cognitive ability (e.g., decision making/problem solving, emotion regulation) and lowered coordination and reflexes.

The more ethanol ingested, the more dopamine is secreted and communicated between neurons (i.e., nerve cells). One of dopamine’s functions is to make you feel pleasure or ‘rewarded’ for doing things that are good for humans, hence, from an evolutionary perspective, we are likely to do them again to help us thrive in our environment and social world. Dopamine is secreted when we:

• eat healthy foods (but also recently developed processed foods that are high in sugar and salt)
• exercise
• achieve goals
• be productive (e.g., finish a task like cleaning, cooking, work-related tasks)
• master new skills (e.g., learning an instrument or a new talent), and
• have positive and stimulating social interactions

Ethanol influences so much dopamine secretion and communication that the brain becomes unable to make responsible decisions cognitively. The simultaneous experience of euphoria and lowered cognitive ability means we are more likely to be “happy” about making irresponsible decisions.

Increased dopamine is how drinking alcohol “blocks” unpleasant emotions like fear, stress, anxiety, and insecurity. When we don’t feel these unpleasant, yet necessary, emotions we will behave in ways that are dangerous, abnormal, potentially embarrassing, and generally problematic.

Another significant brain region affected by ethanol is the hypothalamus and the pituitary glad [together known as the hypothalamic-pituitary axis]. These structures control the entire hormonal system. The hypothalamus monitors the body, and it will send instructions to the pituitary gland based on information it receives from the hypothalamus. The hypothalamus is aware that ethanol is flooding the brain and it starts adjusting the secretion of hormones via the pituitary gland.

One of the instructions it gives the pituitary gland is to start modulating the adrenal glands to secrete cortisol (i.e., stress hormone) and epinephrine and norepinephrine (i.e., adrenaline).

Now, our cognitive capacity is diminished, inhibitions are lowered, and we will experience a rush of stress hormones and adrenaline coursing through the body. Cortisol and adrenaline will provide a boost of energy. It will increase the heart rate, blood pressure, body sweat, sugar levels in the bloodstream, and enhances the brain’s ability to use glucose. Glucose is a “fuel” source for brain functioning, including the generation of neurotransmitters. Behaviourally, we can see this in children when we say they are “hyperactive” because they’ve ingested too much sugar.

The pituitary gland will also slow the secretion of anti-diuretic hormone (aka. vasopressin). A diuretic is something that makes us urinate. If the anti-diuretic hormone (also called vasopressin) slows down, then we won’t be “holding on” to water as effectively, hence we begin to urinate more. People call this “breaking the seal”.

9. South of the body, blood is pumped into the kidneys via the renal artery which spreads through the renal cortex. The blood is then filtered into urine and expelled from the body. The lowered anti-diuretic hormone will dilate (become wider/bigger or more open) blood vessels in the kidneys which means more blood gets passed through and filtered, but it also means we lose a lot more body water which leads to dehydration. Vasopressin is essential in the control of osmotic balance, blood pressure regulations, and kidney function, therefore, when vasopressin is lowered, we are losing essential water and minerals/electrolytes. Electrolytes are involved in urination because the kidneys need them to make the process of filtering blood more efficient.

The loss of water and electrolytes will contribute to a hangover. Electrolytes play a role in cellular water absorption so if we are losing more water than we are bringing in, and we are losing the electrolytes that support the absorption of water, we become dehydrated very quickly.

10. The Hangover

Symptoms: nausea, fatigue, diarrhoea, vomiting, paranoia, anxiety, anorexia (i.e., loss of appetite), increased thirst, muscle weakness, irritability, sweating, increased blood pressure, and headache.

The exact cause of a “hangover” is not yet known however variables affecting the hangover are:

• individual differences such as sex, size, body fat, genetics etc
• lack of sleep
• general health
• drinking behaviour e.g., frequency, duration, quantity
• food intake before and during
• water intake before and after
• your body’s ability to metabolise alcohol i.e., excessive amounts of acetaldehyde due to fewer enzymes to metabolise alcohol in the liver before entering the bloodstream
• general behaviour while drinking e.g., poly-substance use, dancing, sexual activity, risk-taking behaviours etc.

Strategies for Controlled Drinking

• Setting personal drinking limits and sticking to it
• Alternating alcoholic drinks with soft drinks i.e., one alcoholic drink then a water, soft drink, or juice
• Have a meal before drinking
• Switching to low alcohol drinks
• Having regular alcohol-free days/weeks/months
• Identifying high risk situations for heavy drinking and creating a management plan

Engaging in alternative activities to drinking

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.

The phrase “Say what you mean, but don’t say it mean” is all about the balance between honesty and kindness in communication.

Here’s what it means:

• “Say what you mean”:
  Be clear and truthful. Express your real thoughts and feelings. Don’t beat around the bush or pretend to agree when you don’t.
• “But don’t say it mean”:
  Speak with kindness and respect. Even when you’re being honest or giving criticism, there’s no need to be rude, hurtful, or aggressive.

Why it matters:

This phrase promotes healthy communication. It’s a reminder that:

• You can be honest without being harsh.
• Tone and delivery matter just as much as the words.
• Empathy and respect should guide your conversations—even when it’s hard.