Many recovering substance users also have problems with process addictions that can complicate their long-term recovery from substance use. A 2010 Patient Survey which asked about compulsive behaviors such as: over-eating, excessive spending, sexual acting out, gambling, work and internet 30 days prior to admission to treatment found 45.4% of patients surveyed admitted to having struggled with one or more forms of a compulsive behavior prior to treatment. It is not uncommon for an individual to enter recovery with different addictions. Often, in treatment the focus will be to remain abstinent from the substance. When these individuals achieve recovery, their risk increases to go on to either maintain an existing compulsive behavior or engage in replacement behaviors. This addictive interactive behavior process works parallel to the chemical addiction as the brain is pleasure, reward-driven and seeks behaviors that can medicate, fuse or replace each other just like the chemical substances can.
The compulsiveness, or addictiveness, of the behavior comes from a person’s need to cope. In “Slave Master: How Pornography Drug & Changes Your Brain” author Hilton, explains how the overuse of the dopamine reward system that causes addiction when the pathways are used compulsively, decreases the amount of dopamine in the pleasure areas available for use. The reward cells become “starved” creating a craving for dopamine. In this addictive state, the person must act out in addiction to boost the dopamine to sufficient levels to feel “normal.”
So how does this relate to cross addictions? When a person engages in more than one addiction, those different addictions can interact, reinforce and intertwine with each other aside from just co-existing. For example, a very common co-addiction is tobacco and alcohol. Research shows that co-addiction pleasure pathways established co-exist. When a person removes one pleasure producing behavior the reward pathway is now not “complete” if the person continues to use tobacco. This actually increases the individual’s risk for cravings of alcohol as the pathway is constantly seeking the “other half” of the reward. Overtime, if the individual does not give up the tobacco use it can put the person at increased risk for relapse on alcohol. The brain is always trying to remain in a state of pleasure and balance. Sometimes as a way to reduce the cravings for dopamine, other addictions develop by way of the following:
- Cross Tolerance
- Withdrawal mediation
- Alternating addiction cycles
This whole process of addiction interaction reminds me of a childhood game Whac-A-Mole, whose simple objective was to hit, or whack, randomly appearing moles back into their holes using a padded rubber mallet. Sounds simple right? If anyone has played the game, you can sympathize with how fun, yet frustrating the process is. The game is now used to express a repetitious and seemingly futile task, as each time a mole appears and is successfully “whacked”, another one immediately appears elsewhere. As we work with addicts, it doesn’t really matter what the primary addiction is as our patients have such a high risk to maintain or develop another addiction. It really does seem in our work with addictions we are playing Whac-A-Mole and as we succeed in whacking one addiction; another pops back up such as gambling, sex, gaming, food or work.
So how do we win the game? We need integrated treatment approaches that actively focus on assessing and treating the spectrum of process addictions. This often becomes a barrier for treatment programs, as it requires specialized training in multiple addictions. Truly integrated treatment will specifically address the interactions between the substance use and process addictions simultaneously and have programming that matches.