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Whac-A-Mole: Understanding Addiction Interaction

MolePosted by: Jaime Goffin

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
  • Replacement
  • Alternating addiction cycles
  • Masking
  • Numbing

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.

date:  Nov 11, 2014
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Red Flag Rule Compliance

Red Flags Rule Compliance in Mental Health Practices

 Posted by Ben Hicks, MLS, CMAA

With the enforcement of the Red Flags Rule almost 4 years ago, I am surprised how many people don’t know what I am talking about when I broach the subject. I think with fines of at least $2500.00 people should be more aware of this government regulation, if for no other reason than to know how it may affect their practice.

For those of you new to practice, or for those who missed this regulation because you were busy practicing, let me bring you up to date.  The Federal Trade Commission instituted these rules at the end of 2010, to help creditors and lenders stop identity theft. A red flag refers to “potential patterns, practices or specific activities indicating the possibility of identity theft.”

So what does that have to do with your practice? Well, depending on how you do business, you may fall under this rule because clinicians are considered “creditors” if they:

  1. Provide services and then bill patients later; or
  2. Regularly allow their patients to defer payment for services, including by setting up payment plans, on a “regular” basis.

If the Red Flags Rule apply to you, you are required to develop and implement a written “identity theft prevention program” intended to identify, detect and respond to red flags that could denote that identity theft is happening in your practice.

Below are two helpful links. The first you can use to help put together an identity theft prevention program. It is an article which includes an identity theft prevention program template created by the American Psychological Association. The second link serves as an example of a statement of non-applicability of Red Flags Rule.

Guidance for Psychologists on “Red Flag Rules” Compliance

Statement Regarding Non-Applicability of Red Flags Rule,_Tools_&_Forms_files/Red%20Flag%20Rule.pdf

The basics of a good identity theft prevention program include:

  • A policy directing how your practice will verify patient identity at the time of intake (e.g. a government issued ID)
  • A policy stating that when collecting intake information, the staff should also be alert for conflicting information (e.g. discrepancies in an address, age or signature)
  • How you will respond if a Red Flag is detected (e.g. contacting the patient or notifying law enforcement)
  • Require that you review the program annually to ensure its effectiveness.

Best Notes offers a number of great tools to help you with your identity theft prevention program including a place to add patient pictures, intake information and a copy of a photo ID. Security measures let you know who has logged in and accessed patient information. These measures come built into the software and help in the prevention of identity theft.

Please bear in mind that while I feel the provided references and information can be of a benefit to your practice, you must not rely on the information on this website as an alternative to legal advice from your attorney or other professional legal services provider. If you have any specific questions about any legal matter you should consult your attorney or other professional legal services provider. You should never delay seeking legal advice, disregard legal advice, or commence or discontinue any legal action because of information on this website.


date:  Oct 27, 2014
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Notes from the Field

What a challenging time to be a provider in behavioral health care as the need for accurate assessments has been at the forefront of patient care with the revisions of the DSM-5 and ASAM 3rd edition.  Practitioners need to be even more effective in assessing patients and matching comprehensive services to patient’s needs to achieve desirable outcomes. (more…)

date:  Oct 17, 2014
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