Overview of Behavioral Addictions

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, NCC

Define behavioral addictions Examine some of the most common

behavioral addictions Explore similarities and differences between

behavioral and chemical addictions Discuss similarities and differences in

treatment between chemical and behavioral addictions

Objectives

A substance, person or activity Outside of ones self Used to escape from emotional or physical

pain Continued despite negative consequences

What is an Addiction

Addiction serves a survival purpose. Addiction represents the best way a person had to

cope until now The addiction can become the person’s best friend Everyone’s ability to deal with life on life’s terms

differs Patients can address the ways issues from the

past are impacting them today

Paradigm Shift

Lack of early bonding (Trust/Mistrust) Lack of confidence (Industry/Inferiority) Lack of self-esteem (Identity or Intimacy) Recreational or Prescribed Use Mental Health Issues

How does it start

Recreational Use Occasional Use for Relief Increasing craving Increased triggers (stimulus generalization) Unable to discuss the problem Efforts to control fail (increased time and energy) Continued use despite negative consequences

◦ Stop using see the original problems plus the addiction-created problems◦ Use again

Jellenik Curve

Makes the decision to change Seeks to understand and address the reasons for

◦ The original distress◦ Distress created from the addiction

Addresses physical issues maintaining the distress Develops healthy coping skills Improves self esteem Rebuilds healthy support network

Jellenik Curve

Tolerance (marked increase in amount; marked decrease in effect)

Characteristic withdrawal symptoms; substance taken to relieve withdrawal

 Substance taken in larger amount and for longer period than intended (loss of control)

DSM Criteria

Persistent desire or repeated unsuccessful attempt to quit

Much time/activity to obtain, use, recover Important social, occupational, or

recreational activities given up or reduced Use continues despite knowledge of

adverse consequences

DSM Criteria

Use continues despite adverse consequences◦Emotional Problems

Depression Anxiety Guilt Anger/Resentment

DSM Criteria

Use continues despite adverse consequences◦Cognitive Problems

Memory problems (loss, blackouts) Confusion Paranoia

DSM Criteria

Use continues despite adverse consequences◦Physical Problems

Hepatitis, HIV and STDs Inadequate sleep or nutrition Reduced immune system Injuries

DSM Criteria

Use continues despite adverse consequences◦Relationship Issues

Lying Manipulation Secrecy Change of Friends Difficulty getting along with others

DSM Criteria

Use continues despite adverse consequences◦Occupational Issues

Poor work attendance Poor quality or productivity Job loss

DSM Criteria

Use continues despite adverse consequences◦Spiritual Issues Hope Faith Integrity Discipline Courage Compassion

DSM Criteria

If you have any questions or comments thus far, and have not already asked them, please do so during the break.

BREAK10 minutes

Inability to consistently Abstain Impairment in Behavioral control Craving; increased “hunger” for drugs or

rewarding experiences; Diminished recognition of significant

problems with one’s behaviors and interpersonal relationships

A dysfunctional Emotional responsehttp://www.asam.org/for-the-public/definition-of-addiction

Addiction Characteristics

Chemical AddictionsChemical Addictions Behavioral Addictions Substances directly

impact the brain and/or nervous system

Activities that impact the pleasure centers◦ Adrenaline rush◦ Dopamine rush◦ Endorphin rush◦ Oxytocin

Cause chemical reactions in the brain Are a tool to escape or avoid pain Produce a tolerance Have psychological withdrawal symptoms Can have devastating biopsychosocial

consequences

Similarities Between Behavioral And Chemical Addictions

Abstinence is not possible or ideal for some behavioral addictions (i.e. sex, food, shopping, exercise)

Many treatment centers ignore the substitution of a behavioral addiction for a chemical addiction

Differences Between Behavioral And Chemical Addictions

Think about behaviors that your patients engage in when they are deprived of their addiction of choice. What behavioral substitutions appear?

Apply It

Food Sex/Pornography Gambling Shopping

Exercise Internet Relationships Chaos/Drama

Behavioral Addictions

Generally, the more primitive the primary addiction or the more fundamental need it meets, the earlier it started.

Once an addiction starts, psychosocial development slows or stops, especially as it relates to coping and relationships

When faced with two choices, the tendency is to choose the more rewarding option

To increase motivation for change the less rewarding choice must become more rewarding

The alternate behaviors need to be equally rewarding as the “addiction.”

Basic Behavioral Principles

When assessing a person for mental health issues, always ask about how they cope and apply a modified CAGE questionnaire◦ Have you ever felt you needed to Cut down?◦ Have people Annoyed you by criticizing your behavior?◦ Have you ever felt Guilty about your behavior?◦ Have you Eliminated or reduced important roles, tasks

or relationships because of your behavior

Assessment

When assessing someone with other addictions OR a family history of addiction look for behavioral addictions

For many people, behavioral addictions are a relapse warning sign for other mental health or addictive issues

Assessment cont…

If you have any questions or comments thus far, and have not already asked them, please do so during the break.

BREAK10 minutes

Function Manifestation

◦ Tolerance◦ Withdrawal◦ Unsuccessful effort to cut down◦ Excessive time/energy to obtain, use, recovery◦ Other activities reduced or eliminated◦ Continued despite negative consequences

Emotional | Mental | Physical | Social | Occupational

Apply It: Gambling

Function Manifestation

◦ Tolerance◦ Withdrawal◦ Unsuccessful effort to cut down◦ Excessive time/energy to obtain, use, recovery◦ Other activities reduced or eliminated◦ Continued despite negative consequences

Emotional | Mental | Physical | Social | Occupational

Apply It: Food

Function Manifestation

◦ Tolerance◦ Withdrawal◦ Unsuccessful effort to cut down◦ Excessive time/energy to obtain, use, recovery◦ Other activities reduced or eliminated◦ Continued despite negative consequences

Emotional | Mental | Physical | Social | Occupational

Apply It: Pornography

Function Manifestation

◦ Tolerance◦ Withdrawal◦ Unsuccessful effort to cut down◦ Excessive time/energy to obtain, use, recovery◦ Other activities reduced or eliminated◦ Continued despite negative consequences

Emotional | Mental | Physical | Social | Occupational

Apply It: Shopping

Function Manifestation

◦ Tolerance◦ Withdrawal◦ Unsuccessful effort to cut down◦ Excessive time/energy to obtain, use, recovery◦ Other activities reduced or eliminated◦ Continued despite negative consequences

Emotional | Mental | Physical | Social | Occupational

Apply It: Exercise

Function Manifestation

◦ Tolerance◦ Withdrawal◦ Unsuccessful effort to cut down◦ Excessive time/energy to obtain, use, recovery◦ Other activities reduced or eliminated◦ Continued despite negative consequences

Emotional | Mental | Physical | Social | Occupational

Apply It: Internet

Function Manifestation

◦ Tolerance◦ Withdrawal◦ Unsuccessful effort to cut down◦ Excessive time/energy to obtain, use, recovery◦ Other activities reduced or eliminated◦ Continued despite negative consequences

Emotional | Mental | Physical | Social | Occupational

Apply It: Chaos

Is abstinence possible Decisional Balance

◦ Pros of it Alternate way to meet those needs

◦ Cons of it◦ Pros of stopping◦ Cons of stopping

Alternate way to meet those needs

Treatment

Possible triggers◦ Environmental

Media, surroundings Sight, sound and smell

◦ Temporal Times of day Holidays

◦ Emotional◦ Social

Treatment

Interventions◦ Support groups◦ Coping skills training

Use strengths Index card or phone

◦ Identify stressors and triggers and alternate ways to cope

◦ Identify any underlying neurochemical imbalances◦ Rule out physical causes of distress

Treatment

Chemical and behavioral addictions◦ Often occur together◦ Often co-occur with other mental health “stuff”◦ Represent the best the person could do with the

tools they had…until now Abstinence is not always a possibility with

behavioral addictions The causes of the distress must be

addressed

Summary

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