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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