More than 20 million American adults struggled with addiction involving drugs and/or alcohol in 2016, the National Survey on Drug Use and Health (NSDUH) publishes, over 15 million of whom battled an alcohol use disorder. Addiction is defined as a compulsive and chronic brain disease that interferes with a person's daily life obligations, interpersonal relationships, and other area.
The American Society of Addiction Medicine (ASAM) reports that addiction actually changes the way the brain works and disrupts its normal functioning. Pathways to reward and parts of the brain responsible for emotional regulation, impulse control, motivation, movement, learning, and memory can all be impacted. Someone who struggles with alcohol addiction is unable to stop drinking, even if they want to, and will often drink longer and more often than they intend. Addiction is signified by a person's lack of ability to control their behaviors and cravings to repeat these actions, which can be self-destructive.
Not all addictions involve substances like drugs or alcohol. The most current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a category for "behavioral addictions," Psychology Today publishes. Behaviors other than drinking and drug use may produce the same type of euphoric "high" that causes pleasure and therefore is repeated. Things like gambling, internet use, shopping, tanning, skin picking, playing video games, and sexual behaviors are examples of possible behavioral addictions.
Individuals may continue to engage in these behaviors despite the fact that doing so has negative consequences in their lives. A person may develop cravings to perpetuate these behaviors, and the behaviors themselves can interfere with a person's daily life activities and obligations. Individuals may even suffer from withdrawal symptoms if the behavior is not repeated, Psychology Today reports, and experience irritability, sleep disturbances, agitation, and mood swings if they don't give in to the craving.
Behavioral addictions and alcohol/drug addictions have many similarities in that they both disrupt a person's daily life and can have serious consequences without treatment. The main difference between the two is that a behavioral addiction may not have the physical symptoms or side effects that drug and alcohol addiction can have, such as the significant and potentially life-threatening physical withdrawal symptoms. Addiction, involving either alcohol, drugs, or behaviors, is all about a loss of control over one's actions, and specialized treatment programs can address these issues.
Co-Occurring Behavioral Issues and Addiction
Often called process addictions, behavioral addictions are becoming more recognizable and mainstream. ABC News reports that the definition of addiction includes any action that is mind-altering and leads to compulsive behaviors that impact everyday life. This can include not just alcohol or drugs then, but any behavior that creates a feeling of pleasure that a person repeats and cannot stop doing. This action leads to changes in the brain's wiring.
For example, when someone drinks alcohol, some of the brain's natural chemical messengers, like dopamine, may be elevated. Dopamine signals the body to feel pleasure. Chronic exposure to alcohol can then interfere with the brain's ability to continue to manufacture, transport, and absorb dopamine in the way it used to before. Instead, it will rely on alcohol to stimulate dopamine production. When a person doesn't drink then, or alcohol processes out of the body, dopamine levels drop. When this happens, moods can also dip, and withdrawal symptoms like irritability, agitation, anxiety, depression, sleep functions, memory and cognitive abilities, and cravings can set in. These negative side effects can cause a person to want to keep drinking to stop these bad feelings.
The same can be true for a behavioral addiction. These actions may illicit similar changes in the brain in relation to the reward processing center, its chemical makeup, and regions of the brain that help to control impulses and emotions. Someone who struggles with a gambling addiction, for instance, may get intense pleasure from gambling, and suffer from cravings and emotional withdrawal symptoms when they stop gambling. Behavioral addictions can create a range of issues, just as drug and alcohol addiction can, including:
- Financial strain
- Legal and possible criminal problems
- Relationship struggles
- Difficulties at school and/or work regarding production and output
- Mental health concerns
- Physical health issues
Addiction involves emotional dysregulation and impulse control issues. A behavioral addiction and alcohol abuse can then easily go hand in hand. A person who struggles with difficulties controlling their impulses to one behavior may be more inclined to then have issues overindulging in alcohol or other substances. The American Journal of Drug and Alcohol Abuse publishes that people who struggle with a behavioral addiction also report a lifetime history of a substance use disorder somewhere between 21% and 64% of the time. This is called co-occurring disorders – when two issues are present at the same time in the same person. The high rate of co-occurrence could be due to genetic or biological reasons, such as a family history of addiction that can then increase the odds that a person will also suffer from such disorders.
Overlapping brain regions or neurobiological functions may be involved in the onset of these co-occurring disorders. Someone who has a hard time controlling their impulses (possibly related to brain function or chemistry) may engage in multiple behaviors that can be risky or self-destructive, for instance. High levels of stress and environmental aspects can play a role as well.
Alcohol can become a method of self-medicating emotional difficulties, as it can serve to provide a temporary release and escape. Alcohol can become a coping mechanism that can then turn into more of an issue, as dependence can form with chronic abuse. It may be unclear which one came first, the behavioral addiction or the alcohol abuse; however, they can both contribute to each other, and complicate and exacerbate each other as well.
Treatment Options for Co-Occurring Issues
Co-occurring issues are often intertwined in such a way that integrated treatment is considered to be the optimal form of care. An integrated treatment program will help to manage the symptoms of both disorders at the same time. Treatment providers will all work together with similar goals in mind.
The International Journal of Preventative Medicine publishes that the similarities between behavioral addictions and drug addiction mean that treatment modalities that work for one may then be beneficial for the other. Medications, behavioral therapies, relapse prevention and educational programs, and support groups are all usually included in a comprehensive treatment plan. Unlike drug or alcohol addiction, there are not generally as many physical side effects that may require medical attention for a behavioral addiction.
When someone suffers from both alcohol addiction and a behavioral addiction, however, withdrawal symptoms may be significant, and medical detox is often the first stage of a complete treatment program. A medical detox program provides a safe and secure environment where alcohol can process out of the body, often with the help of medications, under the constant supervision of trained professionals. Both mental health and medical needs can then be attended to as needed.
After detox, a person will enter into either an outpatient or inpatient addiction treatment program that specializes in co-occurring disorders. Cognitive Behavioral Therapy, or CBT, sessions are typically included in any treatment program for co-occurring disorders. CBT helps individuals to recognize negative and self-destructive thoughts that then contribute to maladaptive behaviors, such as substance abuse, gambling, etc. The reasons a person engages in these behaviors are explored. Self-reflection can help to improve self-esteem, which can in turn aid in curbing negative behaviors. Methods for coping with stress and tools for managing triggers to relapse are also worked on during CBT group and individual sessions. Medications can help to regulate emotions and create chemical balance in the brain that is needed to heal during treatment.
Support is an important aspect of treatment of co-occurring issues. Peer-based, self-help groups can provide a healthy outlet for individuals to show them encouragement and empathy in a safe and welcoming environment. It can be extremely helpful to talk to other people who understand, and who can provide support and hope for recovery. Family and individual counseling is also beneficial during treatment for co-occurring disorders, as it can help the whole family unit to be on the same page and learn to communicate better.
Treatment for co-occurring disorders is highly individual. Usually, a detailed assessment and drug screening are performed prior to admission into a program in order to design a personalized plan for recovery. Addiction in any form is a treatable disease, and with the right treatment plan, a person can learn how to live a full and meaningful life in recovery.