You are here because you are one of the millions in the United States concerned about addiction. Maybe you want to understand for yourself because of your own struggles or for someone in your life. Addiction has many faces but the process of being addicted is an age old human story.
Faces of Addiction
Because of the hijacking of the reward pathway, us humans can become addicted to many different things. Addiction can take the form of Chemical or Behavioral. Chemical addiction is often referred to as substance abuse which is a drug or alcohol that directly affects the brain. Whereas a behavioral addiction is more indirect and affects the reward pathway.
Chemical:
- Alcohol
- Stimulants (methamphetamine, cocaine and prescription stimulants)
- Nicotine (tobacco, vapes)
- Opiates (including pain medications)
- Hypnotics (sedatives, benzodiazepines, barbiturates)
- Cannabis
- Hallucinogens (PCP, LSD)
- Inhalants (pain thinners, spray paints, gases)
Behavioral:
- Gambling
- Food
- Internet
- Smartphones
- Social Media
- Porn
- Sex
- Spending Money
- Video Gaming
Important to note that in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which those of us in mental health use for diagnosing only includes gambling and internet gaming as behavioral addictions. 17 years ago I began my psychotherapy career working in substance addictions. Over the years, I began working with people who showed the signs of substance addiction but it wasn’t drugs that they were using but behavioral addictions. It isn’t diagnosable but behavioral addictions are a focus of treatment.
Defining Addiction
Addiction is the continued use of a substance or behavior despite harm to self or others.
Emma came to see me for alcohol addiction. She grew up in a rough home and then after college became a software engineer. She had relationships but nothing long lasting and didn’t have children. She drank on occasion. Later she tried to help her brother who struggled with living on his own. She began drinking more. He moved in with her and she spent lots of money on him. She drank every weekend often with her brother. He spent money she gave him and didn’t try to get on his feet. Then she got sick. By this time she was drinking nightly. She took time off of work and then her drinking got “out of control.” She finally lost her job, her house and finally ended up living with friends.
Rob came to see me after his wife said “get help to quit or leave.” She caught him spending money on internet porn sites and sex chatting sites. He was a successful accountant with a wife and two children. During the first pregnancy he worked many hours and his wife had lots of health struggles. He would distract himself from the worrying with porn on his phone. With their second pregnancy, she was also sick and had a baby to care for. He was working insane hours and felt guilty for not helping so he distracted himself more and more. During the second pregnancy his wife went to stay with her family 1300 miles away so that her mother could help. He was home alone, working lots of hours, alternating between worrying about the pregnancy and feeling guilty he wasn’t there for her. At this time, every moment he had he was on his phone and spending money on sex chat sites and trying to hide what he was spending.
Both of these clients were using something alcohol or porn and that use became excessive and continual. For both people, they used in spite of the problems it created. Emma’s drinking wasn’t the cause of her health problems, but sure made it worse. Instead of stopping after she lost her job she continued until she lost everything. Rob moved money and did all sorts of things to hide the money spent, argued with his wife once she was home so that she would leave him alone and he said he was working. Their marriage was on the rocks and he stood to lose his wife and both of their children. He could’ve easily lost his job as his work computer was monitored and he did sometimes view porn on his work computer.
The Stigma of Addiction
- Many people see addiction as a “moral failing” as opposed to a treatable condition
- Terms such as junkies and addict bring up visions of poor dirty people who break the law
- Criminalization of drugs has led to discrimination. Blacks in 2018 were 4X more likely to be arrested for cannabis possession than whites and both groups use at similar rates
- 10.4% of people who believe they need treatment don’t seek treatment
- 8% don’t get treatment out of work related fear
- A 2019 survey of primary healthcare providers found that many hold stigmatizing views against opioid use disorders
- Systemic discrimination exists in the access of treatment based on socioeconomic and race status. (Stats according to National Institute on Drug Abuse NIDA)
Treatment for substance abuse at one time was to shame the person for using which came out of the moral failing model. Contemporary treatment attempts to treat addiction like a medical condition. The medical condition approach is attempting to reverse the stigma so that people will actually engage in treatment. The more as individuals and society view addiction in a negative light the fewer people who seek treatment and that can lead to deaths from overdoses, suicides and a host of addiction related fatalities.
The “How” of Addiction
There is a component of choice in addiction. We aren’t walking around the grocery store when someone sneezes on us and we catch “addiction”. Imagine Joe and Bob who stop in the local pub for a drink after securing the big client. At 9:30 pm, Joe tells Bob, “Oh it’s getting late. Time to call it a night.” And Bob says, “I think I will stay.” If Bob repeats this often enough he is in some real trouble.
It isn’t as easy then to make the choice to stop. Why is it that then Bob realizing that he is about to lose his job just doesn’t stop? One clue, it isn’t about willpower.
To understand, it’s time to get in a time machine and visit our human ancestors to learn how the reward pathway gets hijacked (please watch the video below).
How to Stop Addiction
Now you see that the reward pathway becomes hijacked directly from chemical stimulation and indirectly from behavioral stimulation. In other words, substances introduce chemicals to the brain and behaviors excite pain and pleasure. Thanks to learning that the chemical or behavior leads to pleasure and the brain compensates with a lowered baseline for dopamine, we are now left chasing the high. This is when a person will use in spite of the consequences as well as thinks compulsively about the source of addiction – getting, using, avoiding consequences, etc.
Rob learned that consuming porn led him to feeling better. Over time that resulted in a new low baseline and more or novel to get the same “high”. Rob added sex chatting and started paying for it.
Path to Hell
This is what I use to describe a downward spiral that perpetuates use. Lowered baseline isn’t just for pleasure but also the threshold that we believe we can tolerate pain. So when stressed, use. When sad, use. When nervous, use. When confronted, use. It becomes THE coping tool. And the threshold to use that coping tool gets lower and lower.
Rob wanted to quit. He would commit every day that he wouldn’t look at porn. Then over breakfast he would be faced with tension from his wife as their marriage was strained because of the porn or be faced with a rather unreasonable deadline at work and he would get down. Lowered baseline means he isn’t feeling that great to start. Now he is upset, has one dominant coping tool which is a big no-no and begins to have cravings. Craving is his brain’s way on saying “You know what to do to feel better.” Then he uses. He feels better but just as quickly is thinking “I’m such a loser! I said I wouldn’t and here I am. What is it going to take to learn?” He feels even worse. Views porn. More shame. Feels bad. New commitment, more stress, heaping more and worse insults on himself, more intense cravings, more use.
Stopping is Possible
What is learned can be unlearned. Every day thousands of people break the chains of addiction so to speak.
- 1 in 10 people in the United States report recovering from a substance use problem
- 11.1% of adults in the US or 27.5 million people report a substance abuse problem in their life and 74.8% report recovery (Recovery Research Institute)
- 3 of 4 people who experience addiction eventually recover (NIDA)
Treatment
When trying to access mental health services, it is confusing and often requires patience. The confusion comes from the different titles of psychotherapists and licensure as well as where the services take place. Here is a cheat sheet.
Licensures: There are basically three levels of licensure in mental health.
- Licensed substance abuse counselors usually have an associates degree and work with substance abuse issues and cannot address any mental health issues.
- The bulk of therapists have a master’s degree and practice in many settings and can work with both substance abuse and mental health. These can be counselors, family/couples counselors, and master’s level social workers. Within this category there are two levels of licenses – apprentice and independent. We all start out as basically apprentices and then after time, supervision and testing we become (if we chose to) independent practitioners.
- Psychologists have a doctorate degree and may do therapy. Many chose to do research or psychological testing.
- Psychiatry are practitioners whose roles tend to be medications only and include psychiatrists and often psychiatric nurse practitioners
Settings or where therapy takes place: Even before covid lockdown and especially since many therapists work remotely and see clients, as I do, online. These therapists can work for themselves in a private practice as I do and others may work in larger corporate or nonprofit agencies. These are all referred to as outpatient centers.
Inpatient is rehab centers where someone goes for 30 days minimum to as long as a 1 year for primarily substance abuse treatment. These can be state run, privately held and nonprofit including centers ran by religious organizations. Some of the inpatient programs have step down programs that start with inpatient, then step down to a sober living environment or intensive outpatient programs. Psychiatric inpatient are hospitals that often are short term stays for mental health issues and some provide detox from substances.
Support Groups: these are free programs open to the public to support people in recovery.
The most famous of these is Alcoholics Anonymous which has a 12 step program for alcohol. Now there are support groups for many chemical and behavioral addictions from Overeaters Anonymous to Sex Addiction Anonymous. Spiritual 12 step programs exist for Christian, Jewish, Islam and Buddhist believers. SMART Recovery is based on a CBT model called Rational Emotive Behavioral Therapy and is very effective for chemical and behavioral addictions. These groups meet in person in many communities and have online meetings as well.
Addiction Treatment Programs Work
The research is clear – recovery is possible. Eventually 75% of people reporting substance addiction do recover long term. (There isn’t much in the way of data for behavioral addiction recovery beyond gambling and food addition since at this time diagnosing criteria). Most programs utilize a form of cognitive behavioral therapy which works to change beliefs, reinforce behavioral changes and increase goal oriented thinking/behavior.
The research is also clear – relapse is high. Relapses are returning to use after a period of recovery. Sometimes these can be short lapses to longer relapses when someone returns to using. Some people quit completely on their own, some with one course of treatment and others enter treatment inpatient and outpatient several times prior to sustained recovery.
When I quit smoking cigarettes in the late 1990’s I had a quit date in February and it wasn’t until October when I was able to sustain cessation. I know of people who smoked their last cigarette and that was that. Others like myself tried to quit multiple times before finally succeeding (I finally had a good enough reason/goal to quit). Some stop and then restart for some reason.
Medication support – currently there are medications that can help with stopping alcohol, opioids and nicotine and other medications can support people with antidepressants, etc. Some of these medications help with safely detoxing from a substance and if detox isn’t followed by treatment, resuming drug use is quite high after detox.
There is not a one size fits all approach. Some programs may boast that their program works the best. However the best program is the one that works for the individual. Some people quit an addiction on their own, use a combination of outpatient therapy (in person or self guided) and support group and others start with inpatient and work through the intensity levels from inpatient to outpatient with support groups.
Self-Guided Addiction Courses Offered:
Who Are Substance Courses For?
First of all, everyone CAN benefit from a therapy without the therapist course whether a short Mini Workshop of the longer Therapy Course. You are led through the material with guidebooks and audios and videos and these courses are based on a proven therapy model of a form of cognitive behavioral therapy (CBT). CBT courses for clients have data showing their effectiveness. National Alliance on Mental Illness (NAMI) has studied self-guided CBT courses.
Some considerations for success with self-guided courses:
- Dedicate time – to get the most out of the course, be willing to practice the activities throughout the week and move through the full length therapy courses methodically mastering a lesson prior to moving to the next.
- Be consistent – the more consistent you are with the lessons the more that change will occur and continue beyond the coursework
- Not a once and done – this is the most common mistake with any self-improvement program including face-to-face therapy that clients and some therapists make and that is lack of follow through. New habits take time.
- Follow the program – the lessons are guided and built to be sequential. If someone skips around and picks and chooses what to do, it will be confusing. This is one problem I’ve seen in courses and therapy.
Is this a good fit for you? Some considerations include:
- Schedule doesn’t allow for regular face to face therapy
- Don’t want a diagnosis that comes with therapy using insurance
- Self-directed and willing to dedicate time
- Want help but not the stigma with face-to-face therapy
- Deductible is high and the cost of weekly appointments aren’t doable
- Wish to save money
- Maybe tried an online counseling membership with poor results (Many of these services are quite low payers to therapists and turn over is high. Also some services have broken confidentiality of their clients breaking trust.
Hypnosis
I have used hypnosis for years with addiction, trauma, anxiety, depression, pain, weight loss and overthinking problems. I use it because it works. To learn more about how hypnosis works and why I use hypnosis, read Hypnosis as Treatment. How does it work? and Why Use Hypnosis in Self-Help? It Works!. All my self guided courses whether the Mini Workshops or Therapy without Therapist always include a section on hypnosis with a variety of self hypnosis tracks. These are based on hypnosis scripts and techniques that I have created over the last nearly two decades working with clients.