ADDICTIVE BEHAVIORS Adapted with permission from the works of Ruth C. Engs*

Transcription

1 ADDICTIVE BEHAVIORS Adapted with permission from the works of Ruth C. Engs* THE ADDICTIVE PROCESS AND ADDICTIVE BEHAVIORS According to W.R. Miller in The Addictive Behaviors, an individual can become addicted, dependent, or compulsively obsessed with any activity, substance, object, or behavior that gives them pleasure. Several researchers imply that there is a similarity between physical addiction to various chemicals, such as alcohol and heroin, and psychological dependence involved in such activities as compulsive gambling, sex, work, running, or eating disorders. The reason for this is that these behavior activities may produce beta-endorphins in the brain, which makes the person feel "high." These and other reports suggest that if a person continues to engage in the activity to achieve this feeling of well-being and euphoria, they may get into an addictive cycle. In so doing, they become physically addicted to their own brain chemicals, leading to continuation of the behavior even though it may have negative consequences. Others feel that these are just bad habits. Most physical addictions to substances (i.e., alcohol, heroin, barbiturates) also have a psychological component. For example, someone who has not used alcohol for years may still crave a drink. Thus some researchers feel the need to look at both physical and psychological dependencies upon a variety of substances, activities, and behaviors as an addictive process and as addictive behaviors. They suggest all of these behaviors have a host of commonalities that make them more similar than different from each other, and they NOT be divided into separate diseases, categories, or problems. Common Characteristics of Addictive Behaviors There are many common characteristics among the various addictive behaviors: 1. The person becomes obsessed (constantly thinks of) the object, activity, or substance. 2. They will seek out, or engage in the behavior even though it is causing harm (physical problems, poor work or study performance, problems with friends, family, co-workers). 3. The person will compulsively engage in the activity (do the activity over and over) even if they do not want to and find it difficult to stop. 4. Upon cessation of the activity, withdrawal symptoms (irritability, craving, restlessness, depression) often occur. 5. The individual experiences a loss of control. The person does not appear to have control as to when, how long, or how much he or she will continue the behavior. (they drink 6 beers when they only wanted one, buy 8 pairs of shoes when they only needed a belt, ate the whole box of cookies, etc.) 6. The person often denies problems resulting from their engagement in the behavior, even though others can see the negative effects.

2 7. The person hides the behavior after family or close friends have mentioned concern. (i.e., hide food under beds, alcohol bottles in closets, doesn't show spouse credit card bills, etc.) 8. Many individuals with addictive behaviors report a blackout for the time they were engaging in the behavior. (i.e., don't remember how much or what they bought, how much they lost gambling, how many miles they ran on a sore foot, what they did when drinking, etc.) 9. Depression is also common in individuals with addictive behaviors. That is why it is important to make an appointment with a physician to find out what is going on. 10. Individuals with addictive behaviors often have low self-esteem, and will often feel anxious if they do not have control over their environment. There is not a consensus as to the cause, prevention, and treatment of addictive behaviors. A United States government publication, Theories on Drug Abuse: Selected Contemporary Perspectives, came up with no less than forty-three theories of chemical addiction and at least fifteen methods of treatment. As an example of this confusion, many people consider addictive behaviors such as gambling and alcoholism as "diseases," but others consider them to be behaviors learned in response to the complex interplay between heredity and environmental factors. Some researchers argue that, unlike most common diseases such as tuberculosis, which has a definite cause (a microbe) and a definite treatment model to which everyone agrees, there is no conclusive cause or definite treatment method to which everyone agrees for most of the addictive behaviors. This lack of agreement causes problems with prevention and treatment approaches for the addictive behaviors. Other professionals debate whether total abstinence or controlled use of a substance (such as alcohol) or activity (such as gambling) is desirable, or whether or not a substitute chemical (such as methadone for heroin) or activity is a desired treatment method. In the area of addiction to food or exercise, of course, very few individuals advocate total abstinence as a solution. Though the theories for the causes of addictive behaviors and their treatment are numerous, various methods are also available to help a person who has an addictive behavior. Regardless of the method, it involves making good choices. SMART Recovery can help in making those good choices. It is the view of SMART Recovery that to some extent, everyone is subject to addictive behaviors, as they can easily be compared to the common stage of romantic or infatuated love where an individual is constantly thinking of their beloved, and pines for and suffers when not in their presence. A person in such a state of mind is said to be obsessed with the object of their affection, and often subordinates other aspects of their life (i.e., health, work, other relationships, etc.) to their fulfillment of the almost unbearable need and longing to be with that person. Both life and literature has provided many examples of passionate and desperate lovers who have died for or as a result of their love of someone. Along with the more common addictive behaviors relating to alcohol and drug use, more and more individuals are coming to SMART Recovery seeking help with their addictions to other substances,

3 activities, objects, and behaviors. The SMART Recovery tools and 4-Point Program can be utilized, applied and helpful to those dealing with these addictive behaviors as well. EATING DISORDERS There are several types of eating disorders. Some individuals overeat to the point of obesity, others consume large amounts of food and then prevent its assimilation by vomiting or using laxatives, and still others starve themselves so as to be thin. All of these are considered to be addictive behaviors with no clear cause. Anorexia Nervosa In the addictive behavior called anorexia nervosa, a person begins to believe that they are too fat, even if they are of normal weight for their age and height. The individual feels that they must constantly diet and starve themselves to be thin and beautiful. Once the person starts dieting, they find it difficult to stop. They will often spend great emotional energy thinking of ways to avoid food and to cover up their lack of eating. They may wear bulky clothing, throw food away when no one is looking, and frequently exercise in the middle of the night to burn up calories. Due to lack of eating and extreme diets, anorexics are extensively malnourished and exhibit signs and symptoms of starvation. Symptoms of anorexia include cessation of menstruation, extreme thinness, edema (swelling in various parts of the body from electrolyte imbalance), thinning or falling hair, tooth decay, and dry skin from dehydration. Even with these symptoms they continue to compulsively lose weight to the point of emaciation and sometimes death. Along with losing weight, they are often obsessed with obtaining extremely low body fat composition. Even when they have lost weight to the point of emaciation, they view themselves as being fat. Anorexics have even been hospitalized and have died, stubbornly maintaining that they were still too fat. During the past fifty years, being beautiful in North America has meant being thin. The mass media has emphasized youth along with thinness as the accepted prerequisites for happiness and social desirability. This has resulted in an increase in compulsive dieting and eating disorders. Yates et al. feel that a cause of anorexia is that the individual believes he/she is out of control over life. In order to gain some measure of control, achieve social desirability, and overcome fear of personal ineffectiveness, the person stops eating. Another theory proposed by Yates et al. is that emaciated anorexics have elevated brain levels of endorphins, which may be associated with the elevated mood many anorexics report, a feeling that could serve as a potent re-enforcer of the destructive behavior. According to this research group, anorexia may also be related to a malfunctioning hypothalamus, which controls the release of morphine-like endorphins in response to stress. Bulimia

4 The person who overeats or binges on food and then prevents absorption by purging (via laxatives, vomiting, water pills, enemas, etc.) is considered to have bulimia. In this obsessive behavior the person feels driven to consume food as well as to purge themselves of it to prevent gaining weight. It is often associated with anorexia. Bulimia can occur with individuals who are of normal weight or even overweight. The bulimic person often plans and organizes the consumption of a large amount of food. The planning is often ritualistic and secretive. So great an amount of time and energy is spent thinking of food that it often interferes with an individual's ability to function. This behavior is usually cyclic in nature, with the person binging due to loneliness, depression, or boredom and then purging due to feelings of guilt about binging. Symptoms of bulimia include tooth decay, dehydration, constipation, weakness, lightheadedness, low blood potassium, cardiac arrhythmias, kidney damage, swelling of salivary glands, and irritated esophagus. The blood chemical imbalance can lead to heart attack. The individual is usually secretive about the behavior and may make numerous trips to the bathroom as the result of laxative abuse or desire to vomit. The cause of bulimia is not known, but various theories including emotional stress, need for relief from anger and depression, and pre-occupation with body size have been suggested. As with anorexia, bulimia may be related to a malfunctioning hypothalamus or a need to be in control of one's environment. Compulsive Eating As in any other addictive behavior, the compulsive eater is obsessed with the object of the compulsion, namely food. The person has a compulsive urge or craving to eat and will often eat when not hungry. The individual will often binge in secret, away from others, and will lose control over how much food he/she eats. For example, a compulsive eater may consume a whole box of cookies when he/she intended to have only one. This often occurs when the person is feeling lonely, angry, insecure, depressed, anxious, or bored. As with other addictive behaviors, the individual will deny that he/she has overindulged. When asked, the person may claim that he/she only ate "a couple of pieces of chicken" when two chickens were actually consumed. Compulsive overeating usually results in obesity. However, according to Hooker and Convisser, the "compulsive eater is not necessarily identifiable by her body size because many women who eat compulsively also are compulsive dieters." There is a difference between being overweight and being obese. Overweight is weighing more than one should for his or her body structure, height, and sex. It is possible to be overweight and still be in good health. Weight lifters and others who do muscle-producing exercise are often overweight but have a very low proportion of body fat. However, individuals who are obese are more than 30 percent over their ideal weight and have a high body fat content.

5 Obesity can lead to serious health problems. Excessive body fat is associated with diabetes, hypertension, and heart disease. It is also linked to varicose veins, problems in pregnancy, digestive disorders, arthritis, and respiratory disorders. It has also been found that eating patterns of obese individuals are different from those of normal-weight persons. Obese people often eat more rapidly and take larger and more frequent bites than normal-weight individuals. They also appear to expend less physical energy than average-weight persons due to lack of exercise and slow movement in daily routine. However, as with the other addictive behaviors, a simple cause of compulsive eating is not clear. GAMBLING When a gambler behaves mindlessly and irresponsibly, losing money, depriving the family, and harming the community, they are often treated as a criminal, rejected, or punished by friends and society alike. During the 1970s, the attitude towards the compulsive gambler as a weak-willed person or criminal began to change. Pathological or compulsive gambling began to be viewed as an addictive behavior. The compulsive gambler loses control over the behavior, denies that they have a problem, is easily depressed, and has a low self image. Surprisingly, compulsive gamblers rarely have a history of antisocial behavior, either as children or adolescents. They tend to perform well at school and work. While still in their teens many experienced a "big win," either at a race track, casino, or lottery, of such proportions that it made a lasting impression on them. They often return to the track, casino, or even the stock market with the expectation of winning big again. There are three stages that the compulsive gambler goes through. In the early or winning phase, the dependency on gambling develops as the individual begins to bet more frequently and tends to win as their knowledge of gambling odds and risks is developed. During this stage, the person still "controls" the behavior and can stop gambling. Rarely does the individual borrow money, since winnings are usually enough to support continued gambling. This phase may continue for months to years and typically ends with a substantially big win. During the next phase, the losing phase, the individual begins to gamble alone instead of with friends and begins to bet large amounts of money. Around this time, because the individual is gambling more, they begin to lose. Out of frustration, the individual begins to bet more money and take more chances. As their winnings are quickly depleted, the person begins to draw upon other resources in order to "get even." This is often money that has been earned, saved, or invested. If the person continues to lose, they feel a sense of urgency to win back what has been lost and eventually may borrow money. The individual then tries to cover up and may lie about their gambling, which alienates both family and friends. When friends or family do lend money to help the person get out of debt, it usually is quickly lost.

6 During the last or desperation phase, the person disregards creditors, family, and friends and begins to take even further risks. They may engage in illegal loans, thefts, or other crimes. The person often loses their family and job. Depression is common, and suicide attempts are frequent. The cause of compulsive gambling is not known. Most gamblers talk about the "thrill" or "high" they get while gambling, and it is speculated that, as in other addictive behaviors, perhaps betaendorphins are produced in the brain, which causes the individual to repeat the behavior to obtain the pleasant feeling. It is interesting to note that during treatment, compulsive gamblers undergo withdrawal symptoms similar to symptoms of persons addicted to depressant drugs (i.e., headaches, abdominal pain, diarrhea, cold sweats, tremors, and nightmares). OTHER ADDICTIVE BEHAVIORS There are a variety of other activities, behaviors, or even hobbies upon which some individuals can become psychologically dependent. Some of these activities may not be as life threatening as chemical addictions or eating disorders, but they can have profound negative effects on the individual and society. The reason why some people compulsively engage in a behavior, while others can engage in the same activity without becoming psychologically dependent upon it, is not known. In general, any behavior that is compulsively done by a person to the extent that it causes physical, social, or psychological problems to the individual, their family, or society would be considered to be an addictive behavior. WORK Our society rewards hard work. Work hard, play hard, save your money, and anything in the world can be yours is the basis of this philosophy. Society implies the person who spends much time at the office or studying, if it brings more money, job promotion, or better grades, is "being productive. Many individuals who have spent most of their time working have made extremely positive contributions to society and have often changed history because of their dedication. On the other hand, if the "work" becomes an obsession to the extent that family, friends, other interests, or hobbies become unimportant and ignored, the person is often labeled a workaholic. Complete devotion to work, to the exclusion of close relationships, often leads to family problems and divorce. It can lead to loneliness in old age, when the person realizes that all of his or her accomplishments really do not mean much, were not rewarded properly, and who will care a 100 years from now what I did or did not do." Those individuals with an addictive behavior towards work who become "absent parents" can cause psychological problems in their children. For example, if a father promises his child that they will go to the basketball game on Saturday and, when that day arrives, tells the child that he will not be able to take the child because of a business emergency, the child may lose faith in the father, especially if the behavior occurs frequently.

7 People with a work addiction often have low self esteem, feel inadequate, have a compulsion to set goals and meet them, and feel anxious and distraught when they are not "doing something." They find it difficult to relax and just "do nothing." When "relaxing" they often feel guilty because they are not being productive, and will spend their free time becoming more and more anxious because they are doing anything until they are back at work again. COMPUTERS With the increase in home computers and computer games, incidences of computer addictions and "hackers" have emerged. Those with compulsive computer behaviors have been known to spend hours at their computer without eating, bathing, or sleeping. When deprived of the computer, they go through withdrawal symptoms of irritability and anxiety. The primary lure of the computer for one with a computer addiction is that the person can have complete control over it. It does what it is told and is always predictable in its behavior or action. The person can create a world of their own, with its own set of rules and behaviors. Likewise, the machine will never exert peer pressure or express anger or insults or talk back. This is often a comfort to a young adult who is confused about sex roles, parental expectations, career choices, and the development of intimacy with another person. Though the cause of compulsive computer interaction among young people is not known, they have similar psychological characteristics to individuals with other addictive behaviors. They tend to have low self image and to feel insecure and out of control over their environment. In addition, they typically have poor interpersonal skills. EXERCISE In our society, since the days of the ancient Greeks, athletes have been admired, especially the ones who have gone above normal performance limits of the human body. However, excessive participation in various physical activities has overtones of addictive behavior. Runners who run over 100 miles a week with unhealed stress fractures or other painful and serious injuries, and who become depressed when they cannot exercise, are exhibiting signs of an addictive behavior. Extreme commitment to athletics, like extreme commitment to work, has a time-honored place in our society. But that extreme commitment has been shown in some cases to be self destructive and harmful. The obsession with the activity usually begins at a time of heightened stress. The elevated mood change or "high" experienced by long distance runners is thought to serve as a re-enforcer for the behavior, and they may become addicted to this "high" in order to feel worthwhile.

8 LOVE AND RELATIONSHIPS An individual can become obsessed with another person to the point that other areas of their life are neglected. The person focuses all of their attention and energy on the "love object," to the exclusion of friends, family, and other life commitments. Even when the person knows intellectually that the obsession is causing harm, even thinking about breaking up the relationship will bring on an anxiety attack. When the relationship is finally terminated, by either party, withdrawal symptoms of sleep and eating disorders, shaking, confusion, weeping, and feelings of failure, depression, and hopelessness occur. There are two basic form of love addiction. In the first, the relationship is often one sided, with the object of the person's love not even interested in, or aware of, the obsessed person's infatuation. The love is based upon imagination and not upon a relationship. An example of this would be someone "madly in love with the guy with the dark hair who sits in the front row of English class," to whom the person "in love" rarely speaks. Individuals with one-sided addictions often feel inner emptiness, incompleteness, insecurity, and anxiety if they do not have a relationship. Some of these individuals enjoy the "chase." However, if the loved one finally becomes interested in them, they quickly lose interest. This type of person is addicted to the challenge of making an unloving person love them, and will often go from one relationship to another without ever finding anyone who is "just right" for them. Sometimes two people are addicted to each other. These individuals seldom interact with others and tend to be possessive of each other and jealous of their lover's interactions with other people. They are motivated by their own need for security and not by an appreciation of each other's personal qualities. Addicted lovers will see each other more and more in order to maintain a secure state, often completely rejecting other people. When they are apart, they "long" for each other. Neither feels that he or she is a whole person without the other. Even if their constant contact degenerates into conflict, fights, and problems, they feel that they cannot separate. Some characteristics of love addiction occur within all relationships. However, if the relationship begins to be destructive, with constant mental or physical abuse by one or both partners, and neither person can break it off, then it is addictive. The cause of love addiction is not known, but, as in the other addictive behaviors, the person usually has low self image, feels insecure, is frequently depressed, and undergoes "withdrawal symptoms" when deprived of the object of their obsession. GROUPS Throughout history, social movements have been started by individuals who were extremely committed to their causes. However, some individuals may become so involved with various religious sects, cults, political or social action groups (even a self-help group) as to become addicted to them.

9 When a religious sect such as the "Jonestown" group has such an influence over individuals to the point where they will commit mass suicide, a compulsive state is thought to have occurred. As with other addictive behaviors, the group or cause-dependent person often has low self esteem, feels insecure, is anxious, and is looking for "something" to give meaning to their life. Individuals are considered to be addicted to a group or cause if they constantly talk about their beliefs to everyone they meet, feel that the group's philosophy is the "only true way," and believe that everyone else is wrong, immoral, or "condemned" if they do not believe as they do. Compulsive "groupers" often feel guilty if they are not attending gatherings or working for the cause almost every day. They sometimes begin to spend less time with their families, jobs or recreation and have been known to lose their employment because of their intense involvement with "the cause." If they cannot be with their group, they often feel depressed, anxious, and irritable. Similar characteristics can be found in individuals with commitments to a variety of political, environmental, religious, and social movements. However, like work and athletic commitment, this type of dedication has often been rewarded in our society and has produced both positive and negative social effects over the centuries on a worldwide basis. On the whole, any activity that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially has become an addictive behavior.