The Dance of Destruction:

Transcription

1 The Dance of Destruction: Compulsive Behaviors and Process Addictions Presented By: Coleen Moore, MA, LCPC, CAADC, CCGC, MISA II, SAP Housekeeping... Take care of you move about as needed Share openly -- we all have much to learn from each other -- interact Enjoy and Network -- let s have fun while we try to learn something Learner Objectives Gain an understanding of the assessment procedures for process addictions Learn to recognize the signs/symptoms of process addictions Recognize the similarities between process and chemical addictions Gain competence and confidence to work with individuals with process addictions Here we go!! Close your eyes... Imagine your life is filled with chaos and disappointment, turmoil and strife... You have very few support systems, and no internal skill set for dealing with the demands life places on you... And you hear these words... Self-medicating 101 Comfort food Retail therapy What happens in Vegas stays in Vegas Casual sex Chat room or virtual reality We are accustomed to working with clients who cope with chemicals, but more and more often, we are seeing those we work with turn to processes to attempt to fill the voids and quiet the noise in their lives. 1

2 What is a Process Addiction? Compulsion to engage in a pattern of behaviors (sex, food, Internet, video game, compulsive gambling, compulsive shopping/spending) and to continue in the process despite adverse consequences. How Does a Behavior Become an Addiction? ACCESSIBILITY ACCEPTABILITY + PREDISPOSING FACTOR POTENTIAL ADDICTION Alarming numbers affected by addiction 22 millions (substance) 13 million (shopping) million (ED) 6-9 million (gambling) Millions (sex) million (Internet) Similarities to Chemicals Loss of control Unsuccessful attempts to cut down or stop the behavior A great deal of time spent thinking about or engaging in the behavior Continuing the behavior despite related consequences Withdrawal symptoms such as irritability, headaches and restlessness A need for increased amounts of the substance or behavior Changes in social, occupational, or recreational activities as a result of the behavior Differences from Chemicals No saturation No intoxication Screening Tools Assessment Tools Abstinence is defined differently 2

3 Defining the Screening Tool Determines the possibility that a condition is present Determines the need for further evaluation Defining the Assessment Tool Determines diagnosis Determines severity Goals of Screening/Assessment Tools Evaluate acuity (suicidal/homicidal) Referral to appropriate level of treatment, other community agencies Child abuse Domestic violence Development of psycho-social summary and treatment plan Screening/Assessment Tools Screening SOGS (Adult) MSOGST (Teen) Virtual Addiction Test Sexual Addiction Screening Test Debt/Spending Screen Eating Disorder Inventory Assessment DSM IV What should you know about the different process addictions? 3

4 Process Addictions How to diagnose? Have an understanding Awareness Familiarity with the language/lingo What criteria are needed for something to be a process addiction? Same criteria The criteria Gambling Increased tolerance Withdrawal symptoms Loss of control Attempts at abstinence Preoccupation Changes in lifestyle Disregard of recommendation to stop/decrease behavior The Compulsive Gambler Action Seeking Escape Gambler The Action Seeker Predominately male Start young Competitive Gambling friends Grandiose Criminal activity, arrest record Narcissistic Money is principal relapse issue Do become escape gamblers 4

5 The Escape Gambler Predominately female Non-competitive Short gambling career Late onset Relationship issues Debts lower, no attempts to control Emotion is primary relapse issue Four Descriptive Symptoms Progression of behavior Cannot accept losing Preoccupied with gambling Disregard for consequences Suicide Treatment Strategies 1 in 5 Pathological Gamblers Attempts Suicide National Council of Problem Gambling 2003 GA Meetings Manage Crisis and refer as necessary Psychiatric Medical Suicide Suicide Risk Assessment / No Harm Contract Internet Addiction Distress Wasting time on the computer Checking Facebook or Online games Out of touch with the real world Chats, texts, no time for sleep 5

6 Internet Addiction: Applications Used A Growing Epidemic Research on Internet Addiction American Psychological Association's (APA) New Disorder Growing number of other countries How widespread is the problem? Internet addiction to addictive syndromes similar to impulse-control disorder Online Gaming Hobby or Obsession? Warning signs Fatigue, sleep deprivation Impairments in school, job, family Lying about how long on Internet Hiding bills related to fees for Internet Physical complications Symptoms of carpal tunnel Back strain Eye strain What Happens When Attempts Are Made to Quit? Experience Withdrawal: Screening Anger Depression Relief Fantasies about the game Mood swings Anxiety Fear Irritability Sadness Loneliness Boredom Procrastination Upset stomach Virtual Addiction Test 6

7 Treatment Strategies Food Addiction Defining Abstinence Abstinence Contract Developing Sobriety Plan 12 Step Meetings When to re-integrate Internet use? Facts about Eating Disorders Develops in adolescence or early adulthood American Journal of Psychiatry Frequently co-occurs with depression, substance abuse, and/or anxiety disorders New England Journal of Medicine Bulimia is most common eating disorder Eating Disorder Stats Anorexia: 1 out of 100 Bulimia: 4 out of 100 Binge Eating: 1 out of 100 Overweight: 60% Obese: 34% Men: make up 10% of all EDs ( Warning Signs: Emotional and Psychological Preoccupation with appearance or weight Moodiness, irritability Anxiety, depression or suicidal thoughts Anxiety around meal times Guilt or self-dislike Warning Signs: Behavioral Overeating Dieting or making frequent excuses not to eat Change in clothing style Hoarding food Trips to bathroom after meals 7

8 Warning Signs: Social Social withdrawal Avoidance of social situations when food is involved Decreased interest in leisure activities Warning Signs: Physical Weight loss or rapid change in weight Changes in hair Changes in menstrual cycle Low blood pressure Dizziness or fatigue Sore throat Easy bruising Screening Eating Disorder Inventory Comprehensive Treatment Plan Medical Care Psychosocial Nutrition Medication management, if appropriate Treatment Strategies Sex Addiction Defining Abstinence Food Journals Sobriety Plan Nutritionist 12 step meetings Treatment expectations Medical 8

9 Sexual Addiction: Precipitating Factors Sexual Addiction Abused as children For men addicts For women addicts Additional addictions Sexual Addiction: Out of control sexual behavior Compulsive masturbation Indulging in pornography Having multiple affairs Prostitution Anonymous sex Compulsive sexual episodes Voyeurism Dangerous sexual practices Sexual Addiction: Consequences 60% of sex addicts have financial difficulties 58% of sex addicts have engaged in illegal activities 83% of sex addicts suffer from other addictions Signs of Sexual Addiction Out of control behavior Increased need Persistent/desire Continued use Persistent use of acting out Severe mood changes Withdrawal Inordinate amounts Neglect Screening Sexual Addiction Screening Test 9

10 Treatment Strategies Defining Abstinence Abstinence Contract Sobriety Plan 12 Step Meetings When to re-integrate sexual behaviors? Treatment Focus 12-step program Cognitive-Behavior Therapy Interpersonal Therapy Group Therapy Medication Shopping/Spending What s the big deal, anyway? The average compulsive spender is $23,000 in debt (Univ of Florida) Between 2 and 8% of the U.S. population spends compulsively (Univ of Florida) Compulsive spending is a leading cause of consumer credit card debt in the U.S. (Federal Reserve) The Big Deal, con t Who is a compulsive spender? Approximately 74 million Americans are compelled to purchase, but have not yet found the behaviors to be destructive. (Stanford University) $ Used to be primarily female, but men are becoming more heavily involved $ Typically experience anxiety and/or selfesteem issues $ Tend to be more impulsive than the general public 10

11 How does spending become an addiction? If you enjoy an activity or behavior do you repeat it? If engaging in an activity provides sexual release are you likely to engage in it again? If you participate in an activity and are able to forget about worries or problems for a while will you do it again? Screening Debt/Spending screen Making the Diagnosis 1. Preoccupation Y or N 2. Increase in tolerance Y or N 3. Attempts at abstinence Y or N 4. Withdrawal syndrome Y or N 5. Escape and relief Y or N 6. Disregard of recommendation to discontinue the behavior Y or N 7. Dishonesty related to behavior Y or N 8. Legal history Y or N 9. Impairment of significant life areas Y or N 10. Financial consequences Y or N Counseling theory and techniques 12 Step Psychodynamic CBT (Cognitive-Behavioral Therapy) Change theory DBT (Dialectical Behavioral Therapy) Trauma Treatment (CBT, Group Therapy, Family, Medication, EMDR) Motivational Interviewing (plus FRAMES) Multi-systemic Therapy Suicide risk assessment Questions, Wrap-Up & Evaluations Thank you for your participation! Contact information: Coleen.Moore@Proctor.org