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Understanding Addictive Disorders

Each year, millions of Americans find themselves caught in a cycle of addiction to alcohol, drugs, gambling, or other substances/ behavior.  They must struggle daily with the effort to become and remain free of the drugs or behaviors to which they feel uncontrollably drawn.

Affected individuals are diagnosed on the basis of the particular substance or activity to which they are addicted.  However, individuals with any type of addictive disorder may exhibit related symptoms, and both causes and treatment are similar.

The Nature of Addiction

An addictive disorder, as opposed to temporary reliance on a particular substance or behavior, can be distinguished by several distinct symptoms:

Tolerance. Over time, an individual requires increasing amounts of the preferred substance/behavior to achieve the same physical or psychological effects.

Withdrawal. When an individual tries to curb the addiction, withdrawal symptoms such as anxiety, rapid heartbeat, sweating, etc., will occur.

Lack of control. The individual has extreme difficulty cutting back or controlling the addictive behavior, even when aware of negative consequences.

Preoccupation. Cravings for the desired substance or behavior are constant.  Increasing amounts of time are spent planning, participating in, and then recovering from the addictive behavior, with employment and relationships often threatened.

Causes of Addiction

Are addicts “born that way,” or do they develop addictive disorders due to environmental factors?  In this nature vs. nurture debate, both answers may be true. Psychological, genetic, environmental, and other factors that determine a particular individual’s likelihood of developing an addiction may be interrelated.

Biological factors.  Studies have shown that the likelihood of twins developing the same addiction is 50-70%, and familial rates of such addictions as alcoholism are significant. Other research has pointed to such biological factors as abnormal dopamine levels influencing addictive behavior.

Psychological factors.  Is there such a thing as an addictive personality? While no such diagnostic code exists, many experts believe that certain personality traits make individuals more vulnerable to addiction.  They include: sensation seeking, impulsivity, poor coping skills, anxiety or depression, insecurity, and feelings of social alienation.

Environmental factors.  Stress may the factor that figuratively pulls the addiction trigger in an individual who is biologically or psychologically prone to develop one. A history of trauma, for example, is frequently found in individuals who develop an addiction, particularly any type of severe stress in childhood.  Physical or sexual abuse also increases the risk of developing an addictive disorder.

Treatment of Addiction

Numerous treatment approaches have developed that provide benefit to individuals in acute stages of addiction, and a robust recovery movement provides ongoing support and management of the illness. Treatment modalities include:

Medical approaches.  Depending upon the nature of the addiction, an individual may benefit from medical detoxification and an inpatient rehabilitation program.  While the use of medication is often discouraged, short-term use of medication is necessary in some instances.

Psychotherapy.  Many contemporary forms of “talk therapy” have demonstrated positive results in individuals with addiction, including the following:

  • Cognitive behavioral therapy;
  • Motivational enhancement therapy;
  • Dialectical behavioral therapy;
  • Relapse prevention therapy.

These therapies teach individuals better coping skills, including recognition of triggers to addictive behavior, stress reduction, relapse avoidance, and impulse control.

Psychotherapy may be conducted in an individual or group setting. Family therapy is often encouraged in order to reduce enabling of addictive behaviors, as well as to heal broken relationships.

Community and family supports. Peer support is a cornerstone of most successful recovery programs. Recovering individuals find ongoing support through a variety of community organizations such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or similar groups.  Many support groups are based on the twelve-step recovery model first established for AA.

In addition to counseling, families may benefit from support groups such as Al-Anon for assistance in dealing with a loved one’s addictive behavior.

Addictive disorders can be daunting, but with proper treatment and support, individuals can experience recovery and return to full function in their homes and communities.

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Problem Gambling: Addiction or Habit?

Do you know someone who gambles excessively?  If so, perhaps you’ve wondered if this individual just had a bad habit or if he or she was actually addicted to gambling.  It’s a question that even the experts have debated.  But the latest diagnostic publication of the American Psychiatric Association, the Diagnostic and Statistical Manual (DSM)-V, confirms that excessive gambling can indeed be an addiction, just like substance abuse.

The Nature of Gambling Addiction

“Problem” gambling, also referred to as pathological or compulsive gambling, affects an estimated 2 – 4% of the population. Before recent changes by mental health clinicians, it was classified as in impulse control disorder.  Like kleptomania (uncontrollable stealing) or pyromania (impulsive fire setting), compulsive gambling was considered a mental disorder associated with poor impulse control.

With further research, a new classification of the disorder has been made.  In the DSM-V, compulsive gambling is considered to be one of the “substance-related and addictive disorders.”  Why the change?  There is growing clinical evidence that pathological gambling has much in common with traditional substance abuse disorders.

First, the effects of the respective disorders on individuals’ work, financial, and personal lives can be similar. Neurochemical testing and brain imaging have also made a case for the belief that gambling activates the brain’s reward system in a manner similar to drugs.  For example, compulsive gamblers report highs from gambling as well as cravings.  Furthermore, gambling problems tend to run in families, indicating potential genetic factors. Finally, pathological gamblers are more likely to abuse alcohol and other drugs.

Symptoms of Gambling Addiction

In order for an individual to be classified as having a gambling disorder, at least 4 of the following symptoms must be present:

  • Frequent preoccupation with gambling;
  • Tendency to gamble increasingly large amounts of money;
  • Using gambling to cope with feeling distressed;
  • Lack of success in controlling, cutting back, or stopping the behavior;
  • Lying to others to hide gambling or committing illegal acts to finance;
  • Restlessness or irritability when attempting to decrease or stop gambling;
  • Frequent and often long-term “chasing” of losses with increased gambling;
  • Loss of a job or relationship due to behavior;
  • Reliance upon others to get out of financial straits.

Many of these symptoms resemble classic addictive symptoms, such as withdrawal and loss of control.

Individuals with pathological gambling problems are more likely to exhibit symptoms of other psychiatric problems.  In addition to substance abuse, such problems may include mood disorders, anxiety, or personality disorders.

While the effects of pathological gambling should not be minimized, viewing the behavior as evidence of an addiction rather than a character flaw can be helpful in encouraging an individual to seek treatment.  It may also remove some of the stigma associated with the behavior.  With appropriate intervention, individuals with gambling addictions can recover and live productive lives. (And that’s a sure bet!)