People continue to associate Addiction with substance use. I hear many people reflect that, since they don’t have problems with drugs or alcohol, then they don’t have Addiction. I am here to burst the bubble on this myth. Not to be a Debbie Downer, but to actually help people in their quest for health. I cannot tell you how many people have come into my office (or visited me virtually in the current day and age we exist in), lamenting about different symptoms that all have common themes and patterns. In a previous article, I wrote about how food is a ‘drug’ that everybody’s brain uses for a ‘hit,’ just like someone who has Addiction’s brain will seek out actual drugs or alcohol. This pursuit is something most of us are vulnerable to. Due to evolution and our built-in survival mechanisms, there are very few families out there that do not have some predisposition to what we call ‘Addiction.’ What do I mean by this word? I have based my practice on the brain, science, and evidence-based information that the brain circuit functioning of someone with Addiction is different then someone without. Remember, just because most of us have a genetic predisposition towards Addiction does not mean that we all manifest it. Environment, trauma, exposure, and other triggers play a role in determining what genes get expressed and which do not. So, back to the definition of Addiction. One that has played a pivotal role in my practice is the American Society of Addiction Medicine’s Definition, which is:
“Addiction is a treatable, chronic medical disease involving complex
interactions among brain circuits, genetics, the environment, and an
individual’s life experiences. People with addiction use substances or
engage in behaviors that become compulsive and often continue despite
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases” (from ASAM.org). This definition was revised in the past few years but the long definition that came out in 2012 provides a greater scope of the condition called Addiction. You can read that long definition here.
In easier to understand terms? Addiction is about the brain’s unhealthy attachment to the pursuit of escape, reward, and/or relief. The brain follows the neurotransmitters and what it has been trained to pursue. This impacts behaviour, as well as thoughts and feelings. It also means that if Addiction is rooted in our primal reward circuitry and impacts higher functioning parts of the brain, that its impact is not exclusive to drug and alcohol use. Below I elucidate on the top 5 areas that Addiction impacts beyond drugs and alcohol. These areas are usually active for those who have Addiction involving drugs and/or alcohol, as well these can be the areas that are the predominant concern for the individual.
As discussed in ‘Food: Our collective drug’ I described how food has an intoxicating effect on the brain. The reward circuitry impacted by Addiction is basically our internal traffic light. It tells us when to start, slow down, and stop behaviours that aide or detract from our survival. One of the main behaviours this circuit is designed to control is our relationship with food because without it, we do not survive. Therefore, it is my working observation that everybody who has Addiction has issues with food. From a common sense reasoning standpoint, how could they not? If someone has gotten to the point of a problematic relationship with drugs, alcohol or another obvious behaviour (like shopping, gambling, work, or other areas discussed below), then they are already experiencing the behavioural indicator that their reward circuitry is malfunctioning. Usually it has been programmed to go for longer periods then they would like or is functional before the slow down and stop functions kick in. This would be the traffic equivalent of a light that has a green light that runs for 5 minutes before the yellow light kicks in for a brief flash, then the red light. How long the red light is on varies, but it is usually not for very long before the green light kicks in again. For a person (since we’re different from traffic lights), this is “too much go and not enough stop.” This is where the harm of Addiction comes from.
What does this look like with food? What we commonly refer to as ‘Eating Disorders’ are the more extreme examples. People may wonder how the Eating Disorder of Anorexia Nervosa fits in on this quest for ‘more’ because Anorexia is actually the pursuit of less. Well, it is and it isn’t. It is the pursuit of less food, but the pursuit of more _____________ (fill in the blank with perfection, thinness, control, validation, achievement, accomplishment, or beyond). So while the brain is not using food itself to fuel the quest for ‘more,’ the pursuit of less food becomes the quest for ‘more.’ Confused yet? Good, as that means I’ve got you thinking and hopefully challenging some of your longstanding misunderstandings about this topic.
I could copy and paste the first paragraph from my discussion about food into this section but, since you just read that, I’ll say ‘ditto’ here. The reward circuitry of the brain that controls our quest for survival primarily controls our drivers for food, sex, and we could also say, relationships as those lead to sex (though it’s more complicated then that). Once again, people who are aware they have Addiction in another area also benefit from exploring their relationship with sex because it is always impacted. It is a matter of exploring ‘how’ it is impacted, not ‘if.’ This is because the reward circuitry is malfunctioning so of course there will be implications on food, sex, relationships, and other behaviours like motivation and mood, to be talked about below.
For some people, sex becomes the predominant behaviour that their brain uses for escape, reward, and/or relief, for others it is secondary or lower down on the list. Regardless of where it is on this personal hierarchy of behaviours impacted by Addiction, it is on the list. Recovery involves exploring boundaries, triggers, and self-care (in a nutshell, of course there is MUCH more to recovery then this and these topics themselves are deep and complicated). Recovery in all of these different areas is similar with common principles and themes applying, it is just a matter of bringing them into the specifics of that behaviour. For example, only focusing on boundaries with bars and clubs will be a protective step in addressing Addiction involving alcohol, drugs, as well as sex, but there are likely other triggering thoughts, events, environments, feelings, and people that tie into each of these. Not exploring these will leave people frustrated because they are more likely to keep relapsing with alcohol, and/or starting to act out with sex more because alcohol is now unavailable.
The colloquial way Addiction involving relationships has been referred to by the public and even by clinical materials is ‘codependency.’ There are lots of resources out there on codependency, with Melody Beattie’s being amongst the most well-known and popular. I am a fan of her work; however, sometimes I find people’s interpretation of it misses the mark of the depth of what is going on. Traditionally codependency is used to refer to an individual who engages in caretaking behaviour of someone with Addiction. While this is one manifestation of Addiction in relationships, it certainly is not the only way Addiction can manifest. How else can Addiction in relationships show up? Poor boundaries; lack of self-care; putting others’ needs before your own; using caretaking for a sense of purpose, validation or approval; driving intensity through chaos, drama, shame, conflict; using relationships for avoidance; and/or deriving a sense of identity from relationships are a few additional ways that Addiction in relationships can show up and be problematic. I’ve had many clients who present to counselling for support around this topic. Some have barely touched alcohol or drugs, but from a young age their brains were ‘drinking’ from the well of relationships and this can be just as fuelling, if not in some ways more so, then external substances.
As I’m writing this article and starting to get fatigued, ready for lunchtime, my motivation is starting to wane. This is a pretty natural response to engaging in a sustained task for a period of time. Some people, however, get to the point where they struggle to get out of bed in the morning, take a shower, brush their teeth, eat, or do other fundamental acts of self-care. Others can do these things but may struggle with other tasks or activities in life. There might be key things they avoid or ‘procrastinate’ on. The majority of people describe this symptom as a result of being ‘lazy’ and think it is caused by a lack of willpower or trying. Yet, the people I see who present with low motivation have usually tried harder then anybody to be motivated and productive, they just keep hitting an internal wall. This wall can be called Addiction. It may not always be the case, as there might be other physical or mental health challenges going on that are inhibiting motivation, but challenges with motivation are a common part of Addiction. This may be too much or too little of.
The brain is an interesting place and Addiction manifests differently for everybody, with common features. Motivation is one area where there are some stark differences. For some people, at the extreme, they are basically non-functional, whereas for others they are driven to over-achieve. Both of these are actually coming out of the same place, the brain just takes them in a different direction. On the low motivation end, the driver is escape and relief from the pressures of life (short-term, not at all long-term), as well as the reward of whatever people are engaging in while they’re avoiding (this might be another behaviour like media, drugs, alcohol, food, sex). So basically it’s win-win for the brain, though the person feels awful.
On the high achieving side, the brain is pursuing the reward of achievement-accolades, validation, money, success, power, or whatever the brain is seeking the most. There is also a heavy dose of escape and relief in the over-achievers. I find many of them struggle with relationships and feelings, including relationship with self and esteem, so covering this up with constant busyness is a ready made solution.
Recovery on the low motivation side involves establishing small, realistic, step-by-step goals for action to start to build some momentum and help people move through the inertia, while recognizing the push back that their brain is giving them. Recover on the high motivation side involves delving into the emotional drivers of the behaviours while also implementing boundaries (putting the brakes on slowly but steadily) to allow for a detoxification. People will not stop functioning or producing, but aim to bring things back in balance.
Get ready to be a bit annoyed (or maybe not). Most people I see who present for ‘depression’ or ‘anxiety,’ as we talk further, would end up meeting the criteria for Addiction. Meaning:
A. Inability to consistently abstain (from behaviours or even from ‘drinking’ from the feelings. Think- perseveration, rumination, dwelling)
B. Impairment in behavioural control (unable to stop themselves from dwelling and/or acting out in their feelings)
C. Cravings (not that they crave feeling bad, but the brain craves the dopamine that comes from intense feeling)
D. Decreased recognition of problems in relationships and behaviours
E. Dysfunctional emotional response.
This ABCDE is a symptom check-list of sorts that comes out of that long definition from ASAM mentioned above. These criteria can apply to feelings as a standalone, or exist along with these criteria popping up with other behaviours.
For recovery, if people can start to identify the unhealthy part of their brain, how it operates and what it pursues, this helps with boundaries, a sustainable self-care plan, and ongoing health. If people continue to view their emotional symptoms as a core part of them or down to bad behaviour or lack of control, they continue to struggle.
The long and short of it is that Addiction is a complex medical condition that impacts so many people in so many ways. If you are struggling in any of these areas mentioned, I hope you are able to find healthcare practitioners who can support you in your journey of change, rather then just symptom-managing. Recovery and health is possible.
Paige Abbott is a Registered Psychologist in Alberta, Canada and has worked with individuals struggling with Addiction for over a decade. She has been Registered since 2009.