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Addiction Interaction, Relapse and Recovery

The views expressed are those of the author and are not necessarily those of Scientific American.


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Substance abuse and dependence rarely occur in a vacuum. Today’s addict is faced with a multitude of issues that may co-exist and compromise recovery. Co-existing addictions/compulsive behaviors such as drugs and alcohol, pathological gambling, sex, food, work, internet and gaming can become chronic and progressive if left unidentified and untreated. Many of these addictions don’t only coexist, but interact, reinforce and fuse together becoming part of a package known as Addiction Interaction. The term “Addiction Interaction Disorder” was introduced by Patrick Carnes PhD in 2011.

Caron Treatment Centers conducted a research study among adult patients with drug and alcohol addictions to determine what percentage may be at risk for sex and love addiction. The 485 participants were given the SAST-R (Sexual Addiction Screening Tool-Revised a 45 item forced choice (Yes/No) instrument): Carnes, Green & Carnes, 2010. The findings of this study indicated that 21 percent of individuals being treated for primary substance dependence scored at risk. Another interesting finding from the study showed a higher percentage of cannabis, cocaine and amphetamine abuse or dependence diagnosis in the individuals that scored at-risk for sexual addiction. In addition, at-risk individuals had higher percentages of mood disorder, PTSD and eating disorder diagnoses.

ASAM’s definition of addiction is a primary, chronic disease of the brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. The neural pathways are altered when drugs or other compulsive addictive behaviors exist. Changes in the neural plasticity occur which alters the brain wiring. Neurons that fuse together wire together which creates an interaction of addictions. When the pleasurable or reward-driven behavior stops, there is a decrease of dopamine (and possibly other neuro-transmitters depending on what the behavioral effect is), therefore causing a sensation of a “crash” or withdrawal, compelling the person to re-engage in the original euphoric behavior (Milkman & Sunderwirth, 1987).

Pleasurable, reward-driven behaviors can serve to self-medicate, fuse, or replace each other just like substances interact. For example, alcoholism is put into remission, and gambling addiction substitutes the absence of alcohol; this is known as “Replacement.” This puts the individual at high risk for relapse back to drug of choice. Another process known as “Fusion” occurs when two or more addictive behaviors develop into one episode. For example, when sex and cocaine are combined, the individual cannot engage in either addictive behavior without the other addiction present. This cycle repeats over and over. Addictions can cycle back and forth in a patterned and systematic way, which leaves the co-addicted individual at higher risk for relapse.

The addictive behavior of one addiction can serve as a ritual pattern to engage another. Actions such as buying and preparing drugs can activate the pleasure center of the brain. Alterations in the reward center of the brain could lead to distorted perceptions about people, places, & things, as well as interfere with the brain’s ability to process feelings. Furthermore, circuits in the brain found in the reward center have routes to the part of the brain that affect memory, judgment, and our intellect. If all of a patient’s addictions are not addressed during treatment, their likelihood of relapsing is much greater. An integrated approach is best. This approach takes a thorough look at what other compulsive behaviors or addictions may be contributing to one’s chemical addiction and provides the individual with a broader understanding of potential risk factors.

During a patient’s stay at Caron, we use multiple screening tools such as the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF), the Sexual Addiction Screening Test – Revised (SAST-R), Sexual Dependency Inventory –R 4 (SDI-R 4.0), South Oaks Gambling Screen-Revised (SOGS-R) and Eating Attitudes Test-26 (EAT-26). Patients are given these screens and assessments if they endorse certain behavioral questions during the psychosocial interview, but can be given a little further into treatment when patients start to be more honest and open about themselves. From these assessments, there is a clearer picture of the addictions and disorders from which the patient suffers.

Because of the interactive nature of multiple addictions, it is necessary to use an integrated multidisciplinary treatment approach. Caron has certified and licensed addictions experts from an array of disciplines: addictions counselors, psychologists, psychiatrists, spiritual counselors, nutritionists, medical team of nurses and physicians. The treatment philosophy at Caron is built on the foundation of the 12 Steps and evidence based practices; for example, CBT (Cognitive Behavioral Therapy), Mindfulness Practice and MI (Motivational Interviewing). In addition, patients are offered specialty groups such as Addiction Interaction groups and tasks, 12 Step lecture series, Family of Origin group, Seeking Safety group, Parenting, Body Image, Grief and Loss. While patient treatment will vary depending on each individual’s circumstances, it is important to make them aware if multiple addictions co-exist. Additionally, psycho-education helps patients work through shame and “normalize” behavior based on their history. It is also essential to identify relapse triggers, high risk situations, relapse signs and symptoms, repetitive patterns and relapse thinking and develop interventions to address these issues along with an integrated continuing care plan.

Patients and their family members are encouraged as part of the treatment process to attend the 5 day Family Education Program which is didactic and experiential in design. The goal is to educate and assist the family in understanding the disease of addiction while providing support and encouragement for their part of the recovery process.

The goal is to give the individual and their family the gift of Recovery for Life!

For more information on Addiction Interaction Disorder, please visit (PDF).

Cheryl Knepper About the Author: Cheryl D. Knepper, MA, LPC, ATR-BC, CCDPD, ICCDPD,CSAT-S is the Vice President of Continuum Services for Caron Treatment Centers in Pennsylvania. The Caron Continuum philosophy is to promote achievable and sustainable Recovery for Life. Ms. Knepper directs the Continuum of Care at Caron, incorporating 12 step facilitation and evidence based practices, with a strong emphasis on integration of services which offers the patient and family an opportunity to experience a continuity of care which is quality based. She presents at national and international conferences on addiction related topics. She is a licensed professional counselor, board certified art psychotherapist, certified international co-occurring disorders professional and certified sex addiction therapist supervisor. Follow on Twitter @CaronTreatment.

The views expressed are those of the author and are not necessarily those of Scientific American.



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  1. 1. wndrwmn08kc 10:59 am 04/29/2013

    Alcohol is a drug! Among some of the common obstacles we addicts have had to overcome is the insane ability we have at rationalizing, so by the world continuing to separate alcohol as a drug the addict mind will always find room to compromise the use and abuse of this worldly accepted drug. “Alcohol and other drugs” is truly a wording for those who are serious about their desire to help the suffering addict.
    Laura G.
    Clean Date 12/31/07

    Link to this

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