By: James L. Fenley, Jr., MD Addiction is a disease with many potential faces, including, but not limited to, alcohol and other drugs. Also, once someone is addicted to alcohol or other drugs—whether they are in recovery or not—their addiction can generalize to other areas, such as gambling, eating, or sex. When one form of addiction replaces another, it is sometimes referred to as a substitute addiction. It is important to note that all forms of the disease of addiction, whether they involve substances or behaviors, share the same dynamics and characteristics. These characteristics include: • Compulsion • Loss of control • Increased time engaged in addiction at the expense of normal activity • “Rush,” arousal, euphoria, immediate gratification • Means of “going fast” to relieve emotional pain and stress • Continued use in spite of negative life consequences Terrence Gorski, a noted authority on relapse prevention, mentioned these other forms of addiction as relapse triggers for alcohol and other drug addictions. Examples of substitute addictions:
- Work
- Relationships/love
- Sex
- Gambling
- Internet
- Food/eating disorders
Workaholism With substitute forms of addiction, the behavior is the same as that of the active alcoholic or drug addict. With workaholism, for example, the workaholic has the compulsion to work, no matter the consequences. There is a fast pace to it that produces euphoria or a high, and at times a sense of power. Work knows no limits, at the expense of family time, relationships, and even physical health. As with alcohol and other drug addictions, the workaholic is in denial and has little insight into the problems he or she is causing. Gambling addiction Gambling addicts often begin with a winning streak, but as the addiction progresses, they are no longer gambling to win, whether they realize it or not. They are driven by the adrenaline and the rush of “risking it all,” and then are crushed when there is no more money or hope of getting it. In desperation, they sometimes resort to criminal acts to obtain the money to feed their addiction. For the gambling addict to be interested in a particular form of gambling, three things must be true: (1) the result of the wager must be immediate, (2) the addict must believe intellect is involved in whether he or she wins or loses, and (3) there are no limits on how long he or she can play. With the introduction of video poker came the perfect game for the gambling addict. The number of gambling addicts increased as whole new segments of the population became involved—housewives and college students. For stay-at-home moms, it brought a new kind of excitement and, at first, enjoyment to their lives. For the college student with access to Mom or Dad’s credit card and the Internet, the temptation was just too great. Internet addiction Another common substitute addiction is Internet addiction. It is often difficult to diagnose because the addiction may remain hidden and because of the addict’s degree of denial. The Internet plays an incredibly important role in our society for business transactions, entertainment, educational programs, and communications. Because of its many applications, it lends itself to a variety of different manifestations of addiction. Some professionals argue that the Internet is primarily a vehicle for pre-existing substitute addictions such as gambling, relationship or sexual addiction, or video game addiction. However, the majority of experts would agree that the Internet itself is addictive. Internet addicts may spend thirty to eighty hours a week on the Internet, and go on binges that may last from ten to twenty consecutive hours. As a result, there may be disruption of sleep patterns, increased susceptibility to disease, decreased work performance, worsening home relationships as a result of isolation, and carpal tunnel syndrome (entrapment of the median nerve as it passes through the wrist, causing pain, burning, and numbness in the hand). Relationship addiction Relationship addiction or love addiction, terms often used interchangeably, typically can be classified into two types. The first is addiction to being in any relationship at all. With this type, the addict often moves from one relationship to another, seemingly without cause. The second is addiction to a single relationship, often with escalating negative consequences over time if the other person no longer cares for or becomes less interested in the addict. At the core of relationship addiction are poor self-esteem and a huge fear of abandonment. These issues can often be traced to the “don’t talk” rule of growing up in an addicted or dysfunctional home where there may have been significant abuse and/or neglect. The relationship addict feels as if he or she will die if not in a relationship. The addict, above all, desires intimacy, but at the same time fears it and flees from it. Relationship addicts also often have a poor sense of their own identity, trust issues, and dependency. More dependent addicts will stay in abusive relationships for the illusion of intimacy, suffering and sacrificing, with little idea of how to be good to themselves. Often seen in drug- addicted relationships, relationship addicts become more and more enmeshed in their situation. Sex addiction Sex addiction is really not about sex, but about trying to fill that big hole inside created by poor self-esteem and a need for caring and intimacy. While it is true that the sex addict may feel some temporary sense of power where sex is concerned (particularly in contrast to the powerlessness he or she felt as a sexual abuse victim), sex addicts usually have no insight into why they are acting out sexually. As with other forms of addiction, tolerance develops. With sexual addiction, tolerance is manifested by increased frequency of sex, new conquests, or new or more dangerous types of sexual thrills. The compulsion in the sex addict is to get the feeling of sexual arousal and release. The sex itself is an illusion of intimacy and a means of getting relief from emotional pain and other stressors. As with other forms of addiction, denial plays a major role in the sex addict’s thinking. Suicidal thoughts are not uncommon as the negative consequences mount in terms of family, job, health, and so on, in an individual with already poor self-esteem. Guilt, shame, and depression are major issues to be dealt with in treatment. Eating disorders The three forms of eating disorders are bulimia nervosa, anorexia nervosa, and binge eating disorder. Part of what makes eating disorders so difficult to treat is the frequent coexistence of other psychiatric illnesses such as major depression, obsessive-compulsive disorder, and different personality disorders (for example, borderline personality disorder or avoidant personality disorder). A variety of different causes have been proposed including AD/HD, genetic factors, peer pressure, idealized body type seen in the media, and early childhood trauma or abuse. Treating professionals should always refer patients with this diagnosis to a facility with a history of successful treatment of eating disorders for evaluation or treatment. Be aware of the potential for substitute addiction. We live in an addictive culture. Our country has become a complicated, “going fast,” consumer-oriented, pleasure-seeking place. He or she should use the tools of recovery that were given in treatment. Work a twelve-step model of recovery and remember that commitment, slowing down, struggling, and dealing with emotional pain are all part of living a spiritual life one day at a time. This blog post is an excerpt from Finding a Purpose in the Pain – A Doctor’s Approach to Addiction Recovery and Healing – by James L. Fenley, Jr., MD; Published by Central Recovery Press (CRP).
Las Vegas Recovery Center is an alcohol and drug addiction and chronic pain treatment center located in Las Vegas, Nevada. We offer a ride range of addiction and pain recovery programs, including detox, inpatient and outpatient care and a robust alumni and family program.
