Two of a Kind: The Link Between Substance Abuse and Process Addictions
Process addictions occupy highly contested territory. While addictions to drugs and alcohol are undeniable addictions with fully realized medical models and extensively developed treatment resources, process addictions are still treated with suspicion amongst many outside the treatment community. However, increasing evidence of the neurobiological changes created by process addictions is changing public perception of these compulsions and fuelling the recognition of a broader scope of addictive behaviors. At the same time, researchers are also learning that substance and process addictions have a close and complex relationship that requires sophisticated emotional and behavioral interventions for complete addiction recovery.
Substance addictions and process addictions often go hand in hand, and when they occur simultaneously, they are referred to as co-occurring addictions. A Japanese study, for example, found that over 30% of those with a food addiction were also addicted to alcohol.[1. http://onlinelibrary.wiley.com/store/10.1111/j.1440-1819.2007.01779.x/asset/j.1440-1819.2007.01779.x.pdf;jsessionid=2684A9F2BB207DEE9079FAD476F6DEEA.f02t02?v=1&t=ifzr16g6&s=f113b37596626d13586ce3ebddaaefc6ca40d9dc] Other research has found that alcoholics and people with drug addictions are 4 to 10 times more likely to be addicted to gamblingthan the general population, and there are similarly strong links between substance addiction and other process addictions, including sex addiction and internet addiction.[2. http://www.hindawi.com/journals/isrn/2013/342392/] These addictions may exist independently as two discrete but equally powerful methods of coping with distress. In other cases, the behaviors coalesce and reinforce each other; you may celebrate a gambling win by binge drinking or pick yourself up after a loss with a few lines of coke. You may use meth to increase the intensity of your sexual experiences as you compulsively seek out more extreme sexual highs. The addictions can feed off each other, reinforcing your need for the process and the substance.
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Even if you have been devoted to a single addiction, incomplete recovery may cause you to move on to another. While some simply replace their substance of choice with another harmful drug, others get out of the substance business altogether and replace illicit substances with behavioral addictions, referred to as addiction substitution or transfer. These new addictions may at first appear innocuous compared to the defined risks of substance abuse; exercising compulsively is surely a step up from shooting heroin, shopping addiction won’t make your teeth rot and give you psychosis like meth, etc. As Dr. Nicole Avena from Columbia University says,[3. https://www.thefix.com/content/substituting-addictions]
In the case of cross addiction or substitute addiction, a recovering alcoholic, for example, may turn to food as a source of reward and pleasure. This relationship with food could develop into a substitute addiction. In some ways, this may seem like a “safer” addiction to have, but it can still be damaging and very distressful to the person suffering.
While process addictions may be harm reduction measures some of the time, they are not harmless, and can result in profound psychological, social, physical, and financial damage that ultimately disrupt your ability to function.
The Addictive Personality Myth
Some chalk co-occurring addictions and addiction substitution up to an “addictive personality,” the idea that some people are inherently wired for addiction and will indiscriminately express their innate addictive drive toward whatever is in front of them. However, many experts disagree with the addictive personality theory, pointing out that there is “no consistent support” for the concept.[4. http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1099-1077(199602)11:1%2B%3CS9::AID-HUP747%3E3.0.CO;2-6/abstract] Earlier this year, Dr. Maryann Amodeo from the Boston University School of Social Work published a paper asserting that “personality characteristics ascribed to the addictive personality can and do result from the addiction; they do not predict it.”[4. http://www.tandfonline.com/doi/abs/10.3109/10826084.2015.1007646?journalCode=isum20] Furthermore:
Addicted individuals who choose to use other drugs, in various manners or patterns, or manifest compulsive behavior during and/or after treatment, do so because of inappropriate or incomplete treatment or a partially resolved addiction, not an addictive personality.
In other words, the traits that have been identified as static, pre-existing qualities that cause addiction, such as impulsivity and risk-taking, are in fact not inborn, but develop in response to addiction itself and continue to be expressed in the absence of effective recovery.
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In order to break free from addiction, then, the underlying addictive drive must be identified and disrupted. Rather than an intrinsic and immutable part of your personality, substance and process addictions are often attempts to cope with serious emotional pain, and unless that pain is dealt with, the desire to quell it through addictive behaviors will remain. Taking full inventory of the roots of your addiction is necessary to develop healthy coping mechanisms and fortify yourself against both relapse and substitution. But comprehensive therapies during treatment are not enough; the real test of addiction recovery comes when you return to your everyday environment and have to make decisions without the guidance of clinicians or treatment peers. As Dr. Deni Carise tells The Fix, “[W]e need to educate our patients about the dangers, particularly in early recovery, of other addictions cropping up.” As such, aftercare planning is essential to ensuring ongoing sobriety and behavioral health to guard against the emergence of new addictions during this vulnerable time.
Alta Mira offers the highest standard of care for people living with substance and process addictions. Contact us today to learn more about how we can help you or your loved one realize effective, sustainable addiction recovery.