Substance abuse and dependence is impacted by many variables. Unfortunately, individuals struggling with addiction encounter numerous 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 coexist and interact, reinforce and fuse together creating what scientists call Addiction Interaction. The term “Addiction Interaction Disorder” was introduced by a sexual addiction expert: Patrick Carnes PhD in 2011. What this suggests is that it is likely that when an individual suffers from one addictive behavior, they may also struggle with another type of compulsive disorder. Both of these conditions can complicate and reinforce the other making recovery more difficult, requiring a cognitive behavior therapy in addiction.
ASAM’s definition of addiction is a primary, chronic disease of the brain reward, motivation, memory and related circuitry. Dysfunction in these brain 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 to attain that euphoric sensation creating a vicious cycle of addiction (Milkman & Sunderwirth, 1987).
Pleasurable, reward-driven behaviors can serve to self-medicate, fuse, or replace each other. For example, alcoholism is put into remission, and food 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 meth-amphetamines 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 (Scientific American, April 29, 2013).
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. Consequently, if an individual’s addictions are not addressed during treatment, their likelihood of relapsing is much higher. An integrated approach is indicated. This approach identifies all compulsive behaviors or addictions that may be contributing to one’s chemical addiction and provides the individual with a broader understanding of potential risk factors or high risk situations.
Because of the interactive nature of multiple addictions, it is necessary to use an integrated multidisciplinary treatment approach such as Cognitive Behavioral Therapy (CBT), Mindfulness Approaches and Motivational Interviewing along with group work focused on recovery. 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. With proper support and treatment and individual can begin the journey of healing and receive the gift of recovery.
Source: Cheryl Knepper
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