Chemical and Behavioral Addiction Overview Part 1 | Addiction Counselor Exam Review

Hey there, everybody, and welcome to today's presentation on the introduction to chemical and behavioral addictions. This is part one of two, and I'm your host, Dr. Donnellice Snipes. In this segment, we're going to define behavioral addictions, explore the A, B, C, D, E's of addiction, explore some of the ways that addictions begin, review the consequences of use in general, and review the Jelinek curve. So what is an addiction? Now we're really talking about what people generally call an addiction. The dsm, the Diagnostic and Statistical Manual, has some different criteria. And currently it really doesn't recognize a lot of behavioral addictions as addictions. But in the general population, we still refer to them as addictions or addictive behaviors. So I don't want you to get too caught up on labels, but what we're talking about is when someone uses a substance, person, relationship or activity outside of themselves to escape from emotional or physical distress, stress, and they continue to use despite multiple negative consequences. And that last phrase is what's really important. A lot of people will engage in certain behaviors in order to escape or numb their stress temporarily. But that is not their main coping skill. And if it starts causing problems, they quit doing it. When people quit, continue to do it even though it's causing them significant negative consequences, that's when it becomes a problem. According to the ASAM, addiction can be easily characterized by the ABCDEs. A person has an inability to consistently abstain from the activity, chemical, etc. There is impairment in behavioral control. They experience craving, physiological or psychological craving for this substance, person or activity. When they are not able to access it. There's diminished recognition of significant problems in with their behavior and in their relationships. And there's a dysfunctional emotional response. So Those are the ABCDEs. Now, that's generally not going to show up on an exam or anything. But it is a quick, handy guide, if you will, to help you remember the characteristics of what we refer to in general as addictive behaviors. So how do addictions start anyway? Some people are fine all the way through, you know, childhood, even adolescence. And they don't develop addictions until later in life. Other people develop addictions as early as eight, nine years old. Yeah, eight or nine years old. I've seen it. So we really want to explore. How does it start? Well, adverse childhood experiences, abuse, neglect, insecure attachment, anything that happens during childhood that overwhelms the child's ability to cope and they don't receive support can be traumatic to them. But trauma can happen at any age. It's not just adverse childhood experiences. It's any trauma a person experiences that causes traumatic injury that they have an inability to cope with that can lead to disruption of their secure attachments, a lack of confidence, a feeling of helplessness, hopelessness, anxiety, depression, low self esteem. So the person who is using, whether it's a chemical or a behavioral addiction, the person who is using is in pain. And it's important to remember that they are in pain, experiencing some kind of distress. Other people, especially when we talk about substances, begin or may begin with recreational or prescribed use. So they start drinking and it makes them feel good and they have no problem with drinking, for example, for years. And then something happens that causes them to up their game. They start drinking more, they start to deal with distress. As they drink more, then their body becomes tolerant to it and they need more of the same substance. It starts as they start drinking more, it actually starts creating changes in their body and brain. And we'll talk about those changes later. But the same thing can happen also with prescribed use. If somebody is using a substance as prescribed, then they're not prescribed it anymore, but they still feel like they need it. They will also develop a tolerance after a period and it can turn into an addictive behavior. It's also important to remember at this point that addictions don't necessarily mean the person engages in the behavior every single day, all day long. We can have people who engage in binge behaviors, binge drinking, binge using, binge gambling, etc. And it only occurs maybe on weekends, and they may justify that. But we'll talk about how we can help them ferret out whether it's causing them problems or not. People also may start using in order to self medicate mental health issues, whether it's mood disorders, personality disorders, and by the way, most personality disorders are strongly tied to adverse childhood experiences and childhood trauma. So we've got that going on. Psychotic disorders, some people may use in order to quiet the voices in their head or, or to avoid the, or try to dampen the hallucinations, adhd, ptsd, and the list goes on. So there are a myriad of reasons why someone may start using or up their use to the point that their body starts adapting to it, developing a tolerance, and it starts becoming what we commonly refer to as an addiction. It's important to have this paradigm shift, and I feel very passionate about this. Addiction serves a survival purpose. Addictive behaviors serve a survival purpose. People don't just say, hey, how can I screw up my life today? People don't Say hey, let me choose this today because I really don't give a crap about anything else in my life until it's gotten to the point where they're so overwhelmed that it's more painful to be sober than it is to be using. So it's important to remember that it was. Sometimes people refer to it as a creative way to survive, not necessarily the best way. Addiction represents the best way a person had to cope until now. All of their other coping skills may have gotten overwhelmed or they may have started increasing their using, experienced physiological changes. So then the withdrawal feelings were so unpleasant that they felt like they had to continue to use. There's a variety of reasons why people may continue to use. But we need to get away from this notion that, that people can just stop and everything will be better when they stop. Their body has got to adjust. And there's a post acute withdrawal period for all addictive behaviors that people go through. And it is hard, it is painful, it is distressful. So it's important to recognize that this is not just quote a choice and we'll talk about that a little more later too. The addiction can become the person's best friend. And what I mean by that is that addictive behavior helps them numb the pain, helps them numb the distress, helps them feel okay. When nothing else seems to get the job done, they can rely on it, it is consistent, it is responsive. And everyone's ability to deal with life on life's terms differs. So what may not seem like a big deal to you may seem like a huge big deal to somebody else. And there are a variety of reasons for that. But minimizing what they're going through and saying, well that's no reason to use is unhelpful. You know, they were doing the best they could. So important to remember that it doesn't mean that they can't do better in the future, but it means they wanted to survive and they were doing the best they could. People can address the ways issues from the past are impacting them today. So if somebody experienced trauma in childhood, well they can't make that go away. It's just, it is the past is the past. But they can alter the way it affects their self esteem, they can alter the way it impacts the their interactions with other people. They can alter, they can integrate that experience and embrace the dialectics that emerge from it. So let's talk about the DSM criteria for addiction tolerance. That means a marked increase in amount or due to a marked decrease in effect. So with substances, people need to drink more in order to get the same buzz or use more and to get the same high. When we talk about behavioral addictions, people need to engage in riskier behavior. Gambling, they need to spend more money or play riskier games. Sex, they engage in higher risk behaviors. Pornographies, the same way. And we'll go through a lot of these later. But it's important to recognize that for most of these things, the brain develops a tolerance and it gets to a point where it says, yeah, been there, done that, doesn't do anything for me anymore. People experience characteristic withdrawal symptoms and the substance is taken or the behavior is engaged in to relieve the withdrawal. And it's important to remember that this can be psychological or physiological withdrawal. But when people engage in any kind of addictive behavior, whether it's gambling or sex or substances, that rush of neurochemicals, that repeated rush of neurochemicals causes changes in the way the brain works. So even people who engaged in behavioral addictive addictions are going to potentially have some alterations in the way their brain works. So they are going to potentially have these cravings and these withdrawal symptoms because they're not going to have the same level of dopamine responsiveness that they had prior to use. They're not going to have the same balance of neurochemicals and hormones that they had prior to use. And all of those things, when dopamine, norepinephrine, glutamate, gaba, when all those, any of those things get out of whack, people are going to experience, experience withdrawal symptoms. Substances can be taken in larger amount and for longer period than intended. And this can apply to behaviors too. Gambling, for example, you know, you, somebody may log in for online gambling and intend to only spend X number of dollars or only do it for 30 minutes and before they know it, they've spent 10 times what they expected. And they've been on the, on the computer gambling all night long. So, you know, it's important to recognize that this can apply persistent desire or repeated unsuccessful attempts to quit. Well, a lot of times people try to quit and they, they just say, okay, I'm not going to do that anymore. Well, that's a problem. If their brain and their body has undergone physiological changes, if they don't have alternate strategies to deal with life on life's terms, then they are pretty much setting themselves up for failure. It's important to remember they did the best they could with the tools they had. If they haven't developed any new tools, then guess what? They're not going to be super successful probably in just abstaining. If their brain and their body has undergone physiological changes, then their body now is used to having that, it has adapted to having that influx of those neurotransmitters. So when it's not there, they actually feel deficient, if you will, in, in those neurotransmitters. And when they feel that way, they feel horrible. The pain increases, you know, a lot of distress increases. So guess what? Absent other tools, oftentimes they return to what actually makes life tolerable. A lot of time or activity is spent obtaining, using or, or recovering from use of the substance or activity. So thinking about it, getting it, or figuring out how to engage in the behavior, engaging in the behavior and then recovering. And this can be physical recovery, can be financial recovery, emotional recovery. Important social, occupational or recreational activities are given up or reduced. The person begins to focus. Because when they're not using that addictive behavior, they're not getting the surges of dopamine and other feel good chemicals that they need once their body has adjusted. So they're wanting, they're craving use in order to feel quote, normal. And a lot of times that means giving up other activities because when they go to try to do those things, they're not engaging in that behavior. And when they're not engaging in that behavior, they feel like crap and use continues despite knowledge of adverse consequences. Yeah, a lot of times they can look around and see what's happening. But the pain of not using without having new skills, new supports, those things may feel overwhelming. And as they look around at the consequences of their behavior, that increases a lot of their distress, which makes it even harder to deal with life on life's terms. So let's talk about some of these adverse consequences. And this is obviously not all of them, but people may experience hepatitis, HIV and STDs depending on the type of addictive behavior they're engaging in inadequate sleep or nutrition. And this is true for a lot of addictive behaviors because sleep is foregone in order to engage in those behaviors. Sometimes, especially when people are still trying to maintain a normal. I don't like that word, but I don't know what else to use in this facade. You know, everything is fine here, nothing to see. So they're going to work and they're, you know, plugging through their day, but then they come home and they engage in that behavior all night long or some sort addictions. Addictive behaviors also disrupt the person's circadian rhythms and their ability to get quality sleep, they may experience reduced immunity. Well, that is part and parcel of high stress levels and reduced quality sleep. We see the immune system starts to go on the fritz. So they may get sick easier and be more vulnerable to physiological illnesses. And people may experience more injuries. You know, this isn't just under the influence of substances where they fall down or pass out. But people who are significantly fatigued may fall down and do things that are riskier or they're not paying attention to things and be more susceptible to injuries Affectively or emotionally. People who are engaging in this behavior often experience when they are not directly engaging it or under the influence. If we're talking about substances, they often experience depression, anxiety, guilt, anger, resentment, grief, jealousy. Pretty much the entire basket of unpleasant emotions may overwhelm somebody when they are not using. When they start to sober up, they may have been part of the reason the person started using in the first place, but not necessarily. But ultimately, when somebody has an addiction or engages in addictive or compulsive behaviors, Many times when they're not engaging in those behaviors, they're experiencing some, if not all of these cognitive problems. So this refers to how we think, how we process things. People may experience memory problems because of using substances or, and blackouts. They may experience memory problems because they're not getting that adequate sleep. So their brain is actually not remembering as much. When they're under stress. There are high levels of a substance called glutamate in the brain, which actually impairs memory formation. They may experience confusion, confusion and foggy headedness. And a lot of that can also be attributed to changes in sleep and changes in neurochemicals. And some people experience paranoia. Now, it could be rampant paranoia, But a lot of people also experience paranoia because they are afraid that someone else is going to find out about their addiction. So they become paranoid that they're being judged. They become paranoid that people are going to find out or something bad is going to happen. And it can keep their anxiety ramping up, which increases glutamate, which reduces quality sleep, which impairs immunity. See how all this kind of feeds in environmental impacts. And under environmental, we include financial and occupational issues because it's difficult to to maintain safe, stable housing, for example, and a safe environment when you are unemployed, when you are homeless. So financial and occupational are important. People often start having poor work attendance because as their fatigue goes up, as their sense of hopelessness goes up, as their need to more frequently engage in the behavior goes up, Work becomes less of a priority. When they are at work, they may have poor quality or productivity in their work because they're exhausted, they're foggy headed, they're having difficulty concentrating on things, which can lose to job loss. When people's finances start taking a hit, or when they're spending everything they make on their behavior, then they may lose their housing or it may result in unstable housing. We need safe, stable housing. That's just if you look at Maslow's hierarchy, that's one of those things that is an inherent need. So when people don't have it, it increases stress, it increases distress, which can increase the desire to escape. And a lot of people become unable to afford basic needs. So nutrition, medical care, medication that becomes ever more difficult to come by. So we see people's health starting to fail, we see their nutrition starting to fail. And when we talk about relapse prevention, one of the mnemonics in recovery circles is halt. Hungry, angry, lonely and tired. People need to be able to be rested. They need to feel safe. They need to get their nutritional needs met because their body can't repair itself if it doesn't get the basic building blocks. And finally, relationship. Well, there's one more after this, relationship issues. When people are in engaging in addictive behaviors, they may lie and manipulate others. They may be very secretive because they're trying to protect that addiction. They know it's probably not the best thing for them. However, they also believe at that point that they can't do without it, that being without it is too painful, too overwhelming. So they will do their best to shield that addiction from other people's knowledge so they don't get judged, so they don't have to try to quit. They may change their friends and start surrounding themselves with other people who engage in similar addictive behaviors. They may have difficulty getting along with others, they may be more impatient. The tolerance for other people tends to go down. And as the need for the substance goes up. So the more time, the more energy, the more whatever people feel they need to invest in the addictive behavior in order to feel okay, the less time and energy and everything else, they have to invest in everything else. And spiritual issues, hope, faith, integrity, discipline, courage, compassion. Those are some of the big ones that often go out the door. When people are in full blown addiction, they don't have hope, they can't see a hopeful future. When they sober up, it is exceedingly painful. They don't have faith a lot of times in other people to help them. They may lack faith in themselves to be able to do things they often lack faith in, in a higher power. So they feel not only hopeless, but sometimes helpless because they don't believe that there's any options. Their integrity may go out the door because they want to be this type of person over here. However, in order to survive right now, engaging in those behaviors causes them to engage in other behaviors like lying and manipulation and other things that go against their main principles. So it's a tug of war between I feel I have to do this to survive, and this is the person I want to be. Now, let's talk about the Jelinek curve for a minute. And this is the relatively predictable pattern that people go through with when they start to develop addictions. So there's recreational use. In order to find something that is going to make you feel good, you actually generally have to have tried it before. So recreational use and recreational use doesn't necessarily progress past that for everybody they're using it, whatever it is, it makes them feel good. It helps them relax. Okay? At that point in time, people who have other coping skills, who have social supports, who are physically healthy, tend to be at less risk than people who don't have those things. The next phase is occasional use for relief. You go from oh, this makes me feel good to oh, this can also numb the pain. This can also help me relax after a really bad day. So people may start occasionally using, may not progress past that for a lot of people because their occasional use is complemented, if you will, when they sober up and they can get into their wise mind, they have other tools in order to deal with it. But for others, it moves to increased craving. When they, they start occasionally using and those occasions start becoming more frequent because that stress still exists. When they occasionally use for relief and then they sober up, they don't have the tools to deal with whatever's causing their distress. So that tends to continue to get worse. So they use again. And as they continue to use, their body starts going through changes. So they start having increases in cravings because they're craving, feeling better. They're craving the levels of dopamine and norepinephrine and those sort of chemicals in our brain that help us feel okay. Then we start seeing increased triggers. So as people start craving, they start using more. And then things that are associated with their using, like the places they use or the people they use with, become more, more numerous because they're using more often. So maybe they only used to use at home. Maybe they only used to engage in the behavior on their home computer. Well, then maybe they Start, you know, occasionally, every once in a while they used at work. And now every time they go to work and they see their computer at work, it's like, yeah, I want to use again. So the computer at work, in addition to the computer at home now becomes a craving. And then computers everywhere start to become a craving. They become unable to discuss the problem. A lot of times shame has started to set in here because they start recognizing that this is detrimental, but they continue to do it anyway. They don't see a way out. They feel like they're drowning in whatever else is going on. Their efforts to control the problem fail. They are using increased time and energy trying to control it. And then eventually it still happens anyway. And then this is often they're attempts to self treat so they don't have to admit to anybody else that there's a problem. They don't have to admit that they may have been doing something that wasn't helpful or healthy. Well, when those efforts to control fail, and they usually do because again, they're not replacing them with alternate tools, you know, they may try something here and something there. But until they understand what caused it to begin with, until they understand, pause. Until they understand that they're going to need new tools to cope with life on life's terms, especially while their body is recovering, they are at high risk for craving and relapse. Ultimately they reach their bottom. And bottom is different for everybody. But there comes a time where the pain from using, the distress caused by using is too much and they are ready. The pain of recovery seems like it'll be less than the pain of continuing to use the pain. And this often happens when they have alienated or pushed away a lot of their social support, lost their job or started having problems in their job. You know, like I said, everybody's bottom is a little bit different. But they look at what's going on and they go, okay, recovery looks like it's going to be really freaking hard and painful, but this is intolerable. So it's, it's a matter of severity that once they've made the decision to change, they seek to understand and address the reasons for the original distress. How did I get here? Why did I start using in the first place? What happened? What was the stress or stressors and how can I deal with them so they're not continuing to haunt me? And they also need to understand and address the distress created from the addiction. The difficulty in their relationships, the loss of trust, the lying, the jobs that were lost, the reputation that was lost all the things that happened during the addiction is stuff they're going to have to work through and process. Think of each one of those things as shrapnel from the addiction bomb. And each one of those pieces of shrapnel needs to be extracted and the wound healed. They begin to address physical issues that are maintaining the distress. Many, many people have changes in sleep, increases in pain, some develop autoimmune diseases, some develop sexually transmitted diseases, etc. When they're using. And it's important to address those issues because the body has to recover. As long as the body is under stress, it's not going to be able to effectively help the person feel happy and pain free, which is going to mean that the cravings are at least an undercurrent, if not just screaming at them. They start to develop healthy coping skills. They improve their self esteem and rebuild their healthy support network. So there is a process and it's important during the process to make sure that while people are going up the curve towards recovery, that they put in anchor points so if they start to slip, they have resources and things they can do to sort of catch themselves if they will. Both behavioral and chemical addictions serve as a means of coping with the stress. They follow a relatively predictable pattern and can have significant physical, affective, cognitive, environmental and relationship consequences.