Addiction comes in packages – not the type of packages you want on your birthday or for Christmas, but packages that develop over periods of time and involve excessive behavior with more than one object of addiction. Rarely in my clinical work and research have I experienced patients that struggle with only one addiction, typically they have multiple types of addictions.
If you abuse methamphetamine or cocaine, chances are good you have struggled with out-of-control sexual behavior. If you gamble, chances are good you also drink or smoke. If you use drugs of any kind, you likely drink and use cannabis as well.
Packages usually include a lot of other issues:
- Mental Health problems
(trauma, depression) - Physical Health problems
(chronic pain, diabetes, hypertension) - Wide Range of Psychosocial Problems
(relationships, debt, unemployment, legal problems)
When we combine all the issues with addiction what we see clinically is a complex mess. What makes treatment so difficult is really understanding how all the issues interact with each other, and where to start with intervention. Many who receive treatment from a private practice clincian rely on what happens in just one hour out of 168 in a given week. Not much time to intervene when so many issues are present.
One of the best descriptions of packages is a chapter written by Patrick Carnes, Robert Murray, and Louis Charpentier titled Addiction Interaction Disorder found in the Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment
For example, masking occurs when:
an addict uses one addiction to cover up for another, perhaps more substantive addiction
Such is the case when a patient says:
I did all those sexual things because I was high on methamphetamine
The key point: We need clinicians to treat the entire package
To successfully intervene it is necessary to address the package of addictive behavior, and the co-occurring issues that go alone with the addictions as well. We must move away from treatments and interventions that focus exclusively on specific objects of addiction, and learn to think systemically about all of the various issues causing problems. This is why I am not a fan of certifications focused exlusively on drugs, gambling, or sex.
I like how you wrote this. I believe this is something that most addicts do not agree with at first. Many people think that if you go intro treatment for say a heroin addiction and you are treated for three weeks that you are magical “fixed”. That doesn’t help the depression, anxiety, loneliness, ect that caused them to use in the first place. You often read about celebrities going for two or three week stays in an inpatient treatment center and when they are done they proclaim that they have a new found way of life. Three weeks later you see them on a downroll spiral back into the same lifestyle. Like you have said in a few of your other blogs long term treatment is key in recovery. Addiction in not a quick fix situation, it is a complex situation with many variables.
Thanks for the feedback! and yes, addiction is a complex problem that does not have any quick fixes.
J
I too believe you must treat the whole person when looking into the treatment of addition. When an addict moves from one addiction to subdue the other this just causes a more serious problem.
The addict will always return to the original addition and have to new formed addition to deal with on top of the original one. When a person drinks they smoke and then they want to rid themselves of the drunk feeling so they turn to a stimulant like Meth or Cocaine.
Now they have created a mood and mind altering cocktail of destructive behavior. Prolonged exposure can turn into mental health issues. Co-Occurring disorders are more common than not with the recovery community. The big question I have encountered would be, is a person still clean if they are taking psych meds?
I say yes! If any medication is taken as intended then it is not abuse. To abuse is to take it to the point getting high.
I appreciate you sharing this. I feel that people often don’t succeed in addictions treatment because the treatment does not address all the issues the person is experiencing. Their mental health and environment are especially something I believe need to be addressed before a person can conquer addiction. Depression and anxiety are prevalent issues among people who misuse substances, and I believe very few of them know that they are depressed or experiencing an anxiety disorder. They may just think something is wrong with them, further isolating them. If I hadn’t been told I was depressed and wasn’t receiving treatment, I know with almost certainty that I would have never stopped abusing drugs because I had no coping skills in place to deal with my depression. Something I have also seen very often in my own social circle of recovering addicts, is what we call “trading,” one addiction straight across for another. I’ve had multiple friends join abstinence-only programs such as NA, or AA, and then promptly lose control of their sexual behavior. They feel they don’t have a problem anymore because they aren’t using, but they are engaging in risky, out-of-control behavior for the “high” of it, or to temporarily escape reality – fueling those same mechanisms that they were while they were using. I would like to see treatment programs partner with other programs to create a community for addictions treatment that addresses a wide spectrum of issues, from trauma to homelessness to sex to depression – and more. I think this is the key to seeing more people succeed in addictions treatment, and in their lives after treatment.
Rhianna, thanks for your feedback, very well said and I agree with it all!
J
“Rarely in my clinical work and research have I experienced patients that struggle with only one addiction, typically they have multiple types of addictions.”
I really appreciate this because as I was struggling to gain control of my addictions or in the past have tried to help others, it has been suggested “keep drinking, but try to give up smoking first.” Yet, the two are so closely wrapped up in the other that this seemed and seems, unreasonable. I also know for myself and many of my friends, alcohol and drug use is accompanied with eating disorders. I very much like the verbiage of “packages.” It implies what I was explaining, that these things are not just separate problems that sit next to one another, but are all wrapped up together.
I have been treated separately for eating disorders and alcohol and drug addiction, and it has never been mentioned that these two things could be linked. Only when my life began to be more stable and was happier did both of these struggles really start to fall away- I have seen this in many of my family and friends as well. I don’t know anyone who quit smoking cigarettes, but then continued to binge drink daily.
How would the medical community go about training people to treat holistically when it feels like medical school is becoming more and more specialized. Why was it in my treatment they physicians never even had a conversation with each other to make sure they were coming at my treatment from all angles? How did we get to this place we are now, of all treatment being compartmentalized?
Dr. Fitzgerald,
I feel like the addicts often blame themselves for the addiction and not seeking treatment because of the stigma with drugs. As a result, they become more isolated from their support systems and begin to get frustrated as they try to escape their addiction. Addiction as you mentioned, is often composed of many other underlying issues. Therefore in order to fix this, I believe the clinician has to understand the patient inside and out like you said. People have many stressors in their lives which vary form person to person. These stressors, in my opinion, play a huge role in determining the mental state of the patient and the well being of a patient. We all know that people use drugs to get the pleasures that come with them because they have no one to share their problems with. Especially nowadays, people are constantly working and working having no time to share their feelings with the ones they love. And once they find a way to escape reality even for just a moment, the fight against addiction begins. And I think to successfully treat a patient, not only the clinician is involved but also the ones closest to the patient.
All good questions Katharine, but in general I would say that we have a long way to go in training physicians about trauma and addiction. Like many fields, the curriculum is set by Boards and includes so much stuff that often many important topics like addiction get just a surface-level intro because there is no time to take a deeper dive. We also live in a world that likes to compartmentalize things…often a mirror of the internal world of those who are in positions of power.
J
I defiantly agree with your idea because i know couple people who have many addiction.The bottom line is addiction to one harm substance ,but in reality they exposed or had many addicting behaver like stealing and committing crimes to fulfill their needs in this case addiction to sunstance.The other thing you wrote very clear was about the consequence of addiction like depression and anxiety.
Dr. Fitzgerald,
I really like how plain and simple you have made this topic. I would have to agree with all you have written. I have a friend whose brother is all over the spectrum of overuse and “chaotic misuse” of drugs. Sadly, not only does he struggle with the addiction/dependance on cocaine, but also struggles with using marajuana as well as other drugs in combination. He has been on the streets for about a year now and doesn’t want to change his behavior. Once I read about this “package” a connection was made instantly to his situation and what you had written. It makes a lot more sense now, after reading the descriptions given above.
Thank you,
Madalina
I like the way you said that addiction usually come in packages. And I agree that addiction can lead to many bad things happen along with it. Mental health, behaviors and bad attitudes are those that need to be considered. Addiction also lead to committing crime or other social consequences. When someone does not have enough money to treat their need of drugs, they may steal money, becoming a robber or commit crime. Usually, people need and want are high, but in the case for those addicts, their needs and wants become even higher and uncontrollable.