1 of 3 Concurrent Treatment of Chemical and Behavioral Addictive Disorders since 1994
Treating BEHAVIORAL and Chemical Addictive behaviors together
Do you suffer from Prescription and/or illegal Chemical Dependency
Exercise - Health Addiction/Compulsion
Video Game Addiction
Compulsive Shopping Addiction
Problem Gambling Addiction
Other addictive compulsive behaviors
By Rai Cornell
Behavioral addiction refers to several mental health conditions in which a person engages in a particular behavior repeatedly; even if the behavior causes them harm—it may seem as if they simply cannot resist engaging in it.
The World Health Organization defined addiction as a recurring pathological relationship with a person, place, thing or event with life damaging consequences. Common behavioral addictions—also known as process or behavioral addictions—include gambling addiction, compulsive spending, eating disorders, love and relationship addictive disorders, shopping addiction, sexual and co-sexual addiction, hoarding, and kleptomania (impulsive stealing).
While the compulsivity associated with behavioral addictions may seem uncontrollable, treatment options are available to those who suffer from them.
WHAT FACTORS CONTRIBUTE TO HAVING A BEHAVIORAL ADDICTION?
A number of factors contribute to the development of behavioral addictions, including personality, substance abuse, and genetics. For example, you may have heard the term “addictive personality” in the context of addiction, treatment, and recovery.
While no clinical criteria define an addictive personality, research has shown that people who suffer from substance abuse or behavioral addictions tend to share common personality traits.
For instance, people who score high on personality and behavior assessments for impulsivity and sensation-seeking are more likely to suffer from a process addiction.
Similarly, people who score low on harm-avoidance are also more likely to suffer from a behavioral addiction.
Individual behavioral addictions are more common in people with a specific set of personality traits.
For instance, a person who scores high in harm-avoidance and shows traits of psychoticism, interpersonal conflict, and self-directedness may be more likely to suffer from internet addiction.
People who score high on impulsivity (an inhibition of motor activity) are more likely to suffer from active behavioral addictions, such as skin-picking or hair-pulling (trichotillomania).
1 Another factor that may contribute to a behavioral addiction is substance abuse. Researchers have studied in depth the relationship between substance abuse and gambling disorder, showing that addictive gamblers are approximately 3.8 times more likely to have an alcohol use disorder.
1 However, it is unclear whether a gambling addiction makes someone more likely to engage in substance abuse, if substance abuse increases the risk of developing a gambling addiction, or if the two conditions are caused by some other, unknown factor.
The influnce of Genetics
Genetics is another important factor that influences whether or not someone will develop a behavioral addiction.
If you have a first-degree relative (such as a parent or sibling) who suffers from a process addiction, you are at increased risk of suffering from either a behavioral or substance addiction yourself.
A study of identical and fraternal twins revealed that genes are responsible for 12–20% of the risk of gambling addiction, and environmental factors account for 3–8% of the risk. Further research has shown that 64% of the risk of developing both a gambling addiction and an alcohol use disorder is attributable to genetics.1 More research is required to identify whether genes play a role in the risk of other behavioral addictions.
Research has shown that urge-driven disorders, such as gambling addiction and kleptomania, trigger the release of extra dopamine, which causes feelings of pleasure. The factors that contribute to the onset of a behavioral addiction are unique to each person, which makes predicting behavioral addiction nearly impossible. However, what is clear is that when you continue to engage in the maladaptive behaviors associated with behavioral addiction, your brain is rewarded each time, which makes the addiction increasingly more difficult to overcome.
Research has shown that urge-driven disorders, such as gambling addiction and kleptomania, trigger the release of extra dopamine, which causes feelings of pleasure.1 Therefore, every time you engage in that behavior, your brain receives a pleasurable jolt of dopamine.1 Unfortunately, the brain becomes reliant on the behavior in order to feel that heightened sense of reward.1 A relative decline in these dopamine surges can leave you with feelings that resemble depression, which might further compel you to engage in the addictive behavior once again to feel good, further reinforcing the cycle of addiction.
WHAT ARE THE TYPICAL SIGNS AND SYMPTOMS?
The most recent version of the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists only one behavioral addiction (gambling disorder), three behavioral compulsions (hoarding disorder, trichotillomania, and excoriation), and one impulse-control disorder (kleptomania).2 However, all behavioral addictions have common traits, such as:1
Preoccupation with the behavior.
Diminished ability to control the behavior.
Building up a tolerance to the behavior so the behavior is needed more often or in greater intensity to get the desired gratification.
Experiencing withdrawal if the behavior is avoided or resisted.
Experiencing adverse psychological consequences, such as depression or anxiety symptoms, when the behavior is avoided or resisted.
Mental health professionals and addiction experts continue to debate the existence of and diagnostic criteria for other behavioral addictions such as sex, gaming, internet, and porn addiction, but evidence is mounting to support their validity as a diagnosable addiction.
COMMON BEHAVIORAL ADDICTIONS
According to the DSM-5, gambling disorder is characterized by a persistent and recurrent gambling behavior that leads to personal distress and problems in social, occupational, or other areas of functioning.2 You may be suffering from a gambling disorder if you meet four or more of the following criteria during a 12-month period:2
A need to gamble with increasing amounts of money to feel excited
Restlessness or irritability when trying to restrict or cut back on gambling
Repeated unsuccessful attempts to control, stop, or reduce gambling behaviors
A mental preoccupation with gambling, such as thinking of ways to get gambling money or reliving past gambling experiences
Gambling to relieve stress
Returning to gambling after significant monetary losses, especially with the intention of gaining back losses
Lying to conceal gambling activity, involvement, or debts
Jeopardizing relationships, jobs, or education for the sake of gambling
Relying on others to get out of desperate financial situations caused by gambling
Hoarding disorder and trichotillomania are behavioral addictions that are classified in the DSM-5 as obsessive-compulsive disorders. Hoarding is a persistent difficulty in parting with physical possessions, regardless of its value, the space one has, the need for money, a safe living environment, or other resources.2 Hoarding is sometimes associated with a shopping addiction, though there is no official diagnosis for shopping addiction in the DSM-5.
Trichotillomania is another process addiction that is labeled as an obsessive-compulsive disorder.2 Trichotillomania is the compulsion to pull out your own hair, which often results in hair loss and significant social or occupational functioning.2 Similarly, excoriation is a skin-picking disorder in which you compulsively pick at your skin until lesions form.2 Excoriation causes significant impairment in day-to-day functioning because you are unable to stop the behavior.2
Kleptomania—the impulse to steal items—is classified in the DSM-5 as an impulse-control disorder and is defined as the recurrent failure to resist stealing objects, especially objects that are not necessary for use or monetary gain.2 If you suffer from kleptomania, you will experience tension right before stealing, followed by relief and pleasure immediate afterward.2
While gaming, internet, porn, sex, food, and shopping addictions are not officially APA-verified conditions, many experts believe that they should be included in the DSM. Researchers are continuing to work on developing standard criteria for identifying these other behavioral addictions. And, although these addictions are not included in the DSM-5, many reputable inpatient, outpatient, individual, and group treatment options for these behavioral addictions are available.
(Read more next blog) part 2
TREATING BEHAVIORAL ADDICTIONS - Michael Yeager B.A., LCDC, C.ht, CAS, SAP, CTC
As a addictions counselor, since 1/1/73) it has been my goal to find and facilitate recovery strategies that get results. In the 1980's when I was with Centennial Peaks in Boulder, Colorado I began this approach while being coached by Terry Kellogg, an advanced thinker in the addiction treatment field. All programs I've managed since then including my private practice have integrated this concept; all programs have experienced excellent results. The program I run in my practice is designed to treat the disease of addiction, so all behavioral addictions are included. I concurrently treat Prescription drug addiction as well as illegal drug addiction, & behavioral addictions (sexual, problem gambling, compulsive spending, work, relationship, love, eating (over or under), nicotine, any behavior used to medicate vs resolve a live problem, affected family members - co-dependency - survivors of incest, abuse, trauma, PTSD and grievers suffering the effects of death and non-death related losses. I provide pain management & non-medical detoxification services using the NADA Protocol with Auricular Acupuncture and hypnotherapy. I also work to help people resolve stress, fears of (flying, test taking, public speaking etc), phobias, etc. with Hypnotherapy, Therapeutic Massage, Reiki,
Thought Field Therapy, Emotional Freedom Techniques, CBT, DBT, EMDR, Solution Focused Therapy, Brain Spotting, The Silva Method, Reality Therapy, the 12 Step Approach, Healing Touch, Touch for Health & Applied Kinesiology to assess the truth vs falsehood nature of the client information given, the nature of the problem and the most effective resolution.
Directly below find the “Yeager Recovery Model” which is a compilation of Broken Toys Broken Dreams by Terry Kellogg, EST, The Forum, More to Live, The Course in Miracles, the 12 steps, Self-Management and Recovery Training (SMART) Recovery, Cognitive Behavioral Therapy Albert Ellis, As a Man Thinketh James Allen, Anatomy of the Spirit Carolyn Myss, "Letting Go, Power vs. Force and Transforming Levels of Consciousness" Dr. David Hawkins (non-duality), Life Energy & The Body Doesn't Lie John Diamond, Conscious Language Robert Tennyson, and Michael Yeager’s experience, creativity and insight into "why people are the way they are and how they can change if and when they want to even a little bit". The answer is available as soon as the question appears, one does not exist without the other. The care givers MUST give up their belief "that time is what we need more of to heal", time heals nothing it is what we do with time that heals. Strictly from the dualistic approach, if one can become damaged in an instant one can become healed in an instant as well. Illness (mental, physical, spiritual, sexual, financial) are something the person participates in, consciously or unconsciously, therefore it is ones conscious participation in recovery that brings it about.
In the "Yeager Recovery Model" it is stated that “We are each responsible for how we react/respond to all life events. Certainly in our pre-verbal and younger years we were sponges, simply taking information in as there was no discernment possible, so we decided, assumed, took as law these decisions/experiences that we didn’t know we could question. As we grew up these decisions of younger years helped form our growing up decisions and if left unquestioned their foundation as our truth became stronger. Not because they were "True" but because we did not know we could question them.
Shame, imposed or self-generated, implies that one is simply, bottom line not enough, can never be enough, may try to be enough but their core self will always pull them back to this core of not enough, appears to be strong in all addicts. Or the opposite of I am better than most/all. Both state separation. Addiction mentality is based in part on the idea that “one is too many and 1,000 is not enough”. The drive of the addict is to get enough to “do it” which is never accomplished.
As life and the events in life are empty and meaningless, in and of themselves, and that they are empty and meaningless is empty and meaningless, and remains as such till each person experiencing the event assigns them a meaning and then attaches themselves to that meaning. This simply means that they have assigned an event a meaning and attached self to that meaning nothing more. The event itself is still neutral in meaning. The work of therapy is to help the client detach from the meaning they originally gave to the event, to then tell the only TRUTH about it which is "it happened" and re decide now how they want to relate to it now.
Each person is the key player in their own life. The event/s in life, the emotion or lack thereof, are of their own creation, based upon how they believe about ourselves, what family, social, peer group, taught that they accepted and internalized. Also what got incorporated as a youth about acknowledgement and expression of emotion, how they personally relate to the event, how much history they have attached to this event, what their negative or positive beliefs about themselves are. This approach dives into this aspect (the beliefs) of the person as they relate to acceptance of a problem and the steps that can be taken to resolve it.
Through denial, minimization, personalization, enmeshment, feelings of abandonment, rationalization, delusion incomplete grief etc., people grow into unconsciousness and can, as the poet said, "go from adolescence to senility without ever knowing what happened in between". This is why it is so important that the co-dependent/addict stop their addictive behaviors to give them a chance to simply wake up to their own sense of reality.
It is from this foundation that applied kinesiology (muscle testing) is used to help identify core foundation issues, create the most effective treatment plan to resolve the issues, pick from a variety of therapies to bring about a swift and permanent recovery. Amino-acids, diet and nutrition are incorporated in the beginning to reestablish balance to the brain chemistry which will enable the client to hear and respond in a responsible recovery manner.
(Read more next blog) Part 3
In Auricular acupuncture, the “Shen Men, Kidney, Liver, Lung, Autonomic Nervous System” meridians are used to restore balance. Energy Psychology approaches like EFT/TFT/EMDR/TAT/Psy-K are used to uncover and release the unconscious resistances to healing, being about resolution to past traumas, fears etc. Cognitive Behavioral Therapy, NLP, Voice Dialogue, Hypnosis and Solution Focused Therapy are incorporated to help get the person's cognitive thinking grounded as they reframe their internalization of life events and decide now how they want to relate to the events and the people involved in the events. Grief Work is incorporated from the beginning to facilitate an emotional release from the ties that once bound them to co-dependency, addiction and all dysfunctional relationships.
Therapeutic aftercare and support groups like SMART Recovery, 12 steps, Women for Sobriety, Secular Order of Sobriety, Rational Recovery, Church, and Recovery Coaches are utilized to aid the client in the ongoing continuing effort to establish a new “recovered” internal and external view of self. Individual care is taken to align the client with the most effective approach depending on spiritual orientation/understanding, level, comfort or need for group support, ability to respond to self-correction, internal motivation to change, individual acceptance of the traditional disease concept, level of internal surrender to idea they have an addiction and return to safe drinking/drugging is not possible or that their addictive behavior is a learned response and can be unlearned.
In my book "12+2 Steps Young People in Recovery" 4 (great workbook for people of all ages) many of these components are covered. You can download an e-book version or order the hard copy at www.contemporaryteaching.com. Go to www.amazon.com look up title or Michael Yeager
Behavioral addiction treatment and rehabilitation presents a challenge in many cases because, unlike treatment for drugs or alcohol, abstinence can be impossible. For example, a person who is addicted to overeating cannot cut food out of their life. For this reason, some types of behavioral addiction treatment programs focus primarily on rehabilitation and recovery rather than detoxification or abstinence.
Behavioral addiction residential treatment programs address the underlying psychological issues that led you to develop the process addiction. These programs often follow the same structure as substance abuse treatment programs, including 12-step programs, motivational enhancement, and cognitive behavioral therapies that have proven successful at treating behavioral addictions.1 These treatment programs focus on helping you develop healthier ways of dealing with life and daily stressors.
In addition to residential programs, outpatient behavioral addiction treatment is another option for those struggling with these conditions. Outpatient therapy involves visiting a treatment facility or medical professional on a daily or weekly basis during the beginning stages of treatment. As you begin to feel more control over your behavioral addiction, treatment may become less frequent. Outpatient treatment usually involves a maintenance period in which you visit twice monthly or once per month to receive supportive ongoing care.
During individual or one-on-one counseling, you meet privately with a behavioral health counselor who is trained in behavioral addiction therapy. Sessions focus on identifying the emotional issues and underlying causes of the behavioral addiction, which can include trauma therapy, if applicable. One-on-one counseling offers you a chance to privately voice concerns that may otherwise be uncomfortable to talk about with others in a group setting.
In many behavioral addiction treatment programs, therapy is based on the cognitive behavioral therapy (CBT) model. CBT focuses on eliminating unhealthy or negative behaviors by replacing them with positive, healthier options. This form of treatment teaches new behavioral patterns as well, but the focus is usually on the motivations behind the behavior rather than the physical actions themselves. One of the main goals of CBT is to change or modify the thought processes that led to the behavioral addiction.
Another treatment option is group therapy in which you attend a session that at least two other patients and one behavioral health counselor are present. Group therapy allows you to share common experiences and understand that you are not alone in the addiction and recovery process. During group therapy sessions, the therapist may lead your group in a focused topic or leave the topic of discussion up to the group members. Common topics in group sessions include denial, legal problems, relationship problems, work problems, health issues, financial struggles, identity crises, and stress.
Similar to group therapy, non-12 step and 12 step support groups,
12-step recovery programs provide a structured framework for working through behavioral addiction problems while having the support of others who have gone through similar experiences. 12-step programs have a spiritual basis to them and suggest participants to admit that they do not have control over their addictions. Non-12-step programs follow a similar structured framework, but exclude any spiritual affiliation and emphasize taking personal accountability for one’s addiction. Non-12-step, 12-step, and group therapy programs are excellent options for long-term recovery because they offer built-in support from people who understand how hard overcoming addiction can be. It has been found that 100% of the people who remain in recovery are those who follow the program they choose most all of the time.
The type of behavioral addiction treatment program you need will depend on your specific addiction. For example, a gambling addiction requires abstinence as part of the treatment program, while overeating requires relearning behaviors so that you can modify negative patterns and engage in healthy eating. The staff at the facility you choose will assess your situation and your addiction, and then determine the most effective behavioral addiction treatment for your unique circumstances.
A majority of addiction treatment facilities focus on treating chemical addictions and leave the other addictive disorders to be discovered or resolved at a later date. Several different types of these addiction treatment facilities are available, including state-funded, nonprofit, and privately owned rehabilitation facilities. All facilities, no matter how they are funded, must comply with patient privacy rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).3
There are only a handful of facilities that advertise and provide treatment for the behavioral addictions. One reason for this is purely financial; insurance will not pay for treatment of the behavioral addictive disorders. I find that another reason is that some staff has not been educated in treating these addictions and the “number 1 problem concept” philosophy is still adhered to by staff and administration. “Get them clean and sober first then some of these other addictive behaviors may drop away on their own”. The CEU courses found on www.contemporaryteaching.com address these other addictive disorders and how to treat them.
The decision about which type of treatment facility to choose depends on whether you plan to use health insurance or private pay, where you want to complete your treatment, and what sort of addiction you are working to overcome. Some treatment facilities specialize in one particular kind of addiction (such as gambling addiction), while others offer various programs or an all-inclusive program to treat people with a variety of different addiction struggles. You can also choose from inpatient and outpatient programs, or a sequential combination of both.
Ideally, people suffering from behavioral addiction will receive multiple forms of treatment. For example, in an inpatient, outpatient or individual therapy setting, clients may participate in one-on-one therapy sessions, group therapy, skills building activities, and coping skills development. This diverse therapeutic approach offers the greatest chance of success in beating a behavioral addiction.
Go to www.contemporaryteaching.com for information about all 77 approved and SKYPE CEU courses.
Grant, J. E., Potenza, M. N., Weinstein, A. & Gorelick, D. A. (2010). Introduction to Behavioral Addictions. American Journal of Drug and Alcohol Abuse, 36(5), 233–241.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Association.
United States Department of Health and Human Services. (2016). Summary of the HIPAA Privacy Rule.
Michael Yeager’s 44 years of clinical experience and personal recovery observations. 12+2 Steps Young People in Recovery workbook