ADDICTION AND COMPULSIVE BEHAVIOURS

Addiction, also called Substance Dependence, is a state of psychological and physical dependence on a legal or an illegal substance. The term Addiction is also applied to Compulsive Behavioural disorders where a person also shows a lack of control with regards to being able to engage in a specific behaviour in a moderate fashion. When Compulsive Behaviours are taken to extremes, individuals often have difficulties in important areas of life and in important relationships. Other situations in which people show compulsivity are with Sex, Porn, Internet, Gaming, Television, and Gambling.[1] People who engage in Addictions or Compulsive Behaviours often experience three forms of dependence, or cravings: behavioural dependence (seeking substance-seeking activities), physical dependence, and psychological dependence.[2] Over time, people develop tolerance to the Addictive and Compulsive Behaviours, meaning that the person will need more and more substance or escalate the Compulsive Behaviours in order to get the same rewarding results.

Substance-Related Addictions

  • Tobacco
  • Alcohol
  • Coffee
  • “Street” Drugs
  • Prescription Drugs

Behaviour-Related Addictions

  • Food
  • Love
  • Sex
  • Pornography
  • Television
  • The Internet
  • Video Games
  • Shopping
  • Gambling
  • Work
  • Lying
  • Stealing
  • Setting Fires
  • Fame
  • Money
  • Power
  • Rage (Intermittent Explosive Disorder)
  • Body Image
  • Exercise
  • Sleeping
  • Working
  • Thrill-Seeking/ Adrenaline

Canadian Statistics

  • In 2015, 13% of Canadians were smoking cigarettes, which amounts to 3.9 million smokers.[3]
  • More males (16%) reported smoking as compared to females (10%) in 2015, with males consuming 15.2% cigarettes per day compared to females (11.9%).3
  • Smoking was more prevalent among young adults aged 20 to 24 (18%) compared to youths aged 15 to 19 (10%) and adults aged 25 and older (13%).3
  • Six percent of former smokers had quit less than one year prior to the survey while 94% were long-term quitters.3
  • Sixty-three percent of daily smokers reported that they were considering quitting cigarette use in the next 6 months and among them, 41% considered quitting in the next 30 days.3
  • Thirteen percent of Canadians used at least one illicit drug in the past year.3
  • Drug use was higher among males (15%) than females (10%).3
  • Drug use was also higher among youths aged 15 to 19 (21%) and young adults aged 20 to 24 (31%) than among adults aged 25 and older (10%).3
  • Cannabis was found to be the most prevalently used drug (12%) compared to other drugs like cocaine, ecstasy, methamphetamines, and hallucinogens (2%).3
  • Three percent of Canadians aged 15 and older reported experiencing at least one harmful experience in the last year, as a result of their drug use. Youths aged 15 to 19 years (6%) and young adults aged 20 to 24 (8%) reported experiencing more harmful situations, compared to adults aged 25 and older (2%).3
  • Seventy-seven percent of Canadians reported consuming an alcoholic beverage in the past year, with males (81%) reporting greater alcohol use during the past year compared to females (73%). Alcohol use was higher among young adults aged 20 to 24 (83%) than youths aged 15 to 19 (59%) and adults aged 25 and older (78%).3
  • In 2015, 20% of Canadians consumed more than 10 to 15 alcoholic drinks per week.3
  • Twenty-two percent of males consumed more than 15 drinks per week while 18% of women consumed more than 10 drinks per week.3
  • Young adults aged 20 to 24 had riskier patterns of alcohol consumption compared to youths aged 15 to 19 and adults aged 25 years and older. 28% of young adult drinkers consumed more than 10 to 15 drinks per week while 16% of youth drinkers and 19% of adult drinkers consumed more than 10 to 15 drinks per week.3
  • Between the years 2012 to 2013, a total of 155,210 Canadians accessed publicly funded substance abuse treatment centres.[4]
  • Most individuals suffering from Substance Abuse access residential treatments (programs in which overnight accommodation is provided for the purpose of Substance Use or gambling treatment), non-residential treatments (e.g. outpatient services, halfway houses, youth shelters, mental health facilities or correctional facilities) and non-residential withdrawal management programs (initial supervised, controlled period of withdrawing substances of abuse such as social detox, daytox, and home detox) once a year. Other individuals suffering from Substance Abuse attend residential withdrawal management programs (programs where clients spend nights at the treatment service facility for supervised withdrawal of abused substances) twice or more throughout the year.4
  • Males who suffer from Substance Abuse accounted for the majority of the people accessing specialized services that are mandated to provide alcohol, drug, and/or gambling treatment programs and services (specialized treatment services). Individuals between the ages of 25 to 34 also accounted for the majority of those who accessed specialized treatment services. A majority of people (37.4% to 55.8%) were also listed as unemployed during the time they received treatment.4
  • Between the years 2013 to 2014, approximately 79% of adult Canadians participated in some form of gambling in any given year. 2.6% are moderate risk gamblers and 0.9% are problem gamblers.[5]
  • At least 31,792 helpline calls about gambling problem were made between 2013 and 2014 and at least 6,705 counselling clients sought help for their own gambling problem.5

Behaviours associated with Addiction and Compulsive Behaviours:2

  • Difficulty controlling the Addiction or Compulsive Behaviour, which results in a failure to fulfill major role obligations at work, school, or home.
  • A great deal of time is spent in doing Compulsive Behaviour, activities necessary to obtain the substance, use of the substance, or recover from its effects.
  • The substance is often taken in larger amounts over a longer period of time, in order to get the same effects.
  • The Compulsive Behaviours are taken to a greater and greater extreme in order to get the same rush/high.
  • Individuals deny that they have a problem despite the fact that they have interpersonal relationship problems caused by the worsening of the Addiction or Compulsive Behaviour.
  • Important social, occupational, or recreational activities are given up or reduced because of Addictions or because of engaging in Compulsive Behaviours.
  • Concealment of the Addiction or the Compulsive Behaviour.
  • Difficulty with the law, due to the Substance abuse or Compulsive Behaviour.

Feelings associated with Addiction and Compulsive Behaviours:[6]

  • Helpless
  • Anxious
  • Guilty
  • Depressed
  • Euphoria while intoxicated with substance or doing the activity associated with Compulsive Behaviour.
  • Irritable

Thoughts associated with Addiction and Compulsive Behaviours:

  • “I am in so much pain and the only thing that can make me feel better is this.”
  • “For a long time, I did not want to stop doing this. But now that I want to stop, I can’t and my partner threatened to leave.”
  • “I want to erase every nasty thought that bugs me every day of every week.”
  • “Whenever I get lost in my Addiction or Compulsive Behaviour, I do not have to worry about anything else.”

Addiction, Compulsive Behaviours and the Body:6

People engaging in Addictive and/or Compulsive Behaviours often experience physical symptoms that include the following:

  • Lack of co-ordination
  • Restlessness
  • Weight gain/loss
  • Hallucinations
  • Heart Palpitations
  • Blurred vision

Addiction, Compulsive Behaviours and the Brain:

Substance abuse and Compulsive Behaviours impact the rewards system of the brain (cortical and limbic regions of the brain), called the “brain-reward circuitry.” Whenever the brain experiences a rewarding sensation after the use of substance or the engagement in Compulsive Behaviour, the brain learns that repeating the behaviour/taking the substance will result in the same positive or numbing feelings and sensations, which in turn then motivate the person to continue using the substance or engaging in the Compulsive Behaviour. The Addiction or Compulsive Behaviour continues because the brain continues to seek that rewarding sensation.2 In other words, the rewarding consequences of the Substance or Compulsive Behaviour increase the likelihood that the person will continue using the substance or engaging in that behaviour, through the process of learning and pairing of “feeling good” with the substance/Compulsive Behaviour.

Does Psychology work?

  • Mindfulness Therapy (MT): The trait of mindfulness refers to having a mindful attitude and behaviour in everyday life, including not reacting to and accepting one’s own momentary thoughts, feelings, body sensations, and perceptions. MT targets mechanisms underlying Addiction, such as helping people pay attention to Addiction-related internal (“I feel bad inside” or “I have bad thoughts”) and external cues (“I pass by this neighbourhood and I want to stop at the pub” or “when I wake up, I like to have a cigarette with my coffee”). MT also helps people unlink the rewards that people have experienced after they engaged in substance abuse or Compulsive Behaviour, such as feeling more relaxed or being able to sleep after drinking alcohol. Studies suggest that MT helps people have more positive emotions, reduced reactivity to Addiction-related cues, greater control over themselves, and improved response to natural rewards.[7]
  • Cognitive-Behavioural Therapy (CBT): CBT is based on the notion that thoughts cause behaviours, emotions and body sensations and that these thoughts determine the way people perceive, interpret, and assign meaning to their environment. By modifying a person’s thought processes, their maladaptive behaviours and uncomfortable feelings and body sensations can be changed.[8] Studies found that CBT combined with motivational interviewing has a clinically significant effect on treatment outcomes of Depression and Alcohol Use Disorders compared with treatment as usual (counselling and/or medication treatment).[9]
  • Eye Movement Desensitization and Reprocessing (EMDR): This therapy desensitizes the behavioural, physical, contextual, and psychological triggers. The Addictions Protocol (Desensitizing Triggers and Urge Reprocessing [DeTUR] Protocol), focuses on processing and eradicating present triggers that induce craving.[10] Additionally, EMDR is an effective treatment for Addictions due to traumatic events/experiences.[11]

Tips to Manage Addiction and Compulsive Behaviours![12]

Completing counselling for Addiction and Compulsive Behaviours is a must. Given that individuals may encounter cravings and triggers that will make them want to go back to those behaviours, here are some tips to manage cravings:

  • It is important for the person to identify personal triggers and have a plan for what he or she should do when they encounter these.
  • Practicing what to do when encountering these triggers also helps. Practicing will help this behaviour become a habit and will make it easier for that person to do when he or she does encounter a trigger or a craving.
  • Take care of one self by eating and sleeping well, exercising, and remaining aware of your emotions. When people take care of themselves they become more equipped in handling things that cause a relapse.
  • Do not test whether you have recovered from the Addiction or Compulsive Behaviours by re-engaging in these behaviours. Recovery is an ongoing process.

Addiction includes elements of abuse of the substance and dependence on the substance. Abuse and dependence can also be applied to Compulsive Behaviours such as gambling, eating, internet use, gaming, and stealing. People who engage in substance abuse or Compulsive Behaviours often find it difficult to stop these behaviours because the brain has learned that the body will receive a reward after engaging in these behaviours. Fortunately, HopeWell Psychological can help. We use various therapies such as Mindfulness Therapy, Cognitive-Behavioural Therapy, and Eye Movement desensitization and Reprocessing and tailor the treatment to suit the individual’s specific needs.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] VandenBos, Gary R. APA Dictionary of Psychology. Washington: American Psychological Association, 2015. Print.

[2] Sadock, Benjamin James, Sadock, Virginia Alcott, & Ruiz, Pedro. Kaplan & Sadock’s Synopsis of Psychiatry. Philadelphia: Wolters Kluwer, 2015. Print.

[3] Statistics Canada. “Canadian Tobacco Alcohol and Drugs (CTADS): 2015 summary.” Government of Canada. Health Canada,  2017. Web. Apr. 2017.

[4] Pirie, T., & National Treatment Indicators Working Group. “National Treatment Indicators Report: 2012-2013 Data.” Canadian Centre on Substance Abuse. 2015. Web. Apr. 2017.

[5] “Canadian Gambling Digest 2013-2014.” Responsible Gambling Council. Canadian Partnership for Responsible Gambling, 2015. Web. Apr. 2017.

[6] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington: American Psychiatric Publishing, 2013. Print.

[7] Garland, Eric L., Howard, Matthew O., Priddy, Sarah E., McConnell, Patrick A., Riquino, Michael R., & Froeliger, Brett. “Mindfulness Training Applied to Addiction Therapy: Insights into the neural mechanisms of positive behavioural change.” Neuroscience and Neuroeconomics 5. (2016): 55-63. http//dx.doi.org/10.2147/NAN.589257.

[8] Winters, Ken C., Tanner-Smith, Emily E., Bresani, Elena, & Meyers, Kathleen. “Current Advances in the Treatment of Adolescent Drug Use.” Adolescent Health, Medicine and Therapeutics 5. (2014): 199-210. DOI:  10.2147/AHMT.S48053.

[9] Riper, Heleen, Andersson, Gerhard, Hunter, Sarah B., de Wit, Jessica, Berking, Matthias, & Cuijpers, Pim. “Treatment of Comorbid Alcohol Use Disorders and Depression with Cognitive-Behavioural Therapy and Motivational Interviewing: A Meta-Analysis.” Addiction 109.3. (2014): 394-406. DOI: 10.1111/add.12441.

[10] Markus, Wiebren, & Hornsveld, Hellen K. “EMDR Interventions in Addiction.” Journal of EMDR Practice and Research 11.1 (2017): 3-29. https://doi.org/10.1891/1933-3196.11.1.3

[11] Wise, April, & Marich, Jamie. “The Perceived Effects of Standard and Addiction-Specific EMDR Therapy Protocols.” Journal of EMDR Practice and Research 10.4 (2016): 231-244. https://doi.org/10.1891/1933-3196.10.4.231

[12] Green, Kate. “5 Tips for Managing Triggers during Addiction Recovery.” Psych Central. 2013. Web. Apr. 2017.

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