The best Intervention is Prevention. We are often unaware of what it is we are trying to prevent and typically look into the rearview mirror with regret. Recovery includes accepting direction from those who can coach or mentor you.
The following is not meant to be a technical presentation of Obsessive-Compulsive Disorders, Addiction and/or Co-Occurring Disorders, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-R), but rather a common sense understanding of the difference between being focused, obsessed and, addicted. The following information is intended to raise awareness as to the nature of the “beast” called addiction with all its tributaries so the individual(s) know what they are potentially, or currently, up against.
Be it positive or negative in its origin, an addiction is a behavior which will destroy the individual rather than build him or her up. Sex and pornography, eating, gambling, exercise, shopping and digital scrolling are examples of process addictions. Over time, as the addiction progresses, more thoughts and behaviors revolve around that core integrating habit to the exclusion of other activities.
A co-occurring disorder is a condition that exists separate and apart from the addiction, though it has an interactive and compounding consideration for treatment. For example, sexual trauma, the highest percentage of traumas in the PTS category, may be occurring alongside substance use, creating a state of “helpless, hopeless, incomprehensible demoralization” which commonly precedes suicide.
Some activities are inherently positive while others are inherently destructive. No one would dispute the positive effects that exercise and proper nutrition have on one’s life. However, even positive activity has the potential to undermine all the goodness it was meant to contribute to one’s life.
A point of diminishing return exists in everything. What started out as an innately positive activity can result in an imbalanced, one-dimensional life where all other relations and activities must support that activity at the expense of others. The joy of the activity may have been lost and/or it becomes an activity to avoid other parts of one’s life.
We could say the above is a good general “lay” operational definition for addiction, whether it starts out as a positive or negative behavior. Let’s also assume, without getting into a long discussion and debate, there is a healthy difference between being focused and driven, versus an obsessive-compulsive disorder (OCD) or addiction.
William Glasser, M.D. in his book “Positive Addiction”, asserts “a positive addiction increases your mental strength and is the opposite of a negative addiction, which seems to sap the strength from every part of your life, except in the area of the addiction.”
Jeffrey K. Zeig in his article “Positive Addictions: Choosing Your Habits Wisely” suggests that the distinction between a positive and a negative addiction has to do with issues of morality or values. While there are some subtle and obvious distinctions between positive and negative addictions, there are universal similarities in the addictive process regardless of the addiction.
In both cases, be it a positive or negative activity, it is important to understand the progressive nature of the process and generally understand that transition from one stage to another does not have discrete boundaries. In the case of a substance, it may have started out as a single thought that drove the individual into action, but thoughts drive behavior.
Over time, more of one’s thoughts and behaviors revolve around that core integrating activity to the exclusion of others. In addition, with time, the addict will evolve to only associating with those whose thoughts and behaviors reflect their own. Addiction is often a transition or progression that occurs without detection until one day we wake up and those close to us notice the change, often before we do. This may result in relationship challenges and/or transitions.
Every addict’s journey is fueled by people, typically friends and family, who unwittingly do those things that make the journey more comfortable than it would be without their “support”. It is typically done in the name of love. Everyone who starts out on their progression have people, sometimes with the best of intentions, supporting their journey, potentially and unwittingly, into addiction.
There are unwitting enablers and intentional enablers. Unwitting enablers may be unaware what is going on but make it easy for the addict to progress in their addiction. Intentional enablers know the destructive effect they are having on the addict and don’t care. Every professional athlete who was involved with performance enhancing drugs probably had people helping them along the way knowing they were cheating and doing the wrong thing. There are some CrossFitters who are getting that same artificial edge.
In some cases, unwitting enablers are parents who know their kids will drink or use drugs, so they provide a safe home to smoke that joint or have some beers with the other kids, justifying this support through rationalization. It could be the drug dealer who is ready, willing, and able to provide you with drugs. It could be a significant other who lies to cover up your activity thereby allowing you to avoid the consequences of your behavior. It could be a friend who says or does nothing knowing their friend is regularly getting drunk and/or loaded. In all cases they are as involved in the addictive process as the addict.
The cornerstone of the path into addiction is built on denial. In the early stages of the progression where the natural consequences haven’t become as painful as they will later, it is easier for self-delusion to exist. As incredulous as it may sometimes seem, even when the consequences have become catastrophic, the addict is still capable of denial of monumental proportion. The clinical files are stacked with individuals who have had multiple treatment episodes, lost family, fame, and fortune, but persist on their journey into self-destruction.
As one progresses on the path of addiction, they will start lying, manipulating, and deceiving those in their life. A new personality and person emerge. Sadly, and tragically, the one the addict lies to, manipulates, and deceives the most is him or herself. As the deception increases, it frequently makes the receiver of the charade wonder whether they are losing their mind. Things are just not adding up and they can’t fathom that their child, spouse, or friend would look them right in the eyes and lie, manipulate or deceive. It is devastating, painful, and depressing to discover the long-lasting charade. To some degree, addiction can be viewed as a “disease of dishonesty.”
No addiction starts without a contextual background, and family disease is typical. As the addict chases their addiction, the family member (or friend) chases the addict. In a sense, they both become addicted to the chase, one to the substance or activity the other to the addict.
This chase lasts until the family member’s veil of denial is lifted. Once the family catches on to the lies, manipulation, and deceit, and to what they may view as their own naïveté and stupidity, love is frequently mixed with rage and subsequently sadness and depression in the family. The progression typically goes from denial to heartache, and ultimately heartbreak. An addict who is practicing their addiction has the potential to destroy themselves and their family. Until recovery starts, the typical family progresses from confusion, to heartache, and subsequently heartbreak, with all the emotions that go with that process. All members of the family suffer; all need to recover.
A co-occurring disorder is a condition that exists separate and apart from primary addiction though it has an interactive and compounding consideration for treatment. Common among the military and first responders is PTS(D) due to the high exposure to traumatic events.
Moreover, as addiction progresses, the consequences on relations, career, legal, and financial matters deteriorate eroding one’s self esteem creating depression and anxiety as a natural result of the addiction. It now becomes challenging to sort out if the depression and anxiety is a result of the drugs and alcohol or a separate disorder that stands on its own.
Making the matter even more complicated, when addicts visit mental health professionals, they all too often lie or withhold information about their drug and alcohol use. The unassuming professional winds up diagnosing, treating, and often prescribing medication for a mental health condition which is really an addiction. The fictitious diagnosis develops a life of its own as it is passed on from one clinician to another. This is called a “legacy diagnosis.”
Perhaps the mental health condition that makes recovery most challenging is “Oppositional Defiant Disorder” (ODD) coupled with “Attention Deficit Disorder” (ADD). The challenge of taking direction and staying focused seems to plague many struggling to recover, whether or not those diagnoses were made during the individual’s developmental years.
It should come as no surprise that sexual trauma is the highest percentage of traumas in the PTS category. Research by the Veterans Administration reveals 25% of all women who serve have been sexually assaulted while on active duty, while the greatest number of sexual assaults in the military is man on man. It is estimated that civilian women are also sexually assaulted at the same frequency.
The short-term effects of sexual trauma include shock, confusion, fear, anxiety, and panic attacks. Some of the long-term effects of sexual trauma include depression, eating disorders, sexual dysfunction, substance-use disorders, relational problems, suicidal preoccupation, homelessness, and death by suicide. There is no event in life that has a more derailing and intractable effect on healthy development than sexual trauma.
In the rooms of 12 Step meetings, it is common to hear the phrase: “jails, institution or death” suggesting it is the alternative to “recovery”. For someone who has been in those rooms for several decades, I have witnessed its truth. There exists a high correlation between substance abuse, creating a state of helpless, hopeless, incomprehensible demoralization which commonly precedes suicide.
Among homeless veterans, a significant number are found to have a Substance Use Disorder (SUD) along with a Co-occurring Disorder. First Responders are found to have a higher death by suicide rate than deaths caused during on the job duties. SUD and Co-Occurring Disorders typically precede death by suicide.
When most people think of an addiction, they immediately think of drugs or alcohol. However, there are a variety of addictions that are related to an uncontrollable obsession or compulsion to engage in that behavior. These process addictions include: sex and pornography, eating, gambling, exercise, shopping, and the internet.
The consequences of the process will typically define whether it is an addiction or not. Much like not everyone who has a drink of alcohol is an alcoholic, it will become obvious who the real social drinker is and who is the alcoholic. Process behaviors will typically reveal the healthy from the unhealthy when consequences are considered. Nevertheless, consequences are not the only determining factor. Process addictions often occur as a co-occurring addiction alongside drugs and alcohol.
Sexual addiction would include any combination of the following: chronic, obsessive thoughts and fantasies; compulsive relations with multiple partners, including strangers; lying to cover up behaviors; preoccupation with having sex, even when it interferes with daily life, work productivity and work performance; inability to stop or control the behavior, putting oneself or others in danger due to sexual behavior; experiencing other negative personal or professional consequences.
The strain that infidelity puts on a marriage is an obstacle that often proves hard to overcome, frequently leading to divorce. It is important to remember that sexual activity per se is not a sign of sex addiction. Sex is a healthy human activity and enjoying it is normal. Moreover, people typically differ in the strength of their sexual drive and the pleasure they derive from the activity without it being considered an addiction.
Sexual addiction does not include pedophilia or bestiality, often considered irreversible. Pornography has often been considered challenging to define but clearly identified when witnessed. Pornography has exploded in its prevalence much like the growth of the internet. It is often considered the mistress in marriage and relations and evokes the same sense of betrayal of intimacy.
Just as every addiction progresses along its own destructive path for addicts and their significant others, so does recovery progress along its own path. It is typically a slow process that is done one day at a time.
The first year in recovery is needed for each to establish a foundation of recovery. It takes time to learn what the tools of healing are, time to use the tools and time needed for the healing to take place. In other words, healing takes time. Be patient.