Overview of Behavioral Addictions: Defining, Understanding Causes, Progression, and Initial Treatment Strategies

This podcast episode provides a comprehensive overview of behavioral addictions, broadening the definition of addiction beyond just chemical substances to include activities or even people used to escape emotional or physical pain. A core argument presented is that addiction should be viewed not as a disorder, but as a survival mechanism developed when individuals lack adequate coping tools to deal with life's challenges. The speaker emphasizes that for many, the addiction becomes a 'best friend' or the only way to feel normal, highlighting the unique and subjective nature of each person's ability to cope with their circumstances.

The episode delves into the developmental origins of addiction, citing critical periods such as a lack of early bonding (impacting trust and the ability to interpret inner cues), challenges during Erikson's stages of industry vs. inferiority (leading to lack of confidence), and identity vs. role confusion (resulting in self-definition based on external factors). It also explores various pathways to addiction, including recreational use, prescribed medication (e.g., opiates becoming 'screw it pills' for anxiety), and the complex interplay with undiagnosed or co-occurring mental health issues. A key distinction is made that regardless of whether mental health issues precede or result from addiction, they must be addressed in the recovery process.

Practical insights for clinicians are provided, stressing the importance of offering immediate hope and actionable tools to clients, and 'striking while the iron is hot' due to the fluctuating motivation inherent in addiction. The Jellinek curve is introduced to illustrate the typical progression from incidental exposure to increased craving, failed attempts at control, and eventually hitting 'bottom.' Treatment strategies involve a holistic approach: addressing the original distress, managing physical issues (like chronic pain or thyroid imbalances), restoring healthy circadian rhythms, and developing robust coping skills by identifying 'exceptions' (times when the client was not engaging in the addictive behavior) and leveraging past successful coping mechanisms.

Finally, the discussion covers the DSM criteria for addiction, including tolerance, withdrawal, loss of control, persistent desire to quit, significant time spent on the addiction, reduction of other important activities, and continued use despite adverse consequences. The biopsychosocial fallout of addiction is detailed, encompassing emotional problems (depression, anxiety, anger, resentment), cognitive impairments (memory loss, confusion, paranoia), and physical health issues (inadequate sleep/nutrition, injuries, STDs). The episode concludes by underscoring the necessity of rebuilding self-esteem and healthy support networks, and the practical utility of written coping strategies and contact lists for managing cravings, as individuals in crisis states may struggle with clear thinking.

It's a substance, a person or an activity and that's the first part that I really want you to think about. It's not just a substance a lot of people when they think about addiction think about chemical addictions and it's not just a chemical addiction it's a substance a person or an activity pretty much anything that can help someone feel like they're escaping outside of oneself.

The addict part or the addiction part comes in when you continue to do that despite negative consequences.

I want you to think of addiction not as a disorder but as something someone chose or developed as a survival purpose they could not deal with life on life's terms with the tools they had when that started.

Because the addiction is the one thing that hasn't let them down and if it's an addiction they've probably been doing it enough but they need to use in order to even feel normal it's become their best friend.

Most addicts need to learn to trust their own cues most of them probably never learned to effectively do it to begin with.

People who start using opiates and start abusing o pious we really want to look for some anxiety issues in addition to obviously chronic pain and just the general addiction issues.

It's important to me that you think about whether it really matters whether someone started their addiction before or after the mental health issues because once they stop using regardless of when it started they're still gonna have that mental health issue.

The first time they do it whether it's bungee jumping skydiving gambling whatever the issue is or whatever the addiction is that first time produces an amazing euphoric rush after that isn't never quite the same so then they need to intensify it or mix it with something.

Anger is a very very very functional protective mechanism it ramps up that fight or flee reaction it tells a person and there's a threat.

When people start craving it's almost like they go into sort of a crisis state they're not going to think as clearly so if they have it written down either in their phone or on an index card in their wallet they're going to be a lot more likely to use these tools.