One of the benefits of residential treatment is the many opportunities clinical staff have to become acquainted with clients. Whether it’s sharing a laugh over lunch or chatting during breaks, those connections matter. Working through issues in structured group and individual therapy allows our clinical staff to learn about the clients they support. Getting to know clients so intimately affords a greater appreciation of the challenges inherent in addiction and the treatment offered.
In 2009, the clinical team at Sunshine Coast Health Centre took an informal poll. It found that approximately 3 out of 5 clients were, prior to treatment, acting out sexually. While we know that individuals with one addiction often have multiple or concurrent addictions, we underestimated its prevalence. Training staff on process addictions is a step in the right direction, and we know that implementation is another matter entirely. An important first step is looking at how we define addiction.
How Can We Define Addiction?
Addiction is a complex condition that can be defined by its etiology, symptoms, and scope. Etiology is the investigation into factors and influences over time that leads to substance use disorder development. It leaves people to define addiction in general terms such as “addiction is a brain disease”. The truth is there are many factors that can contribute to the development of a substance use disorder. From biological and genetic factors to personality traits, everyone is vulnerable.
The Three C’s
Addiction can be understood by the severity of its associated symptoms, also known as Symptom Severity. The 3 Cs, a self-test, can be applied to any substance or activity:
Compulsion – obsessively thinking about and planning around a substance or activity so that an individual has regular, convenient access. Compulsion is what happens during the abstinence stage of the cycle.
Control – an inability to control the amount of time engaged in an unhealthy activity, or the amount consumed of a harmful substance, once initiated. Control is what happens during the active stage of the cycle.
Consequences – repeated engagement in an unhealthy activity or harmful substance despite negative consequences. Often, the consequences stage is motivation enough to return back to the abstinence, or compulsion stage.
Defining Addiction by Scope
It was not that long ago that the term “alcoholism” was the predominant term used in addiction treatment circles. According to the Hazelden Foundation, it wasn’t until 1958 that their clinical staff recommended using a new term. Using the term “chemical dependency,” to replace “alcoholism” better reflected the growing trend of marijuana, cocaine, and heroin misuse in the United States.
Fifty years later, it’s not just illicit drugs, but prescription drugs. It’s not just substances, but activities or “processes” such as gambling, sex, online gaming, and eating disorders. However, while the term “addiction” is now more commonly used than “chemical dependency”, the vast majority of residential addiction treatment centers in North America still focus almost exclusively on drugs and alcohol. Admittedly, our own website and printed literature reflect that we, too, are first and foremost a chemical dependency treatment program.
The Challenges of Treating Process Addictions
Lack of Evidence-Based Treatment
Until recently, the vast majority of addiction research and program development has focused on chemical dependency. Gambling addiction has been recognized for a long time now. However, very little research has surfaced on the treatment of gambling addiction. This is somewhat puzzling considering the government’s growing dependence on gambling revenues.
Lack of Consensus
Another consideration is the lack of consensus around what is considered an addiction, such as food and sex. For example, sexology advocates argue that much of what is considered sex addiction is normal sexual behaviour essential for healthy sexual development and survival. Other experts believe that sexual addiction is actually part of obsessive-compulsive disorders. Therefore referring to it not as an addiction, but as sexual compulsivity.
Lack of Medical Care
While individuals struggling with eating disorders have had access to specialized treatment, these programs are scarce. Programs are typically government outpatient programs or private residential programs in the US. Ultimately, eating disorders can be life-threatening and require medical monitoring, which are procedures not typically offered in residential rehabilitation programs.
Impact on the Peer Group
Another concern of programs specializing in chemical dependency is the impact that individuals with other addictions will have on the peer group. In general, it is quite common for individuals with drug or alcohol addiction to have concurrent gambling, sex addiction, or eating disorders.
Furthermore, there is a prevailing notion that people who are exclusively processed-addicted may not be compatible with the dominant, chemically-dependent peer group. There is an additional challenge when sexual behaviour crosses over into sexual offending such as pedophilia, compulsive masturbation, incest, and rape.
Lack of Clearly Negative Consequences
Unlike chemical dependency, gambling, or eating disorders, individuals struggling with sex addiction or online gaming addiction show symptoms that may seem less harmful. Therefore, the perceived need for treatment may not be as obvious.
Training Clinical Staff
Addiction is rarely taught in graduate or medical school and professional development workshops rarely offer courses in process addictions. Therefore, training often requires that staff travel to the United States or that a presenter is brought up for training on-site.
Tailoring the Program
Part of treating a variety of addictions is to first differentiate their unique aspects. With this knowledge, we can then integrate new treatment techniques or knowledge into a program that embraces these differences but includes the effective components of previous modalities.
Why We Remain Committed to Treating Process Addictions
Our clinical program emphasizes personal meaning; being true to one’s sense of self. As Program Director, Geoff Thompson, often tells clients, “it’s not in the bottle.” Including individuals with process addictions in the peer group will help chemically dependent clients understand that, even in the absence of drugs or alcohol, individuals can still have addictions. Therefore, process-addicted clients are living proof that drugs and alcohol do not have some sort of magical, addictive property.
In sum, by identifying with individuals that have different addictions clients may come to see that addiction manifests itself in many ways in our society.
Oprah Winfrey dedicated a segment on her TV show to severely obese children. A 14-year-old girl interviewed in the middle of a food binge confessed that “once she starts she cannot stop.” She went on to say that when she starts to feel down about herself, she eats. I know more than a few kids that find the same sort of relief through online gaming.
Treating multiple addictions at the same time is the best approach to take, despite the additional challenges to staff and the program. Hopefully, other private and government addiction programs will also consider expanding their notion of addiction to include process addictions.
At Sunshine Coast Health Centre, our programs are based on Meaning-Centred Therapy. We help our clients discover the power of using meaning and purpose to overcome addiction. If you or someone you know is struggling, give us a call today.