In the last 26 years, I have treated over 5000 patients with addiction problems. I found that treating addictive behaviours is really no different from treating addictive substances. It is best that they should be treated all at the same time and in the same general way in order to reduce the risk of relapse.
My observation was that the substance addictions and the behavioural addictions tend to come in clusters: the ‘Hedonistic’ cluster, the ‘Nuturant-Of-Self’ cluster and the ‘Relationship’ cluster.
In the ‘Hedonistic’ cluster, in which the addict says, ‘To hell with it, I’ll do what I want’, the closely associated substances are alcohol, recreational drugs, mood-altering prescription drugs (painkillers, sleeping tablets, antidepressants and tranquillisers), nicotine and caffeine.
In that same ‘Hedonistic’ cluster are the addictive behaviours of sex and love addiction, gambling and risk-taking.
If someone is addicted to any one of these substances or behaviours, it is worth looking at all the others. Any untreated addictive outlet will be likely to lead to relapse.
In the ‘Nurturant of self’ cluster surrounding the eating disorders – anorexia, bulimia and compulsive over-eating – the substances that lead to cravings are the refined carbohydrates, sugar and white flour. In addition to bingeing, vomiting, starving or purging, the commonly associated addictive behaviours are shopping and spending, work and exercise.
The ‘Relationship’ cluster comprises just two addictive behaviours – compulsive helping (using oneself as a drug for other people by doing too much for them and not enough to protect oneself) and relationship addiction (using other people as if they were drugs).
Some people have addictive outlets in just one of these clusters, some in two and some – like me – in all three.
It is possible that each of these addictive clusters is governed by a single gene. For that reason, it is sensible to be abstinent from all substances and behaviours within any addictive cluster in which one outlet is problematic. For example, the Betty Ford Clinic showed that cigarette smokers have double the relapse rate of non-smokers in going back to using alcohol or recreational drugs.
There is no point in giving up one or two addictive substances and behaviours while leaving the others unchecked. They will simply take over the addictive urge.
Sex and love addiction has a high suicide rate because it tends to destroy families and other close relationships and lead to pathetic loneliness.
Gambling and risk-taking includes ‘betting’ (that’s what it is) on stocks and shares and other investments, commodities, property ventures and other business risks. These may be part of normal life but we compulsive people do not know when we are doing too much of a good thing – and we find we can’t stop even when we do know.
Work includes hobbies and interests, cults or sects and also internet addiction. Collecting can become obsessive. Religious preoccupation or extremism can lead to suffering on an individual, national or international scale. What is made out to be beneficial, in this life or the next, can lead to utter carnage.
In each case, a behavioural addiction can undermine recovery from the associated substance addictions, as well as being damaging in its own right. For example, caffeine itself is rarely damaging but high quantities of cola or other caffeine drinks can stimulate the urge to use other drugs.
Gambling and risk-taking can destroy families every bit as much as heroin or cocaine addiction.
Nicotine addiction is very common among alcoholics or drug addicts and is also common in compulsive gamblers. It may not kill them in the short term but it often gets them in the end and causes devastating suffering. The major risk for young people is that nicotine addiction leads back to whatever was the first addiction for those individuals.
A bit of retail therapy is comforting for almost anybody but compulsive shopping and spending, buying things we don’t even want or need or throwing money away in crazy flamboyance, is very distressing – and cripplingly expensive.
Working and exercising are sometimes thought to be ‘positive’ addictions. That is very far from the truth. They can both be highly damaging. There is no such thing as a ‘positive’ addiction. All truly addictive behaviour is progressive and destructive.
Compulsive helping has nothing in common with friendly helping. It patronises and belittles. It turns caring into care-taking, doing so much for other people that they don’t learn to be responsible for themselves. The self-denial of compulsive helping can cause fearful damage when it leads to taking huge risks when providing employment or services for the intended benefit of others.
Not all people in the helping professions are compulsive helpers but those who are can cause a lot of trouble and distress. When politicians are compulsive helpers the national or global economy, and the safety of the whole world, can be at stake. They don’t know when to leave well alone.
Relationship addiction can take away all genuine pleasure from marriage, or other partnerships, when the single-minded purpose is satisfaction for one person at the expense of another.
All in all, addictive behaviours can destroy individuals, relationships, businesses, financial fortunes and even whole communities. We ignore them at our peril.