The reasons for initially trying different socially acceptable legal drugs (e.g. alcohol, cigarettes, etc.), and/ or illegal drugs, or for that matter any addictive behavior involvement (e.g. gambling, binge-eating, etc.) are multi-factored (e.g. peer-pressure, boredom, etc.). In the twentieth century approximately 65% (Helzer et al., 1990) of healthy American individuals (born in a family–free from a history of substance abuse for example, and raised in a positive environment with positive values and conditioning) experiment with underage drinking and possibly smoking cigarettes at least once as adolescents or during a “college dorm – binge drinking” – phase of life.
Because human behavior is so complex, an attempt to understand the reasons individuals continue to use, and/ or abuse themselves with substances and/ or maladaptive behaviors to the point of developing self-defeating behavior patterns and/ or other life-style dysfunctions or self-harm is enormously difficult to achieve. Many researchers therefore prefer to speak of risk factors that may contribute, but not be sufficient to cause addictions. They point to an eclectic bio-psychosocial approach that involves the multi-dimensional interactions of genetics, biochemistry, psychology, socio-cultural, and spiritual influences.
Risk Factors / Contributory Causes / Influences:
1. Genetics (family history) – is known to play a role in causing susceptibility through such biological avenues as metabolic rates and sensitivity to alcohol and/ or other drugs or addictive behaviors.
2. Biochemistry – the discovery of morphine-like substances called endorphins (runners high, etc.) and the so-called “pleasure pathway” – the mesocorticolimbic dopamine pathway (MCLP). This is the brain center or possible anatomic site underlying addictions at which alcohol and other drugs stimulate to produce euphoria – which then becomes the desired goal to attain (tolerance – loss of control – withdrawal).
3. Psychological Factors – developmental personality traits, vulnerability to stress, and the desire for tension and symptom reduction from various mental health problems and traumatic life experiences.
4. Socio-cultural/ Spiritual Factors – cultural attitudes, marital, relational, legal, financial, and religious psycho-social stressors (etc.), along with the existence of a so-called drug culture that promotes the availability of alcohol and other drugs and/ or addictive behaviors as tension reducers and/ or pain relievers.
Family genetics, and bio-psychosocial, historical, and developmental conditioning factors are difficult and sometimes impossible to be changed within individuals. The standardized performance-based Addictions Recovery Measurement System philosophy incorporates a bio-psychosocial disease model that focuses on a cognitive behavioral perspective in attempting to alter maladaptive thinking and improve a person’s abilities and behaviors to solve problems and plan for sustained recovery. Many healthcare consumers of addiction recovery services have a genetic pre-dispositional history for addiction. They have suffered and continue to suffer from past traumatic life experiences (e.g. physical, sexual, and emotional abuse, etc.) and often present with psychosocial stressors (e.g. occupational stress, family/ marital problems, etc.) leaving them with intense and confusing feelings (e.g. anger, anxiety, bitterness, fear, guilt, grief, loneliness, depression, and inferiority, etc.) that reinforce their already low self-esteem. The complex interaction of these factors can leave the individual with much deeper mental health problems involving self-hatred, self-punishment, self-denial, low self-control, low self-respect, and a severe low self-esteem condition, with an overall (sometimes hidden) negative self-identity.
There are many definitions for addiction as it is a complex phenomenon. The American Psychiatric Association avoids the term entirely. The World Health Organization defined addiction as “a state of periodic and/ or chronic intoxication produced by the repeated consumption of a natural or synthetic drug. This state of intoxication is manifested by an overpowering desire, need or compulsion with the presence of a tendency to increase the dose and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always psychic and physical dependence on the effects of the drug” (Gossop and Grant, 1990, p. 20).
Addictive diseases generally have been associated with substance abuse. More recently, the concept of addiction has been broadened to include behavior patterns that do not necessarily include alcohol or drugs. Bradshaw (1990) defines addiction as a “pathological relationship to any mood-altering person, thing, substance, or activity that has life-damaging consequences” (p. VIII). Arterburn and Felton (1992) define addiction as “the presence of a psychological and physiological dependency on a substance, relationship, or behavior” (p. 104). Shaef (1987) defines addiction as “any process over which we are powerless. Addiction takes control of us, causing us to do and think things that are inconsistent with our personal values, and which lead us to become progressively more compulsive and obsessive” (p. 18). She divides addictions into two broad categories: Substance addictions (e.g., alcohol, drugs, nicotine, and food, etc.) and process or behavioral addictions (e.g., gambling, food, religion, and sexual addictions, etc.).
Similar to alcohol and substance abuse disorders, process or behavioral addictions have personality factors that tend to characterize their etiologies, behavioral manifestations, and their resistance to change even though they do not involve a chemical addictive substance. For example, although most people can gamble occasionally, (e.g., Saturday night poker games, betting on major sporting events with friends, and/ or playing a slot machine while on vacation, etc.), an estimated six to ten million Americans lose control.
Pathological Gambling, according to Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR, 2000) is characterized by recurrent and persistent gambling behavior that disrupts family, personal, or vocational pursuits. It also involves continuous or periodic loss of control; a preoccupation with obtaining money for gambling; irrational behavior; and continuation of this behavior in spite of adverse consequences (Rosenthal, 1992).
People also develop dependencies on certain life-functioning activities that can be just as life threatening as drug addiction and just as socially and psychologically damaging as alcoholism. As noted previously 30.5% of American adults suffer from morbid obesity or being 100 lbs. or more above ideal body weight. Some do suffer from hormonal or metabolic disorders, but most obese individuals simply consume more calories than they burn due to an out of control overeating Food Addiction lifestyle pattern.
Hyper-obesity resulting from gross, habitual overeating is considered to be more like the problems found in those ingrained personality disorders that involve loss of control over appetite of some kind (Orford, 1985). Binge-eating Disorder episodes are characterized in part by a feeling that one cannot stop or control how much or what one is eating (DSM-IV-TR, 2000).
Williams (1993) suggests that religious addicts experience three of the same symptoms as other addicts: craving or the need for a fix; the loss of control; and continual use. Johnson and VanVonderen (1991) define Religious Addiction as “the state of being dependent on a spiritually mood-altering system.” In a change intended to encourage mental health professionals to view patients’ religious experience more seriously, the DSM-IV included an entry entitled, “Religious or Spiritual Problem” (Steinfels 1994). One type of psycho-religious problem involves patients who intensify their adherence to religious practices to an obsessive-compulsive and sometimes delusional mental state of mind. I personally had the unique opportunity of writing my doctoral dissertation on religious addiction entitled, “Hawaii and Christian Religious Addiction.” During that process, I discovered a significant relationship between self-appointed, authoritarian church leaders and religious addictive beliefs, behaviors and symptoms (Slobodzien, 2004).
Likewise, Sexual Addiction affects an estimated three to six percent of the U.S. population. Sexual addiction takes many forms to include obsessions with pornography and masturbation to engaging in cyber-sex, voyeurism, affairs, rape, incest, and sex with strangers. Though solitary forms of this addiction may not be overtly risky, they can be part of a pattern of distorted thinking and identity conflict that can escalate to involve harming the self and others. An example of a Sexual Disorder (NOS) or Not Otherwise Specified in the DSM-IV-TR, (2000) includes: distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by an individual only as things to be used. The defining elements of this kind of addiction are its secrecy and escalating nature, often resulting in diminished judgment and self-control (Carnes, 1994).
The fundamental nature of all addiction is the addicts’ experience of helplessness and powerlessness over an obsessive-compulsive behavior, resulting in their lives becoming unmanageable. The addict may be out of control. They may experience extreme emotional pain and shame. They may repeatedly fail to control their behavior. They may suffer one or more of the following consequences of an unmanageable lifestyle: a deterioration of some or all supportive relationships; difficulties with work, financial troubles; and physical, mental, and/ or emotional exhaustion which sometimes leads to psychiatric problems and hospitalization. Addictions tend to arise from the same backgrounds: families with co-dependency including multiple addictions; lack of effective parenting; and other forms of physical, emotional and sexual trauma in childhood. Since it is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist, the initial therapeutic intervention for any addiction needs to include an assessment for other addictions.
Poly-behavioral dependence is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances – nicotine, alcohol, & drugs, and/ or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.
For more info see: “Poly-Behavioral Addictions and the Addictions Recovery Measurement System”
James Slobodzien, Psy.D., CSAC, is a Hawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. Dr. Slobodzien is credentialed by the National Registry of Health Service Providers in Psychology. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in hospital, prison, and court settings. He is an adjunct professor of Psychology and also maintains a private practice as a mental health consultant.