27. Multiple disorders common among addicted population

By Tom O'Connell

Is someone simply an alcoholic, and that's it? Or a drug addict? An overeater? A compulsive gambler? And that's it? No, that's not it. It's more complicated than that.

Very often, addicts have primary and alternate addictions. And when they give up the primary addiction they tend to escalate any other addictive tendency that may be present. It's about the use of energy. When we stop giving our psychic energy to one behavior it tends to move elsewhere.

Have you ever noticed that when you've been worrying about something, and then resolved it, you soon find yourself giving top priority to worrying about something else?  We replace a resolved worry with new ones because we're in the worry habit, and life keeps presenting us with new problems to solve. But simply working to solve the problem is not enough. We choose to worry while we're trying to solve it because we're addicted to worry, and it's like that with other addictions too.

The alcoholic stops drinking and increases coffee consumption, returns to smoking,  escalates gambling behavior and other kinds of risk-taking, engages in compulsive sexuality, starts overeating, and may move from being casual about work to a new mode called workaholism. And one or more of these behaviors may afflict the same person.

In our country we've been fighting a war on drugs for many years without taking into consideration the complexity of the addiction picture. What about the stress of modern life that sets people up for a host of addictions? What about the recent news that one out of four people in Massachusetts are substantially overweight? Why? Are they turning to food addiction to cope with life? Also, what about the mental impairments and physical disabilities people were either born with or triggered by their addictive behavior?

Adding to the confusion is the language we use. In a recent issue of Academy News, provided by the American Academy of Health Care Providers in the Addictive Disorders, Dr. Raymond Hanbury was very effective in his criticism of the language used in treatment. For example, "dual diagnosis" usually means a person has an alcohol/drug problem along with a mental health problem. But Hanbury says that very often there are more than two problems, and the term "multi-disabled" may be more realistic. Other terms would be "multiple diagnoses" or "multi-diagnoses."

So the language is very important because how we label a person may limit how we care for that person. And this truth is as important for loved ones of impaired people as it is for the treatment professionals. If we focus on just one aspect of a loved one's addiction problem and are not aware that other complications exist at the same time, or that new impairments will probably emerge when the primary one is curtailed, then we are setting ourselves up for perplexity and disappointment.

Does Dr. Hanbury have any evidence to back up his contentions? He notes, "The National Institute of Mental Health reports that 35% of alcohol abusers and over 50% of drug abusers have at least one additional mental disorder." Is this surprising? It has long been known that people often turn to addictions to self-medicate. A person who is manic will use alcohol or another sedative drug for relief. A person who is depressed will often turn to stimulants to offset the depression.

Addressing the existence of physical disability as another complicating factor, Hanbury provides this insight: "Patients with physical impairments present additional treatment concerns...whether the causes of the disability are congenital or traumatic. These clients are particularly vulnerable to the abuse of alcohol and/or other substances." Then he points out, "Physical disabilities are often accompanied by a psychiatric disorder, e.g. Adjustment Disorder."

What's more, Dr. Hanbury notes that sometimes there is an addiction prior to a traumatic injury. Take a  drinking and driving accident, for example. And think about the likelihood of Post-Traumatic Stress Disorder emerging after the injury. Hanbury makes a good point here. We would be well advised to avoid looking at addictions out of context and we should investigate the whole person, not just one behavior.

Discussing rehabilitation, he builds on his previous statements. "The goal of rehabilitation is to enable the client to overcome his/her disabilities as much as is possible...helping the client to be no longer multi-disabled....It is important to recognize all aspects of a client's functioning, including medical conditions, substance use/dependence, and psychological state. Only then can we plan our treatment(s) appropriately."

His approach makes sense, but there is one thing missing from his comments: the spiritual condition of the client. This, in my view, cannot be ignored if the whole person is to be treated successfully.

If there is one point to be affirmed in this essay it is that when we are dealing with the human condition, and especially health problems, it is wise to remind ourselves that complexity is not the exception, it is the rule.

- Back -