Addiction and addictions
You won't be surprised to learn that the use of addictive drugs of all types is a global problem. What is surprising, however, is that few experts agree on what addiction really is, or what causes it. Some doctors and healthcare workers view addiction as a disease whereas outside the profession many people think in terms of having an 'addictive personality', and yet the evidence for both concepts is inconclusive. As we will see, our attitude to addiction is just as much shaped by cultural attitudes as by the medical evidence. But before we look at the nature of addiction, and why it affects men more than women, we should remind ourselves of the scale of the problem.
Historically addictions have been difficult to treat either via psychotherapy or medication. Thankfully new techniques and medications are now available to improve the probability of success.
Where physical dependence is involved (where physiological change has taken place - alcohol / class A drugs) detox may be appropitate prior to the commencement of therapy. Historically it was important that the client was not under the influence at the time of therapy - this is less valid with the advent of EMDR.
In some instances addictions may be masking underlying issues such as anxiety / trauma. Therapists that leave such issues unresolved risk an increased risk of lapse.
A number of substances tend to affect sleep substantially either during the period of usage or as a side effect of cessation. Generally this is a passing phase but should still be addressed as a matter of routine. Self hypnosis can be particularly effective to enable relaxation and sleep.
EMDR has a good track record in terms of dealing with addictions and underlying issues if they are present. Hypnotherapy is effective in terms of altering the unconscious response to situations / feelings / desires as well as reducing / removing withdrawal symptoms. Hypnotherapy that utilises behavioural approaches can also be employed. Cognitive techniques should also be utilised to address conscious behaviour.
A number of NLP techniques are effective in terms of installing aversive reactions and / or desentitisation to specific stimuli.
Therapy should be concentrated on the initial period following cessation. During this period of approx 30 days there is a valuable window of opportunity to implement change. Thereafter ongoing support should be available but dependence on therapy should be offset by empowering the client with self-help techniques.
There has been much coverage of the benefits of Ibogain / Ibogain with therapy / EMDR. Whilst not discounting the approach at all, care should be taken not to overstate the benefits or to underplay the risks.
Drugs of abuse
The United Nations estimates that the world is host to 8 million heroin users, 13 million cocaine users, 30 million users of amphetamines, 141 million cannabis users, 227 million sedative users and 1100 million tobacco smokers. Over 100 million people are dependent on the tobacco trade for their livelihood.
Alcohol is thought to cause around 33,000 deaths per year in Britain, with one in four hospital admissions being related to alcohol. Drinking is implicated in 60 per cent of suicides, 40 per cent of domestic violence cases and 39 per cent of domestic fires.
Probably the most common and problematic substance with potential for abuse, nicotine is highly addictive. The various toxins in cigarette smoke kill many thousands of people annually.
Approximately 3 per cent of the British adult population has a gambling problem. Of these, about 500,000 are 'pathologically compulsive'.
Legal prescription drugs
Some estimates put the number of Britons addicted to over-the-counter drugs and prescription drugs to be around 2 million.
Sex and pornography
Accurate statistics relating to sex addiction are not available but the problem is thought to be relatively common.
Cases of pornography addiction are very common. Some studies estimate that about 10% of the adult population may be affected.
Sex addiction is a complex issue with a number of facets which may include intimacy issues, psychosexual problems and an inability to trust. It is defined by the Diagnostic and Statistical Manual of Psychiatric Disorders as 'compulsive searching for multiple partners, compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships or compulsive sexuality in a relationship.'
Men and addiction
Men are much more likely to be addicted to alcohol and other substances than women. Two thirds of attendees at Alcoholics Anonymous are men (although this figure was 80 per cent in 1972). A large American study has found that men are twice as likely as women to have a substance dependence disorder, with a lifetime prevalence of almost 36% for men and 18% for women. In other words, over one third of the male population of the US have been dependent on alcohol or drugs at some stage of their lives. Men in the 25 to 34 year age group were twice as likely as those in the 45 to 50 year old age group to report substance dependency. Alcohol and drug abuse are strongly associated with an increased suicide rate in men.
In a large British study men were three times more likely than women to be alcohol dependent and twice as likely to be drug dependent. Almost 8 per cent of British men and almost 5 per cent of women said that they had been drug dependent at some time in their lives, 3 per cent of men and 1 per cent of women reporting dependence during the previous year. Marriage appears to protect men from addiction problems. Never being married or becoming single is associated with increased alcohol consumption, while getting married is associated with a drop in alcohol consumption.
'Substance misuse' is used to describe a drug user who experiences mental or physical harm as a result of their habit without necessarily being addicted to the substance in question.
Substance misuse needs to be contrasted with substance dependence (also known as addiction). Dependence occurs at a more advanced stage of the addiction process. Doctors make a diagnosis of addiction if three or more of the following features are present:
- a strong desire or sense of compulsion to take the substance.
- difficulties controlling the substance-taking behaviour in terms of when it occurs, being able to stop or the amount consumed.
- a physically unpleasant withdrawal state when not consuming the substance.
- further substance use to relieve or avoid the withdrawal state.
- evidence of increased tolerance (increased doses are required in order to achieve effects originally produced by lower doses).
- progressive neglect of alternative pleasures or interests because of the substance use.
- persisting with substance use despite clear evidence of harmful consequences.
- narrowing of a person's personal repertoire; ie taking the substance becomes more important than anything else.
12 Steps/NA/AA (Narcotics anonymous / alcoholics anonymous)
The 12 step NA/AA apporach works well when combined with psychotherapy.
The 12 steps for eg the AA are:
- We admitted we were powerless over alcohol — that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory and when we were wrong promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Diagnostic and statistical manual criteria (DSM)
Research: Manganiello, A. J. (1984). A comparative study of hypnotherapy and psychotherapy in the treatment of methadone addicts. American Journal of Clinical Hypnosis. 26(4). 273-279.
Significant differences were found on all measures. The experimental group had significantly less discomfort and illicit drug use, and a significantly greater number of withdrawals. At six month follow up, 94% of the subjects in the experimental group who had achieved withdrawal remained narcotic free.