Addiction is confusing. It is confusing to seasoned professionals. Let’s just admit it.
It is not a specified diagnosis under the DSM or ICD; it’s only broadly referential to a sometimes amorphous categorization.
Take a look at a broad array of definitions (some even from reputable research organizations), which emphasize sometimes different things:
Clarity through the confusion
While still in the middle of a ‘call to arms’ in clarifying Addiction is, we ultimately have a very stable understanding of the symptoms/criteria of problematic behaviors, and most of the time, how to treat them.
Substance Use and Addictive behaviors do exhibit many consistencies despite the actual substance or reward behavior pursued, and they respond to similar treatments. Regardless of the organization, the following are usually consistent details across definitions:
"Types" of Addicts
There is an extensive history of attempts to categorize addiction, through “typologies.” Prior to scientific research, which began with E.M. “Bunky” Jellinek, there were many attempts to understand the mystery of addiction, but mostly from an observational or anecdotal standpoint.
We don’t have any consensus yet, but why is it important to know what type or level or continuum a person is on? At a minimum, we need to understand where a person falls on a continuum if we are to treat effectively.
Here is one continuum of use problems (Adapted from Earleywine, M. (2016). Substance use problems (pg. 2). Göttingen: Hogrefe.):
As I like to say, "Don’t drive your lawnmower on the freeway." Just like you wouldn’t do this (I hope), don’t assume that therapy alone, or a doctor alone, or worse, doing nothing- alone- will be enough “horsepower” to get you where you need to go.
Effective treatment requires applying the factors necessary to get the job done. The person who abuses a substance occasionally on weekends will need to be treated different than the person who is “hooked” on something.
Two categories of professional treatment exist, with incorporation of several additional supportive factors:
Besides treatment, supportive factors often include, but are not limited to:
Take addiction seriously. Don't know whether your are addicted or not? Find out.
Addiction is a complex- bio-psycho-social-spiritual- issue. Problems with drugs, alcohol, or behaviors on a spectrum of addiction cause substantial disability, even death. And here's the kicker- people who have problems with these often experience lapses in judgement and poor insight into having a problem.
Start with a strong assessment by a competent professional who is trained and experienced. Look for evidence based treatments (think CBT or Motivational Interviewing). Advocate for truth and be assertive. Ask hard questions of your provider. When providers get shifty or start to recommend some unusual treatment when you need a first line treatment, exercise caution.
I'm Justin K. Hughes, MA, LPC, and I specialize in the treatment of Addiction through CBT and Motivational Interviewing (MI). As always, please like or follow me, using whatever platform you prefer. Also, subscribe for meaningful content regularly!
The Myth of Disappearing Distress. If I do the right things, I won't have to face suffering, right?
It's easy for me as a therapist to exhort my clients to stay focused on the prize DESPITE the distress they feel. How easy it is to get off track! And while it's also easy for me to tell someone else this, it can be very cumbersome to do in practice. I, too, struggle to keep focused when challenges hit. But I'm always best prepared when I lean on my team: #support #faith #accountability #truth.
In Vivo Exposure
Directly facing feared objects or situations, examples include:
Getting on a flight, touching a doorknob that feels “contaminated,” not going back to check a lock, or going to a social gathering.
Good exposure attempts to match the content and detail of a person's fear as close as possible. So, for example, if a person fears “going crazy” in a social setting, the best exercise will be working up to facing that, not just exposing to the thought or word. On the other hand, if the fear is that a person will have inappropriate impulses (to harm, sexually, etc.), sitting with the intrusive thought and being present will serve best.
Imaginal exposure involves accessing the content of fears and anxieties through cognitive means. For example, a fear that someone will fail, make the wrong decision, harm someone, die, or choose the wrong relationship are not accessed by activating these life occurrences. They are addressed imaginally.
There are many ways to practice Exposure imaginally, but the most common are writing scripts, stories, listening to recordings, watching videos, or using visualization.
To be clear, Imaginal exposure often is the most confusing and hardest to grasp of exposure practices, as it seems to be creating negative thoughts or “bringing” unrealistic and negative thoughts on- the seeming antithesis of most of psychology and cognitive therapy. But what is really done here is only facing what a person is already experiencing, thinking and feeling.
Intentionally bringing up physical sensations that are feared, such as:
Heart racing, shortness of breath, sweaty palms.
Ways to do this when a person's health allows are breathing through a cocktail straw, breathing rapidly, or sitting up quickly.
Virtual Reality (VR) Exposure
With the advent of new technology, we have a recently emerging type of exposure. Some may class Virtual Reality into imaginal exposure, but it can be seen as a cross between in vivo (situational) and imaginal. This is especially helpful with treating disorders such as Flying Phobia, where the access to an actual plane and flight to practice can be cost-prohibitive and difficult.
What is Exposure Therapy?
Exposure therapy is a psychological treatment that is practiced in Behavioral and Cognitive Behavioral Therapy (CBT). It is indicated as a first line treatment for a number of disorders such as
Exposure therapy helps clients to systematically confront fearful stimuli along with changing fearful responses. This relearning increases confidence and decreases disruption in life. Over time, discomfort and fear typically decreases through active engagement rather than avoidance, suppression, neutralization, or ritualization.
The evidence base is very strong for its use and effectiveness, though it is currently only applied a minority of the time in clinical settings.
How Do You Do Exposure Therapy?
The principles of exposure may be simple, but the specifics- personalized to any one individual- involve many working parts.
According to Dictionary.com, their word of the year is "Misinformation." Defined as "false information that is spread," misinformation occurs "regardless of whether there is intent to mislead."
Misinformation, and its brother, disinformation, can be harmful. Clearly. Though much of the current state of discussion around this concerns external affairs. Much of what we are responsible for at least begins internally (how we respond and engage).
Aligning our thoughts, beliefs, and behavior with reality- what's true and realistic- is a crucial "mechanism of action" that helps facilitate positive outcomes. This is particularly true in the method of therapy I use- CBT (Cognitive Behavioral Therapy),
We know that cognitive distortions [click for pdf list] only prevent us from succeeding and growing. These errors are harmful especially when they are consistent approaches to thought, such as All-Or-Nothing Thinking (I missed my workout today; I might as well skip this week), Mental Filtering (I know they said they enjoyed meeting me, but they must not like me because they talked more to other people), and jumping to conclusions (I just know that she got off the phone quickly because she thinks I'm an idiot!). The deeper these go, the more impactful they are and harder to break.
So in a world of misinformation, make sure you first tell yourself the truth, whether it's difficult or comforting. In this time of the year that is special, wonderful, challenging, or downright awful for some, what can you do?
Be realistic. Tell yourself the truth, and to others. Align your thoughts, beliefs, and actions with commitment, purpose, and meaning (and if you're not sure what yours is, find it with help!), and try to get as close to what's honest and accurate. Be a good researcher (humble). Don't get snowed by misinformation. Give the gift of realistic, truthful thinking. Your brain will thank you (and probably everyone else will, too).
Merry Christmas, and Happy Holidays!
Want a surefire way to experience more gratitude? Be grateful.
I'm not trying to sound trite; those who practice gratitude are more grateful. I struggle to apply this discipline myself. But when I do, I see the world differently. Enjoy the following video (thanks to my brother for passing along).
$1.6 Billion. That's 1,600 x 1 MILLION Dollars. For the person who won roughly that amount in South Carolina (and the rest of us):
Would it surprise you that your emotional well-being really doesn't improve by becoming wealthy? There’s been a host of research in recent years that look into happiness and money. Possibly the most commonly known one is the National Academy of Sciences study on well-being and money.
This study’s now famous $75,000 mark suggests that a person’s emotional well being (how they feel day-to-day) AND their evaluation of life (their overall perspective of how they are doing) improves up to the point of earning $75k per HOUSEHOLD in the United States. Beyond this mark, emotional well-being doesn't significantly improve, though a person will evaluate their life as better if they earn beyond this mark. To quote their findings, “We conclude that high income buys life satisfaction but not happiness, and that low income is associated both with low life evaluation and low emotional well-being” (Kahneman, et al. 2010).
So what do "happy money" spenders do? Research by Elizabeth Dunn and Michael Norton in Happy Money: The Science of Happier Spending (2014) reveals how money is spent makes the crucial difference in happiness.
Are you making the most of what you have? Are you caught up in materialism and consumerism? Today is always a great day to do something different.
Justin K. Hughes, MA, LPC
Do I want this, or do I not? Is this my actual desire, or what I don't want? Does this thought or desire define me? What if it's terrible or horrible?
Sometimes the things I think about are because I value them or desire them.
Sometimes the things I think about are because I don't value them or desire them.
What the heck?
Egosyntonic and Egodystonic are two psychological terms to describe phenomena of thoughts/urges that are synonymous and antonymous to what a person desires or wants. Sometimes our thoughts reflect very much what we desire or want, but around 90% of people endorse having "intrusive thoughts," or unwanted thoughts.
It is crucial to do a good functional analysis on a thought/behavior to determine whether someone is doing something in order to pursue- or to avoid- the very same thing.
Yesterday and today both I witnessed bad car wrecks. I haven’t seen a car wreck in over two years. Not only have I been more cautious driving since, today I caught myself telling my wife possible reasons for seeing two crashes in a row.
“Hey babe, maybe people are absent-minded with summer and vacations. Be careful.”
However, I inferred meaning that may have nothing to do with what actually happened. Do you ever do that? Read into what your significant other is saying? What your clients are thinking? Make an assumption? We all do that. Decisions. Determinations. Judgments.
I work with thoughts and thinking day-in and day-out. A big part of my job is to help folks live in reality. Correcting distortions and errors in their thinking is a large part of this. Of course, as a human being, I experience this just as much as the next person. It is a discipline to not only look to logic and reason, but also to connect with emotions and experience- and attempt to be grounded.
I hope I always continue to work on this.
So the reasons why a nice Mercedes got its hood completely crumpled may not really be in my purview. Nothing wrong for me to guess. However, it is significant for me to stay aware that my thoughts stick close to reality, because the further they diverge from it in day-to-day life, the more likely I am to make determinations that are wrong. The more I do this, the more firmly rooted my beliefs become. My emotions will follow my beliefs. And my beliefs determine my course. My course affects others. Others affect history. See where this is headed?
Incredibly sad is the news that in a matter of days, two revered, loved, and famous celebrities committed suicide. This morning I was hit by discovering that after Kate Spade ended her life, Anthony Bourdain also ended his. After I prayed for their families, I knew I needed to send out this blog.
Suicide is an incredibly complex issue. Let me be simple at the risk of sounding reductionistic. Working in various settings in mental health for around 13 years, I have seen incredible hope bloom out of the desolate landscape of deep, dark depression. I have seen hope abound where there seems to be no hope. Personally, I have lost a friend, a neighbor, and a fellow college colleague to suicide over 15 years- and those are just the closest to me. There’s more. It’s so sad.
But there is hope.
How can I say this? I see it every day. None of us can ever fully control even our own best intentions for ourselves, let alone outcomes for others. Even as a counselor, I don’t have any more ultimate power to stop someone from committing suicide. Treatments that work for most are readily available. Treatment is often very effective. Sometimes several tries and different types of programming are needed. But you must take a step. Maybe it is to help, maybe it is to seek help.
Things that don’t work:
Things that do work:
If you or someone you love struggles, please seek help! My industry’s entire focus is helping people. Please call 911 or go to the hospital if your life- or someone else’s- might be in danger. There is no shame in this. Reach out to a therapist who is experienced in treating your concerns. May you find hope for yourself or others- hope that runs deeper than the saddest and darkest moment.
National Suicide Prevention Lifeline
Look under “Crisis” or find other helpful resources.
A Psychotherapists' thoughts on healthy living.
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