I remember driving past a church one evening with a colleague. A large group of people stood out front, shrouded in an impressive cloud of cigarette smoke. “AA meeting,” my colleague remarked. He didn’t actually know this for a fact, but this is one of those iconic images of recovering alcoholics: coffee cup clutched in one hand, cigarette in the other.
Treatment programs don’t usually address nicotine addiction; they say it is just too much to take on in the early weeks or months of recovery. It is probably the most common cross-addiction. People who quit smoking years ago will start up within days of quitting drinking, looking for something to make them feel better.
Recovery from addiction can feel like a game of whac-a-mole™, that classic carnival game where you mallet a mole as it pops up from its hidey hole, only to have one pop up from another hole. Whack away; there is always another mole taunting you from another hole.
Cross-addictions are nothing new, but the fact that treatment centers are now addressing them during the first 30 days of recovery is.
Binge eating is another classic cross-addiction in early recovery. We’re not just talking about hitting the plate of cookies at a 12-step meeting, but binge eating as a way to compensate for changes in how you feel now that you don’t have drugs or alcohol. Carbohydrates seem to be the food (drug) of choice: lots of flour, lots of sugar.
Carbohydrate binging can lead to massive weight gain in the first few months of recovery. We know that when a recovering addict leaves treatment 20 pounds heavier than when they came in, they are likely on the road to a serious cross-addiction. It’s critical to address this type of substitution behavior immediately, or the recovering addict can easily tip the scales into obesity in a few months.
What do cookies, chips, and pints of mocha chip have in common with drugs and alcohol? Extensive animal research has confirmed that addiction to sugar is a real phenomenon that is mediated by endogenous opiates and can be blocked by opiate antagonists. In addition, carbohydrate loading increases the synthesis of brain serotonin, improving mood and decreasing anxiety. Overeating becomes just one more form of self-medication.
Another way we see recovering addicts compensate when they lose their drug of choice is through sexual acting out. If this behavior happens in treatment it can be very destructive to the therapeutic environment, and it is even more destructive if not addressed before the client returns home. In fact, unaddressed compulsive sexual behavior can be an enormous trigger for relapse with drugs and alcohol.
If the behavior escalates to sex addiction, the recovering person may use drugs and alcohol to mute feelings of shame and guilt. They may begin to use alcohol to calm their nerves if they are looking for anonymous sex partners on the Internet or through mobile “hook up” apps.
Whatever the cross-addiction might be – food, sex, gambling, shopping, compulsive exercise, or the like – the drive is the same. The recovering addict wants to feel better, which often means they want to feel less. Drugs, nicotine, and carbohydrates all happily oblige by altering serotonin levels in the brain.
What can the science of addiction tell us about cross-addictions? The American Society of Addiction Medicine has made clear that regardless of the source of the addiction (substance or behavior), the result is the same: a pattern of destructive behavior that includes a compelling craving for the substance or activity; a negative impact on health, self-esteem, family, relationships, finances, or career; and an inability to stop the behavior despite those adverse consequences.
Dirk Hanson, author of “The Chemical Carousel,” has written a great piece on “neuroaddiction” and how the addicted brain is different from the nonaddicted brain.
He points out one of the most important truths about addiction: It is both a cause and a consequence of those brain changes.
I have seen cross-addiction in many forms, but it always comes back to this very human susceptibility to any substance or behavior that impacts the reward centers of the brain. We like to feel good. Some people don’t feel very good. Drugs, carbs, alcohol, cigarettes, and the big win at the craps table make a lot of those people who don’t feel very good much of the time feel really good for a brief moment.
Unless treatment programs address the underlying psychiatric issues that compel the addict to find some way, any way, to feel what they often self-describe as “normal,” relapse will continue to be a common hallmark of addiction.
The only way to win the whac-a-mole™ game is to rack up points: The better you recognize the clues, the faster you whack that mole back into its hole and the more points you get. To thrive in recovery, you must spot those cross-addictions quickly, not slip into denial, and address them through positive outlets, nonaddictive psychopharmacological interventions, and effective behavioral therapy.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry, and addiction medicine. He is the CEO of Elements Behavioral Health, a network of addiction treatment programs that include rehab centers in Malibu, Los Angeles, Tennessee, and Florida. You can follow Dr. Sack on Twitter.
Whack-a-Mole photo available from Shutterstock.
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From Psych Central's website:
Some Foods Are Addictive | Wheat Sugar and Food Addiction | Addiction Recovery (February 28, 2012)
Last reviewed: 22 Feb 2012