Treating Individuals with Addictive Personalities
In mainstream America, the term addictive personality is most often invoked when people are trying to explain a behavior that they know isn’t good for them but in which they engage nonetheless.
Typically, describing oneself or another as having an addictive personality lends a lighthearted tone to what may be a serious issue. As Michael Weaver, MD, explains in a WebMD article on this topic, from a medical standpoint, there is no such thing as an addictive personality. Further to this point, there is no reference to addictive personality disorder in the mental health expert’s definitive diagnostic guide, the Diagnostic and Statistical Manual of Mental Disorders (5thEdition).
There is, however, ongoing research focused on identifying the factors that influence the development of addictive behaviors. At present, as noted in Psychology Today, research suggests that 10-15 percent of the American population is prone to addiction. The possible reasons why this subset of the population face an increased risk of addiction are far too complex to be flatly summarized as an addictive personality disorder. Yet this leads to an important question: What is it that makes some people more vulnerable to experiencing addiction? A look at the traits associated with addictive behaviors can provide some insight into this complex area.
Characteristics Associated with Addictive Behavior
Research shows that certain factors have a weighted influence on whether a person is part of the minority who are more likely to develop addictive behaviors compared to the general public. HBO, as part of a public education commitment, provides helpful information. As HBO explains, the following are considered to be the main factors involved in the development of addiction:
- Use of drugs of abuse at an early age
- The presence of a mental health disorder
- Trauma experienced in childhood
- A person’s social environment
This list is based on extensive research across different types of addictive behaviors. In the area of genetics and alcoholism, for example, research has found that more than 60 percent of people who experience alcohol abuse have a history of alcohol abuse in their families. Yet research is also clear that genetics alone does not determine a person’s propensity to become addicted to a drug or a process, such as gambling.
It is well accepted that nature (genetics) and nurture (environment) are key players in the formation of addictive behaviors. A fast glance at the foregoing list makes it clear that social factors are also highly impactful. Childhood traumas can include parental strife, divorce, neglect, sexual abuse, or poverty, and they serve to predispose a person to addictive behavior. A person’s immediate environment, such as living under duress or in the presence of people who abuse drugs, can be influential as well.
Research shows that the age at which a person engages in an addictive behavior can create structural changes in the brain that then predispose the person to develop an addiction. For instance, according to one review study, 40 percent of individuals who began drinking alcohol before 15 years of age developed an alcohol use disorder. In the case of marijuana, a research study referenced by the American Psychological Association is illuminating. The study found that adults who began to smoke marijuana before 16 years of age smoked this drug 25 times per week with an average intake of 15 grams. The adults studied who started smoking marijuana after the age of 16 smoked about 12 times each week and consumed an average of 6 grams of the drug.
In the field of addiction research and treatment, it is well observed that there is a strong connection between mental health disorders, such as bipolar disorder, and addictive behaviors. According to the National Institute on Drug Abuse, substance abuse and mental health disorders cannot be assumed to be causally related. There are different types of relationships between substance abuse and mental health disorders. For example, studies show that marijuana use may lead to psychosis in some individuals because the drug triggers the emergence of this symptom, which is related to an underlying mental health disorder. In some cases, individuals may begin to abuse drugs as an attempt to self-medicate. One research study on people with schizophrenia who smoked cigarettes found that smoking resulted in a decrease in their symptoms and improvement in their cognitive functioning; however, the study does not advocate the use of cigarettes. In yet other cases, the substance abuse and mental health disorder arise from overlapping factors, such as genetics, deficits in brain function, or childhood trauma.
From a clinical standpoint, there is no definitive checklist of characteristics that can be used to help determine if someone will engage in substance abuse. The foregoing discussion highlights risk factors. An understanding of these risk factors can help individuals, families, and clinicians to develop preventive strategies in order to stop addictive behaviors before they emerge. But an awareness of these risk factors can also help to treat addictive behaviors once they have manifested. For instance, risk factors can be turned into therapeutically oriented questions, such as, “When did the addictive behavior begin? Is there a family history of such behaviors?” This level of inquiry, once an addictive behavior has developed, can get to the root causes of the behavior and provide a foundation for recovery.
Treating Those with Addictive Personalities
Treatment in a research-based recovery center for an addiction to a drug or behavior typically takes a holistic approach. While it is critical for the treatment team to address the specific type of addiction, a main objective of treatment is to heal the addictive behavior itself. But how do treatment professionals achieve this goal? What goes on in recovery programs?
In broad strokes, a comprehensive recovery center provides the following services:
- A thorough intake process: helps the treatment team to create a tailored recovery plan
- A detoxification process: a supportive environment conducive to abstinence, or, in the case of certain drugs like opioids, provides safe substitution therapy
- Therapy: individual sessions and group sessions
- Family services: family therapy, social events, and family education
- Case management: supportive services that provide help with housing, job placement, childcare needs, and transportation to aftercare, such as 12-Step meetings
- Mutual aid meetings: peer support or 12-Step meetings, such as Alcoholics Anonymous, Narcotics Anonymous, etc.
- Aftercare guidance: information on how to engage in effective aftercare after completion of the recovery program
For purposes of this discussion, which is not focused on addressing a particular type of addiction but rather addictive behavior itself, it is most helpful to consider how therapy is used in treatment. Once a recovering person has undergone the relevant detox process, the next phase of treatment is therapy, a main pillar of treatment in recovery programs. There are different types of therapy in use at recovery centers. The following is a sample of research-based therapies, meaning they have been shown to be effective in the context of addiction treatment:
- Motivational Interviewing (MI)
- Cognitive Behavioral Therapy (CBT)
- Seeking Safety (a trauma-focused therapies)
- Rational Emotive Behavior Therapy (REBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
Cognitive Behavioral Therapy is a widely used therapy approach. A trained therapist can use this method in either individual sessions or in group therapy. CBT has been proven to be effective across different types of addictions. The number of individual sessions may vary based on the recovering person’s needs. Typically, a rehab center that uses CBT will provide clients with 1-2 individual sessions each week in addition to group therapy 4-5 days each week. The following are some general highlights of the CBT method:
- Long-lasting effects: Research shows that the benefits of CBT continue even after sessions have ended.
- Effectively focuses on needs identification: In sessions, recovering people are guided to investigate the needs underlying their addictive behavior.
- Offers re-education: Recovering clients are provided with the tools to develop cognitive skills to cope with stress and thereby develop healthy behaviors to replace the addictive ones.
- Self-esteem building: In therapy, recovering people learn ways to overcome negative self-image, low self-esteem, and destructive thoughts.
For greater insight into the innovative methods now used to treat addictive behaviors, consider the Seeking Safety approach. This method is touted for its effectiveness and flexibility. While it addresses both the trauma underlying and/or associated addictive behaviors, it does not require recovering individuals to delve deeply into the traumatic experience, which can be painful to revisit. The following are some of the main benefits of the Seeking Safety method:
- Recognizes and addresses the recovering person’s vulnerabilities: A main goal of Seeking Safety is to help recovering people to establish safety at the level of their relationships, behaviors, emotions, and thoughts.
- Integrated treatment: A therapist will work with the recovering person to address the trauma and addictive behavior in tandem.
- Focus on client empowerment: Trauma and addictive behaviors undermine personal power; to counteract this, Seeking Safety teaches clients self-empowerment strategies.
- Comprehensive approach: Seeking Safety takes a holistic approach. The therapy is committed to improving the behavioral, interpersonal, and cognitive aspects of the recovering person’s life as well as providing case management.
Therapy is a dynamic process. It is well accepted in the treatment community that addiction treatment services must be responsive to the needs of clients as they progress through treatment. In addition, certain therapies may be most beneficial during different phases of treatment. While there is no exact science to healing addiction, there are numerous research-based therapies that can be engaged to optimize the process.
Relapse Prevention and Recovery Maintenance
According to the National Institute on Drug Abuse, there is a 40-60 percent rate of relapse in the drug addiction context. The considerable relapse risk is a main reason why there is a strong consensus in the recovery treatment field that detox is not enough to end addiction. For this reason, recovery treatment programs offer layered treatment services after the detox phase is completed. A comprehensive drug recovery program builds relapse prevention techniques into its treatment platform. It can even be said that every treatment service is a relapse prevention strategy. The overarching goal in addiction treatment programs is that recovering individuals achieve lasting recovery and not just a temporary break from their addiction.
Recovery from addictive behaviors does not end when formal treatment in a rehab program is completed. Aftercare is considered to be a critical part of the ongoing recovery process. Stated most simply, aftercare services are those services that a recovering person engages after inpatient or outpatient treatment ends. The following are some of the most common types of aftercare services:
- 12-Step meetings or other self-help groups with a non-faith focus, such as SMART Recovery meetings
- Group therapy sessions
- Sober living homes
- Complementary care or holistic treatments, such as acupuncture, yoga or exercise
- Individual therapy sessions
- Ongoing efforts to self-educate on how to maintain long-term recovery
Periodic drug testing is also considered a vital part of aftercare. Testing is sometimes included in an ongoing counseling program or onsite at a sober living home.
Drug testing can help treatment professionals to keep a recovering person safe.
It is well established in treatment programs that relapse can be part of the recovery process, and the key is a fast, effective response. A relapse is never a failure but rather a cue to revisit treatment options and step up the level of services engaged. Recovery is a long-term goal, and remaining flexible and responsive to different needs along the recovery continuum is instrumental to lasting sobriety.