The autopsy report for Celebrity Rehab star Rodney King was released less than one week after fellow programme alumni Joey Kovar was found dead in his friend’s apartment. King was under the influence of cocaine, PCP, marijuana and alcohol when he drowned in a swimming pool.
After our weekly “aftercare” meetings, my rehab cohorts and I used to watch Celebrity Rehab together, moaning and kvetching about how we didn’t have a pool or a garden. We did, however – like on TV – have to face our sometimes-bitter loved ones during family week.
Denise was in her mid-60s, attempting treatment for the first time, listening to her daughter publicly berate her to our group.
“I just can’t trust her around my children anymore,” the daughter complained to our designated family therapist. “My mom gets out of control when she drinks, and it’s unfair to the kids.”
Denise checked into treatment just a few hours before I did. She introduced herself as an alcoholic, but I quickly learned that her real drug of choice was food. We bonded during our 30-day treatment programme.
The doctors attributed Denise’s sudden alcoholism to the physiological changes resulting from her recent gastric bypass surgery. Indeed, people who undergo certain weight loss procedures can double their risks for developing alcoholism. But someone like Denise, who had all the pre-surgery risk factors, should have been warned about her likelihood to addiction hop post-operation and treated accordingly.
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“Addiction transfer” is the tendency of an addict to substitute one addiction for another while recovering from the first. Of course, all addicts experience a strong desire to repeat a known mechanism of stress and pain alleviation. But, neurologically speaking, addicts transfer substances and behaviours in order to cope with a perceived lack of dopamine in the brain.
Denise was far from the first person I’d seen switch from one destructive outlet to another after swearing off the first. My own life had been a perpetual cycle of compulsive behaviours and substance abuse, never sticking with one long enough to hit “rock bottom”. From food to shopping to men to prescription medication to hard drugs, my memories are more easily tracked by obsessive binges than by time alone. So when I finally entered treatment, I was eager to find a solution.
Instead, I picked up a nasty cigarette habit and a handful of prescriptions for unwanted, non-narcotic medications.
During family week, my dad suggested that I “replace” my drug addiction with a more productive addiction (his suggestion was exercise). After all, he had seen me invest my obsessive tendencies into school my whole life. His idea was met with laughter from the counsellors and staff, all of whom felt he should stick to his own field: financial engineering.
Addiction manifests itself in different compulsions and behaviours, which is critical to recognise during the treatment process. Rather than identifying patients by their drug of choice, which may be transitory, research suggests we institute a broader conceptualisation of this complex brain disease. Denise and I, for instance, would have been better served if the treatment staff had approached us as candidates for “addiction syndrome”, as opposed to an alcoholic and an opiate addict.
“Addiction syndrome” [PDF] is the idea that common pathways underlie related addictive behaviours, causing many individuals to switch from one compulsion to another. Studies supporting the syndrome model have found that different objects of addiction (for example, eating, gambling and drug use) all stimulate the neurobiological circuitry of the central nervous system.
In one such study, functional magnetic resonance imaging (fMRI) concluded that both money and beauty activated the reward system of the brain in a similar fashion as that associated with the anticipation of cocaine users’ experience. Scientists have, in turn, asserted dopamine as a critical neurotransmitter in the development and maintenance of both behavioural and drug addictions.
There are similar neurobiological consequences for chemical and behavioural addictions, like the appearance of tolerance and withdrawal. Research has shown that the emergence of neuroadaptation is not unique to chemical dependency; in fact, disordered gamblers frequently increase their bets in order to reach the same high.
The syndrome model is also supported by the high rates of co-occurrence addiction maintains with many mental health problems, like depression, bipolar disorder, post-traumatic stress disorder, schizophrenia and other neuropsychiatric disorders such as eating disorders and attention deficit/hyperactivity disorder.
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Although neurobiological reward activity is the most well-known evidence defending the addiction syndrome, genetics can also contribute to a person’s vulnerability to addiction. Studies in male twins have determined that shared genetic and environmental risk factors for drug and alcohol use are not substance-specific. Because there is evidence that genetics do not account for someone’s susceptibility to disparate objects of addiction, psychosocial influences enhance neurobiological risk factors to determine how someone experiences addiction.
During the first year of recovery, about 80 to 90 per cent of individuals who enter treatment programmes will relapse. While relapse may be due to inadequate or ineffective treatments and interventions, revising the way we view and diagnose the disease may substantially improve these outcomes. In order to fully address addiction, we must consider the precursors, manifestations and consequences of all addictive behaviour, regardless of the presence of drugs and alcohol.
My insurance-supported treatment programmes, like most, implemented the 12-step model. At a women’s Alcoholics Anonymous (AA) meeting I attended after treatment, I frequently noticed other members struggling with ferocious addiction transfer. When an elderly woman cried, “I just can’t stop eating!” another member told her to save it for the Overeaters Anonymous (OA) meeting the following day. I attended the OA meeting several times, and it was comprised of the very same 20 women who frequented the rooms of AA.
We were all suffering from the same chronic condition – addiction syndrome. Separating us into different groups didn’t change the result.
Contrary to the beliefs of many 12-steppers, the AA programme doesn’t address many of the psychiatric and biochemical issues at the root of chronic alcoholism. Instead, by means of a new routine (meetings), AA provides a model for habit change. By providing a new routine for similar cues and rewards, AA can work as a positive form of “addiction transfer” for the recovering alcoholics in the programme (this may be less surprising for some than others).
When coupled with pharmaceutical and psychosocial treatments, certain replacement habits can be extremely effective for those of us with “addiction syndrome”. But some replacement habits are more effective than others.
A 2005 study found that AA was a successful habit replacement for members only until life stresses got too high. At that point, true believers in programme effectiveness were more likely to sustain sobriety than casual believers.
So what’s the best bet for those of us looking to make serious life changes?
For me, it’s exercise. Turns out my dad’s suggestion to replace my addiction with a more positive one wasn’t so ridiculous. In fact, it’s been said that Alcohol Anonymous co-founder Bill Wilson wanted people to be every bit as devoted to their habit of going to meetings as they were to getting their drink on.
So until today’s treatment programmes catch up to the research, seems the best an addict can hope for is to actively switch addictions, just as Wilson suggested almost a century ago.
Chelsea Carmona is a freelance writer whose work has been featured in major media outlets like The Washington Post, The Christian Science Monitor, The San Francisco Chronicle and The Huffington Post. Chelsea’s work focuses on drug policy, addiction, and women’s issues. She works for the Op-Ed Project as the West Coast Regional Manager.
Follow her on Twitter: @CarmonaChelsea