When we broaden our vision on cross-addiction, it is imperative that we discuss the similarities and differences among the various forms of addiction.  Too often, I hear clients report that they are “alcoholics or drug addicts” but they fail to acknowledge any other forms of compulsive behavioral disorders.  When asked, “do you have a gambling problem or are you addicted to sex, lust, adrenaline, and relationships?”, the vast majority fail to recognize that addiction is addiction—no matter what is looks like.

First, let’s define what an addiction is: An addiction is a cognitive; behavioral; spiritual disease that manifests itself in the afflicted individuals life in a variety of ways.  Three definable and observable characteristics of addiction are: loss of control, increased tolerance, and continued use despite adverse consequences (DSM-IV TR, 2000).  When someone starts to lose control over their maladaptive behaviors, their ability to set established limits on that behavior is diminished or becomes non-existent.  Once they engage in the behavior, an obsessive-compulsive physiological cognitive process begins and their upper level cognitive processes (mainly the ability to think rationally) are “short-circuited” to the point that they obsess about the continuing use of that behavior.  For example, an alcoholic may say, “I am only going to have 2 beers or I’ll leave the bar at 8:00 p.m.”, and find themselves still at the bar at 11:00 p.m., having consumed 12 beers.  In another example, a pathological compulsive gambler walks into a casino thinking they are only going to bet $25, and finds themselves there hours later, having gambled $250 or more.  Definable and observable characteristics of loss of control can be seen in all forms of addiction (e.g., alcohol, illicit and prescription substances, sex, nicotine, food, pornography, rage, relationships, spending, self-mutilation, internet …).  Increased tolerance is the brains’ need for more of the substance or behavior to achieve the desired effect.  In alcohol, for example, where someone would begin to feel the intoxicating effects of alcohol after consuming two beers, now they require four or more beers to begin feeling the effects.  In compulsive pathological gambling, where someone could feel energized and satisfied from gambling with $20, now it takes $100 to achieve the same desired effect.  Increased tolerance can also be observed in all forms of addiction.  Continued use despite adverse consequences is the compulsion to continue acting in a behavioral manner—despite the fact that it is causing you harm and you recognize it is causing you harm but you continue to act in that manner anyway.  Here is the insanity of this behavior; let’s say I am a carpenter.  While building a house, I accidentally nail my thumb to a board.  Rightfully, realizing how much that hurt, and not desiring that to re-occur, I would be a lot more careful in the future.  However, if I continued to act in a manner that placed me at risk of repeating that behavior, it’s fair to say that my behavior would be    considered dysfunctional.  Continued use despite adverse consequences can be defined and observed in all types of addictions.

Having said all this, I would like to point out that in order for someone to fully recover from an addiction, they must stop   engaging in ALL forms of addictive behaviors.  That means, an alcoholic jeopardizes their recovery when they smoke marijuana or ingest other drugs; a drug addicted person is likely to relapse when they consume alcohol; an alcoholic/addict is likely to return to their drug(s) of choice when they hang around a casino; a compulsive pathological gambler is likely to relapse when they use psychoactive substances; and a sex addict is far more likely to engage in sexual behaviors under the influence of mood-altering substances.  Why?  All addictions originate and are centered in the primitive part of our brain; more specifically, the nucleus accumbens and the ventral tegmental area (VTA)—or the pleasure-reward center.  When psychoactive substances or mood-altering behaviors are introduced to this area of the brain, the foundation of addiction is formed. When a behavior is continually reinforced with a sensation of pleasure or reward, the brain becomes conditioned to the response (pleasure) from the outside stimuli (stress, boredom, loneliness, fear, anger, money ...).     So, you’re an alcoholic or an addict and you don’t think you have a gambling problem, right?  Wrong!  Your thoughts and behaviors are exactly the same as a compulsive pathological gambler.  Look at the following scenarios:  It’s early in the evening, and you’ve had a hard day at work.  Instead of going home after work, you decide to stop at the corner bar for a few beers before calling it a night.  You have diabetes and doctors have warned you against consuming alcohol.  By 8:00 p.m. you’ve downed 5-6 beers and a couple of shots with the boys.  You’re feeling a bit tipsy but “okay to drive”.  You get into your car and drop the keys on the floor.  Scrambling to find them, you hit your head on the steering wheel.  Picking up the keys, you slide them into the ignition, start the car, and drive away toward home.  Are you gambling?  Yes, everyone knows that the DUI laws are extremely strict and you’re gambling with your life, someone else’s life, your freedom, and hundreds, if not thousands, of dollars in attorney/driving reinstatement fees.  You’re rolling the dice that you won’t get caught.  In a second scenario, you’re an addict, and you decide you need a fix.  After gathering your drug paraphernalia, you head toward the city to score heroin.  The anticipation of getting high makes your mind begin to race.  As you approach the city limits, your stomach knots; your heart palpitates; your palms begin to sweat; your respiration shallows, and you feel nauseated.  Police are all around.  Fears of incarceration only serve to increase the adrenaline that is rushing through your veins, and fear of being mugged or ripped off heighten the flight or fight sensation.  Once you “score” you need to escape without getting caught possessing a controlled substance.  Finally, after making it out safely from the area, you commence the ritualistic process of scrapping,   preparing, straining, and drawing the heroin into the hypodermic needle—ready to inject the drug into your veins.  Are you gambling?   You “bet” you are!  And, the stakes are extremely high!  Life versus death; health versus disease; freedom versus incarceration; family/friends versus loneliness and despair; emotional pain/discomfort versus emotional escape.  In addition, compulsive pathological gamblers experience the same physiological characteristics as drug addicts while engaged in gambling or in preparation to gamble (heart palpitations, increased respiration, hypertension, sweating palms, indigestion).  The DSM-IV TR diagnostic criterion for  Pathological Gambling (diagnostically coded 312.31) states the “the essential feature of Pathological Gambling is persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits the individual may be preoccupied with gambling (e.g,. reliving past gambling experiences, planning the next gambling venture, or thinking of ways to get money with which to gamble”). The diagnostic criterion for the pathological gambler are identical to the criterion describing someone who is alcohol or substance dependent; sexual dependent relationship      dependent; food dependent; shopping dependent; self-injurious dependent, etc…  All dependencies have the tendency to disrupt an individuals personal, family, or vocational pursuits, and all include cognitive or behavioral preoccupation.

In order to achieve long-term abstinence from any maladaptive behavior, the addicted individual must “build their life around their recovery instead of building their recovery around their life”®, remain cognizant of all dysfunctional cognitions and behaviors that may—even remotely—jeopardize their program of recovery, and     implement a comprehensive plan of action to avoid possible pitfalls.  Remembering that ALL addictions originate in the pleasure-reward center of the brain (the nucleus accumbens and the ventral tegmental area), the brain understands a euphoric reward as a reward, and it does not differentiate the origin of the reward.  Over time, with repetitious use or repetitious behaviors, the brain becomes conditioned to expect the reward when exposed to a stimuli (operant conditioning).  That expectation creates a craving, and the craving triggers a response. Therefore, “addicted to one, addicted to all” is a slogan that individuals in recovery need to remain forever mindful of.

   Jeff Gilbert

Founder & Executive Director