There are two classes of addictive behavior: substance addictions and process addictions. The substance addictions include alcohol, drugs (licit and illicit) and food. The process addictions include gambling, sexual addiction, pornography, eating disorders, self-mutilation, shopping, working and any other behavior which becomes compulsive to the degree that it interferes with day-to-day life.
Treatment for alcoholism includes total abstinence, individual therapy, medical management and participation in a support network. Dr. Coughlin will work with the individual or family to locate appropriate detox facilities and/or physicians to assist in medical management of withdrawal symptoms. She will design an individual treatment program to address the client´s specific needs for support and rehabilitation during the first year of recovery. All clients are encouraged to participate in a self-help support network. The most commonly attended support groups are Alcoholics Anonymous, Rational Recovery and Celebrate Recovery.
While many people differentiate between street drugs (cocaine, heroin, methamphetamine, marijuana, etc.) and prescription drugs (valium, xanax, adderall, percoset, vicodin, oxcontin, etc.), when it comes to addiction it matters little whether the drugs are obtained legally or illegally. Treatment for drug addiction follows the same protocols as for alcoholism. The individual may require a medical assesment and referal to detox to establish abstinence. Ongoing medical management is often recommended due to the impact of drugs on brain biochemistry. Support groups such as Narcotics Anonymous, Rational Recovery and Celebrate Recovery can greatly assist the recovery process. Psychotherapy will assist in making lifestyle changes needed to support recovery. Individual treatment may be necessary as the emotions hidden by drug addiction begin to surface in recovery.
Compulsive overeating is clearly addiction to a substance, most often sugar or starches which quickly convert to sugar. The term sugar coma alludes to the sedating effect food can have on individuals who are stuffing their feelings. Treatment for compulsive overeating must begin with addressing the underlying emotions which trigger the overeating. Unlike other substance addictions, Dr. Coughlin believes it is necessary to achieve therapeutic stabilization before establishing abstinence. With food addiction, abstinence refers to eliminating trigger foods and controlling quantity; the ultimate goal is to enjoy all types of foods in appropriate quantities.
The treatment for process addictions is similar regardless of the nature of the addiction. Dr. Coughlin will first assess the severity of the addictive behavior, evaluating the function it serves for the individual and developing an individualized treatment program. Clients may be referred to a psychiatrist for medical management of mood instability which frequently accompanies cessation of process addictions. This is seen as a short-term support for the individual and is not meant to suggest these addictive behaviors represent mental illness. Many process addictions also have support groups that can assist in providing social support, empathy and understanding (e.g. Gamblers Anonymous, Sex and Love Addicts Anonymous, Debtors Anonymous).
Sexual exhilaration is intoxicating and can be physiologically mood altering with the release of endorphins (naturally produced morphine-like compounds). In this regard it is similar to substance addictions as some sex addicts are chasing an altered state of consciousness. Sexual compulsivity may take many forms ranging from compulsive masturbation to sexual promiscuity. People often feel embarrassment or shame about sexual compulsions. Dr. Coughlin addresses sexual addiction without judgment, viewing it as a process addiction which has taken control of the individuals life; working with the client to establish normal sexual behavior.
Pornography may be seen as a subtype of sexual addiction. There is a tendency for viewers of pornography to increase the variety and intensity of the material they find stimulating. In this manner, the individual builds a tolerance and increases their exposure to the point where it often interferes with other activities (e.g. sleep) and relationships. The internet provides ready access to pornography causing many more individuals to be exposed and become addicted to viewing this material. Occasionally employees are referred for violation of company computer policies prior to termination. If you, or someone you know, is risking a job by viewing pornography on work computers, please call to discuss treatment. Any compulsive behavior which continues despite risk to job stability is considered addictive.
Gambling represents the essence of habit formation. Those addicted to betting and games of chance have been conditioned by what is known as an intermittent reinforcement schedule. This is the most resilient method of conditioning behavior; when you don’t know when you will win but anticipate that a win will come, you keep gambling often far beyond what you can afford to lose. Gambling can destroy health and family relationships, there is a least one reported incident of death directly attributed to gambling.
This is included as a process addiction because, like so many addictions, self-mutilation can become compulsive as the individual uses physical pain to escape or express emotional pain. Unfortunately individuals build a tolerance to self-injuring pain causing the behavior to escalate with deeper cuts, more varied means of injury and more intense involvement in order to achieve the same effect. Whether self-injury is used to escape, or express, emotional pain; treatment must address those underlying issues. Individual therapy is best for most people who self-injure.
Dr. Coughlin separates Bulimia Nervosa and Anorexia Nervosa from Compulsive Overeating. It is her experience that Bulimia and Anorexia originate in self-image, control and social image issues rather than addiction to a substance (food). The addiction then becomes one of managing food intake and/or body size. Individuals with eating disorders frequently spend the majority of their waking lives planning what, when, where, and how they will eat or not eat. For bulimics purging becomes an art form. For anorexics minimizing food intake is a prized accomplishment. Dr. Coughlin works with food addicts to uncover the function the eating disorder serves, replace management of food with more functional behavior, and help the individual develop normal eating patterns.
People who are bored or dissatisfied with their lives may, if money or credit allows, find escape in shopping. The criteria which defines other addictions holds true to identify the shopaholic. When shopping is done so obsessively and compulsively as to interfere with day-to-day life, it is deemed addictive. Compulsive shoppers usually shop and buy items in excess of what they need or can use. They will often exhaust financial resources without regard for living expenses (rent, food, utilities) and frequently destroy their credit. The financial strain snowballs into relationship issues causing problems similar to those experienced in gambling households.
Dr. Coughlin established a Workaholics Anonymous meeting for college faculty in 1975. At the time, it was a tongue-in-cheek excuse for a social gathering at the end of the week. As with all humor, there was a basis in reality, she and her colleagues were all working compulsively. Although the University, like most employers, rewarded this compulsive work ethic, it clearly was detrimental to a healthy balance. Working addiction is common among highly successful professionals. It is of clinical concern when work begins to define the self to the exclusion of other relationships, rest and relaxation. Dr. Coughlin now works with others to establish a balance between the vital areas of an individual’s life; therapy becomes an accountability process to assure the balance is maintained.