Alan M. Yorker, LMFT August 26, 2014 GSAS Conference Addiction Interaction Disorder: New Concepts in Understanding Addiction and The Dance of the Addictions Alan M. Yorker, LMFT August 26, 2014 GSAS Conference

Cross Addiction STAY TUNED! Old definition - having two or more addictions New definition – observation of how separate addictions interact or interrelate – STAY TUNED!

Part 1 – Understanding Addiction Interaction Disorder as a new model for addiction

A true addiction is a compulsion to do something repeatedly that proves to be harmful to oneself and/or others. True addictions are progressive (i.e. strengthen/worsen over time). True addiction involves repeated cycles of toxic behavior. True addiction has harmful impacts on family, friends and society.

Four Modalities of Addiction Substances (e.g. alcohol, street drugs, food, tobacco/nicotine, pharmaceuticals, etc.) Activities (e.g. work, sex, gambling, exercise, worship, cleaning, etc.) Relationships (i.e. codependency) Mind/body states (e.g. anger, arousal, histrionics, etc.)

Part 2 – The Dance of the Addictions 1985 Orford, “The triad of drink, sex and gambling share many features; each has given rise to fascinating and similar logical and semantic problems.”

Early 90’s - Carnes reports less than 13% of all addicts have only one addiction.

1993 Huebner – In Eating Disorders, Endorphines, and other Addictive Behaviors finds similar neurochemical reactions with compulsions and deprivations.

1994 Carnes - Addiction Interaction model conceptualized.

2001 – Leshner, “Addiction is a disease that manifests as compulsive behavior.”

2001 - van der Kolk - Discovers traumatic reactivity and alteration in the brain leading to excessive behaviors, i. e.addiction.

A model was needed to integrate the addictions.

Addictions have meta-patterns that are important and are discernable clinically. This is the basis of “Addictive Interaction Disorder.”

Addictions don’t just coexist Addictions don’t just coexist. They interact, reinforce and become part of one another.

They become packages which can be unbundled and examined separately as is done currently. However, they need to be examined as a whole to get to the heart of the problem.

Eleven (11) Addiction Interaction Dimensions have been identified.

Cross Tolerance: When two addictions coexist and reinforce each other (e.g. workaholism and sexual addiction)

Withdrawal mediation: When one addiction mediates another, (e. g Withdrawal mediation: When one addiction mediates another, (e.g. caffeine, nicotine)

Replacement: When one addiction replaces another (e.g. Bill W.)

Alternating Addiction Cycles: When addiction shifts focus (thin and sexually hyperactive vs. obese and sexually aversive)

Masking: Blaming one addiction for another (e. g Masking: Blaming one addiction for another (e.g. “I did it because I was so drunk”)

Ritualizing: Set behavioral patterns of dress, place, routine.

Intensification: Two or more addictions fused or partially fused together or infused.

Numbing: Using one addiction to soothe oneself or calm oneself after another (e.g. drinking to relax after sex, watching TV for hours after amphetamine abuse. Drug binge)

Disinhibiting: Using one addiction to lower one’s inhibition to another (e.g. drinking to “get up the courage”, using drugs to engage in risky behavior)

Combining: Using multiple addictions to create a wave of “high” (drinking followed by drug use, followed by risky sex, followed by gambling)

Inhibiting: Using an addiction to limit or control another (using MJ to avoid using cocaine, gambling online to avoid accessing child porn)

Deprivations: A mirror of interactions

Table 2.1 Addiction and Deprivation Characteristics Compulsive behavior. Loss of control. Efforts to stop (out of control – chaos). Preoccupation obscures risk Loss of time affects obligations. Continuation despite obvious Consequences Despair Shameless Compulsive behavior. Excessive control. Efforts to initiate (supercontrol repression). Obsession exaggerates risk. Loss of time affects obligations. Continuation despite obvious Consequences Despair Shameful

Table 2.1 (cont.) Addiction and Deprivation Characteristics Escalation: More is better. Distress: Anxiety, restlessness, irritability. Losses. False empowerment. Reduces anxiety. Escalation: Less is better. Distress: Anxiety, restlessness, irritability. Losses. False safety. Reduces anxiety.