1. Addiction Interaction Disorder: Understanding Multiple Addictions
Patrick J. Carnes, Ph.D.

2. Gambling (N=103) 2

3. Alcoholism (N=740) 3

4. Substance Abuse (N=664) 4

5. Eating Disorder (N=213) 5

6. Addiction Interaction6

7. Challenges to Recovery
Addiction is a brain disease

8. Addiction is a brain disease expressed in the form of compulsive behavior.
Alan I. Leshner, MD
Former director of the National Institute on Drug Abuse

9. Nucleus Accumbens—Brain’s Reward Center
Neurochemistry
Nucleus Accumbens—Brain’s Reward Center
Normal
Obese
Red indicates high number of receptors for dopamine
People short of dopamine have difficulty feeling joy.
Alcoholic
Cocaine
Hans Breiter, director of the Motivation and Emotion Neuroscience Center at Massachusetts General Hospital 9

10. DA Concentration (% Baseline)
Natural Rewards Elevate Dopamine Levels 50
100
150
200 60
120
180
Time (min)
% of Basal DA Output
NAc shell
Empty
Box
Feeding
Source: Di Chiara et al.
FOOD
100
150
200
DA Concentration (% Baseline)
Mounts
Intromissions
Ejaculations 15 5 10
Copulation Frequency
Sample
Number 1 2 3 4 6 7 8 9 11 12 13 14 16 17
Scr
Bas
Female 1 Present
Female 2 Present
Source: Fiorino and Phillips
SEX
©2008 Patrick J. Carnes, PhD 10 10

11. Effects of Drugs on Dopamine Levels
100
200
300
400
500
600
700
800
900
1000
1100 1 2 3 4
5 hr
Time After Amphetamine
% of Basal Release DA
DOPAC
HVA
Accumbens
AMPHETAMINE
100
200
300
400 1 2 3 4
5 hr
Time After Cocaine
% of Basal Release DA
DOPAC
HVA
Accumbens
COCAINE
100
150
200
250 1 2
3 hr
Time After Nicotine
% of Basal Release
Accumbens
Caudate
NICOTINE
100
150
200
250 1 2 3
4hr
Time After Ethanol
% of Basal Release
0.25
0.5
2.5
Accumbens
Dose (g/kg ip)
ETHANOL
Source: Di Chiara and Imperato 11

12. Common Language of Technological Change
Internet sex as the “crack cocaine” of sexual compulsivity
– Al Cooper Ph.D.
Machine video poker as the “crack cocaine” of compulsive gambling
– Robert Hunter, Ph.D.

13. Definition of a Black Hole:
A celestial phenomenon when a massive star collapses from its own gravity. A black hole has such a strong pull that not even light can escape from it.

14. Addiction Interaction
An addiction phenomenon where multiple addictions combine to overwhelm a person by their complexity and power. Phenomenon is so strong, no specific focus is strong enough to escape from it.

17. Challenges to Recovery
Addiction is a brain disease
Addiction can be the gateway to the pursuit of excellence

18. Challenges to Recovery
Addiction is a brain disease
Addiction can be the gateway to the pursuit of excellence
Addiction often has a trauma component

19. 265 Indicated Some Abuse (92.3%)
ABUSE AND ADDICTION
265 Indicated Some Abuse (92.3%)
(N=264)
Sexual
Physical
Emotional No 11 35 17
____ 63
23.9%
Yes 31 60
110
____
201
76.1% No 26 51 36
____
113
42.8%
Yes 16 44 91
____
151
57.2% No 7 10 4
____ 21
8.0%
Yes 35 85
123
____
243
92.0%
One Addiction
2 – 3 Addictions
4+ Addictions

21. National Violence Against Women Survey
Persons raped or physically assaulted in lifetime by sex of victim
Women -- 55% or 55,383,350
Men -- 67% or 61,955,644
Last twelve months:
Women -- (302,091) 1,913,243
Men -- (92,748) 3,153,432

22. NAVW Survey
Seventy-six per cent of the women who were raped and/or physically assaulted since the age of 18 were assaulted by a current or former husband, cohabiting partner, or date.
Another twenty six per cent knew their assailant.
Only fourteen per cent were victimized by a stranger.

24. Compulsive Attachment: Key Characteristics
Troubled people
Hero and pathological giving
High Intensity and Drama
Boundary Collapse
Impression Management
Conflict Avoidance

25. “The addictive dependence on feelings of pain…”
Alice Miller, The Drama of the Gifted Child

27. Addiction Interaction Disorder
Addictions more than coexist, they interact, reinforce, become part of one another. They become packages.

29. Cross Tolerance
A. Simultaneous increase in addictive behavior in two or more addictions.
B. Transfer of a high level of addictive activity with little or no developmental sequence.

30. Withdrawal Mediation
One addiction serves to moderate, relieve, or avoid withdrawal from another.

31. Replacement
One addiction replaces another with majority of emotional and behavioral features.

32. Alternating Addiction Cycles
Addictions cycle back and forth in a patterned systemic way.

33. Masking
Addict uses one addiction to cover up for another, perhaps more substantive addiction.

34. Ritualizing
Addictive behavior of one addiction serves as a ritual pattern to engage another.

35. Intensification
Fusion dependence: neither addiction separately is sufficient; only simultaneous use is sufficient.

36. Intensification
Partial Fusion: Addict combines addictions in such a fashion to be more potent than each addiction separately; addictions are used independently part of the time.

37. Intensification
Binge Features: episodic multiple use, yet functionally independent of one another.

40. Numbing
Addiction is used to medicate shame or pain caused by other addiction or addictive bingeing.

41. Disinhibiting
One addiction is used to lower inhibitions for other addictive acting out.

42. Combining
Mixing addictive experiences to moderate responses due to neuropathway interaction.

43. Addiction Interaction: Patient Recognition (N=650)
Cross Tolerance – 59%
Withdrawal Mediation – 59%
Numbing – 59%
Fusion –57%
Masking – 56%

44. Addiction Interaction: Patient Recognition (N=650)
Replacement – 47%
Disinhibiting – 46%
Ritualizing – 44%
Combining – 38%
Alternating Addiction Cycles –36%

45. Addiction Interaction Paradigm Changes:
Diagnostic Framework: revision of DSM
Treatment Process: depth and scope
Treatment Focus: the underlying issues
Relapse Prevention: addictions as packages
Altered Strategies: first step, screen, neuropathways
Mirror Patient Realities: professional allegiances

46. Challenges to Recovery
Addiction is a brain disease
Addiction can be the gateway to the pursuit of excellence
Addiction often has a trauma component
Addiction can take many forms
Addiction treatment is difficult to access for many

47. Challenges to Recovery
Addiction is a brain disease
Addiction can be the gateway to the pursuit of excellence
Addiction often has a trauma component
Addiction can take many forms
Addiction treatment is difficult to access for many
Addiction and recovery interfere with advocacy

48. Additional Information48

49. For more on the Certified Sex Addiction Therapist (CSAT) trainings, the task-centered approach to addiction recovery, and assessment testing for sexual, work and financial issues go to: or
or call
(480) 49

50. Gentle Path Press For books, workbooks, CDs & DVDs
on the subject of sex addiction and recovery,
please visit:
or call
(800) 50

51. SexHelp For additional information about
Dr. Patrick Carnes, links to other resources,
current topics in research, and popular literature, go to: 51