Rachel Pauli: Welcome to today's webinar, ‘Overcoming Addictions’. My name is Rachel Pauli and I will be the host for today’s webinar.
Please remember a copy of the PowerPoint as well as the tip sheet are under the Event Resources section. If you have any questions you can submit those through the Ask a Question box.
Our presenter today is Dr. Phil Quinn. Dr. Quinn is a Chief Psychologist at South Shore Mental Health Center, a psychiatric consultant at the University of Massachusetts Medical School and is a corporate consultant and trainer.
So without further delay, Dr. Quinn, I will turn things over to you.
Dr. Phil Quinn: Rachel, thank you very much. Today, we're going to be discussing ‘Overcoming Addictions’. We're going to be talking a number of issues. We're going to talk about addictions comparing habits in addiction. We're going to look at one disorder, gambling, it’s sort of a representative disorder, meaning that it's similar to a number of issues that we're going to discuss.
We’re going to discuss the stages of change and why people from times are unsuccessful at changing their habit or addiction that they elected for a change. Also we will discuss issues in terms of treatment.
What are some of the issues that we are facing when we talk about addictions? Obviously, any of these listed here can be habits or just a normal part of life. We all use the phone, for example, we all use the Internet, but when these issues start to dominate our lives, and even positive things like exercise can become an addiction to any of these issues, whether it be working too much, gambling, shopping, exercising, et cetera, can really become more compulsive, and it would be no longer helping our lives, but actually making life a little bit more difficult for us.
When we talk about habits, one of the things we have to remember is, this they develop from many reasons. We develop habits and addictions really in some ways to make our lives easier. We all have read about the opioid epidemic that we are experiencing in the United States. Many people started innocently taking a prescribed medication and moving onto street drugs after that. Many people use social media, it’s a way to stay in touch with family and friends and it slowly turns into something different. So there are many reasons that we develop these habits and addictions.
What is important to recognize is it's when they turn into something different, when they turn into a problem that they start to control their lives they would realize that we have a problem.
Let's take a look at habits for a moment. How much really sort of automatic things that we do everyday, some are conscious, some are not, whether it's in a morning we brush our teeth, we don't consciously think about that, we just sort of follow our daily routine.
When we get dressed in the morning, we probably get dressed in the same sequence everyday, why? Because these things make our lives a little bit easier.
Remember, habits can be good, bad, neutral, positive or negative. For example, again, brush your teeth in the morning, that's a good habit, we do it in the morning, we do it in the afternoon, but it's not something that we have to think about it, but it keeps us healthier.
If we look at a bad habit, such as eating, obviously everyone of us needs to eat on a regular daily basis, but it's when we start eating habit, eating out of anxiety, worry, et cetera it can become a problem. Some things are neutral, like for example, whether it be pacing, et cetera, but it is important to remember that the habits that make our lives easier those are the things we should keep. The habits that are now becoming intrusive, we may want to think of changing those. Often habits and addictions are really coping strategies. They can be healthy ways to help our lives better. For example, you go for a walk after lunch everyday, that may be a habit, but that’s something it may reduce stress. We take a moment to do some deep breathing exercises or think of positive things during our days. So those things can be very healthy and that's important, because if we have healthy habits we now have fewer decisions to make everyday. Such thing is decision fatigue, if we have too many decisions to make everyday it makes our lives more difficult.
So habits can make our lives easier because we have fewer day-to-day decisions, which leaves more energy for important decisions. We have more time, our day goes smoother, our healthy habits allow us, help us to reach and maintain our goals, for example, if you have habit of walking everyday, that will help us maintain healthy weight. Also healthy habits reduce some motivation, we need to do things. For example, if we want to exercise read and write, we don’t have to, if we have a healthy habit of having a healthy breakfast every morning, we don’t have to be motivated to do that, we do that automatically. Finally, healthy habits can reduce stress. Former President Barack Obama used to wear basically two types of suits; I guess a grey and a blue, why? He had a lot of important decisions to make everyday and what he didn’t want to do is spend all his energy on habits, on decisions that were important. So he just chose one suit or the other every morning.
Unhealthy habits can lead to stress, and that’s important, because now if I am overeating I am starting to worry about what that mean for me. It can create a medical problem, such as increased cholesterol level. It can cause a psychological problem because I get anxious about it. It can also lead to other problems such as alcohol use, drug use. So a glass of wine everyday or every other day in the evening may relax us, but once we get to two or three glasses of wine, that can create a problem.
Unhealthy habits can also lead to other situations like problems within our family, personal problems. If a person spends too much time on social media, it impacts your ability to interact with your family. If we spend too much time surfing the web at work, it may create a difficulty in our career, and if we gamble too much, what may be fun every once in a while can cause significant financial difficulties.
And finally, unhealthy habits, whether it be alcohol use, food and intake, gaming on the Internet, gambling, they can lead from something that may be fun and enjoyable and start to invade our lives and create a myriad of difficulties.
Well, let’s take a look at addiction. Addiction is primarily a chronic disease of brain reward, motivation, memory and other related circuitry. Dysfunction in these circuits can lead characteristic biological, psychological or social problems. This is reflected individual pathologically using a substance, for example, and that’s really the key, it gets out of our control. So it’s not a person who would like to have a glass of wine after work, it’s a person who needs to have a glass of wine after work.
Sometimes I am wondering is what I am dealing with a habit, or what I am dealing with an addiction. Let’s look at it, because in some of them there is a fine line between the two often, but what do we really think, it’s really the inability to regulate habit, no ability to regulate practical decisions and causes distress. We spend an inordinate amount of time and energy whether it is to pursue the habit or addiction or whether it’s to hide this habit of addiction. It creates financial and personal risk, so maybe family, work, finances, and there are negative consequences. Even though the individual may understand the negative consequences, they continue using the behavior. So even though I know I am causing myself considerable financial problems I continue to gamble, I continue to lose money. Finally, there is a psychological component. We feel shame or guilt. We have to hide these behaviors from our friends, colleagues, and loved ones.
Well, let’s take a look at a particular disorder and what is important to remember whether it’s gambling, whether it’s gaming on the Internet, surfing the web, often these habits/addictions follow a similar path. So in gambling we need to gamble more and more money to achieve the excitement. Very similar to tolerance, we need more-and-more alcohol to get the desired effect. So the small bet that worked in the past no longer works for us, we have to gamble more money.
We are restless and irritable when attempting to cut down, that’s essentially withdrawal because we are not gambling on a regular basis, we feel that loss and we could feel it really physically or psychologically.
A person with gambling disorder has made him unsuccessful, efforts to control or cut back or stop gambling, and you realize it’s out of your control, it’s just not a matter of stopping something; it’s the inability to stop something. And there is a preoccupation with either gambling or wondering how it’s going to go. The person cannot watch a game, a sports game on TV for fun for example. They are always wondering is the team going to be spread.
Paradoxically often -- the person often gambles when feeling distressed. It becomes a coping strategy, so actually the gambling, and even the loss of money makes you feel better for a moment, but ultimately it causes considerable distress.
After losing money in gambling, the person returns the next day or that later that day and it’s essentially chasing the loss, you lose $100, you try to get that $100 back and now you are down $200.
And there is often a lot of concealment with involvement of gambling, aiming or anything like that, and a person has put in jeopardy significant relationships in their lives with their partner and children. It brings a lot of difficulty in jobs, educational problems, et cetera, and that’s really the important aspect. And finally in gambling, we rely on others, we lend this money to solve this problem.
What is important in gambling is the affect of intermittent reinforcement. What does that mean? It means that nobody gambles and wins all the time. They win periodically, but that’s a very strong and powerful reinforcement if the person goes back and gambles some more and the problem perpetuates.
Often when people try to change a habit or addiction we go through a variety of changes, and that's important to recognize, it’s just not a matter of one moment where we have a problem behavior and the next moment we give it up. We often encroach for a variety of stages, Prochaska and DiClemente have developed the stages of change, or you look at pre-contemplation, contemplation, preparation, action and maintenance.
During the pre-contemplation stage we are thinking about change but have no plan of action and maybe no real motivation, and often at this stage, people are not successful because they haven't planned accordingly.
As a problem continues whether it’s gambling or any other addictive or habitual behavior we may go to a contemplation stage where we are realizing at some level the habit is now causing us -- causing disruption in our life and it’s no longer helping us, it's no longer enjoyable, it’s become a problem.
In the preparation phase it’s the time that we actually plan and ask ourselves what am I going to do to change, what am I going to need, what support am I going to need? We will realize at this point the change is hard and we need a specific action plan. During the action plan, we actually implement the changes that we feel necessary, whether it’s going for a professional help, asking for family support et cetera.
Finally, the maintenance stage, and the maintenance stage is very important. We have all read about people who have lost a lot of weight and had died and once they reach their goal, they rebound back. The exciting part is over for example if we have lost weight people are no longer complimenting us on our loss, so we don’t get that support and we need to look for ongoing sources and support in order for us to be successful. Have we replaced that negative habit with another coping strategy? If eating was our coping strategy, if gambling is our coping strategy or day-to-day stresses that if we haven’t implemented it in another coping strategy we often have difficulty. So what's important is we have to look at how we are going to maintain our gains, and that's what's done in the maintenance phase of our work.
But how we change a habit? Charles Duhigg wrote a book ‘The Power of Habit’ and why do we have these habits? As we talked earlier some of these habits make our lives a little bit better, but sometimes we have to notice what is the trigger, what is underlying cause, why do we gamble for example, is it because we are nervous or anxious or worried and that takes our mind off it?
What is the risk of the bad habit? We have to admit that how we're losing in our lives, what's the negative aspect, and finally, what is the reward, why are we really doing something? Until we understand why we're doing something, it's very hard to change our behavior, and this is where we can seek out help whether it's from a mental health provider, the PORT Group, and our EAP. The Employee Assistance Program can be a valuable source of direction and helping you change a habit before becomes a significant problem, or help you change an addiction after it has become a significant problem.
One of the things we have to realize is habits, addictions take place overtime. As a result, they're not changed overnight, so we often have to recognize that we have to have patience.
In many disorders there are sort of relapse remitting disorders that sometimes we slide back into that. We have to go back to our action phase and solve the problem again.
Fortunate there is treatment for any type of habit or addiction. The first step obviously is a recognition of a problem. We have to realize that this habit again whether it be gambling, using social media, using a substance, et cetera, is now not helping our lives, not making our lives easier, but actually making our lives a little bit more difficult. So if we recognize that this problem is now intrusive in our lives depending on the problem it may be important to consult a medical professional. If you have an alcohol problem addiction it may not be possible or healthy to stop immediately, we may need medical treatment.
If we have a weight problem due to overeating, we may have to take a look and have an appointment with a nutritionist, our primary care physician. See if there have been any medical consequences of our addiction. If we de-conditioned and we would like to start a positive habit of exercise it may be important to run that by your primary care physician to help you deal with this problem, so you can exercise safely.
Finally, it maybe important to consult mental health professionals because the addictions or habit maybe covering up mental health issues, such as, depression or anxiety.
The PORT groups can be very helpful. Then you have formal support groups such as AA or Overeaters Anonymous, et cetera. They maybe informal support groups that are just as powerful. For example, if I want to start an exercise program, having a running buddy or a group of running buddies or walking buddies, can be very helpful, why? Because they can help motivate us when our motivation is down. So having a support group, either formal or informal, be very helpful. Often people with depression or anxiety that is causing us this negative habit or addiction.
Mental health counseling can be very helpful, and often if you seek help through a psychologist, social worker, et cetera, they will use cognitive behavioral therapy. Briefly cognitive behavioral therapy helps a person understand the cognitions, what are the reasons that I do something, and what is the behavior. So for example, if I'm anxious and gambling reduces my anxiety for a moment, I have to recognize that I'm anxious, what are the thoughts that I'm having, and instead of gambling do have positive habits such as deep breathing, visualization or going for a walk.
Marital counseling can be very important, our partners can be a help or a sabotage. If I am addicted to cigarettes, for example, and my partner is smoking, I am going to go to craving. If I am addicted to gambling and my partner is gambling on the web I am going to go into craving. So often we need support from our partner to help us deal with them.
Family counseling, often family issues are involved in what we are doing. So we have to may have to restructure them.
Relapse prevention, that’s really key, and if we solve a problem and relapse we start all over again, so it is important to recognize what are the situations that may cause me to be relapsing. For example, if I gamble on football games and it’s coming up to bowl season that may put me in that risk, so I have got to plan for that. We need ongoing support.
And finally, one of the healthy coping strategies that we have developed; we all need coping strategies to get through life, so part of the treatment is developing those positive coping strategies, so we will have something in our tool-belt during times of stress.
Ongoing groups and peer support are really evidence-based treatments that they help us work, Alcoholics Anonymous or AA, is probably one of the most known sources of support, and the reason for that is, that we can go to a meeting at anytime and find people who are dealing with the similar problem, understand what we are going through and offer support. Other forms of alcohol recovery or drug recovery are the SMART Recovery, Narcotics Anonymous, Al-Anon for loved ones. But Gambling Anonymous and Overeaters Anonymous can be very helpful because we go into a gambling anonymous program. They understand what we are experiencing; also, we may get good tips for dealing with our problem that they have used.
Now some of the issues that we face, whether it be a shopping, sexual addiction, a variety of other issues, sometimes we have to have a targeted clinical group and that maybe if so if there is a mental health facility in your area, a hospital in your area, ask your primary care physician if he could refer you to a group that will help you deal with your specific problems. Again, why they are so successful? They are successful because we know that the people in the room have gone through the same things that we are going through and not only it can be supportive and helping us change, but also can help us anticipate the pitfalls, the holes in the road that we may experience as we go down the path to recovery.