Addictions and the problems they conceal

Addicts may be suffering from co-occurring afflictions such as bipolar disorder and schizophrenia – but, unfortunately, are misdiagnosed.

brain scan_521 (photo credit: MCT)
brain scan_521
(photo credit: MCT)
The Oxford English Dictionary traces the term “addiction” to Roman law, under which it was a “formal giving over by sentence of court; hence, a dedication of person to a master.” This notion of relinquishment of control by the addicted person is the central feature of many lay and professional definitions of the term.
Ron, 56, is a successful businessman who has his own company. He has been married to L. for 30 years, and they have two children who are attending universities. Throughout his marriage, Ron has played around with the idea of infidelity, sometimes coming very close to cheating on his wife. Finally, he crossed the line and started having an affair. For two years, the affair continued with the same woman, and he even paid to set her up in an apartment She was his mistress and sexual plaything. His wife did not catch on to his behavior; he always had the excuse of working late at the office. After two years, Ron decided he wanted out of this arrangement. He then started to spend money on high-class prostitutes, one of whom he requested to see over and over, at least twice a week. Again, his wife did not know what was going on. Ron started to drink during these encounters. His alcoholism became very intense, and he could not cut back on his heavy drinking and his sexual addiction. He came to me after almost dying of alcohol poisoning, and is currently actively involved in Alcoholics Anonymous and recovery.
CLEARLY, RON is a sex addict and alcoholic. But what most people didn’t know – including a few psychiatrists he consulted and several therapists he saw briefly during his addiction run – was that Ron also had a coexisting psychiatric condition: bipolar disorder, or manic-depressive illness. In fact, his mania, which expressed itself in his workaholism and hypersexuality, could only be calmed down by his use of alcohol, a classic example of what experts in the addiction field call self-medicating.
Ron is not alone. Scientific studies have found that almost 25% of all addicts – be they drug and alcohol abusers, gambling addicts, workaholics, shopping addicts, or sex addicts – suffer from bipolar disorder and/or attention-deficit hyperactivity disorder (ADHD). Other psychiatric and emotional illnesses that regularly co-occur with addiction include conduct disorder, posttraumatic stress disorder and schizophrenia.
In the case of drugs and alcohol, a therapist has to be careful to evaluate which came first, the mental illness symptoms or the addiction. As noted in Ron’s case, mental health problems often lead to the use of alcohol or drugs as a way to self-medicate. Conversely, there are cases where an individual begins to develop the symptoms and signs of a mental illness only after using drugs, suggesting that drug abuse has caused or exacerbated the mental disorder. Only a trained clinician who understands the overlap between addiction and mental health problems can determine the true culprit and give a correct diagnosis.
Careful assessment and treatment of co-occurring disorders is critical to maximizing the chances of success in treatment. If one of the co-occurring disorders goes untreated, both usually get worse and additional complications often arise.
The good news is that people with addictive disorders can be successfully treated. Finding the right opportunity to motivate the individual to change, what we in the addiction field call a teachable moment, is the challenge. Many things may get people to want to change their behavior, particularly if they have compromised their health or career, gotten in trouble with the law, or created havoc in their social and/or family relationships. Ron compromised both his health and his family relationships.
Evidence-based studies have shown that relapse-prevention, a cognitive-behavioral therapy, is the best treatment for addictions. This should always be combined with motivational counseling, 12-step programs and, when necessary, psychiatric evaluation to diagnose and treat other coexisting psychiatric illnesses. Family counseling and guidance is also essential, to bring the family on board to support the individual’s recovery. Behavioral and cognitive change should be the immediate and first goals of recovery, later followed by emotional insight into the etiology of the problem. Like Ron, a person with an addiction who really wants help can get it – it’s there.
The writer is a marital, child and adult psychotherapist practicing in Jerusalem, Tel Aviv and Ra’anana.