Addictive Behaviour: Addressing Change
By Angus R. MacDonald, MTS, M.Div.

Addiction and its consequences are one of the most serious health problems facing our society today. There is little question that addiction is a multifaceted chronic condition that continues to baffle not only the medical community but addiction counselors and the addicts themselves. Addictive behaviors represent confusing and complex patterns of human behaviour that have defied explanation throughout history. Addictions have been with us since cave people drank fermented mash from skulls and traditions say a substance that transforms reality is deeply rooted in our human imagination.

This article is an attempt to address a very large and complex problem in a very limited space. Medically, addiction is a chronic and progressive disease that has psychological, physical, behavioral and social consequences. But addiction can also be viewed as engaging. To excess, in any kind of behaviour for one’s own pleasure. One of the ironies of addiction is that what begins as a search for pleasure soon evolves into a constant struggle to avoid pain. The addictive habit exists simply to keep withdrawal symptoms at bay.

Deepak Chopra, M.D., in his book “Overcoming Addiction” says “addicts hope to find a shortcut to paradise, but it proves to be a wrong turn”. This is an absolutely crucial point about addictions, whether it involves drugs, food, alcohol, tobacco, gambling, sex, internet or any of the thousands of other temptations that present themselves daily in our lives. Addiction begins by looking for the right thing in the wrong place. Chopra presents it this way: “Suppose a young man finds a substance that instantly transports him to a completely different experience of life, if only for a short time. Suppose another young man, stalled in his career and feeling the pressures of family life, feels more relaxed if he stays up after his wife has gone to bed and drinks a beer – and he feels even better still if he consumes half a dozen of them. Whatever the experience, in either case, if it provides pleasure there will naturally be a desire to repeat it. Repeating it is a choice, at least initially. Later, when addiction has taken hold, it becomes a need, and even a compulsion”. As part of the process of addiction, the addictive personality develops.

There is no hard evidence to prove that the addictive personality exists before one becomes addicted. Craig Nakken, in his book “The Addictive Personality” suggests that there are certain addictive values which fuel the addictive personality, such as:

• the lack of close relationships
• object worship
• self-centeredness
• the need for control and perfection
• goal-mindedness

While the addictive personality can be seen as an outcome of addiction, Nakken also sees their values as a potential cause of addiction because they are so prevalent in society. In order to have a successful recovery, one must be aware of the traits of the addictive personality. Knowing about the addictive personality and how it fuels the addiction is the best way to stop the cycle from repeating itself and begin the road to recovery.

Signs of Addictive Personality

• false sense of control - believing they have the ability to limit the addictive behaviour
• false sense of comfort – not seeing the dangerous effect of their actions on themselves or others
• rationalizing one behaviour and denying that there is a problem
• changing one’s life to access the addictive substance or behaviour

experiencing financial and/or legal problems as a result of the behaviour

Although a full discussion of recovery is beyond the scope of this article, it is important to note that not all people suffering addiction are impaired in every aspect of their daily life. There is a progression of substance use and abuse, which also applies to the non-chemical addictions such as: sex, Internet, food and gambling. According to Metro Addiction Prevention and Treatment Services literature, the initial stages include:

(1) first use/experimental use;

(2) experimental use/irregular use;

(3) regular use.

The next three stages are worthy of some clarification:

(4) Harmful use:
- Your health suffers.
- You have less energy, less stamina, more emotional ups and downs
- You have memory loss or blackouts
- You get into trouble legally, financially
- Your relationships with family, friends and coworkers become strained.

(5) Dependence:
- You feel physically and/or emotionally uncomfortable when the substance is not available
- You will go to great lengths to make sure it is available
- You think you need the substance to feel better – to cope with stress, to relax, to deal with self-consciousness, etc.

(6) Addiction
- The substance becomes a central focus in your life, your lifestyle revolves around it
- You spend a great deal of energy thinking about the substance, using it, and getting some more
- You no longer use for the same reasons you used to. Use is compulsive and has developed a “life of its own”.

Perhaps the greatest deterrent in making progress in the treatment of addictions is denial on the part of the addict. One’s absolute refusal to accept the fact that the problems they face in their lives are caused by they’re addictive behaviour. Within Alcoholics Anonymous, there is an old man sitting among recovering alcoholics that confesses, “I didn’t get in trouble every time I drank, but every time I got in trouble, I was drinking”. However, people don’t leap from a state of ignorance about their problem directly into the motivation to change.

An accepted method within treatment circles of introducing change and understanding how people change is outlined I Prochaska and DiClementie’s “Stages of Changing Behaviour” model which recognizes the complexity of the human decision making process. This Harm Reduction Approach supports a continuum of change, which acknowledges that small incremental steps are still progress and necessary to longer-term change.

The “Stages of Changing Behaviour” model defines five stages of change. A person may stay in any stage for a length of time or move back and forth. Relapse is possible at any time. Outlined are some ways one can use the model to understand where a client/patient is in the change process, and how you can support them.

Pre-Contemplation
Client Harm reduction assumes that this is where the client is – that the client has no intention of changing behaviour in the foreseeable future. The client is unaware of the problem(s) even it others see it.

You Give information and feedback, suggest choices, but do not insist on them r push the client into them.

Contemplation
Client The client says, “I think I have a problem with my drug use, but I’m not sure if I can, or want to, change it”. Many people who cannot see themselves substance-free in this stage, can see themselves making small changes in their substance use which will reduce harm and make them healthier.

You Present intermediate choices, such as cutting down rather than stopping, or changing the route of administration (e.g. from injecting to smoking), or looking at dangerous combinations and less harmful alternatives.

Planning & Preparation
Client The client works through some of the change choices they have chosen. In terms of harm reduction, this person has entered a recovery process. The talking indicates movement toward change.

You Support and guide the appropriate and effective choices the client makes (e.g. tapering off, using less harmful substances, practicing vein maintenance). Maintain a realistic basis for change.

Action
Client The client takes small steps over time and builds upon them to modify their behaviour. There is a great deal of back and forth and some grains are consolidated for a time, then lost, then re-consolidated. The client uses you as an external monitor of their activity.

You Help the client increase their sense of self-efficacy (the client’s perception that they are capable of carrying through with this action). Help them focus on their successes. Help them tae credit for what they accomplish.

Maintenance
Client The client works to maintain the small changes that were made and avoid returning to the old ways of using. Uses newly developing skills that replace the substances as a coping mechanism.

You Help the client identify and use these strategies, supporting the progress.

Relapse
Relapse is a word that is familiar to substance use treatment and 12 Step Programs. Another word that is used is slip. Both words mean returning to using drugs or alcohol after a period of non-using or using less. This can and does occur in any and all stages of change. The client’s struggle to achieve their goals is difficult, workers need to provide support that is not shame-based.

Helpful Websites

• alcoholics-anonymous.org
• al-anon-alateen.org
• ca.org (cocaine anonymous)
• cybersober.com
• gamblersanonymous.org
• netaddiction.com (cyber/online addiction)
• sa.org (sexaholics anonymous)
• smokehelp.org

Angus R. MacDonald, MTS, M.Div. may be reached at Roth Associates in Psychology. at (902) 454-6166. Roth Associates in Psychology is a full-service counselling Firm whose Registered Psychologists and Social Workers offer assistance to children, adolescents, adults, couples and families.