Categories
Addiction

Internet-Based Addictions IRL

While it is not uncommon for people to post selfies and statuses describing their every thought and action, for many individuals, social networking sites (SNSs) have become a medium to engage in compulsive and addictive behaviors. As emergent disorders, internet-based addictions constitute a relatively young branch of psychological research. In spite of this, the increasing prevalence of online addictive behavior has resulted in myriad studies of broad internet-based addictions, including those related to social networking, gaming, cyber stalking, as well as others.

Before diving into the clinical specifics, it is pertinent to examine the inherently addictive nature of phone culture in general. The format of SNSs and mobile operating systems themselves play heavily on the reward centers of the human brain. For example, every time we check a notification to remove that pesky number badge, we are immediately negatively reinforced (an unpleasant stimulus is removed) when the little red circle is no longer there. There is another more powerful example: intermittent reinforcement, the strongest of all reward schedules. Intermittent reinforcement encompasses an inconsistent and unpredictable schedule of behavioral rewards. The fact that every notification is different, and that each has a different value to us, makes every instance of checking them a gamble, so to speak. In fact, gambling addiction is one of the most difficult to overcome for this very reason: intermittently being rewarded makes the reward that much stronger. In this light, it is no wonder that a wide range of rather esoteric addictions and compulsions are derived from internet use, such as SNS-based addictions.

One might think that social networking would improve the quality of life for people, as socialization is an innate necessity of the human brain. In less scientific terms, it is typically considered pleasurable to be social. Research has contrarily shown that there is actually a negative association between life satisfaction and the amount of time spent on facebook, and goes on to suggest that the addictive qualities of the internet may be a factor explaining this trend (Steiger, 2019). Another study, utilizing various personality inventories to examine the relationship between Instagram addiction and personality, found a negative association between Instagram addiction and agreeableness, conscientiousness, and self-liking. They contrarily found a positive association between Instagram addiction and daily internet use (Kircaburun & Griffiths, 2018).

In addition to SNS-specific addictions, the internet as a whole, provides the basis for other modern compulsive and addictive behaviors, such as with gaming and cyber stalking. In fact, research has shown that online gamers exhibit withdrawal symptoms, especially “craving to game, impatience, increased sleeping, increased eating, lack of pleasure, irritable/angry, anxious/tense, restless, difficulty concentrating, and increased dreaming” (Giordano et. al, 2020). Stalking, an “emotional and sentimental addiction”, has progressed into its modern form of cyber stalking, increasing the ease with which stalkers may victimize their targets via the internet (Majchrzyk, 2012). Related research, including a study of the activity of men on Facebook with a focus on correlations between self-presentation behaviors, self-objectification, and level of Dark Triad (Machiavellian, psychopathic, and narcissistic) traits, portrays that “those high on Dark Triad traits may employ SNSs to execute ‘cheater strategies’ that help them achieve their interpersonal and social goals despite their antisocial personality traits”, such as editing their posted selfies (Fox & Rooney, 2015). Beyond enabling catfishes to lie about their true identities for personal gains, the endless supply of internet-provided anonymity may catalyze severely dangerous and violent behaviors.

Daily internet use seems, at this point, unavoidable. There are however, tactics that may be employed to prevent internet use from becoming problematic, or to decrease behavior that is already troublesome. Monitoring one’s screen time, setting temporal limits on gaming and social networking, and speaking with a healthcare professional may help to stop or curtail addictive and compulsive internet-based behaviors. At the very least, it is pertinent to be mindful of the various behavioral issues that may arise from excessive internet use.

References

Fox, J. & Rooney, M. (2015). The Dark Triad and trait self-objectification as predictors of men’s use and self-presentation behaviors on social networking sites. Personality and Individual Differences, vol. 76, 161-165. https://doi.org/10.1016/j.paid.2014.12.017

Giordano, A. L., Prosek, E. A., Bain, C., Malacara, A., Turner, J., Schunemann, K., & Schmit, M. K. (2020). Withdrawal Symptoms Among American Collegiate Internet Gamers. Journal of Mental Health Counseling, 42(1), 63–77. https://doi.org/10.17744/mehc.42.1.05

Kircaburun, K., & Griffiths, M. D. (2018). Instagram addiction and the Big Five of personality: The mediating role of self-liking. Journal of behavioral addictions, 7(1), 158–170. https://doi.org/10.1556/2006.7.2018.15

Majchrzyk, Z. (2012). Stalking – Desire, Impulse, Obsession, Compulsion, Addiction. Between Pathology and Postmodern Culture. Sveikatos Mokslai (Journal of Health Sciences) 22(2), 99-106. https://sm-hs.eu/wp-content/uploads/2019/02/278-983-1-PB.pdf

Stieger S. (2019). Facebook Usage and Life Satisfaction. Frontiers in psychology, 10, 2711. https://doi.org/10.3389/fpsyg.2019.02711

Categories
Addiction Trauma and Stressor Related Disorders

Connections Between Trauma and Addiction

People who have experienced trauma typically need to devise coping strategies for handling stress. Unfortunately for many people, addiction becomes a source of comfort and escape. The association between trauma and the development of various addiction later in life may be even more profound than we realize.

A strong friend of mine, who wished to remain anonymous, was kind enough to describe her experience of trauma and subsequent addiction as follows: “I remember my mom physically abusing me and my dad saying that it was my fault since I tested her patience and lived in a fantasy world. [My parents] would constantly tell me I was crazy, drag me to doctors for issues and always find something wrong with me. [My addiction] was a coping mechanism from my dog dying, my mom having cancer, my best friend stealing, and all the abuse from my past”.

According to one study, which utilized a questionnaire administered to women who were seeking treatment for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD), nine out of ten participants reported a history of childhood trauma. The researchers also found that the severity of the trauma was positively correlated with the severity of various symptoms, such as “depressive symptoms, dysthymic symptoms, socio-phobic symptoms, and distrust,” as well as an earlier onset of substance use (Lotzin et al., 2019).

In addition to substance use, PTSD has been linked to less externally obvious addictions, such as food addiction. Earlier this year, one study reviewed overlaps and distinctions between the histories and behaviors of a sample of women with food addiction and substance use disorders, compared with a control sample of women without addictions. Through administering various standardized questionnaires and scales, they found that “women with SUD or food addiction have similar PTSD and depression symptom profiles, and exhibited more problems with emotional dysregulation as compared to [the control group]”. They go on to suggest that “food addiction and SUD [may] have similar neurobiological signatures, including abnormalities in reward pathways, and may respond to similar types of treatment” (Hardy et al., 2019).

Childhood adversity, such as abuse, trauma, and neglect yield alterations in the dopaminergic, oxytocin, and glucocorticoid systems of people, as described in detail by one study. These changes exist molecularly, neuro-endocrinologically, and ultimately behaviorally. People with trauma thus suffer from such afflictions as insecure attachment style, risk-seeking, and symptoms of depression and anxiety. They are more susceptible, down to the molecular level, of developing addictions later in life (Kim et al., 2019).

It is vital to always keep in mind that people who are addicted to drugs are more often than not, simply coping with unimaginable pain in a destructive way. The more resources they have available to them, the more hope there is that they can live their lives free from the bondage of addiction. As the brain is specifically wired to respond to rewards, there is nothing wrong with people who use. When provided with alternative coping skills and a supportive network, it becomes possible for them to heal from both addiction and the damage of an adverse childhood.

References

Hardy, R., Fani, N., Jovanovic, T., & Michopoulos, V. (2018). Food addiction and substance addiction in women: Common clinical characteristics. Appetite, 120, 367–373. doi:10.1016/j.appet.2017.09.026

Kim, S., Kwok, S., Mayes, L. C., Potenza, M. N., Rutherford, H., & Strathearn, L. (2017). Early adverse experience and substance addiction: dopamine, oxytocin, and glucocorticoid pathways. Annals of the New York Academy of Sciences, 1394(1), 74–91. doi:10.1111/nyas.13140

Lotzin, A., Grundmann, J., Hiller, P., Pawils, S., & Schäfer, I. (2019). Profiles of Childhood

Trauma in Women With Substance Use Disorders and Comorbid Posttraumatic Stress Disorders. Frontiers in psychiatry, 10, 674. doi:10.3389/fpsyt.2019.00674

Categories
Addiction

One Show at a Time

For people with a history of substance use disorders, it can be difficult to enjoy situations in which those around them are drinking or using recreational drugs. With clouds of marijuana smoke permeating the air and visibly intoxicated people in the crowd, concerts and music festivals may be considered dangerous territory to those who strive for total abstinence. While the obvious solution to this dilemma would be an altogether avoidance of these scenarios, it would be quite impractical for avid music fans to spend their lives dodging every show. Attending concerts with friends who also abstain from drinking or drugging can make a world of difference to lessen the sense of overwhelming vulnerability. Luckily for those unable to find clean companions, there are several groups in place that have made it possible to safely attend on one’s own.

Enjoying music can be a spiritual and therapeutic experience for many people.  According to one study, singing is capable of both increasing immune system function and altering hormones and neurotransmitters associated with happiness and reduced stress (Kang et al., 2018). People who are in recovery from a past of using drugs may feel vulnerable when at a concert where for example, clouds of marijuana smoke permeate the air and it seems as though almost everyone in the audience is holding a beer. Luckily, several support groups exist that are linked to specific bands – groups that typically set up a table somewhere in the venue and hold meetings during intermissions. The Wharf Rats for example, are a group of deadheads (avid Grateful Dead fans) who have chosen to live lives free from drugs and alcohol. They formed in the 1980’s, are not affiliated with any twelve-step group, and are still going strong today. When attending a Dead & Company concert, or any other related show, it is possible for concertgoers to find them, usually at a table colorfully clad with yellow balloons, candy, and inspirational stickers stating things such as, “another dopeless hope fiend” or “one show at a time.”

Following in the footsteps of these deadhead pioneers, other support groups have formed within jam band culture. Fans of the Disco Biscuits can feel safer at shows, knowing The Digital Buddhas table is there if needed. Moe. fans can seek out the Happy Hour Heroes, while seeing the band. The Wharf Rats also set up tables at other Dead-related shows, such as JRAD and DSO concerts.

To gain some insight as to how meaningful these groups are for so many people, I interviewed my enthusiastic friend, Adam Colton, who participates in several of them:

Q: How long have you been participating in the clean jam band scene? What was your first experience like?

A: “I first heard about the Wharf Rats (clean/sober dead-heads) when I was in rehab. Speakers would come up to share their experience, strength, and hope. One speaker in particular stood out, and I really related to her passion for live music. I was so excited and relieved to know there were other people who were clean that were still able to go to shows. I stayed away for my first year, until I felt confident enough to go see moe. at Beekman Beer Gardens in Manhattan. I remembered there was a yellow balloon table, as several bands in the jam band scene have, and made it safely there. I felt free, connected, safe, liberated.”

Q: How many tables have you volunteered to do so far?

A: “I’ve been participating in the clean jam scene for just over 7 years. I’m coming up on 9 years clean. I have volunteered at countless tables since, for several bands. Although the jam scene features a big drug culture, most people are open to and support the presence of a community of concert goers that remain substance free.”

Q: You recently started another group for the band, Pigeons Playing Ping Pong – what has that been like?

A: “Creating the clean/sober group for Pigeons Playing Ping Pong has been one of my proudest accomplishments in recovery. I got to go on a dream vacation and cross Red Rocks (Morrison, CO) off my bucket list. I traveled across the country to see two of my favorite bands and one DJ. I got to see 4 shows that week at Red Rocks. I had already been in contact with their manager, who was very open at the idea of having a clean/sober presence at their shows. I was volunteering at moe.’s table, when I met PPPP managers, bassist, and drummer. My excitement was matched by theirs. I got to present ideas, and began to organize and structure a group of clean/sober people who would volunteer at PPPP shows across the country. Our first table was that fall tour, in 2018. We’re called “Sobird Flockers”.

Navigating through all the obstacles that would arise, stepping up into this leadership role has been a gigantic learning experience. Keeping my vision, our shared vision at the forefront–creating a space for people who choose to remain substance free at shows, is what supports me through any hardships that I’ve encountered. We have a group of 500 people on facebook, and tons of people I’ve met throughout the years all over the country. You can imagine all the different personalities. Our unity and passion for what we do ties us all together.”

Q: What is your favorite thing about being part of these groups and why?

A: “My favorite thing about these groups are the connections, the community. The smiles, the gratitude. I’ve met so many people all over the country, and have built deep connections and friendships with them and their families. Some of my closest friends are people I’ve met being of service. Becoming part of each others support groups spending holidays together, a sense of belonging, purpose… community. Knowing we all create that space together, seeing someone for the first time realizing they can do what they’re passionate about clean/sober. Seeing a new person for the first time achieving that level of freedom, happiness, bliss. 

 Because that’s what we do. I need to talk about freedom. My passion for live music is a lot more than just attending concerts. It’s the personal/spiritual freedom I feel while at a show, the connection, the love. These are almost direct opposites of the hold that addiction had on me. Strangers become family. To be able to share that with a group of people who all feel the same.”

It’s a beautiful thing for people with a history of substance use disorders to be able to enjoy life again without the need to drink or use drugs. These grassroots groups portray the importance and power of strong support networks for people with a history of substance use disorders. Many of the members also happen to be the nicest people you’ll ever meet. If any concert-goer is in need of support, be it a hug or a listening ear, these groups may be an infinitely valuable resource for approaching recovery one show at a time.

References

Pettersen, H., Landheim, A., Skeie, I., Biong, S., Brodahl, M., Oute, J., & Davidson, L. (2019). How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study. Substance abuse : research and treatment, 13,1178221819833379. doi:10.1177/1178221819833379

Kang, J., Scholp, A., Jiang, J. (2018). A Review of the Physiological Effects and Mechanisms of Singing. The Voice Foundation Journal of Voice, vol 32, issue 4, 390-395. doi:10.1108/03090560710821161Wharf Rats. (n.d). retrieved from http://wharfrat.org/

Categories
Addiction

Is Addiction Really a Disease?

While the classification of addiction as a disease is largely accepted within medicine, in the last few years it has become a subject of debate. Notably, Marc Lewis a neuroscientist, who recovered from a crystal meth habit, has published books and articles challenging the brain disease model of addiction (BDMA). Lewis instead embraces a developmental-learning model, placing an emphasis on the fact that substance use disorders occur as a result of classical conditioning and habituating behaviors associated with drug use.

Lewis’ publications are self-described as being “free from…the disease bias” (Lewis, 2017), by which he means that labeling people who have substance use disorders as “diseased” may not only misrepresent various neurobiological aspects of addiction, but also serve to reinforce already problematic associated stigma. Lewis calls for the “[reframing] of addiction as the development of coping habits within a social matrix…[and argues] that the brain is designed for exactly that.” Within this conceptualization of addiction exists a powerful and parsimonious solution to problematic substance use: removing environmental antecedents to addictive behaviors should over time, eliminate these behaviors and their consequences altogether.

Dr. Lewis’ line of thought is in direct conflict with much of what is accepted in psychiatry, research, and the recovery community. According to his model, recovery is possible without any, let alone long-term, treatment. Great news, right? While the flourishing rehab industry, Big Pharma, and researchers, for whom much funding is justified by the disease definition, would likely not think so, it seems reasonable to assume a person who is penniless and addicted might.

Several researchers have evaluated the developmental-learning model. In her response to Lewis’ work, Maia Szalavitz agrees that “disease…is an imprecise word (with a lot of damaging baggage) whose main function is to generate access to medical care” (Snoek & Matthews, 2017, p.3). Kent Berridge expresses a similar, but less critical, sentiment about maintaining the current model, describing the disease label as something that “is not unreasonable and deserves to be tolerated” so as to ensure continued access to treatment for those who need it (Snoek & Matthews, 2017, p.2).

Financial and political consideration aside, there are pros and cons to this idea of recovery sans professional intervention. For every unique case of addiction, there exists an individualized solution. There is however, an unquestionable need for biopsychosocial care during the initial phase of recovery–detox. Detoxification from certain substances, such as alcohol or benzodiazepines can be incredibly dangerous–even potentially fatal. While withdrawal from other types of drugs, such as opiates, is less directly lethal, it is possible to die while detoxing from them mainly due to severe dehydration and hypernatremia from persistent vomiting and diarrhea, which may ultimately lead to heart failure. Furthermore, detoxing presents with dangerous psychiatric symptoms such as hallucinations, depression, and severe anxiety–all of which should ideally be professionally monitored.

Once a person has finished detoxing, there is likely a need for a certain level of continued care, as reacclimating to life without drugs poses myriad challenges. With proper guidance and support, living a life free of addiction becomes more possible and the chances of relapse diminish. Whether this care is necessary at a professional level is something that can only be assessed on a case-by-case basis. Overall, once a certain level of independence is accomplished, continued care may not be necessary at all.

Lewis’ theory is both progressive and valuable, at the very least sparking an open discourse about how best to classify and treat addiction. While acceptance of his model may yield solvable financial and political problems, it may also provide an insurmountable level of hope for people with substance use disorders. The developmental-learning model eliminates the widely accepted notion of “once an addict, always an addict”, the very crux of the disease model problem. Lifelong misdiagnoses and diagnoses proliferate self-fulfilling prophecy and inhibit potential recovery. Labels become trap doors. As such, this less permanent model paints a more hopeful picture of recovery.

References

Darke, S., Larney, S., Farrell, M. Yes, people can die from opiate withdrawal. Addiction.2017;112:199–200

Lewis M. Addiction and the Brain: Development, Not Disease. Neuroethics. 2017;10(1):7–18.doi:10.1007/s12152-016-9293-4

Snoek, A., & Matthews, S. (2017). Introduction: Testing and Refining Marc Lewis’s Critique of the Brain Disease Model of Addiction. Neuroethics, 10(1), 1–6. doi:10.1007/s12152-017-9310-2