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Addictions

Addiction refers to strong urges to engage in behaviours or take substances despite negative consequences. There is a sense of lack of control and there can be mixed feelings about continuing with the behaviour. Addictions are often misunderstood and there can be enormous judgement from others as well as the person with the addiction. Having an addiction is often a source of shame as people struggle with repeated efforts to make changes in their behaviour. Recent advances in research have improved our understanding of addictions and have helped to she light on the complexity of both substance and behavioural addictions. Most people think of addiction in terms of addiction to a substance for example, drugs, smoking, alcohol or food, but addiction can also be to experiences or behaviours such as gambling, sex, shopping or even over-work. Not surprisingly, addiction can cause difficulties in almost all areas of life, especially in our relationship with ourselves and those around us.

There are two main models that explain addiction. The first is the disease or medical model, which suggests that addiction is a complex and chronic illness, much like diabetes or cardiovascular conditions. This model suggests that some individuals are genetically more vulnerable to addiction, and display desensitisation of the reward circuits in the brain. Research suggests that the neurotransmitter dopamine is highly important in this process, because of its role as a reward communicator and thus strong motivator. When an individual engages in a behaviour that releases dopamine, the reward pathway lights up. However, the brain tries to maintain equilibriam at all times, and as such, tries to reduce the amount of dopamine in the brain. Over time, this leads to a need for more of the substance or behaviour to get the same level of reward or pleasure, and ultimately, to a conditioned response to the substance or behaviour. Furthermore, research suggests that individuals with an addiction show reduced functioning in brain regions responsible for regulation and decision-making, another result caused by disruption in the dopamine/reward system of the brain. These changes can leave individuals feeling powerless to their addiction, and require support to shift.  

The second main model to explain addiction is the psychological model. This model suggests that addiction is a set of learned coping behaviours in response to our environment, beliefs, thoughts, emotions, and sensations. Frequently, addictive behaviours may begin as a way to cope with other mental health concerns (such as trauma-related concerns, depression, or anxiety), or with difficulties in our environment (such as stress, relationship concerns, or grief). Over time, addictive behaviours become conditioned and overlearned, and individuals struggle to find alternative ways to cope. Additionally, the addicted individual’s behaviour is likely to lead to further difficulties, which in turn may cause an increase in mental health symptoms and maladaptive coping behaviours. This can get individuals stuck in a cycle of addictive behaviours.

Our approach to addictions

Our treatment is focused on helping you to understand your experiences in a non-judgmental forum where you can make informed decisions about the direction of the work. Your psychologist will first conduct an assessment of your current concerns, needs, and goals, and collaborate with you on what interventions best suit your needs.  From there, we will work together to provide evidence-based treatment, such as:

  • Psychoeducation about addiction - its affect on the brain and body and how its maintained, to understand what is going on for you and how to best treat your concerns
  • Motivational interviewing - to provide you with a non-judgemental forum to reflect on the impact of the addiction and to explore your thoughts and feelings about change.
  • Cognitive therapy may be used to identify and shift thinking patterns, beliefs, and interpretations that get in the way of using helpful coping strategies.
  • Identification, understanding and reflection on the behaviours that are involved in the addiction. It may be useful to develop alternative coping strategies before attempting to change the dynamic of the addictive behaviours. 
  • Distress tolerance and emotion regulation techniques are often very helpful to assist with the reduction of reliance on addictive behaviours to manage our emotional world and relationships.
  • Guidance and support in reducing the harm associated with behaviours or ceasing the addictive behaviours altogether. 
  • Forward planning of relapse-prevention to structure and strengthen the strategies that will help to maintain change.
  • It is well-understood that underlying trauma is a contributing factor in the development and maintenance of addictions for many people. Treatment may include addressing these factors to help you to achieve lasting change. All treatment, particularly any that involves trauma work is paced carefully and proceeds only when the client is ready and willing to do that depth of work. 

Refs

DSM 5
Volkow, Koob, & McLellan (2016)
Miller, Forchimes & Zweben (2011)

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