When Addictions Multiply
Suzanne was hooked on drugs and alcohol, perfectionism, and managing her body image – which became an eating disorder. Until recently, co-existing conditions like Suzanne’s were called dual diagnosis and co-morbidity. Dual diagnosis denoted either the presence of two or more addictions or the presence of chemical dependence along with a mental health problem such as major depression, bi-polar disorder, anxiety disorder, etc. Obviously, one set of symptoms can complicate the diagnosis and treatment of the second set of symptoms.
Suzanne’s dilemma is an excellent example of the way various unhealthy dependencies interact. As a result of alcohol and marijuana use, she gained weight, which compelled her to diet strenuously because she couldn’t allow herself to be less than perfect. Next came the abuse of diet pills, followed by bulimiarexic behavior (periods of self-starvation alternating with periods of bingeing and purging). The fear and guilt accompanying these actions made Suzanne so miserable that she drank to escape her negative feelings, which increased her caloric intake and thus her weight, for which she tried to compensate by starving herself or by over-eating and then purging.
In the realm of multiple interacting dependency disorders, there are several other common combinations: (1) alcoholism plus workaholism, (2) alcoholism and rageaholism, which often acts itself out as spouse or child abuse, (3) workaholism alternating with sexaholism, (4) relationship addiction along with chemical dependence, and (5) religion addiction plus sexaholism. I have yet to meet an addict who is subject to only one addiction. Multiple interacting dependency disorders are probably the norm in this society.
In fact, it is not uncommon for an addict to struggle with three or more major compulsions. I’ve had several clients recently who were suffering from a combination of sexaholism, religion addiction, and workaholism. Another typical combination is relationship addiction and compulsive caretaking, which interface handily with addiction to misery and worry. Each plays off the other and creates incredible internal conflict.
The conjunction of workaholism and alcoholism demonstrates how various dependencies exacerbate one another. Some workaholics pump so much adrenaline during the workweek that they have to drink on the weekend in order to relax, which places them at risk for alcoholism. If they “act out” in some way while they are drinking (sexually, for example), they are compelled to work even harder the next week to redeem themselves for the ways in which they acted out when they were drunk. Guilt plays a role in perpetuating addictive behavior.
Dr. Patrick Carnes, internationally known expert on sexual addiction, says that compulsive behaviors are interrelated, like gears in a machine. If one addiction is activated, the others will be close behind. Thus, to prevent relapse, all addictions – not just one of them – must be addressed therapeutically. I believe it is best to treat multiple addictions simultaneously or in close sequence, which obviously requires extended care. The common roots of the various unhealthy dependencies (arrested development, emotional repression, shame, lack of boundaries, etc.) must also be addressed. A good treatment program covers all of these bases.
In his book Don’t Call It Love, Dr. Carnes offers these suggestions for addicts suffering from multiple dependencies: (1) work on the most threatening addiction first, then work on the next most threatening; (2) get a sponsor and a solid home group (twelve-step fellowship) for each addiction; (3) learn how the addictions interact and how each is stimulated; (4) recognize that they are all connected to shame – face shame and work it out therapeutically; (5) make yourself personally accountable to others; and (6) remember that sobriety in one program does not guarantee sobriety in another.
Suzanne is enjoying sobriety and high-quality relationships today because she was willing to take these issues into account. She understands that a multifaceted disease such as hers requires a multifaceted recovery regimen. She knows that there are no instant cures. All she will ever have is a daily reprieve from her illness based upon the consistent maintenance of her spiritual program.