Why being sober doesn’t always mean you are Doing well.

Recovery is difficult. It takes time, patience, and dedication, but all too often people have the idea that being sober and in recovery is interchangeable with being “well” and better. While sobriety and recovery are huge steps that need to be celebrated, we can sometimes be sober but not healthy. According to CAMH, “ people with mental illness are twice as likely to have a substance use disorder compared to the general population”. What this means is that for those who have a mental health diagnosis, it is likely that if both the alcohol/ substance use disorder and mental health diagnosis aren’t treated together, the rate of relapse will be higher or other issues can arise. The reason for this is that many people begin using heavily and get addicted due to self-medicating and changing their brain's reward system. For those who haven’t received an official diagnosis or aren’t aware that their symptoms are a mental health issue, this could cause further issues and ongoing relapse as they attempt to soothe themselves and self-medicate to feel better. Stats also show that those with more serious mental health issues tend to use more than those with some or no mental health issues. 

While most people understand what a relapse looks like, there are other complications that can go unnoticed by family, friends, and others who aren’t trained in the area of addiction. Relapse in itself is basically described as “when a person returns to using drugs or alcohol after a period of sobriety” and a slip is ““where a person may drink or use, but then immediately stop again”.

But what if someone doesn’t go into relapse and begin using drugs or alcohol, what other behaviours can indicate that someone is recovering well from their primary AUD/SUD but aren’t doing “well” in other areas? Cross addictions can sometimes pop up when individuals have learned to successfully discontinue their primary drug and alcohol addiction, but not cope well with life or treat underlying mental health issues. Some cross-addictions may take the shape and form of addictions to other drugs and alcohol, but I am going to focus on process/ behavioural addictions. A behavioural addiction looks like a compulsive behaviour that affects a person the same as an alcohol or drug addiction would. An individual is compelled to partake in the behaviour beyond “normal” amounts and continues despite the negative consequences it caused to their physical and mental health, relationships with those close to them, and so on.

For a more detailed understanding, let’s look at Jim. Jim is a 45 year old man with a history of alcohol use disorder and mental health issues. Jim has successfully conquered his AUD and has been sober for 10 years, however, Jim is easy to anger, he is restless, and he often works 12 hours or more a day. When Jim isn’t working, he finds other activities to partake in to “kill time”. Jim also spends a large quantity of his time on social media scrolling through Facebook and often picks his phone up when with family and friends. Jim compulsively checks his emails and even describes them as “overwhelming” and causing uncomfortable feelings of anxiety and distress at times. Jim however sees this as being a hard worker and dedicated to his business. Jim’s wife however continues to feel disconnected and second to all his “activities” and relationship issues have started to creep into their marriage because of it. Jim feels uncomfortable when not working and can become upset and argumentative when his wife nags at him to reduce his workload or that she feels it’s problematic.  

 Or Sammy. Sammy is a 20 year old female. She finished high school but spends her days and nights playing video games and shopping. She often can’t visit the store to buy groceries without venturing into the gaming aisle or toy section without buying something. She plays video games late into the night and can’t wake in the morning. Sammy has recovered from an eating disorder she had early in high school and experimented with alcohol use and drank alone for a year before quitting. Her parents are worried that her behaviours are problematic because they are causing her to spend money she doesn’t have and interfere with her ability to find and keep a job. 

So, what is the connection between AUD/SUD and behavioural addiction? Dopamine. When individuals use drugs and alcohol, dopamine in the brain increases, and the reward system becomes activated. The more and more it becomes activated, the more it needs to be stimulated to have the same effect. Over time, the more and more dopamine that is used, the more the system becomes “burnt out” as the number of dopamine receptors decrease due to the heavy load of dopamine in the brain. When dopamine receptors decrease, the need to stimulate yourself or use substances increases. So once a person stops using, they may still have depleted dopamine receptors and begin acting impulsively and acquire process/behavioural addictions in order to increase the amount of dopamine in their brain subconsciously, or knowingly. When a person isn’t acting on increasing their dopamine they may begin to suffer from depression or anhedonia, which is a state of loss of pleasure. The loss of pleasure and need to supplement dopamine through behavioural addiction now creates a new problem for those in recovery as low self- control can become problematic and create cascading events.

Some of the most prevalent and known behaviour addictions seen in cross addiction are Gambling, Sex Addiction, Shopping Addiction, Exercise Addiction, Internet Addiction, Food Addiction, and Work Addiction. So how does one distinguish between a habit, routine, “work ethic” and addiction? Generally speaking, a habit is something that people do that becomes second nature. You wake up and make a coffee, then get dressed and brush your teeth before work. It’s a routine that you have settled into and doesn’t cause any negative consequences in your life. It often creates ease and predictability and leads to a more fulfilling life. Things become addictive however when there becomes an intense, increased focus on the behaviour, and it may start taking over other parts of their life and other obligations.

Some questions you can ask yourself to distinguish a habit vs addiction are:

Am I unable to stop the activity or behaviour once started or am I doing this activity more than I want to or planned to ?

Is this activity or behaviour interfering with other areas of my life or taking time away from other things?

Are people in my life concerned or voicing complaints about the activity or behaviour?

Do I get anxious when I can't engage in the behaviour or activity or do I get withdrawl symptoms when I am not engaging in it?

Am I getting most of the pleasure in my life from this behaviour or activity?

So what can be done if you are noticing that you’re excelling at sobriety from your primary addiction but you’ve slipped into a new one or someone in your life believes you are experiencing a process/behaviour addiction?

*Seeking a mental health assessment. Research shows that half of adults with ADHD have had or will have a SUD in their life.  Knowing this information is helpful because many people with undiagnosed or untreated ADHD share similar symptoms to those above. Hallmark ADHD symptoms include impulsive behaviour, low self-control, trouble coping with boredom, and restlessness. Visiting a dr to get a referral for a proper ADHD evaluation and treatment if the diagnostic criteria is met can be very helpful for those who may be suffering from undiagnosed or untreated ADHD. Caution must be taken by doctors and patients though due to the addictive nature of the ADHD meds however so individuals must be prepared to be honest with the diagnosing and prescribing doctor about their addiction and recovery process. Sammy may be dealing with untreated anxiety and depression and be using video games and shopping to distract her and keep her active so she doesn’t have to deal with intrusive thoughts or bad feelings. An assessment and mediations if decided by a dr and patient, may help ease some of the negative behaviours associated with process addictions and make it easier to start scaling back shopping and video games to a healthier level.

*Seeking addiction counselling for the process/behavioural addiction. If you have already established a good rapport with an addiction counsellor for your pre-existing addiction, this may be a good time to give them a call. Addiction counsellors can help us pinpoint problem areas in our life and why we may be venturing back into addictive behaviour, or why we have never truly exited from it and have simply replaced it. Learning how to cope with stressors in our life and examining what may be driving us to act compulsively on certain activities or behaviours can be the starting point to cutting them down to healthy levels and repairing relationships in our life that may be becoming strained because of them. Having family sessions with the addictions counsellor as well may help you and your partner discuss the behaviours and learn how to support each other as you begin your recovery work to cut back the behaviour.

*Being honest with yourself and listening to those around you. Yes, this seems very simple, but it is very hard when we feel like we don’t have an issue. It’s not easy to hear someone thinks we have something “wrong” with us, or that we are doing something “bad”. Guilt and shame often precede addiction and only grow as the addiction grows. Learning that those who love us are looking out for us and themselves can help us become more self-compassionate. It sounds contradictory to think “someone pointing out a flaw is helping and not trying to hurt me?” YES. Being honest with yourself as well and recognizing when something is interfering in your quality of life and that of those you share your life with is a big challenge, but the more you become self-aware and able to see things and be honest, the easier it becomes to tackle problems and keep them from returning.

*Finding the areas of your life you are trying to avoid. Sometimes we begin doing activities to distract us from other things we aren’t necessarily thrilled with doing or don’t even want to be bothered with. Perhaps Jim no longer wants to be married to his wife and feels uncomfortable about the topic. Jim instead works endlessly and tries to avoid her until bedtime. Maybe he is worried about retirement, but it is at an unhealthy level where it’s become an obsession. His compulsion to work to obtain money and feel safe has become an addiction. Finding the things that are bothering us and working on adopting healthier coping skills that can help replace the maladaptive behaviours we are currently using is necessary for recovery. Aside from an addiction counsellor, perhaps if Jim no longer feels happy in his marriage, he should speak to his wife and visit a marriage counsellor. If he’s having a fear of retiring, a few sessions with a psychotherapist to discuss his fears will help him learn emotional regulation skills, map out whether they are rational or not, and learn how to delegate a better work to life ratio for him and his wife so she isn’t feeling left out.

Most people are just trying to get by with what they have available. There is no shame in this as long as you aren’t hurting others, but once you become aware of the issue, you- and only you have the power to change it. As the ancient philosopher Zeno said, “Man conquers the world by conquering himself.”