Edmonton Addiction Counselling & Therapy
Addiction presents in two different forms. Psychological addiction can be identified when the addicted person shows psychological responses (e.g. anxiety, depression, irritability / anger, mood swings, obsessive thinking, poor judgement, etc..) when they can no longer access the addictive substance or engage in the addictive behaviour. Physical addiction occurs when the body is addicted to the use of drugs, medications, alcohol, glue or any other substance. Physical addiction is generally recognized when the addicted person shows physical signs (e.g. changes in heart rate, blood pressure, thinking ability, physical cravings, physical agitation, etc...) when they can no longer access the addictive substance.
A person may be physically addicted, psychologically addicted, or both. This is why some individuals seem to have no physical difficulty quitting smoking, or going "cold turkey" from drugs or alcohol. Their addiction is primarily psychological. Other people need to have medical interventions to "come down" or "detox" because they may have life threatening physical reactions to abruptly halting their addictive behaviour.
Addiction therapy or addiction counselling is focused on treating psychological addiction. A person may be actively engaging in addictive behaviour when they start therapy, or they may be trying to "stay clean". Addiction may present as a substance abuse (i.e. drugs / alcohol), as an impulse control issue (i.e. theft, gambling), or as a process / behaviour pattern (i.e. gambling, internet, exercising).
Why start addictions counselling?
People begin addictions counselling for many reasons. These reasons may include:
- lack of personal or career sucess
- constantly have let others down
- chronic money issues
- social stigma
- emotional / psychological distress
- tired of hiding / lying
- ultimatums by friends or family
- social isolation / ostracized
- "hitting bottom"
- loss of access to children
- desire for change
- feeling / acting out of control
- risk of / job loss
- loss of friends
- required by court or employer
- health issues / fear of dying
- becoming like an addict parent
- failed drug test
When does an ACTIVITY or BEHAVIOUR become an addiction?
Psychologically, an activity or behaviour becomes an addiction when you become dependent on it to avoid or 'deal with' another activity, emotion, or thought. For example, some people drink to feel less anxious in social situations. Some people smoke to 'fit in' with the group of smokers they like to spend time with. Others use drugs to temporarily forget past events. People may eat to suppress emotional pain, engage in sex to reduce loneliness, or set fire to things to overcome a sense of powerlessness. As with physical addiction, once you stop or slow the addictive behaviour, psychological withdrawal symptoms may begin. Typically this involves a sharp intensification of emotional distress or thinking about whatever the addictive behaviour was being used to obscure. Depending on the person, psychological addiction may be more than, equal to, or harder to overcome than physical addiction. It is not unusual for a person to substitute one addiction for another when the initial addiction becomes untenable (e.g. overeating because there is no alcohol in a 'dry camp', or overexercising in an attempt to quit smoking).
Physically, an activity or behaviour becomes an addiction when you need to increase the amount of the substance to gain the same effect. The need for more of the substance to have the same effect is called tolerance. Often when you have developed a tolerance for something, the body is also dependent on it. If you stop taking something that the body is dependent on, the body may go into a physiological crisis, called withdrawal. Withdrawal symptoms can be quite severe, and are often the reason people struggle to "kick the habit". In some cases withdrawal symptoms can become so severe they may lead to death without medical intervention. This is why individuals who decide to treat a physical addiction are encouraged to do so under a physician's care, and in certain situations, are encouraged to do so in a hospital setting should urgent medical intervention be necessary.
What kinds of addiction are there?
Addictions tend to fall into three types. Substance addictions, impulse control addictions, and behavioural or process addictions. Some types of addictions may be fall in more than one category depending on the role the addiction serves (e.g. eating to much of one kind of food may be a substance addiction, over eating in general to feel better may be a behavioural addiction)*.
Substance Abuse / Addiction
- street drugs (e.g. opioids, cocaine, amphetamines...)
- abuse of prescription medications (e.g. sedatives, hypnotics, sleeping pills...)
- consuming / sniffing alternate substances (mouthwash, glue, felt markers...)
- tobacco / smoking
- video games
- spiritual obsession (different than religious devotion)
Impulse Control Addictions
- self-harming / pain-seeking (e.g. cutting, risk-taking behaviour, self-sabotage...)
- kleptomania (compulsive stealing)
- pyromania (compulsively setting fires)
- intermittent explosive disorder (compulsive aggression and harm to others)
Who is at risk for addiction?
While anyone may become addicted to a behaviour, substance or impulse, certain factors have been shown to increase the likelihood of addiction. Some factors are:
- exposure to single or multiple event trauma
- history of being abused / neglected
- exposure to domestic violence
- other family members with addictions
- prior history of addictions
- tendency to impulsivity
- unstable childhood
- low self-esteem
- mental health issue (e.g. depression, anxiety, etc..)
- regular contact with peers with addictions
- history of chronic or overwhelming stress
- lack of healthy social supports
- unmanageable losses (e.g. friends, family, career, etc...)
- environment that supports or normalizes addictive behaviour (e.g. going out drinking with the team every Friday evening)
What are signs of Addiction?
Most people do not recognize the signs of addiction unless they have prior experience with addiction or people who have addictions. It is much easier to notice the signs "after the fact", as many addicts become experts at hiding or minimizing their addiction. Even when directly asked, an addict may deny they have an issue, either because they fear recrimination, or possibly because they do not see that they have a problem. A common defence for an addict is "I don't have a problem, but you do (or are the problem)". Even when an addict seems to blame everyone else but themselves for the problems associated with addiction, they may still refuse to acknowledge that they might be a part of the issue.
Common signs of addiction may include:
- always thinking or talking about the addiction
- repeatedly engaging in the addiction even though it hurts themselves or others
- trying to convince others to engage in the addiction
- hiding / denying addictive behaviours
- unable to limit or stop addictive actions (out of control)
- blaming others for chronic problems
- financial stress
What happens in addiction counselling?
In the first session the therapist will go over confidentiality with you. If you are attending therapy on your own accord, this is a fairly straightforward process. If you are attending counselling because you were required to by your employer, for insurance reasons, or due to a legal requirement, etc., there may be additional paperwork to allow the therapist to notify your employer (for example) that you are attending sessions, working on any assigned homework, and what progress you are making.
After that the therapist will work with you to identify your addictive behaviours, the causes of those behaviours, and develop a treatment plan. Sometimes the addictive behaviour is easy to identify. Sometimes there are primary addictions (often the reason you came to counselling), and then lesser addictions that are not as noticeable but will still cause problems if left untreated. Determining the cause of addictions is a major element of treatment. Treating the historical cause of the addiction increases the chance of stopping the addiction and preventing a relapse.
For example, many individuals engage in addictive behaviour to deal with historical trauma. In this case you and the therapist need to use trauma therapy (e.g. Eye Movement Desensitization Reprocessing - EMDR, Exposure Therapy, etc.. ) to resolve those past issues. Sometimes when the past trauma is resolved the addiction also dissipates. Other individuals engage in addictive behaviour to deal with current events. In that case, you and the therapist will work on skills to more appropriately manage current triggers. This might include learning stress management techniques and emotional regulation skills. Common therapeutic approach include Cognitive Behaviour Therapy (CBT), Mindfulness or Acceptance Therapy (ACT). When an individual is using addictive behaviour to deal with a mental health issue, the therapist will work with them to treat the mental health issue (e.g. depression, generalized anxiety, social phobia, bi-polar disorder, borderline personality disorder, etc...) alongside of the addiction. This may involve using therapeutic approaches such as Dialectal Behaviour Therapy (DBT), Hakomi, Hypnotherapy, etc..).
Couples and Addiction
When a couple is coming in to deal with addictions, the therapist will attempt to determine how much of the addictive behaviour is being supported by the relationship, and how much pre-existed. Pre-existing addictive patterns may have to be treated individually. Where the addiction is being sustained by the relationship though, the therapist may utilize a variety of couples therapy approaches to help open up communication processes and emotional connection so that there is increased understanding and support. Reducing enabling behaviours within a couple is often central in treating addiction issues. Therapeutically resolving the negative experiences within the couple often disrupts the elements sustaining an addictive behaviour. Emotionally Focused Therapy (EFT) is often effective in reducing distress within a couple, which may help in reducing addictive behaviour.