Our integrative approach is one of harm reduction (Dennis, 2019), or “progressive recovery” (Schwartz et. al.) With progressive recovery, addicted people are offered groups as cultures of resilience to begin to develop healthy, emotionally regulatory relationships with people in a professionally facilitated clinical setting. Gradually, the patients can rely less on substance or process addictions as authentic attachments develop with the help of therapeutic holding environments. The term, “process addictions,” refers to out-of-control behavioral processes such as gambling, sex addiction, relationship addiction, exercise addiction, technology addictions, and work/activity addiction. Eating disturbances can have components of both chemical and process addictions. Awareness of the interplay among eating disorders, addiction involving drugs/alcohol and process addictions is critical to successful treatment outcomes (Schwartz et al., 2015).
Patients who develop the disease of addiction involving one substance often develop addiction involving another substance and/or behavior. In part this is because the underlying brain reward circuitry has been already primed and altered as the disease of addiction developed. As patients progress in recovery from what most in our field would refer to as a “primary” addiction, addictions involving other behaviors or substances often magnify, emerge, or rise to the surface from a more concealed place. Across the lifespan, a person may engage in addiction involving multiple different behaviors or substances, with patterns often shifting with efforts to manage harmful consequences. A person may entirely give up one addiction, such as anorexia, only to subsequently engage in others, such as alcoholic drinking, compulsive spending, or sex addiction.
Most treatment providers, our DSM, public policy and lay people alike view addiction not as a primary illness commonly co-occurring with other illnesses like mood disorders, PTSD, rooted in underlying brain pathophysiology involving reward circuitry, front striatal circuits, limbic lobes and prefrontal cortex, but as a drug or behavior specific phenomenon. From this vantage point, focus is maintained on the substance (a symptom) rather than the disease (a brain disorder with spiritual, psychological, social and emotional ramifications). Public policy, prevention and treatment efforts remain focused on drug epidemics rather than addiction epidemics, addiction treatment and addiction prevention.
According to NAMI, Dual diagnosis (also referred to as co-occurring disorders) is a term for when someone experiences a mental illness and a substance use disorder simultaneously. This also applies to eating disorders. According to the 2006 National Survey of Drug Use and Health, 5.6 million people in the United States have co-occurring substance use and mental health disorders. According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. The problem is growing, and these figures are likely significantly underestimated due to misdiagnosis.