All Things Substance

Is sex addiction a real thing? What does the research say about problematic sexual behaviors? How can we evaluate potential issues with sexual behavior?

The word addiction and the word sex shouldn't be put together, at least by therapists. It's used in popular culture often, but we didn't get trained that it's an addiction. There's a reason for that, it's not an addiction. That's what science tells us. Today's episode is an interview with an expert in the field of sexual health, Dr. Eli Coleman of the University of Minnesota.

• Can you be addicted to food?
• Is it possible to find recovery from food addiction?
• What should therapists know about food addiction?

Food addiction is a real thing, even if the DSM doesn't say it yet. Food addiction is not an addiction to eating, it's an addictive reaction to types of food and ways of eating. Today is the second part of the podcast where we will examine the current science on the topic of food addiction. If you didn't get a chance to listen to Part 1, head over to episode 15 to listen to the interview from last week.

• Can you be addicted to food?
• Is it possible to find recovery from food addiction?
• What should therapists know about food addiction?

Food addiction is a real thing, even if the DSM doesn't say it yet. Food addiction is not an addiction to eating, it's an addictive reaction to types of food and ways of eating. Today's podcast is part 1, our interview with Kelly Coffey. Part 2 is where we will examine the current science on the topic of food addiction.

In this Podcast:

• Interview with Kelly Coffey, the person behind Strong Coffey Wellness for Women and the acclaimed Pleasure Principles course
• Coffey explains how she got to the place she is today as a trainer and coach for women all over the world
• Why diets don't work for most people
• The three types of eaters (blessed, stressed and obsessed)
• How to connect with Coffey to learn more

• What do mental health therapists need to know about gambling?
• What types of gambling are there?
• What's the connection to mental health?

Gambling is a pretty specialized topic. Mental health therapists are a logical place for problem gamblers to show up. I'm making the case that we should be checking in about this with each client. Even if we only find a few problem gamblers over our careers, the freedom of having that secret out in the open can make all the difference.

In this Podcast:

**There is a sound issue about midway through where there's a small echo. It resolves later in the podcast. I apologize for the sound issue!

• More things "count" as gambling than we typically think of.
• Gambling is trading something of value and hoping for something of greater value.
• Gambling disorder is a diagnosable condition with real tolerance and withdrawal syndrome.
• Loss-chasing is what sets symptoms apart from substance addictions
• There are three types of games: games of pure chance, games of mostly chance and games of mostly skill
• The most popular and most lucrative of all gambling (for the house that is) continue to be slot machines.
• Slot machines are very different than the days when they had physical reels.
• Electronic gaming machines (a more accurate term for what passes as slot machines today) are using specific mechanics to reinforce continued play.
• It's suggested that EGM's are deliberately used to get gamblers hooked
• Approximately 90% of a casino's income comes from 10-20% of their patrons. These represent the problem gamblers.
• Casino's are known to extend "credit" to problem gamblers in large quantities to keep them playing.
• Depression is highly correlated with gambling. Anxiety, personality disorders and Bipolar disorder are correlated as well.
• Alcohol abuse is also highly correlated with problem gambling along with use of drugs (stimulants especially).
• There are high suicide rates among problem gamblers.
• A phenomenon that is being considered for inclusion as "gambling" is loot boxes.
• It is suggested that gaming companies are using the same tactics for loot boxes as the casinos are.
• There is concern that loot boxes are creating a generation of problem gamblers and targeting people when they are at a vulnerable stage of development.
• There are some screeners available to help therapists assess this gambling.

• What do mental health therapists need to know about gambling?
• What types of gambling are there?
• What’s the connection to mental health?

Gambling is a pretty specialized topic.  Mental health therapists are a logical place for problem gamblers to show up. I’m making the case that we should be checking in about this with each client. Even if we only find a few problem gamblers over our careers, the freedom of having that secret out in the open can make all the difference. 

In this Podcast: 

**There is a sound issue about midway through where there's a small echo. It resolves later in the podcast. I apologize for the sound issue!

• More things “count” as gambling than we typically think of.
• Gambling is trading something of value and hoping for something of greater value. 
• Gambling disorder is a diagnosable condition with real tolerance and withdrawal syndrome. 
• Loss-chasing is what sets symptoms apart from substance addictions
• There are three types of games: games of pure chance, games of mostly chance and games of mostly skill
• The most popular and most lucrative of all gambling (for the house that is) continue to be slot machines.
• Slot machines are very different than the days when they had physical reels. 
• Electronic gaming machines (a more accurate term for what passes as slot machines today) are using specific mechanics to reinforce continued play. 
• It’s suggested that EGM’s are deliberately used to get gamblers hooked
• Approximately 90% of a casino’s income comes from 10-20% of their patrons. These represent the problem gamblers. 
• Casino’s are known to extend “credit” to problem gamblers in large quantities to keep them playing. 
• Depression is highly correlated with gambling. Anxiety, personality disorders and Bipolar disorder are correlated as well. 
• Alcohol abuse is also highly correlated with problem gambling along with use of drugs (stimulants especially). 
• There are high suicide rates among problem gamblers. 
• A phenomenon that is being considered for inclusion as “gambling” is loot boxes. 
• It is suggested that gaming companies are using the same tactics for loot boxes as the casinos are. 
• There is concern that loot boxes are creating a generation of problem gamblers and targeting people when they are at a vulnerable stage of development. 
• There are some screeners available to help therapists assess this gambling.

• What does the DSM V have to say about internet gaming?
• What types of games are part of this proposed disorder?
• Is internet gaming addiction a real issue?

Video games are often seen as sucking away people's time and the popularity of games is at an all time high with no sign of stopping. It's hard to tell what it would look like if someone had a "problem" with video games. The DSM has a proposed disorder and in some parts of the world this diagnosis would potentially be given more often. In the States, the prevalence is estimated to be small.

In this Podcast:

• Internet gaming disorder (IGD) is not officially part of the DSM V. It is included as a subject that "needs further research."
• The term "internet gaming" is referring to video games.
• The name internet gaming is misleading as many games that can take a tremendous amount of time aren't on the internet at all.
• There are several types of games (and subtypes). This list is meant to be a general overview.
• The main types of games are single player (both off and online), MMO (massive multiplayer online), RPG (role playing games), FPS (first person shooters), mobile games (played on phones and tablets), Battle Royale .
• There are multiple types of single-player games. Additionally many games have both single and multiplayer versions.
• The type of game that a person plays is very specific to each gamer and they will likely be immersed in the culture of gaming around that type of game.
• The proposed symptoms for Internet Gaming Disorder are nearly identical to the symptoms of substance use disorder, but the wording is for gaming instead of substances.
• People who struggle with gaming too much share other characteristics. Some examples are not going to work/school in order to engage in gaming or recover from a game night (needing to sleep because the person was up all night), spending all of their time focused on the game in a way that they are neglecting other things, spending more money than they can comfortably afford to spend, to name a few.
• The key in evaluating gaming in your clients is to find out if there is distress or decompensation in functioning as a result.
• We should be cautious not to confuse enthusiastic engagement with pathology.
• IGD is likely real. The prevalence is said to be about .3-1% of all people who engage in these types of games. There is a higher prevalence in some Asian countries and treatment centers exist to treat IGD.

• What does the  DSM V have to say about internet gaming?
• What types of games are part of this proposed disorder?
• Is internet gaming addiction a real issue?

Video games are often seen as sucking away people’s time and the popularity of games is at an all time high with no sign of stopping. It’s hard to tell what it would look like if someone had a “problem” with video games. The DSM has a proposed disorder and in some parts of the world this diagnosis would potentially be given more often. In the States, the prevalence is estimated to be small.

In this Podcast: 

• Internet gaming disorder (IGD)  is not officially part of the DSM V. It is included as a subject that “needs further research.” 
• The term “internet gaming” is referring to video games. 
• The name internet gaming is misleading as many games that can take a tremendous amount of time aren’t on the internet at all. 
• There are several types of games (and subtypes). This list is meant to be a general overview. 
• The main types of games are single player (both off and online), MMO (massive multiplayer online), RPG (role playing games), FPS (first person shooters), mobile games (played on phones and tablets), Battle Royale .
• There are multiple types of single-player games. Additionally many games have both single and multiplayer versions. 
• The type of game that a person plays is very specific to each gamer and they will likely be immersed in the culture of gaming around that type of game. 
• The proposed symptoms for Internet Gaming Disorder are nearly identical to the symptoms of substance use disorder, but the wording is for gaming instead of substances.
• People who struggle with gaming too much share other characteristics. Some examples are not going to work/school in order to engage in gaming or recover from a game night (needing to sleep because the person was up all night), spending all of their time focused on the game in a way that they are neglecting other things, spending more money than they can comfortably afford to spend, to name a few. 
• The key in evaluating gaming in your clients is to find out if there is distress or decompensation in functioning as a result. 
• We should be cautious not to confuse enthusiastic engagement with pathology. 
• IGD is likely real. The prevalence is said to be about .3-1% of all people who engage in these types of games. There is a higher prevalence in some Asian countries and treatment centers exist to treat IGD. 

In the addiction treatment world, abstinence and harm reduction can often be seen as contrary to each other. We need both models available in order to truly help clients. Our goal is to meet clients where they are and help walk with them to building a life worth living sober.

In this Podcast:

• Abstinence is based on the biological model of addiction that we discussed in Episode 7 (Brain Science and addiction)
• Abstinence is based on the idea that the only way to arrest addiction is to remove the substance(s) that cause craving
• Much of the literature and programs promoting abstinence are based in the 12 Steps and 12 Traditions of Alcoholics Anonymous.
• Some early treatment programs were strictly abstinence based and would turn people away or discharge them if they were found to be using.
• Harm reduction was created as a result of those clients needing services that were accepting of their stage of change.
• Harm reduction aims to minimize the negative effects of drug use on the person who is using.
• There are many harm reduction strategies.
• The three discussed in the podcast today are the availability of naloxone (the antidote to opiate overdose), needle exchange programs (providing clean needles free of charge to IV drug users), and medication assisted treatment programs using Suboxone (or methadone).
• We need to talk about the whole spectrum of treatment with all clients. Presenting harm reduction and talking about progression's impact.

In the addiction treatment world, abstinence and harm reduction can often be seen as contrary to each other. We need both models available in order to truly help clients. Our goal is to meet clients where they are and help walk with them to building a life worth living sober. 

In this Podcast: 

• Abstinence is based on the biological model of addiction that we discussed in Episode 7 (Brain Science and addiction)
• Abstinence is based on the idea that the only way to arrest addiction is to remove the substance(s) that cause craving
• Much of the literature and programs promoting abstinence are based in the 12 Steps and 12 Traditions of Alcoholics Anonymous. 
• Some early treatment programs were strictly abstinence based and would turn people away or discharge them if they were found to be using. 
• Harm reduction was created as a result of those clients needing services that were accepting of their stage of change. 
• Harm reduction aims to minimize the negative effects of drug use on the person who is using.
• There are many harm reduction strategies. 
• The three discussed in the podcast today are the availability of naloxone (the antidote to opiate overdose), needle exchange programs (providing clean needles free of charge to IV drug users), and medication assisted treatment programs using Suboxone (or methadone). 
• We need to talk about the whole spectrum of treatment with all clients. Presenting harm reduction and talking about progression’s impact. 

• What does progression mean when talking about addiction?
• How does progression relate to the DSM criteria?
• What addiction criteria shows up most often?

Progression is the key to addiction. It's not about choice or willpower. It's a biologically based occurrence that is a guarantee in addiction. Progression moves people along the stages of use into addiction, unless they are able to stop using before things move too far.

In this Podcast:

• Progression is the key factor in developing an addiction
• Progression happens because of the changes in the brain that we covered in episode 7
• For some people the consequences they face because of substance abuse is enough to stop them and progression can be halted
• People don't tend to call for their substance use issues. Instead they tend to start with mental health and may or may not bring up their use to their therapist.
• The DSM criteria use the designation of mild, moderate and severe to categorize use disorders
• Tolerance is the most common criteria people present with
• Cravings tend to be one of the harder criteria for people to meet
• Withdrawal is almost always related to a severe use disorder, except where the substance is marijauna. Then withdrawal could appear in a moderate use disorder.
• Our goals change depending on what the client wants to work on and where they are in the progression of their use.