For years many people thought that addiction was a manifestation of moral or psychological problems. Today most addiction professionals believe it is a primary disease. Of course, addiction has emotional aspects, and these are part of the presenting problems. Many addicts seem to have no signiﬁcant psychological problems except the addiction, and many psychological and psychiatric problems have nothing to do with addiction. Some addicts may have both, and they are called dual diagnosis patients. It is difﬁcult to separate addiction and psychological problems in their ongoing behavior.
Apparent Psychiatric Behavior
The confusion comes when you do crazy things as part of your addiction. Twelve-Step group members commonly share in meetings behavior they might have “been locked up for” when they were drinking, using, gambling, bingeing, purging, starving, or obsessed with their bodies or their addictive behavior.
While psychologists have batteries of psychological tests and clinical criteria to evaluate emotional disorders, we suggest a simple yardstick for ﬁguring out what is going on in your Twelve-Step group meeting or with other people you meet.
First, be aware that as many as about 10 percent of the people in a recovery meeting (or almost anywhere else, for that matter) may have some kind of psychological problem that probably should receive some professional help. Of course, not all those people need to be hospitalized or present any kind of threat to themselves or others.
Then, look at how you and others respond to that person. Program members are usually fairly tolerant of eccentricities and emotional instability. But occasionally you will encounter someone who talks or behaves in a way that is enough out of the usual, even for an addict, that others have difﬁculty relating, and even begin to be uncomfortable or fearful because of their behavior.
We have found this to be the best test, because in a peer-group recovery program, any who cannot relate to others, or whose behavior scares people off, are simply not likely to recover without some professional help.
Genuine Psychiatric Behavior
Psychiatric problems can exist in people with no signs of addiction. If both occur, they will aggravate each other. Some examples are depression, phobias, schizophrenia, and personality disorders. Treatment should include intervention and treatment plans for both.
The dangers are the extremes. One is the idea that if we treat the depression, the addiction will go away. The other is that we should treat the addiction and the depression will go away.
Multiple personality Recent research and clinical experience suggest that multiple personality disorder (MPD) is much more common than we thought. It seems to occur most often in response to severe trauma, like that of abuse, which is no stranger to many addicts’ families. To avoid having to remember a horrible experience, they generate a new personality, which either does not remember or is somehow detached from the experience. Once this process begins, it becomes easier and easier to spawn new personalities when needed to protect the collective whole. Through therapy, some MPD patients have identiﬁed hundreds of personalities.
This dramatic and fascinating psychological phenomenon is usually frightening for MPD patients and their families. It is common for the personality that is usually “out” to be unaware of the other personalities, and families seldom interpret the variations in behavior as multiple personality disorder. So most MPD patients don’t know they have it until it is discovered by an alert therapist. Fortunately, with proper therapy the personalities can be “integrated” so that they cooperate, and MPD families can function fairly normally.
For the rest of us, we may simply be aware that for some people, the “child within” or the extreme mood swings may be much more literal than we imagined. Addictions counselors and other professionals are learning more about MPD so they can screen for it and refer clients and their families for specialized help.
Surviving Some people suffer from serious emotional and mental disturbances but can share honestly and fairly appropriately in meetings. If they concentrate on their problems with their addiction, and can care about others as well as themselves, they will probably ﬁt in OK. Those who are coming primarily for recovery from their psychiatric problem and have little or no real signs of addiction should probably seek professional help instead. In some areas there may even be a group like Emotions Anonymous where they would be more comfortable.
If you are involved with someone who has signiﬁcant psychiatric troubles, remember your limitations. Help if you can, but if it begins to threaten your recovery you should politely suggest that they ﬁnd someone else who is better equipped to help them.
Psychological problems, see also: Addiction, Defenses, Delusion, Dichotomous thinking, Disease concept, Dual diagnosis, Emotions Anonymous, Feelings, Judgment, Magical thinking, Mental aspects, Obsession, Priorities, Sleep, Stinking thinking, Therapy & treatment, Visualizations.
Updated 8 Sep 2015
Addictionary 2 by Jan & Judy Wilson
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