Christian Therapy Services
Sunday, January 26, 2020

Hidden Addictions

Hidden Addictions
                      by Dr. Stan Eastin
It was in my office, 1200 miles from home, when Barbara finally stopped running and decided to face the destruction brought about by her compulsive spending.1 When she left her small southern town, she resigned herself to the possibility of never seeing her two small children again. At the time, it seemed they would be better off motherless than to have a mother who was completely out of control of her life. Not uncommon for individuals with hidden compulsive or addictive behaviors, the people in Barbara's church would have said she was the perfect mother with the perfect family. But the carefully composed facade fell apart when there was no way to juggle the accounts to cover the embezzlement from her job and credit options were exhausted. Fortunately, Barbara avoided criminal prosecution and returned home. But, even without legal consequences, the uphill climbs to regaining her family, her husband's trust, and financial solvency will continue for years.
Our country has suffered incredible destruction from unavoidable, natural disasters over the past few years, but addictive and compulsive behaviors are avoidable, unnatural disasters which also destroy individual lives, families, businesses, and churches. Even though Barbara's compulsion to spend had become as powerful and as destructive as an alcoholic's compulsion to drink, chemical addictions and non-chemical compulsive behaviors are viewed as being different by traditional theorists and researchers who work in the area of addictions. Contrary to this prevailing notion, I believe the chemical and non-chemical compulsive and addictive behaviors (CABs) are psychologically similar, only differing in the object or behavior that is compulsively pursued. When taken together, these behaviors represent a hidden plague of unparalleled proportions. And in the late Twentieth Century, the list of CABs seems to be constrained only by the potential number of activities we can engage in. If a behavior can be repeated and taken to a destructive extreme, someone is taking it there. This tendency of our fallen nature holds profound implications for the church and every client that walks into a therapist's office. 
                                                 The Similarities Between the CABs
Many late Twentieth Century authorities on addictions, sometimes called addictionologists, have claimed that in order for any compulsively repeated behavior to be a true addiction, it must start with a foreign chemical which is ingested, injected, or inhaled. This chemical must produce, after prolonged use, both increased physiological tolerance to and increased need for the substance as well as withdrawal symptoms if the substance is discontinued. The addictionologists resent theorists who link the term addiction to activities such as gambling, sex, computers, or TV. They assume addictions only occur because the body develops a physiological dependence on the substance, and it is that need which drives the behavior.      
Interestingly, many chemicals often thought of as addictive agents do not meet the tolerance and withdrawal criteria. In fact, neither criterion is now considered mandatory to diagnose a chemical addiction. For example, neither marijuana, cocaine, nicotine, hallucinogens, nor amphetamines meet both of these criteria. Even with those substances which develop a physiological dependency, the observed pattern is that once the addict has detoxed and the physical cravings have passed, addicts return again and again to seek out their preferred drug. How could they still be addicted after their bodies have given up the physical need if that is all that is involved? Can there also be a psychological addiction which three weeks or even three years of abstinence can't eliminate? 
If a psychological factor helps to drive the chemical addictions, it opens the door to a vast number of behaviors not involving chemicals which are similarly compelling and consuming. Gambling and other compulsive behaviors relegated to the former status of alcoholism--poor will power, bad choices, simply failures of character--may also be driven by some of the same powerful psychological forces that a detoxed alcoholic faces. Indeed, many of the non-chemical addictions have proven to be as destructive, as resistant to intervention, and even as life threatening as the chemical addictions. But what do they have in common?
There is evidence for the presence of a psychological fault line in the mind which fractures in relative proportion to the amount of pain in an individual's early life and is exacerbated when the individual experiences pain or stress in the present. It is this fault line combined with the psychological structure of the mind which sets the stage for all of the CABs. Although the researchers, theorists, and treatment specialists working with CABs have typically focused on their differences fracturing them into separate, isolated camps, the similarities are remarkable. A few of the features they have in common are   
1) a preoccupation with the behavior (or substance)
2) greater amounts of time, energy, or resources are expended than intended or available
3) tension or anxiety builds when away from the behavior leading to a temporary release of tension when the behavior is engaged
4) repeated thoughts about and/or attempts to control, cut back or stop the behavior
5) secretiveness and/or lying are utilized to limit the knowledge of significant others regarding the true extent of the behavior
6) continuation of the behavior in spite of physical, emotional, relational, or financial health being compromised.
                                            The Extent of the Problem
With the arbitrary barriers removed and the great number of similarities exposed, the total number of chemical and non-chemical CABs is staggering. Unfortunately, an accurate estimate of how many individuals suffer from destructive forms of CABs is impossible because of several factors. First, these individuals feel shame and embrace secrecy, seldom revealing the true extent of their activities. It is extremely difficult for anyone, especially Christians, to admit they are out of control. Problems seldom come to light until the participant has been caught several times or has caused a great deal of damage, usually after repeatedly swearing they would cut back or stop. The second problem is that the different CABs are seen by researchers in isolation. This results in different estimating practices using different reporting methods and statistics. The final issue confounding an accurate estimate is that many CABs have yet to be recognized by sources such as the DSM IV or the media. People often never know what to call what they do. The numbers would be overwhelming if an anonymous survey focusing on the similarities within these behaviors were ever administered to the general population.
In spite of the difficulties mentioned above, estimates of some of the CABs are available. A tally of the lifetime prevalence rates of the chemical addictions including alcohol, prescription, and illegal drugs yield a figure of between 20 and 26.6% of American adults who have been dependent upon one or more of these substances.2 This figure does not include nicotine addiction which totals another 36% all by itself.3 
The non-chemical CABs have traditionally been relegated to subclinical status. The prevalence and destructive impact of some of them are just recently beginning to be understood and recorded. Some behaviors such as the eating disorders, homosexuality, and extramarital affairs are typically not thought of as CABs even though they often fit the same criteria.
Gambling, probably the non-chemical CAB which many authorities come closest to calling an addiction, is the most well researched. It has grown exponentially with the huge explosion of Indian gaming, Internet betting, and state-sponsored lotteries and casinos. The number of lives destroyed by gambling has grown in parallel fashion. Internet betting alone grew over 1000% in just two short years between 1996 and 1998, catapulting from $60 million to $600 million. The total amount which will be wagered legally this year in the U.S. alone is expected to exceed 600 billion dollars; that breaks down to $2,400 for every man, woman, and child (and doesn't include billions more wagered in office pools, over golf putts, or at Friday night poker games). This represents an increase in legalized gambling of about 3,450% in the two decades since 1976. Estimates indicate 5% of Americans4, including 1.3 million adolescents5 and 5.5% of college students6 are wagering out of control. Who knows how many more would qualify if compulsive stock market players, another form of high stakes gambling, were included. 
Sexual CABs include chronic promiscuity, compulsive masturbation, and obsession with pornography, along with sexual deviancies such as pedophilia, exhibitionism, and sado-masochistic practices. These behaviors trap an estimated 3 to 6% of American adults and an unknown number of adolescents.7 These numbers do not include compulsively pursued, family--and sometimes church--destroying, affairs (which secular reporting agencies treat as normal) or homosexuality which has also been declared normal by both the American Psychological and Psychiatric Associations. National polls estimate between 50 to 65% of men and 45 to 55% of women have engaged in extramarital affairs.8 Not all of these would be diagnosable as CABs, but many would. Homosexual behavior, which often meets CAB criteria, is reported at 3.8 to 10% of men and about half that for women.9 
Another group of behaviors which aren't commonly defined as addictions but fit the CAB criteria are the eating disorders. A national association on Eating Disorders estimates the number of Americans who suffer from Anorexia or Bulimia to be about eight million.10 Compulsive self-mutilation, which some experts call the Anorexia of the Nineties, claims another 2 - 3 million.11
A host of other CABs have received some media attention and warranted some research but haven't been officially recognized. These include compulsive; shopping (6% of adults)12, TV watching (2 to 12% of all Americans watch at least 56 hours per week)13, computer games (5-7% of 11 to 16 yr. olds)14, Internet use (between 2 and 8 million users spend at least 40 hours per week on line)15, and running (5.5 million).16
Finally, another huge list could be made of the less prevalent CABs that have received little or no attention from the media. Examples from my own clinical practice include a 12-year old who has been stealing and hoarding diapers and undergarments since age 4; two boys who compulsively play with their own feces; a mother who frequently locks herself in the bathroom and cuts her hair for 20 hours straight; a wife who measures every gram of food she eats and constantly weighs herself throughout the day; a husband whose two car garage is overflowing with boxes containing every scrap of paper he's ever touched; a union representative on an expense account who eats through an entire restaurant menu two times before leaving; two men addicted to 900 phone numbers, one to sex lines another to psychic lines, both running up huge bills; and a body builder who has destroyed his health by taking illegal steroids in order to look better. The list of possibilities is endless.
Taken alone, most of the non-chemical CABs present a relatively small impact, but when just the behaviors we have numbers on are added together, they total 34.3 to 61% of all Americans. If chemical CAB's are added to those totals, the percentages of afflicted individuals rises to between 48.5 and 87.6%. If smoking is added, the percentages jump to 90.3 and 113.6%. If extramarital affairs are factored in, the totals catapult to between 146 and 188% of the total number of Americans living in the U.S. who suffer from CAB's at one time or another in their lives. These numbers do not include such common CABs as workaholism which would drive the totals drastically higher. Certainly, not all of the CABs are immediately destructive. Many just make life more difficult or miserable either for the partaker or for their loved ones. 
The above percentages obviously exceed the number of people who live in the U.S. They are inflated by the fact that many people prone to CABs end up suffering from two or more of them in their lifetime and thus get counted more than once (e.g., some alcoholics smoke, gamble, and are prone to affairs). But, the figures are also lower than they would actually be because of the vast number of CABs that are either relatively isolated, haven't been identified as such, or haven't been researched enough to have been estimated yet.  
Based on these estimates, CABs appear to be nearly as pervasive as sin itself. In fact, one definition of sin in Scripture is the notion missing the mark by having too much or too little of something, an apt brief definition of a CAB. No other epidemic comes close to causing such wide spread affliction in our era of medical breakthroughs. Undoubtedly, CABs directly drive a high percentage of other problems such as our high divorce rate, high crime rate, small business failures, employment problems, child abuse, and personal bankruptcies. Indirectly, they lead to or compound physical ailments and emotional problems, even suicide. The destructive financial and emotional impact of CABs is impossible to estimate.
Like Barbara, the vast majority of individuals who suffer from hidden CABs are not heroine junkies or career criminals. They are respected business people, policemen, pastors, homemakers, U.S. Presidents, college students, and college professors. They are our family and our church family. They are our neighbors for whom it is finally acceptable to admit to depression or anxiety, but not to their hidden addictions. Barbara, who was recently treated for depression, never revealed to her therapist or her pastor the shameful compulsion which drove her deeper into despair. They never asked either. Once we understand how prevalent the CABs really are, maybe we will start asking.
1.         The name and identifying information have been changed to protect the confidentiality of the client.
2.         L.N. Robins, & D.A. Regier, eds., Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (New York, NY: Free Press, 1991); R.C. Kessler, D.A. McGonagle, S. Ahozo, C.H. Nelson, M. Hughes, S. Eshleman, H. Wittchen, & K.S. Kendler, "Lifetime and 12-Month Prevelance of DSM-III-R Psychiatric Disorders in the United States. Results From the National Comorbidity Study," Archives of General Psychiatry 51 (1994) 8-19.
3.         Robbins, Psychiatric.
4.         Steven Crist, "All Bets Are Off," Sports Illustrated, (26 January 1998), 82-92; James Popkin, "America's Gambling Craze," U.S. News & World Report, (14 March 1994), 42-46.
5.         Timothy C. Morgan, "The Invisible Addiction," Christianity Today (8 April 1996), 12.
6.         Tim Layden, "Book Smart," Sports Illustrated, (10 April 1995), 68-81.
7.         Nick Gallo, "The New Addictions," Better Homes and Gardens, (May 1994), 42, 50.
8.         Grant L. Martin, "Relationship, Romance, and Sexual Addiction in Extramarital Affairs," Journal of Psychology and Christianity 8, (4) (Winter 1989), 5.
9.         Alfred Kinsey, W.D. Pomeroy, and C.E. Martin, Sexual Behavior in the Human Male, (Philadelphia: Saunders, 1948) cited in V.L. Bullough and B. Bullough, eds. Human Sexuality. An Encyclopedia, (New York: Garland Publishing Inc., 1994), 335; S. Roberts & C. Turner, "Male-Male Sexual Contact in the USA: Findings From Five Sample Surveys, 1970-1990," Journal of Sexual Research 28 (1991), 91-519; G. Ramafedi, "Demography of Sexual Orientation in Adolescents," Pediatrics 89 (1992), 714-21. 
10.       Carolyn Costin, The Eating Disorder Sourcebook, (Los Angeles: Lowell House, 1996), 18-19, citing 10 year study by the National Association of Anorexia Nervosa and Associated Disorders.
11.       Dateline NBC, Jane Pauly & Stone Phillips (26 October 1998).
12.       Thomas O'Guinn & Ronald Faber, "A Phenomenological Case Study of Compulsive Buying," Journal of Consumer Research 16 (September 1989) 147-57.
13.       Gallo, Better, 50.
14.       C.A. Phillips, S. Rolls, A. Rouse, & M.D. Griffiths, "Home Video Game Playing In Schoolchildren: A Study Of Incidence and Patterns of Play," Journal of Adolescence 18 (1995), 687-91.
15.       Kendall Hamilton & Claudia Kalb, "They Log On, But They Can't Log Off," Newsweek (18 December 1995); Carol Potera, "Trapped In The Web," Psychology Today (March/April 1998), 66-72.
16.       Richard Benyo, The Exercise Fix, (Human Kinetics Publishing, 1989), 69.