COLORADO SPRINGS — All addictions, whether chemical or behavioral, should be viewed as different manifestations of an underlying addiction syndrome—and addiction recovery programs will fail to achieve optimal outcomes until their protocols reflect this view, Howard J. Shaffer, Ph.D., said at a symposium on addictive disorders sponsored by Psychotherapy Associates.
“We need this different way of viewing and assessing the nature of addiction so that we can do better in treating it,” he said in an interview.
Between 80% and 90% of individuals recovering from addiction will relapse within the first year, possibly because their treatment is too narrowly focused on a single substance or behavior, rather than on their general susceptibility to addiction, said Dr. Shaffer of Harvard Medical School and director of the division on addictions at the Cambridge (Massachusetts) Health Alliance. “The existing focus on addictive substances does not adequately capture the origin, nature and processes of addiction,” he wrote in his initial description of the syndrome model of addiction (Harv. Rev. Psychiatry 2004;12:367–74).
“Genetic predisposition to addiction is not drug specific,” he said, pointing to the phenomenon of addiction “hopping” as an example. This phenomenon is commonly seen in addiction recovery programs, when the addiction that is being treated—alcoholism, for example—is replaced by another previously unrecognized addiction, such as exercise or disordered eating, he said.
Indeed, in an ongoing study of 508 subjects with multiple drunk driving offenses, Dr. Shaffer has found a high rate of coexisting addictions. These include alcohol abuse/dependence in 98%, substance abuse/dependence in 42%, nicotine dependence in 17%, and pathological gambling in 2%.
In addition, he found comorbid mental disorders in the group, including alcohol/substance abuse/gambling disorder in 99%, generalized anxiety disorder/depression or dysthymia in 20%, conduct disorder in 22%, posttraumatic stress disorder in 14%, and mania in 9%.
“Most [comorbidities] are being missed, and so that's the next issue. We have to do a really rigorous evaluation,” Dr. Shaffer said.