Spotlight on... addiction

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By Amy Wall

A glass of wine after a long day at work, a flutter on an online gaming site, online shopping – these are all normal behaviours. But how do you tell when that glass of wine or online bet is starting to become a problem? We spoke to Professor Colin O’Gara, Consultant Psychiatrist and Head of Addiction Services at Saint John of God Hospital in Dublin, to explore this often misunderstood topic.

“Substance addiction, which would include alcohol, would be the most common addiction in Ireland by far at the moment. How I define it would be the persistence of ingestion or engaging in taking the substance in the face of adverse consequences. That’s the generally accepted definition of addiction,” says Professor O’Gara.

“For the behaviour piece, it’s the same definition but just with the persistence of the behaviour in the face of adverse consequence. With the behaviour then there’s also this added piece to it of whether it adds to your life or whether it takes from your life. Examples there would be gaming, exercise, shopping and time spent online.”

Professor O’Gara says that in his clinic they tend to see people who have severe difficulties by the time they’re referred to them but he says there is a fine line when it comes to addiction. A good example, he notes, is mobile phone use.

“Device usage can add to somebody’s life or, similarly, it can tip over into a scenario where it’s taking from someone’s life…” he says.

“We’re dealing with the traditional addictions of drug and alcohol and then the last ten years we’ve started dealing with gambling, which was over mobile phones. Now we’re starting to see the next wave, the next generation of addictions which, again, a lot are phone based or computer based.”

Professor O’Gara says this rise in phone based addictions is down to the tempting technology that we have available at our fingertips. Our devices and the software on the has never been better, however it’s important to see that there’s a downside to this too.

“There’s human consequences for all of this and we’re at the cold face of that now. A lot of our practice is dealing with that. Maybe not for direct referrals. We’re not being referred, ‘Please see this person for mobile phone overuse,’ but we’re getting there. We’re getting there more and more and I think, within the next decade, we’re going to see a huge shift over to those kinds of addictions.”

Professor O’Gara says that there are strong similarities between forms of addiction, like gambling addiction, and other types of addiction like alcohol or substance abuse.

“The reason gambling disorder was included in the international classification system [in] may 2013, that’s the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders], that’s the most updated classification system for psychiatric disorders and addictions. And the reason it was included in that was partly because the clinical presentation is very, very similar,” he says.

“Gambling disorder presents in the exact same ways as does drug and alcohol. But if you look across the other potential addictions, it’s the same features. It’s needing to do more of the same behaviour to get the same desired effect, a decline of other activities. They’re central features of addiction... but anywhere you’ve got a process that’s kind of normal, so exercise or sex or eating, it’s going to be very controversial because where is the dividing line in all of that?”

So how do you know when you’ve crossed that line?

“In a lot of cases, the whole way addiction works, is that people don’t know they have a problem. What we call they’re lacking insight. Again, there’s a good component of individuals that would have an idea, an awareness, that they’re drinking too much and what people can do, or if they’re taking a substance and it’s causing them problems, a good way to look at it is to try and take a diary of how much one is taking of the substance, how much one is spending on it.”

Professor O’Gara says there are often tell-tale physical signs as well. Such as stomach problems or the development of ulcers if you’re drinking a lot or having to visit your GP.

“Then there’s the mental health side of things, so increasing anxiety, low mood and using alcohol, for instance, as a stress reliever when one should be maybe looking at other more adaptive ways of dealing with stress like exercising or doing mindfulness or using stress-relieving techniques.”

It’s important to note that there is still a huge stigma associated with addiction and it’s hard for someone to identify as an addict. If you notice addictive behaviour in a loved one, what’s the most helpful way to speak to them about it?

“The topic is not an easy situation. It’s certainly not. Anybody who has done this or deal with this will know that it’s a difficult situation and people have to tread carefully,” says Professor O’Gara.

“The advice is to stay positive, number one, that you can get a result. Number two, try compassionate collaboration as opposed to outright confrontation. Number three, I would say to people, in the process, protect themselves and think about getting themselves to AL-Anon or even a counsellor themselves so they can be guided through the process. Get as much help around them while they’re doing it.”

When it comes to addiction, often the focus is on the person who is directly struggling. However it’s so important for family members and loved ones to take care of themselves while supporting or living with someone who is struggling with addiction.

“Number one is to mind yourself. Its’ a difficult process caring for and living with somebody with an addiction. It’s a difficult and challenging process so minding oneself [is essential]. I’m not just paying lip-service to that. What I mean is attending Al-Anon would be a good start or Gam Anon or any of the support groups. Watch getting drawn into late night discussions, arguments, that are going to affect your wellbeing. Try to keep normal patterns, sleep and that,” says Professor O’Gara.

“Number two is to detach. Detach when you know you need to detach. What that means is not trying to control a situation that you know you can’t control. Being able to identify situations that you can’t control in particular because there will be situations where there is no immediate answer… For instance if somebody is living with somebody who is drinking heavily but they’re still functional, sometimes it might mean not getting into arguments or discussion that you know you’ve got into before and they’re going to lead nowhere.

“Sometimes pulling back and working on your own health is a better option at that time prior to then working out what to do in the future. It can be a long process sometimes and people have to mind themselves.”

If you feel that you may be struggling with an addition, it’s important to know where you can get help. Professor O’Gara offers the following advice…

“The options are self-help and then professional help. They’re the two main categories and there is evidence to suggest that people can get well themselves. That’s not often put out there but it’s true because that’s what the research supports – that a lot of people stop themselves.

“Step number one is identifying and acknowledging that you have a problem. Step number two is putting a plan in place to deal with that. At step number two you’ve got the option of going professional or keep going yourself. If you’re going to go yourself, you can get yourself to mutual support meetings such as AA or GA or any of the mutual support meetings or you can go to counselling which is available in a lot of localities now.”

Catherine Devane