“It’s A Deficiency Disorder”. Clients Understanding of Substance and Behavioral Addictions and Treatment Needs: An Interview Study

During past decades, researchers and clinicians have acknowledged the cooccurrence of substance and behavioral addictions (excessive food intake, sexual activities, Internet use, gambling, exercise, and shopping). It has for example been shown that clients who attain abstinence from substances instead might “switch addiction” and develop excessive gambling [1, 2]. It has also been shown that clients might use substances and one or several behaviors concurrently [3, 4]. The phenomenon is complex and it is often difficult to distinguish between the switching of addictions and the concurrent use of substances and behaviors. In this study, the term co-occurring addictions refer to both the switching of addictions and the concurrent use of a variety of objects. Co-occurring addictions are not uncommon. It has been estimated that 58% of individuals with any addiction have 2-4 other co-occurring addictions [5]. When clients in substance abuse treatment had the opportunity to self-report behavioral addictions (sexual activities, food intake, gambling and exercise), 67% reported such difficulties [6]. Through brain imaging studies it is possible to evaluate underlying brain systems pathology and also visualize effectiveness of treatment [7] and through interview studies it is possible to investigate the shared phenomenology of addiction to substances and behaviors [8-10]. In line with this, some researchers view addiction to substances and behaviors as varying expressions of an underlying difficulty or deficiency [11-14]. The term behavioral addiction is however questioned. It has for example been noted that any behavior might be labeled as addictive and the term might thus come to lack meaning [4, 15]. Moreover, there are researchers who differentiate between substances and behaviors since some characteristics and prerequisites are specific to certain behaviors. Excessive Internet use is for example connected to accessibility to the Internet, and since older clients use the Internet to a lesser extent, their risk to develop excessive use is relatively low [16]. Moreover, difficulties with food intake and exercise should be considered with respect to questions of physical attractiveness, since such difficulties are connected to strivings for physical attractiveness [17]. With awareness of the many clients who struggle with one specific substance or behavior, and with awareness of the importance of investigating substances and behaviors separately, this paper concerns addiction as a syndrome that might take varying expressions.