Addiction and Co-Occurring Disorder Diagnosis and Treatment Overview for Counselors

This podcast episode, hosted by Dr. Donnelly Snipes, provides a comprehensive overview of addiction and co-occurring disorders, specifically tailored for counselor continuing education. It begins by defining addiction according to ASAM and DSM-5-TR as a treatable, chronic medical condition influenced by complex interactions among brain circuits, genetics, environment, and life experiences, emphasizing a holistic approach. The discussion highlights that addiction involves compulsive substance use or behaviors that continue despite causing clinically significant distress or impairment, and introduces the 'TWAP OUT' mnemonic for diagnostic criteria, noting that tolerance and withdrawal are no longer mandatory for diagnosis.

The presentation delves into various types of addictions beyond substance use, including sex, pornography, gambling (including stock/crypto trading), gaming, adrenaline, and internet addiction. It then explores common 'addictive thinking' patterns such as blame, lack of time perspective, selective effort, justification, minimization, emotion-based reasoning, a loud inner critic, personalization, magnifying/minimizing, a need for control, perfectionism, and feelings of powerlessness. The episode also examines the diverse motivations behind addictive behaviors, ranging from escaping traumatic memories, abandonment anxiety, and daily life pressures to numbing physical pain, controlling emotions, improving attention, silencing inner critics or voices, recreation, and even revenge.

Dr. Snipes outlines the profound impact of addiction across multiple domains: physically (HPA axis dysregulation, microbiome alterations, increased inflammation, poor sleep), affectively (anger, guilt, anxiety, depression, despair, loneliness), cognitively (brain fog, pessimism), environmentally (financial and housing instability), and relationally (shame, low self-esteem, conflict, isolation, paranoia). The progression of addiction is described as moving from recreational use to self-soothing, increased frequency/intensity, and eventually using to cope with cravings and withdrawal symptoms, often leading to a cycle of worsening self-perception and continued use.

Finally, the episode stresses the critical importance of screening for common concurrent or comorbid disorders, as addiction rarely exists in isolation. Frequently co-occurring issues include ADHD, Adverse Childhood Experiences (ACEs), anxiety, depression, bipolar disorder (with a note on medication non-compliance and impulsivity during manic episodes), cardiovascular disease, chronic illness and pain, eating disorders, liver diseases, and malnutrition. The overarching message is that effective treatment requires addressing the whole person and their entire biopsychosocial context, not just the addiction in isolation, and maintaining the belief that change and recovery are possible.

"addiction is a treatable chronic medical condition involving complex interactions among brain circuits genetics the environment and the individual's life experiences"

"people with addiction use substances and or engage in behaviors that become compulsive and continue despite causing clinically significant distress or impairment in Social occupational or other areas of functioning"

"tolerance and withdrawal are not required anymore for a diagnosis of addiction"

"the person experiences a craving for that substance or behavior they're thinking about it a lot they really can't get it out of their mind they want it they feel like they need it"

"when people are using an addiction that is their best coping skill they have or the one that's most effective to help them numb the pain or Escape until now they're trying to survive"

"feelings are not facts"

"we need to help people look at progress not perfection"

"it is almost never in in my clinical experience people almost never just have an addiction they have an addiction and a mood disorder they have an addiction and something else"

"sleep is crucial in recovery"

"every person you deal with whether you're a physical health doctor or you are a mental health professional every person you deal with should be screened for adverse childhood experiences and Trauma"