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GETTYSBURG MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
23, August 2001

Dealing with Addictive Behavior

The columns for the last several weeks have dealt with concepts of freedom, motivation and addictive behavior. To define it again, a person is carrying on addictive behavior when they are unable or unwilling to control behavior that damages their health, their performance and/or their relationships. Behaviors that damage health would include alcohol or cigarette abuse. Addictive behavior that impairs performance would include alcohol abuse, verbal abuse of others or bulimia. Examples of behaviors that destroy relationships include verbal abuse, alcoholic behavior, gambling addiction, spending or shopping addiction, or morbid obesity to the point where the individual’s self-image or attractiveness to others is destroyed. These are very painful considerations. Almost invariably, the individual engaging in addictive behaviors states that they simply cannot stop what they are doing.

How does one get out of the addictive rut and engage in more constructive and satisfying behavior? There are a series of steps that a person can take to address these problems. The first of these is for the individual to recognize that he/she is engaging in addictive behavior. In order to successfully change the behavior, the individual has to recognize this for themselves. Invariably, spouses, children, parents and companions try to point out to someone that they are addicted and almost invariably this leads to a barrier that the addictive person puts up to deny that they have a problem. Step one in dealing with addictive behavior is to free the addicted individual to make their own decisions. Parents and children and spouses and friends are rarely effective in convincing the addicted individual of their problem. They need to back off and let the person become responsible for their own behaviors.

Step two in dealing with addictive behavior is for the addicted individual to recognize that they are responsible for their own behavior. They need to recognize that they have control of themselves to both start or to stop what they are doing.

The next consideration in regard to stopping addictive behavior is for those around the addicted person to stop facilitating the behavior. So many times, the alcoholic has a well-meaning and compassionate companion or spouse or child that will bring them the alcohol that they are abusing. Many times, the favorite foods that a person gorges on are brought into the home and provided by a well-meaning spouse or parent. Those facilitating the addictive behavior need to recognize what they are doing and be kind enough to the addicted individual to stop supporting the addiction.

In addition, the addicted individual needs to be allowed to experience the consequences of their own behavior. As long as well-meaning companions shield addicted individuals from the consequences of their behavior, that behavior is still being facilitated. Lastly, the addicted individual needs to recognize that they can learn from their experience, modify their behavior and have greater freedom in the future.

Examples always make the above abstract concepts clearer. The example of Bill is perhaps an extreme story but illustrates many of the points made above. Bill was a 32-year-old, married, father of three, and at 5 feet 6 inches tall, he weighed 270 pounds, smoked two packs of cigarettes per day and frequently drank to excess on weekends. He was a very successful insurance salesman who worked long hours and frequently had weekend appointments away from his family. This led to significant conflict with his wife and there had been discussions of a divorce. He came to medical attention because of chest pain that he interpreted to mean that he had “a little bronchitis.” In fact, he had a heart attack and soon after his admission to the hospital, he had a cardiac arrest from which he was resuscitated. This was sort of an attention-getting event and he recognized that he had had a near death experience. He wanted to know how to avoid another heart attack. During his recovery, he was addressed by an addiction counselor and the nature of his behavior was clearly delineated. He was a very intelligent young man and was able to recognize his addictive behavior. He was receptive to the counseling suggestions. Fortunately, he had a very supportive wife and family. He discontinued the cigarette habit and was one of a very few individuals who was able to drink in moderation once he recognized how destructive his alcohol habit had been. He made a point to initiate an exercise program. His wife acknowledged that she often bought all of the foods that he wanted although knowing that they were not “good for him.” She changed the nature of the food that was in the home, the meals that she served and she was able to help him lose weight.

Lastly, he modified his work habit to spend more time with his family. If he had evening interviews, he arranged to take an afternoon or morning off to pick the children up at school or take them to school or out for a meal. Five years later, there had been a dramatic change in his health profile and very little of this had to do with medication. Few people are faced with the extreme that this individual was but the principles on how to deal with the problem are the same for all. Fortunately, this young man was able to recognize an “offer he couldn’t refuse” and did change his ways. Nobody would ever say it is easy to change but, gloriously, the freedom to change resides in the individual. Having seen the grotesque health and social consequences of addictive behavior, I promise that it is worth changing.