Substance-Abuse, Eating Disorders, Behavioral Dependencies & Codependency

Substance-Abuse: I have considerable experience treating alcoholism and drug-addiction. Although the controlled withdrawal from hard drugs usually requires residential treatment in a special clinic or hospital, many aspects of substance-abuse, especially alcohol dependency, can best be treated in a private-practice setting. Alcoholism is not a disease of the down and out. On the contrary, it is unfortunately also a plague of the successful professional, as well as of the businessman and housewife. These people can benefit from a treatment outside of the clinic, avoiding the disruption and embarrassment which would otherwise be caused by residential treatment. Alcoholism is a progressive disease, if not treated, and so it is very important that those, who feel they may have a problem in this area, find a convenient and flexible source of help and support, whenever and wherever they need it. In the case of drug-dependency itself, ambulant care is helpful and often necessary to maintain abstinence gained during treatment in a clinic.

I gained knowledge of substance-abuse diseases through basic research, which I conducted in the field of Neuropharmacology during eight years at the Max-Planck-Institute for Psychiatry in Munich and while treating alcoholics and drug addicts at a clinic of the American Military. Affective-Cognitive-Behavioral Psychotherapy, which has been shown to be so helpful in the treatment of other disturbances, such as depression, is also very helpful in the treatment of substance abuse. Sufferers need to develop new ways of thinking, behaving and dealing with their emotions, for example, with feelings of stress, boredom, loneliness and anger or new ways of finding pleasure, which do not involve substance-abuse, during their continuous recovery. The process of giving up smoking can also be seen and understood within this framework.

Eating-Disorders: I also treat many patients suffering from eating-disorders, such as compulsive over-eating (COE), binge eating disorder (BED), anorexia and bulimia. The disturbances have different causes and require different kinds of treatment. Bulimic Patients can stuff huge amounts of food into themselves only to regurgitate it a short time later (“get rid of it”). Getting rid of it relieves their fear of weight gain, but the urge to gorge comes back again. Bulimia usually starts as a hunger-attack after a period of dieting. The origin of COE and BED seems to be, according to more recent research, quite different. Binge eating, which is accompanied by a nearly complete loss of control, and over-eating in general do not necessarily start after dieting, or even in relationship to a desire to loose weight. Instead, excessive food-consumption activates neural reward systems, momentarily reducing uncomfortable feelings, such as anxiety, loneliness, sadness, anger, boredom and feelings of emptiness or meaninglessness and temporarily stimulating positive feelings, such as comfort, security and satisfaction. Similar to addictive behavior, it is often referred to as Emotional Eating and is usually associated with poor body image and low self-esteem. In some ways the treatment of over-eating parallels methods used for the treatment of chemical dependencies, with the exception that suffers can not give up food as addicts can give up substances supporting their addiction. Individuals must learn better ways to deal with their feelings and to enjoy their food in non-addictive ways. Without food-enjoyment, good health and nutrition can not be maintained.

Contrary to people suffering from over-eating, anorexic patients are undernourished and underweight. People with this disorder are similar to people with obsessive-compulsive-disorder (OCD), except that they have specialized in fat-fighting. They suffer from the fear of gaining weight and often feel, paradoxically, that they are over-weight. Their stubborn need to be thin at all cost reflects their basic values and represents an important part of their own self-esteem and identity. For this reason, the disease is very difficult to over-come. It is particularly prevalent among young women, but is also growing in prevalence among young men. Its treatment shows parallels to that of OCD, but may require medical intervention, when low weight threatens life.

Behavioral Dependencies: In addition to substance-abuse and eating disorders, there are also behavioral dependencies, which do not depend upon the intake of a substance, but rather upon an excessive activity or compulsion, such as gambling, shopping, sexual activities, internet-surfing or internet games, computer games, etc. As in the case of substance-abuse, behavioral dependencies have the character of an addiction, because they are hard to give up, even when they may cause sever interference with normal life. They can be treated successfully with integrated psychotherapy. Another activity, which is more socially accepted, but destructive to good health, is smoking, which must be placed firmly between a behaviorally dependent and substance-dependent activity. Nicotine gum, which can replace the nicotine gotten from smoking, is helpful, but not sufficient to end the desire to smoke. Despite the physical withdrawal signs caused by withdrawal from smoking and nicotine, which include nervousness and irritability, many individuals are able to successfully give up smoking on their own. Behavioral therapy can support efforts to stop smoking. A combination of nicotine substitution and psychotherapy makes the chances of being able to permanently stop smoking much greater.

Codependency: Without going into great detail on a complicated and important subject, a word must be added about people who suffer because of their own relationship to people with addictions, behavioral compulsions and dependencies (see above) and psychological disorders. For most people, happiness is about loving and being loved. For children of parents with alcoholic or other dysfunctional problems, love can mean pain and life in a no-win situation. Unfulfillment as an adult is often connected directly to childhood experiences with a disturbed or addicted parent, although the connection may not be easy to see. A codependent is someone who has beenemotionally deprived – deprived of a good self-image, a sense of security and an ability to have fun. As an adult, codependency often takes the form of tolerating intolerable, irresponsible behavior. In their efforts to help, protect and save people they love, they drain themselves and enable bad behavior to continue. As a result, the codependent is hurt and may feel powerless and defeated.

Typical codependent traits can be: dependencies of their own and behavioral compulsions (compulsive over-eating, drinking, over-working, over-responsibility in caring for others, or even chronic negativity and opposition to others); delusions, based on denial, lack of awareness of the stress they are under, believing other people’s happiness will lead to their own, believing that their behavior is normal; frozen feelings; low self-esteem; stress-related illnesses.

Codependency is very treatable. People suffering from it can be taught better ways to cope and to stop enabling destructive and chaotic behavior.