When it became clear, after the start of the pandemic lockdown, that Eduweek would not take place in September 2020, the EAPASA Board mobilised to find a way to bring Eduweek’s education to the Association’s members over the ensuing months in an accessible, online format that would not only bring up-to-date learning, but would also provide CPD points for attendees. With the EnOv8 team’s assistance and the indispensable support of our sponsors, in September 2020, EduWeb was born.

Looking back over the past 21 months, in review of over 30 EduWeb seminars, through which a wide range of gifted and experienced health and wellness specialists have shared their knowledge, we are proud of having been able to pivot in the face of national lockdown protocols and use technology to continue to educate and interact with our members. We are also humbled that our EduWeb presenters would give so freely of their time and expertise to share leading-edge information with their industry peers. EduWeb has given over 1000 attendees a ring-side seat to gaining knowledge of the unfolding effects that COVID-19 has had on employees and the world of work. It has also brought us back to basics, to ‘sharpen our collective saw’ when it comes to understanding mental, physical, spiritual and financial health. 

And now, two years later, we have come full circle and, once again, are looking forward to convening and attending Eduweek 2022. We will be back to meeting in person, but will also use what we have learned about employing technology to enhance Eduweek 2022 as we Unite to Advance Employee Wellness. Thank you to all those who helped EAPASA to be front runners in using technology to seamlessly transition from in-person to digital gatherings and education. 

BEHAVIOURAL ADDICTIONS

Our final EduWeb seminar was presented by Carol Venter from ICAS and Steven Davids, who is a social worker in private practice and works full-time at Sunnyside Drug Recovery Unit, on the subject of behavioural addictions. 

Behavioural addictions in context

Addictions come in all shapes and form and have increased during the pandemic. There are many reasons for this including increased stress and anxiety due to uncertain times; financial, family and work pressures; relationship stress; fatigue and burnout due to additional responsibilities; and the lack of accessibility to support and treatment. It has been easier to mask addictions while people are mainly at home. It is more hidden than ever before – previously work colleagues may have been able to detect the physical signs of addiction. The use of technology in the privacy of an addict’s own home has facilitated an increase in behavioural addictions such as gambling online.

What is behavioural addiction

Behaviour addiction is very similar to substance addictions in terms of hijacking the brain’s circuitry – reprogramming the brain’s reward system:

“Behavioural addiction is a form of addiction that involves a compulsion to engage in a rewarding non-substance related behaviour despite negative consequences to a person’s physical, mental, social or financial wellbeing.”

Key aspects of behavioural addiction 

These have commonalities with substance addiction and include:

• Loss of control
• Urges and impulsion to engage in the behaviour
• Increased tolerance
• Preoccupation with the behaviour
• Distorted perceptions and thoughts
• Excessive behaviour and present for 12 month or more
• Negative consequences such as an inability to quit

Categorisation and criteria for diagnosis

The DM5 does include behavioural addiction, classifying this as a ‘substance-related and addictive disorder – with gambling being the only behavioural addiction currently recognised.  Several other non-substance or behavioural addictions that were considered are: sex, exercise and shopping. These were not included due to insufficient peer-reviewed evidence to establish diagnostic criteria. They are currently classified as impulse control disorders by the DM4.

The progression of a gambling addiction

Gambing addiction follows a slippery slope as the addict spirals out of control.

The DSM criteria for diagnosis of compulsive gambling: 

• Often preoccupied with gambling, i.e. having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money to gamble.
• Gamble when feeling distressed, i.e. helpless, guilty, anxious, depressed
• After losing money gambling, often return another day to get even (“chasing one’s loses”)
• Lie to conceal the extent of involvement with gambling
• Have often jeopardised a significant relationship, job or educational opportunity as a direct result of gambling
• Rely on others to provide money to relieve desperate financial situations caused by gambling – to bail them out
• Have committed some sort of illegal activity. Sometimes see this as “borrowing” the money with the best intentions of paying it back.

Why the concern?

• Undiagnosed, addiction to gambling presents as suffering from financial problems, depression, anxiety and stress
• There is a high rate of co-morbidity and cross-addiction
• Increased accessibility due it being a growth industry – online and in casinos and small gambling venues 
• It is associated with family disintegration, presenteeism and absenteeism, bankruptcy and illegal activities such as fraud, as well as other mental health problems
• Gamblers only seek help when they reach rock bottom and a high percentage are of them suffer from suicide ideation 

What are the risk factors for a gambling addiction?

• Accessibility to gambling and cash (or credit)
• Exposure to gambling early in childhood
• A bid win early on
• Boredom and free time
• Loneliness and needing escapism
• Flexibility at work / freedom from supervision
• Financial problems
• Impulsiveness, substance abuse, family history, stress
• Being risk takers, competitiveness
• Adverse childhood experiences (ACEs) or unresolved trauma
• Unhealthy or lack of coping mechanisms
• Family history 
• Casinos practice an 80/20 rule – 80% of profits from 20% of patrons
• Casinos win 96% of the time
• Occasional or “near” wins
• The “interactiveness” of games with touch-screens etc 
• Moneyless play
• The attractive set up in casinos with lights, music, childcare, enticement of perks/rewards
• Online it is easily of accessibility / anonymity
• Repetitive behaviour
• Rewards
• Excitement and thrill

What are the possible signs and symptoms?

• Disinterest in usual activities
• Withdrawal from relationships and friends
• Irrational behaviour and mood swings
• Defensiveness and over-sensitivity
• Fluctuating energy levels
• Memory lapses and impaired concentration
• Lying, secretiveness and dishonesty
• Presenteeism and declining performance
• Absenteeism – especially around paydays
• Financial problems – taking advances and loans, cashing in on pension and other policies
• Frequent job changes to access retirement funds or seek increased salary

What are the possible treatment plans?

• Assessment and diagnosis – particularly early identification
• Outpatient treatment is viable with counselling and support groups

Gambling addiction can be contained very easily through handing over financial control to a family member. Addicts can have themselves self-excluded from casinos through the Gambling Board. They can join Gamblers Anonymous – in-person or online.

• Inpatient treatment – particularly those needed comorbidity and life-risk rehabilitation and aftercare. Addicts diagnosed with suffering from suicide ideation should be closely monitored by family members during the critical period 
• Treatment plans can benefit from including Cognitive Behavioural Therapy for impulse control disorders
• Motivational enhancement can be used
• Psychosocial education is useful as addicts can be so caught up in the shame of their addiction that they don’t see it as a disease
• Financial planning 
• Relapse prevention, for example by identifying triggers
• Family involvement and support is vital
• Encouraging healthy lifestyles: Alternative interests and hobbies, promoting work-life integration and stress management 

How can the workplace bring addiction interventions?

The workplace can play a role in behavioural addiction alleviation: 

• EAPs and Health & Wellness programmes can promote work-life balance and healthy lifestyle choices to grow awareness, as well as providing addiction education in the workplace and providing Stress Management interventions.
• In the workplace, addiction can be normalised as an unhealthy coping mechanism / behaviour / habit adopted because the sufferer was not provided with (or able to access) a healthy alternative to their ritualised comfort seeking.
• Employers can practice intervention before embarking on disciplinary processes as a duty of care to their employee, approaching the individual with empathy rather than blaming and shaming them.

Addiction – what is its origin and meaning?

After an interesting debate on the difference between the concepts of dependence (as in a person being dependent on Insulin) and addiction, Stephen looked up the word ‘addiction’. It comes from the Latin word ‘addictus’.

ADDICTUS:  To devote | Sacrifice | Sell out | Betray | Abandon

‘Addictus’ speaks to the words ‘to devote’. Stephen is amazed by the devotion, the rate at which addicts will devote their lives to the acquisition and consume of a substance; to why they would sacrifice everything – their family, marriage, job – for this consumption. He is amazed at them selling out, selling their own possessions and the possessions of others to get their hands on that substance. Why would be sell their all?

Addictus also peaks to a level of betrayal – how an addicted individual would betray personal and employer relationships. Addictus speaks to ‘to abandon’. The abandonment of those close to them and their feeling of being abandoned as the addiction progresses.

Jean Bergeret is a French psychotherapist, who studied chemical addiction. His interpretation of the word, addictus’ is “to be bound by a bondsman”. What challenges professionals is the high rate of relapse, as the bondsman can never be paid. Bergeret defined an addict as “a slave bound a debt”. In the modern day meaning of ‘addictus’ there lies a concept that addiction is a way for an addict to pawn their bodies as a way to pay off their debt from the past. But, they are their own bondman. Imagine being both the slave and the slave driver – someone who feels the compulsion to use a substance to fill a void that has you in bondage with you as your own slave driver. 

• Their continued use in spite of the consequences. An individual can be imprisoned for using, be brutalised in prison and yet relapse when they are released. Can they have just one drink? 

The result of RAT studies

• Not all rats became addicted
• 10% became addicted
• It is assumed that 10 – 17% of the population becomes addicted 

Within this 10% of addicts, there are individuals who want to stop, but cannot. To help them we need to:

• Help the person to limit the availability of drugs

• Ask what strategies they use to acquire drugs and help to disrupt it 
• Ask how do drugs find you? There is a relationship between an addict and their dealer. There is a level of paradoxical psychology use to keep the addict tied to the dealer.
• Find out how to cut of both routes in order to limit drug availability

• Pharmacological interventions

• Benzodiazepines are used to stimulate the inhibitory system in the brain. The downside is that patients regularly become dependent on this medication. 

• South Africa is moving away from the ‘dirty’ drugs like, Tik or Mandrax, moving toward ‘clean’ prescription and OTC drugs

• Bottom line: There is no escape from withdrawal. Benzodiazepines just slow withdrawal

• Be prepared to deal with:

• Trauma
• Unresolved conflict

• Sober time

• Addiction is linked to cellular memory. The body has come to learn that it needs the drug for neurons to fire. At first the body will overcompensate and then crash and go into withdrawal. 
• Substitute treatments, such as Suboxone and Methadone cause withdrawal to be less violent but longer lasting.
• It has been found that addicts have fewer D2 receptors, so addiction is linked to biology. There is research underway to understand more about manipulating these receptors. 

• Behavioural interventions

• Helping to create new neural pathways
• This is potentially linked to increasing D2 receptors

• Creating a Safe Space

• We live in an uncaring society and need to create a safe space for recovering addicts to return to. 
• When people come out of addiction they may start to self-harm to trigger serotonin and dopamine

In conclusion:

We do not all react the same way to drugs. It is a bio-psycho-socio-spiritual issue. We cannot under-estimate the “higher power / spiritual component” of rehabilitation. 

If you were not able to attend this valuable seminar, click here to view it on EAPASA’s Facebook page.