The opening chapter on substance-related and addictive disorders in the DSM–5 states in the second paragraph that a variety of behaviors not related to drugs activate reward systems similar to those activated by drugs of abuse, producing some behavioral symptoms that appear comparable to those produced by substance abuse disorders. The behaviors that are mentioned include gambling, sex, exercise and shopping.1
We should more closely examine that statement, with a special emphasis on understanding how those behaviors that we refer to as coping mechanisms are an active dynamic of all addiction, chemical or non-chemical.
There are two behavioral reward systems. Positive reinforcement is often used to reward a behavior. Life can provide these rewards. The reward can be a cookie from a parent for doing a chore, it can be some form of recognition, or it can be the satisfaction that comes with a job well done. The behavior is associated with the cue that fires the neurochemical reward, with the result that the behavior continues long after the reward is discontinued.
Life isn’t all pleasure, however; it is also filled with danger and pain. As we all experience pain, we also all develop methods of dealing with discomfort. These methods, or coping mechanisms, vary in magnitude relative to the amount of pain.
Coping mechanisms produce rewards by relieving pain. Coping is a means to relieve pain or discomfort by either eliminating it or replacing it with something more comfortable. Scratching an itch is an easy-to-understand example of this. The itch is a form of discomfort, and scratching it produces a good sensation—until the scratching produces a sore. Boredom is one of the most significant discomforts in our world, and we have developed countless activities for relieving it. It is not uncommon to experience a compulsion to find something to do when bored, regardless of how risky it may be, if it produces relief. The relief is the reward. This is a negative reinforcer.
When a coping behavior is re-enacted for the same result, it becomes learned. When it is repeated out of memory or without conscious thought, we can say it has become habituated. Locking the car door is an example of this habituation. We get out of the car, lock it and walk away without really thinking about it. The car “at risk” is the discomfort, locking it is the behavior, and safety is the reward.
The coping behavior meets our need for a reward (feeling of relief). So why is this subject a matter of concern for professionals in the addictions field?
Substance abuse therapists often take referrals from other systems of care in addition to treating those who seek help for addiction themselves. This can involve working extensively with juvenile justice, children's services, adult corrections, employment services, public schools, business, health services and mental health services. In my own career, I have noticed destructive behavior patterns with individuals referred by these systems that go well beyond substance abuse. In fact, many of the individuals referred do not use drugs, even though their pathway to self-destruction has made it seem that way.
I have always found these self-destructive behavior patterns to be coping mechanisms. The consequences of these behavior patterns are just as harmful to the affected individuals and their loved ones as drug use, and just as difficult to change.
Whether the behavior is sleeping too much, hanging out with questionable friends, engaging in violence, spending all day looking for sex, or engaging in excessive Internet and television use, these individuals have the same struggles as individuals addicted to chemicals. Memory-linked reminders cue these addicts to the relief rewards, they experience cravings, and they repeatedly fail to change, even when these behaviors are clearly leading to self-destruction. Scratching the itch feels good, but it produces a sore.
In the case of violence or gambling as a coping mechanism, this logic is easily accepted. Interestingly, the same logic also may apply to mental illness. Laurie Ahern wrote in an article for the National Empowerment Center that mental illness is a coping mechanism.2 She cites mania, depression, obsessive-compulsive disorder and agoraphobia among issues that are probable responses to trauma, but also understandable as coping mechanisms. She makes a strong case for these being learned behaviors.
Role of the workforce
The trials of working in the addiction field are well-known and generally revolve around the lack of funding and status within healthcare. This is troublesome in that the field has so much to offer to the healthcare industry and to the community in addition to treating substance use disorders.
The battle to achieve adequate public and private reimbursement for services hasn’t changed for 40 years. Yet there is no question that the systems noted in this article offer financial opportunity for addiction specialists beyond treating alcohol and drug abuse.
A recent challenge in the addiction field has been attracting and retaining an adequate workforce. We have a lot of talent retiring, and too few young people showing interest in the field. Rather than retrench, there is an opportunity to push addictions forward by developing the research needed to substantiate the treatment of other addictive behaviors. Coping mechanisms are a rich resource toward which to advance the field with new product lines.