When most people hear words such as “alcoholic” or “compulsive gambler,” they typically think of two separate people: The first person is addicted to alcohol, while the second person is addicted to gambling.When Dr. Patrick Carnes hears those words, he automatically suspects that the alcoholic and compulsive gambler are one and the same person.That’s because Carnes has long been a proponent of the idea that it is very common for people to have multiple addictions, or cross addictions. For example, a person may be a drinker, smoker and gambler all rolled into one. Or a person may have an addiction to both cocaine and sex. In fact, Carnes said, it is not uncommon for a cocaine addict to trade sex for cocaine.

Carnes is a nationally-known author and speaker on addiction and recovery issues. He is executive director of Pine Grove Behavioral Health and Addiction Services in Hattiesburg, Miss.On Friday, Carnes discussed the prevalence of multiple addictions with counseling professionals during a daylong workshop hosted by the Central Nebraska Council on Alcoholism and Addictions at Evangelical Free Church in Grand Island.Advances have been simultaneous in the understanding of brain chemistry and addiction, including the phenomenon of multiple addictions, Carnes said. To illustrate that point, he showed a slide with a brain scan of a person of normal weight who had no addictions. That brain scan contained red highlights, illustrating the presence of a high number of receptors for dopamine. Dopamine serves many functions in the body, but one of them is giving people an ability to feel pleasure or joy.On that same slide, Carnes had brain scans of an obese person, a person using cocaine and a person classified as an alcoholic. Each of those slides showed had no red to reveal the presence of receptors for dopamine.Next, Carnes showed charts illustrating the percentage of “natural reward” increase in dopamine levels for people when they ate food and when they had sex. Dopamine levels in the brain increased about 50 percent when a person ate food and doubled when a person had sex.After that, Carnes showed the rise in the brain’s dopamine levels for people who ingested alcohol, nicotine, cocaine and amphetamine. The graph showed a doubling in dopamine for the highest level of alcohol consumption, more than a doubling of dopamine levels for nicotine, more than a tripling of dopamine levels for cocaine and about a 1,000 percent increase in dopamine levels for amphetamine use.“There is no such thing as a recreational crystal meth user,” Carnes said.

Addictions are sneaky because the harm they cause are not immediately apparent, Carnes said. The first time a person is exposed to nicotine, for example, he normally feels more alert and more able to multitask. Carnes said that is not a false perception. However, nicotine’s effect on the brain over the long term results in the exact opposite effect.

He said a study of executives who smoked showed that they were less able to focus and multitask than executives who were nonsmokers.

 

An addict typically gets diminishing returns with all kinds of addictive substances, not just nicotine.

Different addictive substances — and various addictive behaviors — tend to cut the same biochemical path in the brain, Carnes said. He said people who are allowed to keep smoking while in a 30-day residential treatment program for alcoholism may be four times as likely to relapse after release from the program as those who were also banned from smoking during treatment.

That’s because the brain of the person who continues to smoke may feel as though “it is missing something” whenever the person smokes, Carnes said. That “missing something” is likely alcohol.

One of Carnes’ slides said that “addictions more than coexist, they interact, reinforce, become part of one another. They become packages.”

 

As a result, he showed slides showing a number of possible interactions, including a few of the following:

— Cross tolerance, which is a simultaneous increase in behavior in two or more addictions. Addictions usually develop over time, but cross tolerance means a person may transfer from one addictive activity with little or no developmental sequence for the second addiction.

— Withdrawal mediation, which is when one addiction serves to moderate, relieve or avoid withdrawal from another addiction.

— Replacement, when one addiction replaces another, while retaining the majority of emotional and behavioral features.

— Alternating addiction cycles, when addictions cycle back and forth in a patterned, systemic way.

–n Intensification, which means a person has two addictions, but neither feels sufficient by itself, so he must engage in both addictions at once.

Carnes said the traditional view of addiction is that only substances have the ability to change brain chemistry and lead to addiction. But he said behaviors also can do the same.

Especially for behavior, culture can play a role in addiction, he said. The Internet has made pornography much more available to everyone. Because of the Internet, preteens and young teems can have either unwanted or intended exposure to pornography.

 

During a morning interview with The Independent, Carnes said his workshop would emphasize something else: When professionals work with a client, they need to be inquisitive enough to discover whether the person who wants to be treated for alcoholism is also suffering from other addictions.

 

He said he also will emphasize the current 30- to 90-day treatment model is not enough to break addiction. That process, which includes re-engineering the brain, will take three to five years.

Carnes said he advocates 30 tasks to accomplish that work. For the addict, those tasks can begin with breaking through denial, establishing sobriety and building a culture of support, to a second stage of self-examination whether problems are being caused by multiple addictions, finding meaningful work and finding a balance in lifestyle. The third stage of tasks includes re-establishing good relationships with the immediate family