An addiction combo is the existence of several different addictions within or exhibited by the same addict. What relevance do addiction combos have relative to the etiological paradigm of addictions? The answer is simple: That if addiction combos are found in a higher incidence than chance, addictions are caused by an underlying addiction producing brain mechanism and are not distinct entities themselves. In the latter case, if each addiction were a separate entity etiologically, we would find only one addiction per person usually and only rarely two or more. [The incidence of two addictions in a person, if each addiction was a separate entity would be the product of their separate incidences. For example, if alcohol addiction incidence was 10% and gambling was 2%, then we would expect to find the combo, alcohol addiction + gambling, in .1 times .02 = .002 or .2% of the population. What we actually find, however, is that among alcohol addicts gambling addiction is found to be 23 times as likely than in non-alcohol addicts. Thus, there is a common entity causing both.] This is, of course, exactly what the Hypoism paradigm predicts and the current psychobabble paradigm doesn’t. Addiction combos of all varieties occurring in higher incidence than the product of their individual incidences is proof in favor of the concept of addictabibility rather than random choice.
In Hypoic’s Handbook I discuss the COGA study, a current study of alcoholics and their families attempting to find the gene or genes causing “alcoholism.” Part of the data being recorded is also “other behaviors and addictions” within probands (the alcoholic) and their family members. If you will remember, I said that this study could be quite useful in delineating Hypoism if this part of the study were done thoroughly, looking for different individual addictions and addiction combos among the probands and the family members. It turns out that other studies are currently looking at these kinds of things too, so will be helpful in filling in the gaps the COGA study, because of its lack of thoroughness, leaves unfilled.
In this article I will list studies that I come across from time to time that show high incidences of addiction combos as evidence for Hypoism’s addictability paradigm. That this phenomenon, addictability, is genetically mediated is shown by the high heritabilities of each of the individual addictions separately. If anyone ever does a heritability study of the combos, something that hasn’t been done yet, they will find high heritability numbers for these combos as well.
1. Tsuang, M., et al. Co-occurrence of abuse of different drugs in men. Archives of General Psychiatry 55:967-972, 1998
2. Laura Jean Bierut, MD, et al, Familial Transmission of Substance Dependence: Alcohol, Marijuana, Cocaine, and Habitual Smoking. A Report From the Collaborative Study on the Genetics of Alcoholism,Arch Gen Psychiatry. 1998;55:982-988
3. Welte, J.W. et al. Co-occurrence of alcoholism and gambling addiction. Sept. 2001 Journal of Studies of Alcohol.
4. Petry, N. and Tawfik, Z. Co-occurrence of drug, alcohol, gambling, and risky sex in teens, November, 2001 issue of Journal of the American Academy of Child and Adolescent Psychiatry.
Here's an article that raises the questions and makes some connections:
Alcoholism Susceptibility Linked To Compulsive Gambling, Shopping by Joan Arehart-Treichel
Psychiatric News July 19, 2002 Volume 37 Number 14
Although fascinating insights into pathological gambling, compulsive buying, and some other addictive behaviors are emerging, many questions about such behaviors remain. One might say that "Steve," a 50-year-old from Augusta, Ga., has the cards stacked against him as far as alcoholism is concerned. Both his parents were alcoholics. Thus, Steve may well have inherited a double dose of alcoholism susceptibility. Yet Steve isn’t an alcoholic; he has a gambling problem. Nonetheless, his gambling compulsion may also have derived from a double whammy of alcoholism susceptibility. This possibility was suggested at a symposium on behavioral addictions at APA’s 2002 annual meeting in May in Philadelphia. There is ample scientific evidence that alcoholism susceptibility and pathological gambling susceptibility are related, David Gorelick, M.D., a psychiatrist at the National Institute on Drug Abuse in Baltimore, Md., reported. For instance, persons with an alcohol problem often have a gambling one as well. The evidence comes from studies conducted not just in the United States, but also in Canada and Switzerland. A dose-response relationship has been found between how much people drink and their risk of pathological gambling. There are also striking similarities between alcohol abuse and gambling abuse: a preoccupation with the behavior, an increase in the behavior during times of stress, the need for more of the behavior to achieve the desired effect, and withdrawal symptoms from the behavior. It could be that alcoholism and pathological gambling have the same cause, Gorelick conjectured. Compulsive Buying What’s more, alcohol excess and gambling excess might possibly be related to a third addictive behavior—compulsive buying, said another symposium speaker, Michel Lejoyeux, M.D., a psychiatrist at the University of Paris in Colombes, France. Lejoyeux studied 158 university students and found that 20 percent were compulsive buyers. He then compared the compulsive buyers with the noncompulsive students. He found that the former drank greater amounts of alcohol, smoked more often, and spent significantly more money on gambling than the noncompulsive students. However, whether compulsive buying shares any biological origins with alcohol and gambling addictions is far from clear. In fact, compulsive buying may be related to depression since all of the compulsive buyers in Lejoyeux’s study met DSM-IV criteria for a major depressive disorder, and a number came from a family with a history of depression or bipolar disorder. In contrast, a genetic propensity for depression is probably not sufficient to trigger compulsive buying; certain personality traits—say, sensation seeking—may be necessary as well. The reason? Lejoyeux found that sensation seeking was considerably more prevalent in the depressed compulsive buyers than in the depressed subjects who were not compulsive buyers. Pedophilia, exhibitionism, fetishism, and other addictive sexual behaviors are probably not related to alcohol, gambling, and buying addictions, suggested Florence Thibaut, M.D., a professor of psychiatry at the University of Rouen in France and France’s premiere authority on addictive sexual behaviors. The basis for this statement is that addictive sexual behaviors usually do not coexist with other types of addictive behaviors. In fact, questions about the origins of addictive behaviors are currently a lot more numerous than are answers, symposium speakers said. For instance, the personality trait of impulsivity seems to be a hallmark of addictive behaviors. After all, youngsters who are impulsive often end up gambling and/or abusing substances by age 17 years, Gorelick reported, and compulsive buyers are not only sensation seeking but impulsive, Lejoyeux said. But might certain addictive behaviors—for example, pyromania—be more planned than impulsive? Jean Ades, M.D., a psychiatrist at the University of Paris in Colombes, France, raised this possibility. Marc Potenza, M.D., an assistant professor of psychiatry at Yale University and director of the Yale problem-gambling clinic, reported that he and colleagues had used functional magnetic resonance imaging and videotaped cues of happy, sad, or addiction-related scenarios to see what parts of the human brain might be involved in pathological gambling or cocaine addiction. They found that the anterior cingulate—a part of the cortex lying close to the corpus callosum in the front part of the brain—as well as the thalamus and basal ganglia appear to be involved in both pathological gambling and cocaine dependence. These brain structures have also been implicated in alcohol dependence as well as in nonaddictive behaviors like the obsessions and compulsions of obsessive-compulsive disorder, Potenza said. But are they involved in all addictive behaviors? The jury is still out, symposium speakers indicated. Kleptomania Link? Might there be a link between compulsive buying and kleptomania? Ten percent of Lejoyeux’s compulsive buyers had engaged in kleptomania at some point, he discovered, but he doesn’t think that shoplifting is the same as compulsive buying, he said. Could there be a connection between compulsive buying and addictive sexual behaviors? Some of Lejoyeux’s compulsive buyers admitted to feeling sexual excitement when they made purchases. Finally, might childhood sexual abuse play a role in addictive sexual behaviors? It is a possibility since a number of those who engage in such behaviors were sexually abused as children, Thibault said. However, the relationship between sexual addiction and sexual offending is far from clear, she admitted.
Mood, Substance Abuse Disorders Common Among Sex Offenders
[My letter to the editor:
Re: Mood, Substance Abuse Disorders Common Among Sex Offenders For over 12 years I have been hypothesizing that sex offenses were caused by sex addiction as part of the Hypoism paradigm, the disease that causes all addictions. For over 12 years this hypothesis has been ignored and censored. This article's data is strong evidence in favor of my hypothesis because hypoics not only have a single addiction but usually many addictions all in conjunction and all caused by the common pathophysiology, addictability. Besides the mood disorders seen in hypoics, the most common "other symptom" seen in these sex addicts, though they were never called sex addicts in the article, a big clinical mistake and bias, was substance addictions, seen in 85%. Thus, these "sex offenders" are hypoics with sex and substance addictions. If other addictions were looked for my guess is that 100% would have other addictions, drugs and behaviors, the primary symptoms of Hypoism. Why is this significant? Because Hypoism has a defined pathophysiology, the genetic alteration of a particular brain mechanism, the decision-making apparatus or instinct regulating mechanism, and out of this understanding come ways for preventing addictions and recovery from addictions, actually from the underlying disease Hypoism, including sex addiction, something that truly doesn't exist today because sex addiction is viewed as caused by the "psychobabble" mechanism which has no valid theory behind it or treatment no less any way to prevent it. This is all delineated in my book, Hypoic's Handbook. The continued censorship and ignoring of Hypoism has only one effect on our country - to perpetuate all those addictions and their consequences that we all want to stop. This is a big price to pay for the continued belief and use of a wrong theory of behavior.]
Psychiatric News May 21, 2004 Volume 39 Number 10
It’s likely that deviant sexual attractions or antisocial personalities are at the root of sexual crimes, but many sexual offenders also have a mental illness.
Most sexual offenders have paraphilias or antisocial personalitiesand in many cases also have depression, bipolar disorder, oran impulse control disorder.
These findings come from a study conducted by Neal Dunsieth,M.D., an assistant clinical professor of psychiatry at WrightState University in Dayton, Ohio, and colleagues and are reportedin the March Journal of Clinical Psychiatry.
"To our knowledge," they noted, "ours is now the largest groupof sexual offenders evaluated using structured clinical interviewsfor psychiatric disorders, personality disorders, and paraphilias."
Their study included 113 convicted sexual offenders voluntarilyparticipating in an 18-month, residential, sexual-offender treatmentprogram in Columbus, Ohio, between 1996 and 2001. All were male,aged 18 years or older, and 35 years old on average. About two-thirdsof the subjects were white, and one-third were African American.All were convicted of at least one sexual offense. None, however,admitted to a sexually sadistic murder.
Upon admission to the treatment program, all participants wereevaluated with a number of structured clinical tools includingthe Structured Clinical Interview for DSM-IV Axis I Disorders,augmented with modules for DSM-IV impulse control disordersnot elsewhere classified and sexual disorders; the StructuredClinical Interview for DSM-IV Axis II Disorders; a history ofsexual and physical abuse; a history of psychotic, mood, anxiety,eating, substance use, impulse control, and paraphilic disordersin first-degree relatives; a review of medical and legal recordsand polygraph examinations.
Not surprisingly, 74 percent of sexual offenders were foundto have a paraphilia, 56 percent met criteria for antisocialpersonality disorder, 28 percent met criteria for borderlinepersonality disorder, and 25 percent met criteria for narcissisticpersonality disorder. More unexpectedly, however, many had otherdiagnoses. Fifty-eight percent had a mood disorder, 35 percenthad bipolar disorder, 38 percent had an impulse control disorder,and 23 percent had an anxiety disorder. Moreover, 85 percentqualified, according to DSM-IV criteria, for a lifetime diagnosisof substance abuse disorder.
In addition, offenders with paraphilias were much more likelythan other offenders to have mood, anxiety, and impulse controldisorders. More than half of the subjects had been victims ofsexual abuse themselves, while more than a quarter had beenvictims of incest.
The study did have some limitations, Dunsieth and his team noted.For example, no non-sexual-offender control group was used inthe study, and investigators who diagnosed subjects for psychiatricdisorders were not blinded to their sexual offenses. Nonetheless,Dunsieth told Psychiatric News, the results imply that clinicalpsychiatrists should "assess mental illness in sexual offendersand note a strong correlation between deviant sexual attraction[paraphilias] and an increased incident of mental illness."
"Overall this is a very positive study," Richard Krueger, M.D.,medical director of the Sexual Behavior Clinic at New York StatePsychiatric Institute, said in an interview. For one thing,he said, "it is very difficult to do this kind of study. Oftendepartments of correction or parole are resistant to involvementin academic studies." For another, he added, "they did a familyhistory of sexual offenders, which is not often reported, andI think that is an important contribution."
He agreed with Dunsieth that the study results "highlight theimportance of a full psychiatric assessment of individuals involvedwith sexual crimes. Often they get plugged into sexual-offenderprograms without a psychiatric evaluation."
"This is a welcomed study reminding us that the sexual-offenderpopulation is a heterogeneous group composed of multiple overlappingdiagnostic subgroups," Charles Smith, M.D., clinical directorof the Whiting Forensic Division of the Connecticut Valley Hospitalin Middletown, Conn., told Psychiatric News. "This diagnosticheterogeneity has serious implications for the design of socialpolicy to ensure public safety by containing the behavior ofknown sexual offenders. Dunsieth and colleagues demonstratevery convincingly that subgroups of sexual offenders can beidentified with divergent therapeutic problems and differentialtreatment concerns. It is a reasonable extrapolation of thiswork to envision treatment interventions and risk-reductionstrategies tailored to, and optimized for, different sexualoffender subgroups."
"The study does offer hope," Smith added, "that treatment ofcomorbid mental health conditions among some sexual offendersmay be an effective approach to decreasing offender recidivism."
The sexual offender treatment program on which this study wasbased and data collection for the study were financed by theOhio Adult Parole Authority.
Psychiatric and legal features of 113 men convicted of sexual offenses.
Dunsieth NW Jr, Nelson EB, Brusman-Lovins LA, Holcomb JL, Beckman D, Welge JA, Roby D, Taylor P Jr, Soutullo CA, McElroy SL.
Center for the Study of Criminal Behavior, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0559, USA.
BACKGROUND: To increase understanding of the relationships among sexual violence, paraphilias, and mental illness, the authors assessed the legal and psychiatric features of 113 men convicted of sexual offenses. METHOD: 113 consecutive male sex offenders referred from prison, jail, or probation to a residential treatment facility received structured clinical interviews for DSM-IV Axis I and II disorders, including sexual disorders. Participants' legal, sexual and physical abuse, and family psychiatric histories were also evaluated. We compared offenders with and without paraphilias. RESULTS: Participants displayed high rates of lifetime Axis I and Axis II disorders: 96 (85%) had a substance use disorder; 84 (74%), a paraphilia; 66 (58%), a mood disorder (40 [35%], a bipolar disorder and 27 [24%], a depressive disorder); 43 (38%), an impulse control disorder; 26 (23%), an anxiety disorder; 10 (9%), an eating disorder; and 63 (56%), antisocial personality disorder. Presence of a paraphilia correlated positively with the presence of any mood disorder (p <.001), major depression (p =.007), bipolar I disorder (p =.034), any anxiety disorder (p=.034), any impulse control disorder (p =.006), and avoidant personality disorder (p =.013). Although offenders without paraphilias spent more time in prison than those with paraphilias (p =.019), paraphilic offenders reported more victims (p =.014), started offending at a younger age (p =.015), and were more likely to perpetrate incest (p =.005). Paraphilic offenders were also more likely to be convicted of (p =.001) or admit to (p <.001) gross sexual imposition of a minor. Nonparaphilic offenders were more likely to have adult victims exclusively (p =.002), a prior conviction for theft (p <.001), and a history of juvenile offenses (p =.058). CONCLUSIONS: Sex offenders in the study population displayed high rates of mental illness, substance abuse, paraphilias, personality disorders, and comorbidity among these conditions. Sex offenders with paraphilias had significantly higher rates of certain types of mental illness and avoidant personality disorder. Moreover, paraphilic offenders spent less time in prison but started offending at a younger age and reported more victims and more non-rape sexual offenses against minors than offenders without paraphilias. On the basis of our findings, we assert that sex offenders should be carefully evaluated for the presence of mental illness and that sex offender management programs should have a capacity for psychiatric treatment.
Nicotine Dependence and Psychiatric Disorders in the United States
Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Bridget F. Grant, PhD, PhD; Deborah S. Hasin, PhD; S. Patricia Chou, PhD; Frederick S. Stinson, PhD; Deborah A. Dawson, PhD
Arch Gen Psychiatry. 2004;61:1107-1115.
Background No information is available on the co-occurrenceof DSM-IV nicotine dependence and Axis I and II psychiatricdisorders in the US population.
Objectives To present national data on the co-occurrenceof current DSM-IV nicotine dependence and other psychiatricdisorders by sex and to estimate the burden of all US tobaccoconsumption carried by nicotine-dependent and psychiatricallyill individuals.
Design Face-to-face interviews.
Setting The United States.
Participants Household and group-quarters adults (N = 43 093).
Main Outcome Measures Prevalence and comorbidity of currentnicotine dependence and Axis I and II disorders and the percentageof cigarettes consumed in the United States among psychiatricallyvulnerable subgroups.
Results Among US adults, 12.8% (95% confidence interval,12.0-13.6) were nicotine dependent. Associations between nicotinedependence and specific Axis I and II disorders were all strongand statistically significant (P<.05) in the total populationand among men and women. Nicotine-dependent individuals madeup only 12.8% (95% confidence interval, 12.0-13.6) of the populationyet consumed 57.5% of all cigarettes smoked in the United States.Nicotine-dependent individuals with a comorbid psychiatric disordermade up 7.1% (95% confidence interval, 6.6-7.6) of the populationyet consumed 34.2% of all cigarettes smoked in the United States.
Conclusions Nicotine-dependent and psychiatrically illindividuals consume about 70% of all cigarettes smoked in theUnited States. The results of this study highlight the importanceof focusing smoking cessation efforts on individuals who arenicotine dependent, individuals who have psychiatric disorders,and individuals who have comorbid nicotine dependence and otherpsychiatric disorders. Further, awareness of industry segmentationstrategies can improve smoking cessation efforts of cliniciansand other health professionals among all smokers and especiallyamong the most vulnerable.
Psychiatric Correlates of Gambling in Adolescents and Young Adults Grouped by Age at Gambling Onset
Wendy J. Lynch, PhD; Paul K. Maciejewski, PhD; Marc N. Potenza, MD, PhD
Arch Gen Psychiatry. 2004;61:1116-1122.
Background Gambling is a prevalent behavior, yet few studieshave investigated its mental health correlates. Although early-onsetengagement in behaviors with addictive potential has generallybeen associated with more severe problems, direct investigationof a nationally representative sample of gamblers grouped byage at onset of gambling has not been performed.
Objective To identify differences in psychiatric correlatesof gambling and gambling-related attitudes and behaviors inadolescents (aged 16-17 years) and in young adults (aged 18-29years) with early-onset (before age 18 years) and adult-onsetgambling.
Design Logistic regression analysis.
Setting Public access data set derived from random-digit-dialingtelephone surveys.
Patients The study analyzed data from adolescent (n = 235),early-onset adult (n = 151), and adult-onset (n = 204)past-year gamblers and adolescent (n = 299) and adult(n = 187) nongamblers in the Gambling Impact and BehaviorStudy.
Main Outcome Measures Gamblers and nongamblers were comparedwithin each group on measures of sociodemographics and psychiatrichealth. Adolescent, early-onset adult, and adult-onset past-yeargamblers were compared on measures of gambling attitudes andbehaviors.
Results Adolescent gamblers were more likely than adolescentnongamblers to report alcohol and drug use and abuse/dependenceand depression. Elevated rates of alcohol and drug use and abuse/dependencewere observed in early-onset adult gamblers vs adult nongamblers,and only elevated rates of alcohol use were observed in adult-onsetgamblers vs adult nongamblers. Substantial differences in reasonsfor and patterns of gambling were observed among the 3 groupsof gamblers.
Conclusions Adolescent-onset gambling is associated withmore severe psychiatric problems, particularly substance usedisorders, in adolescents and young adults. More research isneeded to investigate the relationships and inform preventionand treatment strategies.
Harv Rev Psychiatry 2004;12:367–374,
Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology, Howard J. Shaffer, PhD, CAS, Debi A. LaPlante, PhD, Richard A. LaBrie, EdD, Rachel C. Kidman, BA, Anthony N. Donato, MPP, and Michael V. Stanton, BA "In this article, we suggest that evidence of multiple and interacting biopsychosocial antecedents, manifestations, and consequents—within and among behavioral and substance-related patterns of excess—reflects an underlying addiction syndrome. We propose, in particular, that addiction should be understood as a syndrome with multiple opportunistic expressions (e.g., substance use disorders and pathological gambling). Our goals in this column are to (1) describe a new, syndromal model of addiction, (2) review the most recent literature that supports viewing addiction as a syndrome, and (3) indicate how this perspective can advance clinical practice and identify areas in which more research is needed. To accomplish these goals, we review the empirical evidence for this addiction syndrome and organize it into three primary areas: (1) shared neurobiological antecedents, (2) shared psychosocial antecedents, and (3) shared experiences (e.g., manifestations and sequelae)."
Donald W. Black, Patrick O. Monahan, M'Hamed Temkit and Martha Shaw
The cause of pathological gambling (PG) is unknown. The current study was conducted to determine whether PG is familial, and to examine patterns of familial aggregation of psychiatric disorder. To that end, 31 case probands with DSM-IV PG and 31 control probands were recruited and interviewed regarding their first degree relatives (FDRs). Available and willing FDRs were directly interviewed with structured instruments of known reliability, and best estimate final diagnoses were blindly assigned for 193 case and 142 control relatives over age 18 years. The results were analyzed using logistic regression by the method of generalized estimating equations. The lifetime rates of PG and “any gambling disorder” were significantly greater among the relatives of case probands (8.3% and 12.4%, respectively) than among the control relatives (2.1% and 3.5%, respectively) (OR = 3.36 for “any gambling disorder”). PG relatives also had significantly higher lifetime rates of alcohol disorders, “any substance use disorder,” antisocial personality disorder (ASPD), and “any mental disorder”. “Any gambling disorder,” alcohol disorder, and “any substance use disorder” remained significant after a conservative Bonferroni correction. Interestingly, PG families were significantly larger than control families. We conclude that gambling disorders are familial and co-aggregate with substance misuse. The data are also suggestive that PG co-aggregates with ASPD. Further research on the heritability of PG is warranted.
You can take the addiction out of the hypoic, but you can't take the Hypoism out of the addict.