an exploration of the phenomena of multiple addictions and addiction interaction disorder in ...

383 Pages·2014·2.01 MB·English

by  Michael Merle

AN EXPLORATION OF THE PHENOMENA
OF MULTIPLE ADDICTIONS AND
ADDICTION INTERACTION DISORDER IN
DURBAN, SOUTH AFRICA

HELEN KEEN

Student Number: 9151915

Submitted in fulfilment of the degree of Doctor of Philosophy in the
College of Humanities, School of Applied Human Sciences, University of
KwaZulu-Natal, Durban.
Supervisors: Dr Reshma Sathiparsad ; Professor Myra Taylor

October 2013
ABSTRACT

Addiction to drugs is a widely acknowledged problem in South Africa. Newer developments in
the study of addiction include behaviours such as gambling and sex as part of a broader
syndrome. International research has established that most people with one addiction are at risk
for co-occurring addictions which are frequently undiagnosed and untreated. Multiple addictions
(MA) have been shown to combine in specific patterns to produce addiction interaction disorder
(AID) resulting in a more complex, treatment- resistant illness.

This was the first study South Africa to investigate if people with substance use disorders had
other addictions. The research had three aims: to establish if in-patients admitted to three drug
rehabilitation centres had other addictions, to investigate the extent of the MA and AID and to
determine whether the treatment programmes managed them appropriately. The study employed
the mixed methods research design and was located at three in-patient facilities in Durban,
KwaZulu-Natal. During the first phase, discussion groups were held with professionals that
explored their perceptions of MA, AID and current treatment programmes. The second phase
involved a survey of 123 participants screened for poly-substance abuse, sex (including internet)
addiction and problem gambling. The third phase utilised in-depth interviews with 25 participants
displaying MA to understand the development of addiction, AID and treatment received. The
data were analysed utilising descriptive and statistical analysis for the survey data, and thematic
analysis for the in-depth interviews and discussion groups.

The study found a high incidence of MA within the survey population of 54%; 37% of
participants tested positive or at risk for problem gambling and 41% tested positive for sex
addiction with 24% of the participants being positive for both. In-depth interviews revealed high
rates of trauma, especially for the female participants and demonstrated the complex
interrelationship between addictions. AID was identified in all 25 participants. In KwaZulu-
Natal, it appears that MA and AID are currently not being assessed or treated. The study
highlights the need for a broader conceptualisation of addiction which would improve current
assessment and treatment and has implications for further training of professionals and addiction
policy in South Africa.

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COLLEGE OF HUMANITIES

DECLARATION - PLAGIARISM

I, Helen Keen declare that

1. The research reported in this thesis, except where otherwise indicated, is my
original research.

2. This thesis has not been submitted for any degree or examination at any other
university.

3. This thesis does not contain other persons’ data, pictures, graphs or other
information, unless specifically acknowledged as being sourced from other
persons.

4. This thesis does not contain other persons' writing, unless specifically
acknowledged as being sourced from other researchers. Where other written
sources have been quoted, then:

a. Their words have been re-written but the general information attributed to
them has been referenced
b. Where their exact words have been used, then their writing has either been
placed inside quotation marks or, if over 40 words, placed in an indented
paragraph and referenced.

5. This thesis does not contain text, graphics or tables copied and pasted from the
Internet, unless specifically acknowledged, and the source being detailed in
the thesis and in the References sections.

Signed: …………………………………………………………

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A thoroughly good relationship with ourselves results in
being still, which doesn’t mean we don’t run and jump
and dance about. It means there’s no compulsiveness.
We don’t over-work, over-smoke, over-seduce. In
short, we begin to stop causing harm.

Pema Chodron

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PROLOGUE

I have been in practice as a social worker since 1983, and have encountered the
consequences of addiction in every setting in which I have worked. I had the privilege of
doing my practical work at a chemical dependency rehabilitation centre in 1982, and my
research dissertation examined the role of groupwork in the treatment of alcoholism. I
have encountered the devastating effects of addiction throughout my career. Addiction
has caused havoc in the lives of many of my clients and their families and led, personally,
to much frustration as a practitioner. A turning point came for me when I attended
Patrick Carnes’ workshop in 2008 on sex addiction and multiple addictions. This
workshop provided me with a more profound grasp of addiction and why addicts cannot
stop or just say ‘no’, especially in the face of serious consequences. The information
provided on MA and AID, as well as the developments in the field of neurobiology, made
the problem of addiction, paradoxically, far more complex, but, also, clearer and simpler
to grasp.

In summary, my interest in this topic is part of my ongoing development as a social
worker, my commitment to individuals and families who are affected by addiction and in
working with them to offer the best treatment for this complex illness.

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ACKNOWLEDGEMENTS
My thanks go to many the people who accompanied me on my journey in accomplishing
this thesis and without whom I would not have been able to complete this process.

Firstly, I need to thank the participants for sharing their stories with patience, great
courage and honesty, and allowing me to learn so much from them.

I am grateful to the staff and management of the three centres who welcomed me into
their institutions and for their encouragement and willing participation in the research
process.

I owe an enormous debt to my two supervisors, Doctor Reshma Sathiparsad and
Professor Myra Taylor for their invaluable insights, encouragement, support and
guidance throughout this challenging journey. Thank you for your patience and unselfish
assistance.

Thank you to those who helped me with editing: Emeritus Professor Reverend Father
Rodney Moss for his encouragement and assistance, to Professor Geoffrey Harris for his
valuable insights and to Ms Carrin Martin for her guidance.

To my family, Michaël, Nicholas and Alexander for their patience, love and support,
without whom this thesis would not have been possible. And finally, I need to express my
deep gratitude to the grace that has continually guided me and the spiritual support I have
received from my relationship with God.

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CONTENTS

CHAPTER 1: STUDY OVERVIEW
Page

1.1 Introduction 1
1.2 Background 4
1.3 Problem statement 8
1.4 Research questions 8
1.5 Aims of the research 9
1.6 Objectives of the research 9
1.7 Principal theory upon which the study is based 10
1.8 Definition of key concepts 14
1.9 Significance of the study 15
1.10 Outline of chapters 16

CHAPTER 2: LITERATURE REVIEW: AN OVERVIEW OF
DEFINITIONS, CHARACTERISTICS AND CAUSATION OF
ADDICTION

2.1 Introduction 18
2.2 History of the use of the term addiction 18
2.3 Definitions and characteristics of addiction 19
2.3.1 Definitions of addiction 20
2.3.2 Diagnostic criteria and characteristics of addiction 21
2.4 The rewards of addiction 27
2.5 Important factors in the causation of addiction 29
2.5.1 The family’s role in addiction 30
2.5.2 The role of trauma in addiction 39
2.5.3 Adolescence 45
2.6 Chapter summary 48

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CHAPTER 3: LITERATURE REVIEW: MULTIPLE ADDICTIONS,
ADDICTION INTERACTION DISORDER AND TREATMENT

3.1 Introduction 50
3.2 The four categories of addiction 50
3.3 Multiple addictions and addiction interaction disorder 52
3.4 Substances 53
3.5 Process addictions 58
3.5.1 Gambling 59
3.5.2 Sex addiction 64
3.5.3 Other process addictions 69
3.6 Relationship addictions 71
3.6.1 Codependency 71
3.6.2 Trauma bonding 72
3.6.3 Co-sex addiction 72
3.6.4 Compulsive romantic attachment 72
3.7 Core feeling state addictions 73
3.8 Addiction interaction disorder 74
3.9 Treatment of addiction and relapse rates 79
3.9.1 Treatment 79
3.9.2 Relapse rates 82
3.10 Chapter Summary 84

CHAPTER 4: METHODOLOGY

4.1 Introduction 85
4.2 The research methodology 85
4.3 The research design 91
4.3.1 The research process 92
4.3.2 Selection of the research sites 96
4.3.3 Time frame of the research and pilot study 98

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4.3.4 Sampling 100
4.3.5 Development and selection of the research instruments 103
4.3.6 Data collection 111
4.3.7 Data management 118
4.3.8 Data analysis 119
4.4 Validity and reliability of the findings 124
4.5 Ethical considerations 126
4.6 Chapter summary 128

CHAPTER 5: DATA ANALYSIS: PROFILE OF IN-PATIENTS

5.1 Introduction 130
5.2 Biographical information 131
5.2.1 Personal profile 131
5.2.2 Education and employment 133
5.2.3 Admission to rehabilitation 134
5.2.4 Co-occurring physical and mental conditions 134
5.2.5 Other family members with addiction 136
5.3 Drug use 136
5.4 Problem gambling and sex addiction 139
5.4.1 Presence of problem gambling 139
5.4.2 Presence of sex addiction 140
5.4.3 Presence of internet sex addiction 140
5.4.4 Relationship between gambling and sex addiction 140
5.4.5 Sexual abuse as a child and relationship to
sex and gambling addictions 141
5.5 Previous treatment 142
5.6 Discussion of results from in-patient survey 143
5.6.1 Biographical data 143

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5.6.2 Education and employment 146
5.6.3 Admission to rehabilitation 147
5.6.4 Co-occurring physical and mental conditions 147
5.6.5 Drug use 148
5.6.6 Problem gambling 152
5.6.7 Sex addiction 153
5.6.8 Sexual abuse as a child 153
5.7 Chapter summary 154

CHAPTER 6: DATA ANALYSIS: THE DEVELOPMENT OF
ADDICTION AND SUBSTANCE USE DISORDER

6.1 Introduction 156
6.2 Development of addiction: Role of the family of origin 156
6.2.1 Family relationships 158
6.2.2 Other family problems 165
6.3 Development of addiction: The role of trauma 168
6.3.1 Experiences of trauma in childhood 168
6.3.2 Experiences of trauma in adulthood 178
6.4 Substances 182
6.4.1 Drug debut and effects 183
6.4.2 Crossing the line into addiction 187
6.5 Chapter Summary 191

CHAPTER 7: DATA ANALYSIS: MULTIPLE ADDICTIONS

7.1 Introduction 192
7.2 Gambling 193
7.2.1 Gambling debut and its effects 194
7.2.2 Gambling addiction 197
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