Two different types of activities—substance use and compulsive behavior—increase dopamine output, producing a "feel good" sensation that can trigger and reinforce addiction. Host William C. Moyers talks with recovery expert Brenda Iliff about cross addiction (addiction interaction disorder), the condition of replacing one problematic substance or behavior with another. Iliff explains why addictive behaviors around food, sex or gaming thrive in secrecy and where to find recovery help and support.
0:00:15 William Moyers
Hello and welcome to Let's Talk, a series of podcasts by the Hazelden Betty Ford Foundation on issues related to substance use prevention, research, treatment and recovery from addiction to alcohol and other drugs. My name is William Moyers, I'm your host and I've worked at the Hazelden Betty Ford Foundation for 23 years now. But before that, I was a patient in 1989 and again in 1991. And so I know these issues personally and I know these issues that we talk about professionally, and so too does my guest today, Brenda Iliff. Hello, Brenda.
0:00:51 Brenda Iliff
0:00:52 William Moyers
Welcome back. Brenda is the Executive Director of Hazelden Betty Ford's operations in Florida and has been an employee, I guess is the best way to say it, of Hazelden for more than 20 years now. You and I go way back.
0:01:02 Brenda Iliff
Yes we do. Yes we do.
0:01:05 William Moyers
Tell me, today our talk is about—it's a topic that I used to call cross addiction. But it's now got a new term, addiction interaction disorder. What is that?
0:01:17 Brenda Iliff
Addiction interaction disorder is when people struggle with more than one addiction. So with cross addiction a lot of times people think it's, you know, yes my brain can't handle alcohol and it can't handle meth. And that's true. Where when we talk about addiction interaction disorder, we're talking about separate either substance use disorder such as food or behavioral disorders such as sex. So, addiction interaction disorder is moving between addictions or sometimes it's when one addiction exacerbates another addiction.
0:01:53 William Moyers
Is that because in our rewired brains the effect of alcohol can be the same as the effect of food?
0:02:01 Brenda Iliff
0:02:03 William Moyers
How does that work?
0:02:04 Brenda Iliff
Well the brain doesn't really care where it gets the feel-good from. And there, you know, we all love that feeling of dopamine. So like with—with food, we—we eat and we have a little bit of dopamine that's released and it feels good. We're sexual and we have a lot of dopamine released and it feels great. We flirt and we have a little dopamine release and it feels pretty good. With—we drink and we have more dopamine released. We'd use crack cocaine and we have a lot of dopamine released and it feels good. For some folks, they—they get—they cross the line into addiction because they keep seeking that feel good.
0:02:45 William Moyers
So they're out of control whether it's in the use of their cold beer or warm whiskey or in their use of relationships or food or other things that affect the brain the same way.
0:02:53 Brenda Iliff
Yeah. A lot of the times the symptoms of addiction, we have to look at the symptoms of addiction. So is it out of control, have I tried to control it, have I given up social events or relationships because of this? Am I obsessed with it? Am I thinking about it? Am I thinking about using it, am I thinking about recovering from it, am I thinking am I actually using it? I mean with any of the different addictions, we could do a 24-hour clock and the person's either thinking about it or recovering from it or using during that whole 24 hours.
0:03:28 William Moyers
What percentage, roughly, do we know of people would suffer from this addiction interaction disorder? What I mean by that is those who have the alcohol or drug issue, what percentage of them would also have this crossover addiction?
0:03:44 Brenda Iliff
Well, we know that the general population, about 10 percent, struggle with alcohol and drug disorder. So they're already at risk for other addictions. 'Cause the brain doesn't care where it comes from. Because of the stigma of the other addictions, there hasn't been a lot of study on how many. I—I have heard that up to 20 to 30 percent of people struggle with other addictions.
0:04:05 William Moyers
0:04:06 Brenda Iliff
And I think the research is pretty clear that a lot of times, one addiction can lead someone into another addiction. You know we say that with the meth epidemic. Where these young girls with eating disorders were using meth to help with their eating disorder and then all of a sudden they were in a mess, you know. We've seen it with the gastric bypass world. Where people who've had binge eating disorder have the surgery and all of a sudden they're two to three times more likely than the normal population to turn into alcoholics, so.
0:04:37 William Moyers
I have a friend actually who had the gastric bypass surgery because he needed to work on his eating issues and it succeeded there but it wasn't too long before he discovered that he was addicted to alcohol.
0:04:51 Brenda Iliff
0:04:52 William Moyers
And he's gotten help for that and is recovering. Is there a certain perverse stigma around people addicted to food or to sex or—
0:05:02 Brenda Iliff
0:05:03 William Moyers
Talk about that stigma versus the stigma of regular addiction.
0:05:07 Brenda Iliff
Well, thanks to organizations like Hazelden Betty Ford and others, we've done a lot around the stigma of addiction to alcohol and other drugs. There's still a stigma but when we talk about the stigma of food or sex, there's a huge stigma there. In fact many times those fields are like 60 years behind the alcohol and drug field. Even in the rooms of Twelve Step, rooms of Alcoholics Anonymous or Narcotics Anonymous, we don't talk about food or sex. And granted, that's because our primary purpose is around alcohol and drugs. Even at Hazelden Betty Ford, our primary purpose is alcohol and drugs. And getting people sober from that. But what that leaves people with is nobody's talking about this, I must really be bad.
0:05:52 William Moyers
0:05:54 Brenda Iliff
I must really be unique. I'm gonna keep this secret. And we know what secrets do for people.
0:06:00 William Moyers
0:06:02 Brenda Iliff
You know. With the food and with the sex it's so easy to sneak and to hide, you know. We talk about the three A's. If it's Anonymous, if it's Affordable, and if it's Available, people are more likely to go into that addiction. So we see that with the internet. You know. I can see a little pornography, it's anonymous. For most people that's pretty innocent. But for some people, it triggers a part of the brain where they can't stop and it's available and it's affordable. As a—as a—as a person maybe with food, I can eat alone. Nobody bothers me. I send my—my family to bed at night so that I can eat. And I can get food with lots of sugar and lots of fat and it's cheap, too. It's cheaper than eating healthy. So, those three A's can really impact addiction.
0:06:55 William Moyers
So let's talk about the fact that there is a way out. There is treatment.
0:06:59 Brenda Iliff
0:07:00 William Moyers
There is, right?
0:07:02 Brenda Iliff
Yeah, absolutely. Absolutely. There's a lot of people in recovery right this second from sex addiction, from food addiction, but they don't always talk about it. Because the shame is so huge.
0:07:14 William Moyers
So then there is recovery for people struggling there, but it—but the treatment is different, is it not, than the treatment say for alcohol or other drugs because with those substances, we're told stay away from them. But we can't stay away from food, we can't stay away from procreation, we can't stay away from those other behaviors or activities that would be considered "normal" if it wasn't for their addiction. So how do we—how do you talk through that?
0:07:39 Brenda Iliff
Well, a lot of it is about learning about the addiction. Even with alcohol, people still drink. They just don't drink alcohol. They—they learn about that chemical that triggers the brain. For food addiction they might learn about whatever that chemical is for them. For a lot of people it might be the sugar, for others it might be the fat. For others it might be wheat. For others it—it's the whole volume, that feeling of fullness, or that feeling of starving that can trigger the obsession. So, they would learn about the addiction. For sex addicts, it—there's certain triggers. There—there is differences in the treatment. You might talk about inner circle behaviors and middle circle behaviors and outer circle or green, red and yellow food. So there's different language that people use—
0:08:26 William Moyers
0:08:26 Brenda Iliff
In—in the recovery process. There are treatment centers that specialize in those addictions, Hazelden Betty Ford does not.
0:08:33 William Moyers
But we refer on, right?
0:08:35 Brenda Iliff
We do. We do refer.
0:08:36 William Moyers
0:08:37 Brenda Iliff
There's also things called intensives. Where people go for four to six days, similar to our Family Programs. Where they get an immersion, they learn about the addiction, they—they're able to detox if you will, from it. And then get sent to Twelve Step recovery groups. And there's a lot of Twelve Step recovery groups. They have different names in different parts of the country. So, for sex, there's Sexaholics Anonymous, Sex and Love Addicts Anonymous, Sex Addicts Anonymous, Recovering Partners. For food there's Overeaters Anonymous, there's Food Addicts Anonymous, there's Eating Disorders Anonymous. Anorexics, Bulimics Anonymous. There's a lot of different Twelve Step programs. But the principle is you put down the substance or the behavior. You don't put down all behaviors or all substances, you put down the one substance or behavior. And then you use the community and the support. You identify with other people who get 'I eat like you do. I act out sexually. I give up all my relationships like you do.' You know. And that connection is really in many ways very, very deep among people.
0:09:42 William Moyers
So addiction as we know is an illness of isolation and the antidote to it is togetherness. Or we—
0:09:49 Brenda Iliff
0:09:49 William Moyers
And that would be true whether it's alcohol or other drugs—
0:09:50 Brenda Iliff
0:09:51 William Moyers
Or food or sex. So, before we wrap it up here, what do you say to families of people who are struggling with these kinds of addictions? They must feel that sense of not—they must suffer.
0:10:04 Brenda Iliff
Oh, hugely. You know, watching your loved one get bigger and bigger or smaller and smaller or leave the meal to go to the bathroom to binge and purge.
0:10:15 William Moyers
0:10:15 Brenda Iliff
Or, watching your loved one—the police come and taking your loved one's computer because they have child pornography on it. Just like with alcohol and drugs, we talk to families about you didn't cause it, you can't control it and you can't cure it. But you can cope with it and you need connection.
0:10:35 William Moyers
0:10:36 Brenda Iliff
You need connection. One of the differences with sex addiction is instead of using the word codependency; we would use the word betrayal.
0:10:44 William Moyers
0:10:45 Brenda Iliff
Because have really been traumatized.
0:10:47 William Moyers
0:10:47 Brenda Iliff
They have no idea and then all of a sudden their partner is gone or even sometimes arrested. So.
0:10:54 William Moyers
So where do families, or where do individuals who are struggling with these kinds of addictions, where do they go for help? Do you have any resources?
0:11:02 Brenda Iliff
Yeah, there's a couple websites that might be a good start and then they can go out from there. For sex addiction, the—the website sexhelp.com is a good web—website. Where people can take kind of a little screening question.
0:11:17 Brenda Iliff
And what I like about that website is they have one for the partners, too. So that they can—they can ask questions. And then for food addiction, foodaddictioninstitute.org has a lot of information about what might be some substances or how can I tell if I have an eating disorder or a food addiction. 'Cause they are very different.
0:11:37 William Moyers
Mmm-hmm. And then of course people can come to Hazelden Betty Ford if they're struggling with alcohol and other drugs and these issues.
0:11:43 Brenda Iliff
0:11:44 William Moyers
And typically what we do is we will address the addiction of alcohol or drugs first and then refer on to another program.
0:11:51 Brenda Iliff
We yeah, absolutely, absolutely.
0:11:54 William Moyers
Brenda Iliff, thank you very much for sharing with us your remarkable reservoir of expertise.
0:11:55 Brenda Iliff
Thanks, William. thank you for asking.
0:12:01 William Moyers
You're a shining example of—of how it works in our organization and I feel honored to be able to share the studio with you today and this podcast.
0:12:08 Brenda Iliff
And back at you, back at you.
0:12:10 William Moyers
And also to share it with you all, our viewers and our listeners. On behalf of the Executive Director of Let's Talk, Lisa Stangl I wanna thank you for inviting us, Brenda and me, and all the rest of our colleagues, into your lives through these podcasts. We will continue to produce these prod—podcasts on a regular basis. And they'll cover the gamut of all the issues that really matter to us as an organization and to you as people walking that walk as well. Thank you very much.