Ep. 162 | Understanding Addiction: From Substance Use to Behavioral Patterns

Karin Ryan (00:01.592)
Hello and welcome to another episode of Everyday Therapy. I am Dr. Karen Ryan, a licensed psychologist, and I'm here with Brett Cushing, licensed marriage and family therapist, your two co-hosts. And we have a special guest today. We have Rob Murphy, who is here, and today we are talking about understanding addiction from substance abuse to behavioral patterns and the different ways that addiction can impact our lives and hijack our brains. So we're talking about that, but today I want to introduce you to Rob Murphy who's here with us. We're so happy you're here, Rob.

Welcome. Thank you. Happy to be here. Yeah. Tell us a little bit about yourself and what you do here at Sagent Behavioral Health. Yeah, so I am a substance use counselor. So I I've been in the field for a few years now. And I actually just work with patients who have come to us with a substance use disorder. I facilitate a group on Monday nights. It's a lower level intensity group, so it's usually about

Four hours of group a week and then one individual a week. And so I work with them on education about addiction. and basically you know, at this level of care, a lot of it's about life skills and kind of how to reimmerse yourself into the world after you've you've gone through that. Yeah, you bet. And really walking with people through that it sounds like what's one of your favorite things about your job?

You know, I mean there's there's a lot, right? I mean it's it's the I would say the favorite thing is when somebody actually gets it, right? Because I think sometimes it depends on how we get here, right? It can be external forces that kind of lead us to it, whether you've got some legal stuff or some other things going on, maybe it's pressure from family. But, you know, when somebody kinda comes into this thing and they're not really sure about it and then all of a sudden you start to see them make some changes.

And I get for a short period of time, maybe ten weeks, right? So I don't get to see too much of it, but I can definitely see a shift and when somebody gets it, it's it's like the coolest thing. Yeah, yeah, absolutely. When those pieces fall into place, right? And that's

Karin Ryan (02:06.146)
You something we hope to talk about here today is to help give some understanding too, to help maybe start those few pieces, right? And then knowing that there's other resources for all those pieces to come together. Yeah, so today we're talking about again, like understanding addiction from substance use behavioral patterns. And like Brett, what are your thoughts about kind of this topic and getting us started today? I so appreciate you being here, Rob, because I hear people talk a lot and I've done it myself. I'm so addicted to whatever. You know, it's should

I am addicted to sugar. I am addicted to relationships, I'm addicted to work. And it's sort of this ambiguous, generalized term, and but yet at the other end of the spectrum, some people think you can only get addicted to illicit drugs. And when you said I help people define addiction, I'm looking forward to perhaps you helping us understand what is addiction, what does it mean, and how do you define that? Yeah, I mean it probably

probably can be defined certain ways. You talked about drugs of abuse, right? Like alcohol, you know, cannabis.

you know, all the various types of different drugs and yes, why those can have definitely a little bit more of a destructive pattern. you know, a lot of people talk about the gateway drugs and I you know, you talked about sugar, right? Sugar is like one of those things where a lot of people can get addicted to it. It's in everything, right? It makes things more palatable. It tastes things, but so yeah, there's there's like differences in kind of like what we can be addicted to, especially

nowadays with social media, TikTok, Instagram, right? I can find myself getting stuck on reels and all of a sudden an hour's gone by and I'm like, what what just happened here? Yeah for sure. Right? So definitely different different behaviors. But what typically happens is it causes a d significant disruption in your life, right? Maybe it's fa with family, maybe it's social ob obligations,

Karin Ryan (04:10.752)
And it's kind of that repetitive behavior that you can't get out of and it starts to interfere with other areas of your life. And then as I hide my sugar laden coffee here in front of you. yeah, people tend to withdraw a little bit sometimes. Is that kind of how it interferes? Yeah. So a couple of different things. Like especially with like substances of use, right? You get two different types of

Conditioning, right? You get the positive, you get the positive reward of the addiction going way up and then you get the negative effect, right? So you get the negative reward of if I don't use it, I'm gonna my body goes into withdrawal, right? It's craving the substance. And so that's why, you know, with with drugs and alcohol, it can be really difficult because you get both types of of rewards, reinforcements, right? And so your brain tells you, I actually actually need this substance.

Yeah. Yeah, and you're talking about kind of the reward system and I think about how when we're in like real

like, you know, deeper addiction, that's when we've got the, you know, tolerance and we have the withdrawal and those sort of things. And I think it's helpful too to recognize like how do we get there? Like how does our body do that? And how does our body respond to certain substances and certain stimuli, right? And you're highlighting it's not just, you know, alcohol, you know, cocaine meth or marijuana. It's it can be many things in our lives that we have to access every day, right? Like I'm gonna eat sugar every day. I'm gonna go on social media every day. And if people are like

gonna maybe I gamble every now and then or I do different things. We're exposed to these certain kind of like triggers, right? Every day. And one of the things that I, you know, feel like is so helpful to understand is like the dopamine hijack and like what that is. And so how to understand like how do we get this way as humans? Like what leads to this? And I think understanding that can be really helpful. That you explain that to clients from the expert. Like, how do you explain the dopamine hijack? Yeah, so essentially dopamine is

Karin Ryan (06:13.898)
when I think of dopamine I think of motivation, right? Dopamine gets us to do something more. And so you know, when when humans were evolving is especially it's, you know, food, water, sex, right? We would get dopamine pings from that. And it typically would put it at levels like above. So what it tells the brain is, you need this, right? It's a survival. It becomes a survival. You have to have certain foods to stay alive.

Right? Yeah. Absolutely. Absolutely. So, those types of things work on the dopamine. And so like when when the brain, you know, when we flood the brain with like dopamine, it tells us to do a behavior over again. Right. And so that's that's typically kind of how that stuff works. Yeah. Yeah. And I remember I was in one like training.

And they highlighted and it was so helpful for me to understand this. Like if you are starving in the desert and there's a plate of broccoli and a plate of like gooey, oily, chocolatey brownies, like we want your body to eat the brownies. Yes. It's gonna give you more. Even though like long term we were like, yeah, eat broccoli every day. Yes. But I think that was such a helpful piece for me to like realize like, that natural, like intense like craving or why our body responds, is because that's what will help us survive. And so if you find yourself feeling like guilt or shame of like, my god.

Gosh, how could I be so drawn to this? Like your brain is literally designed to be drawn to that to survive. Absolutely. Absolutely. And and you know, with drugs of addiction, whether it's alcohol, like you said, meth, heroin, like all of that stuff, it it works on dopamine, right? It floods the body with dopamine and above and beyond like where dopamine levels should be, right? Like food, water.

you know, you get levels to like a hundred, right? And so it tells you like this is really, really good. You should do more of that. And it encodes the brain. When you introduce substances, it throws those levels to like two hundred. If you introduce a a a drug like methamphetamine, it throws it to a thousand. Yeah. Right? And so it becomes more of a survival thing. And oftentimes people wonder, like, hey, your life's falling apart. Why are you doing this? And the aspect is

Karin Ryan (08:29.196)
the brain is hijacking that that reward system and it's saying, You need this for survival, right? You need this over food, water, any of that type of stuff. Yeah.

Yeah, and that's why you think like when people will hear like how could you choose this over your family or this when the brain is truly hijacked, like it isn't a choice because you feel like you have to s you want to survive. Hundred percent. Hundred percent. And as we speak about dopamine, I know having ADHD, I know that dopamine receptors in the brain, there's without getting too technical, i it it's not always just that it's lower dopamine, but the signaling and it's transferring in the brain doesn't operate as typical.

as in maybe other people and so

I understand that there's people with ADHD because of that dopamine malfunction, if you will, they are much more prone, like up to thirty percent of people in treatment for addiction are people with ADHD. So to really underscore how important dopamine is, when when it's not operating the way it typically would, people are a lot more vulnerable. But do you experience that too with people with ADHD? I just I know it's true.

But I know if you've experienced it. Yeah, like so typically o oftentimes when we introduce substances and stuff like that, there is what we call co occurring disorders, right? So there's maybe an underlying mental health condition, right? And typically, like you had mentioned ADHD. I I see a lot of ADHD people gravitate towards a stimulant like methamphetamine, right? There is there is a high occurrence between that.

Karin Ryan (10:09.036)
Basically because the stimulant almost levels them out, it makes them feel normal. That is actually the prescribed drug to treat somebody with ADHD is Adderall, which is a stimulant. Right? And so you see a lot of co occurrence with that. And so it now becomes a thing is how do I control this ADHD? on the opposite spectrum with like alcohol anxiety, right? You see a high co occurrence of people with

anxiety and so you know that works on GABA and and the dopamine levels, right? GABA reduces like that anxiety, right? And it it lowers like that inhibition. So like when I'm coming in here, I'm feeling a little bit anxious, right? It's like, how do I how do I work on that? And so you typically see high cooccurrences of alcohol because it reduces that anxiety. And so people people with high anxiety gravitate towards alcohol.

Yeah. And you highlight, you know, you did a nice job of explaining earlier, Rob, about how

Right, that kind of like makes you feel better, right? So it's like the dopamine receptors up to a hundred or two hundred. and same thing with like, you know, when we use alcohol then we start to feel better, you know. what happens to our bodies and our brains like after we've continually kind of had that high dopamine level, or we continuously kind of like bring ourselves like down and relax for with certain substances? Like what happens to the mind and the body? As far as like how how does that end up being harmful, right? Where you're like, great, well I'll just

Keep you know getting my dopamine, right? So at some point, right, it starts to interfere. But like I'm curious about kind of how do you explain how it like starts to impact the body and what happens to the brain then, how it can't like re-establish. Does that make sense? Yeah, so I if I think I'm getting this correctly. So as far as like what happens to like the body, right? The and I was thinking about this when I was thinking about this podcast, I was like the body and brain are pretty unique organisms, right? I mean, they are pretty self-sufficient, they do things.

Karin Ryan (12:10.58)
ex exactly how they should. They compensate or undercompensate or overcompensate. Yeah all day, every day. Yeah. And so like especially with like dopamine, like after using substances for a while, the brain tells tells the system that, hey, we need we should be producing less dopamine. Right? And so when we do produce less dop dopamine, we go into down regulation. Yeah. Right. And so when we're down regulation, like when we start to come down and withdraw

we are not feeling motivated, right? We are feeling like tired, exhausted and all that stuff. And so it now becomes a thing where we use in order to just get back to normal, to baseline.

And so that's where it would fit with like that I don't enjoy the things I used to or I feel down or these tasks that aren't as rewarding feel so much more difficult because now we're like way under essentially resource in our brain. Yes. Sure. And I think we can all relate to that too. Sometimes people look at those who have an addiction and wonder kind of incredulously, how did they ever get to that? And why don't they just stop? But at some level we all do this. We we can self medicate, like you said, with sugar, with carbs, with behavioral things.

We do, maybe not to that extreme. So, in some sense, I think we can all relate to this. And what can happen is that we are actually the brain gets so chemically tricked into viewing that a harmful harmful substance or behavior is now vital. So, can you help us with the how do we get to that point though? When we can I think we can relate to yeah, we all self-medicate to make ourselves feel better. How does it become

come to that point where something is so vital but it's also so harmful, like that addiction cycle. It's it's one of those things where like, you know, I there's something called like the gel net curve. I don't know if you've ever heard of that, but basically it's kind of like and and they can't see me do this, but it's it's kind of like this upside down, or it's actually kind of like a U, right? And so you can start like if if I were to kind of

Karin Ryan (14:22.934)
talk about alcohol, right? So like maybe when we first get introduced to alcohol, it's like the occasional relief stuff, right? We feel really good about it, things start working out. And then, you know, our brain is telling us like again, it's hijacking that that reward system and it's telling us this is good. So now we start to introduce alcohol when we've had a difficult day at work. Right. So we do some occasional relief drinking, right? Or now instead of

you know, going to see a movie or going to the park, maybe I want to pick up a substance or a drink and and so now it starts to becoming occurrences in every part of our life. And so as we start to do that, we start to go down because the dependence starts to starts to become more evident, right? And then we start withdrawing from from things in like everyday life, right? And it still kind of goes further down and then we kind of get caught in this this loop.

Right, we get caught in this little loop where it's like, I don't know I don't know what I can do to have fun, but my brain tricks me and tells me, Hey, I know how we can get out of this. Yep. Right. And it's like let's let's take this substance or let's use this in order to do it. And so it starts to impact our our lives and then we start to withdraw from family, from friends, right? We stop doing the things that we do because the substance starts gradually taking over.

And so I've heard it put this way, that when we have certain vulnerabilities then. So maybe we have we've tried a drug or some behavior that gives us that chemical release. And as a result of that we feel really good. So maybe then when I'm stressed, hungry, angry, lonely, tired, bored, maybe have some past trauma in my life, any time that comes up, there's a part of the brain that says

Not a problem. Yes. I know what to do. Let's go to the stuff that's gonna bring us back again. Is that a pretty accurate very accurate, very accurate? Because like boredom, you talked about boredom, that is like a trigger for a lot of people, right? it's just like, what do I do? Especially for like social media those sort of things, right? It's right there. You feel uncomfortable, right? And there is this like, I need to do something because I am so uncomfortable right now. Yep, and your brain's telling you.

Karin Ryan (16:44.886)
I know what will what will solve this, right? And so that's that's one of those things. Like you mentioned the the hungry, angry, lonely, tired, right? HALT is we call it the acronym. you know, if I'm hungry, I should probably eat a little bit of food, right? If I'm angry, I need to take care of that. If I'm lonely, take care of that. But the boredom is kind of it's a big trigger for a lot of people. Yeah. especially and and so like when I'm working with people, if if they're out of work.

And stuff like that and they don't have really much to get up for every day. Yeah. It's hard, right? So just finding some sort something to get up for. Yep. work, routine. Routine is so helpful and for those of people in recovery because their routines have gone completely sideways. They have no routine. Yeah. They're waking up whenever, right? They're the routine the routine is their addiction, right? That's the routine, that's the habit, that's the behavior. Yeah.

Yeah, and as you're describing that and you're thinking and I'm thinking about people who start to withdraw or kind of make those changes, then what you know, I have experienced with individuals, right, is then like there can be guilt. And there can be shame that they're, you know, so on the other end, when people are really busy and have a lot of things on their plate and then they start to withdraw or they start to make changes or people start, you know, their loved ones start kind of expressing frustration or concern that then there's this guilt that plays, right? And that ironic like then actually

leads is fits in that cycle that then makes us want to avoid that feeling. And so we get trapped in it where it's like I know how to feel better but I'm worried about like how it's gonna impact me but I still need to do it and so da da da da da and there we go. Yeah that cycle. Yeah so what do you feel like is really important for people to know if they're in that phase, right? As it goes through when they're in that part of feeling guilty and feeling shame. Like what do you feel like is really helpful for people to know?

You know, I I I think what works really well is you're not alone. and so oftentimes, you know, we say the opposite of addiction is connection. Yeah. Right? And so oftentimes when we're in that shame spy spiral, what do what do we wanna do? We wanna isolate, we wanna withdraw, we wanna slowly pull away from the things that we need as human beings to motivate us to move forward, right? And so it can be difficult because you get into that shame cycle that I can't believe I'm doing this.

Karin Ryan (19:10.412)
And what does that encourage me to do? It encourages me to withdraw, pull pull back. I you know, when family members start calling, I maybe ignore that call, right? Because that shame and that guilt is just going through. And then just addiction in general with the stigma, right? Oftentimes people can look at it there's not a lot understood about it, and sometimes people look at it as a moral failing, right? Why don't you just stop? you know, your family

your family you're losing your family and yet you keep using. And it's hard for people, you know, around it that don't have a substance use disorder or addiction problem to really get that. Why is this person continuing to choose the drug over their family? Yeah. Yeah. And when you say not alone, like twenty one

Right.

That reinforce addiction. Right? Like our social media, like gambling sites, advertisements, you know, like the socialization of alcohol use, like it is, there are triggers everywhere. Everywhere. So you are not alone. Like our and our brains are naturally wired, and we're experiencing all of these, you know, risk factors. And that's what's so tragic about it, too. I've seen in in just clinical practice, mental health, and in working with people who've come out of addictions, this sense of

Of isolation and and shame is so damaging. I I don't think we can overestimate how powerful shame is to cause us to not just isolate, but really engage in even more destructive behaviors. And the antidote is

Karin Ryan (20:53.686)
to talk about it, to be open about it. And and you know, it just kind of takes all the power away from it, but it's so hard to do that. It's it's uncomfortable. Right. Especially if you're feeling shameful about yourself and you've got a lot of guilt to face another human being. It's terrifying. Yeah. Right? And you're thinking you're a bad person and all this stuff. And it's like part of like recovery deals with you know, we say this in twelve step recovery is

you know, lean into that discomfort, right? Because it can be really difficult. And so like getting comfortable with being uncomfortable. Yeah. And that's that's a difficult thing to do. Right. So how about we've touched a little bit about this and chemical dependency versus behavioral dependency. And just a couple of minutes, could you highlight the difference of what you know, what is which and how do I know if I have one?

As far as yeah, substance use disorder, I mean it it definitely impacts certain areas of your life, right? So, like am I taking the substance more, right? Do I start doing that? Am I, you know, do I need to take the substance in the morning just to alleviate any sort of the withdrawal things? Is it impacting my relationships with maybe family, friends? Am I calling into work more frequently, right? am I doing things when it's physically

hazardous to my life, like driving intoxicated can be one of those things, right? And so those are kind of what would trigger something. you know, if you definitely see like it takes more of the substance in order to just feel that normal response, you're probably there's probably a pretty good indication that you're starting to become dependent on it. And that's the thing, the dependency. And so it can be a substance and it can be a behavior.

Behavior, yeah, absolutely. And so like, I talk a you know, I talk to my clients about this, but oftentimes, you know, we talked about that boredom thing. So like when I'm in recovery and I'm feeling bored, I just want to change it, right? And so maybe we talk about cross addiction. Right. So cross addiction is I'm no longer doing this substance, but I feel like I need to do something else. So I gravitate and maybe it's shopping.

Karin Ryan (23:14.25)
Shopping's a huge thing, right? I get a huge dope you know, when the Amazon package arrives. Right. Or when you hit like add to cart and then when you like confirm. Yes. It's it's an initial right relief. Yep. But then it kinda goes back into that shame and and you know, guilt after I get it because now I can't afford it, right? I'm spending too much on this. Or maybe it's gambling. Yeah. Right. Which is so tricky 'cause then it's like always that maybe I'm gonna get it, maybe I'm gonna get it, and then borrowing money

Hiding, right, those are all signs too, right? Yeah. Yeah. And like the behavior piece that you were talking about, right? We create these narrow pathways in our mind shortcuts, essentially, right? And so if if something's good, we tend to kind of do that stuff repetitive and it and it creates a shortcut to where it becomes now more of an automatic response and we don't even think about it, right? That behavior has been so ingrained into our our brain, it's just like, okay, we don't even think about it, we just respond.

Yeah. Yeah, and you you know, Rob, I really appreciate you highlighting kind of that the importance of being in community and being with people and tolerating that discomfort and how hard like that can be. I'm wondering if you're willing to share, what do you do right as the the counselor in the room to

help facilitate that. Like, what what do you think will be helpful for people to know like when you walk into a group or you meet with a, you know, counselor like myself, here's what you're gonna experience. And here's why. You know? Yeah, you know, and I and I always you know, when I when I have people come into the group, right, I I have them talk and share their story, kind of what brought you here. Right. And I think most people come in with the same response, right? I'm nervous, I'm scared,

I'm uncomfortable. And what they find out is within usually a week or two, they start to realize that, I am with these other people who share something similar to me. And there can be something kind of relieving about that, right? I you know, in my groups, I don't always talk about, you know, here's how you stop drinking, right? It's about how do we rebuild your life, right? How do we take a look at these areas? What can we to

Karin Ryan (25:29.784)
Bring some more structure into your life so that your brain can predict really kind of what's gonna go on with the day, right? Because our brain craves like predictability, right? We wanna know what's going on. And so the more I can, you know, maybe it's maybe it's the sleep cycle, right? fixing that, going to work, right? So we're not so much in our heads thinking about, my God, this is not gonna stop. And so

Part of it is staying busy, staying active, doing things, right? Maybe going to the gym, having a set work schedule, going to bed, getting the proper night's sleep, eating, right? Eating three meals a day, brushing your teeth, doing like the daily activities that bring some sort of sense of normalcy back in. Yeah. And safety. Yeah. Safety, yeah. Rob, as we wrap up, I have one regret and that is we

Don't have more time to keep talking about this. I have so many more questions and topics that I wish we could dive into so perhaps we can come back and revisit this. As we close, obviously you have a heart for this, and for people who are going through this, what would you want to say to people listening, just from your heart to them? What would you like them to know? Just that this isn't easy, right? It's like it's it's it's one of those things that you're not alone.

There are so many people that are in this and life does get better, right? Life can get better and it doesn't happen overnight. Happens by work. And so for a lot of people, you know, I I think they get tripped up on the fact if they have like a lapse, right? And that can kind of set them back and then they get this mentality of why even bother and might as well continue on and stuff like that. And it's like this work is not easy and what you're doing by just showing up and starting

is a starting point and it does get better. Things start to improve in your life and your life can get better. And I and I and I tell all my clients this. I was like, if you take a look at it like this, we are pretty lucky because we actually get to hit, you know, some of our lives have gone so far down, we get to hit that reset button, right? We get to maybe create a life that we never even envisioned. And it's possible, right? Like I, you know, I'm I'm in long term recovery myself.

Karin Ryan (27:52.842)
I was a sales guy long before this. I got to reshape my career. I got to start over. I got to do things and it was awesome because it was like I I got it I look at it as an a opportunity rather than my god, my life's never gonna be the same. Well, it can be better than what you ever envisioned it. Well thank you for that that word of hope for people. I know and and

In doing therapy, i it's really fascinating to see where people move from I can't to I can. And and I think you just underscored that here in your parting words. And we I hope people who are listening can if you're struggling with this, you can say to yourself, not just I need to do better, but start with I'm doing the best I can. Yep. And I can do better. And we at Sage in Behavioral Health are delighted.

at the opportunity and privilege to walk alongside you that are struggling with addictions. We have our own substance use department, which pretty large, and then we have really a comprehensive network of services around that with psychiatry services, psychological testing, individual therapy, etc. So we would really enjoy the opportunity to walk alongside of you. Hopefully if you're listening and you're learning about addiction, our hope is that you can come away from this and

Have a sense and understanding that we're all struggling with something and we wanna be patient and we wanna be compassionate with one another. Thank you so much for joining us. We look forward to sharing with you next time. Take care. Thank you.