The recently released film Thanks for Sharing is an incredibly accurate portrayal of the ways in which many addicts struggle with more than one addictive substance or behavior. Frankly, there have been a lot of films about addiction and recovery over the years, some of them quite realistic and well done, but none has ever taken this good a look at cross- and co-occurring addictions. (People who are cross-addicted switch from one addiction to another. People with co-occurring addictions indulge multiple addictions simultaneously.)
With addicts, this type of comorbidity occurs all the time. I see it almost daily working with clients and in my clinical development work with Elements Behavioral Health. In fact, Elements’ entire network of treatment centers is focusing more and more every day on the multiple issues that most of our clients present with. Sometimes it’s multiple addictions, sometimes it’s an addition coupled with depression, anxiety, or a similar diagnosis. Sometimes it’s trauma paired with depression or anxiety. Etc. Whatever the combination, hardly anyone we see walks in with just one cut-and-dried problem. It’s incredibly important that clinicians everywhere recognize this fact and find ways to treat the totality of their clients rather than focusing on a singular (usually glaring) issue.
The film Thanks for Sharing subtly but clearly looks at this, following several individuals as they struggle to abstain not just from compulsive and destructive sexual behaviors, but from cross- and co-occurring addictions. Three characters in particular stand out in this regard.
- Mike (Tim Robbins) is both compulsively sexual and an alcoholic. He is fifteen years sober from alcohol and problematic sexuality. At one point in the movie he strongly considers relapsing, and it is clear that if he does, it won’t be with one problem or the other, it will be both.
- Neil (Josh Gad) is compulsively sexual and has an (undiagnosed) eating disorder. At one point we seem him binge eating with doughnuts, getting disgusted with himself and throwing the last few in the wastebasket, but returning to them a few minutes later. It is a painful moment, and highly indicative of the push-pull that all recovering addicts face. Josh wants to do right by himself, but at the same time he has a desperate need to self-medicate his ongoing emotional discomfort.
- Dede (Pink) has been in recovery for her drug addiction for some time, but she can’t seem to stay sober. It is only after her narcotics anonymous sponsor points out the fact that all of her relapses are triggered by her compulsive sexual and romantic behavior that she recognizes she might have a dual, fused issue.
For many individuals, cross-addictions set in with a vengeance in early recovery. Both Neil and Dede experience this in the film. A few other common cross-addiction scenarios are:
- A woman completes treatment for her alcoholism and returns home. She is active in alcoholics anonymous and outpatient therapy, and remains sober. However, she gains forty pounds in her first year clean. Essentially, she has replaced alcohol with food.
- A man completes treatment for drug addiction and returns home. To fill the hours that used to be spent getting high, he plays online poker. He relies on the rush of gambling to replace the intensity of his drug use, and before he realizes it he’s maxed out his credit cards, emptied out his IRA, and depleted his daughter’s college fund.
Frankly, battling cross- and co-occurring disorders can feel a bit like playing a game of addiction-related whac-a-mole. One addiction pops up, and while you’re busy pounding it down another problem emerges. The game is even tougher when co-occurring behaviors are heavily intertwined, as is the case with both Mike and Dede in Thanks for Sharing. In such cases, relapse with one addiction nearly always leads to a quick relapse in the other.
More on the Film
The comorbidity element is just one of the many things that Thanks for Sharing gets right. Clearly, the writers of this film are deeply familiar with both active addiction and recovery. For one thing, the movie does not show people being “struck sober” simply by walking into a 12-step meeting. One character relapses badly, there are several near relapses, and one person tells the group he is sober when he is very clearly not. Furthermore, there are several gritty scenes showing active addiction. Happily, these are tempered by moments of honesty, humor, and genuine recovery. The film also shows how even those with long-term sobriety are not saints. Mike, for instance, with fifteen years behind him, still struggles to relate to his wife and son in any sort of meaningful, intimate way. We also get to see the long-term damage that Mike’s addiction has wrought on his family.
The most gratifying part of the film, from an addiction-recovery perspective, is its recognition that addicts don’t get well in a vacuum. In fact, they almost never find or maintain sobriety without outside help and ongoing social support from others in recovery. Thanks for Sharing shows this repeatedly without ever getting preachy. The best example occurs when Dede finds herself at the doorstep of an ex-boyfriend. She calls fellow newcomer Neil for help, and over the phone he walks her through the process, helping her to understand that if she rings the ex’s doorbell she’ll almost certainly get high soon thereafter. And the call helps Neil as well, as he was about to relapse when the phone rang. As any addict with even a short amount of sobriety can tell you, these serendipitous moments happen all the time in recovery.
More on Cross- and Co-Occurring Addictions
Whatever the addiction—alcohol, drugs, or a compulsive behavior—the motivation behind it is the same. Addicts want to feel better, which actually means they want to feel less. Addictive substances and behaviors all happily oblige by altering brain chemistry in ways that temporarily distract the addict from uncomfortable emotions, stressful situations, and underlying psychological conditions. Unfortunately, the result is always the same in the end: a pattern of destructive behavior that negatively impacts all aspects of life—intimate relationships, family, work, school, finances, health, freedom, and happiness. It is therefore imperative when treating or recovering from addiction to recognize the potential for other addictive behaviors. Those are the issues that can very easily keep an addict mired in depression and compulsivity. Addictions, not just the primary addiction but any secondary addictions, must be addressed head-on, often simultaneously, because if the addict doesn’t heal from all of the problems, he or she might not heal from any.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He has developed clinical programs for The Ranch outside Nashville, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. An author and subject expert on the relationship between digital technology and human sexuality, Mr. Weiss has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others. He has also provided clinical multi-addiction training and behavioral health program development for the US military and treatment centers throughout the United States, Europe, and Asia.