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Can one addiction lead to another? Killam award supports grad student's quest to find out

PhD candidate Andrew Kim studying gamblers to better understand addiction substitution process
November 3, 2016
Andrew Kim, a PhD candidate in clinical psychology at the University of Calgary, received a Killam predoctoral award to support his research into the little-understood process of addiction substitution. Photo by Riley Brandt, University of Calgary

Andrew Kim, a PhD candidate in clinical psychology at the University of Calgary, received a Killam predoctoral award to support his research into the little-understood process of addiction substitution. Photo by Riley Brandt, University of Calgary 

The Killam Trusts support top-ranked Canadian post-secondary students and professors who are making exceptional contributions to society. The pathfinding work of the nearly 7,000 Killam Laureates from Canada and around the world promote international understanding — fulfilling the Killam dream of a better world.

Jared Fogle had it all. He was the man who lost 245 pounds by eating nothing but sandwiches from Subway. Dubbed the “Subway Guy,” he became rich and famous as the restaurant chain’s spokesperson and one of America’s most successful pitchmen.

Then, in 2015, he lost everything.

Last year, Fogle was sent to prison for having sex with minors and trading in child porn. At his sentencing, Fogle’s defence lawyer argued, unsuccessfully, that Fogle had substituted his previous addiction to food for an addiction to sex. 

Trading one harmful behaviour for another

But is substituting one addiction for another a common occurrence? If so, how can someone be treated successfully for an addiction — whether it’s to gambling, alcohol, food or sex — so that they don’t develop another, potentially more harmful addictive behaviour?

These are questions Andrew (Hyoun) Kim, a PhD candidate in clinical psychology, is trying to answer. With the help of a Killam predoctoral award and his supervisor, professor David Hodgins, Kim is studying people addicted to gambling to better understand the process of addiction substitution so that clinical researchers can develop more effective interventions.

“In clinical setting we hear about this quite often. In fact, 12 step programs, like Alcoholics Anonymous, have a ‘13th step’ in terms of recovery and that step is when people substitute their addictive behaviour for a sexual compulsion,” Kim explains. “Or we hear of someone who has a problem with gambling and they start recovering from that behaviour but then they increase their alcohol consumption so, while giving up gambling, they’ve taken up a secondary addictive behaviour to get the same effect they got from gambling. So you really wonder if it was a successful recovery.”

Why some people substitute still poorly understood

Despite anecdotal evidence, Kim says the concept of addiction substitution is poorly understood both theoretically and practically. One of the challenges researchers face is that there is little empirical evidence to back up clinical accounts. A systematic review of the literature Kim conducted revealed that there are even differences of opinion on what terminology to use. Some people call it switching hypothesis, others call it cross-addiction.

To get a clearer picture of the process of addiction substitution and what predictors might indicate what causes people in recovery to substitute, Kim will interview 280 gamblers across North America falling into three categories: those who have recovered and not substituted another addiction, those who’ve recovered and given up a secondary addiction, and those who’ve recovered and have now developed another addictive behaviour.

“Part of my hypothesis is that when people are engaging in recovery — say from alcohol — they may be focusing on just the symptoms of drinking but not necessarily addressing the underlying psychological processes that lead people to engage in problematic drinking or gambling in the first place, for example the inability to regulate emotions adaptively. When this is not addressed, chances are higher that someone will switch to another addiction to get that relief.”

Opportunity to shape the field of addiction research

Kim’s research goals are twofold: enhance the effectiveness of current treatments for addictions and help treatment providers better understand and identify the disorder, and push the current boundaries of this field of study.

“Treatment is a big part of what we do so if we can increase the effectiveness of treatment for people engaged in addictive behaviours and make treatment providers more aware of addiction substitution so they are better able to plan for it, that could positively impact many lives,” he says.

Theoretically, not much is known about addiction substitution. There is ongoing debate about what should be classified as an addiction — extreme exercise for example. There is also a need to better understand the boundaries between addiction and impulse control disorders such as skin picking and kleptomania. Kim is incorporating these aspects into his research with a view to re-shifting how disorders are classified and, thus treated, perhaps leading to a more effective treatment for addictive behaviour that targets underlying causes and the processes that lead to addiction rather than the addictive behaviour itself.

“There’s not much out there in the literature so it just opens the door for me and Dr. Hodgins and my collaborators to shape the field, to be the pioneers in this area, to really understand the process of substitution, what should be classified as an addiction, and what can we do to provide better treatment. So the door’s wide open. It’s kind of scary but also exciting.”

Kim says the Killam award will support his work to bring more awareness to his area of research. “It’s a prestigious scholarship that will help to get my research out there,” he says. “Being recognized is very validating for the work I’ve put in with the help of my supervisors. And it also gives me a bit of pressure to work harder and make it happen.”

About the Killams

Established in 1965 by Izaak Walton Killam and his wife Dorothy J. Killam, the Killam trusts are one of the only private, philanthropic trusts for higher education in Canada. Larger than the Rhodes Trust with a value of close to $450 million, the prestigious awards support only five Canadian universities.