How Trauma Work Best Occurs in Addiction Treatment (Part Two)

By Robert Weiss LCSW, CSAT-S

The Traumatized Addict

In my previous posting to this site I briefly discussed the undeniable link between chronic childhood trauma and adult-life psychiatric symptoms and disorders, most notably addictions, observing that this link is rarely addressed in treatment (potentially leading to addiction relapse). I then discussed the need for dual addiction/trauma assessment and treatment, with suggestions on how assessment best occurs, followed by a brief discussion on how to effectively move forward with initial treatment, noting the need for client safety, early sobriety and a trusting therapeutic alliance. This blog furthers that discussion, presenting a formalized three-stage integrated trauma/addiction treatment model.

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How Trauma Work Best Occurs in Addiction Treatment (Part One)

By Robert Weiss LCSW, CSAT-S

How Trauma Work Best Occurs in Addiction Treatment (Part One)What Is Trauma?

My esteemed colleague, Dr. Christine Courtois, provides a brief definition of trauma in her new book, It’s Not You, It’s What Happened to You, writing: “Trauma is any event or experience (including witnessing) that is physically and/or psychologically overwhelming to the exposed individual.” She then notes that trauma is highly subjective; incidents that might be highly traumatizing to one person may be humdrum for another. (Some people are more resilient than others.) She also notes that there are many types of trauma:

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Some Clients Need a Dating Plan…

By Robert Weiss LCSW, CSAT-S

Some Clients Need a Dating Plan...Not Everyone Knows How to Date

For many psychotherapy clients, issues with relationships and intimacy are paramount. Typically, individuals seeking help with these issues display insecure attachment styles, usually the result of inconsistent, neglectful and/or abusive parenting – though many other forms of early-life (and even adult-life) trauma may also be in play. Sometimes these clients have turned to an addiction, either substance or behavioral, as a way to cope with the discomfort caused by adult-life relationships. In my practice I have dealt with many such people, primarily sexual addicts and co-occurring sex/drug addicts. For these clients, an integral (and somewhat advanced) part of the healing process is learning how to date in healthy ways. Oftentimes the creation of a “dating plan” is quite helpful.

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Breaking Up Is Hard To Do, Especially in the Digital Age

By Robert Weiss LCSW, CSAT-S

162456296Relationship Drama: Digitally Enhanced

Relationship breakups and the angst surrounding them have always been solid psychotherapeutic fodder. As we’re all aware, these issues are challenging in and of themselves, and they also tend to evoke deeper emotional and psychological issues that can be worked through over time in therapy. On the one hand, this can be quite productive, as a well-managed clinical crisis often leads to useful therapeutic insights and breakthroughs. On the other hand, the emotional pain of a disintegrating relationship is nearly always incredibly distressing for the client, particularly if that client is emotionally fragile to begin with.

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The Sex Addicted Client: General Advice for Clinicians

By Robert Weiss LCSW, CSAT-S

The-Sex-Addicted-Client-General-Advice-for-CliniciansDo You Speak Sex?

Treating sexual addiction is not for the squeamish. Sex addicts, if and when they become honest in therapy, often relate harrowing tales of abuse and acting out. Many have engaged in sexual activities that even a seasoned prostir careers, their homes, their tute would blush to hear about, and they’ve often done so with more partners than they can count. They’ve put themselves, their spouses, their sexual hookup partners, theihealth, their children, and so much more at risk—all for a quick and ultimately meaningless sexual fix. Many were either covertly or overtly sexually abused in childhood and/or adolescence, sometimes repeatedly and horrifically. They may also have a concurrent addiction, usually some form of substance abuse but occasionally another behavioral addiction or even an eating disorder (especially among women), and this too can lead the client into episodes of traumatic experience and bad behavior.

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Recognizing the Consequences of Sexual Addiction

By Robert Weiss LCSW, CSAT-S

Recognizing-the-Consequences-of-Sexual-Addictio-2Assessment Questions

It’s not exactly a clinical secret that most of the sex addicts who enter therapy do so in response to their addiction’s related symptoms—disintegrating relationships, depression, severe anxiety, inability to focus at work or in school, social isolation, and the like. Rarely do these individuals walk in the door say, “You know, I think maybe I’m a sex addict, and that’s probably the first thing I need to deal with.” Instead, sex addicts will tell you that they’re unhappy, and that they’re having a variety of life and relationship problems. In my previous blog I discussed the fact that therapists should always ask at least a few specific but non-graphic questions about sexual activity during assessment in an effort to unearth sex-related issues. These questions may include the following:

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Does Your Client Have a Cybersex Problem?

By Robert Weiss LCSW, CSAT-S

Recognizing-the-Consequences-of-Sexual-AddictionLevels of Cybersex Use

In today’s digitally driven world it can be difficult to distinguish between those whose involvement with online sexual behavior is recreational, those whose involvement is “at-risk,” and those who are cybersex addicted (those whose lives and functionality are negatively affected by repetitive online sexual activity). This is compounded by the fact that most of the people who are struggling with cybersexual activity who enter psychotherapy choose to talk about their symptoms (depression, anxiety, issues with sleep, inability to form lasting relationships, and the like) rather than their problematic patterns of cybersexual activity. Making matters worse, current therapeutic evaluation tools (standard bio-psycho-social assessments) typically do not ask clients much about their sexual lives or sexual histories, meaning these issues can easily go undiscovered and unaddressed (to the client’s detriment). This non-discovery is aided and abetted by the very nature of the Internet, which, in addition to being highly affordable and continually accessible, allows for relatively anonymous use, making it easy for cybersex abusers to keep their behaviors private and to psychologically compartmentalize what they are doing.

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Out of Control Sexual Behavior: Addiction or Offending?

By Robert Weiss LCSW, CSAT-S

Out of Control Sexual Behavior: Addiction or Offending?When It Comes to Sex, Confusion Reigns

After more than two decades spent treating both sexual addicts and the occasional offender, I’ve watched the field of sexual disorders assessment and treatment come very far in its understanding of both sexual addiction and sexual offending. Nevertheless, the general public is often wildly misinformed on both topics, as are at least a few clinicians. One of the most common misperceptions is that sex addicts and sex offenders are one and the same. This is most definitely not the case.

In reality, there are significant differences between sexual addicts and sexual offenders. Sex addicts are people who engage compulsively in one or more consensual sexual behaviors, continuing those behaviors despite directly related negative consequences – relationship woes, problems at work or in school, loss of interest in previously enjoyable activities, lack of self-care, declining physical and/or emotional health, financial issues, and more. Sex offenders often have similar symptoms, but their sexual activities are nonconsensual, violating the rights of others, breaking the law, or both.

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Addicts Just Want to Have Fun (in Recovery)

By Robert Weiss LCSW, CSAT-S

Addicts Just Want to Have Fun (in Recovery)All Work and No Play…

Jack a 52-year-old divorced high school guidance counselor, after a stint of inpatient substance abuse rehab, had nine months sober from both alcoholism and marijuana addiction. In addition to working 8 to 5 every weekday, Jack kept a journal, meditated daily, and attended at least one twelve step meeting each evening. He also met with his therapist once per week and his twelve step sponsor twice weekly. Until the eight month mark of sobriety, he was riding the “pink cloud” of early recovery – that blissful time when many recovering addicts feel so relieved to finally be addressing their longstanding problem that, no matter what comes their way, they feel generally positive and cheerful about themselves and the world.

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Another Study Links Compulsive Sexual Behavior to Other Forms of Addiction

By Robert Weiss LCSW, CSAT-S

Another Study Links Compulsive Sexual Behavior to Other Forms of AddictionStatus Quo (For Now)

In mid-July I published a blog discussing a recently released fMRI (brain imaging) study showing that the brain activity of sex addicts, when they are shown pornography, mirrors the brain activity of drug addicts when they are exposed to drug-related imagery. That research strongly suggested that sexual addiction not only exists, but that it manifests in the brain in profoundly similar ways to more readily accepted forms of addiction like alcoholism, drug addiction, and gambling addiction. Publication of this study was highly significant in light of the American Psychiatric Association’s unexplained and unexpected refusal to include Hypersexual Disorder (aka, sexual addiction) in the DSM-5 last year. This despite Harvard Professor Dr. Martin Kafka’s well-researched and elegantly presented argument, commissioned by the APA, in favor of such a diagnosis.

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Recent Comments
  • Humbled_Man: This is an amazing article. I’m a narcissist and sex addict in therapy (as a person with NPD and...
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