Archives for Addictions
In his popular 2015 TED talk, “Everything You Think You Know about Addiction is Wrong,” journalist Johann Hari discusses research into the underlying causes of and effective treatments for addiction, ultimately concluding, “The opposite of addiction is not sobriety, it’s connection.” While Hari is not a scientist and he tends to overgeneralize in his presentation, making it relatively easy to nitpick, his belief that addiction is linked to early-life and adult struggles with emotional intimacy is, in my opinion, right on target. In fact, any therapist who has worked with addicts on a relatively routine basis will recognize the addictive pattern he describes.
A new study by Mateusz Gola, Karol Lewczuk, and Maciej Skorko, published in The Journal of Sexual Medicine, looks at the factors that drive people into treatment for problematic porn use. In particular, Gola and his team wanted to determine if frequency of porn use or consequences related to porn use are more important. Unsurprisingly, as sex addiction treatment specialists like myself and Dr. Patrick Carnes have been stating and writing for more than a decade, when diagnosing and treating porn addicts the amount of porn a person uses is considerably less relevant than his or her porn-related consequences. In fact, Dr. Carnes and I have consistently defined porn addiction based on the following three factors:
Ten years ago the first edition of Cruise Control: Understanding Sex Addiction in Gay Men was published in response to what I viewed as a meaningful missing puzzle piece for gay men to learn and grow. At that time there were few if any self-help books specific to gay men. Thus, gay men had to interpret their challenges and experiences through the written lens of heterosexual life and culture. Although...
In previous postings to this site, I have written about the differences between sexual addiction and sexual offending, the various types of sexual offenders, the treatment of sexual offenders, and therapist reporting requirements when dealing with sexual offenders. However, I have for the most part left a crucial aspect of this therapeutic relationship unaddressed – advocating for (or against) sexual offenders (in particular, child porn offenders) in the sentencing process.
For the last five years (at least), Jerry, a handsome 36-year-old office manager, has put the search for sex ahead of all else – even though he’s not having any in-person sexual encounters. Instead, he looks at and masturbates to hardcore pornography for several hours each weeknight and all day on the weekends, and occasionally he engages in mutual masturbation with strangers via webcam. Until a few years ago he tried to also date in real life, usually going out with nice women who were interested in a long-term relationship. He says that he really liked one of them, but that he was never really present with her and she eventually broke things off. He admits that on their dates he was usually more focused on going home and going online than on her. As it turns out, she broke up with him because she thought he was cheating on her (and in a way he was). That was three years ago, and Jerry has not been on a date since. He has tried several times to quit using porn, and sometimes he manages to do so for a day or two. But before long he feels depressed and lonely and he goes back online as a way to escape the pain. Recently, he’s started using his office computer to access porn during work hours – a situation that he knows will not end well. And yet he continues.
It’s March. Valentine’s Day is a distant memory and wedding season looms. Essentially, this is the time when psychotherapy clients often want to review and discuss their romantic relationships. For clients who struggle with problematic behavioral choices related to love, attachment and intimacy, in particular love addiction (also known as romance addiction and relationship addiction), this can be a very difficult undertaking. These individuals see friends and loved ones finding relationship success, while they take one manic spin after another on the relationship merry-go-round – desperately hoping to find that one special person who can make them feel complete and worthwhile and loved for longer than a few days or weeks at a time.
Making Resolutions... The season for overindulgence is finally past. Now is the winter of our discontent with all of that intemperance, and our desire to make commensurate life changes. This year I will stop overeating and bingeing on junk food, and I will lose at least 20 pounds. This year I will cut down on my drinking. This year I will limit myself to $50 per week at the casino. This year I will stop smoking pot and taking other drugs.
Status 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.
The Client Margaret, a 29-year-old married mother of two preschool aged children, starts in therapy at the insistence of her husband, Jason, who wants her to stop drinking and popping pills. In the first session, she tells you there is nothing wrong with her behaviors, and it’s her husband who’s off-base. “He expects me to be this perfect little 1950s housewife. He doesn’t understand that women like that just don’t exist. I’m only coming to therapy to get him off my back.” And quietly, just before the session ends, she says, “You can refill my valium prescription, right?”
Two Kids, One Bottle, Vastly Different Response Best friends Eric and Thomas are 14 years old. They are from upper-middle-class families. They make good grades, play sports, and are getting interested in girls. At their eighth grade graduation Thomas tells Eric that his older brother has invited them to an end-of-school party. They know they’re only being invited so Thomas won’t rat on his brother for being at a party where kids are drinking, but they don’t care because they’re invited to their first-ever high school party. As a further inducement to silence, Thomas receives a bottle of rum from his older sibling.