Because I sometimes find that the issues therapists deal with differ by region, I like to chat with men and women at the forefront of our profession in various areas of the country. Among these clinical leaders is Jeff Zacharias, Owner, President, and Clinical Director of New Hope Recovery Center in the Lincoln Park area of Chicago. New Hope primarily serves Chicago’s LGBT community. Jeff also has a private practice in Lincoln Square. He specializes in the treatment of all forms of addiction, with a focus on sex and love addiction.
Recently I spoke with Jeff about the issues he commonly sees in the Chicago area, and how he and his colleagues approach treatment to those particular challenges.
Alcoholics and drug addicts don’t drink and use to feel better; they do it to feel less. In other words, addiction is a disease of escape and dissociation from stress and other forms of emotional discomfort. This means that substance abusers don’t get drunk or high because they’re looking to engage with other people, they do it because they’re hoping to avoid the turmoil of other people. Nevertheless, our very human desire for connection that is present from birth onward remains in effect. As such, drug addicted individuals typically do want to connect, even though they are desperately afraid of the trauma that might ensue.
Cindy Feinberg is a recovery coach and addiction case manager in New York City. She and her staff are committed to helping addicts and their families move toward recovery and a better life. She coordinates on an ongoing basis referrals to treatment specialists (treatment centers, therapists, interventionists, sober companions, MDs, and the like), at the same time managing all other aspects of care appropriate for a client and the client’s family. I have been so consistently impressed with both her intervention and recovery coaching ability that I wanted to share a bit about her world with you here.
Few places call upon people to be more vulnerable, more often, than addiction and behavioral/mental health treatment settings. Complicating matters is the fact that people who enter treatment for addiction or any other highly destructive psychiatric disorder are nearly always filled with shame – feeling as if they are inherently flawed, defective, less than, and unworthy. Sharing about these feelings and the incidents that led to them is incredibly painful, and, as such, these individuals would usually rather eat dirt than talk about them. As therapists, of course, we understand that shame thrives in darkness but withers in sunlight. In other words, we know that the best way to reduce the power of shameful feelings and incidents is to have them witnessed and understood when surrounded by safe and supportive others.
Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.
- Dr. Brené Brown
Training the Trainers
In early November, forty addictions and mental health staff from Elements Behavioral Health facilities nationwide gathered at The Ranch treatment center near Nashville, Tennessee for three days of intense and rigorous professional training. Our goal was to experience and learn the new Daring Way™ shame resilience curriculum, which is based on the extensive research of Dr. Brené Brown. Among the delegation were senior therapeutic staff members from Promises Malibu, Promises Professionals Treatment Program, Promises Young Adult Program (West LA), Malibu Vista, Promises Austin (formerly known as Spirit Lodge), The Ranch, The Sexual Recovery Institute, Lucida, The Right Step, and The Recovery Place. As a result of this effort, each of therapists in attendance is now certified as a Daring Way™ Facilitator Candidate (CDW-C). In short order these clinicians will become fully certified Daring Way™ Facilitators, and the Elements family of treatment centers will wholeheartedly incorporate the Daring Way™ shame resilience curriculum into its ever-growing family of treatment programs.
Not long ago the New York Times published a rather vitriolic article titled “An Intervention for Malibu.” For the most part, the Times chose to denigrate the 35 state-licensed drug and alcohol rehab facilities located in the small, upscale seaside village just outside Los Angeles. Much of the contempt centered on the fact that media vans and crews consistently clog the Malibu streets, with shutterbugs and TV crews alike hoping to catch the likes of Lindsay Lohan or Robert Downey, Jr. stumbling into or out of yet another treatment center. Residents of the town just plain don’t like the press swarming their ultra-swanky neighborhood, and I can certainly understand that.
Mars vs. Venus – in Recovery
We have long known that there are significant differences in the ways that men and women think, act, and relate. To a large extent these differences are neurobiological in nature as male brains and female brains show significant structural differences. For starters, the brains (and heads) of boys and men are about 9 percent larger than those of girls and women. The extra brain matter in males is mainly white matter, the part of the brain that transmits signals between brain cells. At the same time, males have relatively less of the corpus callosum, a structure that allows the left and the right sides of the brain to communicate. (Generally speaking, the left brain controls logic, analytical thinking, and objectivity, whereas the right brain controls intuition, synthesis, and subjectivity.) It seems the male brain has more connections to nearby cells, but less connectivity between the two hemispheres; vice versa for females. These basic structural differences explain, at least in part, some of the readily observable differences in male and female behavior.
In sexual addiction treatment, clinicians help clients carefully self-define the sexual behaviors that do not compromise or destroy their meaningful personal values, life circumstances, and relationships. Clients then commit in a written sexual sobriety contract to only engage in sexual behaviors that are permitted within the bounds of that predetermined pact. As long as the client’s behavior remains within his or her concretely and mutually defined boundaries, that individual is sexually sober. (I have written extensively about “boundary plans” in a previous blog) But how can we help sex addicts deal in healthy ways with the people, places, and things that trigger them to act out? After all, every time they leave the treatment setting the real world awaits-with all the same temptations as ever (and, thanks to the ever-expanding Internet, probably a few new ones).
As mentioned in last week’s blog, sexual sobriety does NOT entail long-term sexual abstinence. Often, a 30 to 90 day “cooling off” period of complete abstinence from all sexual behavior, including masturbation, is recommended when an addict enters treatment—mainly to help the addict gain perspective on his or her problematic behaviors—but in no way, shape, or form is ongoing abstinence the goal.
In fact, the heavy lifting of sex addiction recovery is not this short period away from sexual behavior; it is instead the gradual (re)introduction of healthy sexuality into the addict’s life.
But if sexual sobriety doesn’t require total sexual abstinence in the way that chemical sobriety requires total abstinence from alcohol and addictive drugs, what does it require?
Generally speaking, to achieve sexual sobriety sex addicts must define—working in conjunction with a knowledgeable sex addiction therapist, a 12-step recovery sponsor, or some other sexual recovery accountability partner—the sexual behaviors that do not compromise or destroy the addict’s values (fidelity, not hurting others, etc.), life circumstances (keeping a job, not getting arrested, etc.), and relationships.
The addict then commits in a written sexual sobriety contract to only engage in sexual behavior that is permitted within the bounds of that predetermined pact. As long as the addict’s sexual behavior remains within his or her concretely defined boundaries, the individual is sexually sober. It is important that these plans be put in writing, and that they clearly define the addict’s bottom line behaviors to be eliminated.
Having spent two decades working with relationship and sexual addicts—male and female, straight and gay, younger and older—I have come to accept that people entering sex addiction recovery typically have little to no idea of what achieving “sexual sobriety” really means or entails. This confusion is in sharp contrast to nearly any alcoholic or drug addict entering treatment, who more or less already knows that he or she will have to abstain completely from alcohol and/or illicit drugs to be sober.
Unsurprisingly, the most frequently asked question by newcomers to sexual addiction treatment is: “Am I ever going to be able to have a healthy, regular sex life, or will I have to give up sex forever?” And this question is usually followed by a statement along the lines of, “If I have to give up sex permanently, then you can forget my staying in treatment.”
Fortunately, unlike sobriety for alcoholism and drug addiction, sexual sobriety is not defined by ongoing abstinence—though a short period away from sex is often recommended as a brief, early part of the healing process. Ultimately, sexual addiction treatment addresses sobriety in much the same way it is handled in the treatment of eating disorders, another area where sobriety does not mean permanently abstaining. (You can’t very well abstain from eating!)