Addiction

Addiction most often is a dual diagnosis meaning there is some other problem that is driving the addiction. I believe that it is a therapists role to not only help the individual recover form the addiction but also to uncover the reasons for the addiction. Addictions are an escape. You want to escape your feelings, thoughts, beliefs: that don’t feel good.

Addiction & How I Treat It

Given that most addicts are in emotional pain it is common for an addict to want to and escape it and by using whatever substance whether it be drugs, alcohol, sex, food etc. that they are addicted to escape from the feelings that they do not want to feel anymore. People that move towards depressants, such as alcohol and benzodiazepines (Xanax, Valium, Klonopin) as forms of addictions tend to have anxiety-based issues that may be driving their addiction. People who become addicted to opiates amphetamines etc. (OxyContin, Cocaine) tend to feel feelings of depression that drive may drive their addiction. Individuals that feel empty inside tend to move towards things that fill them up in one way or another such as alcohol, food, and sex addictions. These are generalizations not intended for diagnosis purposes but to give you a general idea of possible treatment paths. All addictions for me, come down to a mind / body approach. People who want to escape their feelings usually have issues with self acceptance and feeling wrong, bad, not good enough, guilt or feelings of shame. Changing these foundational belief of a client with addictions to one of self acceptance, self esteem self-love and safety I believe is paramount in treating any addiction in the most loving, non judgmental way possible along with holding the addict responsible but not at fault for the addiction.

***These are generalizations not intended for diagnosis purposes but to give you a general idea of possible treatment paths. Always seek a licensed mental health professional for diagnosis and treatment of any disorder.

Sex Addiction

Sexual addiction is a popular model to explain hyper-sexuality ”sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one’s control. Hypersexuality is typically associated with lowered sexual inhibitions, and alcohol and some drugs can affect a person’s social and sexual inhibitions.

There are differences of opinion among sexologists as to whether the phenomenon represents an actual addiction or even a psychological/psychiatric condition at all. Proponents of the sexual addiction model draw an analogy between hypersexuality and substance addiction, recommending 12-step and other addiction-based methods of treatment. Other explanatory models of hypersexuality include sexual compulsivity and sexual impulsivity. Sexologists have not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon.[1][2] Some experts believe that sexual addiction is literally an addiction, directly analogous to alcohol and drug addictions. Other experts believe that sexual addiction is actually a form of obsessive compulsive disorder and refer to it as sexual compulsivity.[3] Still other experts believe that sex addiction is itself a myth, a by-product of cultural and other influences.[4][5]

ASAM

On August 15, 2011 the American Society of Addiction Medicine issued a public statement defining all addiction (including sex addiction) in terms of brain changes. “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”[6]

The following excerpts are taken from the FAQs:

“The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. This the first time that ASAM has taken an official position that addiction is not solely “substance dependence.” This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system. Food, sexual behaviors and gambling behaviors can be associated with the pathological pursuit of rewards described in this new definition of addiction.”

“We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes more, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors. So, anyone who has addiction is vulnerable to food and sex addiction. [7]

DSM

The American Psychiatric Association publishes and periodically updates the Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely recognized compendium of acknowledged mental disorders and their diagnostic criteria.

The version published in 1987 (DSM-III-R), referred to “distress about a pattern of repeated sexual conquests or other forms of nonparaphilic sexual addiction, involving a succession of people who exist only as things to be used.”[8] The reference to sexual addiction was subsequently removed.[9] 

Continuation despite consequences: When addicts take their addiction too far, it can cause negative effects in their lives. They may start withdrawing from family life to pursue sexual activity. This withdrawal may cause them to neglect their children or cause their partners to leave them. Addicts risk money, marriage, family and career in order to satisfy their sexual desires.[19] Despite all of these consequences, they continue indulging in excessive sexual activity.
Obsession: This is when people cannot help themselves from thinking a particular thought. Sex addicts spend whole days consumed by sexual thoughts. They develop elaborate fantasies, find new ways of obtaining sex and mentally revisit past experiences. Because their minds are so preoccupied by these thoughts, other areas of their lives that they could be thinking about are neglected.
Epidemiology

Sexual addiction is hypothesized to be (but is not always) associated with obsessive-compulsive disorder (OCD), narcissistic personality disorder,[20][21] and manic-depression.[22]There are those who suffer from more than one condition simultaneously (co-occurring disorder), but traits of addiction are often confused with those of these disorders, often due to most clinicians not being adequately trained in diagnosis and characteristics of addictions, and many clinicians tending to avoid use of the diagnosis at all.[1][23][24]

Specialists in obsessive-compulsive disorder and addictions use the same terms to refer to different symptoms. In addictions, obsession is progressive and pervasive, and develops along with denial; the person usually does not see themselves as preoccupied, and simultaneously makes excuses, justifies and blames. Compulsion is present only while the addict is physically dependent on the activity for physiological stasis. Constant repetition of the activity creates a chemically dependent state. If the addict acts out when not in this state, it is seen as being spurred by the obsession only. Some addicts do have OCD as well as addiction, and the symptoms will interact.[23]

Addicts often display narcissistic traits, which often clear as sobriety is achieved. Others do exhibit the full personality disorder even after successful addiction treatment.[20]

Etiology
Addiction theories

According to Patrick Carnes the cycle begins with the “Core Beliefs” that sex addicts hold:[25]

“I am basically a bad, unworthy person.”
“No one would love me as I am.”
“My needs are never going to be met if I have to depend on others.”
“Sex is my most important need.”

These beliefs drive the addiction on its progressive and destructive course:[25]

Pain agent First a pain agent is triggered / emotional discomfort (e.g. shame, anger, unresolved conflict). A sex addict is not able to take care of the pain agent in a healthy way.
Dissociation Prior to acting out sexually, the sex addict goes through a period of mental preoccupation or obsession. Sex addict begins to dissociate (moves away from his or her feelings). A separation begins to take place between his or her mind and his or her emotional self.
Altered state of consciousness / a trance state / bubble of euphoric fantasized experience. Sex addict is emotionally disconnected and is pre-occupied with acting out behaviours. The reality becomes blocked out/distorted.
Preoccupation or “sexual pressure” This involves obsessing about being sexual or romantic. Fantasy is an obsession that serves in some way to avoid life. The addict’s thoughts focus on reaching a mood-altering high without actually acting-out sexually. They think about sex to produce a trance-like state of arousal to eliminate the pain of reality. Thinking about sex and planning out how to reach orgasm can continue for minutes or hours before they move to the next stage of the cycle.
Ritualization or “acting out.” These obsessions are intensified by ritualization or acting out. Ritualization helps distance reality from sexual obsession. Rituals induce trance and further separate the addict from reality. Once the addict begins the ritual, the chances of stopping that cycle diminish greatly. They give into the pull of the compelling sex act.
Sexual compulsivity The next phase of the cycle is sexual compulsivity or “sex act”. The tensions the addict feels are reduced by acting on their sexual feelings. They feel better for the moment, thanks to the release that occurs. Compulsivity simply means that addicts regularly get to the point where sex becomes inevitable, no matter what the circumstances or the consequences. The compulsive act, which normally ends in orgasm, is perhaps the starkest reminder of the degradation involved in the addiction as the person realizes they are a slave to the addiction.
Despair Almost immediately reality sets in, and the addict begins to feel ashamed. This point of the cycle is a painful place where the Addict has been many, many times. The last time the Addict was at this low point, they probably promised to never do it again. Yet once again, they act out and that leads to despair. They may feel they have betrayed spiritual beliefs, possibly a partner, and his or her own sense of integrity. At a superficial level, the addict hopes that this is the last battle.

According to Carnes, for many addicts, this dark emotion brings on depression and feelings of hopelessness. One easy way to cure feelings of despair is to start obsessing all over again. The cycle then perpetuates itself.[26]

Sex Addiction No More

Alcoholism

Alcoholism, also known as Alcohol Addiction, is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker’s health, personal relationships, and social standing. It is medically considered a disease, specifically a neurological disorder, and in medicine several other terms are used, specifically “alcohol abuse” and “alcohol dependence” which have more specific definitions. In 1979 an expert World Health Organisationcommittee discouraged the use of “alcoholism” in medicine, preferring the category of “alcohol dependence syndrome”. In the 19th and early 20th centuries, alcohol dependence in general was called dipsomania, but that term now has a much more specific meaning. People suffering from alcoholism are often called “alcoholics”. Many other terms, some of them insulting or informal, have been used throughout history. The World Health Organization estimates that there are 140 million people with alcoholism worldwide.

Alcoholism is called a “dual disease” since it includes both mental and physical components. The biological mechanisms that cause alcoholism are not well understood. Social environment, stress, mental health, family history, age, ethnic group, and gender all influence the risk for the condition.Long-term alcohol abuse produces changes in the brain’s structure and chemistry such as tolerance and physical dependence. These changes maintain the person with alcoholism’s compulsive inability to stop drinking and result in alcohol withdrawal syndrome if the person stops.  Alcohol damages almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems.

Identifying alcoholism is difficult because of the social stigma associated with the disease that causes people with alcoholism to avoid diagnosis and treatment for fear of shame or social consequences. A common method for diagnosing alcoholism is evaluating responses to a group of standardized questions. These can be used to identify harmful drinking patterns, including alcoholism.  In general, problem drinking is considered alcoholism when the person continues to drink when they want to stop because of social or health problems caused by drinking

Treatment of alcoholism takes several steps. Because of the medical problems that can be caused by withdrawal, alcohol detoxification is carefully controlled and may involve medications such as benzodiazepines such as diazepam (Valium). People with alcoholism also sometimes have other addictions, including addictions to benzodiazepines, which may complicate this step. After detoxification, other support such as group therapy or self-help groups are used to help the person remain sober. Thombs (1999) states according to behavioural sciences alcoholism is described as a maladaptive behaviour. He explains this must not be confused with misbehaviour. Behavioural scientists explain that addicts have a behaviour pattern that may lead to destructive consequences for themselves, their families and society. This does not label addicts as bad or irresponsible. Compared with men, women are more sensitive to alcohol’s harmful physical, cerebral, and mental effects

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