Pathological Eating Disorders and Poly-Behavioral Addiction

When considering that pathological eating disorders and their related diseases now afflict more people globally than malnutrition, some experts in the medical field are presently purporting that the world’s number one health problem is no longer heart disease or cancer, but obesity. According to the World Health Organization (June, 2005), “obesity has reached epidemic proportions globally, with more than 1 billion adults overweight – at least 300 million of them clinically obese – and is a major contributor to the global burden of chronic disease and disability. Often coexisting in developing countries with under-nutrition, obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups.” The U.S. Centers for Disease Control and Prevention (June, 2005), reports that “during the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30 percent of U.S. adults 20 years of age and older – over 60 million people – are obese. This increase is not limited to adults. The percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6-19 years, 16 percent (over 9 million young people) are considered overweight.”

Morbid obesity is a condition that is described as being 100lbs. or more above ideal weight, or having a Body Mass Index (BMI) equal to or greater than 30. Being obese alone puts one at a much greater risk of suffering from a combination of several other metabolic factors such as having high blood pressure, being insulin resistant, and/ or having abnormal cholesterol levels that are all related to a poor diet and a lack of exercise. The sum is greater than the parts. Each metabolic problem is a risk for other diseases separately, but together they multiply the chances of life-threatening illness such as heart disease, cancer, diabetes, and stroke, etc. Up to 30.5% of our Nations’ adults suffer from morbid obesity, and two thirds or 66% of adults are overweight measured by having a Body Mass Index (BMI) greater than 25. Considering that the U.S. population is now over 290,000,000, some estimate that up to 73,000,000 Americans could benefit from some type of education awareness and/ or treatment for a pathological eating disorder or food addiction. Typically, eating patterns are considered pathological problems when issues concerning weight and/ or eating habits, (e.g., overeating, under eating, binging, purging, and/ or obsessing over diets and calories, etc.) become the focus of a persons’ life, causing them to feel shame, guilt, and embarrassment with related symptoms of depression and anxiety that cause significant maladaptive social and/ or occupational impairment in functioning.

We must consider that some people develop dependencies on certain life-functioning activities such as eating that can be just as life threatening as drug addiction and just as socially and psychologically damaging as alcoholism. Some do suffer from hormonal or metabolic disorders, but most obese individuals simply consume more calories than they burn due to an out of control overeating Food Addiction. Hyper-obesity resulting from gross, habitual overeating is considered to be more like the problems found in those ingrained personality disorders that involve loss of control over appetite of some kind (Orford, 1985). Binge-eating Disorder episodes are characterized in part by a feeling that one cannot stop or control how much or what one is eating (DSM-IV-TR, 2000). Lienard and Vamecq (2004) have proposed an “auto-addictive” hypothesis for pathological eating disorders. They report that, “eating disorders are associated with abnormal levels of endorphins and share clinical similarities with psychoactive drug abuse. The key role of endorphins has recently been demonstrated in animals with regard to certain aspects of normal, pathological and experimental eating habits (food restriction combined with stress, loco-motor hyperactivity).” They report that the “pathological management of eating disorders may lead to two extreme situations: the absence of ingestion (anorexia) and excessive ingestion (bulimia).”

Co-morbidity & Mortality

Addictions and other mental disorders as a rule do not develop in isolation. The National Co-morbidity Survey (NCS) that sampled the entire U.S. population in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), roughly 50% had a diagnosable Axis I mental disorder at some time in their lives. This survey’s results indicated that 35% of males will at some time in their lives have abused substances to the point of qualifying for a mental disorder diagnosis, and nearly 25% of women will have qualified for a serious mood disorder (mostly major depression). A significant finding of note from the NCS study was the widespread occurrence of co-morbidity among diagnosed disorders. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more additional disorders. These persons with a history of three or more co-morbid disorders were estimated to be one-sixth of the U.S. population, or some 43 million people (Kessler, 1994).

McGinnis and Foege, (1994) report that, “the most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Acknowledging that the leading cause of preventable morbidity and mortality was risky behavior lifestyles, the U.S. Prevention Services Task Force set out to research behavioral counseling interventions in health care settings (Williams & Wilkins, 1996).

Poor Prognosis

We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private treatment programs (for example) relapse within the first year following treatment (Gorski,T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?

Diagnostic Delineation

Thus far, the DSM-IV-TR has not delineated a diagnosis for the complexity of multiple behavioral and substance addictions. It has reserved the Poly-substance Dependence diagnosis for a person who is repeatedly using at least three groups of substances during the same 12-month period, but the criteria for this diagnosis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting Medical Condition’s section (DSM-IV-TR, 2000); maladaptive health behaviors (e.g., overeating, unsafe sexual practices, excessive alcohol and drug use, etc.) may be listed on Axis I only if they are significantly affecting the course of treatment of a medical or mental condition.

Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field, when the latest DSM-IV-TR does not even include a diagnosis for multiple addictive behavioral disorders. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictive and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals’ life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.

New Proposed Diagnosis

To assist in resolving the limited DSM-IV-TRs’ diagnostic capability, a multidimensional diagnosis of “Poly-behavioral Addiction,” is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging – psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.

Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 – month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances – nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.

New Proposed Theory

The Addictions Recovery Measurement System’s (ARMS) theory is a nonlinear, dynamical, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. Multiple influences trigger and operate within high-risk situations and influence the global multidimensional functioning of an individual. The process of relapse incorporates the interaction between background factors (e.g., family history, social support, years of possible dependence, and co-morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, cravings, motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in an individual’s behavior can result in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous little interactions.

The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual’s primary addiction. The ARMS’ theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension.

The ARMS acknowledges the complexity and unpredictable nature of lifestyle addictions following the commitment of an individual to accept assistance with changing their lifestyles. The Stages of Change model (Prochaska & DiClemente, 1984) is supported as a model of motivation, incorporating five stages of readiness to change: pre-contemplation, contemplation, preparation, action, and maintenance. The ARMS theory supports the constructs of self-efficacy and social networking as outcome predictors of future behavior across a wide variety of lifestyle risk factors (Bandura, 1977). The Relapse Prevention cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the ARMS theory.

The ARMS continues to promote Twelve Step Recovery Groups such as Food Addicts and Alcoholics Anonymous along with spiritual and religious recovery activities as a necessary means to maintain outcome effectiveness. The beneficial effects of AA may be attributable in part to the replacement of the participant’s social network of drinking friends with a fellowship of AA members who can provide motivation and support for maintaining abstinence (Humphreys, K.; Mankowski, E.S, 1999) and (Morgenstern, J.; Labouvie, E.; McCrady, B.S.; Kahler, C.W.; and Frey, R.M., 1997). In addition, AA’s approach often results in the development of coping skills, many of which are similar to those taught in more structured psychosocial treatment settings, thereby leading to reductions in alcohol consumption (NIAAA, June 2005).

Treatment Progress Dimensions

The American Society of Addiction Medicine’s (2003), “Patient Placement Criteria for the Treatment of Substance-Related Disorders, 3rd Edition”, has set the standard in the field of addiction treatment for recognizing the totality of the individual in his or her life situation. This includes the internal interconnection of multiple dimensions from biomedical to spiritual, as well as external relationships of the individual to the family and larger social groups. Life-style addictions may affect many domains of an individual’s functioning and frequently require multi-modal treatment. Real progress however, requires appropriate interventions and motivating strategies for every dimension of an individual’s life.

The Addictions Recovery Measurement System (ARMS) has identified the following seven treatment progress areas (dimensions) in an effort to: (1) assist clinicians with identifying additional motivational techniques that can increase an individual’s awareness to make progress: (2) measure within treatment progress, and (3) measure after treatment outcome effectiveness:

PD- 1. Abstinence/ Relapse: Progress Dimension

PD- 2. Bio-medical/ Physical: Progress Dimension

PD- 3. Mental/ Emotional: Progress Dimension

PD- 4. Social/ Cultural: Progress Dimension

PD- 5. Educational/ Occupational: Progress Dimension

PD- 6. Attitude/ Behavioral: Progress Dimension

PD- 7. Spirituality/ Religious: Progress Dimension

Considering that addictions involve unbalanced life-styles operating within semi-stable equilibrium force fields, the ARMS philosophy promotes that positive treatment effectiveness and successful outcomes are the result of a synergistic relationship with “The Higher Power,” that spiritually elevates and connects an individuals’ multiple life functioning dimensions by reducing chaos and increasing resilience to bring an individual harmony, wellness, and productivity.

Addictions Recovery Measurement – Subsystems

Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed – how should we effectively manage poly-behavioral addiction?

The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual’s comprehensive life-functioning progress dimensions. The “ARMS”- systematically, methodically, interactively, & spiritually combines the following five versatile subsystems that may be utilized individually or incorporated together:

1) The Prognostication System – composed of twelve screening instruments developed to evaluate an individual’s total life-functioning dimensions for a comprehensive bio-psychosocial assessment for an objective 5-Axis diagnosis with a point-based Global Assessment of Functioning score;

2) The Target Intervention System – that includes the Target Intervention Measure (TIM) and Target Progress Reports (A) & (B), for individualized goal-specific treatment planning;

3) The Progress Point System – a standardized performance-based motivational recovery point system utilized to produce in-treatment progress reports on six life-functioning individual dimensions;

4) The Multidimensional Tracking System – with its Tracking Team Surveys (A) & (B), along with the ARMS Discharge criteria guidelines utilizes a multidisciplinary tracking team to assist with discharge planning; and

5) The Treatment Outcome Measurement System – that utilizes the following two measurement instruments: (a) The Treatment Outcome Measure (TOM); and (b) the Global Assessment of Progress (GAP), to assist with aftercare treatment planning.

National Movement

With the end of the Cold War, the threat of a world nuclear war has diminished considerably. It may be hard to imagine that in the end, comedians may be exploiting the humor in the fact that it wasn’t nuclear warheads, but “French fries” that annihilated the human race. On a more serious note, lifestyle diseases and addictions are the leading cause of preventable morbidity and mortality, yet brief preventive behavioral assessments and counseling interventions are under-utilized in health care settings (Whitlock, 2002).

The U.S. Preventive Services Task Force concluded that effective behavioral counseling interventions that address personal health practices hold greater promise for improving overall health than many secondary preventive measures, such as routine screening for early disease (USPSTF, 1996). Common health-promoting behaviors include healthy diet, regular physical exercise, smoking cessation, appropriate alcohol/ medication use, and responsible sexual practices to include use of condoms and contraceptives.

350 national organizations and 250 State public health, mental health, substance abuse, and environmental agencies support the U.S. Department of Health and Human Services, “Healthy People 2010” program. This national initiative recommends that primary care clinicians utilize clinical preventive assessments and brief behavioral counseling for early detection, prevention, and treatment of lifestyle disease and addiction indicators for all patients’ upon every healthcare visit.

Partnerships and coordination among service providers, government departments, and community organizations in providing treatment programs are a necessity in addressing the multi-task solution to poly-behavioral addiction. I encourage you to support the mental health and addiction programs in America, and hope that the (ARMS) resources can assist you to personally fight the War on pathological eating disorders within poly-behavioral addiction.

For more info see:

Poly-Behavioral Addiction and the Addictions Recovery Measurement System,

By James Slobodzien, Psy.D., CSAC at:

[http://www.geocities.com/drslbdzn/Behavioral-Addictions.html]

Food Addicts Anonymous: http://www.foodaddictsanonymous.org/

Alcoholics Anonymous: http://www.alcoholics-anonymous.org/

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,

Text Revision. Washington, DC, American Psychiatric Association, 2000, p. 787 & p. 731.

American Society of Addiction Medicine’s (2003), “Patient Placement Criteria for the

Treatment of Substance-Related Disorders, 3rd Edition,. Retrieved, June 18, 2005, from:

http://www.asam.org/

Bandura, A. (1977), Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review,

84, 191-215.

Brownell, K. D., Marlatt, G. A., Lichtenstein, E., & Wilson, G. T. (1986). Understanding and preventing relapse. American Psychologist, 41, 765-782.

Centers for Disease Control and Prevention (CDC). Retrieved June 18, 2005, from: http://www.cdc.gov/nccdphp/dnpa/obesity/

Gorski, T. (2001), Relapse Prevention In The Managed Care Environment. GORSKI-CENAPS Web

Healthy People 2010. Retrieved June 20, 2005, from: http://www.healthypeople.gov/

Publications. Retrieved June 20, 2005, from: http://www.tgorski.com

Lienard, J. & Vamecq, J. (2004), Presse Med, Oct 23;33(18 Suppl):33-40.

Marlatt, G. A. (1985). Relapse prevention: Theoretical rationale and overview of the model. In G. A.

Marlatt & J. R. Gordon (Eds.), Relapse prevention (pp. 250-280). New York: Guilford Press.

McGinnis JM, Foege WH (1994). Actual causes of death in the United States. US Department of Health and Human Services, Washington, DC 20201

Humphreys, K.; Mankowski, E.S.; Moos, R.H.; and Finney, J.W (1999). Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Ann Behav Med 21(1):54-60.

Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H. H,-U, & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United

States: Results from the national co morbidity survey. Arch. Gen. Psychiat., 51, 8-19.

Morgenstern, J.; Labouvie, E.; McCrady, B.S.; Kahler, C.W.; and Frey, R.M (1997). Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. J Consult Clin Psychol 65(5):768-777.

Orford, J. (1985). Excessive appetites: A psychological view of addiction. New York: Wiley.

Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing the boundaries of therapy. Malabar, FL: Krieger.

Slobodzien, J. (2005). Poly-behavioral Addiction and the Addictions Recovery Measurement System (ARMS), Booklocker.com, Inc., p. 5.

Whitlock, E.P. (1996). Evaluating Primary Care Behavioral Counseling Interventions: An Evidence-based Approach. Am J Prev Med 2002;22(4): 267-84.Williams & Wilkins. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria, VA.

U.S. Department of Health and Human Services. Healthy People 2010 (Conference Edition). Washington, DC: U.S. Government Printing Office; 2000.

World Health Organization, (WHO). Retrieved June 18, 2005, from: http://www.who.int/topics/obesity/en/

Fear: A Friend Or A Foe For An Addict?

I remember that there were moral value classes in my school and it was decided that we would be taught Bhagwad Geeta to instill certain ethics in us, which would be beneficial in the long run. I would like to share the same here before we come to the main point. So there was a time when Lord Krishna told Arjun, who was supposed to fight for his territory, that he would be killed by his fears before he would even start fighting the war! So he was asked to gather all his strength and fight with full might- first with his fear and then with the opponent army.

The reason I have brought this point here is that fear indeed is the biggest enemy of human beings and most of the times we lose our life’s battles because of that. Now you must be thinking, how is it related to addiction?

Let us start connecting it with a few examples related to an addict’s life.

1. Sam is a weed addict, who has planned a trip to Goa. He plans to be there for 3 days and collects his substance according a week before he leaves. He scores 3 grams more than what he generally scores. Why?

2. Mike is a heroin addict. He is left with money just enough to reach college. He knows that he would not be given his pocket money before the new month starts. There are still 2 days left for that. He chases all his left stuff in one go, due to anxiety. Why?

3. There is an order from the court- No more cigarettes to be sold. Matt collects 100 boxes from different shops. Why?

Answer to all the questions remains the same and that is FEAR. Sam is scared, what if his weed gets over before his trip ends. Mike is scared, how would he sustain those two days and what if he does not get the money to buy more? Matt is scared, what if he won’t get his next stick of cigarette?

There are various fears that an addict holds. It is not just related to his substance, but various situations that he encounters in his life. And these fears might even display paradoxes like existence of fear of change and fear of constancy or no change! Fear of others and before that fear of oneself! Fear of non conformity in peer group and fear of relapse at the same time! So we can say that fear indeed is a powerful motivator. It can make any human do anything, rather it brings people in a Do Or Die situation.

Power to Make Your Fears Come True Can Be Used As The Power To Make Positive Assertions Come True Too

I have often heard this from people “Whatever you fear, it would definitely come true. But if you think of something positive, it might not come to pass.” It is a myth. It is all in your mind. If you have the energy to get your fears manifested into reality, then you can utilize the same amount of energy in getting positive things created.

Connecting it with addicts, they always have this fear that their trepidations are going to strike them hard in reality. They want to escape them.

We all work as per our convenience. So when an addict wants to take his substance, he would think of various alibis. He would speak about his bad experiences in life. But what about the ‘Bad Trips’ of drugs that he had? Would he ever say that I don’t want to do drugs anymore because I vomited and lost my senses after I took it? But yes, he would definitely say that I don’t want to feel happy without drugs, because if I do, I will lose my reason of happiness!

School of thought of Humanistic Existentialism says that we all have a purpose to live. There is nothing that humans do without a reason. Addicts consider all the negative reasons to live. They choose to keep themselves scared of happiness and joy without drugs.

What Needs To Be Actually Done Instead Of Fearing Situations

Recognition of Thoughts- reckon what exactly your thoughts and feelings are.

Gain Control Over Them- after you know accept your thoughts and feelings, you control them. It is your mind, so do not let it control you, but you control it.

Reason Them Out- since there would be various thoughts at a time, so you need to reason out with your understanding what their implication on your life could be or has been.

Look at the Practicality of Solutions Your Mind Gives- once you have seen what repercussions you have faced because of your actions, you must introspect with consequential thinking and give your thoughts a reality check to see the possibility of putting them down into practice.

In case of a Positive Response from the Mind, Get it into Reality- finally, if you think that there is something positive that you can practice, you must just do it.

We know that it is not that easy to change that fearful streak. But you have perfected your fear through constant practice, you can perfect confidence and taking the right decisions through practice too. You or your loved ones need rehabilitation if you think that there are too many fears bothering your or their mind and you or they are unable to quit using any psychoactive substance.

Try it at least. And see how well it works. You know, there is always light at the tunnel end.

Common Themes in Addictions

It doesn’t matter whether the addiction is to substances, gambling, alcohol, shopping or sex. All those with an addiction share common things:

1. Strong Feelings – Everyone has a wide range of feelings that can be positive or negative. People who lead with their feelings, however, often end up living in the ditch! I have found, over the years that many of my clients who suffer from an addiction state that their anxiety motivates them to turn to unhealthy coping strategies. Their unmanageable feels often play a key role in their addiction pattern.

2. Lack of skills – Those who don’t know how to deal with their feelings in a healthy way, look for alternate methods. For example, someone who has problems with relationships and doesn’t have a good self-image, might be a likely candidate to become a workaholic. They might become very valuable in the workplace and learn specific work skills but doesn’t solve their other personal problems.

3. Enablers – Most people with addictions can name the person who first introduced them to the substance or activity that led to an addiction. They also usually have people in their lives who have contributed to or allowed the addiction to continue with their inappropriate behaviours.

4. Fantasy and Cravings – When a person is thinking about the addiction in an obsessive manner and has cravings to use their focus is not available for their responsibilities.

5. Detachment – Sometimes it may seem like the addict has two people living inside. There is the public person who presents well and the private person who is involved in a secret lifestyle. In many cases, the person has been able to detach one from the other and sometimes even doesn’t remember doing specific things because they have become so good at separating the two. This is common with a number of problem areas such as eating disorders and sexual addictions.

6. Tolerance – Over time, the amount or strength of a substance or activity that is needed to produce a high will need to be increased in order to get the same effect. Those who begin by looking at pornography, for example, may increasingly require more frequent or more powerful images. Some may advance into chat lines and affairs, begin hiring prostitutes or add violence to their sexual experiences.

7. Withdrawal – Distress can occur when the addiction is not fed. A person may become frustrated, angry or unable to function when they are abstaining. Withdrawal can be physiological and/or psychological in nature.

8. Consequences – Those with addictions often also experience relationship problems, financial and employment issues, legal encounters, deteriorating health, shame and self-loathing. Over time, their lives can become unmanageable.

9. Defense Mechanisms – Denial, projection, blaming, repression, rationalization, intellectualization, minimization, deflection and manipulation are some of the ways that the person avoids facing reality and getting treatment.

10. Temptations – A person who is addicted has formed a life that promotes the addiction. Their friends, activities, schedule and habits all revolve around the addiction. S/he are able to get a shot-term “fix” easily as that has been their pattern. Recovery therefore involves facing one day at a time, knowing that commitment to change long-term will be difficult.

11. Opportunities to change – It doesn’t matter where one goes in the world, there are supports and resources to help the person who is addicted. But that person has to be ready and willing to change. Alcoholics Anonymous, group therapy, public agencies and private therapists are only a phone call away. Employers offer Employee Assistant programs and insurance companies usually recognize addiction as a medical issue that qualifies for disability benefits.

12. People who love them – If you are worried about someone who is involved with an addiction, you need help. You cannot change another person but you can work on yourself. The best thing you can do today is book an appointment with a psychologist who specializes in addictions so you can begin working on your healthy future.

10 Common Questions Men Have About Sex Addiction

1. Question: Am I a sex addict?

Answer: There are a number of red flags that can signal an addiction to sex. A person who uses sexual activity be it intercourse, viewing pornography, phone sex, chat rooms, prostitution or masturbation as a numbing agent, something to prevent them from feeling bad, may have a sex addiction. Other indicators the sexual behavior is causing the addict problems include their spouse becoming upset over their behavior or they’ve gone into debt over payment for phone sex lines or Internet pornography sites. Spending an excessive amount of time viewing pornography Over 10 hours a week is another red flag, since this sexual behavior is interfering with time spent with friends, family or at work.

Another key factor is the addict has tried to stop engaging in sexual behavior but failed. When all these things come together, it’s time to ask a professional about getting help.

2. Question: Can I be cured?

Answer: Many sex addicts have reported being able to bring their sexual behavior under control, through any one of a variety of treatment methods. Some attend intensive rehabilitation facilities; others go to therapy sessions, attend 12 step meetings or use medication and a host of other techniques to control their sexual behavior. This can include finding a trusted person to act as an “accountability partner.” Or for pornography addicts, it can mean the use of pornography blocking computer programs.

3. Question: Does being cured mean I give up sex?

Answer: No. Unlike chemical dependencies related to alcohol or drugs, sex is recognized as a healthy aspect of life. Treatment for sex addiction, while it does involve a period of abstinence, seeks to bring harmful and unwanted troublesome sexual activity under control to where it is no longer causing harm. It may lead to stopping viewing pornography, discontinuing solicitation of prostitutes and other “bottom line” behaviors or even illegal activities. The goal is stopping harmful behavior, but certainly not giving up sex.

4. Question: Is sex addiction even real, or just something people use to excuse their behavior?

Answer: Truth be told, there are some experts who don’t feel sex addiction is real and say it’s more a product of conflicting social norms and mores. Other say sex addiction exists but do not feel it meets the definition of an addiction in the same way addiction to alcohol or drugs does. For a sex addict seeking treatment, it may be a moot point. To get treatment, first one has to recognize they have a problem and stop trying to use their own willpower alone to control it. Many people have sought treatment for sex addiction and reported results. Much of the criticism about its validity has been aimed at celebrities embroiled in public sex scandals and is hardly analogous to the average person not living in the public eye. Sex addiction is real and one struggling with unwanted sexual behaviors certainly can attest to that fact.

5. Question: What caused this? How did I get to be this way?

Answer: There is no definitive cause for sex addiction, and for each person it will be different. Many sex addicts report being sexually abused at a young age and growing up with a distorted view of sex and what a healthy sex life should be. For others, it is simply the rush of chemicals in their brain after discovering a parent’s pornography stash or coming across it in some other fashion. Still others indicate the accessibility of Internet pornography had them fall into a cycle, while there are those who turned to using sex as a numbing agent during a difficult period in their lives and began relying on it as a coping mechanism. For some growing up with abuse, neglect, abandonment and enmeshment have cause the to seek out other ways to feel good about life and themselves.

While knowing the cause of sex addiction is important, those on the path to recovery should not seek to dwell on the unchangeable past; instead, they need to focus on their present actions.

6. Question: Does viewing pornography and sexual interaction over the Internet count as cheating on my spouse?

Answer: Not to be glib, but it can depend on the spouse. Certainly many women do feel that their spouses having cybersex or phone sex with another woman qualifies as infidelity. They may not react in the exact same way as if it had been physical sex with another woman, but the impact on a relationship can be dire. First, the wife will feel betrayed. She won’t trust her husband if he’s been hiding his behavior. She may can feel bad about herself, perhaps thinking some failing on her part led the husband to seek these sexual outlets.

Even pornography viewing can be a sore spot for women. Society places a lot of pressure on women to be physically attractive and sexually desirable and they may feel they are in competition with actresses in pornographic videos. This can affect their self-esteem, even if they do not confront their husband about the behavior.

7. Question: Can medication lower my sex drive so I don’t have this problem.

Answer: Yes and no. There are medications out there that can lower a person’s sex drive, and they are often used to treat sex addiction. However, they are limited in their power to erase the problem completely. Some form of therapy, be it a 12 step program or other process, is required.

8. Question: Will I ever be cured or is this a lifelong problem?

Answer: Many people report being able to bring their sexual behaviors under control, sometimes after a period of months or years, and are living lives relatively free of problems related to sex addiction. These people have addressed the factors in their life they had once sought to control by using sex; they have now embedded into their lives multiple tools to avoid falling back into destructive addiction cycles. For some, there is always the fear they will relapse, and some do struggle with sex addiction for long periods of time. There is no quick fix for the problem.

9. Question: I’m also addicted to alcohol. Is my sex addiction just a sign that I’m susceptible to addictive behaviors in general?

Answer: In some ways, yes. Many sex addicts report being addicted to alcohol, drugs, or behaviors such as gambling. They also claim family members with various addictions. It’s certainly been theorized that a person can have a genetic predisposition to addictive behaviors. As to treating multiple addictions, it should be noted that many sex addiction treatment programs are modeled after alcohol treatment techniques developed by Alcoholics Anonymous. 12 step programs such as Sexaholics Anonymous, Sex Addicts Anonymous and Sex and Love Addicts Anonymous model their programs after and borrow their literature from that organization.

10. Question: Am I really a sex addict or is my sex drive just naturally high?

Answer: The difference between a sex addict and a person who enjoys a lot of sex has to do with why the behavior is being sought and the inability to stop an unwanted behavior as well as the obsession and compulsion. A person with a high sex drive is aroused and in most cases can control acting on that arousal. A sex addict is engaging in sex as a coping mechanism, isolating themselves from others even if they have a real life partner for the sex, and engaging in the sex act compulsively. They may feel shame after they complete the act, or some general feelings of depression. Actual arousal is not the primary motivator.