Cards, money, and poker chipsThe feeling-state addiction protocol is a modified form of eye movement desensitization and reprocessing, referred to as EMDR in mental health. EMDR is a trauma treatment modality recognized as one of the main treatments for posttraumatic stress (PTSD) and other forms of trauma.

In EMDR therapy, therapists desensitize a traumatic memory by having the person in therapy use eye movements (or other back-and-forth stimulation) while holding the memory in mind along with the feelings, images, and belief about self in that situation. This causes the brain to process the memory in a way that takes the charge off the memory, so it no longer feels disturbing. In feeling-state addiction protocol, we desensitize the pleasant memory causing the addiction by removing the charge from that memory.

Tom and the Feeling-State Theory of Addictions

The feeling-state theory of addictions assumes that the feeling underlying the behavior, not the apparent object or behavior, is the real goal of unwanted compulsive behavior. In alcohol or drug addiction, the substance creates the [fat_widget_addiction_right]“feeling-state” that causes the compulsive behavior. In behavioral addictions, however, any feeling-state can be linked to any behavior. Feeling-states are state-dependent memories created during an intensely experienced event. With gambling addiction, we look for the positive feeling-state linked to the gambling behavior.

I worked with a person in therapy, who I will call Tom, who came to me because he had “reached bottom with the consequences of his gambling,” as he put it. Tom is a 37-year-old man who started therapy saying that he wanted to overcome two addictions: a very destructive woman and gambling.

The precipitating incident that brought Tom to therapy was having just lost his last $12,000 in a poker game, the final straw that caused him to lose his house. He had recently moved in with his parents, and they insisted he deal with the gambling addiction.

Both of the addictions Tom wished to treat are known as process addictions or behavioral addictions because they are not addictions to a substance. When he first came to see me, Tom was dealing with an intense sadness from losing his relationship and shame from losing his house and moving in with his parents. Tom’s parents agreed to pay for his therapy and insisted he make measured progress, lest they throw him out of the house.

Although addiction to a person and addiction to gambling seem different, like all behavioral addictions, they both involve an addiction to a feeling-state. According to Dr. Robert Miller, who developed the feeling-state addiction protocol in 2011:

“The feeling-state theory of behavioral and substance addictions postulates that addictions are created when positive feelings become rigidly linked with specific objects or behaviors. This linkage between feelings and behaviors is called a feeling-state. When a feeling-state is triggered, the whole psycho-physiological pattern is activated. The activation of the pattern then triggers the out-of-control behavior.”

The first step in eliminating a compulsion, according to Dr. Miller’s feeling-state protocol, is to figure out the feeling-state that drives the compulsion.

Identifying the Real Addictive Behavior

In therapy, we determined that the feeling-state Tom was addicted to with gambling was bonding with his father, which had provided both a sense of belonging and mastery.

Tom had one brother who was five years older. He described his brother as the favorite and the one his dad often Tom was very shy and described himself as someone who had never excelled at anything. He had few friends and participated in few social activities. In fact, the first time he said he felt any positive attention from his father was when he would watch his father’s poker games every week.praised for his intellectual ability and athletic success. Tom was very shy and described himself as someone who had never excelled at anything. He had few friends and participated in few social activities. In fact, the first time he said he felt any positive attention from his father was when he would watch his father’s poker games every week.

By the age of 18, Tom became a good observer and was playing cards with his dad’s poker group. He was skilled and was often the winner. It was this feeling-state of bonding with his father and the feeling of belonging to a group that drove his gambling compulsion.

We processed these strong feeling-states with EMDR, and his craving for gambling started to subside. We then discovered other feeling-states linked to his gambling. They were the feeling-state of freedom and mastery. Once we unlinked or disconnected these feeling-states with gambling, his desire for gambling waned and we could then address the psychological dynamics underlying the “need” for the gambling, such as his relationship with his dad, his feelings of being a “loser,” and the belief he is not smart and can’t succeed at anything.

We also desensitized his attraction to the destructive woman who had recently come back into his life. When he realized how easy it was to remove that attraction for her, it gave his self-esteem a huge boost. This helped him see other dynamics in his life with more clarity and confidence.

I have used this model with many process addictions, including:

I find it to be effective and relatively easy for the person in therapy because the person largely avoids the pain of going through withdrawal.

References:

  1. EMDR International Association. (2014). What is the actual EMDR session like? Retrieved from http://www.emdria.org/?120
  2. Miller. R. (2011). The feeling-state theory of behavioral and substance addictions and the feeling-state addiction protocol. Retrieved from http://www.psychinnovations.com/EMDRSD/Miller_Feeling_State_Addiction.pdf

First, thanks for writing. Second, I’m sorry to hear about your travails; I can only imagine the exhausting and frightening roller-coaster you have been riding. Finally, this may or may not surprise you, but even as a therapist I can relate to your question, “What kind of therapy is best?” I recently read an article by a newly licensed and overwhelmed therapist who said there are something like 200-plus “modalities” for therapists to choose from. It seems every other day someone is inventing a new approach to this, that, and the other. One research study says this approach is solid, the next one says the opposite. No wonder you’re confused!

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Fortunately, clarity can be found, because ultimately any good therapist—in my experience—is there to answer the question, “What is most helpful or healing for this particular person at this particular time?” Nearly all research studies come to the common conclusion that a safe and trusting therapeutic relationship is central to a helpful treatment. If someone has a viscerally strong response for or against one of my recommendations, my job is not to call this “resistance” but rather to listen, explore, and learn what’s going on.

So, point one: Is the therapist you’re talking to listening to you, as an individual, not a generic “anxious client” or “parent of an addicted child,” etc.?

In general, human beings prefer certainty to ambiguity, but offering too much certainty as a therapist is misleading and maybe even unethical. No one has a “lock” on what to do for sure. Now, practical suggestions can be helpful and reassuring. A common “tip” a therapist might offer someone in your situation might be to attend Al-Anon meetings. It certainly couldn’t hurt to try the program. There is much to be gained, even if it ultimately isn’t a good fit. (I’ll return to Al-Anon in a minute.) Other suggestions, such as “Take care of yourself” or “Don’t enable the addicted person” or “Detach with love” are a little more problematic, because although they might sound good, but what do they mean for you and your loved one, in this particular case, with whatever circumstances are happening at that time?

What if a person grew up in a family where setting certain types of boundaries, or stating one’s needs or limitations, drew traumatizing emotional fire? Are they being weak for not “speaking up” or “asserting their needs”? Trauma tells us something is still prohibited or dangerous, in the present, since we are wired for self-protection and safety above all. This is where self-help gives way to psychology, to empathic understanding and exploration of a person’s experiences, beliefs, and needs. Some parents may tell me, “Not giving my addicted child money feels like I’m killing them.” It would be easy for me to wave this off and urge them to withhold—“Hey, it’s for their own good”—but, again, that might be overly simplistic.

I would certainly recommend that you seek a therapist who has experience working with families and parents of addicted children, someone who can empathize and offer suggestions that make sense for you and your circumstances. A sense of safety and trust is essential.

I would certainly recommend that you seek a therapist who has experience working with families and parents of addicted children, someone who can empathize and offer suggestions that make sense for you and your circumstances. A sense of safety and trust is essential. One litmus test is, can you give the therapist feedback on what is or isn’t helpful and how does the therapist handle it? If they become defensive or claim it’s all your “resistance,” I say move on sooner rather than later.

Other factors you’ll want to look for: experience with addiction as it affects families; knowledge of treatment options (including local or community support groups besides or in addition to Al-Anon, and an understanding of Al-Anon, come to think of it!); and a patient but persistent curiosity about your experience. If it seems like a lot to ask, it may be; but to be honest, so what? Addiction is a merciless, complicated issue (some prefer to say “disease,” others don’t); it takes a lot from people and asks a lot from families, so it stands to reason people in therapy will, at least some of the time, need a lot from their therapists. It comes with the territory.

I also suggest you try at least two or three therapists to get a sense of different styles and so forth. This is not uncommon, and it makes a lot of sense.

Finally, a word on Al-Anon. Some swear by it, others say “stay away at all costs.” I think any rigid position is potentially harmful. I think trying it is a good idea. (It is also good role modeling for your child, who may not be so keen on attending meetings at first but may ultimately find them essential.) Try a few different meetings; attending one and disliking it is common, but no two meetings are the same and some fit better than others. Some are turned off by the spiritual talk, others aren’t. I suggest you take what you like and leave the rest. At the least, it allows people in your position to share their experience in a communal setting, offer practical ideas on what has worked and what hasn’t, and may possibly provide support for those, like you, who are overwhelmed and beleaguered. Addiction is a hurricane, and everyone in its path suffers.

I think it is terrific that you are seeking support. That shows a humility and inner wisdom that should be nurtured and supported by the right provider. Sometimes, what people need most is a sense of hope. There is no shame in seeking or wanting this. Yes, sugarcoating or fantasy can be dangerous, but so can hard-edged “realism,” since the truth is we just don’t know what will happen from one day to the next. It is a day at a time for all of us, therapists included.

Thank you for writing, and best of luck to you in your search.

Kind regards,
Darren

Waiting room in an officeThere are many different types of residential treatment centers (RTCs) that offer therapeutic care for a wide variety of behavioral and mental health issues. Choosing a center that is suited to your personal needs is important; however, with many options available, making a decision may be difficult. How can you decide which RTC is right for you? Consider these answers to ten frequently asked questions about RTCs, as well as insight from Darren Haber, MA, MFT, an expert on addictions and compulsions.

1. What is a residential treatment center?

A residential treatment center is a health care facility that helps people experiencing various substance dependency and behavioral issues. For some inpatient treatments, residents may be required to live at the facility for a period of time. Some facilities also offer outpatient treatment to help former residents avoid relapse and to provide options for people who cannot commit to living at the facility temporarily. In most cases, treatment lasts for one to three months.

“[The] average stays tend to be 30 days, but some stay longer, and some shorter. Thirty days seems to be the industry norm,” Haber said.

2. What are the most important things to look for in an RTC?

Check and confirm that the RTC and any programs you wish to attend are accredited and the treatment programs are being administered by licensed, qualified mental health professionals. Ask if the program has a clinical director and about his or her credentials. Learn as much as you can about the treatment center you’re considering through third parties such as the Better Business Bureau, online reviews, and any local consumer protection agencies. If you need it, ensure that an active aftercare program is in place to help prevent relapse.

3. What type of issues do residential treatment centers treat?

Because different RTCs specialize in treating different health issues, the structure, routines, and therapeutic methods used will vary from facility to facility. Some centers take a “lock-down” approach where residents are secured within the facility’s premises and their movements inside the center are restricted. Other RTCs may take an unlocked approach and allow residents to traverse the premises with some degree of freedom; however, residents may only be permitted to leave the center if certain conditions are met.

In recent years, the residential treatment field has expanded. At some centers, everything from substance abuse to sex addiction to codependence may be treated. There are also centers that focus solely on substance abuse or eating disorders, for example.

Issues treated at an RTC may include:

It should be noted, too, that some RTCs specializing in mental health treatment may not provide therapeutic care for substance dependency issues.

4. Why do people go to residential treatment centers?

“Usually because their condition or problem has reached the point where it needs containment—that is, 24-hour medical or psychological monitoring due to harmful behaviors or medical problems—and has become so acute that it requires an acute, sustained focus,” Haber said.

5. What kinds of services are provided by RTCs?

Residential treatment centers offer a variety of services, which may include 24-hour supervision, intensive recovery programs, individual counseling, group counseling, structured activities, educational services, social skills training, vocational training, and relapse prevention services.

6. What are the benefits of a RTC over other forms of treatment?

The environment in a residential treatment center is usually more comfortable than the sterile, functional setting of a hospital. The residents are able to focus solely on their healing and recovery programs as they are removed from the stresses of daily life.

Some treatments, such as chemical detoxification, may be life threatening. For those cases, RTCs provide trained medical personal to keep residents safe during such treatments. Residents also have the opportunity to explore the emotional and psychological underpinnings for their behaviors in counseling sessions with a qualified mental health professional.

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened,” Haber said.

7. What is the experience of being a resident at a residential treatment center like?

“It’s really what the client or patient makes of it. Anyone who participates to the best of his or her ability can potentially gain much and grow and learn tools for lifelong use. If one has been forced in by family but doesn’t believe, for instance, that one truly has an issue with alcohol or addiction, it can feel almost like jail,” Haber said.

8. How can families or friends keep in touch with residents?

“It depends on the policy of the residential treatment center. Some encourage family contact and some don’t. Some RTCs prefer those in treatment wait until their detox is over, or that the person in treatment only meet family members with counselors present. I believe this is a crucial part of treatment that can easily be overlooked, since dysfunctional family systems often play a crucial role in the formation of the illness or addiction,” Haber said.

9. Are there any RTCs in my area?

With the number of treatment facilities currently providing care across the country, chances are there is a residential treatment center nearby. However, it is important to remember that your chances of recovery may be better if the chosen facility is well suited to your personal preferences and specific health condition.

10. How much does treatment at a residential treatment center cost?

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened.”The cost of treatment at a residential treatment center will vary based on the condition being treated, services provided, length of treatment, and the location of the center. For example, The Betty Ford Center, one of the most well-known rehab programs, charges approximately $1,217 per day for inpatient alcohol addiction treatment at their Rancho Mirage, CA location. Other locations may charge more or less, and some may not offer a per-day rate. Most locations develop a program based on a person’s individual needs, which can drastically affect the cost depending on medication or other requirements.

Some facilities may be able to offer a sliding fee based on a person’s income, while some may be low or no cost. Others may offer luxurious settings and amenities. The types and costs of RTCs simply vary. If your personal health insurance covers residential care, even the more costly facilities may become affordable. Call your insurance company for more information regarding your covered benefits if you are in need of inpatient treatment.

References:

  1. The Addiction Recovery Guide. (2015). Drug and alcohol addiction recovery. Retrieved from http://www.addictionrecoveryguide.org/treatment/residential
  2. The American Residential Treatment Association. (n.d.). Types of programs. Retrieved from http://artausa.org/type_programs.html
  3. Federal Trade Commission. (n.d.) Residential treatment programs for teens. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
  4. Hazelden Betty Ford Foundation. (n.d.) Addiction treatment specialties. Retrieved from http://www.hazeldenbettyford.org/treatment/locations/betty-ford-center-rancho-mirage
  5. Mental Health America. (n.d.). In patient care. Retrieved from http://www.mentalhealthamerica.net/patient-care
  6. National Institute on Drug Abuse. (n.d.) Principles of drug addiction treatment: a research based guide. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
  7. Smith, M., & Segal, J. (2015). Choosing a drug treatment program: What to look for in substance abuse rehab. Retrieved from http://www.helpguide.org/articles/addiction/choosing-a-drug-treatment-program.htm

Standing woman looks out windowIt has been more than 30 years since Dr. Patrick Carnes published his book, Out of the Shadows: Understanding Sexual Addiction, which introduced the concept of sexual addiction. One working definition of sexual addiction is a pathological attachment to a mood-altering experience of sex.

At that time, the focus was almost entirely on males who were addicted to sex. But new ground was already being broken. When I first met Jennifer Schneider—an Arizona psychiatrist—in the early 90s, she and a colleague had recently completed a book about couples recovering from sexual addiction.

Schneider and her colleague obtained detailed information about married females who were addicted to sex. Twenty-four women and 17 husbands were interviewed by telephone; 7 of the male spouses declined to take part in the survey. The findings were provocative back then, but they are confirmed by my own clinical observations over the years.

Gender Differences in Sex Addiction

Unlike the majority of men with sex addiction, most women are aware of their codependency when they initially begin therapy with me—either alone or with a partner. Codependency can be briefly described as looking outside oneself to other people in order to define self-worth.

[fat_widget_sex_right]This makes the early stages of recovery particularly difficult for women who are sexually compulsive. Initially, a period of abstinence is important in order to learn to maintain sexual boundaries. But that requires being able to say no without it affecting self-worth. As one woman in therapy put it, “I don’t want to deprive him or drive him to look elsewhere for sex!”

I find that is rarely a problem for a man choosing a period of abstinence. Unfortunately, this culturally learned gender difference makes it much more difficult to rebuild marriages in which the wife is sexually compulsive. Females with sex addiction often feel alone and unsupported as they work toward recovery.

Steps for Women in Recovery

In order to appreciate the complicated nature of sex addiction for women, it’s important to recognize how terrifying psychological isolation can be. One woman told me, “I feel ashamed that I feel lonely even in my marriage, like something in me is broken and defective.”

Consequently, women in recovery benefit most from a combination of supportive individual therapy and group experience, both 12-step and therapist-led. In 12-step meetings such as Sex and Love Addicts Anonymous (SLAA), participants share experiences, strength, and hope. In her book, Ready to Heal: Women Facing Love, Sex, and Relationship Addiction, author Kelly McDaniel lists some of the numerous benefits:

You may not be able to heal your brain alone, and the brain usually doesn’t function at its best capacity when you are isolated. Therapy can provide a trusting relationship and a healthy context for healing.Healing relationships requires healing the mind and the lifelong patterns that have shaped responses to the people closest to you. When your mind is fearful, you may have problems trusting or acting outside of your truest morals and values. Women with sex addiction may have difficulty being their best selves, and many of their sexual behaviors may have fallen outside their value system.

Healing your life also means healing your brain, and this may require professional support. Sexual addiction thrives in isolation. You may not be able to heal your brain alone, and the brain usually doesn’t function at its best capacity when you are isolated. Therapy can provide a trusting relationship and a healthy context for healing. McDaniel makes these suggestions for being a careful consumer when you’re ready to find a therapist:

Women experiencing sex addiction today have a much greater chance of finding a caring and well-trained professional than their mothers may have had. You owe it to yourself to find the best help possible.

References:

  1. Carnes, P. (2001). Out of the shadows: Understanding sexual addiction (3rd ed.). Center City, MN: Hazelden.
  2. McDaniel, K. (2008). Ready to heal: Women facing love, sex, and relationship addiction (2nd ed.). Carefree AZ: Gentle Path Press.
  3. Schneider, J., & Schneider, B. (1989). Rebuilding trust: For couples committed to recovery. Center City, MN: Hazelden.

Flowers in the hands of an older personMost of us take care of others at some point, sometimes putting their needs first or focusing on helping them out of tight situations. In the 1930s, the term “codependent” was introduced to describe the partner of someone who is addicted to alcohol. What constitutes codependency was later broadened to include a wide spectrum of behaviors, from substance use to compulsive gambling to sex addiction. Codependency also expanded to include relationships in which the other person’s needs are always put first, often to the complete exclusion of a person’s own needs. It may be believed that if this is done, self-sacrifice will be recognized, reciprocated, and rewarded by the other person.

In the following fairy tale, titled “The Wife Who Refused to Bury Her Husband,” consider how codependency often plays out:

There was once a woman who loved her husband very much. Her husband became ill, and after a long time he died. The woman didn’t know how she would carry on without him, and the thought of putting him into the cold ground, casting dirt down on top of him, and leaving him all alone in the graveyard seemed unbearable to her.

So she didn’t bury him. Instead, she kept him in their bed, where he had died. She continued to take care of him, bringing him bowls of good, warm broth (for which, of course, he never thanked her), and spending what little money she had on medicine for him (which he never took), and putting bandages on him (which did no good at all). Every night, she slept next to him.

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As you can imagine, the situation became challenging. Insects and other vermin came into the bed where the woman slept each night. As nature took its course, which nature will do, her own health was put at risk. Sometimes as she lay there, trying to sleep, she wept bitterly because it seemed her husband didn’t appreciate anything she did for him. But then she would rally herself: “I just need to take better care of him, that’s all. And besides, I couldn’t live without him.”

The tale opens with the woman’s husband having just died after a long illness. He’s no longer present in the relationship. People we love may become increasingly unavailable when practicing an addiction. Untreated, addictions also tend to get worse over time. William G. McCown and William A. Howatt, in Treating Gambling Problems, describe the phenomenon of “motivational toxicity,” which is the decreasing ability to be motivated by anything other than the addictive experience.

There’s another sense in which a partner or loved one can seem to be “dead.” One aspect of codependency is to always put the other person’s needs foremost and to expect that person to take care of our needs without having to mention them. When this doesn’t happen, people may perceive the other as ungrateful and unresponsive. Another aspect of codependency is the desire to manage and manipulate others. In this sense, one person becomes an object of another person’s management. Rather than experiencing that person as a subject, the way you might experience your own existence in the world, that person experiences the other as something to be controlled and arranged to best protect a sense of safety.

In the fairy tale, the woman is unwilling to bury her husband even though he’s dead. The idea of consigning him “into the cold ground” is unbearable to her.

Being buried is a natural consequence of having died, and so the woman is trying to protect her husband from this consequence. She appears to be confusing her own responses for his. The husband shows no fear or reaction to hot or cold, to loneliness, or company. Sometimes in addiction, nothing impacts the person who is addicted until that person bottoms out—in other words, the addiction no longer protects the person who is addicted from any painful feelings. Hitting bottom is how many people enter recovery.

Sometimes people with codependent patterns of behavior believe that the other person can’t live without them. In a domestic violence situation where an individual isn’t yet ready to exit, he or she might find grounds for staying with the idea: “I’m the only one who can really understand and help my partner.” This person might think he or she is a partner’s or loved one’s last and only chance for living a good life, or even staying alive. Paradoxically, this seems to make an individual feel very important, essential, almost as if the other person carries him or her as the reason for living.

The woman in the fairy tale cooks her husband nourishing meals and uses her money to buy him medicine and put bandages on him. Jennifer Sowle, in The Everything Guide to Codependency, notes, “If you are codependent, you are not powered from within; your quest for power is through controlling others.” We observe this in the woman in the fairy tale as she attempts to do just that. She tries to control something over which she has no control—trying to make her husband “get better,” although he’s in a state she can’t affect.

This may be reminiscent of some of the arrangements a person experiencing codependency might try to make, at great cost. Sometimes these arrangements are financial—bailing someone out of jail, paying a person’s debts, or providing someone with another stint in detox. Often, it’s in the form of energy someone expends and the wear and tear on his or her heart as the other person says they’ve changed and this was the last time they will strike him or her, or have an affair, or go out on a bender. But the promises an addicted loved one makes aren’t always reliable indicators of change. In the story, the husband is dead. Therefore, he’ll continue as he’s going, and the deterioration will continue as well.

As the woman keeps her dead husband in their bed, in the natural order of things, he begins to decompose. This places her at risk. Addiction often brings chaos, and things can fall apart. Consequences can include legal issues, or What could the woman in the fairy tale or anyone do in order to implement boundaries? She might begin by identifying the needs she has in her relationship and assess whether those needs are being met. She might take a moment to reflect on who she is apart from the relationship—what does she like, dislike, believe in, or do for enjoyment? having people present in the home and in a person’s life who aren’t wanted, from social workers to pushers to other people who are addicted to creditors of past-due debts. These natural consequences will affect the partner who is codependent or family members, as well as the person who is addicted. If the woman was going to do something effective, what would it be? Would it be to focus on her husband, trying to get him to respond and change, or would it be to focus on her own behaviors?

“And besides, I couldn’t live without him,” the wife says, which brings us to the heart of the matter. In Breaking Free of the Codependency Trap, Janae B. Weinhold and Barry K. Weinhold note, “You started out as a helpless infant who could not survive without the care of your parents.” As infants, people depend on their caregivers absolutely. It’s quite possible to love and cherish others, to love life in general, and to value your own life, but for those who experience codependency, the idea may be that their life somehow depends on their partner or loved one’s life, and that their partner or loved one’s life should therefore be responsive to their control, which indicates a confusion of boundaries.

What could the woman in the fairy tale or anyone do in order to implement boundaries? She might begin by identifying the needs she has in her relationship and assess whether those needs are being met. She might take a moment to reflect on who she is apart from the relationship—what does she like, dislike, believe in, or do for enjoyment? She might notice that her husband’s condition is just that—his—and that if she continues trying to rescue him from it, she’s depriving him of the chance to learn from his own life (or death, here).

As she becomes more aware of her own needs, she might notice what she doesn’t want around her. She might say to her husband, “If you’re not going to eat the soup I make for you, then I’m not going to make soup for you,” or, “If you’re going to be in our bed, you may not bring insects and vermin in. If you do, then you’re no longer welcome in our bed.” By setting these boundaries and enforcing the consequences, she may come to a place where she can assess whether she wants to continue with her husband the way things are, or whether she wants to implement change in the relationship.

Meanwhile, the hope is that the woman will begin her own inner work, wake up some morning soon, and realize what she’s in bed with.

We can’t do much about anyone’s addiction because it’s not ours to do anything with. Finally, recovery is a choice for the person who is addicted. It’s a choice that may not be selected, but we can choose a path for ourselves. We can choose to bury the past, mourn for what’s lost, and move on.

Child on a swing between separated parentsEarlier this year, a Michigan judge incarcerated three children after they refused to see their father. The children say their father is abusive, but the father claims the mother has initiated a campaign to alienate him from his children. After swift public outcry, the judge released the children, ordering instead that they participate in parental reunification therapy.

Divorced parents often engage in acrimonious custody fights, and some parents may launch extended campaigns to destroy their children’s relationship with the other parent. Parental alienation syndrome, originally coined in the 1980s, remains a controversial diagnosis and is not listed in the DSM-5.

A broken relationship with one parent can be destructive to children, but so can spending time with an abusive parent the child fears. Parental reunification therapy requires children to spend extended periods of time with the alienated parent, often without contact from the other parent. The theory is that this is the only way to break the cycle of parental alienation, but controversy swirls around the practice. Critics say the therapy could be used to force contact with abusive parents, and the treatment may amount to “deprogramming” that can be traumatizing.

Alzheimer’s Disease Consists of 3 Distinct Subtypes, According to UCLA Study

A UCLA study has identified three potential subtypes of Alzheimer’s. Though more research will be necessary, the subtypes could shed light on Alzheimer’s causes as well as potential treatment. Inflammatory Alzheimer’s is characterized by an increase in C-reactive proteins, as well as an increase in serum albumin and globulin levels. Non-inflammatory Alzheimer’s does not produce the same increases, but does lead to other metabolic abnormalities. Cortical Alzheimer’s—which often affects relatively young individuals—affects language first and produces effects that are more widely distributed across the brain.

The Sinister Science of Addiction

Research has long suggested that addiction is a disease rather than a personal failing, and measurable differences in brain chemistry account for much of the behavior associated with addiction. A new video in the Reaction series—a group of videos produced by the American Chemical Society—shows how addiction functions in the brain.

Criminals Acquire Guns Through Social Connections

[fat_widget_right]Popular myths suggest most guns used in crimes are stolen, but new research suggests that friends and family are a more likely option for acquiring guns. Research on the Cook County Jail in Chicago about how jail inmates obtained guns suggests that 60% of the guns were purchased or the product of a trade. Chicago gun laws prohibit selling guns to people with criminal records, so many former inmates are unable to acquire guns at gun stores or through other traditional avenues.

Trial Review Confirms Common Antidepressant is ‘Unsafe and Ineffective’ for Teens

Paroxetine—better known under its brand name of Paxil—has been prescribed to teens to treat depression since 2001, but new research argues the practice should end. Not only was the drug no better than a placebo; it was also potentially dangerous. In 2012, GlaxoSmithKline, the pharmaceutical company that markets the drug, was fined $3 billion for failing to report drug safety information to the Food and Drug Administration and for illegally marketing some of its drugs.

The Psychology of Why People Like Steve Rannazzisi Lie About Having Survived 9/11

A handful of people have been accused of lying about being present at the 9/11 terrorist attacks. This week, comedian Steve Rannazzisi came clean, admitting he had been lying about his presence at the World Trade Center that day. Experts are unsure why some people feel compelled to lie about a history of trauma. Theories include a need to feel involved, a craving for attention, serious mental health issues, and false memories.

More Time Outside Tied to Less Nearsightedness in Children

According to a study of Chinese schoolchildren, spending time outside could reduce the rate of nearsightedness. As many as 90% of Chinese high school graduates are nearsighted. But the study, which followed almost 2,000 schoolchildren for three years, suggests that as little as 45 minutes outside each day could reduce the country’s rate of nearsightedness.

Eating a Lot of Fish May Help Curb Depression Risk—at Least in Europe

Hands garnishing fish course on plateA number of studies have tied Omega-3 fatty acids—present in high quantities of fish—to a potential treatment for depression. A pooled analysis of 26 studies involving 150,278 participants suggests that Europeans who consume fish can reduce their depression risk by as much as 17%. This correlation was found only in European studies. The reduction in depression risk as a result of high fish consumption was higher among men, who saw a 20% reduction. Women’s risk of depression dropped by about 16%.

Young woman playing computerCongratulations! You’ve made one of the best decisions you can make: asking for help. Whether you’ve decided to get help to control or moderate your use of alcohol or substances, or whether you’ve decided you want to be entirely abstinent, or whether you just want to explore the role that addiction might play in connection to an underlying depression, anxiety, stress, or self-esteem issue, you are being proactive in trying to find someone who can help you. Acknowledging that you need help is never easy, but it’s one of the best things you can do for yourself. Finding the right addiction therapist is just as important as making the decision to get help.

Before determining whether the treatment provider is “expert” enough, you have to decide what type of practitioner you would like to consult. Addiction treatment often involves working with a combination of professionals. Probably the most comprehensive place to start would be to meet with an addiction psychologist for a complete evaluation. However, there are several other types of therapists with the necessary and sufficient experience to get you on your way. It is important to know the differences between these sorts of treatment providers.

People often will begin their search for addiction treatment by consulting an “addiction psychiatrist” or “addiction psychologist.” In actuality, these are two very different kinds of professionals. Knowing the difference is essential. Furthermore, the professions of psychotherapist, social worker, and counselor all have different specialties, and their focus and breadth of treatment can vary considerably. In most instances, their credentials are much less important compared to their experience and the connection you can establish with them. Most therapists would likely agree that the most curative factor in the psychotherapeutic relationship is the rapport that develops between therapist and person in therapy. So while you’re looking for someone you can afford, you are also looking for someone with whom you can connect.

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What Is an Addiction Psychiatrist?

An addiction psychiatrist is a medical doctor who specializes in treating people with addictive and mental health issues primarily with medicines such as antidepressants, antipsychotics, and medications that help to treat underlying mental health conditions and comorbid issues. While there are many psychiatrists who don’t prescribe medications much and focus primarily on therapy instead, most psychiatrists manage medications and work closely with psychologists and other therapists who will provide the talk therapy treatment. Subsequent psychiatric appointments following an evaluation tend to be short, about 20- to 25-minute med checks; they are mostly concerned with how a person is adjusting to a drug regimen, minimizing side effects, and gauging effectiveness.

Most importantly, an addiction psychiatrist has special training in prescribing medications to help individuals who are struggling with their substance use. It is important to work with an addiction psychiatrist and not just a general psychiatrist when you are trying to determine the nature of your relationship with drugs and alcohol and considering making behavioral changes. An addiction psychiatrist can prescribe medications to help you detox or withdraw from drug and alcohol use, and they can also prescribe medications to help you with cravings, which could avert relapse.

What Is an Addiction Psychologist?

An addiction psychologist, on the other hand, is a doctor but not a medical doctor. Addiction psychologists are trained mental health professionals who can help you explore the role that addiction plays in your life. An addiction psychologist can help you become more aware of your thoughts, feelings, and behaviors, and teach you different ways of dealing with problems through therapeutic approaches such as cognitive behavioral therapy, motivational interviewing, mindfulness-based relapse prevention, 12-step facilitation treatment, and community reinforcement and family training.

Additionally, addiction psychologists let you talk your way through a problem and help you get to the heart of the issue so you can make the necessary changes that will improve your life for the long haul, and not just put a bandage on a major wound. A typical appointment with a psychologist is 50 to 55 minutes.

Other Professionals Who Can Help

There are other types of addiction therapists in addition to psychologists who might be helpful, including social workers and licensed professional counselors. Social workers may have their master’s or doctorate, while licensed professional counselors may have only a master’s-level education, though both are trained in mental health issues to varying degrees. Social workers in particular are trained in obtaining the best social agency support services, and they tend to take a social and networking approach to the treatment of mental health issues.

Psychotherapists may have any of the above degrees or none at all. A psychotherapist is sometimes a catch-all for someone who practices talk therapy, but the therapist may or may not be adequately trained according to the standards of another professional degree or certificate. For example, a psychiatrist or psychologist may describe themselves as a psychotherapist, but so too can a recovery coach or Joe Shmoe because he’s been a “spiritual advisor” ever since he was electrocuted while trying to repair his garage door. That said, many psychotherapists do receive comprehensive training, but it is important that you vet their experience, training, and credentials, as you should with any other therapist. (GoodTherapy.org does this work on your behalf as it has strict educational and training requirements for membership.)

Certified addiction counselors and certified alcohol and drug counselors are just a few of the titles bestowed to professionals who are counselors but not at the educational or academic level of psychiatrists, psychologists, or social workers. Often, these titles vary slightly according to state board guidelines, which can be somewhat less standardized from state to state. They may be no less qualified to treat you, but it is important to see someone who is licensed in his or her professional field. Ideally, your clinician would be qualified as both an addiction counselor and as a licensed mental health professional.

Finding the Right Addiction Therapist

Now that you know the differences between professionals, let’s talk about how to find the right addiction therapist for you. There are two common ways to find a psychiatrist and/or psychologist: (1) research local addiction professionals online, or (2) identify an addiction therapist who is recommended to you by another professional, friend, or family member. Both are perfectly legitimate ways to begin your search for the best match.

Once you think you have found someone, follow these steps to determine if they are competent, credible, and a good match for you. First and foremost, check their credentials to see if they are who they say they are. Make sure they have the associated degree of the professional discipline you personally are looking for. The professional you go to should be licensed, and the license should be up to date and clearly indicated on his or her website or profile listing.

If you think you found someone but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting.

Secondly, whether you want to see an addiction psychologist, psychiatrist, counselor, or psychotherapist, you should determine what expertise the person has in the field of addiction. This can be daunting because, across disciplines, there is no standardized way of determining one’s expertise in addiction. For example, while psychiatrists can be board certified in addiction medicine, addiction psychologists might obtain their proficiency by having (1) additional certification as a certified alcohol and drug counselor, (2) by being a member of the American Psychological Association Division 50 Society of Addiction Psychology, or (3) by having conducted research and published articles on addiction. Moreover, addiction counselors may have a certification through a state board, yet they may lack the background and training that a psychologist receives in mental health issues. This is important because half of all individuals who are diagnosed with a lifetime prevalence of addiction will also be diagnosed with a lifetime prevalence of another comorbid mental health diagnosis. Furthermore, one might not want to see a psychiatrist who specializes in medication management and may not have as much training and experience in the various treatments involving the talk therapies.

Third, check reviews online. There are excellent therapists who don’t yet have reviews online, perhaps because they haven’t had an online presence or because it’s just not ethical to ask for reviews. Many psychotherapists will have colleagues write reviews for them, which is a helpful way of getting recommendations. One bad review can affect someone’s listing significantly, so look carefully at all the reviews to be fair.

Fourth, review the professional’s website and other sites where their practice might be listed to see that they offer “evidenced-based” or “best practices” treatment. While these buzzwords have quite frankly become passé and obsolete as they have been co-opted by marketers, you want to be sure that your therapist at least knows about the most up-to-date evidenced-based treatment approaches. Ask what treatment the professional uses that is evidenced-based, or ask for an opinion on something you’ve learned about, like harm reduction, 12-step facilitation, motivational interviewing, or mindfulness-based stress reduction or relapse prevention.

Fifth, have a phone conversation to see if you feel some sort of connection to your addiction therapist. This may be a feeling of confidence or an inexplicable bond of initial trust, but in either case, feeling secure with your addiction therapist is crucial. It is completely appropriate to say you are shopping for a therapist and that you’d like to speak on the phone to ask some questions or let the person know what is going on to see if it even makes sense to set up an appointment. This also allows the therapist to gauge whether you’re a good fit for him or her, and if not, to offer a referral.

Sixth, make a follow-up appointment where you can meet the person face-to-face and see if your initial instinct was correct. It is also reasonable to meet once or twice before you decide whether to commit to working with the person while you develop a treatment plan together. Remember, most importantly, you are looking for someone you connect with. You and the professional should both believe that the therapist can help. You are looking for someone you can afford, someone with whom you can feel comfortable, and someone you believe can help you.

If you’re lucky, you may get all these steps right on the first try, but many people do not. If you think you found someone, but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting. Often, the difficult experience you are having with the therapist is related to the reason you are in therapy to begin with. In other words, the conflict or problems you are having with your therapist may be the sorts of problems you have in other relationships and could be driving addictive or compulsive behaviors, and now you have an opportunity to work through those issues with a therapist who is trained to help you see your role in the relationship and in other, more important relationships. This is a wonderful opportunity to learn about yourself.

If your therapist shies away from this sort of dialogue, they will not be helpful to you. Sometimes, the match is just not right and you have to find another therapist. The right person is out there; you just might have to work a little harder to find that person.

Conclusion

In summary, because addiction treatment is a unique field, it is essential that your addiction therapist have a solid background in mental health and not just expertise in addiction. Since many of those with a substance use issue in their lifetime will also meet the criteria for another mental health condition, it is clear that these comorbid conditions are interrelated and may fuel each other. This is why it is so important that your therapist be an expert in both domains. When you seek help for addiction, you may experience issues such as depression, anxiety, trauma, attention-deficit hyperactivity, and relationship problems. Addiction therapists who are not licensed, such as recovery coaches and interventionists, can have an important role, but only when mental health professionals who are licensed are supervising and quarterbacking the treatment.

Once you’ve found an addiction therapist who is a good fit and you begin to understand your addiction issues—medical, psychological, and otherwise—you may feel as if a big weight has been lifted off of your shoulders. While most individuals considering stopping or reducing their drug or alcohol use are loath to imagine their lives without the use of alcohol or drugs, many recovering individuals report that their lives are vastly improved and that that their worst days in recovery are far better than their best days using.

man silhouette in the fogMany people struggle with addictions in today’s stressful society. Drinking and/or using drugs, overeating, sexual compulsions, and gambling are all ways in which individuals attempt to self-soothe and forget about their problems. These misguided methods all have one thing in common—they enable the individual to temporarily attain a different state of consciousness in order to avoid looking at painful emotions they may be feeling.

Alcohol and drugs obviously create altered states of mind, but overeating, gambling, or having a sex addiction do as well. For those who overindulge, food typically brings up early memories of comfort and is used to fill up an inner sense of emptiness. Many who gamble tend to forget or overlook everything except the thrill and excitement of the potential win. For many individuals with a sex addiction, there is an attempt to seek connectedness through the sexual act, without having to connect on an emotional level.

So what are some ways that individuals can learn to cope with their emotions in a healthier way? The following steps can be taken to help overcome an addiction:

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  1. Join a support group. There are many different peer-led support groups available that can be very helpful when trying to overcome any kind of addiction. Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, Sex Addicts Anonymous, or Gamblers Anonymous, for example, are all groups where people can relate to others who are dealing with the same types of issues. Individuals hold each other accountable and are often inspired by others’ success stories.
  2. Explore issues that the addiction may be covering up. Often, people resort to unhealthy coping mechanisms because they are struggling with painful emotions and/or traumatic situations that have not been integrated. Seeking out a qualified therapist can be helpful in working through past trauma and learning healthier ways to cope.
  3. Keep track of your triggers. By noting the times you feel tempted to indulge in an addiction, you can begin to bring more awareness to the situation. For example, do you start drinking after work every time your boss criticizes you? Do you binge on fast food whenever your self-esteem is at a low point?
  4. Look for the purpose your addiction may be serving. Many people struggling with addictions have difficulties with relationships. The addiction becomes their relationship of choice, and the individual may spend much of his or her time thinking about ways to indulge in it, rather than examining underlying issues related to connecting with others.
  5. Learn to experience emotions rather than avoid them. Addictions are often an easy way to escape from feeling painful emotions, but this is only a temporary solution and ends up making the problem much worse. Try to spend five to 10 minutes a day just sitting with your eyes closed and focusing on the sensations in your body. Painful emotions tend to be held in the body and are typically experienced as a tightness or constriction. Practice mindfully sitting with the sensations, honoring and welcoming them, rather than trying to push them away. Remember to breathe in and out deeply when doing this exercise.
  6. Journal about your feelings. Journaling is a helpful tool to get uncomfortable emotions off your chest. Whenever you feel triggered to indulge in your addiction, try to write about the thoughts and feelings that you are experiencing instead. This technique can also be useful right before going to bed, especially if you tend to toss and turn and ruminate over stressful issues.

Overcoming an addiction can be extremely challenging, but using some or all of the techniques above can be a great starting point. If you have a severe drinking or drug problem, you may need to start off with residential treatment in order to be surrounded by individuals who support you on your healing journey.

The first step can feel like the most difficult one, but recovery from any type of addiction is absolutely possible for anyone willing to reach out for help.

holding paper x over mouthAccording to the U.S. Department of Health and Human Services, as many as one in five Americans will experience a mental health issue at some point in their lives. Of the nearly 60 million Americans who experience mental health concerns each year, many will never seek treatment for a variety of reasons including social stigma, cultural norms, and lack of access. In fact, a recent report published in the journal Psychological Science and the Public Interest found that an estimated 40% of individuals with serious mental health concerns either never receive care or start an intervention program without completing it.

The stigma surrounding mental health issues can be a significant barrier to care. Unfortunately, many people unknowingly contribute to the stigma simply with their everyday language choices. A poor choice of words not only stigmatizes, stereotypes, and creates unrealistic assumptions about certain people, but also can trivialize serious mental health conditions and their accompanying experiences.

While society tends to tread lightly around language concerning disabilities, race, or religion, it seems that we do not apply the same sensitivity to language involving mental health. For example, while you might be a little taken aback by someone who uses the word “retarded” to refer to a poor decision, you likely wouldn’t think twice about someone calling a peculiar behavior “crazy” or saying out loud that someone’s “OCD” is the cause for an orderly office.

Help Us Erode Stigma during Mental Health Awareness Month

With May designated as Mental Health Awareness Month in the United States, we would like to encourage you to think twice about the language you use and how it may affect those one in five people who may be your neighbors, coworkers, and friends who experience mental health issues.[fat_widget_right]

Show respect and consideration for those experiencing mental health conditions by avoiding these common stigmatizing phrases we hear in our daily conversations:

‘I’m So OCD.’

All too often people say “I’m so OCD” when referring to simple habits they may have regarding organization, such as arranging books a certain way on a bookshelf or keeping one’s own environment immaculately clean. True obsessions and compulsions can be quite debilitating, involving persistent, unwanted thoughts, rituals, and behaviors, all of which are out of a person’s control.

As many as 27% of people experience some form of obsessive-compulsive behavior. By using the term to describe tidiness, we popularize the experience and make it appear less severe than it actually can be. Next time you find yourself tempted to say someone else is being OCD or claim it as an explanation for your own behavior, consider how you might more accurately share your observation or insight.

‘I Can’t Focus; It’s My ADD.’

It’s not uncommon to hear people refer to themselves as ADHD or ADD when they are inattentive or easily distracted. Today’s high-tech world seems to be characterized by ever-shrinking attention spans, and it seems that people are always fiddling with their smart phones and jumping from one topic to another. However, this is not the same thing as attention-deficit hyperactivity.

Though these types of behaviors may be related to a lack of focus, an actual diagnosis of ADHD is far more complex.

People might casually refer to distracted behavior as ADHD or even go as far as to say that they’re ADHD when channel surfing or changing the radio station before a song finishes. Though these types of behaviors may be related to a lack of focus, an actual diagnosis of ADHD is far more complex and has less to do with boredom and more to do with genetics, neurotransmitters, and electrical activity in the brain. In fact, a major distinguishing characteristic of ADHD is impulsivity, which probably isn’t present in most cases where people erroneously claim ADHD as the source of their inattention.

‘My Ex Is Such a Psycho.’

At some point, you’ve probably heard someone refer to a past lover (or friend, or roommate) as a psycho. People typically use this phrase to refer to someone engaging in erratic or irrational behavior, which in reality is far from psychotic.

Psychosis is a serious mental health condition by which a person loses contact with reality and may experience hallucinations and delusions. An estimated 3% of people experience psychosis, which makes it far less prevalent than the many people who claim to have psychotic past lovers might indicate. Try not to downplay the seriousness of this condition by using the term frivolously.

‘The Weather Is So Bipolar Today.’

Sure, it may snow in the morning, warm up for an hour, and then snow again all afternoon, but it is impossible for the weather to literally be bipolar. Likewise, it’s highly unlikely that your friend having a few ups and downs today is actually experiencing the often debilitating symptoms of bipolar. Using the term bipolar in these contexts misrepresents the experience and can minimize the condition.

A person experiencing bipolar is likely to experience serious shifts in mood that may range from dangerously euphoric to suicidal. These drastic changes can seriously hinder one’s life if left untreated. Instead of using the term bipolar, consider describing the weather as unstable or unpredictable, and referring to your friend as being in a bad mood or having a hard time.

‘This Makes Me Want to Kill Myself.’

You fail your math exam and you exclaim in frustration, “I just want to die.” Or something else mildly unfortunate happens and you casually say, “This makes me want to kill myself.”

According to the Centers for Disease Control and Prevention, suicide is the 10th leading cause of death in the United States with almost 40,000 Americans dying from suicide each year. People who commit or attempt suicide do not necessarily want to die; rather, they may want to be free of pain.

If you find yourself upset with your circumstances and wanting to express your frustrations, be mindful of your word choice in this matter. It’s very likely someone in your vicinity has been touched by suicide in some way.

‘Stop Being So Paranoid.’

Paranoia is a symptom of many mental health conditions and can be detrimental to a person’s life. True paranoia can cause people to have serious trust issues and unwarranted fear and anxiety, as well as feelings of persecution and exaggerated self-importance.

When you find a friend may be worrying too much or over-analyzing something, avoid using the term paranoid and replace it with other descriptive words such as mistrusting or fearful.

‘I’m So Addicted.’

You might find yourself saying something like, “I’m so addicted to this TV show” to mean that you really enjoy it. But most likely, you are not truly addicted to it. Addiction is a serious mental health issue that can destroy lives, both of the person addicted and that person’s loved ones.

There’s a considerable difference between appreciating or enjoying something and being addicted to it. Be mindful of this distinction when you speak.

Although more than 23 million Americans experience some form of substance abuse, up to 40 million additional Americans are indirectly affected by it. These numbers do not account for non-substance addictions such as gambling, spending, or sex addiction.

There’s a considerable difference between appreciating or enjoying something and being addicted to it. A person experiencing addiction may want to stop engaging in an addictive behavior, but may feel unable to do so regardless of its continued negative consequences. Be mindful of this distinction when you speak, so as not to disparage the serious problems addiction can cause.

‘That’s Crazy/Insane/Mad/Nuts.’

It’s becoming far too common to use the word crazy and related synonyms lightly. People may think that using these terms to describe behavior that seems odd, eccentric, or strange is harmless, but it can be damaging to the self-esteem of those experiencing real mental health conditions.

The stigma alone is enough to make people feel isolated, keep them from seeking the treatment they truly need, or cause them to completely deny their symptoms altogether. But these terms, often used in a manner that belittles those who actually experience mental health issues, reinforce the dangerous stigma of mental health issues by painting them in a derogatory way.

Words Have Power; Think Before You Speak

Avoiding stigmatizing terms and phrases that cause shame, minimize experiences, and misrepresent reality can help eliminate a major obstacle to treatment. It’s not simply about being politically correct, requiring that you tiptoe around your words; the point is to simply stop and think about what you say and be mindful of how your choice of words may affect others.

If you would like to learn more about how you can raise awareness of mental health conditions and help remove stigma, check out our blog this month or visit Mental Health America for more information and resources about Mental Health Awareness Month.

References:

  1. Corrigan, Patrick. (September 4, 2014). Stigma as a Barrier to Mental Health Care. Association for Psychological Science. Retrieved from: http://www.psychologicalscience.org/index.php/news/releases/stigma-as-a-barrier-to-mental-health-carhtml
  2. Mental Health America. May is Mental Health Month. Retrieved from: http://www.mentalhealthamerica.net/may
  3. Mental Health America. Mental Health Information. Retrieved from: http://www.mentalhealthamerica.net/mental-health-information
  4. Schumaker, Erin. (April 17, 2015). It’s Time To Stop Using These Phrases When It Comes to Mental Illness. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/2015/04/17/mental-illness-vocabulary_n_7078984.html

Thank you for your question, and congratulations on your sobriety! Fifteen months is great; clearly, in spite of your current woes, you’re doing something right.

I think the answer to your question is in the question itself. Very often relationships that feel “broken,” dysfunctional, and so on lead to an overall bad feeling about ourselves, or low self-worth or self-esteem that, actually, may precede the relationship itself. I have found in my clinical practice that it is not just the relationship that isn’t working; it is the negative way we have come to see ourselves that defines who we seek as partners.

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If we have a negative self-concept—and I know few newly sober people who don’t—then we may seek out partners who have similar challenges with self-esteem, who then tend to act negatively toward others. Why should we act lovingly toward anyone “dumb enough” to be with us? Or, the flipside of the same coin: we feel we must treat with utmost deference anyone who would be gracious enough to come into our lives, since he or she is doing us such a tremendous favor. We therefore tend to dish out or absorb hurtful behavior that reflects a primal woundedness, unhealed and unconscious, guaranteed to keep us in relational unhappiness until squarely faced.

Your boyfriend treats you with much less than the respect and care you deserve—and you are obviously a caring soul—leaving you in a state, I would imagine, of bewilderment and pain. I would assert that abusive relationships, too, are cunning, baffling, and powerful, probably because there is an aspect of the partner that is “good” or caring and aware of the hurtful outbursts, perhaps even expressing remorse after the curses and fists have flown. We also might feel we “get” the person more than anyone else—that he or she is a sheep in wolf’s clothing, etc., and deserves a chance when everyone else is so against him or her. (Surprisingly, I see a lot of abused husbands and boyfriends in my private practice.) But then it happens yet again, similar to a person with alcoholism who rages while drunk and then makes “never again” promises or refuses to talk about it.

If we have a negative self-concept—and I know few newly sober people who don’t—then we may seek out partners who have similar challenges with self-esteem, who then tend to act negatively toward others.

It is not at all uncommon for people who have gotten clean and sober to discover a secondary “addiction” or compulsive behavior (or even relationship or some kind). What you have going for you here is a dawning awareness that there is, indeed, something wrong with this picture: an excellent place to start. Try to keep your eyes and senses open to what your actual experience is here, rather than what “ought” to happen or the “tomorrow” that might be better. I also suggest that you try one or two possible options, namely Al-Anon or CoDA (Co-Dependents Anonymous), as well as counseling, since the roots of your own relationship perceptions and beliefs probably, I venture, go very deep indeed. You might also seek out a women’s group in AA or a women’s group where you can talk about these issues (often shameful and painful to discuss with others) and find proper support and feedback from others who have walked in your shoes (or similar shoes). It can be even more difficult to “quit” an abusive (or something like it) relationship, since we so often feel a strong tie with the “caring” or more aware part of the person per the above, even if he/she can’t or won’t stop. (And don’t believe for a second, in your case, that he can’t; he can, trust me, if there is enough consequence for his not doing so—i.e., losing the relationship!)

It’s time to learn new ways to enforce boundaries, in other words, just as you have done so superbly with the drugs and booze: here again I suggest you define and then communicate to him and, if need be, enforce these boundaries against any verbal, emotional, or physical behavior that crosses the line. There’s no shame in the fact this is difficult, given longstanding beliefs and convictions about ourselves and what we do and don’t deserve, beliefs which may again be unconscious or unarticulated. If we grew up in an abusive environment, we learned that we “must” tolerate chaotic or hurtful behaviors that become commonplace.

Finally, regarding the idea that your kids “should be enough”: watch out for “shoulds”; they only make us feel worse about ourselves. A relationship with children—and congratulations on making amends in that regard, by the way—is naturally quite different than one with a partner. It’s rather like saying, “Why do I need to eat vegetables, I eat plenty of protein and grains”; holistically speaking, we seek and desire different types of love, and naturally, parental love is quite different than intimate or romantic love, which is different than having good friends, etc.

Also, try to remember that you are a role model for your children. You don’t say if you have daughters or sons, but in either event your children will look to you as a prime example of what to expect from women (if they’re male) or how/what women ought to tolerate in their lives from men (if they’re female). Also, I wonder if your ex-husband might feel more comfortable with expanding visitation times if he knew the boyfriend had stopped his acting out or (if he won’t) were out of the picture? Is it safe for your kids if he is around? I don’t know the details, but it’s something to consider. Thanks again for writing. And keep up the good work in your recovery!

Best wishes,
Darren

Laptop in the darkI recently spoke with a young colleague who had just completed training to become a certified sexual addiction therapist (CSAT). She was astonished to hear my stories of what I jokingly refer to as the golden age of phone sex, which I’d say lasted from the mid-seventies, when I worked on a suicide prevention hotline, until about 1998, when the Internet was starting to really take flight.

You may be wondering why the suicide hotline I worked for bears mentioning. There were often callers to the hotline, usually male, who upon hearing a female ask, “How can I help you?” would begin to speak breathlessly about a “huge problem” they had. Our London-born supervisor referred derisively to these fellows as “wankers” and taught us ways to extricate ourselves from, ahem, conversations with them.

By the early eighties, I had ceased taking hotline calls and started practicing as a licensed therapist in my office in West Hollywood, California. Some of the people I helped had issues with obsessive phone sex. Some, again usually male, would spend hours or even days languishing at home or work paying to talk and talk and talk about sex, usually culminating in—you guessed it—masturbation. Neither party, of course, could see the other, so imagination was in full play.

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Frantic wives would call me after they clapped eyes on preposterous phone bills to 1-900 lines. Their husbands would call the next hour or appear reluctantly at my office, struggling with whether they actually had a problem with this potentially addictive (and highly expensive) behavior.

There was big money to be made by investors who snapped up and promoted 1-900 numbers with suggestive three-, four-, and seven-letter words rounding them out—not to mention resourceful women, young and not-so-young, who craftily embodied and impersonated the young subjects of glossy photos in the back pages of men’s magazines. Many people found the lure of “risk-free” phone sex with readily available strangers to be too hard to resist, spending countless hours and thousands of dollars maintaining their compulsive tele-sex habits.

How things have changed with the rise of the Internet and smartphones! Although traditional phone sex lines still exist and some thrive, no longer are people tethered to cumbersome wall sockets that keep them in their bedrooms or office cubicles. We have apps that use GPS to find sex partners near us as easily and anonymously as we locate a good Japanese restaurant. Phone sex is now often fully visual, streaming from hand to cell tower to satellite and back in the blink of an eye. Not only can it be addictive, it’s often free—in a financial sense.

Phone- and web-based sex can be profoundly costly when it comes to the toll on real-life relationships. Live video streaming or face time might be great for those of us who want to commune with a traveling partner or see and interact with grandkids on the other side of the continent. But what kind of effect does pornography and for-profit sex chat have for those who struggle with marital fidelity and remaining sexually sober? For those with a propensity for addictive escape and risky sexual behavior, it’s a whole new world of problems.

If you need some help navigating it, contact a therapist near you. It might prove to be the best call you’ve made in a long time.

Sad girl by fence For anyone facing the demon of substance abuse, one of the most difficult challenges is understanding how their addiction is affecting the people around them, including family and friends. In a haze of drugs and alcohol, it is virtually impossible to understand the impact that substance use and addiction have on the people who are closest. This dynamic is especially prevalent when parents are the substance abusers and they are unable to conceptualize how their use is impairing the growth and development of their children.

When a parent drinks too much or is under the influence of a substance, legal or illegal, many kids are likely to find themselves overwhelmed and unable to deal with their emotional reality. Children may deal with feelings of anger, embarrassment, frustration, fear, and myriad other emotions that they may not know how to express.

If there is substance abuse occurring in the home, often the family will try to manage the fallout internally, leaving kids with the feeling they have to protect a family secret. Sometimes, addiction may be influencing one or both parents in a household, but no one in the family unit is willing or able to address the issue. Even a suggestion that there may be problems with addiction can bring anger and backlash from a parent who is not ready to face his or her own substance issues.

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Substance use can also make home a dangerous place for kids. The addicted parent may not be able to maintain work or a steady income, rendering home life unstable. The potential for abuse also rises in households where one or more parents are under the influence. This lack of stability may adversely affect the emotional development of children, leaving them lost, lonely, and stressed.

The long-term effects of these experiences will influence kids in many aspects of their daily lives. Kids of addicted parents often take on responsibility for the household and become what is commonly called the “parentified” child. Such kids are forced into adult roles and responsibilities that are not being managed by the parents. They may become perfectionists in an effort to manage the emotional instability in the home.

These same kids often carry low self-esteem and face challenges when trying to create intimate relationships outside the home. They often have limited emotional awareness and may be conflict avoidant as a means of maintaining a steady emotional state. Holding the secrets of the addicted parent(s) makes it hard for them to build open, honest relationships, which in turn makes it challenging to develop close connections.

All of these are reasons to find help for kids in families with addiction issues. If one parent, family friend, or relative can step in and recognize the issues occurring in the household, there is a window of opportunity to get professional assistance.

It is vital for kids of alcohol- or drug-addicted parents to realize that they are not alone and that there are other people in their community facing the same challenges. It is also important, with the assistance of a professional counselor or support group, for kids to understand that they are not responsible for the addiction issues that their parents are going through. Having a place to share their story and make sense of the emotional turmoil in their home may help kids of addicted parents to process their feelings and begin to develop a stronger sense of self.

The development of self-esteem, independent of a parent’s addiction issues, can help children to regulate their emotional life and adapt to family needs. By providing a place of safety and understanding for kids of addicted parents, we can help children learn healthy coping skills and understand how addiction can affect any home, not just theirs.

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