dice bouncingWhen your gambling gets out of control, it can be extremely destructive and devastating to you and to those with whom you associate. Because a gambling addiction develops over time, you, your friends, and family members may not notice that your behavior is compulsive or getting out of hand. However, just because you gamble and enjoy gambling a lot does not mean you are addicted to it.

There are ways to determine whether certain behaviors and activities related to your gambling suggest that you are enjoying a recreational activity or if your gambling has become a compulsive habit with potentially serious consequences. As an addiction psychologist and certified addiction counselor in Pennsylvania, which recently bested New Jersey in combined gambling revenue for 2012 and 2013, many people come to me to find help sorting through the interrelated mental health issues that may fuel gambling behavior in order to determine whether they have a mild gambling problem, a major compulsive and pathological issue, or just an expensive hobby that is all in good fun.

It’s rare, but possible, to develop a gambling addiction after your very first gambling experience. When problems develop, they usually progress over time. Many people participate in social gambling for years with no problems. More frequent gambling or life stressors can contribute to social gambling becoming a serious problem. Most casual gamblers can stop gambling when they have to because of losses; they can set a loss limit and easily follow it. People with a compulsive gambling problem feel strong urges to keep gambling to recoup their lost money. When gamblers are betting to chase losses, things can tailspin out of control, gamblers can lose touch with reality, and the issue can manifest in severe and exacting consequences. Over time, this issue can become more and more destructive.

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For many compulsive gamblers, gambling is about the thrill, not the money. Some begin to take bigger risks and place larger bets to keep getting more of a thrill; this can take a financial toll. When a gambler is trying to recoup losses, lives can be destroyed. Many folks with whom I work recount that their bottom was when this shift happened and they realized that they were gambling in the hope they could get back their losses.

A gambling addiction, unlike drug or alcohol addictions, often has no obvious physical signs or symptoms. Many people with problematic gambling habits deny that they have a problem. They minimize the problem or refuse to admit that their gambling is out of control. They often gamble in secrecy, not allowing friends and family to know about their behavior. They may lie, keep secrets, sneak around, or completely withdraw socially. They do this to make it difficult for anyone to interfere with or confront them about their detrimental behavior.

An important part of recovery from a gambling issue is to expose the gambler’s secrets—extra credit cards, hidden cash, unaccounted-for time, lies about income, etc.—over time to the right, supportive people at the right times. A therapist is a great start, and meeting other people who are recovering from gambling addiction can help a person to feel understood, supported, and guided into long-term recovery.

Just as substance abuse is characterized by uncontrollable urges to consume a particular substance, causing negative consequences to the addicted person and those around the person, a gambling addiction is characterized broadly by tendencies to gamble in ways that cause damage to the person who is gambling and those associated with that person. The urge to gamble can be especially overwhelming during episodes of stress or depression. A person may use gambling as an unhealthy way to cope. As the problem develops and becomes stronger, a gambler may become overly focused on gambling (gambling-seeking) and getting money to gamble.

What Are the Risk Factors?

Certain factors may put you at greater risk for becoming addicted to gambling or having a harder time stopping. These include substance abuse (alcohol abuse is common), mood (often depression) or personality issues or attention-deficit hyperactivity (ADHD); age (younger and middle-aged); sex (women gamblers usually start later in life and tend to have depression, anxiety, or bipolar and can become addicted quicker, although these differences are disappearing); family influence (having a parent with a gambling issue increases your chances); certain medications such as those which treat Parkinson’s and restless leg syndrome (RLS), called dopamine agonists, may have a rare side effect that results in compulsive behaviors, including gambling; and certain personality characteristics such as being highly competitive, a workaholic, restless, or easily bored.

The National Council on Problem Gambling, referring to a Harvard study, estimates that two million (or 1% of) U.S. adults meet the criteria for compulsive gambling in a given year. Another four million to six million do not meet the full diagnostic criteria for compulsive gambling, but meet at least one of them and are experiencing problems due to their gambling behavior. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of gambling disorder is made when someone meets at least four of the following nine criteria in a 12-month period:

  1. Tolerance: Needing larger wagers to experience the same “rush” (similar to the “rush” felt by drug users).
  2. Withdrawal: Restlessness or irritability when attempting to reduce or cease gambling.
  3. Loss of control: Repeated unsuccessful attempts to cut down or stop on his/her own.
  4. Preoccupation: Frequent thoughts about gambling experiences, whether past, future, or fantasy.
  5. Escape: Gambling to improve mood or escape problems.
  6. Chasing: Trying to win back gambling losses with more gambling.
  7. Lying: Hiding the extent of the behavior by lying to friends, family, or a therapist.
  8. Risked a significant relationship: Gambling despite damaging or losing an important relationship, job, or other significant opportunity.
  9. Bailout: Turning to friends, family, or a third party for financial assistance resulting from gambling activities.

Do You Have a Gambling Problem?

As with drug and alcohol abuse, it is often an indication that you have a problem if you are wondering whether you have a problem. If you are losing time from your everyday activities because you are gambling or thinking about gambling; spend more time gambling than you intended to; are gambling to escape worries or stave off boredom or loneliness; or spent money you needed to pay your bills or other expenses, you likely do have a gambling problem.

Are your friends and family expressing concern? They might be recognizing the ways in which your gambling is affecting you before you are. The sooner you seek help and treatment, the less damage to your finances, relationships, and work you will have to repair.

Would you like to stop? The first step to getting well is to accept that you have a progressive issue. It is so much easier to change when we want to, at least a little bit, and so much harder to change when we have to.

Quitting for a while or taking a break is a good indication that you have control over your gambling. It’s possible for some compulsive gamblers to go into remission where they gamble less or not at all. Without professional treatment, though, they will usually relapse.

Like other addictions, a gambling issue may wax and wane or come and go, just as different drugs become more in vogue depending on the zeitgeist. Many people who see me for addiction like to think of their compulsive behavior as the whack-a-mole game people play at carnivals. You can whack the mole, but it’s connected to something else and it will pop up again. It might pop up as a different gambling game, drug use, alcohol use, or shopping or food addiction. Whether it pops up in Atlantic City, Philadelphia, Las Vegas, or in a casino near you, gambling is here to stay, and so, too, is addiction. We must learn to live with these tendencies and become curious about how they work and what purpose they serve for us as individuals, our cultures, and society. With increased awareness and understanding, we can learn how to help ourselves and those we love and care about.

For help with an addiction issue, find a therapist.

Evaluating an MRI of the brainIn the popular imagination, compulsive or addictive behaviors such as shopping or sex are regarded as different from chemical dependency on drugs or alcohol. Even some addiction counselors have argued that behavioral addictions are somehow easier to control because they don’t involve an addictive substance. New research, however, demonstrates that, in the brain, sex addiction looks similar to drug addiction.

Sex Addiction and Brain Activity

The study examined the effects of pornography on brain activity in people who have compulsive sexual behaviors. Excessive pornography use is common among people who experience sex addiction. Researchers showed 19 male subjects pornographic images while monitoring their brain activity using functional magnetic resonance imaging (fMRI). They then compared the results to the brain activity of an additional 19 men with a history of compulsive sexual behavior.

The men with a history of compulsive sexual behavior had increased brain activity in the ventral striatum, dorsal anterior cingulate, and amygdala. These regions are the same areas that show increased activity during drug use in people who are addicted.

Darren Haber, MA, MFT, a GoodTherapy.org addiction Topic Expert, finds the results unsurprising, explaining, “It’s no surprise that a so-called behavioral addiction mimics drug addiction, especially when that behavior involves something as primally stimulating and rewarding as sex. What troubles me is that our society still seems more interested in playing a semantics game around debating compulsive sexual behavior as ‘addiction, yes or no’ when this enslaving disorder creates such suffering and shame for countless men and women.” Haber emphasizes that our culture often tacitly endorses sex addiction, compounding the problem that those with addiction face. “Porn is a billion dollar business. Soft-core porn is rampant in commercial media. Women are objectified and exploited globally to make a buck, and yet being a (person who is addicted to sex) is somehow shameful or hard to understand,” he says. [fat_widget_right]

What Qualifies as Sex Addiction?

In a sex-saturated society, it can be challenging to draw the line between normal sexual behavior and sex addiction. For those who experience sex addiction, though, sexual behavior feels obligatory rather than enjoyable. Angela Skurtu, MEd, LMFT, a GoodTherapy.org sexuality Topic Expert, explains, “One of the most difficult struggles partners experience with sex and porn addictions is that these behaviors often take place in lieu of a satisfying sex life with one another. The (person with sex addiction) will struggle because he or she doesn’t actually enjoy his or her sexual behaviors. They feel compelled to engage in these behaviors.”

Skurtu cautions that not all use of pornography use indicates sex addiction. “Clinicians must be careful to educate clients about normal sexual behavior, while also being respectful of the client’s personal values. Watching pornography for 15 minutes or so every other day during masturbation is relatively common. As long as the masturbation does not take the place of a healthy sex life for the couple, it should not be considered problematic behavior,” she says.

References:

University of Cambridge. (2014, July 11). Brain activity in sex addiction mirrors that of drug addiction. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2014/07/140711153327.htm

Young woman climbing in adventure rope parkWhile most social networking profiles are populated with photos of friends and family coupled with a few political or religious rants, it’s easy to spot the page of someone who enjoys risky behavior. These are the social networking profiles covered in photos of skydiving missions, rugged camping trips, and endless exotic travel. While these images can be appealing, they can occasionally be an indication that someone compulsively takes dangerous risks. In some circumstances, they may even have an addiction to risk-taking. While most people are loathe to take on excessive risk every day, people who love the feeling of adrenaline are always looking for a life of adventure.

Adrenaline and Stress

Although adrenaline addiction isn’t a recognized diagnosis—and is unlikely to become one—the “adrenaline junkie” really does exist. Adrenaline, sometimes called norepinephrine, is a hormone and neurotransmitter the body releases in large quantities during times of stress. It’s adrenaline that enables the fight or flight response, and when the body starts releasing large quantities of adrenaline, some people experience a powerful “adrenaline high.” Although everyone produces adrenaline in response to stress, some people crave the process, while other people find an adrenaline dump stressful and uncomfortable.

The Adrenaline Junkie Personality

People who constantly seek adventure have a strong need for stimulation. This can be just a personality quirk. People with domineering type-A personalities are more likely to crave risk-taking. In some cases, though, a craving for adventure can be the product of a mental health condition. A person with attention deficit or ADHD, for example, might need more stimulation than most people, and may resort to adventure-seeking as a form of self-medication. People with domineering type-A personality are more likely to have problematic risk-taking behavior.

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The Post-Rush Crash

There’s nothing inherently wrong with being a risk-taker, especially if you are reasonably cautious. For physical activities, this includes wearing a helmet, listening to an instructor, and taking other basic safety precautions.  For some risk-takers, though, adventure can become an addiction. After the thrill is gone, risk-seeking individuals can experience a post-rush crash that yields feelings of depression or inadequacy. This can necessitate taking bigger and more frequent risks—much like a person’s tolerance to other activities or substances increases with addiction.

Signs You Might Have Problematic Risk-Taking Behavior

Daring physical risks, such as skydiving or BASE jumping, may be indicators of a distressing love of adrenaline,  but these aren’t the only ways people get adrenaline rushes. Creating conflict in your personal life can also spur an adrenaline rush. Some other signs that risk-taking may be problematic include:

Adrenaline junkies often lead interesting lives, and they can be fun to watch. In most cases, adrenaline junkies are just people out for a good time. Just like any other behavior, though, when the search for adrenaline gets out of control, it can lead to dangerous consequences. If you’re concerned about an adrenaline addiction, Adrenaline Addicts Anonymous offers group support.

Many therapists work with people who have problematic risk-taking behavior. You can look for therapists in your area by searching on the GoodTherapy.org therapist directory.

References:

  1. Lencioni, P. (2005, Winter). The painful reality of adrenaline addiction [PDF]. Leadership Review.
  2. Weil, A., M.D. (n.d.). What makes an adrenaline junkie? Retrieved from http://www.drweil.com/drw/u/QAA401366/What-Makes-an-Adrenaline-Junkie.html

figure walking away from cigaretteEvery smoker knows that smoking poses serious health risks, but the prospect of quitting can be daunting. Nicotine withdrawals can last between three and 14 days, and some smokers find the depression and anxiety that may be associated with quitting smoking unbearable.

If you can ride out the first week or two of misery, though, it really does get better. Within a few weeks, you may be wondering why you ever craved a cigarette at all.

For smokers desperately craving just one more puff, these five tips can help quell the nicotine thirst.

Change Your Routine 

Nicotine is highly addictive, but it leaves your body within three days. By the fifth or sixth day, any cravings you feel are psychological, not physical. Changing your daily routine to remove common triggers for smoking can help you cope with these cravings. Try taking a day or two off of work, changing your working hours, or even going on a vacation. When you don’t have constant reminders that you used to smoke, you’re much less likely to miss puffing away your life.

[fat_widget_right]Get Moving

Even the healthiest smokers suffer cardiovascular consequences from their decision to smoke. But within a few hours of quitting, your body begins to repair itself. This makes exercise easier, and exercising without coughing and becoming exhausted can be a powerful reminder that quitting has immediate health benefits. Even better, though, aerobic exercise can help silence even the worst cravings. Try doing a few jumping jacks every time you get a nicotine pang, and aim for a slightly longer workout every day or every other day.

Drink Some Water

The desire to put a cigarette in your mouth can be overwhelming, but try replacing that habit with a healthier one. Sipping cold water through a straw can combat nicotine cravings. Try taking a few deep breaths as you drink, and visualize yourself as a happy, healthy nonsmoker.

Accept the Cravings

When a craving strikes and you need to be doing something else, the energy you need to fight the craving can undermine your ability to work, concentrate, or maintain a decent mood. Rather than fighting cravings, try accepting them. When you feel a craving, tell yourself you’re going to take five minutes to fully experience the craving. Breathe through it while thinking about all the reasons you want to be a nonsmoker. Then get back to what you were doing before the craving came on.

Make Cigarettes Your Enemy

Most smokers conceive of quitting smoking as a time of epic deprivation. If you think of cigarettes as your friend, though, you’ll miss them more when they’re not around. Before you quit smoking, concentrate on every problem cigarettes have caused you—from smoker’s cough to the inability to enjoy a meal without lighting up. When you smoke a cigarette that you don’t enjoy or that gives you a headache, dwell on it. Then, when you give up smoking for good, think of your cravings as nasty reminders of what cigarettes used to do to you.

The cravings aren’t a longing for a friend who helped you through tough times; they’re the voice of harmful nicotine trying to convince you to do something that’s terrible for your body. When you miss cigarettes, think to yourself, “Cigarettes have harmed me so much that I have managed to convince myself that something that tastes bad and is terrible for me is good.” When cigarettes become your enemy, you have little reason to smoke them—even when you get a craving.

Are you working on quitting smoking? You’re not alone—more and more people are getting help with nicotine addiction. Smoking isn’t just a physical habit; it’s a mental health issue. Finding a therapist who works with smoking cessation may help. You can look for a therapist for yourself or a loved one in the GoodTherapy.org directory.

References:

  1. Withdrawals. (n.d.). Retrieved from http://www.quit.ie/en/inner/withdrawals
  2. Withdrawal symptoms and how to cope. (n.d.). Retrieved from http://www.lung.ca/protect-protegez/tobacco-tabagisme/quitting-cesser/withdrawal-sevrage_e.php

Thank you for writing. The fact that your brother is angry at you for helping his family is a likely indication of how severe his gambling has become. (In addition to his seeking “lower companions,” as 12-step literature says.) Your question reminds me of how powerful family “systems” are, especially those affected by (what sounds like) addiction or compulsive behavior. It’s remarkable that you are being generous enough to allow his family to stay with you but wonder if you’re doing “enough.” I think the short answer is yes. You’re doing a great service.

But you ask another question that bears some examining, namely, “Am I doing the right thing here?” I’m coming to the conclusion that when compulsivity or addiction is involved, there is no “right thing.” For instance, partners of addicted spouses will ask me, “Is the right thing to stay or go? Try to help them get into rehab or is that enabling?” The right answer is yes and no to all of the above.

The downside to completely detaching (generally speaking, mind you) is that you begin to feel guilt or self-criticism for being aloof; if you get caught up too much in helping and it goes nowhere, you are likely to feel resentful, taken for granted, and so on. So I suppose there’s this magical balance that much smarter folks than I have not yet figured out. I suppose that, like all things human, God (or the devil) is in the detail. But gambling is particularly destructive because it involves money, which can crush a family’s resources like Thor’s hammer.

The advantage here—not always the case—is that your brother knows he has a problem. Not knowing how to stop is nothing to be ashamed of. Addiction or compulsivity on the level we’re talking about is as much a disease as depression or anxiety. (In fact, addiction parallels both.) How does a person “stop” bipolar? Or diabetes? Well, you see a professional. Fortunately, there are self-help meetings (Gamblers Anonymous) as well as addiction therapists or even treatment centers (such as the Control Center in Los Angeles or Sierra Tucson or The Meadows in Arizona) that can help. (More treatment centers are taking insurance these days.)

The point is, he doesn’t have to know how to stop because he probably can’t. (Step 1 in a 12-step program is saying, essentially, that you can’t stop and your life is chaotic due to that fact.) Also, you might check your own motives in that many family members in your position may (1) minimize the addiction (is it really that bad? Sadly, yes), (2) think you can “do something” best left to a professional counselor or psychologist, or (3) doubt yourself for not “doing more.” You cannot will a person with depression to get better by good intentions; ditto with addiction. The most eloquent Shakespearean speech will not convince an addicted person to do squat. Usually it comes down to setting consequences for the addicted person that may sound hard but tend to get attention: If you don’t stop, you’re going to ruin your family and/or lose your wife and/or access to your children. If you don’t stop, I need to pull away and detach until you get help; it’s too painful for me to watch a ship sink while the captain refuses life boats. Many people addicted to alcohol, for instance, don’t get help until their second, third, or fourth DUI. Many with sex addiction don’t stop until their partner threatens to end the relationship. And so forth.

You may also try to organize a family intervention, either informally or formally. This is trickier than it looks (despite what the movies and TV show us). I know some interventionists who would be willing to consult with you (perhaps for free or low cost) should you want more information on this; you can contact me via this website for more information.

You’re obviously a very caring and loving brother or you wouldn’t be writing. Sometimes the most loving thing you can do is tell the addicted part of the person, “We’re sick of you and how you’ve hijacked the person we love.” I would add that the sooner you and other family members—and your brother—take action, the better. Addiction is progressive and, like a shark, stays hungry and keeps moving. Thanks again for writing.

Best wishes,
Darren

butterfly with flowersMy work with people often drives me to explore themes that are currently showing up in my counseling practice. If you are a counselor, you know what I mean. You may have many clients or therapist consultees presenting with the same needs, perhaps some who are saying similar things of late. That’s not to say that these issues are the “same,” for they are not. Nevertheless, there are topics that may repeat themselves. I pay attention to these because I believe that there is much to explore and learn by being aware of patterns.

A pattern I have seen of late is related to eye movement desensitization and reprocessing (EMDR) work, specifically about the process of being “ready” to do EMDR. I have had a lot of therapists inquiring about their clients’ readiness to do EMDR. Keep in mind that if you are doing EMDR, you are always doing EMDR; it just depends on the phase you are in. If you are one of my EMDR clients or therapist consultees, you know how much I emphasize this as key to understanding the EMDR therapy model. Keep this in mind: EMDR is a process, a model, and not a technique.

EMDR’s preparation phase is phase two of the eight phases of EMDR. EMDR therapists look for people to have a minimum of two state-change skills as part of this phase. In phase two we are making sure that the client has the ability to not only tolerate emotion, but also to shift into a relaxed state, a para-sympathetic response. In other words, can the person bring up a disturbing event, be “in it,” but then also utilize a relaxation skill or calming technique to then change states if needed?

Keep in mind that the concept of changing states may be something that sounds easy, but for many it is not. Some folks seeking to utilize EMDR therapy as part of their trauma recovery may need more extensive preparation-phase support. This is especially true in the case of those struggling with dissociation and addictions.

In its simplest form, a state change means being able to utilize a relaxation skill to settle down one’s system. State-change skills can help the EMDR client to become calmer and more settled while still maintaining “dual attention”—i.e., being present while bringing up traumatic disturbance(s). In contrast, and though it may appear like it, the ability to utilize state-change skills does not mean changing states via dissociation. Certainly, one’s ability to dissociate may appear similar to a state-change skill, and is a survival skill, but dissociation keeps us “away from” traumatic material and from integrating the somatic, visual, emotional, and cognitive aspects of it to then heal.

For example, dissociation takes one away from the present moment because the past feels as if it is happening now and it feels safer to leave the present. But to be able to heal and integrate the traumatic material requires that state of being present. We just have to learn the dance between feeling the disturbing material and being able to shift into a contrasting, calmer state.

In exploring the concept of EMDR and state-change skills, addictions can also be explored as an attempt to chemically or behaviorally illicit a state change. I often explain to people that substance abuse is often driven by an ill-fated attempt to chemically dissociate. One can easily become entrenched in the vicious cycle of using addictive substances and behaviors to shift “out” of traumatic material in order to feel something, anything, and everything different from the pain of a traumatic history. And, for many people, addictions have become a way to change states, to feel away from and out of traumatic material.

The bottom line is that to heal, trauma histories beg to be accessed, stimulated, and reprocessed. The challenge can be in our making sure that EMDR clients are fully supported in having the state-change skills in place to be able to come back, to ground, and to stay present first. Therefore, creating and implementing these state-change skills can be the key to supporting EMDR clients in their recovery and throughout EMDR’s eight phases.

AddictionAddiction occurs when a person becomes physically or psychologically dependent on a substance, thing, or activity, generally leading to withdrawal symptoms when it is unavailable. Many people engage in potentially addictive behaviors recreationally, but when those behaviors are abused to the point of interfering with day-to-day functioning at work, in the classroom, at home, or in relationships, it becomes a serious issue that may require intervention and treatment.

Faces & Voices of Recovery claims on its site that more than 21 million people experience addiction and are not yet in recovery, and according to the National Council on Alcoholism and Drug Dependence, approximately 17.6 million people in the United States experience alcohol abuse or dependence, along with millions more who partake in risky behaviors such as binge drinking. The all-consuming nature of addiction takes a physical, mental, and emotional toll on the addicted person and on those who love and care for him or her. It follows that recovering from addiction takes time, dedication, and support—and ultimately, the addicted person must be the one to summon the resolution and determination to make a full recovery.

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Thankfully, there are several resources available for coping with addiction, be it yours or that of someone you care about. We’ve compiled a list of the 10 best ones—GoodTherapy.org excluded—for 2013. As with our previous top 10 lists, our selections are based on quality and depth of content, presentation, and functionality.

Nominate another website for our Top 10 awards here.

GoodTherapy | Three Reasons to Leave: Abuse, Addiction, and AffairsAs a clinical psychologist and certified addictions counselor, I see husbands, wives, and partners in individual or couples therapy on a daily basis grappling with the decision to leave or divorce their spouse or partner. Therapists have long referred to the three “A’s” of divorce as legitimate reasons to consider ending a relationship when the behavior of one’s partner is clearly destructive, abusive, or there is no reason to believe it will improve. Psychologists have suggested that the top three reasons for divorce are abuse, addiction, and affairs.

Researchers have long reported that financial problems are the top area of conflict for most couples, and that communication is the second most-cited reason for marital discord. While that may be true, these problems pale in comparison to the severe and devastating consequences resulting from abuse, addiction, and affairs.

When people ask me whether they should leave their partner or initiate divorce proceedings, very often it is because of one of the above. Any one of these issues, in and of itself, can be severe enough to make the answer to this question simple, yet it is an intensely personal and complex choice and the decision must be made in the context of careful consideration for oneself, one’s family, and the state and federal laws pertaining to the behavior. It is of utmost importance that, when faced with a partner who is engaged in these behaviors, one consults a professional and receives support, education, and counseling.

These are not decisions that should be made in a vacuum—or alone. As the social creatures and pack animals that we are, we have evolved over time to need and rely on social supports to better understand ourselves and the situations in which we find ourselves. Seeking help and support is a necessary, if not sufficient, first step in making the right decision for ourselves when coping with addiction, affairs, or abuse.

Many people do recover. While keeping safety in mind first and foremost, any one instance of the three “A’s” may be something that couples can bounce back from if they receive enough help and support.

[fat_widget_left]One person with whom I worked found that she began to have feelings for a man she met online who was living in another state. She had no physical relationship with this man, but she continued to be connected with him for two years in what she later determined to be an emotional affair. When she and her husband finally entered couples therapy, she was able to confess her feelings for this man and her “emotional infidelity,” and end the affair promptly. She was able to work on what led her to stray from her husband and to articulate the ways in which she felt she was not getting her needs met at home and in their relationship, and they were able to make changes in order to save their marriage.

Another case of forgiving a violation of the three “A’s” involved a couple in which the man was physically abusive. He would block his wife’s exit from a door when she wanted to leave the house, jealously hack into her email, listen to her phone messages, and place restrictions on when she could go out and with whom she could spend time. At one point, he shoved her and she fell, almost bumping her head on a coffee table. While these are considered abusive behaviors in most states and punishable by law, the couple was able to learn about the definition of abuse—physical, sexual, and emotional—and the man fully engaged in individual and group counseling. He found a local therapist who ran groups for men with anger and physical abuse problems, enrolled in that program, and worked hard on himself for two years to save his marriage and family.

Often, couples enter counseling when marriages are on the brink and it becomes clear that one or both partners need individual counseling before the couples work can be successful. This last case is an obvious example where individual therapy would be essential at the start. The husband in this instance began individual therapy and conjoint group therapy, focusing on anger management and coping skills. Most importantly, he was able to identify and stop the abusive behavior, and the couple was able to resume their progress in couples counseling. After significant time and work, they were able to salvage their relationship and the marriage. This involved the wife’s ability to forgive and trust her husband again, of course, but also the husband’s ability to express his anger toward her in a more acceptable, healthy, and helpful way. The wife certainly needed her own individual therapy before she was even close to being willing to begin the couples counseling.

Addiction may be no different from affairs and abuse in this regard. When one’s addiction is severe, it is clearly grounds for ending a relationship or getting a divorce, but by no means is this always the case. When a husband, wife, or partner adequately addresses his or her drug and alcohol issues or other addictive issues, such as shopping addiction, gambling, or love or sex addiction, a couple can recover from the hurt, shame, and consequences of the addictive behaviors.

Many people are familiar with the quote, “We’re not responsible for falling down, but we are responsible for getting back up.” This is a wonderful analogy for the “disease” model of addiction. If you are walking along, don’t see a hole, and you fall in it, it isn’t your fault. It is, however, your responsibility to get up, to get out of the hole or ask for help. An individual with an addiction is not responsible for having the disease. It is sometimes a hereditary illness, a brain disease characterized by chronic relapse with psychosocial, biological, personal, and cultural origins. However, once someone knows that they have an addiction, they are responsible for picking themselves up, getting treatment, avoiding people, places, and things associated with their addiction, and working a program of recovery involving therapy, meetings, and the use of a support network such as a 12-step fellowship.

A few important things to remember: The three “A’s” and the behaviors surrounding them need to cease right away. In some cases this can be a work in progress, but in others it can’t. Physical, sexual, and emotional abuse needs to stop immediately. Some of these behaviors are obviously illegal and nonnegotiable. There is no way to continue an affair and work on one’s marriage at the same time. Individuals need a comprehensive assessment and evaluation to determine the appropriate level of care and to engage in the level of treatment and support that will keep them and others safe. After this is determined, if treatment is not working adequately and that level of treatment is deemed insufficient, then the individual will need to step up his or her treatment to a higher level of care.

Often, separation is a good idea as couples learn about the addiction, affairs, or abuse. A healthy separation can enable individuals to focus on their treatment and come together as needed when both are ready. This sort of separation enables both parties and their family to recognize that recovery is an individual’s responsibility and it is also a family affair. Whether children or extended family know explicitly about what is going on, to be sure, they are all affected. So when an individual begins recovery, so too does the family, and each member of the family may need support and/or counseling.

It is a spouse’s or partner’s responsibility to communicate to his or her partner what is acceptable and what is not. It is also incumbent on a spouse or partner to become educated about the law, about the disease of addiction, and to learn as much about the psychological underpinnings of the three “A’s” and these sorts of behaviors as possible. It is a partner’s responsibility to communicate as clearly as possible about what he or she believes is going on and to insist that his or her partner get help.

Rarely is anyone able to work through these sorts of problems without the support of professional help. Finding someone to help you and your spouse these days is very easy, however. GoodTherapy.org’s therapist directory is a great place to start. You can also contact your local city or state psychological society or association. Speak with a physician or friend you know who has been in counseling and ask them or their therapist for a referral. Most local therapists are willing to consult at no charge over the phone to help you determine if they might be a good match for you or your spouse.

Welcome matThe term “enabler” has gained widespread recognition and use in popular culture and media over the past several decades. It is a label that can result in a great deal of anxiety and guilt for anyone who has been accused of being, or suspects that they may be, an enabler.

In its original context, enabling refers to a pattern within the families of people addicted to alcohol and drugs, wherein the family members excuse, justify, ignore, deny, and smooth over the addiction. This notoriously allows the addicted person to avoid facing the full consequences of his or her addiction, and the addiction is able to continue.

In a wider sense, enabling can describe a pattern of behavior that becomes organized among the family and friends of not just an addicted person, but any person who is exhibiting poor choices that harm themselves or others and for which they are not being held responsible.

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Who are enablers? Enablers can be romantic partners, ex-partners, parents, adult children, siblings, or friends. The one thing that all enablers have in common is this: they love someone who is out of control, and they find themselves taking more responsibility for the actions of that person than the person is taking for themselves.

The one thing that all enablers have in common is this: they love someone who is out of control, and they find themselves taking more responsibility for the actions of that person than the person is taking for themselves.

Who is enabled? The enabled person may be one who is refusing to take on responsibilities he or she would otherwise be expected to take on in the course of age- and stage-appropriate development. The enabled person may be exhibiting a range of poor choices with alcohol and drugs, ranging from abuse to addiction. This may also encompass poor choices around so-called “soft addictions” such as gambling, pornography, or excessive video gaming. He or she may refuse, or appear unable, to fulfill normative roles of adulthood. If a parent, he or she may underperform or disregard the responsibilities of parenthood. He or she may frequently disrupt romantic partnerships. The enabled person often displays poor money management, as well as disorganized academic and/or career-planning choices. He or she may quit or be fired from a series of promising jobs and educational or training programs. The enabled person often describes himself/herself as a victim of circumstances or of other people.

The enabled person’s behavior elicits a great deal of anxiety within the people who love him or her. This creates a dysfunctional system into which people who are close to, love, or care for the person can become enmeshed: compelled to organize their own behavior around the needs and choices of the enabled person.

Some who use the term “enabler” do so with a heavily negative judgment against the person who fulfills the role. It is commonly believed that enablers are knowingly, even willingly, complicit in the actions of the person they are enabling; that enablers support and condone the negative choices of the person they are enabling.

This is far from true. Enablers do not like or feel OK with what the enabled person is doing. To the contrary, enablers are often the ones most affected by, and most disturbed by, the negative behaviors of the enabled person. They feel extremely anxious about the destructive consequences that the enabled person could face.

Consider the following quotes from self-described enablers in therapy:

In other words, enablers detest the behaviors of the enabled, but they fear the consequences of those behaviors even more. They are locked into a lose-lose position in the family. Setting boundaries feels like a punishment, a rejection, or an abandonment of the person they love. Enablers may struggle with the guilt they would feel if the person they’re enabling were “left alone” to be hurt and damaged by the real consequences of their actions. In some instances, enablers are also protecting themselves and/or children from those consequences.

Enabling, therefore, is a distorted attempt to solve problems. Enablers desperately desire to find a solution to the issues at hand, but their attempts to do so are severely limited by the dysfunctional family system.

Enablers frequently find themselves thinking things like:

Enabling has the effect of releasing the enabled person from having to take responsibility for his or her behavior. Enabling means that someone else will always fix, solve, or make the consequences go away. When someone is in the throes of an addiction or other grossly dysfunctional behavior pattern, he or she begins to rely on the resources available. Enabled persons will come to expect that their behaviors are disconnected from consequences or negative outcomes. Enabled persons may even begin to hold their enabling family members in “emotional hostage” in order to keep this pattern going. They may learn to manipulate their enablers in order to ensure that the help and support keep coming.

In this kind of a system, everybody loses by inches. The enabler is desperate to prevent one enormous crisis, but winds up experiencing a constant state of stress as he or she attempts to manage each smaller daily crisis. Enablers generally are aware that they are being taken advantage of in some way; they often report feeling frustrated, unappreciated, and resentful.

The enabled person becomes stuck in a role in which he or she feels incompetent, incapable, disempowered, dependent, and ineffectual. He or she may gradually accept a self-concept that includes these negative traits, destroying self-esteem.

How, then, does the enabled person also “lose”? The enabled person may wish he or she felt in control of themselves, particularly with regard to addiction; but lacking the life experience and lessons that facing consequences brings, they may not know how to break those patterns. They may not have had the benefit of true self-reflection and self-evaluation of their behaviors. The enabled person becomes stuck in a role in which he or she feels incompetent, incapable, disempowered, dependent, and ineffectual. He or she may gradually accept a self-concept that includes these negative traits, destroying self-esteem and rendering the person even less likely to suddenly do a 180 and become responsible and self-sufficient in the future. The enabled person may essentially be prevented from building the skills and motivation he or she needs in order to practice responsibility and reach his or her full potential. Because the enabler(s) will always solve problems for them, the enabled person does not learn how to solve their problems themselves.

By this point, you may be thinking, “I can see some of the ways I have been enabling my loved one. What now?”

You must accept that while your enabling behaviors come from a place of love, enabling is an ineffective way of solving problems at best; debilitating to all involved at worst. You may buy another day or prevent another emergency, but in the end, you are only postponing the real solution.

The key to breaking the pattern of enabling is to return responsibility to the person it belongs to. This involves setting boundaries between yourself and your loved one. You can no longer attempt to take on responsibility for anyone else’s actions but your own. Your loved one’s choices are (and have always been) his or hers. Your loved one’s outcomes and consequences, as well, belong to him or her alone.

The enabled person lives in the same world, with the same rules, as everybody else. Managing their world for them means that they don’t learn to manage themselves within the world. He or she is very likely to have untapped internal and external resources which have not been utilized because the enabling pattern has short-circuited their growth.

When you set boundaries, you release your need to control the outcomes that your loved one experiences. You allow your loved one the chance to connect his or her own choices to the positive and negative experiences that naturally follow. Their choices, their consequences, and what they do or don’t learn from them are all on their side of the boundary.

On your side of the boundary, this means that you must learn to cope with, and internally manage, the anxiety of not being in control of your loved one. Many recovering enablers find that they must rely on their own sources of support to help them overcome the urge to control and enable. The fear of your loved one being hurt can be so overwhelming that setting boundaries and stepping back can be panic-inducing. Receiving counseling for further insight and support in this area is highly recommended.

When you stop enabling, this does not mean that you stop loving the person. It does not even mean that you cannot help him or her.

When you stop enabling, this does not mean that you stop loving the person. It does not even mean that you cannot help him or her. There is a difference between healthy help and enabling. Healthy help involves providing information, encouragement, and coaching to your loved one. You may give your loved one contact information for doctors, counselors, lawyers, or rehabilitation programs, without feeling the need to force him or her to accept this help. You may discuss with your loved one what the possible consequences of actions might be, without feeling as if you must make sure they make the choice you want them to make. Healthy help puts your loved one in control and allows you to take a secondary role.

Enabling is essentially love turned to fear, and help turned to control. The effects of enabling are toxic to all involved. With a solid understanding of what enabling is, and what it is not, there is hope for families who are acting out this pattern. An experienced individual and/or family counselor can be a valuable source of support for anyone who is looking to break enabling patterns.

Feeling like you’re compelled to self-destruct is a very scary place to be; you probably feel out of control and scared about what might come next or the consequences of the behaviors you’ve described. I imagine that you are also grappling with some feelings of guilt and shame. This response will not give you all the answers you might be seeking, but hopefully it will shed some light on what to do next.

I was struck by your statement “What’s wrong with me?” because I don’t necessarily see anything “wrong” with you. I wonder if you would be willing to look at your behavior not as something that is “wrong” but rather as an indication that you are hurting and this behavior is letting you know. Often, when I see people who are acting out in self-destructive ways it is an unconscious way of self-sabotage. Perhaps you feel unworthy of love, success, and happiness, and act in ways to reaffirm that belief. Perhaps you are afraid of closeness and intimacy and use these behaviors as a way to keep yourself distanced from others. It is really difficult to pinpoint an exact cause without knowing more about your situation, but I would venture to say that you are unhappy and frustrated with how you’ve been living and may be reaching a point where you’re ready to make some changes. Even though you may feel very out of control right now, may I encourage you with the idea that you can always choose a different path and, therefore, a different outcome.

It takes a lot of courage to send in a question like this one; I hope you continue and take the next step of calling a qualified therapist who can help you understand why you’ve made the choices you have and who can journey with you as you decide how you will live from this point forward. It is not an easy road to walk, but it is always well worth it in the end

Sincerely,
Lisa

Father and Son Shouting at Each OtherShouting, yelling, screaming. Nearly all parents have done it; nearly all children age 10 and under have heard it. In small doses, such as in emergencies, yelling is not believed to be harmful. Yet, as common as this interaction is within families, if it happens too often it can break down positive conflict-management skills and flood a family’s emotional field with negative affect.

Why Do We Yell?

The most basic reason we yell in any situation is because, on some level, we feel we are not being heard. Whether literally—the person is in another room, for example—or figuratively, not feeling heard is an incredibly frustrating experience. When we believe we have a valid point and are being intentionally ignored, misheard, or invalidated, inside our brains we are thinking, “They must not really be hearing me. I will speak louder. That should do the trick!”

Yelling also stems from a need for control. Yelling is a form of verbal aggression; it carries the message that the yeller desires to be the loudest and most dominant person in the room. If someone is yelling, it is a good bet that the yeller is feeling out of control and is feeling the need to dominate the interaction.

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Parents often experience frustrating and even oppositional behaviors from young children. Depending on your child’s age, he or she may be focusing on developmental tasks ranging from establishing a sense of independence to experimenting with rebellion. The act of not listening to you can actually be part of your child’s necessary development.

At various times of the day or week, parents’ reserves of patience and energy can already be low. For example, a full-time parent may feel that he or she can barely make it to nap time with sanity intact. A pre-nap meltdown from their toddler hits them at their absolute lowest point of the day. A working parent’s morning can be so tightly orchestrated that just the slightest alteration in routine can cause a cascade of setbacks and tardiness. Throw in an early meeting and some traffic, and there is a perfect storm of frustration which can come lashing out toward a child. Parents can reach a saturation point at which their own coping skills are no longer carrying them through a particular interaction. At these points, parents often resort to yelling in an attempt to regain a sense of validation or control.

What’s the Case against Yelling in Families?

Yelling raises blood pressure, heart rates, and adrenaline levels. Those who yell exhibit higher levels of the stress hormone cortisol in their bloodstreams over time. These physical consequences are also seen in those who are yelled at. Like second-hand smoke, second-hand anger can take a big toll on health.

That’s a case against yelling in general, but in families with children age 10 and under, there are several other reasons that yelling isn’t healthy.

Children look to their parents to maintain the safety—physical and emotional—of the family. Babies and very young children do not yet have the ability to determine the difference between a real threat to their safety and an upsetting or frustrating circumstance. Many parents can attest to this, hurrying to the scene after having heard their toddler scream as if hurt, only to discover the source of the scream was a minor frustration such as not being able to reach a toy. The child’s cognitions in this stage are quite concrete; circumstances are either “all good” or “all bad” and there is little room for ambiguity. Children under age 5 can therefore mistake a parent’s loud tone with an alert to a true threat. This can be terrifying for a child in this developmental stage.

Fear is one of the most basic and universal emotions—every animal experiences it. Fear is centered on a primitive part of our brain called the amygdala. When fear permeates a young child’s emotional experience, such as in a household with daily episodes of yelling, the amygdala will become overly active and this will inhibit the child’s brain from working on higher-level functions such as concentration, reflection, learning, decision making, and behavior planning.

With older children who are more verbal, the words that are shouted can be even more harmful than the tone itself. Even though yelling is an attempt to gain control through aggression, the irony is that in doing so, we actually lose control of our behavior and our ability to filter and manage what we are expressing. Negative labeling, blaming, and other harsh words are especially harmful to children because children accept unconditionally that what their parents say is true. Children between approximately ages 5 and 10 have the cognitive ability to understand the words themselves, but not the adult’s emotional context. They will internalize the messages from the parent without questioning if they are accurate, and will add those messages to their budding self-concept.

[fat_widget_left]Finally, many parents who yell can relate to this scenario: “When I don’t yell, my child doesn’t listen to me. He or she only seems to respond (do what I want) when I yell.” The escalation involved in yelling can become a self-reinforcing feedback loop. Children can become desensitized over time to their parent’s escalation pattern. The child, who is interested mainly in persisting in play or attending to his or her own agenda, will naturally search for ways out of responding to a parent’s demands. We cannot fault the child for this; it is simply a piece of his or her development. The more parent-free space and time a growing child can carve out, the more he or she can explore the world around him/her and his/her own inner experience. The child learns that the parent will eventually escalate to yelling each time, and so the child learns that he or she does not need to respond until and unless yelling is used. The “pre-yelling” time becomes seen by the child as “don’t have to listen yet” time. And the parent, on the other side of this interaction, keeps needing to up the ante over time to get the same response.

How Do We Break the Yelling ‘Addiction’?

1. Set a SMART goal around yelling: a Specific, Measurable, Attainable, Relevant, and Time-bound goal that solidifies your commitment to changing this behavior. Such a goal may sound like this: “Within the next month, I will decrease my instances of yelling on weekday mornings until I’m yelling once per week or less during that time period.” Write down your goal and put it in a place you will see it every day.

2. Find ways to increase true power, so that false control is less tempting. Yelling is false control. It feels powerful in the moment, but it undermines our internal self-control and the quality of our relationships over time. Ways to gain true power include:

3. Assume responsibility for the outcome of each interaction. You are the parent. You set the stage for the relationship between you and your child. If your child escalates, this does not mean you must escalate. If the situation escalates, this does not mean you must escalate. No matter how bad the traffic, how frustrating the missing shoe, how grating the whining, or how sassy the defiance—in the end, you always have a choice.

4. Speaking of choices, realize that yelling is only one of hundreds of things you can choose to do in a frustrating moment. Instead of yelling, you could:

Some parents choose a grounding object, color, or mantra which they use to bring their attention away from their momentary anger and refocus it on their goal.

5. Return often to a developmental lens through which to view your children. At all times, children must be expected to behave as children. They cannot and do not think, process, or behave as you do. It is entirely predictable that children will lose things, drag their feet, misunderstand you, ignore you, and throw tantrums at inopportune times. The more you can remind yourself that this is developmentally normal, the less you will feel personally offended or annoyed by childish behavior.

6. When—not if—you do yell, be prepared to acknowledge and apologize for this to your children. Parents must be willing to role-model to children the process of owning up to poor choices and the effects they can have on others. If as parents we are not willing to do so, how can we expect the same from our children?

Breaking ingrained patterns of interaction like yelling is not an easy thing to do. Parents must take full responsibility for “being the change they want to see” in their families. Parents must make their tendencies and triggers conscious, face them honestly, and focus their attention on them if they wish to change. Keeping a written goal, a list of alternatives, and a developmental perspective will be of great help to the parent who wishes to reduce yelling. Over time, parents who make these efforts will be able to enjoy a great deal more peace in their family, a reduction in stressful feelings, and an increase in the amount of true power they are able to exert over their lives and actions.

Man sky divingWe all know an adrenaline junkie: the friend who jumps out of airplanes for fun, the sibling who spends her time traveling to war-ravaged countries, or the co-worker who spends her weekends speeding on a motorcycle. Adrenaline rushes are readily available at just about every turn. A number of factors can affect whether a person ends up a risk taker or a quiet homebody, but there’s evidence that a little risk-taking now and again is good for almost everyone.

Effects on the Brain

Risk-taking causes real changes in the brain, which might account for why risk-takers quickly seem to become adrenaline addicts. Major risks release adrenaline, which can lead to a quick rush, and dopamine, which causes intense feelings of pleasure. While these chemicals contribute to a powerful high in most people, the feelings can be especially addictive to people who are struggling with feelings of sadness or depression. Over time, risk-taking can function much like a drug. Risk-takers may need bigger risks to get the same rush, and mundane daily activities can start to seem boring and painful.

Personality

Personality plays a major role in an individual’s propensity for risk-taking behavior. While it might seem like those who worry excessively don’t make for ideal risk-takers, some studies indicate that people who score high on neuroticism – a combination of anxiety, moodiness, and worry – are more likely to become risk-takers. The data is not conclusive, though, and some studies have found that risk-takers actually score lower on measures of neuroticism than the general population.

Personality can also affect the kinds of risks a person is willing to take. The dedicated smoker might be terrified of heights, driving, or illness, without ever recognizing that smoking is a risky behavior. Some adrenaline junkies have a preferred risk-taking behavior, and this could be correlated with personality. People who love novelty, for example, might travel to dangerous locations, while people who are highly physical might get their adrenaline rush from rock climbing or mountain biking.

Culture and Peers

Cultural influences play a huge role in whether or not people are willing to take risks. As travel – particularly to remote locations – has become a part of the educational path of middle class students, more and more students are willing to travel to potentially risky locations. Peer pressure plays a huge role in risk-taking, and study after study has shown that people are more likely to take risks in a group setting.

Benefits of Risk-Taking

While some risky behaviors might not be worth their potential consequences, risk-taking in small doses is almost universally beneficial for your brain and mental health. Novel experiences can help to ward off depression and reinvigorate a stale relationship. Risk-taking is often a necessary prerequisite for starting a new business or launching a new career, and the excitement associated with uncertainty can be a powerful antidote to boredom and even depression. Because dopamine produces a natural high, risk-taking behaviors can help you get a positive mood and a new perspective without the risks associated with drug use.

References:

  1. Adrenaline rush: The science of risk. (n.d.). Museum of Science, Boston. Retrieved from http://www.mos.org/imax/adrenaline-rush
  2. Gardner, M., & Steinberg, L. (2005). Peer Influence on Risk Taking, Risk Preference, and Risky Decision Making in Adolescence and Adulthood: An Experimental Study. Developmental Psychology, 41(4), 625-635. doi: 10.1037/0012-1649.41.4.625
  3. Park, A. (n.d.). Why we take risks — it’s the dopamine. Time. Retrieved December 30, 2008, from http://www.time.com/time/health/article/0,8599,1869106,00.html
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