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The Question of Sex Addiction

Tiger Woods during a news conference in, Friday, Feb. 19, 2010, in Ponte Vedra Beach, Fla. (AP)

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Sex addiction has been all over the headlines lately. Tiger Woods put it there this time. And before him, David Duchovny and Michael Douglas and Susan Cheever, and plenty more.

But what is sex addiction, and how is it different from just a lot of sex, or from plain old philandering? And is it for real? Or just a convenient tag that lets Hollywood cads pose as victims themselves?

Tiger’s millions helped turbo-charge his sex life, but what about ordinary people and compulsion? Where’s the line?

This hour, On Point: we’re bringing in the experts to assess sex addiction.

Guests:

Kenneth Adams, clinical psychologist and certified sexual addiction therapist who has treated patients for over 25 years.  He’s clinical director for the Program for Sexual Health and Addiction, an outpatient program that treats sexual compulsion and addiction.  He’s co-editor, with Patrick Carnes, of “Clinical Management of Sex Addiction.”

Pepper Schwartz, professor of sociology at the University of Washington in Seattle, where she teaches one of the school’s most popular courses on the sociology of sexuality.   She’s author of dozens of papers and academic papers on sexuality, and a consultant to the Lluminari Women’s Health Network.

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  • cory

    It is addictive like anything else pleasurable… Chocolate, cigarettes, etc. The cure? Easy, zip up and face your responsibilities!

    I can’t believe someone can make a living treating this made up disorder! Only in America!

  • Expanded Consciousness

    Everyone is addicted to sex. It is a human need. We all need it … so badly.

  • Expanded Consciousness

    The real ‘disorder’ is self-destruction (sex is just the self-destructive route of Tiger Woods, in this instance).

    The other ‘disorder’ is a lack of authenticity. If you want to be single, be single. If you want to be married, be married. If you want to be married and have an open relationship, find that. The addiction here is that of duplicity, addiction to lying to and getting over on another (whether sex is involved or not).

  • Rick W

    Oh great. Thanks onpoint radio for having a lightweight like Pepper Schwart on the air. What a joke.

  • Arnold Tracey

    I think that sexual compulsion or addiction, so-called, is a convenient out.

    Absurd on the face of it.

    I’m afraid it’s juat another – of many – psychiatric loophole.

    Tiger is just an opportunist. A juggler. A man who refused to settle for one female.

    He had a quasi harem. Most men would.

  • Expanded Consciousness

    “How many balls he had in the air” (Pepper Schwartz). Hahaha!

  • Robert Littler

    I believe that sex addiction is a real physiological addiction. What it does to the limbic system is the same as a drug. Just the physical part is easy to see as addiction, then adding the behavioral aspects to the sexual act allows me to see the ritual associated with it much like addicition.

    As for Tiger Woods, I am very tired of this as being news. What he has done is not any different from many many men, myself included. It is about time we have an honest conversation about how we all have our own “Tiger Woods Syndrome.”

  • Gary

    Hmmmm….. what is the therapy for this?

    Do they tie you in a chair in a basement, Gesthapo style and then parade scantilly dressed women in front of you? Do they then ask you how you feel seeing them? And then when you respond ‘I pretty much still want to nail her’ do they slap you across the face and then repeat the process?

  • Judy

    I have just found out my husband of nearly 20 years may be dealing with this issue. I got an STD from him. He had relationships with at least 2 other women in the last year. He has used porn for years, and it escalated to relationships outside our marriage now. He is definitely someone with an extremely high sex drive, and I have found a big emotional disconnect in our sexual relationship for years, which was a big problem in our relationship. We are working through this experience, but if he does not work through this issue he has, we will not make it.

  • Rob Littler

    How many people are addicted to orgasm, and are compulsive masturbators and NO ONE knows?

  • Expanded Consciousness

    It isn’t sex addiction. It is intimacy fear. Everyone has lust. The question is, “Where is the love, Tiger?’ You don’t love your wife, divorce her. I’ll marry her.

  • Todd

    Sex addiction? Back when individuals were still held accountable for their own actions, and before we became a society of “victims” with pseudo-science to provide us an excuse for our every lack of self-restraint, we called this exactly what it is: UNBRIDLED LUST.

  • Gary

    Tiger Woods has absolutely NO REASON to apologize to me for HIS PRIVATE life. Nor do any of the leagon of others who private activities that do NO HARM to me, ahve any reason to apologize.

    If Tiger and the others could get away with it, they SHOULD tell us to mind our own business, and stop living our lives through other peoples private misery.

    Is this kind of intrusion and voyeurism now considered correct behavior for Americans? Tiger may have a problem with his marriage, but I don’t care, or even want to hear about it… Nor should anyone else.

  • Jeff

    Why is this news? I think the guy is lucky and should dip his wick whenever he can. Come on don’t waste your air time on such useless tripe as this.

  • Andy

    People used to believe that alcohol addiction was a moral failure, that gambling addiction was lack of will power and over-eaters simply glutons with no self control/ or self respect.

    But the loss of all you hold dear: health, job, family, finances as a result of a behavior that gives a singular pleasurable experience despite knowing the risks and dangers involved. That is addiction. No one would chose to have this problem, and it is far to embarassing to seek help about, until it is too late and all is lost!

    It is real, tragic and society contributes to the shame.

  • Chuck

    Why not some of the real experts and not the pundits, talking heads, and opinionated callers?

    For instance,– Sexaholics Anonymous
    http://www.sa.org/

  • Charlie Mc

    At last, a topic about which we all consider ourselves to be expert. Read Saint Thomas Aquinas on the seven deadly sins. We have countless stories of the unleashed pursuit of food, drink, sex, money, possessions and power in the Scriptures of all the world’s religions. The “Thou Shalt Not..” of Genesis, has always generated a “Like hell I shan’t” by those who have the power to sieze these objects. Tiger has more of this world’s power than most of us and yet at heart how many of us would not “fall” as he has given his power and opportunity.
    We are urged not to judge others but rather take care of the log sticking out of our own eye. King David’s story is Tiger’s, and maybe a quick reading of Jesus talking with the Samaritan woman at the well
    (John Ch.4)will help us to be compassionate and merciful in our judgements of others’ faults, yet understanding of other’s (Mrs. Woods’) pain.

  • Hildreth Curran

    What percentage of so-called sex addicts are men? I have to wonder if a woman had had over a dozen sexual partners, would we be calling her a sex addict? When a man is promiscuous, we call him a sex-addict; when a woman is promiscuous, society has dozens of deprecatory words to call her.

  • bernadette

    What about gender? sex addiction is overwhelmingly used as a “defense” by men- especially straight men. why is it that men get addicted to sex? this underscores the comments about hyper sexual actitivy as a symptom of other personality disorders. if we examine the sex activity of gay men, there is a sub-culture of many sexual partners, which is not pathologized.

  • LP

    I dated a person who may be described as a “sex addict” for a couple years, and listening to today’s show, I don’t think he had a separate psychological disorder.

    Like the doctor said, there are existing diagnoses that address impulse control, self destructive behavior, and narcissism. My former partner exhibited a sense of entitlement and lack of self-restraint when it came to sex, alcohol, and many other things.

    I believe there are sexual psych disorders that lead people to become sexual predators and sex offenders, but I don’t think the Tiger Woods m.o. qualifies as a new disease. People like him still need therapy, but not a new diagnosis!

  • peter nelson

    I believe that sex addiction is a real physiological addiction. What it does to the limbic system is the same as a drug.

    But that doesn’t make “sex addiction” a separate pathology. Obsessive disorders have been recognized for years in psychiatry as pathologies. People can become addicted to sex, gambling, the internet, someone they have a crush on, and a ton of other things.

    In the old days people drew a distinction between a “physical addiction” and a “psychological addiction”, but now we know that the same changes occur in parts of the mesolimbic pathway of the brain in both cases. Other parts of the brain are likely involved, too. Actual changes in levels of various neurotransmitters (notably dopamine), density of receptors and neurophysiological response to various external stimuli occur the same way whether you’re talking about a drug that directly affects dopaminergic activity (e.g., cocaine) and long term activities that give you pleasure and excitement (e.g., gambling).

    So I think that what we’ll find eventually is that there’s no separate, unique condition called “sex addiction”, but that the underlying neurophysiological mechanisms are at work in many different addictions.

  • http://www.buddhaspillow.blogspot.com Paul Creeden

    Overuse and indiscriminate use of sex is most likely indicative of a physiological and/or psychological problem. Granted.

    However, the simple fact of life is that sex is like any other bodily function. It has become overly sanctified by religion and government as a way to control the reproductive behaviors of people in society. There was once a solid social purpose for this. However, in an age of science, sex education is the way to the future sexual and reproductive health of the species.

    The education sector of our society needs to wrest sex education from the hands of politicians, clerics and pop psychologists, with the full, vocal support of educated parents. By educating children about healthy sexuality, regardless of sexual identity, many of the current health problems caused by sexual dysfunction could be prevented in a much larger segment of the population..

  • Jan

    Frank the recovering “sex addict” took offense at being equated with an offender, as if he was a criminal. Yet, philanderers of any degree are committing offensive acts. While I appreciated Frank’s candor, I don’t think he should have been offended by Tom’s use of that term, nor do I think Tom should have apologized.

  • Isabel

    I have a friend who is probably a sex addict. He gets himself into degrading, embarrassing situations. He has problems with intimacy. He’s a good person otherwise.

    I think we shouldn’t judge people. I also think that Tiger Woods should only appologise to his wife. It’s none of the public’s business.

  • Mary

    Sex addiction caused years of anguish in my marriage and ultimately led to my husband’s premature death. His sons both exhibit signs of the his addicitive behaviors (specific to both sex and alcohol).

    Porn is a major component of our family’s story and I am driven to distraction by the assertion that it is OK–I am a widow and my children without their father so don’t shed any tears for my husband but don’t ever assert that porn and prositution are victimless.

    Whether or not sex addiction rises to the level of clinical diagnosis is less important than the availability of help for the addict and everyone around them.

  • Jeff

    Our society has become such a marketing tool.
    1. You have a problem that’s very bad/dangerous/deadly/socially wrong
    2. It’s not your fault – it’s a “disease”
    3. If you don’t take care of it now, it will get worse or you’ll die
    4. We just happen to have what you need for a “small” price. (Drugs, therapy, excuses, etc.)

  • Mari

    Linking so-called sex addiction with entitlement and narcissism sounds about right to me. Hey, guys get bored with the same old-same old, don’t they have a right to exploit every possible “opportunity” when their lust for the wife cools down? Depends on who you are, I guess.

    Unfortunately, the 2 ordinary, run of the mill, serial cheaters I’ve known never examined their own motives and instead went looking for reasons to excuse their actions when they got caught. It ended very badly for me and my family. Were they sex addicts or just immature, self-centered idiots? My guess leans heavily towards the latter.

    I feel somewhat sorry for a man who lets his genitals drag him along the trail of life but I feel much sorrier for his partners and his kids.

  • Dianna

    How can employers deal with on-line porn abuse in the work environment? In the past this behavior would lead to an immediate dismissal. Can employers be sued for not treating this as medical issue?

  • Neelofer

    We should take poor Madoff out of prison. The guy simply had an addiction. He was addicted to defrauding people of their money.

  • J Baker

    Are Bonobos sex addicts?

  • Judi

    Tom.
    You run a great show and you have the best callers. Thanks for another interesting and educational hour!!!

  • Jennifer

    I work in in-patient psychiatry where we do not recognise “sex addiction”. Try “Narcissistic Personality Distorder” instead.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    If this subject doesn’t make one think, then thinking is not possible.

    Here we have a species, Man, who was ostensibly created apart from the animals of the Earth. And yet having been “created” by some sort of vastly superior intelligence (thereby guaranteeing our success as a species, one would think) exactly the opposite is destined to reveal itself.

    Because with all barriers removed toward the obvious — overpopulation (which stresses the social fabric of the species even further) mankind has at the same time been thrown a huge curve ball … sex as pleasure far above and beyond that which is required for procreation alone

    Consider just how the animals of the Earth have circumvented our fate (early extinction) via their seasonal reproduction design. Man, it would appear, was somehow not nearly so blessed.

    How is it, then, that with an alleged “infinite intelligence” in the driver’s seat, the problems associated with human “sex on demand” in a species with no natural enemies wasn’t foreseen by the so-called “Grand Designer?”

    This makes for one of the strongest cases I know of in the argument in support of the appearance of Homo Sapiens on planet Earth as completely spontaneous, and worse yet, fatally flawed.

  • http://www.pnart.com peter nelson

    He had a quasi harem. Most men would.

    What a sexist bit of blather!!

    I’ve been married faithfully to the same woman for 25 years despite the fact that I regularly work with sexy models and do portfolios used by strippers and workers in the “adult” industry. Some guys like to work on their cars or play golf – this is my little “hobby”. (see my website http://www.pnart.com – NSFW)

    This is the same sort of crap we get everytime some politician “goes hiking on the Appalachian trail” – blah-blah-blah-men are a bunch of animals barely in control of their impulses – give them have half a chance and they’ll drop trou’ and try to mate with anything that breathes blah blah. But that’s why those things make the news – because they’re a scandal – for every high-profile guy who parks his car in somebody else’s garage there’s a hundred who don’t!

    Most men I know love their wives and are faithful to them. Arnold should speak for himself and enjoy his I Dream of Jeannie fantasies in private.

  • Frank

    This is “Frank” who was on the air — I spent 45 days at Gentle Path for sex addiction treatment, and it saved my life.

    It is deeply disturbing to read the vast majority of commenters on most other sites and media outlets, and even a few here such as Arnold Tracy and Donald Baxter, who have the hubris to state with authority that “sex addiction is an excuse” and not a real problem. How can they know without having any first-hand information? Donald or Arnold, have you actually read anything about it? Have you attended a 12-step meeting for sex addicts? If you did, you might begin to have some compassion and understanding of the truth of people who are struggling with their own out-of-control sexual behaviors.

    Admitting to sex addiction couldn’t be more opposite to an “excuse”. Finally facing one’s own sexual acting out, be it affairs, porn, prostitutes, or whatever, is incredibly difficult — the addict feels more shame than any non-addict could imagine. Admitting that one is an addict is the first step towards honestly facing the problem, getting help, and doing the deep personal work to overcome the compulsions, change behavior, and become 100% honest and transparent with partners and loved ones.

    Todd and “Expanded Consciousness” above both refer to lust in a dismissive way. Yet lust is exactly what we refer to in 12 step groups — that we realize that lust is controlling our behavior. Lust, not intimacy. If someone has a very active sex life with their partner, or someone decides to have an affair, that doesn’t fit a definition of addiction. But if the person is getting deeper and deeper into troubling behavior (progressive), finds repeatedly that they can’t stop even when they have sincerely promised to themselves or to another person that they would stop (powerless), and the behavior is affecting their life negatively, e.g. risking a job, marriage, disease, spending all their money, or even injury or death (unmanageable) that is a whole different level.

    So don’t confuse a jerk who uses women, a cheater, a young person who masturbates a lot, or a couple who have lots of mutual, intimate sex, with a true addict whose life is spinning out of control. Many sex addicts may have started with behaviors that are “normal” or at least typical — like a single person having multiple partners, or average masturbation and porn. But if the behaviors keep progressing until they hurt the person’s life and relationships, then it may be a lot more than just philandering or having “a high sex drive.” To me, the clearest sign of really addictive behavior is if a person is living a secret double life, which even they don’t really recognize as a problem.

    Treatment usually includes complete sexual abstinence for a while (typically 90 days), to get through withdrawal from constant intense overstimulation, and get back to “normal”. It may take a lot of confrontation and honest disclosure for a person to get beyond their own rationalizing and minimizing — which usually sounds exactly like the “skeptics” — such as “I’m just highly sexed” or “it isn’t hurting anyone” or “everyone does this” or “I can stop when I want to, but I just don’t want to right now.” Almost no one can conquer this alone — because sexual acting out is so shameful, addicts almost always become isolated and live a whole secret, “split-off” double life.

    Please go read “Out of the Shadows” by Patrick Carnes if you are skeptical about the reality of sexual addiction, or if you suspect that you or your partner, friend or family member may be lost in secret, destructive sexual behaviors. If you are the partner of a sex addict, you might find a lot if support and information in “Mending a Broken Heart” by Stephanie Carnes (daughter of Patrick Carnes).

    I beg of everyone, don’t be so quick to judge or dismiss before you have learned a lot more about this. And remember that while the human mind can never be fully described by any psychological model or label, the addiction model is clearly the most effective, useful approach to treating out-of-control sexual behaviors, whether or not it is exactly the same as substance addiction.

  • Frank

    @ Jeff, on February 25th, 2010 at 10:30 AM: Do you really think there are no consequences for leading a secret double life and cheating on your spouse? You really think it’s fine??

  • Liz

    If Tiger had a true addiction, why wouldn’t his golf game have suffered at the hands of his uncontrollable compulsion? He found the willpower to maintain the hours of practice needed to keep his game at the highest level, yet couldn’t bring that same level of control to his sexual life. All areas of his life should have been affected. Doesn’t sound like an addiction to me.

  • peter nelson

    I am a widow and my children without their father so don’t shed any tears for my husband but don’t ever assert that porn and prositution are victimless.

    I’m sorry about your loss but people can develop self-destructive behaviours and obsessions with LOTS of things. Alcohol is a good example. Gambling, including legal high-intensity investing such as “day trading” is another. And the list is almost endless. So in the end it comes down to the individual and his psychological problems and how he deals with them that we have to focus on. We can’t go around banning things because some people can’t control themselves.

    Human beings are sexual. We are profoundly sexual – WAY more than animals like rabbits which we iconify WRT sex (Playboy bunnies, etc). The reason is that rabbits’ reproductive behavior is governed by estrous cycles so they’re only receptive every so often – humans are ALWAYS sexually receptive.

    For many people – single people, older people, lonely people, pornography and prostitution are their only sexual outlets. It seems cruel to deny them this and enlightened societies don’t try to.

  • Frank

    @ cory, on February 25th, 2010 at 9:57 AM: There are 12-step sex addiction groups all over the world, in pretty much every country. Definitely not an American problem.

    Seriously, do you think the way we casually use the word “addicted” about things like chocolate has anything to do with serious compulsive behaviors that a person can’t stop, despite years of desperate trying? I beg of you, please read and learn about this before being so quick to dismiss other people’s real pain and struggles.

    If you know any cigarette smokers who can quit “easy, just zip up and face your responsibilities,” then I guess you don’t believe nicotine is addictive, and this is a pointless conversation because you seem to have no compassion for many people’s struggles to control their own behaviors in the face of addictive substances or behaviors.

  • John

    12 step programs are a cult. There is no higher power.

  • Frank

    @ Liz, on February 25th, 2010 at 11:33 AM: The very definition of addiction is that it CAN’T be controlled by willpower! So why would his inability to manage compulsive sexual behavior have anything to do with his commitment and talent in golf? It’s not like he was ruining his body with drugs or alcohol – he was ruining his personal life and his honor, not his golf game.

    My experience in my life and of the many addicts I know and which is described in many books on sexual addiction, is that most addicts become incredibly good at hiding their behaviors in a secret double life. They appear as “normal” as possible in the rest of their life, in part to desperately protect their shameful secret from discovery.

    A somewhat different example, not necessarily addicts: think of the many famous religious figures who preached abstinence but were then caught in terrible sexual cheating. Their public presentation belies their secret truth. Maybe that applies to Tiger.

    Final thought, (and I’ll shut up :) In sex addiction treatment I learned that most addictive behaviors are largely driven as a need to cover up or “medicate” uncomfortable feelings. Does Tiger strike you as a person who is in touch with and expressive of his feelings? I wonder if that goes with the super-calm emotionless golfer?

  • eric

    I am commenting here, not because i give a xxx about tiger or your program theme, but because i am very disappointed that wgbx and wbur are not broadcasting the health summit. I cant find anyone on the fm dial broadcasting this event. Conservative talk radio 96.9 is devoting their time to vent the anti-obama position. and i am sure there are plenty of other idiots out there doing the same thing. every one has an opinion but no one is tuned in to the actual debate.
    Fortunately for me it is possible to tune in using internet radio. i am listening to cspan radio on itunes as i type this. but it is supposedly a televised event. On cable cnbc only had the opening remrks. where should i go to tune in??? if the summit were about tiger woods then by god it would be covered live on all the networks for the full 6 hours. and the radio would pick it up too.
    give me a freek’n break.

  • peter nelson

    12 step programs are a cult. There is no higher power.

    It’s hard to say WHAT they are. A few years ago my wife and I wanted to get a relative of ours who had drug/alcohol abuse problems into a private treatment program. (she eventually went to a state hospital in her state).

    Because I have a science background I started reading the research literature and frankly, the treatment science for addiction is ABYSMAL. It’s just plain awful, especially WRT adults. Study groups are too small, acceptance criteria and outcome criteria are too vague. Most studies lack double-blind and control group protocols. Treatment methodology is too vague to make published results easily repeatable. And followup periods are too short. So the science behind treatment methods was just way too junky to give us any confidence, so we didn’t spend our money.

    Also it doesn’t help that AA has a standing policy to not take part in scientific research – not sure about SA.

    Sometimes WRT the “war on drugs” people say, instead of putting people in jail, why not give them treatment? The problem with this is that there is no extant treatment methodology that can show with scientific rigor that it actually works all that well.

  • peter nelson

    i am very disappointed that wgbx and wbur are not broadcasting the health summit.

    That’s because it’s a canned event – it’s just political theater – nothing substantive is likely to emerge from it. So why should public broadcasting waste its airtime?

    We all already know everyone’s positions on this topic so it’s not as though we will be “better informed citizens” by watching it.

  • jeffe

    Frank Woods has ruined his golf game. He’s not competing and will be out of the game for at least a year or more.

    So his addictive personality is self destructive.
    This is not about sex it’s about having an addictive personality. Unless you have lived, known or were an addict you don’t know what you’re talking about.

    You can have an addictive personality and be addicted to video games. Sex is the drug of choice.

    It’s interesting that the program after this is on heroin use and I just listened to it. There was this junky being interviewed who was claiming he was not like other junkies. Well I have news for him, he is. Denial is one of the signs that you have an addictive personality.

    Peter has anyone ever told you that you have a kind of sanctimonious air?

  • jeffe

    So peter are you advocating that we should do nothing because the science is not sure about how this part of our brains works? If 12 steps save 50% it’s worth it is it not?
    That’s fair amount of people who are not using drink or drugs or whatever and are not a burden on society or their families.

  • missy

    i hope that everyone will read what frank has to say… there has been sex addiction in my family for 3 generations… you cannot believe the pain and heartache that it causes. my husband after much hard work, counseling, groups, reading and prayer has been in recovery 6 years. the people that make a joke of this know nothing about it, and the shame that comes with it, or they have the problem themselves and are in denial!!!

  • eric

    I want to apologize to the community here for my off topic post about the health care summit. I made that post with out regard for the serious discussion you are having on a sensitive subject. This discussion obviously is about more than Tiger the celebrity. I am sorry. My beef is with public radio and their decision to not devote more time the news I am concerned about.

  • Liz B.

    Addiction appears to be connected to the level of brain chemicals in our brain (dopamine, seratonin and others, also called neurotransmitters). Everyone has a different mix of these chemical substances and their interaction defines what we want, what we crave for or dislike (drugs, sex, money, gambling, etc). These brain chemicals’ interaction is also determined by the person’s socioeconomic environment.
    Tiger’s case has been characterized as sexual addiction but there are many other addictions. It seems our society is afflicted with so many types of psychological problems that we treat with pills and therapy which are seem to be connected to brain chemical imbalances.
    Perhaps next time a neuroscientist could be invited to shed light on this subject. It’s fascinating but at the same time brain chemical imbalances cause serious damage to individuals and their families and friends and essentially to our entire society.

  • Linda M

    Seems to me that an overwhelming desire to have sex 24/7 would come into the same category as a desire to gamble. It is not a “physical” addiction like tobacco or heroin, but a “mental” one where you like how doing it makes you feel and want to do it again. A compulsion more than an addiction. In Tiger Woods’ case, who cares? What business is it of yours, mine, or anyone besides his wife and mistresses, where he puts his penis?

  • ward merrill

    Where does NARCISSISM fit in with this……?
    I’m more then sure it’s involved and feel it’s the root of this conversation.

  • wavre

    Poor Westerners entangled in the ideal of monogamy! This judeo-christian straitjacket has to be banished along with the hypocrisy that comes with it.Monogamy should be optional. There are more women than men, so let’s give everybody the opportunity to mate…I meant to meet:)

  • peter nelson

    So peter are you advocating that we should do nothing because the science is not sure about how this part of our brains works? If 12 steps save 50% it’s worth it is it not?

    But

    1. We don’t know that they do save 50%! I’ve seen some studies that tried to evaluate AA’s results and which came up with 5%. AA won’t allow their members to be used as research subjects or participate in any research themselves. So it’s almost impossible to judge the merit of 12 step programs.

    2. We don’t know how much of the success of a particular 12 step group depends on the interactions between those specific individuals instead of a particular methodolgy. I.e., Maybe one 12-step group does great and another group the next town over does terrible, even though they were both following the same methodology, just because of the different “chemistry” of the way everyone got along.

    As I said elsewhere, the big problem here is that QUALITY of the scientific research evaluating treatment programs is very poor, so it’s hard to get reproducible results.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    Twelve step programs work. Don’t knock it ’till you’ve tried it.

  • peter nelson

    Addiction appears to be connected to the level of brain chemicals in our brain (dopamine, seratonin and others, also called neurotransmitters). Everyone has a different mix of these chemical substances and their interaction defines what we want, what we crave for or dislike (drugs, sex, money, gambling, etc).

    I think this is way too simplistic. (I have a good neurophysiology background) Most research has shown that repeated exposure to something (a chemical or environmental stimulus, etc), over time actually “rewires” the brain – changing the number or ratio of different receptors, for example, or actually growing new neural tissue.

    All of the major antidepressants take 3-6 weeks to kick in and one theory is that this is because that’s how long it takes for some of those changes to take place. It’s also worth noting that this is true regardless of WHICH neurotransmitter you’re modulating – NRI, SNRI, SSRI, and NDRI antidepressants all exhibit this behavior and all have similar rates of effectiveness.

    The role of specific neurotransmitters is unclear. For example, if you take an SSRI like Paxil you will stimulate parts of the serotonergic system, which will have a downstream INHIBITORY effect on parts of the dopaminergic system. On the other hand, if you take an NDRI like Welbutrin, you bypass the serotonergic stuff but you STIMULATE parts of the dopaminergic system. Ansd yet despite these almost “opposite” actions the two drugs have similar effectiveness for both depression and (according to new studies) anxiety, and take the same amount of time to work. Who woulda thunk it?

  • peter nelson

    Twelve step programs work. Don’t knock it ’till you’ve tried it.

    An anecdotal report means nothing. Show us the scientific evidence.

  • peter nelson

    It is not a “physical” addiction like tobacco or heroin, but a “mental” one where you like how doing it makes you feel and want to do it again

    I already addressed this, above.

    Recent research suggests that “mental” addictions are physical, too, Your brain gets “rewired” by your mental state. Basically it adjusts to a constant high level of certain neurotransmitters or other stimuli by adjusting the ratios of receptors. That’s why when you take the stimulus away you get cravings – your brain has been “rewired” for that “new normal”. Physiologically it’s no different than a opiate addict – if you take opiates for awhile your brain “rewires” for that state so when you go off of them you get cravings.

  • Sheryl

    Is it not amazing how many people have an opinion on this? Bottom line, if he hadn’t been famous, quite possibly not been a person of color, we would not be talking about this right now and he, more than likely, would not be dealing with this problem either. I totally believe that this is a real issue/sickness that does, in deed need treatment. Prior to becoming famous, Tiger was a extremely shy person that couldn’t ask women out on dates before he became famous. He would ask his friends to set him up with or introduce him to women. When the “world is your oyster” and you can have whatever you want, people think that they can do whatever they want and that they won’t be accountable or have to answer to anyone for their actions. This is also an issue of power, there are groupies on every level from murders like Ted Bundy, actors, politicians and athletes and they will have men and women throwing themselves at them and it’s hard to resist. Men and women have this problem. They can’t be committed in one relationship, they are always wanting something new, fresh and at the same time they want someone that they can come home to, someone that will be understanding and allow this behavior. I truly know this to be true because I was in a relationship, married to a man that wanted what he called, “an open relationship.” This is never healthy for anyone involved, shouldn’t be allowed and if the partner doesn’t want to commit than the other person should simply get out of the relationship especially if they don’t want to seek help for their problem. It may be hard to leave and painful but it will be worse if you stay in the relationship.

  • Frank

    @ peter nelson: Show us the scientific evidence.

    There is a paper referenced here where for patients in a substance abuse treatment program, 45% of those using 12 step were abstinent a year later vs. 36% using CBT:

    http://psychology.wikia.com/wiki/Twelve_step_programs#Effectiveness

    and more at
    http://www.hazelden.org/web/public/vcsum0research.page

    It’s clear that not enough science has been done on addiction treatments, particularly 12 step programs. But I don’t know of another treatment methodology that is known to work better. 12 step is free, and it provides connection to people, which is so important to counter the isolation and loneliness of addiction. From my own experience and that of many others I’ve met, we do well in controlling our addiction when we attend meetings, but we tend to fall into relapses if we stop attending. I know, it’s not proof, it’s anecdotal — but there’s no doubt that it feels good to people who commit to the 12 step recovery process, and feeling better is HUGE compared to being isolated in secret addiction.

    So why fight 12 step when it certainly helps many people, there’s no obvious risks, and there isn’t evidence of something better?

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    I didn’t mean to sound terse, peter nelson. If I offended anyone, please accept my apologies. But there are time when anecdotal evidence is all we have.

    It so happens that I represent one of an unknown number of success stories in the recovery arena (9 years and counting). We could all wish that the scientific evidence (meaning “proof,” I guess) were available. Were it so, we wouldn’t be having this conversation.

    I’m at least as “up” on this subject as anyone, and I’m planning a book which I’ll title, “Let’s Read Up On Recovery.” So much of the current literature out there is, as I think you’ve already alluded to, pure garbage — written for the most part by “school boys” (sorry, I don’t know how else to put it) — that the time has come to offer some adult perspective (like caller Frank’s)

    Frank has total understanding of this problem … the problem of compulsive behavior, and yet you see the kind of resistance he’s encountering here.

    Psychologists and professors, even like those appearing on this program, peter, are operating on little more than anecdotal evidence themselves, and of course cannot translate this data into the proofs that they seek. Meanwhile, the addict suffers while society ostracizes those who they think of as having “morality” problems. The situation is as bad today as it was in the First Century when lepers — the “unclean — were left in colonies to rot to death.

    We need to make a meaningful understanding of the addictive behavioral problem a top priority in this country. The problem is only going to get worse, and until we stop demonizing the process, the solution will forever remain in the hands of the charlatans.

  • peter nelson

    There is a paper referenced here where for patients in a substance abuse treatment program, 45% of those using 12 step were abstinent a year later vs. 36% using CBT:

    But this is one study, relying on subject-self-reporting, done 23 years ago and it hasn’t been replicated! Also note that the 12-step program they studied was run by professional therapists – it was not an AA program

    and more at
    http://www.hazelden.org/web/public/vcsum0research.page

    And that one looked at 3 different methods – CBT, 12-step, and MET and found no difference between them – they all appeared to be about 30% effective. And this study and the followup (“Network support for drinking,”) relied on self-reporting and had no control group.

    The problem with 30% is that in psychology 30% is a kind of “magic number”. That’s often the number you see for the control or “no therapy” group. Specifically WRT depression, 30% is the number of people who will remit without intervention. (N.B. NOT the same as the placebo group – they do better).

    Anyone who has had alcoholic or substance-abusing relatives knows that self-reporting is worth absolutely nothing. Substance-abusers are the best liars in the world because they’ve spent years lying to themselves and their loved one. You need outside measurement of how well they’ve stayed clean and sober.

    So I’m sticking to my claim that quality of the research is terrible and very unconvincing. Speaking as someone with a substance-abusing relative, it really bugs me that AA is the “default” treatment, and receiving tax funding, when it has no science behind it. Because I think its presence impedes getting some serious research to REALLY find out what works.

  • Brett

    Frank, I have known 12-Step programs to help many people, but I also have known them to not have worked for many people. Also, in terms of data indicating any 12-Step program’s success, the people who do not successfully complete their programs are not counted in their statistics.

    Anyway, to go into your Wikipedia statistics it says this:
    “Evaluating the effectiveness of 12-step programs has been difficult, based on the relative paucity of well-controlled, peer-reviewed studies. The non-professional nature of most 12-step programs also limits the opportunities for effectiveness studies. In some cases, professional treatment facilities, such as those at the Palo Alto Veterans Administration Hospital in California, incorporate 12-step programs into their addictions rehabilitation programs. Although these 12-step programs are run by professional therapists and, therefore, cannot be directly compared with community-based AA or NA groups, some studies have been carried out to compare the results of these programs with other techniques. In a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Departments of Veteran Affairs medical centers around the United States, five of which were based on twelve-step principles, but run by professional therapists, and five used cognitive-behavioral therapy. Over 45% of the men in enrolled in the inpatient professional twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy.”

    Four things stand out with these statements: 1) There is no citation of which organization conducted these studies and how, under what conditions, etc. 2) The data was only on programs run by professional therapists in treatment facilities and not on community-based 12-Step groups. 3) There were other, at Palo Alto, anyway, therapies used in conjunction with the 12-Step method. 4) When looking at 12-Step vs Cognitive Behavioral the percentages are not dramatically different (especially if you factor margin of error), and they only account for sobriety a year later. Also, this represents one study!!! ONE!!!

    I personally don’t advocate doing away with 12-Step programs, but I also have worked with a lot of people over the years who were not successful with 12-Step programs, and for whom other therapies did work. Yet, there is little choice in terms of funding or in getting support through community resources.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    Anyone who has had alcoholic or substance-abusing relatives knows that self-reporting is worth absolutely nothing. Substance-abusers are the best liars in the world …

    Posted by peter nelson

    Okay, peter. I retract my apology. You’re obviously with “them” and open mindedness would be giving you too much credit.

  • Frank

    @ Peter wrote: it really bugs me that AA is the “default” treatment, and receiving tax funding,

    As we read in every S meeting, “We are fully self-supporting, declining outside contributions.” So yes, they are non-profit orgs, so donations are tax-deductible, but groups receive no outside funding from any source.

    @ Brett: I agree with you — there is a real lack of science in this area. And addiction is incredibly hard for some people to kick, no matter what they try. I’m not advocating 12-step, just reporting that it has helped me and others I know.

  • Brett

    “I’m not advocating 12-step, just reporting that it has helped me and others I know.”
    -Frank

    And when it comes to finding treatment for ourselves, this is where individuals need to be. All people can do is help themselves, ultimately. And, if what people have found to be helpful to themselves can be of benefit to others, then even better. I have worked in the mental health field for a long time and have interacted with people/programs in substance abuse services, so my focus and interest is in what works and why it works, but also in what doesn’t work and why it may not work. I just wish that funding-stream sources were more helpful to people seeking help in terms of offering them choices.

  • jeffe

    I have to say I think Peter Nelson is being contrary just for the sake of it. He enjoys it, at least it seems like he(you) does. There is plenty of evidence of this from other forums.

    The issue is not that a 12 step does not work, it’s that for some it does. People who have addictive personalities and make bad choices need help. Unfortunately they are not always ready to do so. Peter you made some very insensitive comments and it seems to me that it’s more about you proving a point than anything else. Just because you have had a personal experience with a family member and I assume that by the comments you made that they did not get it together, does not mean that a 12 step or other forms of therapy do not work. If a person is not ready to stop they wont.
    You make a lot of claims and throw out all sorts if statistics and complain about the non-profit status of AA and NA. You do not have a medical or psychology background, so how is that you think you can make such absolute comments?

  • http://www.boldfacers.com Annaliese Heussler

    I’m an intern at Boldfacers, an online multimedia publication that spotlights unique talent in Boston. We’re hosting a workshop on Infidelity tonight, 7-9pm, at our studio, 15 Channel Center St. in South Boston! The New York Times writer Benoit Denizet-Lewis (himself a recovering sex addict) will lead a compelling discussion with a panel of experts including a Catholic priest, a polyamory advocate and a sex therapist, who will explore cheating, from the mild to the extreme. Find out more information at http://www.boldfacers.com!

  • Lon C Ponschock

    I’m surprised that no one here has mentioned Jimmy Swaggart or the countless other offenders of public morality before and after him dragged out for this discussion.

    The ones found out reappear in public hang-dog and contrite (like the picture accompanying this program segment) for the public to pillory or excuse in one way or another. What rubbish. All the old NPR ladies can listen in and go tsk tsk tsk.

    Two things drive behavior, with no discussion of psychology please: motive and opportunity. If the opportunity for more men outside the upper class to enjoy social accommodation were available, the motive would become common place.

  • Brett

    I think some of the differences here have to do with the anecdotal, in how people feel based on personal experiences they or people they know have had, versus statistical evidence and looking at a larger framework of what may or may not work/which therapies have a better success rate. In most studies I’ve seen, no therapy can boast a more significant success rate over another. And, historically, 12-Step programs have been notorious for less than scientific data collection.

    I can say that usually an array of strategies/therapies work better than any one approach. For the most part, 12-Step programs are not harmful, however there is always the potential for a program to not work for an individual resulting in a relapse of some sort. All therapies run that risk.

    In general, not just in the area of addiction, the prominent therapy of choice these days is cognitive behavior therapy. Probably, the best approach for an individual is the utilization of that form and some other approach in concert with that. It is a very individual concern where the individual needs some level of self empowerment and some self guidance. I believe this self empowerment is crucial, not only to taylor one’s therapy to one’s needs, but to have lasting success. I have never seen an individual truly prevail over an addiction if he/she is attempting to do so for others/they got caught/the courts have forced them into therapy, etc.

    If a person is amenable to getting help through a 12-Step program and this is what is offered in their community, I would say give it a shot and don’t give up if your particular experience turns out be less than desirable. Remember…not everything works for everybody.

    I do want to say something about people using “12-Step” and “AA” and “NA” interchangeably. These programs employ the same process, conceptually, but their funding streams are different and whether or not insurers will cover you is different from insurer to insurer, and whether “staff” are true professionals is another matter. If you go to AA or NA in your community, it is free, but it is also NOT run by professional clinicians, generally speaking. If you go to a treatment center staffed by professionals, and it gets Federal, state, local funding to provide services, those services will be a 12-Step approach. Period. If you have private insurance and seek treatment for an addiction, generally, you are going to have to seek a 12-Step program. If I had a substance abuse problem and private insurance, I would go to a therapist for “other reasons” so my insurer would cover cognitive behavior. Insurers are less likely to cover cognitive behavior if reasons for seeking therapy are “addiction.” I guess this is my problem with 12-Step programs in that they have sort of a bid-free contract with the government and insurers, in a manner of speaking.

  • peter nelson

    You make a lot of claims and throw out all sorts if statistics and complain about the non-profit status of AA and NA. You do not have a medical or psychology background, so how is that you think you can make such absolute comments?

    I have a better science background WRT neurophysiology than most doctors. And anyone with a good science background can read peer-reviewed research.

    But you don’t have to take my word for it – go to pubmed.gov – this is a vast and thorough repository of scientific and medical research. Identify the relevant material by abstract and then read the full-text articles. Anyone with a good college-level science education – chemistry, biochemistry, physiology, statistics, etc, can do it – you don’t need to be a specialist. I happen to have a more specialized background because for a while I wanted to go into research. After spending some time doing single-neuron recording in the occipital lobes of cats’ brains before deciding to do engineering. I like kitties and didn’t like working in a room full of kitties with lucite blocks screwed into their skulls.

    The problem with saying that 12 step programs help “some people” is that “some people” will get better all by themselves, and “some people” will get better just because they’re doing _something_ and some people will get better because they happen to hit it off particularly well with someone they meet at AA, but they could have just as well met that person at a bar.

    The whole point of the scientific method – statistical significance and control groups and reproducibility and all the other protocol is to eliminate all those other factors so we know that it was the 12 step methodology itself that accounts for the improvements we see.

    It’s like drug trials – you take 500 people and give half a drug and the other half a placebo. Just because 100 people who got the drug got better doesn’t mean it was the drug. You first have to see how the control group did.

    The reason why this is important is that 12 step programs are often funded by taxpayers, and substance abusers are often sent to them by courts, so we’ve given these things a government imprimatur without a scientific basis.

  • Sean

    What’s next? “Oxygen Addiction?” Only in America–open your checkbook and we’ll solve it.

    Ladies, I’m sorry, but here is a cold, hard fact you don’t want to hear or believe…

    Men, including your husband or boyfriend, have a strong desire to have sex with women other than you. And guess what? A lot actually follow through on that desire without you ever knowing. Watch The Discovery Channel and learn how mammals behave and before you say it, no, we’re not better.

    What’s going on in the present day is a clash between how we’re wired and what is acceptable via social/religious mores. It’s not a “disease” or an “addiction” or whatever other buzz words people want to use in order to make money off natural behavior.

  • peter nelson

    Anyone who has had alcoholic or substance-abusing relatives knows that self-reporting is worth absolutely nothing. Substance-abusers are the best liars in the world …

    Posted by peter nelson

    Okay, peter. I retract my apology. You’re obviously with “them” and open mindedness would be giving you too much credit.

    I’m sorry but I’ve had plenty of up close and personal experience with alcohol and drug addicts so I stand by my statement. People with substance abuse problems often have a very hard time being honest with themselves and others about it, and they develop very good strategies for covering up.

    I’ve had relatives tell me or my wife that they’ve been clean and sober for 6 months, 9 months, etc, only to find out that it “wasn’t quite true”. I had one relative who promised that she wasn’t abusing for a year and only when Social Services took her kids away did I find out the truth. My father was an alcoholic and even when he was in treatment we kept monitoring his hiding places because we kept finding stuff.

    So the bottom line is this: any research protocol that depends on people self reporting their drug or alcohol use is unreliable. You need an independent means of knowing whether they are abusing.

  • Bush’s fault

    Thank you for a fascinating, but clearly redundant program. Sex addiction and its behaviors were diagnosed and detailed by NOW, (National Organization of Women) a decade ago as the explanation for the Clinton-Lewinsky affair. I am puzzled as to why NOW’s contribution to the history of this affliction was never mentioned as background to our current examination of this destructive syndrome.

  • jeffe

    Sean it’s an addiction if it gets in the way of ones ability to function. I agree with men have a genetic disposition to mate with a lot partners to make sure that their gene pool is the dominate one. However there is a difference between cheating on your wife or girlfriend if they are not into having an open relationship.

    Desire and acting out on a desire are to different things.

    Take the Bishop case from Alabama. How many times have you been in a meeting with coworkers and someone is acting like a jerk or you get pissed off with someone to the point you think I could hit or worse kill this person.

    Well most people will not admit to having these thoughts but the difference between being rational and out of control is not acting on these desires or unhealthy thoughts.

  • jeffe

    I’m sorry but I’ve had plenty of up close and personal experience with alcohol and drug addicts so I stand by my statement. People with substance abuse problems often have a very hard time being honest with themselves and others about it, and they develop very good strategies for covering up

    So? This makes you an expert? It seems to me the people you are talking about were not ready to quit. It’s pretty simple some people just do not want to stop. That does not mean that for those who do a 12 step or therapy wont work.
    How one dimensional of you.

  • jeffe

    peter one more thing. You are judging people on your personal experiences. This is unfair to people who have remained clean. Because you have not had positive experiences with people turning their lives around from addiction it means it does not work. Do you not see how silly you sound?

    I have to say you have a chip on your shoulder, or so it seems. Unresolved issues with the alcoholic father? Have you ever been to therapy for this?

  • cory

    I have a Chili Cheese Frito addiction. Why do I believe there is a clinical psychologist somewhere who specializes in that?

  • http://beesw.com Carl

    Guess what: MEN CRAVE SEX!!! No matter how loyal a man is, if he has dozens of the worlds most beautiful women offering, that man will slip. Sorry. IT’S NOT A BIG DEAL. The only thing that makes it a big deal is the fact that we expect men to resist so well, and that they thus lie about it.

    If people (men and women) were allowed to slip every once in a while, no major harm, no fowl.

  • joshua

    UNBRIDLED LUST–whats wrong with lust? Go to church if you dont like human nature. Nothing wrong with consenting adults seeking exquisite pleasure–beautiful naked bodies co-mingling.

    Americans are so puritan and morally righteous–who are you to tell me how i should behanve–I’m not hurting anybody. Mariage is such a puritan fascist idea. Why should anyone get married? Why? Why? it makes no sense. If you love somebody–love them. If a hot body tingles your spine–go get it. if she/he is willing–how fun! protect yourself and practice good hygiene.

    Oh, my god-sexualized feelings–what’s wrong with humanity. better get my Bible out.

  • joshua

    Why do we compell Tiger Woods and other public figures to apoloogize to us aout their personal life–its cruel–its none of our business! Lave these people alone. Clinton did nothing wrong andniether did Tiger–the public is so sinister. Tiger or Clinton–they have no dity to apologize to anyboy. Stay the …. out of their business!

    This guy Says Tiger has a personality disorder because he’s getitgn some–this man is so envious.

    If he cheated–his marriage wsall ready over–marriage is joke. Stop juding people–morlists!

  • Joshua

    The mob is so cruel–leave this man alone!

  • joshua

    There is no such thing as addiction. Its an overexxaggeration. We are human. We are compelled to live life and seek pleasure whether its logic, knowledge, dance, art, sex, nature, rowing, hiking, runnig-whatever!

    No one gets the on the high horse when people are compeled to sek cures for disease, reasearch science, write novels, reading, practicing, practicing, practicing a sport to be the est–come on!

    Its such hyporcrisy. its like Freudiean fascist bull that Americans subscribe to–we are proud of our parents when they are considered great or noble people and we give credit to the son when he has such great father and believe the sone will be great too, but if the father is a tyrant and a cruel man like Cheny or or Bush or Hitler we say to the sone–dont worry young man, you are an individual and your future is how you make it. Sins of the father and all that–pleease! Its all rubbish. Stop judgig people! Go live your own life, stop sniffing up my backside! ~famous people

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    If you go to a treatment center staffed by professionals, and it gets Federal, state, local funding to provide services, those services will be a 12-Step approach. Period.

    Posted by Brett

    Not always true, Brett. You are one of the most knowledgeable persons who post here and you’ve just said, correctly I think, that generalizations don’t work in the area of discussion we are having.

    I have experience in both a 28-day rehab program along with years of AA. You’re right to mention costs and/or the subsidization of state-run rehab programs. Do they all work with what would be considered an acceptable level of success? … well, that depends, doesn’t it? What is an acceptable level of success?

    My rehab was in a privately run institution and almost as expensive as these things get. My employer-based insurance paid for 80% and my boss — out of the goodness of his heart — picked up the balance, saying, “You get well and get your a– back here … we need you!”

    Now as to your point — I don’t know about state-run programs, but mine was not AA. The program was designed, however, to prepare us for AA. While in the 28-day program we did attend bi-weekly AA sessions outside the program. I didn’t like these at first, but we attended “speaker meetings” mostly, and they began to “grow” on us — some of us anyway.

    We had clinicians, Brett … real MD’s and real Ph.D’s who conducted a 1 hour session twice a week. I learned about everything that’s been mentioned here today and on the program about brain chemistry and psychology-based behavioral modification patterns as caused by addiction. I consider myself extremely lucky, but then the old agage definitely applies here … “You get what you pay for.”

    I greatly appreciate all that you have posted in this forum here today.

  • peter nelson

    peter one more thing. You are judging people on your personal experiences.

    No, I’m judging it because it makes scientific sense to not rely on self-reporting. Even in the link posted by Frank, one of the critiques says

    Many studies depend on self-reports. That is, the results depend on recovering people to tell the truth about whether they’re staying clean and sober.

    The only way we will be able to give addicts and their families better treatment and more hope is with better science! Better science depends on rigorous methodology, clear objective definitions of terms and full cooperation by the community we need to help. AA’s stubborn refusal to help in this area is doing a major disserivce to alcoholics and their families.

    The millions of people whose lives have been ruined by substance abuse are testament to the fact that regardless of what your anecdotal experience has been, we don’t have a clue in general how to to treat them effectively. According to data in NIH/NIDA (“Relapse and recovery in Drug Abuse” Tims, Leukfeld, ed’s) relapse rates for drug addiction treatment are high – only about 20% of alcoholics remain abstinent after 2 years and only 5% after 8 years. With opiates one study reported in the above found that 97% were re-addicted within 5 years; another one found 77%.

    Also keep in mind that relapse-rate data are based on people who actually complete treatment programs – droput rates are high, so the situation is even grimmer than the above suggest.

  • peter nelson

    So? This makes you an expert? It seems to me the people you are talking about were not ready to quit. It’s pretty simple some people just do not want to stop. That does not mean that for those who do a 12 step or therapy wont work.

    I’m not making any distinction about whether they are ready to quit or not. I’m saying that if you have someone with a history of substance abuse it’s best not to rely on their honesty about whether they’re using. If you interview someone a year after they finished a program to see how they’re doing and they say they haven’t had a drink in a year should the researcher just assume they’re telling the truth?

    BTW, when I was a kid I was briefly in a support group for other kids of alcoholic parents and absolutely ALL of them had stories about their parent concealing the booze or concealing the use of it, or trying to, anyway. There’s nothing funnier or more tragic than an inebriated person who thinks he’s “passing” as sober.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    Do you know who you really need to blame, Joshua, as long as you seem to think that we humans are wasting our time searching for solutions to a non-existent problem? I posted a rationale for this earlier … blame your God. (Uh-h-h, you mentioned the Bible … I didn’t.)

    You fail to acknowledge the pain and suffering NOT OF THE ADDICT necessarily, but the people the addict lives with, loves, and comes in contact with daily. Did your God intend this?

    The destroyed lives AROUND the addict, Joshua, comes as no fault of theirs — none. Is your God really that cruel?

    I suggest that the true consequences of irresponsible behavior (like infidelity) in the human was an OVERSIGHT by an entity somewhere out there that many on this planet are in the habit of considering perfect and utterly without fault.

    Sorry, Joshua. The truth you are attempting to point to is the product of someone “out there” who FAILED in his cosmic creativity modeling class. Unbridled, continual and non-seasonal sexual urges (as in most non-predatory life on Earth) is clearly failing in a predatory life form such as ours.

    Our species will clearly end in overpopulation of the planet. The human has vanquished all rivals, unlike the great animal predators. Other primates … certain apes and others … reproduce continually and non-seasonally, but they are still susceptible to predation. Their numbers remain in control. This is the great mistake made by evolution, in this case.

    Now before you take off on “evolution,” understand what I’m saying. Evolution can make mistakes and has done so billions of times with millions of species going extinct. Evolution means trial and error. I don’t think that could reasonably said of the All Powerful and All Knowing.

    Do you?

  • Kari

    Whether Tiger is a sex-addict or not, whether ANYONE is a sex addict or not, being “diagnosed” does NOT give him/them an excuse. They are still accountable for their actions and should pay the consequences.

    Sex-addiction IS real people, do a little research before you make such judgemental comments. Let Tiger and his family figure out what his problem is and let him deal with it. If it’s sex-addiction or not he still has consequences to face. Having an addiction is NO excuse for bad behavior.

  • Brett

    F. Wiliam Bracy,
    I’m not sure of your point. Sounds as though you were in a private program and that your particular insurance covered 80%. I never said private programs DON’T have professional clinical staff or that private treatment centers DON’T offer therapies other than 12-Step programs. I also said, in another statement in that same comment, “if you have private insurance and seek treatment for an addiction, generally, you are going to have to seek a 12-Step program.” Which is one of my statements more to the point of the situation you describe. The word “generally” was meant to say I’m sure some private plans would pay for other therapies. I don’t know what kind of plan you had, but it was either an indemnity plan (with a straight 80%-20% split) or a PPO. If it was a PPO, this indicates that the insurance company would NOT cover your treatment under their co-pay/HMO part but would allow it in the indemnity part (which, a PPO plan is basically part indemnity, part HMO). So this is some indication of what I am saying. If you had had a straight HMO plan, it sounds as though your treatment would not have been covered at all, if I read this correctly. Also, albeit the rehab clinic was privately run, did it receive any governmental funds at all? Sounds like it didn’t, hence less reliance on a 12-Step model and more on a cognitive behavioral one.

    I believe what separates private insurance plans into coverage for addiction being a 12-Step or a cognitive behavioral approach has to do with whether or not that insurer gets any subsidies from government.

    Also, if one goes to a public treatment center (this gets to my statement you quoted) it will receive most or all of its funds from some form of government (it may also collect some funds from private donations and fees), and it will only offer a 12-Step form of therapy (for addiction). The exception would be that the treatment center may offer cognitive behavioral therapies, but those would not be present as a result of funding by government (for addiction). So, a person seeking treatment would receive a 12-Step solution if he/she had limited funds and wanted treatment. If he/she wanted cognitive behavioral therapy, he/she would have to pay a full rate completely out of pocket if he/she was seeking treatment (for addiction).

    Your treatment sounds like it was conducted at a completely private facility, that it accepted no subsidies, no government funding. Your insurance also sounds completely private. That’s why it was so expensive, and that’s why you were able to receive treatment other than 12-Step.

    AA/NA=free

    12-Step therapy=all publicly funded programs (for addiction)

    Cognitive Behavior Therapy=no public funds (for addiction), although there is funding for Cognitive Behavior as it may pertain to other mental health needs, and one may receive that form of therapy for addiction if one pays out of pocket.

    Private insurance=12-Step (if the insurer gets subsidies); Cognitive Behavior (possibly, if lucky), if the insurer doesn’t get subsidies.

    I hope that isn’t too confusing, and I’m sure I haven’t covered every possible scenario in every state. I also may have read your situation incorrectly.

    I suppose the most important thing is that it sounds like you received good treatment, your private insurance was able to cover 80% of the cost, and your employer (kudos there) did the right thing by covering the other 20%! It also sounds like you are pleased with your success! I sincerely hope I don’t sound patronizing if I say congratulations and I wish you continued success, because I do understand how much of a struggle it is for people to be successful.

    I know it is a one-day-at-time proposition, but I also know that the longer one is sober, the more it is like breathing.

    Success in therapy is difficult to define, but if a person gains some personal insight, some enlightened self-awareness so as to be mindful of behaviors and situations that set the stage for relapse into behaviors of concern, has hope for a change and for a life in balance, and begins to demonstrate change, then I call that a success. I believe people relapse from time to time. I don’t see that as failure, necessarily. I believe it is only a failure if a person gives up.

    And, yes we do get what we pay for. If there is any essential truth in life, that is it! It’s just that a poor person, or a person with subsidized insurance only has the option of a 12-Step, generally, if he/she can’t pay out of pocket, and that is a shame, to me.

    (Sorry for being so long)

  • Brett

    “The only way we will be able to give addicts and their families better treatment and more hope is with better science! Better science depends on rigorous methodology, clear objective definitions of terms and full cooperation by the community we need to help. AA’s stubborn refusal to help in this area is doing a major disserivce to alcoholics and their families.”

    I agree with this. 40% of people who enter AA do not finish the program and quit! Yet, when AA reveals its successes and gives statistics, it doesn’t factor in this stat. So, this skews all of their claims for success.

  • Brett

    Joshua gets the Godwin’s Law award for the day!

  • Erik

    Sexual addiction is just as real as heroin addiction. It is easy to judge others weaknesses…because it alows us to not have to look at our own issues (at least for the short term). Any numbing out from reality (be it alchohol, drugs, gambling, sex, food) and used to excess qualifies as an addiction. Especially when it makes ones life unmanagable and narrow focused. Everyone has an opinion and that is what makes us all unique. Only God alone can judge us in the end anyway.

    If an addict of any kind commits themselves to 12 step recovery and other addiction therapy as necissary they can live free of the compulsion to live in the destructive behavior…one day at a time. Myself and many other good people are living recovery every day.

  • jeffe

    I hope Joshua get’s some help. He seems pretty angry.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    @Brett:

    None of the various and complex programs for recovery, whether private, public, or duck-run for that matter, won’t do you, me, the addict nor society as a whole one single iota of good unless and until the addict himself (or herself) gets ready to step up to the plate and begin taking balls and strikes.

  • Rouzbeh

    Always love the way Tom opens the show:

    Sex is potent, combustible , planted deep in human nature. Indeed.

  • Brett

    F. Wiliam Bracy,
    What you speak of in your last comment is the one fact that is indisputable and above all others: ultimately, there is no magic therapy; the individual has to grapple with addiction on his/her own. He/she may need support and benefit from that support, but he/she is the one responsible and has to come to terms with the addiction. This is why, when anyone prevails over an addiction, it is quite a feat, in my view.

    I have seen so many friends struggle with addiction over the years, and I wonder what compels some to transcend their problem and some to not be able to rise above that thing that has such a grip. I can’t say. It is a question not answered to my satisfaction from anyone I have ever talked to about this. It is sad to hear people dismiss it purely as “laziness” or “lack of will” or some kind of weakness or flaw of character. My observations lead me to believe there is something neurological going on, as if some of us have a neurological switch in redirecting brain chemistry and some of us either don’t have that switch or have a switch that is too frozen to flip.

  • Ellen Dibble

    The last I heard on TV, the talking-head MD’s were saying Tiger Woods really has drug addiction (due to his choice of facility), and the multiple women were the more acceptable front or cover story for that underlying fact. I didn’t hear the hour, but references to this discussion from another forum lead to here. It seems it doesn’t matter, addiction is addiction.
    But I thought addictions were things we turn to habitually IN ORDER TO ENABLE our ongoing lives, not things that GET IN THE WAY. In other words, I plan out an escape or some physiological or emotional tweak to even things out or disrupt some vicious cycle. If it works in repeating ways, of course I repeat it. Is it an addiction if I use it to procrastinate dealing with some reality? Or to shield me from some reality that is inescapable?
    I don’t understand at all.
    I can say that I glean that cognitive behavioral therapy, CBT, is a watchword in Massachusetts, and indigent people who want to beat an addiction want CBT more than AA/NA and seem to be finding ways to get it, maybe from trainees in start-ups. Some have trouble finding compatible sponsors or groups in AA/NA.
    I suppose someone who wants to get well would be a pretty good witness as to what is working. “This group is a waste of time.” “That sponsor doesn’t understand my specific history.” That may not be scientific but it’s the best we have. And I suspect that the capacity for addiction underlies our ability to home-in on experiences that crucially balance our psyches and physiologies. Deep urges tell us what helps.
    Why some people ruin themselves by the use of that same ability? I think they must be awfully tough physiologically to begin with, or they would sense the danger. And I also suspect sex addicts must be emotionally tough or the same would happen: they would go off the deep end in angst and confusion, just derailed by the scatter. There is a word for it that means log cabin all scattered to pieces. Haiti would be an example. Maybe if the external world seems all scattered, people try to duplicate that in their psyches, create a bad dream inside to link to the bad dream outside. Debauched. That’s the word. (A scientific approach would be more social in nature: catch the person in the act of falling, deploy art and culture to make his/her world/family appear more orderly/safe without the help of chemical interdiction, without sexual escapes.)
    It’s easier to match a messed-up world — to recreate its disorder in one’s brain/life — than it is to try to put it in order. Oh, but the addict is MESSING UP the world. Right, but I don’t think that was the intention. I think the intention was to make life more manageable. If the intention is less compulsive and structural, but mainly ad-hoc and situational, then the person is okay. Something like that.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    And one last point, Brett. Why do you suppose it is that if someone were diagnosed with cancer, they would insist on therapy immediately. Yet if diagnosed with alcoholism (etc., etc.) they will not only resist therapy, they will deny the diagnosis.

    Cancer, vs. Addiction: both are almost equally deadly, and while not having backup data for this statement, but considering the vastly greater number of addicts (also no data), I suspect that the mortality figures when weighted for the offset would bear out a mortality rate for addicts (all forms, including accidental deaths (auto, etc.) that is actually greater than for cancer victims.

    Try and explain that(anyone).

  • Brett

    F. Murray Bracy,
    I don’t know why that is or even have thought about it. I guess I see the nature of various diseases, addictions, etc., as suis generis. The nature of cancer is very different than the nature of alcoholism, in my mind, for example.

    Cancer is caused by an uncontrollable division of abnormal cells/a malignant growth as a result. I see alcoholism as an imbalance in neurotransmitter activity/levels as a result of behaviors involving substances that alter brain activity, and when used continually may cause disruptions in neurotransmitter activity/levels in a more sustained way/may be the result of disruptions in brain function that are dormant and activated through the use and abuse of those substances (that’s my own interpretation).

    Alcoholism is tied directly to a behavior, namely ingesting a substance that presumably a person uses to feel a certain way, whether to block out something bad or enhance something good. At least that is how it starts out. People don’t start out to become alcoholics, but they become dependent on the substance–then addicted, and that promotes the alcoholism to the point where they continue using the substance to prevent feeling bad/promote feeling normal, even after it becomes apparent the alcohol is causing problems.

    Certain cancers may also be linked to the ingestion of certain substances, e.g., nicotine, red meat, etc., but not necessarily directly, and people may not be able to discontinue those activities in the midst of having cancer. However, the onset of cancer does not compel the person to smoke or eat more red meat. Some cancers appear even absent of ingesting carcinogenic substances, so there is no causal link between the presence of cancer and behavior.

    A person doesn’t, say, continue to eat red meat or smoke necessarily to curb any urges that we associate with cancer. People drink to quell urges that we associate with alcoholism, though. I have also never heard of any one citing alcoholism as a problem who doesn’t drink, nor have I ever heard of a death from alcoholism in a person who didn’t drink. Possibly someone with those same addictive tendencies may develop some other problem, however.

    I suppose one could make some abstract intellectual comparison to similarities between cancer and alcoholism, and I am not averse to examining avenues of thought that may intrigue one’s mind at any given point in time, no matter how useful they may or may not be; but, the practical concerns of, say, cancer or the nature of addiction would be more of a concern to me.

    Elisabeth Kubler-Ross (“On Death and Dying” and various subsequent books) delineated the stages of grief to a sense of loss, and she first applied those various stages to terminal illness–later to any personal loss, e.g., a job, income, freedom, death of a loved one, etc., but one could also apply those stages to alcoholism. Perhaps, if one receives a diagnosis of cancer, initially there might be some form of denial, but denial is not part and parcel with treating, living with or dying with cancer; it does seem to be an integral component of alcoholism, though. This may be why someone may deny a diagnosis of alcoholism, as well as denying treatment.

    I would think it is rare that an alcoholic would fear death in receiving a diagnosis of alcoholism, at least not in the direct way as receiving a diagnosis of cancer. Some alcoholics may actually drink from a vague feeling of death but more as an abstract concept (and perhaps more of a sense of hopelessness/fatalism). I also feel that if an alcoholic resists treatment, he/she would not necessarily worry about death as a consequence; there might be exceptions to that notion, though. I have heard/seen many times that alcoholics stop drinking when they get news from a doctor that they will die if they don’t stop drinking.

  • Brett

    I wanted to add that a diagnosis of alcoholism is made based on the determination of behaviors (frequency, intensity, duration); the diagnosis of cancer is based on the presence of cancerous cells/a tumor.

    I still don’t feel I’m capturing what I want to say; I suppose the only thing left would be to say we don’t know why some people get cancer, some don’t; we also don’t know why some become alcoholics and some don’t. We also don’t know why, in a definitive, physiological sense why some cancer patients respond to treatment and some don’t, or why some alcoholics in a psychological sense respond to treatment and some don’t.

  • Ellen Dibble

    I think both Nelson and Bracey are scientists to the bone and want the whole scientific explanation and then cure for addiction. Down to the molecule.
    I heard on the news that a sort of need for control, of situations etc., is a trait of addictive personalities. Sounds like the scientific community to me: We want it nailed, up or down, yes or no; does it cure or not, or is it masquerading as a placebo.
    So a scientist (of addictive genetic predisposition or otherwise) would look at the costs of addiction to our society and pick one familiar one, alcoholism, and say if this is a disease, does it not deserve as much analysis and understanding AND CURE as cancer?
    Does it not cause more ravages to families and societies? IF — IF — it is physiological, then let’s get neuroscientists onto this. If it’s not, if it’s not a “real” disease — then we’re into foggy territory.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    @Brett:
    I’m not being clear either, to the extent I’d like, but the idea that cancer frightens us more than addiction, does, in fact, have basis in physiology vs. brain chemistry, psychology, etc., just as you say. But the fascination, for me, lies in the divergence in attitude between two almost equally deadly diseases. I would point out as I should have in my previous post that the schism occurs, I believe, as soon as you ask someone, “Which would you rather be diagnosed with? … cancer or alcoholism. The answer wouldn’t vary … alcoholism, of course. But here’s the catch, I think. The alcoholic (diagnosed or not) believes, in his heart, that he is capable of quitting alcohol at any time. He also knows that he can’t quit cancer. So the real problem whether physiological or neurological is exacerbated by things like attitude, psychology and social environment, including factors like peer pressure.

    Education as practiced in group therapy sessions (AA) should work better than it does if the problem is indeed largely physiological. In other words, the psychological barriers must be overcome before the physiological/neruological problem can even begin to be addressed. This usually happens only after the alcoholic has hit what is called “rock bottom,” and for many it is already too late by then.

    This, in my opinion, is why science views addiction as a disease and should continue doing so.

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