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Posts Tagged ‘cognitive behavioral therapy’

The best addiction treatment option

May 5th, 2012

I get asked which addiction treatment option is the best all the time. The short answer? Whichever one ends up working for the client.

I don’t like being stuck in the corner, having to pick a “best of” option just because I’m asked. For some clients Moderation Management will work, others need intense day-treatment or an in-hospital residential treatment program before moving into a more traditional residential place for a year or more. Some clients feel suffocated by such a structured environment and can’t manage it – outpatient treatment options can be a better fit there.

Sometimes we ask ourselves questions in a way that forces us to make bad choices: Which is better, chocolate or vanilla ice-cream? I reject the premise.

It’s about time we all faced the fact that only rare occasions allow for two-word answers that are absolutely true. The world is full of nuance and if we don’t start allowing some gray into our conceptualization of questions and answers we are going to keep repeating the past mistakes of polarized opposition to a small number of camps that are all equally wrong.

Brain research supports the notion that they way in which questions are posed can affect the sort of answers we look for – our brain pays attention to the stimuli it expects to find. So if you think that all you have to pick from are two or three options, your brain will calculate costs and benefits and spit out an answer – 42. It’s what happens when you ask the wrong question – you get a nonsensical answer.

So I don’t answer question like “which treatment is best?” or “which is more important, biology, the environment, or personality?” The way I see it the pieces are all so interconnected that the separation is false. The question is moot. And that’s true whether you’re picking addiction treatment or a your favorite cone.


Posted in:  Education
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Pathological Gambling- Is it an addiction? Part II

February 17th, 2011

Michael Campos, Ph.D.

This is part II in Michael’s series on pathological gambling (click the preceding for part I):

The risk factors for pathological gambling

Pathological gambing (or gambling addiction)There are a number of factors that are important in pathological gambling including types and number of games played, alcohol use, and socio-demographic factors. Some research suggests that casino gambling, pull tabs, card playing outside a casino, bingo, and sports betting are associated with increased risk for gambling problems. In addition, the number of different types of games played is associated with gambling problems such that the more different types of games a person plays, the greater the risk for gambling problems. Alcohol abuse/dependence is associated with increased risk for gambling problems as well. Finally, socio-demographic factors (e.g., low socio-economic status, minority ethnicity) are associated with gambling problems even after controlling for gambling behavior. Read the rest of this entry »


Posted in:  Education, Gambling
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How it doesn’t work – the dogma of the 12 steps

May 23rd, 2010

Imagine being diagnosed with cancer, going through a regimen of chemotherapy only to have the cancer return within months, and being told by your doctor that there must be something wrong with you and that he can’t treat you unless you let the chemo do its work.

Absurd right?

12-Step dogma

Everyone wants to know if they can become addicted

Unfortunately, if you replace the cancer above with addiction, the chemotherapy with the 12-steps, and the doctor with 12-step dogma, you have what we know as the ________ Anonymous model (fill in your favorite blank). It’s even written in what 12-steppers call The Big Book (officially called “Alcoholics Anonymous”) and often read as part of the “How it Works” section.

“Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves… They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty.”

Well, as far as I’m concerned, this is where the 12 steps lose credibility with me. In any other field, if one treatment doesn’t work, another one is tried, and another. Different people with different conditions may need slightly different approaches. If no known treatment works, experimental ones are attempted. This is how medical science advances. Still, the notion of a physician blaming the patient for a treatment not working is ridiculous. There’s an entire field built around intervention research and I’m pretty sure that simply dismissing the patient as constitutionally dishonest isn’t a common technique.

Treating chronic conditions

In diabetes, like in addiction, there is a rate of compliance with prescribed treatment. And just like among addicts, that rate is relatively low, averaging around 30% or less. Relapse is also pretty common in other chronic conditions like diabetes, asthma, and hypertension, and rests around 50%-60%, not far from estimates for addiction.

Some patients are better at following one regimen while others do better with a different schedule, different doses, or different treatment methods altogether. Similarly, while some addicts respond beautifully to CBT, it seems to help some very little. The same is true for the 12-steps, religion, and a host of other practices. As far as I’m concerned, this means that when an addict seeks treatment, their provider should take a good assessment of the issues, prescribe the treatment that seems to fit best, but if that one doesn’t work, try another method, not throw them out because the favorite approach didn’t cut it.

12-step Dogma Vs. Progress

And therein lies the problem with the 12-steps, whether supporters acknowledge the religious nature of the program or not is tangential, the important thing is that they cling to a book written decades ago much like believers hold onto a bible. Both are collections of stories and messages passed on that no one is willing to re-examine and, if needed, change. Medical texts, and indeed any textbook seeking to stay relevant, stay current by issuing new editions that incorporate new knowledge, but the 12-steps haven’t been touched since 1939, or since the beginning of world war II!!!

Advancement requires flexibility

1939 was an important year, with the 3rd Reich beginning its exploits, Steinbecks’s “Grapes of Wrath” seeing its first publication (another book without major edits since), the first stocking ever sold, and the emerging use of penicillin. I think many of us would agree that there have been some serious advances since that time.

When it comes to addiction, those advances include our vastly improved understanding of the neuroscience, genetics, and general brain function involved. Additionally, the development of very effective treatment modalities, like Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and Contingency Management (CM), has given providers a much more complete toolbox with which to deal with addiction problems. Unfortunately, many within the 12-step community have never heard of any of these methods, or of the use of medications (like Bupropion) to help with cravings. Personally, I think that’s just sad.

How it works. Really.

It’s time to dust off the covers, and incorporate the 12-steps into the bigger picture of addiction treatment. When 12-steppers wonder why people can’t just see the value of the program, I automatically think of the preacher who sat in on of my addiction class and kept yelling that if only addicts accepted Jesus into their lives, they would be saved. Laugh all you want, but not only did the 12-steppers dismiss him, they missed an opportunity. He had a point- those who accept Jesus into their lives fully may succeed in recovering from addiction on that basis alone – but those who fail to do so should be given every other treatment tool available so that they may also.

This is supposed to be the age of inclusion, a time for Change with a capital “C.” Let’s make ourselves proud and help those suffering by making sure that we’re offering every treatment option possible.


Posted in:  Education, Opinions
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The many different options to getting sex addiction help

November 26th, 2009

Contributing co-author: Andrew Chen

online-pornWe’ve already talked about the fact that sex addiction (or love addiction) is defined by the inability to regulate sexual behavior despite negative consequences. We also mentioned already that it affects millions of Americans.

Addictive sexual behaviors can range from compulsive masturbation and porn watching, to compulsive cheating, to pedophilia. If left untreated, sexual addiction can severely interrupt daily functions and prevent meaningful relationships from forming. Fortunately, specialized treatment centers for sexual addiction are becoming more and more available. In fact, David Duchovny, an actor known to have sexual compulsion issues, just checked himself into one of those treatment centers.

Sex addiction help options

There is a number of behavioral and pharmacological therapies that are commonly used to treat compulsive sexual disorders. This review of sex addiction help options is not exhaustive by any means, but it’s long, so take your time:

Individual therapy can help patients address any underlying issues that may be contributing to their abnormal sexual behavior. Surveys of sex addicts show that up to 40% have anxiety disorders, 50% have substance abuse disorders, and 70% have mood disorders (1). Resolving these issues can greatly increase a patient’s chances for a successful recovery from sexual compulsion. There are many different forms of individual-psychotherapy, including Freudian, humanistic, and object centered. The important thing is to find a therapist that fits the patient’s individual style and that makes them feel comfortable.

Cognitive-behavioral therapy (CBT) is very common in treating sexual addiction. CBT teaches its patients to correct irrational thoughts, beliefs, and feelings that lead to addictive sexual behavior (1). In practice, this is often done by role playing, journal keeping, and actual workbook homework. By adopting a healthy mindset, patients can better understand their urges and prevent relapse into unhealthy sexual behaviors. CBT can be practiced within individual sessions or as a form of group therapy.

Group therapy and 12-step programs based on the Alcoholics Anonymous model provide a non-hostile environment where patients can share their experiences and provide support for each other during recovery. Shame, a major issue for sexual addiction, is often best dealt with in a group setting. (2)

Family counseling and couples counseling are also common during recovery. Counseling can help rebuild trust and intimacy that has been lost as a result of compulsive sexual behavior (3). Like individual therapy, these forms of counseling allow for a slightly more tailored, personal approach.

Drug therapy may be used in conjunction with psychotherapy to treat sexual addiction. Selective serotonin reuptake inhibitors (SSRIs) and lithium have been reported to reduce the frequency and intensity of urges to engage in addictive sexual behaviors (2). In more serious cases of sexual addiction such as sexual predation, gonadotropin-releasing hormone and chemical castration agents may be administered to reduce sexual drive. These forms of therapy can allow a reduction in the compulsions that drive the behavior, sometimes allowing the patient to better focus on the therapeutic efforts.

Sex addiction bears great resemblance to substance abuse. However, the goal in treating sexual addiction is not abstinence, but the development of healthy sexual practices (who wants a life without sex?). Compared to substance abusers, it generally takes longer for sex addicts to adopt a healthy lifestyle.

What to expect from sex addiction help

The first year is the most turbulent and poses the greatest risk for relapse as the patient is often experiencing difficulties with their occupation, relationships, or health as a result of their addiction. From the second year of recovery and onward, patients begin to regain the ability to form meaningful relationships and move forward in their personal life (4). However, patients often find that the struggle with their addiction is ongoing, at least for the first few years of their “recovery.” Considering how long it took for the unhealthy habits to develop, it’s no surprise that a substantial amount of time is often needed to reconfigure them.

The important thing is to have support and to take your time. Success often comes on the 2nd, 3rd, or even on a later treatment attempt. If the motivation is there, the chance of beating sexual addiction is good. Keep your focus and try different options or combinations. As always, feel free to email me with questions.

Citations:

1. Briken, P., Habermann, N., Berner, W., and Hill, A.(2007) Diagnosis and Treatment of Sexual Addiction: A Survey among German Sex Therapist, Sexual Addiction & Compulsivity,14:2,131 – 143

2. Schneider, J.P. & Irons, R.R. (2001) Assessment and treatment of addictive sexual disorders: Relevance for chemical dependency relapse, Substance Use & Misuse, 36(13).

3. Salisbury, R.M.(2008) Out of control sexual behaviours: a developing practice model, Sexual and Relationship Therapy,23:2,131 – 139

4. Goodman, A. (1998) Sexual addiction: Diagnosis and treatment, Psychiatric Times, 15(5)


Posted in:  Education, For addicts, For others, Sex, Tips, Treatment
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