October 14th, 2012
Quitting smoking is hard, but that suggestion probably isn’t terribly exciting all on its own since most of our readers probably knew it already. Still, while we’ve talked about quitting smoking using nicotine replacement and medication, we haven’t really touched the subject of all those people out there who just decide to give quitting smoking a try one day without those patches, gums, or pills.
Since something like 95% of those who try their hand at quitting smoking relapse within one year, and most of these people try to quit unaided, I think this is an important topic to touch on. Fortunately, recent research conducted in the U.K. tried to assess the personality and cognitive aspects that end up predicting who will succeed, or fail, in their quit attempt.
The effects of expectation, motivation, and impulsivity when quitting smoking
Quite a bit of research has already shown that when smokers are trying to quit (so we’re talking early on during abstinence), their brains react differently to stimuli in the environment depending on the relationship between those stimuli and nicotine. Stimuli that aren’t associated with smoking (or some other form of nicotine intake) get less attention and show overall less activation of important brain circuits while nicotine associated cues light up the brain just as if nicotine was on board (even though participants were drug free at the time). Essentially, if a stimulus predicts getting a hit, the brain gets smokers to pay attention to it so that they can do whatever is necessary and get a little drug in. Throw in some of that reduced ability to control behavior that we talk about so much (like impulsivity), and which is common not only in smokers but in users of almost every other drug (heroin might be the exception) and you have a recipe for disaster, or at least for a good bit of smoking relapse. And yet if we want to fight the horrible health consequences of cigarettes, then quitting smoking has to be made easier, which nicotine replacement and medications like bupropion have done to some extent.
As part of this equation, knowing the specific predictors of early relapse in people who are quitting smoking may be useful so that professionals planning smoking interventions can do a better job of targeting the most important factors. The study recently published the journal Psychopharmacology tried to assess the relationship between the severity of smoking, the above-mentioned personality factors, and the success of the quitting attempt.
The cool thing about this study is that the 141 people who participated were assessed on a whole set of these cognitive tests twice – once after a smoking free night and a nicotine lozenge and another time after a smoking free night followed by a nicotine-free lozenge. While they couldn’t tell which was which, the procedure gave the researchers an assessment off how different participants’ reactions were with or without nicotine on board. Following the assessments participants were directed to begin their attempt at quitting smoking. While they were asked not to use nicotine replacement options or other medications, they were allowed to use any other resource available and were given a set of information pamphlets that explained expected side effects and likely difficulties during the quit attempt. They were then followed up after 1 week, 1 month, and 3 months. Quitting was identified as minimal smoking (less than 2 cigarettes per week) and was verified both by self report and cotinine testing. There was a small financial incentive to quitting, with people who relapsed after a week getting only £40 (about $60) and those who made it through month 3 getting £150 (about $250), though I’m pretty sure that if $200 was enough to make people quit we’d have just paid up already…
The first thing to note in the results was that 24% of the participants were still not smoking at the 33 month followup. This seems to be about on par with the usually low success rates at 1 year though I’m sure this research group will try to continue following these participants at least up to the 1 year mark and hopefully produce another paper.
The overall most reliable predictor of who quit and who relapsed ended up being the level of nicotine dependence as measured by the participants’ pre-quit attempt cotinine levels and the number of cigarettes they smoked every day. Since cotinine assessments are less biased, it was the most predictive of all throughout the experiment (# of daily cigarettes was no longer predictive at 3 months). Interestingly, self reported impulsivity and smokers’ initial ratings of cravings for cigarettes didn’t end up predicting relapse at all, but those cognitive tests assessing the quitters’ reactions to nicotine associated cues told a pretty interesting story: It seems that early on during their quitting attempt smokers who had more general interference with their cognitive function relapsed sooner. These cognitive problems can be thought of as interfering with normal thinking by nicotine-related cues and maybe even more general interference with brain function. After the 1-week follow-up, at the 1 and 3 month assessment, the odds of quitting had more to do with baseline assessments of motor impulsivity as well as those initial cotinine levels assessing the degree of nicotine dependence.
The take-home: Quitting smoking is hard for different reasons in the first week and later on
If you’ve ever tried to quit you’ve been told you that the first week is the hardest and that once you make it through that the rest is a piece of cake. While this research doesn’t necessarily support that notion, since about 25% of the sample relapsed between each of the followups, it does seem to indicate that the reasons for relapse change after that first week.
It seems that the first week may be difficult because of general cognitive interference by stimuli and cues that are nicotine associated. Those cues make it hard to pay attention to much else and they interfere with normal thinking and attention process, making sticking to the quit attempt difficult. After that point, successfully quitting smoking seems to be associated more with the level of initial smoking and that damn motor impulsivity test. The finding that heavier smokers have a harder time quitting isn’t new and isn’t surprising, but the fact that cognitive effects and predictors of relapse change does suggest that the interventions likely to help smokers quit may need to be different during week 1 and afterward.
Overall, these findings suggest that the cognitive function problems associated with quitting smoking (or smoking in general) may recover faster than do some of the other physiological factors associated with quitting since the initial levels of smoking continued to be highly predictive throughout the 3 month period of followup. Another explanation could be that initial smoking levels affected brain function in ways not assessed by these researchers.
Since so many smokers relapse within the first week (more than 50%), it seems to me that interventions that really focus on the cognitive interference and the extreme attention towards nicotine associated cues and stimuli would be helpful for those quitting smoking. Maybe if we can reduce relapse numbers at 1 week we can have a more gradual fall-off for the following month resulting in significantly higher quit rates.
Interestingly, NIDA and other research organizations are getting really interested in the use of technologies like virtual reality for help in addiction training. It seems that in this context, these sorts of treatments might be useful in helping early quitters train to avoid that cognitive interference. Additionally, medications like modafinil, and maybe even other ADHD medication could be used very early on for those quitting smoking to help recover some of their ability to control their attention thereby reducing the power nicotine associated stimuli have over them. I guess we’ll have to wait and see as those who develop interventions start integrating this research. In the meantime, I’d love to hear from readers who have quit or tried to quit: Does this research seem to support your own experiences?
Jane Powell, Lynne Dawkins, Robert West, John Powell and Alan Pickering (2010). Relapse to smoking during unaided cessation: clinical, cognitive and motivational predictors, Psychopharmacology.
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The first thing to note in the results was the 24% of the participants were still not smoking at the 33 month followup. This seems to be about on track for the normally low success rates at 1 year though I’m sure this group will try to follow these individuals up at that point and hopefully produce another paper. The overall most reliable predictor of who quit and who relapsed ended up being the level of nicotine dependence as measured by the participants’ pre-quit attempt cotinine levels and the number of cigarettes they smoked every day. Since cotinine assessments are less biased, it was the most predictive of all throughout the experiment (# of daily cigarettes was no longer predictive at 3 months). Interestingly, self reported impulsivity and smokers’ initial ratings of cravings for cigarettes didn’t end up predicting relapse at all, but those cognitive tests assessing the quitters’ reactions to nicotine associated cues told a pretty interesting story: It seems that early on during their quitting attempt smokers who had more general interference with their cognitive function relapsed sooner. These cognitive problems can be thought of as interruption with normal thinking by nicotine-related cues and maybe even more general interference with brain function. After that point, at the 1 and 3 month follow-ups, had more to do with baseline assessments of motor impulsivity as well as those initial cotinine levels assessing the degree of nicotine dependence.
The take-home: Quitting smoking is hard for different reasons in the first week and later on
If you’ve ever tried to quit you’ve heard someone telling you that the first week is the hardest and once you make it through that the rest is a piece of cake. Well, this research doesn’t really support that notion since about 25% of the sample relapsed between each of the followups, but it does seem to indicate that the reasons for relapse change after that first week. It seems that the first week may be difficult because of general cognitive interference by stimuli and cues that are nicotine associated. Those cues make it hard to pay attention to much else and they interfere with normal thinking and attention process, making sticking to the quit attempt difficult. After that point, successfully quitting smoking was associated more with the level of initial smoking and that damn motor impulsivity test. The finding that heavier smokers have a harder time quitting isn’t new and isn’t surprising, but the fact that cognitive effects and predictors of relapse change does suggest that the interventions likely to help smokers quit may need to be different during week 1 and afterward. Overall, these findings suggest that the brain function problems associated with quitting smoking (or smoking in general) may recover faster than do some of the other physiological factors associated with quitting since the initial levels of smoking continued to be highly predictive throughout the 3 month period of followup. Another explanation could be that initial smoking levels affected brain function in ways not assessed by these researchers.
Since so many smokers relapse within the first week (more than 50%), it seems to me that interventions that really focus on the cognitive interference and the extreme attention towards nicotine associated cues and stimuli would be helpful for those quitting smoking. Maybe if we can bring the relapse numbers down at 1 week we can have a more gradual fall-out for the following month resulting in significantly higher quit rates. Interestingly, NIDA and other research organizations are getting really interested in the use of technologies like virtual reality for help in addiction training. It seems that in this context, these sorts of treatments might be useful in helping early quitters train to avoid that cognitive interference. Additionally, medication like modafinil, and maybe even other ADHD medication could be used very early on for those quitting smoking to help recover some of their ability to control their attention thereby reducing the power that nicotine associated stimuli have over them. I guess we’ll have to wait and see as those who develop interventions start integrating this research. In the meantime, I’d love to hear from readers who have quit or tried to quit: Does this research seem to support your own experiences?
Jane Powell, Lynne Dawkins, Robert West, John Powell and Alan Pickering (2010). Relapse to smoking during unaided cessation: clinical, cognitive and motivational predictors, Psychopharmacology.
|Posted in: Drugs, Education, Tobacco
Tags: abstinence, activation, brain function, bupropion, cognitive, cognitive interference, cotinine, expectation, experiment, impulsivity, medication, motivation, nicotine, nicotine assocciated cues, nicotine associated, nicotine replacement, quit, quit attempt, quitting, quitting smoking, quitting smoking hard, relapse, research, smokers, smoking
August 5th, 2011
After almost 400 articles for All About Addiction I find it hard sometimes to motivate and write more for the website. Still, writing is why I started this whole thing and it’s the lifeblood of the whole enterprise.
So this week I made a commitment to write every day. I was doing pretty well until yesterday when I missed a day. True, I was off work because of back pain and lack of sleep (11 month old at home) but that’s no real excuse.
Still, the way I see it there are two ways to look at this, or any other event that involves not reaching your goal or keeping true to commitments:
- Failure – Some people choose to look at messing up as a sign of failure, often one that signals their inability to make things happen and to stick to commitments.
- Learning opportunity – Others decide that they’re going to learn from their mistake and figure out how to improve next time.
Even though I’m using missing a little writing assignment as the example here, I think that the same applies to any time you mess up. You get to decide – Failure or Opportunity.
Whether it’s a relapse, a screw-up on the job that gets you fired, or cheating on your spouse. No matter what the outcome, you can decide on how to perceive it. I personally think that it doesn’t even matter how often you make mistakes, although obviously if you just pretend to use them as learning opportunities than you’re fooling yourself.
Addiction gives us enough opportunities to beat ourselves up without taking on extra challenges.
March 6th, 2011
About three years ago, I was attending a national conference on public health (American Public Health Association) and presenting my posters on the relationship between drug use and violence, and sexually transmitted infections and injecting drugs. As I walked the aisles I ran into a woman who runs a Florida addiction “treatment” facility. We talked for a bit about my work, her facility, and then we shared some of our personal stories. Mine included meth addiction, jail, recovery, and now graduate school studying addictions. Everything was great until I mentioned that I now drink alcohol socially… “We’ll save a seat for you” she told me as she handed me her business card. Idiot.
Recovery bullies and addiction treatment
As soon as my version of recovery from addiction didn’t match her expectations, it was an immediate failure. Forget the 6 years I’d spent free from crystal meth use, the excellent graduate school career that was producing real results I was there to present. Forget the fact that my family, my bosses, and my girlfriend at the time thought I was doing amazingly well – As far as this woman was concerned it was her way, or her way. Well I call bullshit on that thinking once and for all.
Unfortunately for her, the research evidence, as well as the actual human evidence that I’ve seen, shows that recovery from addiction comes in many colors and flavors, like pretty much everything else in life. We’ve covered research on all about addiction before showing that the best evidence to date actually calls into question the idea that relapse is the necessary disaster so many paint it as. The fact that the majority of those who meet criteria for drug dependence at some point in their life actually recover on their won is also there, and although this does nothing to reduce the impact of addiction on all those who have an incredibly difficult time quitting, it’s there and can’t be ignored. Drug dependence is almost certainly not a one size problem and the solution is probably far from a one-size-fits-all, no matter how much you like your own solution.
So there’s cognitive behavioral therapy, peer support solutions (like SMART Recovery, Rational Recovery, Life Ring, 12 Step groups like Alcoholics Anonymous, and more), medication-supported recovery (like Suboxone, Methadone, Vivitrol and more), Motivational interviewing and other Motivational Enhancement techniques, as well as a whole host of psychotheraputic approaches that are more eclectic. No research we have to date indicates that any of these approaches is necessarily more effective than others, which means that they are all essentially equally effective. We’ve already talked about some combinations that work very well together, like PHP programs for physicians, but there is absolutely nothing to indicate that the 12-steps (for examples) are somehow superior to CBT, or Rational Recovery, when it comes to treating addiction.
If you get better, you’re a success in my book
When it comes down to it, whether this Florida 12-stepper likes it or not, I am still a social drinker and I still don’t believe that this nullifies any of my other achievements or my successful recovery. More importantly, it doesn’t nullify the success of millions of others, no matter how poorly it fits with some people’s notions. When a life gets overrun by drug use or another addiction, a successful outcome to me means recapturing a functional life that is no longer dictated by the pursuit of that addictive behavior. Anything more or less is a personal preference sort of thing. The problem with these idiots who will absolutely ignore success because it doesn’t conform to their expectations is that they drive people out of treatment and away from success and that is not okay. I’ll continue to call them out for their narrow mindedness and hopefully eventually, their voice will be far from the dominant one.
|Posted in: Education
Tags: 12 step, addiction, Alcohol, alcoholics anonymous, CBT, crystal meth, drug, drug dependence, drug use, Drugs, graduate school, MI, motivational, motivational interviewing, public health, recovery, relapse
December 12th, 2010
The holidays are a stressful time for everyone. Between gift-giving, travel, and keeping up with all parts of the ever-complicated modern family unit, nearly anyone can find themselves driven towards the nearest coping mechanism, whatever that may be. However, for recovering addicts, or those still struggling with an active addiction, the holidays can be a particularly troubling season that can invite a destructive relapse. As with all mental and physical health issues, education and awareness are a powerful first line of defense. By going over some of the most frequently asked questions about addiction and the holidays, we can attempt to shed some light on these issues for addicts and their families to help combat them before, not after, they become bigger problems (like a relapse).
Why Are The Holidays So Difficult For Addicts?
Obviously, as just mentioned, the pressures of the holidays are difficult for everyone. But for addicts, these same issues of money, family and general stress are amplified, often because they are the same age-old issues that lie at the root of the addiction and the beginning of drug use and abuse in the first place. If the recovering addict has not had the opportunity to openly confront family issues in the past, either with the family itself or with a therapist or counselor, the potential for relapse can be great. A vast amount of research shows how stress can bring even long-dormant behavior back to the surface, which should serve as a warning to substance and behavioral addicts alike (like sex addicts or compulsive gamblers). On the other end of the spectrum, addicts without a stable family or group of friends are often left feeling alone and isolated during the holidays, another powerful source of the shame and boredom that can drive addictive behavior.
What Are Some Of The Hidden Struggles That Can Intensify Addiction/Trigger A Relapse?
Most often, these struggles emerge from one of two likely scenarios. In the event of a still active addiction, attempts to hide the problem from friends and family and the resulting stress can, paradoxically, intensify the addictive behavior. And whether the addiction has been treated or not, gathering with family in a familiar place can frequently cause someone to face many of the underlying issues that can be the root causes of a drug addiction or compulsive behavior. To paraphrase Tolstoy, all unhappy families are unhappy in their own unique way, and whether one’s particular family is overly judgmental, enabling, angry, or whatever else, it can serve to restart self-destructive patterns of behavior. For some recovering addicts, there may be a family-imposed secrecy around the recovery itself, which can be trying at a time when the whole family is gathering, ostensibly to celebrate one another. Even the house (including the room where an addict used to act out) and certain family members (like that cousin they used to smoke weed with) can be important cues that may re-trigger cravings and old behavioral patterns. Additionally and importantly, if there is a family history of any kind of past abuse, this can obviously serve as a particularly powerful and insidious trigger for addicts, whether recovering or not. In fact, recent research suggests that these old, root stimuli may be much more powerful for drug addicts than re-experiencing the drug itself.
What Are Some Strategies For Surviving The Holidays?
First and foremost, one must be prepared. Since most people at least know and are aware of the potential issues that might arise within their own families, it is crucial not to try to “wing it.” If you know that your family is going to be asking lots of uncomfortable questions, practice some appropriate answers and don’t feel obligated to discuss any aspect of your recovery that you’re not comfortable discussing. If your family is overly focused on achievement or likes to bring up stories from the past that are triggering or shameful, rehearse your reactions to them. If you have a friend or significant someone who can help, do a little role-play trying out different answers and see how they feel as you actually say them out loud. It will never be exactly the same as you practice, but being prepared can go a long way towards taming the body and brain’s natural stress responses. Just as importantly, if you know you’re liable to encounter events or people that formerly facilitated addictive behavior, role play those likely scenarios and know how you plan on turning down or avoiding those substances or behaviors. For instance, figure out how exactly you’re going to tell your cousin you aren’t going to smoke in the basement with him before you have to actually do it. It will sound a lot less forced and strange the second time around and you will have already experienced some of the associated anxiety. If you’re going to be alone, make distinct plans for your activities and do the best you can to find healthy situations to participate in, even if they seem new or slightly uncomfortable at first. For instance, go ahead and join that group of strangers for a Christmas eve dinner or Christmas day movie instead of spending those times along. After all, uncomfortable or not, a new, healthy experience will be vastly preferable to sliding back into the same old destructive patterns of the past.
Should I Use New Years To Confront My Addiction?
Most everyone is familiar with the New Year’s Resolution as a method of planning major life changes. Of course, most everyone is also familiar with the limited success rate of these resolutions, and of the effectiveness of “going cold turkey” in general. Depending on the addiction, there are certainly things that individuals can do to help themselves- for example, research suggests that when trying to quit smoking setting a quit date and beginning to use replacement patches or supplements in anticipation of that date (in other words, while still smoking) can help reduce the amount of smoking while approaching that quit date, making it easier when the day finally arrives. If you’re planning to quit a “harder” drug than nicotine, you may want to set a whole schedule for reducing drug use prior to the quit date itself. The important thing is to be completely realistic in order for the change to stick. If you’re drinking a bottle of vodka a day, attempting to go completely dry within a week can be extremely dangerous to your health, and will not likely result in a permanent change. Once again, education and preparation are key. Prepare for any sort of quitting by looking online on sites like AllAboutAddiction and WebMD, and identify the medical and psychological issues that are likely to accompany your attempt. Look to see if your problem is one that you can handle alone, or if it is recommended that a doctor help you with the process. Remember that your goal should be lifetime change, not a temporary one. Though it might seem counter-intuitive, if your holidays promise to be especially difficult or stressful, you may want to hold off on trying to quit during them and look at them as a time to lay the groundwork for your post New Year quit attempt rather than going for a full on cold turkey try. Such pragmatism may well help you achieve your true goal.
November 19th, 2010
In cognitive behavioral therapy they’re a big part of the “Five W’s” = When, Where, Why, With, and What. In the various 12-step programs they’re simply referred to as “People, places, and things.” But no matter how you refer to them, drug-associated cues, or “triggers” as they are more commonly known, obviously play a big role in reminding addicted individuals about their drug-seeking behavior, and they are often enough to restart old behavior, even among those who have been abstinent for a while and especially when unprepared for their effect.
Different triggers to reactivate old behavior
Research on relapse (what researchers call reinstatement) has long shown that there are a number of things that can return a person, or an animal, to drug seeking after they have been abstinent for a while. Stress, small drug doses, and the presentation of triggers are all very capable of doing this, even after months of abstinence and likely even years. It’s probably not surprising that giving drugs to an abstinent person can make them want the drug again. In fact, I would venture to guess that most readers believe that this is the most powerful way to induce a relapse (assuming the initial exposure was out of a person’s control and doesn’t count).
Well, recent research suggests that in actuality, triggers, or those people, places, and things, might be more powerful or at least longer lasting relapse risks than even taking drugs!
Triggers, not drugs, are shown to be longest lasting relapse risk
Researchers in Japan trained mice to press a lever for meth, getting them to poke their nose into a hole 60 times for a total of 30 meth administration per three hour session. Every time they poked their nose in the right hole they got a shot of meth and a little light above their nose-poke hole went on (this will become the trigger in the end). Once they were doing this reliably the researchers took away the meth and the animals learned, within 10-20 days, that pressing the lever no longer got them a drug and reduced their number of presses to less than 15 presses per session.
After all this the researchers gave the mice an injection of meth 30 minutes before putting them back in the box – leading the mice to start pressing again for the drug even though in the previous session they has pretty much stopped pressing knowing that no drug was coming. Obviously, the drug injection caused the mice to relapse back into their drug seeking. But, as you can see from the figure below (on the left side, the right side shows that the mice didn’t poke their nose into a hole that did nothing as a control), this little trick only worked once, and the next time the mice were given a shot of meth before being put in the box (after once again being taken through extinction training teaching them that pressing the lever did nothing), they didn’t press the lever any more and just around not doing much.
For the following part of the study the researchers once again took the animals through extinction training (and once again the mice stopped pressing the lever for meth) and then in a following session reintroduced the little light that used to go on every time the mice originally got meth. Just like they did with the meth the animals immediately went back to pressing the lever like crazy, hoping that now that the light was back, so was their meth. Just like with the drug relapse experiment above, the researchers repeated this whole process over two months later, only this time, the little light managed to re-trigger the lever pressing again, unlike the one-trick-pony meth. Seeing this, the researchers went for broke and tried another run of this with the same animals, now following up five months after the last time the animals received meth when they pressed the lever. Again the little light got the animals to increase their pressing, only this time it was a little less impressive than the first two tries (but still significantly higher). All in all, the little light managed to restart the lever pressing by the mice three times and a full five month after the meth-relapse experiment had failed!!!
Conclusion, thoughts, and implications about triggers, relapse, and addiction
In a completely different article I’d written that researchers found a number of different patterns of relapse among alcoholics who went to rehab and that in fact, the vast majority of those who did relapse never went back to the kind of heavy drinking that characterized their earlier problem (see here for One is too many, a thousand not enough). While this research touches on a different aspect of relapse, it once again challenges our thinking about the crucial factors in relapse prevention among addicts. Everyone knows that triggers are important, but the fact that they are at least as powerful and apparently longer lasting dangers than even being re-exposed to the addictive drug is a novel one. Still, this isn’t very surprising given the very long-lasting impact of drugs of abuse (especially stimulants like crystal meth) on learning mechanisms. In my opinion, and based on my own experience, those changes are essentially permanent and the only thing that makes an ex-user less likely to run back to pressing that drug lever when being re-triggered 10 years later is the life they’ve built, the experience they have, and the training they’ve undergone in reacting to those triggers. As you can see from the graph above, if a person runs back to the drugs and actually starts using again on that first, second, or third exposure to a trigger they are likely to start the whole cycle again, possibly making it ever more difficult to escape the next time.
Obviously preventing trigger-induced relapse should be a major strategy of addiction treatment and indeed, from CBT relapse prevention strategies to groundbreaking medications that have been shown to be effective for relapse rate reduction (like Vivitrol, Buprenorphine, Bupropion, and more), there is quite a bit of effort going exactly that way.
Yijin Yan, Kiyofumi Yamada, Atsumi Nitta and Toshitaka Nabeshima (2007). Transient drug-primed but persistent cue-induced reinstatement of extinguished methamphetamine-seeking behavior in mice. Behavioral Brain Research, 177, 261-268.
|Posted in: Education, For addicts, Meth, Tips, Treatment
Tags: 12 step, abstinence, abstinent, addiction, CBT, cues, drug, drug seeking, lever, little light, meth, mice, people place things, pressing lever, relapse, research, stress, trigger, triggers
September 15th, 2010
In a recent post on Internet addiction, we briefly mentioned addictions to internet pornography. There’s no doubt that the easy access, and anonymity, of online access to any and every sexual whim conceivable is at the heart of online porn’s draw. Here we will take a more in-depth look at how Internet porn addiction develops.
The internet porn addiction connection
Excessive use of online porn can be thought of as a manifestation of both Internet addiction and sex addiction. In fact, porn addiction is one of the most commonly reported sex addiction problems, especially among younger individuals and among what Dr. Carnes calls “Phase 1” sex addicts, or the lighter version of sex addiction that doesn’t involve others.
Porn addiction develops much like a drug addiction. After an initially rewarding experience with pornography (a common experience given the cycles of sex we’d mentioned in an earlier post), individuals may experience uncontrollable urges to obtain sexual satisfaction through that form of entertainment (1). The connection between internet porn and sexual gratification is positively reinforced, and the urges become more frequent and more powerful. These connections can become so strong that simply sitting down at a computer elicits a sexual response.
Like in drug addiction the problems arise when urges to view porn conflict with an individual’s daily responsibilities. Instead of leaving for work on time, the addict may decide to stay at home and watch porn – Some porn addicts report staying at home for porn sessions that can last as long as 8-10 hours. The shame and guilt that often accompany these compulsive sexual experiences are also thought to greatly affect the experience of sex addicts and to reinforce the positive experience they receive from their shameful act. Many porn addicts report that they end up in a distressing situation where their shameful sexual release is the only positive experience they get to have.
It should be noted that the majority of people who use online pornography do so recreationally, with little ill effect (2). As is the case with drug addiction, it is only a sub-group of people that become “addicted” and suffer serious consequences from their porn addiction (e.g. lost jobs, disturbed marriages).
Whether we are talking about pornography, gambling or shopping, our golden rule for diagnosing behavioral addictions has been: no impairment, no addiction.
The toll of porn addiction and the refuge of he internet
Internet Porn Addiction can also bring about a different psychological toll than the shame we discussed earlier. As tolerance develops, individuals with porn addiction may also begin to need more deviant material to achieve the same high. This is again similar to the increased quantity and variety need experienced by many drug users and it’s where rape fantasies, fetishes, and child pornography often come into play. Exposure to such material can grossly distort beliefs about human sexuality and ruin interpersonal relationships. Patients that progress in this fashion often report feeling unsatisfied with their sexual experiences and unsatisfied with their partners (2).
We noted that in addiction, shame is a major component of the addiction cycle. This is especially true for sexual addiction. Social norms tell the sex-addict that there is shame in buying an adult magazine (like playboy or hustler) and that there is shame in soliciting a prostitute. Internet porn substantially reduces the risk of getting caught, and therefore of being shamed. Many individuals who experience porn addiction are able to hide their activity from their partners and remain completely anonymous on the web. Online porn is easily accessible, it’s available all the time, and getting free porn is easy. When you add complete anonymity into the mix, you get a recipe for a potentially serious addiction (2).
Porn addiction help – Some Advice
Relapse is common during recovery as patients often experience withdrawal symptoms when their normal consumption of pornography is reduced. In this case, like in many others, relapse is to be thought of as a misstep, and not a failure. See our post on treatments for sexual addiction to see how porn addiction is usually dealt with. In addition to these standard methods, patients can often benefit from the use of Internet filters and “accountability” software that sends a report of their online activity to a partner or therapist. Again, it’s important to recognize that although porn addiction is serious, there are solutions out there and sex addiction help resources in general are growing with the recent jump in awareness brought about by high profile cases like that of Tiger Woods.
1. Griffiths, M. (2001) Sex on the internet: Observations and implications for internet sex addiction, The Journal of Sex Research, 38(4)
2. Cline, V.B. (2002) Pornography’s Effects on Adults and Children
|Posted in: Education, For addicts, For others, Sex, Sex, Tips
Tags: addiction, deviant, Drug addiction, fetish, free porn, hustler, internet, internet filters, internet porn, internet porn addiction, playboy, porn, porn addiction, porn addiction help, pornography, relapse, Sex, sex addiction, sex addiction help, sexual, shame
June 9th, 2010
I’m a drug addict and a sex addict, and as far as I’m concerned, staying anonymous let’s me remain buried in shame, and a double life, that keeps me always one step ahead of those close to me. Did I say too much? Did I give away my secrets? None of those questions matter when everyone knows everything there is to know about you. For a disease couched in anxiety, obsessions, and compulsive behavior, there’s very little that can be more triggering.
The difficulty of confessing addiction
Obviously I’m not naive to the consequences of confessing to others, and I’ve had a few very uncomfortable conversations that ended in people losing my number or superiors telling me they didn’t need to know. When it comes to the former, it’s their choice, and it might be a wise one, but having those who stay close to me know my truths keeps me safe by making me accountable and protects others from being hurt. And I can hurt with the best of them. Maybe that’s why when it comes to physician treated addicted physicians, there are no secrets, no anonymity, the family and employers are made part of the process. Some notable addiction providers (like Journey Healing Centers and others) have programs that explicitly involve the family in the treatment process as well. Getting the secrets out works to break away from the shame.
We’re only as sick as our secrets, even together
On an organizational level, I understand the need for anonymity to avoid having any specific member represent the group. But that logic only holds when everyone is told to remain anonymous. Otherwise, the entire group represents itself, which is, if nothing else, truthful. If one person slips, relapses, or goes into a homicidal rampage, it only makes the rest of us look bad if no one knows that millions others are “the rest of us.”
Over and over I hear people talk about the secret of their addiction and the lies they have to tell to cover up their shameful acts. Unfortunately, that only contributes to the stigma of addicts and makes it all the more difficult to get some perspective on the actual problem: We do things we don’t want to over and over regardless of how much they hurt us or those around us
If you’ve read anything on this site, you know that I believe in many factors that contribute to addiction, including biology, environment, experience, and their interactions. Still, when it comes down to it, the misunderstanding of addiction is often our number one problem. And anonymity does nothing to reduce that misunderstanding.
How we can make a difference
Media portrayals only exacerbate the problem as they show us stories of addicted celebrities who are struggling but then leave the story behind before any recovery occurs. That way we only get to see the carnage but have to look pretty hard to see anything more.
But we can change all this with a small, courageous, action. We can let those around us know that we’re addicts, that we’re doing our best to stop our compulsive behavior and that we want them to hold us accountable. If we slip, we can get back up because we don’t compound the shame of a relapse with lies we tell, and those around us know that even a relapse can be overcome because they’ve seen those examples over and over in all the other “confessed” addicts around.
It’s time to leave the addiction “closet” and start living. We may not be able to change who we are easily, but we can change the way we go about living and make it easier on ourselves and on others. By breaking our anonymity, we can help assuage our own shame and let everyone know that addiction is everywhere and that it can be successfully overcome.
Just a thought…
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Tags: 12 step, addict, addicted, alcoholics anonymous, anonymity, anonymous, anxiety, biology, boss, celebrity, closet, compulsion, compulsive behavior, consequences, courage, doctors, double life, drug addict, employer, environment, experience, family, famous, genetics, group, interaction, journey, mdeia, misunderstanding, narcotics anonymous, obsession, physicians, relapse, secret, sex addict, shame, sick, stigma, superior, trigger