Triggers and relapse, a craving connection for addicts

I’ve already written about one reason why cravings make quitting difficult (find it here). However, cravings and triggers are not just abstract concepts; they are well known, important players in addiction research and I think they deserve some more attention.

What are triggers?

A trigger can be thought of as anything that brings back thoughts, feelings, and memories that have to do with addiction (like a computer reminding a sex addict of porn). In addiction research, these are often simply called cues. The word comes from learning research in which a reward (or punishment) is paired with something (the cue).

For instance, in Pavlov‘s classic experiment, a dog heard a bell ring right before it would get served its daily portion of meat. The dog quickly learned to associate the bell with food, and would begin salivating as soon as the bell would ring, even before the food was presented. In this case, the bell was the cue, and food the reward it was paired with.

The story in drug addiction is similar. I’m sure many of you can relate to the overwhelming memories and emotions that seem to come out of nowhere when you hear music you used to get high to or pass a street where you used to buy drugs (or sex). Each of those examples is a trigger that is simply bringing about a similar reaction to Pavlov’s dog’s salivation. Seeing these things, or hearing them, creates an immediate response to the reward that it was paired with, the drug!

Triggers, cravings, drugs, and relapse

As if matters needed to be made worse, triggers not only bring about responses that make you think about the drug. In fact, over and over in learning and addiction research, it’s been shown that triggers actually bring back drug seeking, and drug wanting, behavior. As soon as a cue (or trigger) is presented, both animals and humans who have been exposed to drugs for an extended period of time, will go right back to the activity that used to bring them drugs even after months of being without it. In fact, their levels of drug seeking will bounce back as if no time has passed. Sound familiar?!

Given these findings, is it any wonder that cravings bring about relapse in so many addicts who are trying to quit? If simply thinking about, or hearing, something that was always tied to drugs can bring about such a strong response, what is an addict to do?

Is there a solution for addicts??

For now, the simplest way to break the trigger-response connection is simply repeated exposure without the reward. As bizarre as this may seem, staying away from the triggers can make their ability to bring back the old drug-behavior stronger. Obviously, this isn’t something that should be undertaken lightly. I’m currently working on putting together a drug treatment system that specifically addresses these issues so that with help, users can eventually release the hold that triggers have over them.

In the meantime, be honest with those around you, and if you’re seeing a therapist, or a good case manager, tell them about your triggers so that you can hopefully start talking about them, and re-triggering them in a safe environment. As always, feel free to email me with any questions you might have.

How does it all start? My thoughts on addiction causes and substance abuse

I was talking with a friend the other night, and he asked me my opinion about the line between addiction and normal behavior. He was wondering whether I think that everyone who looks at porn is a sex addict.

I don’t. (see some of our posts on sex addiction here)

Still, the conversation made me feel like writing something about my views on addiction causes. So here goes:

For the addicts who are still unaware, the line between normal- and addictive-behavior tends to blur again and again until it seems like more of faded smudge on their life. For those looking at addicts from the outside, the line normally seems so clear and so far away that they rarely believe it can be crossed back again.

I don’t personally believe that addiction per se is where things started for most people. By this I mean that no matter how hard we look, I believe that we will never find the elusive “addiction gene“, genes, or trigger.

Having been in the thick of it, I think that substance abuse is nothing but one possible outcome of set of circumstances, both biological and environmental, that lead some individuals down a particular path.

Impulsivity and other addiction causes

As I mentioned in earlier posts, addiction, at least to drugs (and I believe other addictions as well) is very closely related to a set of psychological conditions that have to do with impulse control problems.

I believe that individuals with increased impulsivity are simply more prone to putting themselves in situations that are inherently dangerous to their well-being. A simple example from non-drug related behavior might be one-night stands.

A typical person with no impulse control issues may hold off on sex if the only option was to have it unprotected. They may think to themselves “I need to stop, this could seriously affect the rest of my life.”

A person who has a reduced ability to control initial impulses may have the exact same thought and yet go through with the action, leaving them feeling remorseful and anxious the next day, but still having put themselves at risk.

This is a very common occurrence among sex-addicts. The thoughts are there, the knowledge is there, the ability to connect those to actions is seriously lacking. While some people make moral judgments about this fact, I’ve seen enough research that connects this problem to biological processes and genetics that I’m now resigned to the fact that at least on some level, the issue is physical and neurochemical.

Addiction help – Cures, treatment, and solutions

Still, I think the battle is far from lost. I strongly believe that education, informed by actual knowledge rather than misguided mythology, can put people in a better position to deal with the issues even if their source is outside of their control.

Even aside from pharmacological treatments (as in medications) that can help, there are endless ways to help people learn to be in better control of their actions once they are aware of their initial deficit. That is how AA and many other support groups function. People within them ask others about decisions they’re making BEFORE they act on them.

We know already that when it comes to drugs, the equation changes once the person starts using regularly and for long periods of time.

Chronic substance abuse further breaks down the brain’s ability to control impulses by reducing functioning specifically in the prefrontal-cortex; the part of the brain right behind your forehead which is thouught to be the center of the brain’s control tower.

The cycle seems too obvious: Impulse control difficulties leading to dangerous behavior which leads to further impulsivity issues and so on…

The treatment, like the progression of the condition itself, needs to be long. I don’t believe that any 30 day treatment program will be able to resolve a condition that took years to develop. Still, the issue of treatment will come up again here. This is enough for now…

Question of the day:
Do you have any insights from your own experiences as to how addiction develops?

Meth + Viagra = HIV and STDs?? Sex marathons and their danger

Co-authored by: Jamie Felzer

Sex marathons…what does that sound like to you?  Lots of sex, with multiple partners, for an extended period of time? Bingo! Come on down and collect a prize!!!

Why sex marathons can be dangerous

The combination of crystal meth and Viagra can leave users at a very high risk for contracting sexually transmitted infectionsSex marathons are where people have sex for a prolonged period of time, and often do so with multiple partners where they may seldom use protection.  Clearly this could cause some potential dangers.   All these dangers CAN be prevented (by using condoms, lubrication, and strict hygiene).  What makes these activities even more dangerous is the addition of crystal meth to help participants stay up for these long sex marathons and the prescription drug, Viagra to make sure they can perform sexually during these marathons. Put those two ingredients together and you have a powerfully volatile cocktail.

A collection of studies have been conducted with both hetero- and homosexual males involving the combination of these substances.  It was shown that those who generally used Meth were more likely to have sex, have sex with multiple partners and also more frequently not use protection. Particularly worrisome was the finding that homosexual men who used Meth and were HIV positive were the least likely to use condoms and were also the most depressed. members of this population often had 10 or more sex partners, thus quickly promoting the spread of STDs including HIV (if protection is not used).

Protection is VITAL in combating the spread of HIV

Taken together, these studies reveal that the consumption of Viagra is highly associated with insertive sexual behaviors.  This means that heterosexual men on Viagra more often partake in anal sex and homosexual men on Viagra more often partake in insertive sexual behaviors rather than receptive sexual behaviors. All insertive sexual behaviors have a high chance of causing the transmission of STDs because of the high amount of blood flow and low amount of protective tissues that reside in that area of the body.

Remember the ways of contracting HIV: Anal sex, vaginal sex, IVs and any other form of infectious blood mixing, and mother to child transmission.

Those who used a cocktail of Viagra, Meth and poppers (a form of Nitrates) increased the risk of contracting HIV, Syphilis and Hepatitis B over 100%!! While these drugs can sometimes be used without major complications, the concoction of them together creates a dangerous mix that puts everyone involved at a higher risk of contracting blood-borne diseases.  So, participate in sex marathons at your own risk but no matter what know your status and be sure to use protection!  Regardless of what the studies show, you can beat statistics by using caution during sex.

Citations:

Fisher, Dennis G; Reynolds, Grace L; Napper, Lucy E. Current Opinion in Infectious Diseases. Issue: Volume 23(1), February 2010, p 53–56.

Fisher, D. G., Malow, R., Rosenberg, R., Reynolds, G. L., Farrell, N., & Jaffe, A. (2006). Recreational Viagra use and sexual risk among drug abusing men. American Journal of Infectious Diseases, 2, 107-114.

The many different options to getting sex addiction help

We’ve 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. But how does one get sex addiction help?

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 are 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. My wife and I work with couples and individuals who struggle with sex addiction and intimacy issues and often times, in addition to the work, it requires patience and the passage of 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.

If you’re interested in working with us, please contact us and we will be in touch as soon as possible.

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)

What does it mean to be love addicted? Sex addiction explained.

What do you think of when you hear the words “sex addict“? Do you imagine someone who has sex dozens of times a day? Someone who owns a lot of sex toys? Someone who spends all their time immersed in pornography?

While all of these scenarios, and others, can identify someone with a sexual addiction, the crucial part of identifying an addict has to do with the consequences of the behavior and the person’s inability to control them. That being said, sex addiction is a relatively recent idea. In fact, it’s sometimes called love addiction instead.

So what is sex addiction?

A sexual addict experiences the same type of uncontrollable compulsions that others feel in different forms of addiction (like substance, alcohol, gambling, shopping, etc). In his book (Out of the Shadow: Understanding Sexual Addiction) Carnes talks about the compulsive sexual behavior as guiding a misperception of the self.

In simple words: Sex addicts’ view of themselves depends on their relationship with sexual behavior. Since they often find themselves unable to control the behavior, they often have trouble with their self-image.

What is sex addiction NOT?

Let us look at some of the NOTS of sexual addiction. Sex addicts are not people who are just hypersexual and get satisfied with their sexual behaviors; rather, they are often not satisfied with the sexual activities that they engage in. Sex addicts are not necessarily Casanovas, but are often normal functioning people who find themselves having to hide their compulsive sexual urges.

While some sex addicts do pay for sex, others are compulsive about watching porn and others simply struggle with monogamy. The point is, the stigma of sex addicts as predatory child molesters needs to be put to rest.

How common is sex addiction?

Sex addiction is a major problem in our society. Some estimate that as many as 15 million people in the U.S. are sexual addicts (roughly 8% of all men and 3% of women). Easy access to porn offered by the internet has most likely increased the prevalence of sexual addiction in the past decade. In fact, for most people getting porn addiction help specifically is the problem.

The costs for those suffering from sex addiction are also numerous: Relationships and families are disrupted and destroyed, the addict’s self-esteem diminishes as they are unable to be productive in other areas of their life; illegal activity (like prostitution) ends up causing arrests, and health is often affected through the contraction of diseases.

Am I a sex addict?

Now, don’t immediately assume that you are a sex addict because you fantasize about sex a lot. But how does one know if they are addicted to sex?

The simple rule is: no impairment, no addiction.Sex addiction

On the other hand, if day to day functioning is affected by the behavior (in this case, something sexual), this may be an indication of a problem. So, whether it be having sex often, thinking of sex, or even just being extremely horny, if it’s making a person’s daily activities or relationships dysfunctional and if they are unable to control their behavior they may be defined as a sex addict.

In future posts we will look more into the symptoms, forms, theories, and treatments related to sex addiction. In the mean-time, keep reading, and if you feel brave enough, share your story; who knows, you may be able to help someone else who is love addicted!!!

Sex addiction help from All About Addiction

If you need help finding treatment for your own, or a loved one’s sex addiction, make sure to give our Rehab-Finder a try: It’s the only evidence-based, scientifically created, tool for finding rehab anywhere in the United States!

Addiction-brain effects: Sex addiction, neurotransmitters, and being love addicted

***A disclaimer: Sex addiction is a relatively new concept in science. I haven’t been able to find much research on the subject, so much of what is being said here is my interpretation of the current literature on sexual responsivity in humans.***

sexI’ve already mentioned that scientists are beginning to consider behavioral addictions (like gambling and sex) as being similar to drug addiction. We’ve also covered sex addiction on the site quite a few times.

Since we’d covered the addiction-brain effects of some of the major drugs’ (see here for opiates, crystal meth, and cocaine), I thought it’s time to write about the possible science behind sex addiction.

The sexual activity cycle

Scientists have divided human sexual interaction into 4 stages:

  1. Desire – Represents a person’s current level of interest in sex. It is characterized by sexual fantasies and a desire to have sex.
  2. Arousal – Includes a subjective sense of sexual pleasure accompanied by a physiological response in the form of genital vasocongestion, leading to penile erection in men and vulva/clitoral engorgement and vaginal lubrication in women.
  3. Orgasm – Involves both central processes in the brain and extensive peripheral effects. Orgasm is experienced by the peaking of sexual pleasure, release of sexual tension, rhythmic contraction of the perineal muscles and pelvic reproductive organs, and cardiovascular and respiratory changes.
  4. Resolution – The final stage of the normal sexual response cycle. There is a sense of release of tension, well being, and return of the body to its resting state.

After sexSex addicts don’t seem to have a problem with stage 3, and resolution is more like the end of sexual behavior. So we will focus the rest of our attention on the other stages 1 and 2.

Sex and neurotransmitters

While sex doesn’t involve the ingestion of substances, each of the above cycles does involve the release of many of the neurotransmitters we’ve already discussed (dopamine, serotonin, etc.).

In fact, there seem to be three major area in the brain that are activated during sex:

  1. The Medial Preoptic Area (MPOA) – This is one of the areas where all the sensory inputs to the brain converge. This. This area is crucial for the initiation of sexual response – the move from desire to arousal. It is mostly the release of dopamine within this area that supports sexual responding. Animals with lesions here can’t  mount or thrust.
  2. Paravantricular  (male) or ventromedial hypothalamus – These area are responsible for non-contact sexual responses. Dopamine is once again the main activating agent here.
  3. The mesolimbic system – Important for the motivation towards anything “good” this system is also very involved in motivation for sex, a big part of the desire and arousal stages. As with drugs, it is the release of dopamine with this system that increases the motivation for sex.

We haven’t discussed the first two area much, and from my understanding, their functioning is relatively specific to sexual response. However, we’ve certainly mentioned the mesolimbic system. This is the same system involved in the brain’s processing of opiates, cocaine, methamphetamine, and essentially all other drugs. It is also the system in charge of food motivation.

As you can see, dopamine is an activating neurotransmitter for sexual response. Serotonin on the other hand, plays an inhibitory role in sex. Through its activity on a number of brain area, serotonin reduces desire, arousal, as well as the ability to orgasm. The increase of overall brain-serotonin levels is one of the main reasons for reduced sexual responsivity in individuals who are taking SSRI antidepressants.

What about sex addiction?!

Aside from a few specific authors (like P. Carnes), scientists still find themselves struggling with whether or not behavioral addictions should be considered similar to drug and alcohol addiction or whether they are examples of compulsive, or impulsive, behaviors. I personally believe that these all share more common features than we may yet realize.

Nevertheless, for addicts, the subjective experience of a substance, or behavioral, addiction is similar. It is an inability  to control a behavior in the face of repeated negative consequences that is often accompanied by a need for more and a reduced sensitivity to the act.

Given my recent reading on the brain processes involved in normal human sexual response, I’ve developed my own early theory about sex addiction:

Given that many of the same neurotransmitters are involved in the regulation of sex, it is my belief that sexual addicts or those experiencing sexual compulsions, fall into one of two categories that probably overlap to some extent:

  1. Individuals who have reduced inhibitory capacity (like those with impulse control disorder, ADD, or ADHD for example). These individuals find themselves acting out relatively impulsive behaviors that others without such dysfunction seem to effortlessly control. Given what we know about impulse control disorders, it is no wonder that these individuals often find themselves engaging in more than one such behavior, including drug, sex, and other poossibly addictive activities.
  2. Those who’ve had sex paired with a strong neurological response – Given the important role of dopamine in all rewarding activities (what scientists call appetitive response), it is very possible that two or more rewarding experiences that are linked may increase the brain’s response to any of the individual rewards.

neurons that fire togetherLet me explain the last point: In neuroscience, there’s the concept that Neurons that fire together wire together,” which is to say that events that happen at the same time, if they are strong enough, may form their own neural networks. If something strongly negative (like violence) happens in conjunction with sex, the experience might lower sex responsivity. However, if a strongly rewarding event happens at the same time, the link might serve to enhance response for both future sexual experiences and the linked event.  The people in the first group are likely to often fall into this category due to their use of psychoactive substances. Drugs release huge amounts of dopamine, which may then become linked with sexual response, making sex seeking as strong as drug seeking.

So that’s my take, for now, on sex addiction. Like other addictions, it has to do with the exposure to a very rewarding event that in a subset of individuals ends up developing an exaggerated response or an inability to control it. Since feeling of love and intimacy can often be just as rewarding, people often refer to themselves as love addicted, and not sex addicted.

Sources:

1) A. G., Resnick, & M. H. Ithman (2008). The Human Sexual Response Cycle: Psychotropic Side Effects and Treatment Strategies. Psychiatric Annals, 38, pp. 267-280.

2) E. M. Hull, D. S. Lorrain, J. Du, L. Matuszewich, L. A. Lumley, S. K. Putnam, J. Moses (1999) Hormone-neurotransmitter interactions in the control of sexual behavior. Behavioral Brain Research, 105, 105-116.

Addiction causes – Learned self regulation and its possible benefits for drug use problems

In the first part of this little series on addiction cause and self-regulation I talked about some of the genetic influence on impulsivity that have been shown to also be related to drug use.

In this next part, I want to drive home some recent ideas regarding learning related to self-regulation.

It’s no secret that diagnoses like ADD and ADHD have been seen with much greater frequency in the last decade or so. Slight variations on the same theme, both of these disorders have to do with a person’s (usually a child) inability to appropriately control their impulses and behave appropriately.

The debate about the sources of the large increase in these diagnoses is still ongoing. Some think that they are nothing but an inflated push for pharmaceutical treatment by those who stand to profit from the sale of Adderall, Ritalin, and the likes.

However, if you talk to the parents of the children being diagnosed with these disorders, they’ll be the first to tell you that even though they can’t put their fingers on it, something’s up with their kids…

Tin Can PhoneA recent educational program in New Jersey (at the Geraldyn O. Foster Early Childhood Center) tries to instill in children the concept of internal regulation by making pretend play rules explicit. Children talk to their teachers before embarking on their next imaginary adventure in order to lay out everybody’s role. The idea is that by the generation of internal rules, the children become more aware of how social rules regarding behavior are dependent on their specific role in a given environment.

The creators of the program believe that children’s play in the recent past has become more and more structured. They believe that video-games, explicit toys, and constant oversight have reduced children’s ability to take on roles and depend on their own mind for the rules of behavior.

Adele Diamond, a researcher at the University of British Columbia, has found that children in the program performed much better (up to 35% better) than other children in tests of executive function. It should be noted that the program doesn’t claim, and hasn’t been shown to, get rid of attention-deficit problems in kids that have been diagnosed. Rather overall cognitive function for kids in the program seems improved.

More research on this program is ongoing, but the initial results seem to indicate that educational and developmental aspects of a child’s life can impact their ability to have internal oversight. This is obviously promising and upsetting all at once.

No parent intentionally places their child at a disadvantage, but it seems that the most recent trends of “electronic babysitting” we’ve become so accustomed to may in fact be impacting children in unintended, discouraging ways.

The connection to addiction again has to do with general impulse control problems. Less executive control leaves children generally more vulnerable to behaviors that can be detrimental to their future. As I’d mentioned in one of my earlier posts, most of the negative impact of drug use on the lives of users is not related to long term addictive use. Instead, it is the acute (as in quick and short lasting) negative impact of things like unintended pregnancy, motor accidents, and legal troubles and arrest, that end up impacting adolescent drug users.

Maybe by making our children better able to control their actions, we can protect them from a host of possible problems, including drug use…

Question of the day:
How much of your childhood was spent in relatively free play and how much of it was structured?
How, if at all, do you feel that these different activities have affected the kind of self-control you can, or can’t exert?