Thoughts on Sex Addiction

[Rocky93]

Adam Smith said "Several recent studies have shown that AA for instance, despite its self-reported but wholly undocumented claims of "cure" rates of around 75%, actually has a success rate of 5% to 8%, no more. As would be expected of a lay, unprofessionally conceived treatment modality cooked up in the middle 1930s, when essentially nothing at all was known about brain science or behavioral science or substance-abuse cognitive causality. Cognitive behavioral therapy and related modern treatment modes have far greater effectiveness than the old "abstinence commitment" which is the very thin conceptual reed on which AA's approach is premised.

 

Just one of many reportings on this:

 

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

 

I wouldn't bash AA. Many lives have been repaired and saved through it. AA never claimed to be a cure. It claims the disease can be "arrested" not "cured." It also has never boasted of a success rate. It doesn't self promote. Additionally, anyone who works in the field knows that rate of remaining "clean" and "sober" is generally under 10%. Only that place in California claims to have a cure!!!

 

"Abstinence Commitment" is not a thin conceptual reed. For those with addictions to alcohol and drugs, especially heroin, abstinence is a must. Trust me on that one. I was at 10 funerals in Dec and Jan due to oversdoses of opiates. Several of whom was there first use after a period of abstinence. Process addictions, such as sex, food, and control are those where abstiniece is not a choice most times. Cognitive-behavioral therapy and other treatment modalities are critical in helping people explore the roots of addiction, however, IMHO, knowledge doesn't provide us with relief, it is the requiste action we take and the way we live our lives that peace and serenity becomes more normative than chaos and unmanageability.

 

Don't throw out the baby with the bathwater!! While it is true that AA in some aspects needs to acknowledge and incorporate a deeper understanding of the bio-psycho-social aspects of addiction, I value the contribution it continues to make (as well as other 12 Step Fellowhips) to the recovery of millions of people.

[AdamSmith]

I wouldn't bash AA. Many lives have been repaired and saved through it. AA never claimed to be a cure. It claims the disease can be "arrested" not "cured." It also has never boasted of a success rate. It doesn't self promote. Additionally, anyone who works in the field knows that rate of remaining "clean" and "sober" is generally under 10%. Only that place in California claims to have a cure!!!

 

"Abstinence Commitment" is not a thin conceptual reed. For those with addictions to alcohol and drugs, especially heroin, abstinence is a must. Trust me on that one. I was at 10 funerals in Dec and Jan due to oversdoses of opiates. Several of whom was there first use after a period of abstinence. Process addictions, such as sex, food, and control are those where abstiniece is not a choice most times. Cognitive-behavioral therapy and other treatment modalities are critical in helping people explore the roots of addiction, however, IMHO, knowledge doesn't provide us with relief, it is the requiste action we take and the way we live our lives that peace and serenity becomes more normative than chaos and unmanageability.

 

Don't throw out the baby with the bathwater!! While it is true that AA in some aspects needs to acknowledge and incorporate a deeper understanding of the bio-psycho-social aspects of addiction, I value the contribution it continues to make (as well as other 12 Step Fellowhips) to the recovery of millions of people.

No. Sorry. Everything you say helps make addicts MORE addicted.

[Rocky93]

No. Sorry. Everything you say helps make addicts MORE addicted.

 

Please explain, because I think what you say helps make addicts DEAD!

[+ MostlyLurking]

Gently, please, gentlemen.

[Rocky93]

Gently, please, gentlemen.

 

I'm sorry, I want to be gentle and do not wish to come off argumentative. However, I have been working in the field of addiction for 30 years and these past few years have been escpecially difficult with many deaths of people I have become close with as well as their families. Much of this has contributed to my seeking comfort through my own addiction to sex and pornography. This is why I started the thread. I need to get back to the basics of the 12 steps.

 

However, unless someone is deaf, dumb and blind, they should be well aware of the opioid epidemic in this country where the numbers of overdoses is climbing at a phenomenal rate. I am on the front lines in that battle. I don't consider myself a fundmentalist AA defender, but I will say that many lives have been saved through the 12 steps. When you are sticking an needle in your neck with drugs that you had to sell your body for (men and women alike), through the grace of God to become free of drugs (including alcohol) is a gift not to be taken lightly. Therapy does absolutely nothing for someone still using. I have never met a recreational heroin user. Doctors are the number one drug dealers right now, freely writing Rx's for anyone who asked. They prescribe suboxone or methadone and think it is a cure. Meanwhile, these pharmacuetical companies pay for this "research" that shows how great these are "medical models" are as opposed to the 12 steps. It is all bullshit.

 

There were some valid points made in that article that AdamSmith referenced. The lack of competent professionals working in the field as well as the reluctance of some members of AA to update literature. My believe is we must take a wholistic approach to treatment. Using all the resources available. The 12 steps, IMHO, are core to this. Additionally, I believe therapy and other forms of personal growth and care are critical. Learning to love ourselves, others and having spiritual beliefs in something greater than ourselves are critical steps in this process. I just can't sit back when someone co-signs use of drugs or alcohol to someone who by their use of it triggers an addictive process, or worse yet, after the first use, overdoses and dies because their body can not handle the amount of drugs that they thought they could. Nothing worse than watching parents bury a child. Sorry if I rant, but a tender spot was touched (and I didn't enjoy it!!!)

[AdamSmith]

...Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy. It offers a single path to recovery: lifelong abstinence from alcohol. The program instructs members to surrender their ego, accept that they are “powerless” over booze, make amends to those they’ve wronged, and pray.

 

Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

 

The Big Book includes an assertion first made in the second edition, which was published in 1955: that AA has worked for 75 percent of people who have gone to meetings and “really tried.” It says that 50 percent got sober right away, and another 25 percent struggled for a while but eventually recovered. According to AA, these figures are based on members’ experiences.

 

In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.

 

I spent three years researching a book about women and alcohol, Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control, which was published in 2013. During that time, I encountered disbelief from doctors and psychiatrists every time I mentioned that the Alcoholics Anonymous success rate appears to hover in the single digits. We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than that the program failed them?

 

When my book came out, dozens of Alcoholics Anonymous members said that because I had challenged AA’s claim of a 75 percent success rate, I would hurt or even kill people by discouraging attendance at meetings. A few insisted that I must be an “alcoholic in denial.” But most of the people I heard from were desperate to tell me about their experiences in the American treatment industry. Amy Lee Coy, the author of the memoir From Death Do I Part: How I Freed Myself From Addiction, told me about her eight trips to rehab, starting at age 13. “It’s like getting the same antibiotic for a resistant infection—eight times,” she told me. “Does that make sense?”

 

She and countless others had put their faith in a system they had been led to believe was effective—even though finding treatment centers’ success rates is next to impossible: facilities rarely publish their data or even track their patients after discharging them. “Many will tell you that those who complete the program have a ‘great success rate,’ meaning that most are abstaining from drugs and alcohol while enrolled there,” says Bankole Johnson, an alcohol researcher and the chair of the psychiatry department at the University of Maryland School of Medicine. “Well, no kidding.”

 

 

Alcoholics Anonymous has more than 2 million members worldwide, and the structure and support it offers have helped many people. But it is not enough for everyone. The history of AA is the story of how one approach to treatment took root before other options existed, inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better.

 

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods. At the top of the list are brief interventions by a medical professional; motivational enhancement, a form of counseling that aims to help people see the need to change; and acamprosate, a drug that eases cravings. (An oft-cited 1996 study found 12-step facilitation—a form of individual therapy that aims to get the patient to attend AA meetings—as effective as cognitive behavioral therapy and motivational interviewing. But that study, called Project Match, was widely criticized for scientific failings, including the lack of a control group.)

 

As an organization, Alcoholics Anonymous has no real central authority—each AA meeting functions more or less autonomously—and it declines to take positions on issues beyond the scope of the 12 steps. (When I asked to speak with someone from the General Service Office, AA’s administrative headquarters, regarding AA’s stance on other treatment methods, I received an e-mail stating: “Alcoholics Anonymous neither endorses nor opposes other approaches, and we cooperate widely with the medical profession.” The office also declined to comment on whether AA’s efficacy has been proved.) But many in AA and the rehab industry insist the 12 steps are the only answer and frown on using the prescription drugs that have been shown to help people reduce their drinking.

 

People with alcohol problems also suffer from higher-than-normal rates of mental-health issues, and research has shown that treating depression and anxiety with medication can reduce drinking. But AA is not equipped to address these issues—it is a support group whose leaders lack professional training—and some meetings are more accepting than others of the idea that members may need therapy and/or medication in addition to the group’s help.

 

AA truisms have so infiltrated our culture that many people believe heavy drinkers cannot recover before they “hit bottom.” Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma. “You might as well tell a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack,’ ” Mark Willenbring, a psychiatrist in St. Paul and a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, told me. He threw up his hands. “Absurd.”

 

Part of the problem is our one-size-fits-all approach. Alcoholics Anonymous was originally intended for chronic, severe drinkers—those who may, indeed, be powerless over alcohol—but its program has since been applied much more broadly. Today, for instance, judges routinely require people to attend meetings after a DUI arrest; fully 12 percent of AA members are there by court order.

[AdamSmith]

Whereas AA teaches that alcoholism is a progressive disease that follows an inevitable trajectory, data from a federally funded survey called the National Epidemiological Survey on Alcohol and Related Conditions show that nearly one-fifth of those who have had alcohol dependence go on to drink at low-risk levels with no symptoms of abuse. And a recent survey of nearly 140,000 adults by the Centers for Disease Control and Prevention found that nine out of 10 heavy drinkers are not dependent on alcohol and, with the help of a medical professional’s brief intervention, can change unhealthy habits.

 

We once thought about drinking problems in binary terms—you either had control or you didn’t; you were an alcoholic or you weren’t—but experts now describe a spectrum. An estimated 18 million Americans suffer from alcohol-use disorder, as the DSM-5, the latest edition of the American Psychiatric Association’s diagnostic manual, calls it. (The new term replaces the older alcohol abuse and the much more dated alcoholism, which has been out of favor with researchers for decades.) Only about 15 percent of those with alcohol-use disorder are at the severe end of the spectrum. The rest fall somewhere in the mild-to-moderate range, but they have been largely ignored by researchers and clinicians. Both groups—the hard-core abusers and the more moderate overdrinkers—need more-individualized treatment options.

 

“We cling to this one-size-fits-all theory even when a person has a small problem.”

 

The United States already spends about $35 billion a year on alcohol- and substance-abuse treatment, yet heavy drinking causes 88,000 deaths a year—including deaths from car accidents and diseases linked to alcohol. It also costs the country hundreds of billions of dollars in expenses related to health care, criminal justice, motor-vehicle crashes, and lost workplace productivity, according to the CDC. With the Affordable Care Act’s expansion of coverage, it’s time to ask some important questions: Which treatments should we be willing to pay for? Have they been proved effective? And for whom—only those at the extreme end of the spectrum? Or also those in the vast, long-overlooked middle?

 

For a glimpse of how treatment works elsewhere, I traveled to Finland, a country that shares with the United States a history of prohibition (inspired by the American temperance movement, the Finns outlawed alcohol from 1919 to 1932) and a culture of heavy drinking.

 

Finland’s treatment model is based in large part on the work of an American neuroscientist named John David Sinclair. I met with Sinclair in Helsinki in early July. He was battling late-stage prostate cancer, and his thick white hair was cropped short in preparation for chemotherapy. Sinclair has researched alcohol’s effects on the brain since his days as an undergraduate at the University of Cincinnati, where he experimented with rats that had been given alcohol for an extended period. Sinclair expected that after several weeks without booze, the rats would lose their desire for it. Instead, when he gave them alcohol again, they went on week-long benders, drinking far more than they ever had before—more, he says, than any rat had ever been shown to drink.

 

Sinclair called this the alcohol-deprivation effect, and his laboratory results, which have since been confirmed by many other studies, suggested a fundamental flaw in abstinence-based treatment: going cold turkey only intensifies cravings. This discovery helped explain why relapses are common. Sinclair published his findings in a handful of journals and in the early 1970s moved to Finland, drawn by the chance to work in what he considered the best alcohol-research lab in the world, complete with special rats that had been bred to prefer alcohol to water. He spent the next decade researching alcohol and the brain.

[AdamSmith]

Sinclair came to believe that people develop drinking problems through a chemical process: each time they drink, the endorphins released in the brain strengthen certain synapses. The stronger these synapses grow, the more likely the person is to think about, and eventually crave, alcohol—until almost anything can trigger a thirst for booze, and drinking becomes compulsive.

 

Sinclair theorized that if you could stop the endorphins from reaching their target, the brain’s opiate receptors, you could gradually weaken the synapses, and the cravings would subside. To test this hypothesis, he administered opioid antagonists—drugs that block opiate receptors—to the specially bred alcohol-loving rats. He found that if the rats took the medication each time they were given alcohol, they gradually drank less and less. He published his findings in peer-reviewed journals beginning in the 1980s.

 

Subsequent studies found that an opioid antagonist called naltrexone was safe and effective for humans, and Sinclair began working with clinicians in Finland. He suggested prescribing naltrexone for patients to take an hour before drinking. As their cravings subsided, they could then learn to control their consumption. Numerous clinical trials have confirmed that the method is effective, and in 2001 Sinclair published a paper in the journal Alcohol and Alcoholism reporting a 78 percent success rate in helping patients reduce their drinking to about 10 drinks a week. Some stopped drinking entirely.

 

I visited one of three private treatment centers, called the Contral Clinics, that Sinclair co-founded in Finland. (There’s an additional one in Spain.) In the past 18 years, more than 5,000 Finns have gone to the Contral Clinics for help with a drinking problem. Seventy-five percent of them have had success reducing their consumption to a safe level.

 

The Finns are famously private, so I had to go early in the morning, before any patients arrived, to meet Jukka Keski-Pukkila, the CEO. He poured coffee and showed me around the clinic, in downtown Helsinki. The most common course of treatment involves six months of cognitive behavioral therapy, a goal-oriented form of therapy, with a clinical psychologist. Treatment typically also includes a physical exam, blood work, and a prescription for naltrexone or nalmefene, a newer opioid antagonist approved in more than two dozen countries. When I asked how much all of this cost, Keski-Pukkila looked uneasy. “Well,” he told me, “it’s 2,000 euros.” That’s about $2,500—a fraction of the cost of inpatient rehab in the United States, which routinely runs in the tens of thousands of dollars for a 28-day stay.

 

When I told Keski-Pukkila this, his eyes grew wide. “What are they doing for that money?” he asked. I listed some of the treatments offered at top-of-the-line rehab centers: equine therapy, art therapy, mindfulness mazes in the desert. “That doesn’t sound scientific,” he said, perplexed. I didn’t mention that some bare-bones facilities charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors.

 

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

[LADoug1]

AA helps get you dry. Therapy (especially Cognitive Behavioral) hopefully gets you sober. There is a critical difference.

[LookingAround]

Please don't take treatment advice from an anonymous escort review website. The advice here from people on the street is dangerous.

 

Or from popular magazines. Speak to a licensed professional.

[AdamSmith]

Please don't take treatment advice from an anonymous escort review website. The advice here from people on the street is dengerous.

The Atlantic magazine cited above is hardly an "anonymous escort review web site."

[LookingAround]

The Atlantic magazine cited above is hardly an "anonymous escort review web site."

Don't get treatment advice from a magazine article posted by people on an anonymous escort review site.

[+ WilliamM]

Sinclair came to believe that people develop drinking problems through a chemical process: each time they drink, the endorphins released in the brain strengthen certain synapses. The stronger these synapses grow, the more likely the person is to think about, and eventually crave, alcohol—until almost anything can trigger a thirst for booze, and drinking becomes compulsive.

 

One size does not fit all. Both my first cousin and I knew there was a strong history of alcoholism in my mother's large family. In my 20s, I drank so much that I had frequent blackouts. Because I was so aware of the ways my grandfather and two uncles spent the last ten years of their respective lives, I stopped drinking at age 33 on my own. Now, at age 73, I can have an occasional beer. Family history was the determining factor for me.

 

I discovered a decade later my first cousin stopped drinking for the same reason.

[Rocky93]

Certainly one size does not fit all. There are many ways. Most have to find out from trying and failing - hopefully they don't die in the process.

 

Now, why someone would publish a whole damn article on this blog is beyond me especially after I said I read the article! Just goes to show he has nothing of his own to counter what I had written.

 

There is a reason AA is set up the way it is. Alcoholism and addiction are "spiritual" diseases, not medical diseases - although there are medical corollaries. Therefore, the relief is found through spiritual principles. There is a difference between "recovery" and not using. People can not use again but not have recovery. Realize that many people stop drinking way before AA was founded. Many people stop today, alcohol and drugs, without many conventional methods. Drugs and Alcohol (sex, relationships, gambling, overeating, etc.) are not the problems. They are the temporary solutions we use to numb the pain we feel. The problem is us and the solution is us dealing with the pain, however that might be, and having a new way of living.

 

Why the existence of AA gets someone so upset seems to indicate more about the person than it does about the program.

 

Now, returning to our regularly scheduled program - thoughts on sex addiction??

[LADoug1]

Addictions are negative coping skills. Address the problems that require coping with and there's a good chance the addition can be overcome.

[LookingAround]

Addictions are negative coping skills. Address the problems that require coping with and there's a good chance the addition can be overcome.

If only it were that easy.

[LADoug1]

If only it were that easy.

 

I didn't mean to imply it was easy. I know that it's a terribly daunting problem to overcome. That's why I said one has a good chance and not a sure one.

[AdamSmith]

If only it were that easy.

Easy is the last thing that approach is.

 

Speaking from firsthand experience.

[AdamSmith]

Here are key components of one contemporary model:

 

Three months of three-times-per-week, three-hours-per-day intensive group outpatient cognitive behavioral therapy led/moderated by a mental health professional.

 

Weekly individual CBT counseling.

 

Follow-up twice-weekly step-down group CBT led/moderated by a mental health professional.

 

Optional daily naltrexone therapy. Thinking used to be three months, to reinforce the cognitive behavioral disconnection from the learned notion and behavior that one drink inevitably must trigger a bender.

 

Newest research strongly indicates that a nine-minth course of naltrexone can go beyond even that, to physically rewire the mesolimbic pathway https://en.m.wikipedia.org/wiki/Mesolimbic_pathway into its pre-abuse state.

 

It works.

[AdamSmith]

AA's 1930s methods by contrast are like attempting brain surgery with Neanderthal stone tools.

[MartyB]

To the original post regarding porn/sex addiction for this man I love great porn and see my escort once a week. My porn porn viewing depends on my need to jo. I'm so much happier and feel so good about myself. My porn viewing and seeing an escort once a week is within my budget and doesn't interfere with my job. As for my personal relationship my partner and I don't have sec anymore. I'm not dead yet.

[LookingAround]

 

Newest research strongly indicates that a nine-minth course of naltrexone can go beyond even that, to physically rewire the mesolimbic pathway https://en.m.wikipedia.org/wiki/Mesolimbic_pathway into its pre-abuse state.

 

It works.

 

Although the treatment approaches you mention are good this is going a bit far and sounds like it was written by the drug company.

[AdamSmith]

Although the treatment approaches you mention are good this is going a bit far and sounds like it was written by the drug company.

You have simply my pity.

 

It is a very inexpensive pill, with many generic sources available at minimal cost, that does not make its manufacturers much profit at all. If you had any curiosity, you could Google up the several research studies that document what I reported here.

 

Nor do I have any way to profit from parroting a drug company's party line. So your thought that I would is really disconnected.

[LookingAround]

You have simply my pity.

 

It is a very inexpensive pill, with many generic sources available at minimal cost, that does not make its manufacturers much profit at all. If you had any curiosity, you could Google up the several research studies that document what I reported here.

 

Nor do I have any way to profit from parroting a drug company's party line. So your thought that I would is really disconnected.

I'm a doctor and treat these people. I don't need your pity.

[Rocky93]

I'm a doctor and treat these people. I don't need your pity.

 

Thank you!! I work every day with them and if this approach was as successful - I wouldn't be going to a funeral every week! Nor would there be an epidemic of opioid addictions.

 

I don't know why people claim to have answers for problems which are beyond their pay grade. Just say what has worked for you and move on. Obviously, it doesn't work for all. Take what fits and leave the rest.