Book Review: Prodependence: Moving Beyond Codependency

Rob Weiss’s latest contribution to the recovery community is his book Prodependence:  Moving Beyond Codependency.  This book, and the philosophy of prodependence are an alternate take on the idea of codependency that has been rampant in the addiction recovery movement for decades. 

Codependence has been defined as “a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition, such as an addiction (Merriam-Webster).  In the recovery community the spouse, partner or family of someone suffering from an addiction is often labeled a codependent.  This term came into the recovery lexicon in the 1980’s and became part of everyday language.  A codependency diagnosis was rejected by the APA for the inclusion into the DSM but the “diagnosis” has persisted and there are 12 step meetings for Codependents (CODA)

Rob Weiss’s argument in putting forth the concept of Prodependence is that it codependence is not helpful to the family members of those in active addiction or in recovery from addiction.  Family members loved ones or care givers of people with addictions, in the codependency model, are often told that they are part of the problem as opposed to just trying to cope with a very difficult situation. 

Prodependence is as term to describe “attachment relationships that are healthfully interdependent, where one person’s strengths support the vulnerabilities of another and vice versa, with this mutual support occurring automatically and without question.” (p53.)  Rob prefers this concept as it celebrates a loved one’s desire to help the addict in their life without shame or blame. 

Prodependence looks at the behaviors of the partners or family members of an addict as attempts to maintain or restore healthy attachment and not as enabling.  Treating prodependence is similar to treating co-dependence in terms of encouraging healthy boundaries and self care.  However, it differs by being a strength based, attachment driven model that values loved ones of an addict.

Another key idea behind the concept of prodependence is the idea that a person with an addiction has an attachment disorder and needs healthy attachment to truly heal from their addiction.  Encouraging prodependence, treating addicts and their loved ones with kindness, empathy and respect, can help repair earlier attachment traumas and aid healing. 

Another key difference between prodependence and codependence is that prodependence looks at addiction as an intimacy disorder. As opposed to the older idea of tough love, intimacy disorders are treated with the pursuit of healthy, intimate and ongoing connection.


While suggesting that codependence may be an outdated concept is risky, it does not feel groundbreaking.  This book and the idea of prodependence feels like the natural conclusion when you take into account what we now know from the research about attachment, intimacy and shame.  As Johann Hari suggests in his Ted Talk from a number of years ago, “What if all we were taught about addiction is wrong?”  Perhaps, instead, we should treat people with addictions and their families and loved ones without shame and blame.  We might get farther modeling healthy attachment and boundaries combined with compassion and empathy instead.

Sex, God & The Conservative Church: Book Review

Charity (The United States)’s review of Sex, God, and the ...

I was asked to teach the graduate human sexuality course last fall at the Moravian Theological Seminary. As it had been years since I taught, I was on the hunt for new books for the course.  Because this course was being taught at a seminary, we had to at least touch on religion and sex.  I found Sex, God & the Conservative Church:  Erasing Shame from Sexual Intimacy, by Tina Schermer Sellers, Ph.D. at the AASECT conference and thought it might be a perfect fit.  Once I started to read the book I thought “WHERE HAS THIS BOOK BEEN ALL MY CLINICAL LIFE?”

As someone whose primary clinical practice involves issues related to sexuality (Sex addiction, sexual offending and other problematic sexual behavior), issues of faith are frequently brought into the treatment room. It seems, that for many, faith and sex are intertwined.  As someone who is not a Christian counselor, I didn’t always have the perspective or language to help some clients work through this as much as I could have.  This book is an exceptional resource both for clinicians and clients or church groups.

Sex, God & the Conservative Church takes the reader first through a journey of the history of how sexuality and faith became derailed.  Of particular interest to me, working with sexual addiction, was her discussion of Saint Augustine, who she labeled a sexually troubled soul.  This is of interest to me as one of the main 12 step fellowship groups for sex addiction is Sex and Love Addicts Anonymous (SLAA).  This fellowship is an Augustine Fellowship, named after the saint.

“While Augustine offered much that was foundational in the formation of Christian Theology, sexual desire and his own desire for women, which he was never able to completely escape, tortured him until the end.  His legacy of shame, fear of the body, and suspicion of its desire is with us today” p 33-34

The author suggests that a great deal of the root of sexual shame that Christians struggle with is rooted in his teachings.  I find it ironic, or perhaps a bit upsetting, that one of the main 12 step fellowships for recovery from sexual addiction is rooted in sexual shame.

Once past the history, the book delves into tangible ways to help people heal from their sexual shame and pursue sex positive messages from God and a sex positive Gospel.  Dr. Schermer Sellers frames the healing of sexual shame in a four-step process which will be very helpful for all people who are struggling with sexual shame, not just those that identify as Christian.

  1. Frame – provide sexual education to a client that they did not receive
  2. Name – help the client get their story heard by someone important to them.
  3. Claim – the client works to accept and own their body as a wonderful unique thing to undo the harmful messages inherited from religion and culture
  4. Aim – help the client write a new story of what they believe and what their legacy is to become.

Another aspect of this book that I really enjoy is the authors emphasis on normalizing childhood sexuality and the need for real, accurate and frequent sexual education being taught to children.  When families do not talk about sex and sexuality to children, they often assume it is something to be kept secret.  Worse yet is when a parent or care giver overtly shames a child for expressing normal sexual behavior or curiosity.  This can create a go to thought process of sex being dirty and bad.  If I (the child) have a sexual thought or feeling, I must be bad. Those of us who do this work know that so much of the struggle is rooted in shame and secrets.  If we normalize and teach children about healthy sexuality we can erase the shame that is often at the core of sexual problems.  To again quote the author:

“A culture that shames children for normal sexual expression plants seeds that manifest themselves in adult life in the form of disturbances in relationship, libido, and sexuality.  Sexual shame can sever the experience of sensual pleasure in a deep, loving attachment because it eclipses the person’s ability to feel seen, known, loved and accepted with and through their sensual body.  “ p. 106

I don’t think I can express strongly enough how wonderful this book is.  It should be a required reading for anyone who works with clients who struggle with sexual issues, be they sex therapists, sex educators or sex addiction therapists.  One of my strongly held beliefs is that we have to be sex positive in our work and not perpetuate sexual shame in our clients (see previous writing on being a sex positive sex addiction therapist).  Learning to integrate a sex positive Gospel for those of the Christian faith will go a long way to reduce sexual shame and reduce problematic sexual behavior.

 

For more information on Dr. Jennifer Weeks and her practice, head over to Sexual Addiction Treatment Services.  

You’re Being Investigated for a Cybersex Crime: The Psychosexual Evaluation

 

So far in our series of articles we have talked about finding a good attorney and a good therapist.  The next step in the process is to talk to your attorney about a psychosexual evaluation.  In most states and in Federal cases, the prosecution will have you undergo an evaluation with a therapist who works either for or on behalf of the state, county or Federal government. It is normally always a good idea to have one done by a psychologist who is not working for the organization that is prosecuting you.

First, what is a psychosexual evaluation?  The evaluation is comprised of an interview with a psychologist, a lot of psychological testing and a review of all forensic documents related to your case.  What tests you take often depends on the clinician who is doing the evaluation.  These objective measures will test for factors that may have both influenced your committing the crime you are accused of and may influence you to commit the crime again.  For example, you will likely do some type of personality test to see if you have any mental health diagnoses that influenced your crime such as depression, anxiety, bi-polar disorder, etc.  You will also likely be asked to take some test that will assess your likelihood of having a substance abuse problem, as this is sometimes correlated with certain types of crimes.

How do you find the right person to conduct the psychosexual evaluation?  If you have an attorney, he or she may have a psychologist that they work with closely and will refer you to that person.  If you are looking for this person on your own, there are a few things you should be on the lookout for.  First, you need someone who has a Ph.D. and has been trained to give the types of tests that you need.  Not all therapists have the training to be qualified to administer certain psychological tests.  Second, the psychologist who performs your evaluation needs to be experienced in performing psychological evaluations for sex crimes.  Not all forensic psychologists work with sex crimes.  Some, for example, perform evaluations for competency to stand trial.  Third, your evaluator should be a member of ATSA and familiar with the latest research related to offenders of your type of crime.

A question I often am asked is “what happens if the evaluation says something bad?”  My first response to this question is that there is nothing about an evaluation that is “bad.”  An evaluation is a combination of facts, testing results and opinion based on all those elements.  However, if you are concerned about the outcome of the evaluation, there is a solution.  If the evaluator is retained by your attorney and paid for by your attorney, the report then falls under attorney-client privilege as client work product.  This way, if your attorney does not feel that the evaluation will help you, he or she will not use it during your sentencing.

In most cases, the psychosexual evaluation is used for sentence mitigation.  Your attorney may use a favorable evaluation in the plea negotiation process beforehand.  Your psychosexual evaluation will be part of the pre-sentence memorandum that your attorney files with the court prior to your sentencing.  This report will give the judge information as to some of the reasons why you committed your crime as well as provide the judge with some information about your risk of recidivism (commit another crime).  The judge will take all this information into account when they are determining your sentence.

If your attorney does not suggest an evaluation, ask them about it.  Whether or not you need an evaluation or if it may be helpful will depend on your case and your jurisdiction.  We provide these suggestions as they are helpful in our geographic area of Pennsylvania.

Dr. Jennifer Weeks is the owner of Sexual Addiction Treatment Services.  She specializes in the treatment of sexual offenders and cybersex offenders.  Through her program she provides psychosexual evaluations, treatment and expert witness testimony.  SATS also offers coaching services for those people who are being investigated but are not in Pennsylvania.

You’re Being Investigated for a Cybersex Crime: What to look for in a therapist

In my first blog in this series, I wrote about the fact that getting a therapist is one of the first things you need to do when you are under investigation for a cybersex crime.  I briefly mentioned that you will need a specific type of therapist in that post and I am going to expand on what you need to look for in a therapist here.

Given how expensive this entire process is, one’s inclination is to just find a therapist who takes their insurance, can help with the anxiety and depression they are experiencing, though not necessarily specializing in treating people engaging in cybersex crimes.  I understand that thought process.  However, there are some things you need to know.

  1. Many therapists will not work with sex offenders. You would think or hope that someone who works as a mental health counselor would be able to work with anyone without prejudice.  Unfortunately, that is not true.  Research studies have shown that a high percentage of therapists will not work with someone who is attracted to children or has engaged in sexual behavior with a child (even if it is online).  This means that if you go to see just any therapist, you do not know if you are meeting with someone who is personally comfortable working with you.  If they are not, ethically they are to refer you to someone else.  However, not all therapists will do this.   This means that you may get advice biased by their own opinions about sexual offenders and often this is not accurate or helpful.

 

  1. Many therapists are not comfortable talking in depth about sex and sexuality. If you are going to really get to the root of the behavior that led to you engaging in a cybersex crime, you are going to be talking in depth about sexual behaviors.  This means that the therapist you choose to work with needs to be completely comfortable in their own sexuality and able to nonjudgmentally sit with the sexual behaviors of others.  Again, just as not all therapists can work with sex offenders, not all therapists are very comfortable talking about sex and sexuality.  That might sound odd, but it is true.

 

  1. Most therapists are not trained in treating sexual behavior that crosses into offending. In the process of graduate training to become a therapist, unless a person knows they want to specialize in treating sexual behavior problems from the get go, they are likely to receive limited training in the topic.  Normally all counseling programs make students take one course on human sexuality.  That’s it. This means that a general therapist will not have the training or knowledge to help you with the specific issues that brought you to being investigated for a cybersex crime.

 

What do you need to look for in a therapist?

  1. A therapist who has experience working with sexual behaviors. Most therapists will have listed somewhere on their website or Psychology Today profile what types of issues they work with.  If a therapist states that they work with sexual issues such as pornography addiction, sexual dysfunction, or other sexual health problems, they are going to be comfortable talking to you about details of sexual issues.

 

  1. A therapist who has experience working with sexual offending behaviors such as child pornography, sexting minors, online solicitation, etc. This will require a phone call or an email to the therapist and direct questioning.  Have they worked with people in your exact situation before?  If they have not, you might want to continue searching for a therapist who as at least seen a few people who are in your situation.

 

  1. A therapist who has specific training, certification or professional membership to organizations that work with sexual behavior problems. The best thing is to find a therapist who is a member of ATSA. This stands for the Association for Treatment of Sex Abusers.  This is an international organization that is entirely dedicated to research and treatment of people who engage in sexual offending behavior.  The website atsa.com has a referral page where you can find a therapist.  A second tier choice would be to find someone who is a Certified Sex Addiction Therapist through IITAP (www.iitap.com) or trained through SASH (www.sash.net).  If you find a clinician who is experienced in treating your issue and they are not certified or a member of ATSA please make sure they stay informed of the latest treatment research and trends.

 

Again, if you are reading this you are in a very particular situation and need a very particular therapist to help you.  You need a therapist who is comfortable discussing sexuality in all forms, is willing to work with people who are attracted to children, has experience in treating people with sexual offending behavior and is up to date on the latest research in the field.

Dr. Jennifer Weeks is the owner of Sexual Addiction Treatment Services.  She specializes in the treatment of sexual offenders and cybersex offenders.  Through her program she provides psychosexual evaluations, treatment and expert witness testimony.  SATS also offers coaching services for those people who are being investigated but are not in Pennsylvania.

Pornography Problem…. Erotic Conflict or Addiction?

Computer Key - Porn

When I started in this field, sex addiction was not a common place term.  Therapists who treated sex addiction were not that prevalent and you never heard about sex addiction on the news.  Today, it is a different story.  You hear the term sex addiction all the time, bandied about in the news every time you hear about a celebrity sex scandal.  Therapists who treat sex addiction, whether specifically trained to do so or not, are much more common now as well.

The same goes for pornography addiction.  For some reason, this feels less stigmatizing to many.  Again, there are now large numbers of therapists who treat pornography addiction (whether trained to or not) and there are also many new programs popping up to help men deal with their pornography addictions.  These are often programs not run by a therapist or affiliated with a 12-step program but instead created and run by independent agents or religious institutions.

As the visibility of pornography addiction grows, the type of clients we have coming to the office have changed.  In the beginning, over 8 years ago, the (predominantly) men who were coming in to address problems with pornography were men who had struggled for most of their lives with pornography use.  They were watching more than they wanted to. They couldn’t stop.  They were experiencing serious consequences in their work and relationships or even with the law as a consequence of their pornography use.  These were men who were what I would diagnose as pornography (or sex as a broad moniker) addicts.

Today, many of the men who are coming in with self-diagnosed pornography or sex addictions are men who look at some pornography.  They don’t look at it necessarily a lot (maybe one or two times a week or less).  They don’t look at it for hours and hours on end.  They don’t look at anything illegal.  They often don’t look at any pornography that is more “hard core.”  Often their pornography use is causing a conflict in their relationship.  These are not men that I would diagnose with a pornography addiction, but they call themselves pornography addicts.

This brings me to the title of this writing.  Are these men who come in pornography addicts?  Or are they men who are experiencing an erotic conflict?

An erotic conflict is experienced by a person who is engaging in (or even fantasizing about) a sexual behavior that conflicts with his or her moral values or religious values.  For example, a person who is attracted to sex with the same sex might experience an erotic conflict because their religious beliefs tell them that same sex attraction is wrong.  Their behavior conflicts with their religious beliefs.  A person who is using escorts might be experiencing an erotic conflict because breaking the law is against their personal moral values.  A man who is watching pornography occasionally, a few times a month, might feel as though he has a sexual addiction or pornography addiction because his religious beliefs tell him that lust and pornography are bad.  Therefore, he equates any use of pornography with addiction.

Though there is no DSM-V definition of sexual addiction or pornography addiction, we can extrapolate the criteria from drug and alcohol and gambling addictions (Use disorders in the DSM-V).  This means that someone who is a pornography addict would experience at least two of the following issues:  watching pornography more often than they intended and for longer periods of time than intended; an inability to stop watching pornography; spending a lot of time creating opportunities to watch pornography, crave pornography use; fail to fulfil obligations at work, home or school due to using pornography; continuing to use pornography even after interpersonal problems resulting from use; social isolation due to pornography use; the need for more pornography or more intense pornography to get the same feeling and difficulties when they try to stop using pornography or can’t access it.

Here is my plea to clinicians and to society as well:

CAN WE PLEASE BE MORE DISCERNING IN DIAGNOSING SEXUAL AND PORNOGRAPHY ADDICTION?

What happens when we over diagnose pornography addiction?

  1. We never get to the underlying issue.  If someone is not actually a pornography addict and is experiencing an erotic conflict, often they never get to the root of the issue.  Often, they work a 12-step abstinence model and condemn any experiences of lust as bad or problematic.  This can place moral good or bad judgements on sexual behavior that can cause more psychological harm if the client continues to engage in the behavior.  It can shame the normal biological process of attraction by naming it lust to be removed from the person’s being.  It can also prevent the client from learning about healthy sexuality and what truly arouses and attracts them.  Ultimately, they often never work through the conflict between their body and their beliefs to any healthy resolution.
  2. We cause more shame. Though being a pornography addict is less shameful perhaps than it used to be, being named a sex addict or pornography addict is often a very shameful experience for a person.  This shame must be worked through when the person truly does have an addiction.  When the person does not, the label is often causing more shame and possibly isolation than is necessary.  Often this adds to the “I’m a bad person” thoughts the pornography consumer might have, simply for looking at some pornography.
  3. We trivialize sexual addiction. The therapeutic community and often the public press hotly debate whether sexual or pornography addiction are “real.”  The con side often uses the argument that those who support the idea of sexual addiction are religious conservatives who are condemning normal sexual practices.  When someone with an erotic conflict (often based on religious beliefs) is diagnosed with an addiction, this reinforces the argument that we are trying to morally dictate sexual practices and label them addictions.

My goal here is not to condemn or judge someone’s religious or moral beliefs.  We all have our own set of values that we would like to live by.  My plea is that we, both clinicians and consumers, really look at the behavior.  Is the client presenting in your office who uses pornography an addict or someone with an erotic conflict?  The treatment is different. If they have an erotic conflict the work is to process through the beliefs, sexuality and the conflict to come to a resolution that fits the client’s moral and personal compass.  If the client is an addict, the treatment will likely follow a more traditional addiction model with 12 step attendance, abstinence from certain behaviors and recovery work.

I leave you with my plea again:  CAN WE PLEASE BE MORE DISCERNING IN DIAGNOSING SEXUAL AND PORNOGRAPHY ADDICTION?

 

Dr. Weeks is the owner of Sexual Addiction Treatment Services.

Get Paid to Watch Porn: Cryptocurrency and the Pornography Industry

cryptocurrency-predictions-2018-914087

If you are like me, you have heard of cryptocurrencies such as bitcoin, but know very little about it.  We see newspaper articles about bitcoin values going up and down and articles about how digital currency is going to eventually take over traditional banking.  Other than headlines, most of us don’t pay much attention.  However, as with any new technology, the pornography industry pays attention.

First, here is a 30 second, non-technical review of cryptocurrency.  Cryptocurrency is a decentralized digital cash system, that is kept secure by strong cryptography.  Transactions made with cryptocurrency are irreversible, untraceable to a person’s real-world identity, fast, global, secure and permissionless.  The use of this technology offers a way to pay for things or transfer money that is under the radar of governments and can be kept anonymous from a person’s credit history, spouse, etc.

Cryptocurrency can be used to pay for things but there is also a growing industry of ICOs or initial coin offerings.  ICOs are basically crowdfunding projects.  A company puts forth a white paper with their idea and then asks for investment.  The hope is that the project comes to fruition, and the coin will increase in value.

Why on earth am I talking to you (poorly at that) about cryptocurrency?  Well, it has entered the pornography industry.  On April 17, Pornhub announced that it now accepts the cryptocurrency Verge as a payment option.    The use of Verge allows a pornhub users to buy a subscription to the site in an anonymous fashion.  For those who don’t want anyone, including their credit card company, to know they have purchased a subscription to a pornography site, the use of cryptocurrency is the perfect option.

Another foray into the crypto/pornography world is the Vice Industry Token.  This new token is currently in development but has completed its ICO.  The token wants to take advantage of the attention economy.  The premise is that they wish to remonetize the industry around viewer desire and not that of paid content sponsors.  In this model, tokens will be generated and distributed based on user engagement.  All parties in the process will be rewarded.  Content producers will be rewarded for creating content that gets a lot of viewer attention and viewers will be rewarded.  The company has trademarked the phrase “Get paid to watch porn.”  See the white paper here 

The users of this system will then be able to pay for further pornographic content with the VIT tokens that they have earned by watching pornography.  Basically, someone can watch pornography (which they likely would do already) and earn digital money to do so.  They could then use that digital money to buy more adult content.

For those individuals who struggle with pornography addiction, this is something that adds even more incentive to watch pornography.  Now they can get paid to do something they already do.  For those individuals who are choosing to hide their pornography use from a spouse or partner, this offers a greater opportunity for secrecy.  There are no credit card statements to find.  There is no missing money.  There is an increased amount of anonymity which is one of the three accelerators of problematic internet behavior:  anonymity, accessibility and affordability.

 

Dr. Weeks is the Owner and Director of Sexual Addiction Treatment Services, specializing in problematic sexual behavior, and treatment and evaluation of cybersex offenders.

Book Review: Recovery: Freedom from Our Addictions by Russell Brand

A recovery book by actor and comedian Russell Brand may not be what you might be expecting in the way of a book review from an addiction therapist, but we should all have an open mind, right?

I started keeping a peripheral eye on Mr. Brand when I began focusing my clinical work on sexual addiction.  Mr. Brand made it very public (writing about it in several books) that he attended the Keystone Extended Care Unit in Chester, Pennsylvania for his in patient sexual addiction treatment.  This is what put him on my radar. I have friends and colleagues who work there and have referred many clients to treatment at Keystone ECU.  When his new book about recovery came out, I thought, “why not?”

Recovery: Freedom from our Addictions has been a pleasant surprise from the get go.  This book is a 12-step book.  The book takes the reader through the entire 12 step process, step by step.  Russell shares his own story of recovery, the good and the bad, in a very relatable way.  He also, very openly, shares his own struggles with the steps.  He has struggled with the concept of God or higher power which is a huge road block for many people who attend or think to attend 12 step meetings.  He addresses his own self-centeredness, inability to ask for help and isolation, which is very relatable to anyone who has dealt with addiction of any kind.

In addition to the book, on his website, www.russellbrand.com, he provides a supplement to the book.  He provides the reader with his own questions and worksheets to work the steps.  I have read many 12 step books and I honestly feel as though these are some of the easiest to follow and real guides I have ever seen.  They are absent the preachy vibe that can come with some 12 step worksheets.  They are also rather blunt, which is a style I prefer.  Honestly, I have printed these out and given them to clients who I know struggle with the higher power concept of the 12 steps or have some other issues with their experiences of the people in the 12 step rooms.

Of course, this is a book by Russell Brand, so it is full of obscenity.  It is not for the reader who objects to a multitude of f-bombs in every chapter.  This is part of why I really like this book.  It is real.  It is raw.  It is what actually happens when a person goes through the 12-step program, not a sanitized version of the process that makes many people feel that recovery is unattainable.

The 12th step of AA states that “After having a spiritual awakening as a result of these steps, we tried to carry the message to alcoholics, and to practice these principles in our own affairs.”  This book is Russell’s 12th step.  It is a great 12th step and one of the most enjoyable recovery books I have read in a really long time.

 

For more information on Dr. Weeks clinical work please see our website at www.sexualaddictiontreatmentservices.com 

 

 

Something’s Missing in the Current Drug Prevention Rhetoric

prevention

I have been an addiction therapist for approximately thirteen years.  While for some professions that may not seem like a long time, for a substance abuse professional, thirteen years in the trenches is a very long time. It is thirteen years of being underpaid, overworked, and underfunded.  It is also thirteen years of working with lost and often traumatized souls who may never ever get better.  Thirteen years as a substance abuse professional can make you weary.  However, you don’t end up in this profession and last for any length of time unless it is a calling.

Unless you are completely cut off from the outside world, you have seen many a news article lately about what is being called the heroin or opiate epidemic.  The apparent meteoric rise of addiction problems due to a prescription pill problem that for many turns into a heroin problem.  In March of 2016, the Centers for Disease Control issued new guidelines for doctors who prescribe opioids for chronic pain.  In 2015, hydrocodone combination products were moved to a Schedule II drug classification, indicating their highly addictive potential.  These changes were made in the hope of curbing the opiate addiction problem in our country, but with little effect.

This blog is not meant to be a discussion of anything related to why the situation continues to decline or what to do about it now.  What I want to talk about is prevention.  Most resources, even good resources like www.PASTOP.org, spend most of their page space talking about prescribing, what to do with unused medication, overdose and treatment information.  While all of this is very useful information, it is what I would call secondary prevention.  This is prevention of use by teens or adults, frequently who are prescribed medication initially by a doctor for a legitimate medical issue.  What is missing from the big picture of this prevention discussion is childhood.

Earlier this year, I finished reading both Dr. Gabor Mate’s, In the Realm of Hungry Ghosts and Dr. Bessel van der Kolk’s, The Body Keeps the Score.  Both are must reads for anyone who works in the addiction field.  I would like to share with you the line from In the Realm of Hungry Ghosts that inspired me to write the post.

“The prevention of substance abuse needs to begin in the crib – and even before then, in the social recognition that nothing is more important for the future of our culture than the way children develop.” P. 443

What is missing in almost all current talk about prevention is that, unfortunately, for all the people already addicted or prone to addiction, it is potentially too late.  Why do people become addicts?  Trust me in that no one wants to be an addict when they grow up or enjoys addiction.  Maybe, in the beginning, they liked the effect of the drug, but that quickly wears off.  What many addicts like is the escape.  The ability to take a substance that makes them not feel feelings they don’t like or can’t handle.  They like the fact that when they are taking the substance, they don’t have to sit in reality.  They like that the drug makes their flashbacks go away.  They like the fact that many drugs make them forget for a period of time.

In 13 years, I have yet to meet a drug addict who, at some point in their life, and most likely in childhood, did not suffer from at least one form of abuse or neglect.  Many drug addicts and alcoholics (gamblers and sex addicts too) endured verbal, physical and/or sexual abuse by their parents or family members growing up.  Many endured neglect in childhood as well, whether that was physical or emotional.  Many addicts were bullied in school and had no one safe at home to talk to about their experiences.  These childhood experiences mean that often, they looked for ways to self soothe, ways to cope or ways to feel better even if it was for a short period of time.

The ACE studies (Adverse Childhood Experiences) have shown scientific proof of what addiction counselors have known for years.  The more ACE events in a person’s life, the more likely they are to not only have physical issues but also mental health issues.  People with higher ACE scores are 2 to 4 times more likely to use alcohol or other drugs and to do so at an earlier age.  If a person’s ACE score is 5 or higher, they are 7 to 10 times more likely to use illegal drugs, report addiction or to inject illegal drugs.

So what do we do?  Addiction prevention starts before a child is born.  The in-utero environment of a child affects their neurobiological reaction to stress as an adult.  To stop drug addiction, we need to stop child abuse.  How do we do this?  Obviously, this is a tall order.  Make parenting classes more accessible to all expecting men and women.  Teach not only about physical care of a child but their mental health care as well.  Talk about attunement to a child and how that affects his or her ability to regulate emotion later in life.  Work to create safe spaces in a home and healthy attachment.  Teach communication skills from the start.  Teach healthy coping skills to even very young children.  Teach healthy coping skills to the adults so that they can model these for their children.  Work as hard as we can to prevent physical, sexual and emotional abuse of everyone.

I realize that my goals are idealistic.  I have always said that if the world gets healthy, I would happily change professions.

We need to start addiction prevention from the beginning by having discussions about childhood abuse, neglect and trauma.  We need to work to take away the stigma of therapy and getting help for emotional problems.  We need to teach everyone how to effectively communicate and cope.

I know that this is a tall order and that many do not have the resources to learn all these skills.  We need to work to provide these resources to everyone.  As a society, we need to do more……….

 

For more information on Dr. Weeks please go to our company website www.sexualaddictiontreatmentservices.com.

Photo credit.  The Watsons, NYC, NY.

We Are Failing Male Sexual Abuse Survivors

I specialize in working with sexual addiction and problematic sexual behavior. Most of my clients are men.  Working with male addicts for over a dozen years has taught me, in person, that many more boys are sexually abused than the numbers tell us.  These boys do not tell anyone and do not seek help.  These boys turn into men who are profoundly affected by their sexual abuse experiences as children and most of the time, don’t even know it.  They do not name what happened to them as abuse, or they don’t want to.  They feel so much shame about being abused that they lock part of themselves away so tightly it can take years (like 5 to 7 years) of therapy before they even acknowledge to a trusted therapist what happened to them.  These men who were abused as boys suffer in silence.

I realize that many people (myself included) will respond to this by saying that many girls and women do not disclose their sexual abuse and that they too live lives that are deeply affected by their abuse histories.  Having spent time working in a Women’s Trauma and Addiction PHP and IOP program, I do not dispute this.  However, I see a difference.

When women finally find the courage to come forward to seek treatment for their sexual abuse, they can find resources.  There are many group, individual and support resources for women who are survivors of sexual abuse.  Finding help is not so easy for men.  I will share an example from my practice to explain.

I have a male client who came to me last year who I will call Tom.  Tom has a pornography addiction and came to treatment after the problem began to cause a great deal of disruption in his life.  He had never gone to therapy and near the beginning of our work together, he disclosed that, when he was a boy, he was sexually abused by a neighbor boy who was near his age.  He had never shared this with anyone in his life and as soon as he acknowledged the abuse, the floodgates opened.  He started to have flashbacks and other PTSD symptoms.  Tom is a take charge kind of guy and we nearly immediately started to look for resources for him to do trauma work outside of our individual sessions.

First, we looked for men’s specific groups.  There was nothing and we are directly outside of a major east coast city.  Then we looked for trauma groups.  Tom talked to a few places that had groups for trauma survivors and was told that, as a man, he would make the women in the group uncomfortable so they could not have him join the group.  He then had an intake with a county resource for group trauma work.  After his intake, they told him that his case was too complicated and he could not join the group.  After months of looking, we literally could not find a group for sexual trauma survivors that was either all men or that would allow men into the group.

Tom continues his trauma work in individual therapy but craves the connection and understanding that one gets in group work.  He wants to know he is not alone and the therapeutic community was unable to tell him that, as a man, he is not alone.

Tom is just one example of many that I could pull from my case load.  To me, he is the loudest example of how we, as a treatment community, fail male survivors of sexual assault.  I have had other clients walk out of public events for sexual abuse survivors because, as the only man in attendance, they felt unwelcome and uncomfortable.

Why do we treatment professionals who work so closely with trauma not offer more resources to men? Are we uncomfortable?  Is there a reason we focus more closely on female survivors of sexual abuse?  These are questions to which I have no answers.  I have only heartbreak.  I can only do my part to welcome male sexual abuse survivors into therapy when they come and to start group programming for them in my practice.

I challenge other treatment professionals to process this issue and see what we can do to create more resources for men and to be more welcoming.

 

For a good online resource for male survivors of sexual abuse, please see www.1in6.org