| Proposing a New Diagnosis and Theory for
| |
| | resolving the complexity of assessing and
|
| Patients with Multiple Addictions
| |
| | treating a patient with multiple
|
|
| |
| | addictions?
|
| Experts in the field of addictions are
| |
| | Diagnostic Delineation
|
| presently purporting that between 3 and 6
| |
| | Thus far, the DSM-IV-TR has not
|
| percent of the world's population (193 to
| |
| | delineated a diagnosis for the complexity
|
| 386 million people) are presently
| |
| | of multiple behavioral and substance
|
| affected by a sexual dependency or
| |
| | addictions. It has reserved the
|
| compulsivity (Carnes, 2005). Sexual
| |
| | Poly-substance Dependence diagnosis for a
|
| dependency is a diagnosable and treatable
| |
| | person who is repeatedly using at least
|
| disease, which today is generally,
| |
| | three groups of substances during the
|
| regarded in about the same way that
| |
| | same 12-month period, but the criteria
|
| alcoholism and drug addiction (chemical
| |
| | for this diagnosis do not involve any
|
| dependency) was regarded 40 years ago.
| |
| | behavioral addiction symptoms. In the
|
| Even so, there still exists a wide range
| |
| | Psychological Factors Affecting Medical
|
| of understandable misunderstandings about
| |
| | Condition's section (DSM-IV-TR, 2000);
|
| compulsive sexual acting out, created out
| |
| | maladaptive health behaviors (e.g.,
|
| of ignorance about the nature of sexual
| |
| | unsafe sexual practices, excessive
|
| addiction, and supported and perpetuated
| |
| | alcohol, drug use, and over eating, etc.)
|
| by the multibillion dollar pornography
| |
| | may be listed on Axis I, only if they are
|
| industry.
| |
| | significantly affecting the course of
|
| Sexual Dependency - is a global term that
| |
| | treatment of a medical or mental
|
| covers a wide range of maladaptive and
| |
| | condition.
|
| self-defeating behavior patterns and
| |
| | Since successful treatment outcomes are
|
| relationships such as:
| |
| | dependent on thorough assessments,
|
| 1. Love Addiction - a disorder in which
| |
| | accurate diagnoses, and comprehensive
|
| individuals repeatedly become involved in
| |
| | individualized treatment planning, it is
|
| enmeshed, intense, codependent
| |
| | no wonder that repeated rehabilitation
|
| relationships, even when those
| |
| | failures and low success rates are the
|
| relationships or partners are
| |
| | norm instead of the exception in the
|
| destructive;
| |
| | addictions field, when the latest
|
| 2. Romance Addiction - a disorder in
| |
| | DSM-IV-TR does not even include a
|
| which individuals become obsessed with
| |
| | diagnosis for multiple addictive
|
| the intrigue and the pursuit of romance
| |
| | behavioral disorders. Treatment clinics
|
| and thrive on the thrill of the chase,
| |
| | need to have a treatment planning system
|
| but find it impossible to sustain a
| |
| | and referral network that is equipped to
|
| committed, intimate relationship with
| |
| | thoroughly assess multiple addictive and
|
| another person;
| |
| | mental health disorders and related
|
| 3. Sexual Anorexia - a disorder in which
| |
| | treatment needs and comprehensively
|
| individuals become dominated and obsessed
| |
| | provide education/ awareness, prevention
|
| with the emotional, physical, and mental
| |
| | strategy groups, and/ or specific
|
| task of avoiding sex; and
| |
| | addictions treatment services for
|
| 4. Sex Addiction - a disorder in which
| |
| | individuals diagnosed with multiple
|
| individuals become obsessed with
| |
| | addictions. Written treatment goals and
|
| sexually-related, compulsive
| |
| | objectives should be specified for each
|
| self-defeating maladaptive behavior.
| |
| | separate addiction and dimension of an
|
| But can one really be addicted to love as
| |
| | individuals' life, and the desired
|
| the popular 80's song proclaims? In a
| |
| | performance outcome or completion
|
| recent research study, (Aron, A. 2005)
| |
| | criteria should be specifically stated,
|
| published in the June issue of the
| |
| | behaviorally based (a visible activity),
|
| Journal of Neurophysiology, researchers
| |
| | and measurable.
|
| used functional MRI to watch the
| |
| | New Proposed Diagnosis
|
| real-time brain activity of 17 college
| |
| | To assist in resolving the limited
|
| students (10 women, seven men), all of
| |
| | DSM-IV-TRs' diagnostic capability, a
|
| whom were in the early weeks or months of
| |
| | multidimensional diagnosis of
|
| new love. These researchers concluded
| |
| | "Poly-behavioral Addiction," is proposed
|
| that, love may vie for the same real
| |
| | for more accurate diagnosis leading to
|
| estate in the brain as drug addiction.
| |
| | more effective treatment planning. This
|
| "Early love, rooted as it is in the
| |
| | diagnosis encompasses the broadest
|
| caudate nucleus, is all about addiction."
| |
| | category of addictive disorders that
|
| "It is a drug addiction." "It's
| |
| | would include an individual manifesting a
|
| certainly got some of the main
| |
| | combination of substance abuse
|
| characteristics of drug addiction -- as
| |
| | addictions, and other
|
| with drugs, once you fall in love you
| |
| | obsessively-compulsive behavioral
|
| need that person more and more, so much
| |
| | addictive behavioral patterns to
|
| so that, after a while, you have to marry
| |
| | pathological gambling, religion, and/ or
|
| them. There are other things, too --
| |
| | sex / pornography, etc.). Behavioral
|
| real dependence, personality changes,
| |
| | addictions are just as damaging -
|
| withdrawal symptoms." "And just like the
| |
| | psychologically and socially as alcohol
|
| need for cocaine or heroin, love can make
| |
| | and drug abuse. They are comparative to
|
| people do crazy, sometimes dangerous
| |
| | other life-style diseases such as
|
| things." According to Aron (2005), the
| |
| | diabetes, hypertension, and heart disease
|
| findings help explain instances where
| |
| | in their behavioral manifestations, their
|
| people fall in love with people they
| |
| | etiologies, and their resistance to
|
| aren't even sexually attracted to; or why
| |
| | treatments. They are progressive
|
| others can feel equally strong, sudden
| |
| | disorders that involve obsessive thinking
|
| emotion for a newborn child or even God.
| |
| | and compulsive behaviors. They are also
|
| So does this mean that all people who are
| |
| | characterized by a preoccupation with a
|
| newly in love have an addiction? Are all
| |
| | continuous or periodic loss of control,
|
| men who look at pornography addicted?
| |
| | and continuous irrational behavior in
|
| Are all women who read romance novels
| |
| | spite of adverse consequences.
|
| addicted? Are all people who avoid sex
| |
| | Poly-behavioral addiction would be
|
| considered sexual anorexics? No, no, no,
| |
| | described as a state of periodic or
|
| and no. Then how can we differentiate
| |
| | chronic physical, mental, emotional,
|
| between addiction and healthy
| |
| | cultural, sexual and/ or spiritual/
|
| relationships? Like other forms of
| |
| | religious intoxication. These various
|
| addictive diseases and lifestyle
| |
| | types of intoxication are produced by
|
| disorders such as chemical dependency,
| |
| | repeated obsessive thoughts and
|
| pathological gambling, eating disorders,
| |
| | compulsive practices involved in
|
| and religious addiction -
| |
| | pathological relationships to any
|
| Sexual dependency is characterized by an
| |
| | mood-altering substance, person,
|
| addictive cycle of:
| |
| | organization, belief system, and/ or
|
| 1. Obsession or preoccupation;
| |
| | activity. The individual has an
|
| 2. Ritualization;
| |
| | overpowering desire, need or compulsion
|
| 3. Compulsive behaviors;
| |
| | with the presence of a tendency to
|
| 4. Loss of control and despair; and
| |
| | intensify their adherence to these
|
| 5. Shame and guilt that perpetuates a
| |
| | practices, and evidence of phenomena of
|
| maladaptive belief system of impaired
| |
| | tolerance, abstinence and withdrawal, in
|
| thinking and unmanageability.
| |
| | which there is always physical and/ or
|
| Typically, sexual addictive patterns are
| |
| | psychic dependence on the effects of this
|
| considered pathological problems when
| |
| | pathological relationship. In addition,
|
| issues concerning sexual behaviors become
| |
| | there is a 12 - month period in which an
|
| the focus of life, causing feelings of
| |
| | individual is pathologically involved
|
| shame, guilt, and embarrassment with
| |
| | with three or more behavioral and/ or
|
| related symptoms of depression and
| |
| | substance use addictions simultaneously,
|
| anxiety that cause significant
| |
| | but the criteria are not met for
|
| maladaptive social and/ or occupational
| |
| | dependence for any one addiction in
|
| impairment in functioning. Addicts don't
| |
| | particular (Slobodzien, J., 2005). In
|
| use sex for affection or recreation, but
| |
| | essence, Poly-behavioral addiction is the
|
| for the management of anxiety and/ or
| |
| | synergistically integrated chronic
|
| emotional pain.
| |
| | dependence on multiple physiologically
|
| We must consider that some people develop
| |
| | addictive substances and behaviors (e.g.,
|
| dependencies on certain life-functioning
| |
| | using/ abusing substances - nicotine,
|
| activities such as sex that can be just
| |
| | alcohol, & drugs, and/or acting
|
| as life threatening as drug addiction and
| |
| | impulsively or obsessively compulsive in
|
| just as socially and psychologically
| |
| | regards to gambling, food binging, sex,
|
| damaging as alcoholism.
| |
| | and/ or religion, etc.) simultaneously.
|
| Sexual addiction takes many forms with
| |
| | Conclusion
|
| various levels of severity to include:
| |
| | Considering the wide range of sexual
|
| 1. Controversial behaviors (obsessions
| |
| | behaviors in our world today, one should
|
| with pornography, and sex with strangers
| |
| | always take into account an individual's
|
| to engaging in cyber-sex);
| |
| | ethnic, cultural, religious, and social
|
| 2. Unacceptable behaviors (exhibitionism,
| |
| | background prior to making any clinical
|
| voyeurism, indecent phone calls); and
| |
| | judgments, and it would be wise to not
|
| 3. Profound Sex offender behaviors (rape,
| |
| | over-pathologize in this area of Sexual
|
| incest, and child molestation).
| |
| | Dependency. However, since successful
|
| Though solitary forms of this addiction
| |
| | treatment outcomes are dependent on
|
| may not be overtly risky, they can be
| |
| | thorough assessments, accurate diagnoses,
|
| part of a pattern of distorted thinking
| |
| | and comprehensive individualized
|
| and identity conflict that can escalate
| |
| | treatment planning - poly-behavioral
|
| to involve harming the self and others.
| |
| | addiction needs to be identified to
|
| An example of a Sexual Disorder (NOS) or
| |
| | effectively treat the complexity of
|
| Not Otherwise Specified in the DSM-IV-TR,
| |
| | multiple behavioral and substance
|
| (2000) includes: distress about a pattern
| |
| | addictions.
|
| of repeated sexual relationships
| |
| | Since chronic lifestyle diseases and
|
| involving a succession of lovers who are
| |
| | disorders such as diabetes, hypertension,
|
| experienced by an individual only as
| |
| | alcoholism, drug and behavioral
|
| things to be used. (It should be noted
| |
| | addictions cannot be cured, but only
|
| that the Diagnostic and Statistical
| |
| | managed - how should we effectively
|
| Manual of Mental Disorders has never used
| |
| | manage poly-behavioral addiction?
|
| the word "addiction" to describe any of
| |
| | The Addiction Recovery Measurement System
|
| its disorders).
| |
| | (ARMS) is proposed utilizing a
|
| The defining elements of this kind of
| |
| | multidimensional integrative assessment,
|
| addiction are its secrecy and escalating
| |
| | treatment planning, treatment progress,
|
| nature, often resulting in diminished
| |
| | and treatment outcome measurement
|
| judgment and self-control (Carnes, 1994).
| |
| | tracking system that facilitates rapid
|
| Brief History of Sex Addiction
| |
| | and accurate recognition and evaluation
|
| In 1976, a suburban hospital
| |
| | of an individual's comprehensive
|
| administrator asked Dr. Patrick Carnes to
| |
| | life-functioning progress dimensions.
|
| start an experimental program for
| |
| | The ARMS hypothesis purports that there
|
| chemically dependent families. The
| |
| | is a multidimensional synergistically
|
| theoretical constructs of the program
| |
| | negative resistance that individual's
|
| originated in general systems theory,
| |
| | develop to any one form of treatment to a
|
| especially as it applied to families and
| |
| | single dimension of their lives, because
|
| the 12-steps of Alcoholics Anonymous.
| |
| | the effects of an individual's addiction
|
| One of the many factors which stood out
| |
| | have dynamically interacted
|
| from a family perspective was that the
| |
| | multi-dimensionally. Having the primary
|
| addictive compulsivity had many forms
| |
| | focus on one dimension is insufficient.
|
| other than alcohol and drug abuse
| |
| | Traditionally, addiction treatment
|
| including overeating, gambling,
| |
| | programs have failed to accommodate for
|
| shoplifting, and sexuality. Members of
| |
| | the multidimensional synergistically
|
| groups like Overeaters Anonymous and
| |
| | negative effects of an individual having
|
| Gamblers Anonymous had already pioneered
| |
| | multiple addictions, (e.g. nicotine,
|
| in applying the 12-steps to other
| |
| | alcohol, and obesity, etc.). Behavioral
|
| addictions so the Family Renewal Center
| |
| | addictions interact negatively with each
|
| extended its programming based on the
| |
| | other and with strategies to improve
|
| 12-steps, to sexual addiction.
| |
| | overall functioning. They tend to
|
| In 1983, Dr. Patrick Carnes formally
| |
| | encourage the use of tobacco, alcohol and
|
| introduced the concept of sexual
| |
| | other drugs, help increase violence,
|
| addiction to the world in a text entitled
| |
| | decrease functional capacity, and promote
|
| "Out of the Shadows." Since then the
| |
| | social isolation. Most treatment
|
| field of sexual addiction and compulsive
| |
| | theories today involve assessing other
|
| sexual behavior has developed
| |
| | dimensions to identify dual diagnosis or
|
| dramatically. Terms such as addiction,
| |
| | co-morbidity diagnoses, or to assess
|
| compulsivity, hyper-sexuality, and "Don
| |
| | contributing factors that may play a role
|
| Juanism," all have been used to describe
| |
| | in the individual's primary addiction.
|
| what generically could be called "out of
| |
| | The ARMS' theory proclaims that a
|
| control sexual behavior." Regardless of
| |
| | multidimensional treatment plan must be
|
| its name, clinicians from all fields
| |
| | devised addressing the possible multiple
|
| agree that a syndrome exists in which
| |
| | addictions identified for each one of an
|
| individuals have a sense that they have
| |
| | individual's life dimensions in addition
|
| lost control over their sexual behavior.
| |
| | to developing specific goals and
|
| According to the Society for the
| |
| | objectives for each dimension.
|
| Advancement of Sexual Health (SASH),
| |
| | Partnerships and coordination among
|
| sexual addiction is a persistent and
| |
| | service providers, government
|
| escalating pattern or patterns of sexual
| |
| | departments, and community organizations
|
| behaviors acted out despite increasingly
| |
| | in providing addiction treatment programs
|
| negative consequences to self or others.
| |
| | are a necessity in addressing the
|
| The fundamental nature of all addiction
| |
| | multi-task solution to poly-behavioral
|
| is the addicts' experience of
| |
| | addiction. I encourage you to support
|
| helplessness and powerlessness over an
| |
| | the addiction programs in America, and
|
| obsessive-compulsive behavior, resulting
| |
| | hope that the (ARMS) resources can assist
|
| in their lives becoming unmanageable.
| |
| | you to personally fight the War on
|
| The addict may be out of control. They
| |
| | poly-behavioral addiction.
|
| may experience extreme emotional pain and
| |
| | For more info see:
|
| shame. They may repeatedly fail to
| |
| | Poly-Behavioral Addiction and the
|
| control their behavior. They may suffer
| |
| | Addictions Recovery Measurement System
|
| one or more of the following consequences
| |
| | (ARMS)
|
| of an unmanageable lifestyle: a
| |
| | By James Slobodzien, Psy.D. CSAC at:
|
| deterioration of some or all supportive
| |
| | National Council on Sexual Addiction &
|
| relationships; difficulties with work,
| |
| | Compulsivity
|
| financial troubles; and physical, mental,
| |
| | P.O. Box 725544
|
| and/ or emotional exhaustion which
| |
| | Atlanta, GA 31139
|
| sometimes leads to psychiatric problems
| |
| | (770) 541-9912
|
| and hospitalization. Addictions tend to
| |
| | Sexual Addiction Resources
|
| arise from the same backgrounds: families
| |
| | James Slobodzien, Psy.D. CSAC, is a
|
| with co-dependency including multiple
| |
| | Hawaii licensed psychologist and
|
| addictions; lack of effective parenting;
| |
| | certified substance abuse counselor who
|
| and other forms of physical, emotional
| |
| | earned his doctorate in Clinical
|
| and sexual trauma in childhood.
| |
| | Psychology. The National Registry of
|
| The Society for the Advancement of Sexual
| |
| | Health Service Providers in Psychology
|
| Health (SASH, 2005) report that the
| |
| | credentials Dr. Slobodzien. He has over
|
| symptoms of sexual compulsivity often
| |
| | 20-years of mental health experience
|
| accompany other addictive behaviors:
| |
| | primarily working in the fields of
|
| Alcohol and Drug Addiction - Alcohol and
| |
| | alcohol/ substance abuse and behavioral
|
| drugs alter libido, enhancing it early in
| |
| | addictions in medical, correctional, and
|
| drug addiction and inhibiting it later.
| |
| | judicial settings. He is an adjunct
|
| There is a pattern in cocaine addiction
| |
| | professor of Psychology and also
|
| of selling sexual favors for cocaine. As
| |
| | maintains a private practice as a mental
|
| the cost of drug addiction increases, the
| |
| | health consultant.
|
| drug addict usually can't afford the drug
| |
| | References
|
| from ordinary job income, and must resort
| |
| | American Psychiatric Association:
|
| to (either/or) stealing, drug dealing or
| |
| | Diagnostic and Statistical Manual of
|
| prostitution to support their habit.
| |
| | Mental Disorders, Fourth Edition,
|
| Alcohol and many drugs cause blackouts or
| |
| | Text Revision. Washington, DC, American
|
| amnesia during the drug using experience,
| |
| | Psychiatric Association, 2000, p. 787 &
|
| and if sex is coupled with that drug
| |
| | p. 731.
|
| using experience then the details of the
| |
| | American Society of Addiction Medicine's
|
| sexual experience may not be remembered.
| |
| | (2003), "Patient Placement Criteria for
|
| Food Addiction - Sexual anorexia or
| |
| | the
|
| pathological self-denial of healthy sex
| |
| | Treatment of Substance-Related Disorders,
|
| is a frequent accompaniment of overeating
| |
| | 3rd Edition, Retrieved, June 18, 2005,
|
| and anorexia nervosa.
| |
| | from:
|
| Pathological Gambling - The lifestyle of
| |
| | Arthur Aron, Ph.D., professor,
|
| the gambler often includes
| |
| | psychology, State University of New York,
|
| hyper-sexuality, where both compulsions
| |
| | Stony Brook; Helen
|
| feed the false sense of self-esteem of
| |
| | Fisher, research professor, department of
|
| the addict.
| |
| | anthropology, Rutgers University, New
|
| Religious Addiction - Compulsive
| |
| | Brunswick, N.J.;
|
| religiosity sometimes accompanies sexual
| |
| | Paul Sanberg, Ph.D.,professor,
|
| addiction as the sex addict is seeking
| |
| | neuroscience, and director, Center of
|
| religion to lessen guilt and shame. The
| |
| | Excellence for Aging and
|
| beginnings of compulsive religiosity may
| |
| | Brain Repair,University of South Florida
|
| signal the onset of a period of sexual
| |
| | College of Medicine, Tampa; June 2005,
|
| anorexia.
| |
| | the Journal of
|
| Multiple Addictions
| |
| | Neurophysiology
|
| Since it is impossible to expect
| |
| | Carnes, P.J. (1983). Out of the Shadows:
|
| treatment for one addiction to be
| |
| | Understanding Sexual Addiction.
|
| beneficial when other addictions
| |
| | Minneapolis, MN: Compcare.
|
| co-exist, the initial therapeutic
| |
| | Carnes, P.J. (1989). Contrary to Love:
|
| intervention for any addiction needs to
| |
| | Helping the Sexual Addict. Minneapolis,
|
| include an assessment for other
| |
| | MN: Compcare.
|
| addictions. National surveys revealed
| |
| | Carnes, P.J. (1991). Don't Call it Love.
|
| that a very high correlation exists
| |
| | Minneapolis, MN: Gentle Press Publishing.
|
| between sexual addiction and other
| |
| | Carnes, P.J. (1997). Sexual Anorexia:
|
| substance abuse and behavioral
| |
| | Overcoming Sexual Self-hatred. Center
|
| addictions. Sexual addicts who have
| |
| | City, MN: Hazelden.
|
| reported experiencing multiple addictions
| |
| | Carnes, P.J., & Delmonico, D.L. (1994).
|
| include sexual addiction and:
| |
| | Sexual Dependency Inventory. Wickenburg,
|
| § Chemical dependency (42%)
| |
| | AZ: The Meadows Institute.
|
| § Eating disorder (38%)
| |
| | Carnes, P.J., Delmonico, D.L., & Griffin,
|
| § Compulsive working (28%)
| |
| | E. J. (2001). In the Shadows of the Net:
|
| § Compulsive spending (26%)
| |
| | Breaking Free of
|
| § Compulsive gambling (5%)
| |
| | Compulsive Online Sexual Behavior. Center
|
| Poor Prognosis
| |
| | City, MN: Hazelden.
|
| We have come to realize today more than
| |
| | Delmonico, D.L. (1997). Internet Sex
|
| any other time in history that the
| |
| | Screening Test. [Online]. Available at:
|
| treatment of lifestyle diseases and
| |
| | Delmonico, D.L., Griffin, E.J., &
|
| addictions are often a difficult and
| |
| | Moriarity, J. (2001). Cybersex Unhooked:
|
| frustrating task for all concerned.
| |
| | A Workbook for Breaking Free From Online
|
| Repeated failures abound with all of the
| |
| | Compulsive Sexual Behavior. Wickenburg,
|
| addictions, even with utilizing the most
| |
| | AZ: Gentle Path Press.
|
| effective treatment strategies. But why
| |
| | Gorski, T. (2001), Relapse Prevention In
|
| do 47% of patients treated in private
| |
| | The Managed Care Environment.
|
| addiction treatment programs (for
| |
| | GORSKI-CENAPS Web
|
| example) relapse within the first year
| |
| | Publications. Retrieved June 20, 2005,
|
| following treatment (Gorski, T., 2001)?
| |
| | from:
|
| Have addiction specialists become
| |
| | Lienard, J. & Vamecq, J. (2004), Presse
|
| conditioned to accept failure as the
| |
| | Med, Oct 23;33(18 Suppl):33-40.
|
| norm? There are many reasons for this
| |
| | Marlatt, G. A. (1985). Relapse
|
| poor prognosis. Some would proclaim that
| |
| | prevention: Theoretical rationale and
|
| addictions are psychosomatically- induced
| |
| | overview of the model. In G. A.
|
| and maintained in a semi-balanced force
| |
| | Marlatt & J. R. Gordon (Eds.), Relapse
|
| field of driving and restraining
| |
| | prevention (pp. 250-280). New York:
|
| multidimensional forces. Others would
| |
| | Guilford Press.
|
| say that failures are due simply to a
| |
| | Schneider, J.P. (1994). Sex addiction:
|
| lack of self-motivation or will power.
| |
| | Controversy within mainstream addiction
|
| Most would agree that lifestyle
| |
| | medicine, diagnosis based on the
|
| behavioral addictions are serious health
| |
| | DSV-III-R and physician case histories.
|
| risks that deserve our attention, but
| |
| | Sexual Addiction & Compulsivity: Journal
|
| could it possibly be that patients with
| |
| | of Treatment and Prevention, 1(1), 19-44.
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| multiple addictions are being under
| |
| | Slobodzien, J. (2005). Poly-behavioral
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| diagnosed (with a single dependence)
| |
| | Addiction and the Addictions Recovery
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| simply due to a lack of diagnostic tools
| |
| | Measurement System (ARMS),
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| and resources that are incapable of
| |
| | Booklocker.com, Inc., p. 5.
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