Jerold J. Block, M.D., Oregon Health & Science University: A compulsive-impulsive spectrum disorder Called for inclusion in DSM-V Three subtypes 1.Excessive gaming 2.Sexual preoccupation 3.Email/text messaging Four components: 1.Excessive use 2.Withdrawal 3.Tolerance 4.Negative repercussions
Maressa Hecht Orzack, Ph.D., McLean Hospital Names this phenomenon: Computer Addiction, Internet Addiction, or Cyberaddiction Lists the following psychological symptoms 1.Sense of well-being or euphoria 2.Inability to stop activity
3.Craving more and more time at the computer 4.Neglect of family and friends 5.Feeling empty, depressed, irritable when not at the computer 6.Lying to employers and family about activities 7.Problems with school or work
Kimberly S. Young, Ph.D., Center for Internet Addiction Recovery, defines internet addiction as: “any online-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. She lists the following types: 1.Cybersex and cyberporn 2.Online affairs
Dr. Young (continued) 3.Online gambling 4.Online gaming 5.Compulsive surfing 6.eBay addiction
Dr. Young (continued) Eight key symptoms: 1.Preoccupation 2.Increased use 3.Inability to stop 4.Withdrawal symptoms 5.Lost sense of time 6.Risky behaviors 7.Lies 8.Escape to the internet
The “Triple A Engine” 1.Accessible 2.Affordable 3.Anonymous
“The internet is a perfect drug delivery system:” ◦ Available 24/7, anywhere there is a computer with internet; ◦ Anonymous – assumed, privacy of one’s own space; ◦ Affordable – free or relatively low cost;
◦ Role model – visual modeling of sexual acts performed by eroticized sexual actors; ◦ Memory – visual images, sensate and affect that the brain does not forget; ◦ Arousal - sexual stimulation resulting in arousal, leading to masturbation and reinforced by orgasm; and ◦ Somatic effects – arousal and orgasm results in release of oxytocin from the pituitary gland, under the control of the endorphin system.
Signs of Sexual Addiction Carnes (1991) A pattern of out-of-control sexual behavior Severe consequences due to sexual behavior Inability to stop despite adverse consequences
Persistent pursuit of self-destructive or high-risk behavior Sexual obsession and fantasy as a primary copy strategy Increasing amounts of sexual experience because the current level of activity is no longer sufficient Severe mood changes around sexual activity Inordinate amounts of time spent obtaining sex, being sexual, or recovering from sexual experience Neglect of important social, occupational, or recreational activities because of sexual behavior
Treatment Issues: (Delmonico, Griffin, Carnes, 2002) Multi-faceted approach First Order Change: 1.Reduce access to internet 2.Raise awareness (cognitive distortions, denial, minimization, rationalization, etc.)
Treatment issues (continued) Second Order Change: 1.Attack the appeal 2.Treat co-morbid conditions 3.Include the family 4.Couple therapy 5.Address social isolation 6.Collateral issues 7.Promote healthy sexuality
High-Risk Situation No CopingCopingResponse Decreased Self-Efficacy &Increased Pos. Outcome ExpectanciesSelf-efficacy Lapse Abstinence Violation EffectDecreased Probability Increased ProbabilityOf Of RelapseRelapse
1. Recognize chain of events leading to addictive behavior. 2. Learn how to interrupt the chain of events leading to addictive behavior. 3. Learn coping skills. 4. Develop problem-solving & Self-control skills. 5. Learn decision making & coping with urges. 6. Develop early antecedent interventions. 7. Minimize the extent of relapse 8. Practice
Steps Avoiding lapse 1. Awareness of precedents of high risk situations and warning oneself. 2. Develop specific avoidance strategies 3. Develop coping skills ◦ Assertiveness ◦ Communication ◦ Problem-solving ◦ Anger management ◦ Relaxation techniques
4. Develop urge-coping techniques ◦ Aversion methods ◦ Support system ◦ Substitute behaviors Minimizing Lapse 1. Awareness when in danger 2. Contract for performing or abstaining from specific behavior 3. Protecting activities 4. Awareness of relapse possibility
High Risk Situations Describe past relapses Describe relapse fantasies Identify internal (thoughts, feelings, sensations) and external (situational, interpersonal) cues that “trigger” relapse Develop self-monitoring techniques Develop behavior assessment skills
No Coping Response Skill training ◦ Relaxation training ◦ Stress management ◦ Conflict resolution ◦ Problem-solving Relapse rehearsal ◦ Efficacy enhancing imagery
Lapse Contract to limit addictive behavior Reminder cards What to do when you have a slip Programmed Relapse
Sex Addiction Recovery Groups SA Sexaholics Anonymous (www.sa.org)www.sa.org SAA Sex Addicts Anonymous (www.saa-recovery.org)www.saa-recovery.org SCA Sexual Compulsive Anonymous (www.sca-recovery.org)www.sca-recovery.org SLAA Sex and Love Addicts Anonymous (www.slaafws.org)www.slaafws.org SRA Sexual Recovery Anonymous (www.sexualrecovery.org)www.sexualrecovery.org
1. Addiction is a disease. 2. Individuals with an addiction require support from other recovering, addicted members. 3. Reliance on a “power greater than self” is necessary for recovery. 4. Abstinence from the addicted behavior is the foundation of recovery.
5. Recovery is a life-long process 6. Helping other addicted people is essential to long-term stable abstinence from addicted behavior. 7. Acceptance of the realistic limits of being human is imperative.
Step one: We admitted we were powerless over addicted behavior – that our lives had become unmanageable. Step two: Came to believe that a Power greater that ourselves could restore us to sanity. Step three: Made a decision to turn our will and our lives over to the care of God, as we understood God.
Step four: Made a searching and fearless moral inventory of ourselves. Step five: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. Step six: Were entirely ready to have God remove all these defects of character.
Step seven: Humbly asked God to remove our shortcomings. Step eight: Made a list of all persons we had harmed and became willing to make amends to them all. Step nine: Made direct amends to such people wherever possible, except when to do so would injure them or others.
Step ten: Continued to take personal inventory, and when we were wrong promptly admitted it. Step eleven: Sought through prayer and meditation to improve our conscious contact with God’s will for us and the power to carry that out. Step twelve: Having had a spiritual awakening as the result of these steps, we tried to carry this message to addicts and to practice these principles in all our affairs.