Sex Addiction Assessment

 

Marie Wilson, MA and

Patrick J. Carnes, Ph.D., CAS

The following are some of the extreme examples we see today that exemplify the insanity of sexual addiction:

The signs of addiction. Some would say these cases are matters of sexual excess, bad judgment, or accidents. Others would dismiss them as bizarre or perverted. In reality, they represent a much more serious problem: a life-threatening obsession with sex. Such people are sex addicts. The patterns of their lives signify the presence of an illness we are now beginning to understand.

These cases of sexual addiction all present situations of an obvious loss of control. But many times therapists experience situations that are less clear. For example, the therapist may have little data. Or the addiction may be obscured by convoluted marriages or job situations. Or the addict may simply have dodged successfully all the consequences so far. Also, clients may deliberately deceive the therapist. Sometimes spouses will collude in that deception, although they may still want help desperately.

Sexual Addiction Defined

We are surrounded by the signs of sex addiction yet still resist its reality.
We can accept that people can be sick with alcoholism or can destroy themselves with gambling or food, but not sex. A comparison with other forms of addiction offers a fundamental foundation for understanding the key concepts of this compulsive sexual disorder. An alcoholic or chemically addicted person is said to have a pathological relationship with a mood-altering substance.

The addicted individual’s relationship with the substance becomes primary and, with continued use, impacts the person’s psychological adjustment, economic functioning, and social and family relationships. This relationship between person and substance progresses to the point where alcohol is necessary to feel normal. This progression leads to isolation since the primary relationship is with a substance, not with other people. Distortions in thinking, especially denial become part of how the addict keeps painful feelings and associations related to substance abuse at a distance.
Sexual addiction is similar. Sex addicts use sex in the same way an alcoholic uses alcohol. In other words, sex is used to numb feelings and escape from the painful parts of their lives. The sex addict substitutes a sick relationship for a healthy relationship with others. The sexual experience becomes mood altering and in time becomes central to the sex addict’s life. Leading a fantasy double life is a distortion of reality and separates the individual from those who love and care about them. The fact that the addict has no control over their behavior is a difficult concept for non-addicts to grasp. This is particularly so with regards to sex addiction and in view of the many damaged relationships, ruined marriages, parentless children, and even worse, victims of sexual misconduct or crimes. There is little neutral response to sexual improprieties.
One assumption often made incorrectly, is that addiction to drugs or alcohol decreases inhibition and therefore causes or is substituted for sex addiction. The truth is that alcoholism is a concurrent illness and not the cause of sex addiction. Treatment centers that miss the diagnosis of sex addiction may unintentionally contribute to relapse and to the recidivism factor of alcoholism and drug addiction.

The Making of a Sex Addict

In a study of more than a thousand recovering sex addicts and their partners, research determined that sex addicts tend to come from families where there were addictions of all kinds. For example, mothers (25%), fathers (38%), and siblings (46%) had significant alcohol problems. Mothers (18%), fathers (38%) and siblings (50%) had problems with sexual acting out. Parallel patterns existed with eating disorders, compulsive financial disorders, pathological gambling, and compulsive work. Only 13% of sex addicts reported coming from families with no other addictions.

Family type was also a factor. Sex addicts in this study experienced their families as rigid (77 %), defined as autocratic, dogmatic, and inflexible. Clinically, therefore, sex addicts will have difficulty with limit setting and accountability due to this experience, since accountability means loss of self. For them to comply with such rigidity meant they could not be different in any way. Many sex addicts experienced their families to be disengaged (87%), defined as detached, uninvolved, and emotionally absent. Failure to bond was a norm in these families. So, in part, their addiction stemmed from their search for nurturing without the risk of intimacy or trust. More than 68% of these families of origin were both rigid and disengaged. Therefore, the high probability in treatment is their difficulty with both accountability and trust.

Another major area of impact was the role of child abuse. Addicts reported physical abuse (72%), sexual abuse (81%). and emotional abuse (97%). In addition, the more sexually and physically abused the respondents were as children, the more types of addictions they had as adults. Emotional abuse was a significant factor in addicts who abused children themselves. It is clear that for sex addicts trauma and addiction are inextricably connected.

The Ten Types of Sexual Addiction

In the original research we did for Don’t Call It Love we started with a database of 114 behaviors in which we did a factor analysis. A series of “types” or “constellations” of sexually compulsive behavior emerged in the sex addicts surveyed. Over the years, we have elaborated the ten types as an empirically based model of compulsive sexual behavior. What follows is a review of the ten types.

Fantasy Sex – Notice attractive traits in others and will feel attracted, but they do not move beyond it. There is a safety in staying in the fantasy world as opposed to acting on the fantasy. Romance and sex can flourish when there is no reality testing. The person often becomes lost in sexual obsession and intrigue, including behaviors that support preoccupation.

 

Masturbation to fantasies is how we learn about our own desire. When masturbation becomes compulsive, we make it a way to escape our loneliness. It is about fear of rejection, fear of reality, and reduction of anxiety. It can also be self indulgent in the sense of seeking comfort as opposed to risking relationship. Many sex addicts find refuge in fantasy sex because other forms of acting out are simply too complicated, too risky, or too much effort. Fantasy sex is a way to disassociate from reality including relationships.

Voyeurism – Voyeurs are also non-participants in the sex game. They move beyond fantasy to searching out sexual objects in the real world. It is normal to enjoy looking at others sexually. When that means looking at people who do not know they are being viewed it becomes problematic. When it is about compulsive pornography use it becomes isolating. Voyeurs also venture into flirtation. Sitting in a strip bar and having someone do a table dance for you focusing on another’s sexual demonstration behavior without the voyeur doing anything. To put it in childhood terms, you show me yours and I’ll watch. Usually voyeurism means objectifying the other person so it is not a personal relationship.

Exhibitionism – Exhibitionism is the “I will show you mine” part. It is pleasurable and normal to have others notice you sexually. With a partner it is a significant part of sex play. Some addicts fixate on just being noticed and have difficulty moving beyond that. Eroticism for them is being looked at. For some it is the power of realizing they have captured the other’s attention. For some it is forcing their sexuality on the other, which is angry and aggressive.

From a relationship perspective it is introducing oneself in an inappropriate way. Or seeking attention from others with no intent of going further, which is to tease. Sometimes it is about the pleasure of breaking the rules. When it is obsessional and compulsive, it is a significant distortion of normal courtship.

Seductive Role Sex – Here relationships are about power and conquest. Flirtation, performance, and romance are the erotic keys for sex addicts in this category. They are hooked on falling in love and winning the attention of the other. Often once they have established that, the sexual interest subsides. While they can quickly gain the confidence of others, and can be intimate in the early discovery, romantic stage, establishing a deeper relationship eludes them. They are on the hunt for another.

Another common scenario is to feel trapped like they cannot be themselves. So they have multiple relationships in which they can be different with different people. They have a hard time being themselves or individuating. Often there is a fear of abandonment so having more than one relationship is a way to prevent the hurt they are sure they will receive. They are crippled in their ability to form lasting bonds and enduring relationships.

Trading Sex – Some sex workers actually do form some attachment for their clients but typically bartering sex for money is devoid of relationship. The goal is to simulate flirtation, demonstration, and romance. What actually happens in most cases is about replication of childhood sexual abuse in which the child gained power in a risky game of being sexual with the caregiver. If a prostitute is a sex addict, meaning that they found sex more pleasurable with clients than in personal relationships and are “hooked on the life,” it represents a significant distortion of normal courtship. Often the money is a sign of having been successful at the sexual “game” and the client can be disregarded except as a repeat customer. Forging significant, enduring bonds or being true to yourself as in individuation is not part of the game.

Intrusive Sex – People who do intrusive sex such as touching people in crowds or making obscene calls are really perverting the touching and foreplay dimensions of courtship. In most cases they are using others for sexual arousal with little chance of being caught. Their behavior represents both intimacy failure and individuation difficulties. In their behavior they do not see themselves as predatory although they are. An implicit anger exists and they “steal” sex because they believe no one would respond as they wish. So the goal is to take it without the other’s knowledge. They become quite expert in their subterfuge.

For example professionals such as physicians, clergy, or attorney’s will look quite compassionate when in fact they use their clients’ vulnerability for their own arousal. Stolen intrusion becomes the obsession. On-going relationship life suffers because of the secret shame.

Paying for Sex – Here sex addicts are willing participants in simulated intimacy. They are focused however on the touching, foreplay, and intercourse dimensions without the hassle of relationship. Frequently they tell themselves it is because of their partner’s inadequacies that they resort to prostitution. Compulsive prostitution is a larger problem but it does reflect relationship failure. Often times the failure is about the sex addict’s inability to communicate feelings to their partner or to be willing to work on their own attractiveness behaviors. For some sex is intimacy – or as close as they will allow themselves to be.

Frequently there is sexual anorexia in that it is difficult to be aroused in the presence of someone for whom you care. Commitment to and renewal of relationships are profoundly undermined by the secret life of this behavior.

Anonymous Sex – By definition, this sexual behavior is not about relationship. You do not have to attract, seduce, trick, or even pay for sex. It is compulsive sex, often in high-risk circumstances with people one does not know. Ironically the sexual anorexia counterpart is often also present with the associated loneliness and isolation. Frequently for sex addicts, part of the high is the risk of unknown persons and situations. In part, that stems from early sexual relationships that were fearful. Having to experience fear in order for arousal or sexual initiation to work fundamentally distorts the courtship process. The safety of enduring bond is never there to allow the deeper, profound risks of being known by another.

Pain Exchange Sex – People who are compulsively into painful, degrading, or dangerous sexual practices such as “blood sports” (creating wounds which bleed as part of sex) or asphyxiation, often have significant distortions of courtship. Specifically touching, foreplay, and intercourse become subordinated to some dramatic story line that usually is a reenactment of a childhood abuse experience. For a woman to be aroused only if a man is hurting her is a distortion of what goes into sexual and relationship health. Enduring relationships are difficult to build given the arousal scenarios embedded in high-risk sex.

Exploitive Sex – To exploit the vulnerable is clearly distorted courtship. With sex offenders who rape there exists deep issues around intimacy and anger. Less obvious are non-violent predators that use seduction, as with children or professional sexual misconduct with clients. In the workplace where there is a differential of power, employees can be exploited.

Assessing Sex Addiction

Criteria for assessing sex addiction closely parallels guidelines for assessing substance abuse, alcoholism, and compulsive gambling. On the basis of research and clinical experience, there are ten signs that indicate the presence of sexual addiction. A minimum of three criteria must be met; however, most addicts have five, and over half, have seven or more.

  1. Recurrent failure to resist sexual impulses in order to engage in specific sexual behaviors. Addicts can even see that they are endangering their life and yet they persist in their sexual patterns. Many non-addicts are capable of abusing their sexuality at times, going through periods of sexual excess or making mistakes, but ultimately regaining control. Sex addicts are incapable of permanently making that adjustment by themselves. Addicts will often go to extremes to limit or resist their sexual activity. They make promises to stop and never can. They convince themselves that if they can change some of the external circumstances, this will, in turn, control their behavior. They are unaware that the only way to change their behavior is the desire to change from within, which requires intervention and treatment.
  2. Frequently engaging in those behaviors to a greater extent, or over a longer period of time than intended. Frequently sex addicts lose track of time when they are engaged in their addiction. Hours may pass with little recognition of the outside world or other obligations in their lives.
  3. Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors.
    Sex addicts entering treatment have all tried, unsuccessfully, to stop sexual behaviors with a "white knuckling" approach. Since underlying causes of the behaviors are not dealt with, the addict cannot sustain the control and fails, only reinforcing shameful feelings about self and hopelessness.
  4. Inordinate amounts of time spent in obtaining sex, being sexual or recovering from sexual experiences. For sex addicts, sexual obsession becomes the organizing principle of daily life. Everything revolves around this. The basics of living such as clothes, food, sleep and work become a lower priority. Most of the addict’s time is devoted to initiating sex, being sexual or dealing with the aftermath. There is an extraordinary amount of time spent on the addiction.

In addition, another source of lost time is the time spent dealing with the consequences. Lies have to be covered. Upset and exploited lovers need to be calmed down. Money shortages have to be faced and diseases dealt with. Outraged spouses, disappointed bosses, neglected children and arresting officials all take time. Further subterfuges are required to prevent more discoveries. Addicts become even more depleted by these problems and then attempt to restore or reward themselves with sexual behavior.

  1. Preoccupation with sexual behavior or preparatory activities. Planning, thinking, searching, intriguing, and looking for opportunity becomes a way to get through each day. Sex addicts can easily escape into an altered state simply through obsession and fantasy. For days on end, sex addicts may spend most of their time in a sexual stupor. This becomes a primary tool to help them regulate their emotional life. Sex addicts become dependent upon it to the point that sex is no longer a choice or an option, but rather a coping mechanism that is connected with survival.
  2. Frequently engaging in the behavior when expected to fulfill occupational, academic, domestic or social obligations. Family, friends, and work obligations are all subordinated to the pursuit of sex. Promises are made and broken again and again, damaging the trust that others have in the addicted person. Often relationships that have meaning are neglected in favor of less personal ones or relationships that have sexual potential. Pursuit of educational or career opportunities become sidetracked as volition decreases and is substituted for what seems effortless and easy. The addict wants no distractions from the energy required for sexual fantasies and sexual pursuits.
  3. Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior. Despite the multitude of adverse consequences of their addiction, sex addicts simply cannot contain or control their behaviors, except for very brief periods of time. Sex addiction is a pervasive illness that touches every aspect of the addict’s life, creating chaos and causing damage to anything or anyone in its path. The losses associated with sex addiction are accumulative and just increase over time. Sex addicts lose family, friends, financial resources, health, self-esteem and a connection to a Higher Power. They experiences arrests, humiliation, risk discovery and sexually transmitted diseases, yet still persist.

In a survey we found a seemingly unending array of ways that sex addicts harm themselves and others: The majority of sex addicts say they routinely run the risk of venereal disease. Many have lost a partner or spouse and most have experienced severe marital or relationship problems. Some have lost the rights to their children. Women sex addicts report deep grief over abortions and unwanted pregnancies. Some reported losing the opportunity to work in the career of their choice. A majority have routinely pursued activities for which they could be arrested.

  1. The need to increase the intensity, frequency, number, or risk level of behaviors in order to achieve the desired effect; or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk. Often sexual behaviors escalate over time because the sexual fix becomes more difficult to obtain without increasing effort. This is similar to the alcoholic who at one time felt intoxicated with four beers and whose tolerance has increased to needing at least six beers in order to experience the same effects. In sex addiction, an addict may go through periods of excessive control before eventually returning to or going beyond old levels.
  2. Giving up or limiting social, occupational, or recreational activities because of the behavior. Any activity that interferes with the sex addict’s pursuit of their addiction is given up in favor of activities that feed the addiction. Remember that the planning, implementation and consequences of the addiction are all very time consuming, forcing the addict to give up other life activities. Even activities that were once a source of pleasure or relaxation such as spending time with friends, exercising, fishing, family functions, etc. are now looked upon as interference with the addiction.
  3. Distress, anxiety, restlessness, or irritability if unable to engage in the behavior.
    Sex addicts experience withdrawal from compulsive sexual activities in a similar way that the alcoholic or drug addict experiences withdrawal from chemicals. All compulsive addictive behaviors are mood altering and when mood-altering activities are stopped, there is often an acute, related reaction. No longer able to decrease pain with sex, the addict plunges into despair. Sex addicts report symptoms that absolutely parallel the withdrawal experience of cocaine addiction. Sex addicts have reported these withdrawal symptoms: dizziness, body aches, headaches, sleeplessness, restlessness, anxiety, mood swings, irritability, depression.

Many addicts who have recovered from both a chemical addiction and sex addiction say that recovery from sex addiction was more difficult. They generally agree that while the initial physical symptoms are less severe, the withdrawal experience is more prolonged and more painful.

Collateral Indicators of Sexual Addiction

In addiction, there are 20 collateral indicators, which assist in the assessment of sexual addiction. A minimum of 10 criteria must be met:
1. Patient has severe consequences because of sexual behavior.
2. Patient meets the criteria for depression and it appears related to sexual acting out.
3. Patient meets the criteria for depression and it appears related to sexual aversion.
4. Patient reports history of sexual abuse.
5. Patient reports history of physical abuse.
6. Patient reports emotional abuse.
7. Patient describes sexual life in self-medicating terms (intoxicating, tension-relief, pain-reliever, sleep aid).
8. Patient reports persistent pursuit of high risk or self-destructive behavior.
9. Patient reports sexual arousal for high risk or self-destructive behavior is extremely high compared to safe sexual behavior.
10. Patient meets diagnostic criteria for other addictive disorders.
11. Patient simultaneously uses sexual behavior in concert with other addictions (gambling, eating disorders, substance abuse, alcoholism, compulsive spending) to the extent that desired effect is not achieved without sexual activity and other addiction present.
12. Patient has history of deception around sexual behavior.
13. Patient reports other members of the family are addicts.
14. Patient expresses extreme self-loathing because of sexual behavior.
15. Patient has few intimate relationships that are not sexual.
16. Patient is in crisis because of sexual matters.
17. Patient has history of crisis around sexual matters.
18. Patient experiences anhedonia in the form of diminished pleasure for same experiences.
19. Patient comes from a "rigid" family.
20. Patient comes from a "disengaged" family.

The Sexual Addiction Screening Test (SAST)

A wealth of literature exists on the usefulness of screening instruments to assist in diagnosing alcoholism. Historically, these instruments have proved valuable as adjuncts to the therapist’s assessment process. This kind of tool has been developed for sex addiction, called the Sexual Addiction Screening Test or SAST. Developed in conjunction with hospitals, treatment programs, private therapists, and community groups, the SAST provides a profile of responses which help to discriminate between addictive and non-addictive behavior. To complete the test, patients are asked to answer a total of 25 questions by placing a check in the appropriate yes or no column. The SASTs are available free on Dr. Carnes’ website located at www.sexhelp.com.

The Sexual Dependency Inventory (SDI)

A comprehensive online test is now available that measures all aspects of sexual addiction.  It gives a complete sexual history (without names of course), shows what kinds of things are arousing, what types of behavior are currently being manifested, what makes them appealing, what motivations there are for treatment, what other addictive behaviors are active or at risk, and it shows several measures of how honest the respondent is being with himself and in filling out the test. With a print-out of some 35 pages for the test-taker, it also gives homework assignments to transform the test into a learning experience. This test costs $100, and it can be done anytime by contacting your CSAT counselor, who will be happy to answer further questions about this instrument.

Resources and Guidelines

There are some important guidelines to remember in doing assessments. First, be aware that there are women sex addicts. A tendency exists to see this as only a male problem. For every three male sex addicts, there is one woman. This ratio of men to women is an exact parallel to the gender ratios found in compulsive gambling and alcoholism.
Second, sex addiction is seldom isolated. More that 83 percent of addicts report multiple addictions. The DSM-IV does not include sex addiction under substance-related disorders, but rather in a separate category called Sexual and Gender Identity Disorders. There is however, cause to examine sex addiction from an addiction perspective given that more than 83% of sex addicts report multiple addictions, including chemical dependency (42%), eating disorders (38%), compulsive working (28%), compulsive spending (26%), and compulsive gambling (5%). Studies of alcoholism treatment find sexual compulsion in patients, ranging from 42 to 73 percent.

Third, sex offenders can also be sex addicts. Our data show that serious sex offenses occur in only 13 percent of the cases of the general population of sex addicts. However, a number of studies used sexual addiction criteria to identify sex addicts in groups of sex offenders. The results ranged from 55 percent to 100 percent of the population studied. Often, the compulsive behavior of sex offenders includes non-offending behavior as well.
Fourth, about 72 percent of sex addicts also evidence symptoms of sexual aversion-desire disorder, or as it is sometimes called, “sexual anorexia.” Similar to those with eating disorders, patients will flip from being out of control into a super “in-control” period. Or there will be a binge/purge pattern. Also, it is not unusual to see simultaneous binge/purge, as in a patient who is out of control outside of the marriage and compulsively non-sexual with his or her spouse. There are different criteria for assessing sexual anorexia.
In a recent issue of Sexual Addiction & Compulsivity, David Wines (1997) contributed a study of 57 participants in a Sex Addicts Anonymous group who had been in recovery, on average, two and a half years. In part, stimulated by the Wines study, we started gathering data on patients admitted for inpatient treatment.

Within the first 48 hours of treatment, sex addicts do an assessment with nursing and psychiatry professionals. The attending nurse, the doctor, and the patient discuss each criterion and determine whether the patient’s experiences actually fit the criteria. We then compared our “initial assessment” with the Wines’ “long-term assessment” of individuals with two or more years of recovery. A discrepancy existed between the initial and long-term figures, with the long-term figure always being a larger percentage. The argument can be made that this reflects denial. Addicts in recovery for longer than 2 years will have much more clarity about their illness than those in the initial 48 hours of treatment. Even so, 80 % of those initial assessments yielded at least 3 of the criteria, which is the standard in the DSM-IV for gambling, alcoholism, and substance abuse. Wines found that 94% had at least 5 criteria, and over 50% had at least 7 criteria.

This points, however, to an area of research of strategic importance in the field of sex addiction. If we have accurate descriptors of the patient’s condition, it will help us legitimize the field and the work we do with our clients. Sex addiction has emerged as a clinical entity. With the hard work of many people, this information makes the shadow of sex addiction less elusive now than it was 20 years ago.

 2nd Full Disclosure

(Step 9 Amends)

Christian Sex Addicts and their Spouses:

 Giving and Receiving Disclosure in Grace and Truth

 

Grace and truth are both contagious, and they need each other.  Our communications in marriage should show (and thus inspire) love, respect, and understanding toward BOTH spouse and self:  love your neighbor as yourself.  Disclosing sexual betrayal and sin goes better when both spouses first read this article, and focus on their own behavior, motives, and tone, not what their partner is doing.

There are two points in time where disclosure is most important, and can be considered a “full disclosure.”  At both of these times, it is most helpful for this to be done in a counselor’s office, to support the Spouse.  The first of these disclosures is the initial full disclosure, when the Spouse says she is ready to know everything, and the Addict agrees to tell everything.  It is never a good idea, it is never helpful to anyone including yourself, to say that a disclosure is complete when it is not.  If you are not ready to be fully honest, it is best to ask for a week or two delay, to give you time to get into your counselor’s office to be told how and why to make your disclosure completely honest and kind.  If you think you can’t be both fully kind and fully honest, that is your addiction thinking for you.

The second point in time that may be considered a full disclosure is the only one that should be called the “second final disclosure.”  This comes after the Addict has heard and processed his spouse’s impact letter/statement.  Only then can he know how much damage he has to make amends for.  And only then can he give full account of his character defects, the mind-sets that have motivated his behavior.  Only by taking steps four through eight can the Addict say with any confidence or honesty that he is no longer in denial about his character flaws, and no longer in bondage to them, that he will no longer use them to excuse his misbehaviors.

The Addict will find it hard to accept, but “staggered disclosure” (repeatedly saying that he is disclosing everything, only to find himself doing the same thing again and again) does more harm to the Spouse and to the Addict than simply saying, “I am not ready to be fully honest yet.  I need a week or two to get ready.”  The Spouse will find it hard to accept that early in recovery, neither of them will know for sure how complete the disclosure is.  The Addict may not know enough to disclose everything yet, because suppressed memories may not have all surfaced yet.  His emotional coping skills may not yet be able to handle the shame and fear of full awareness, and so he may be repressing memories from himself without knowing it.

The first nine of the 12 steps, and the corresponding first 19 of the 31 tasks, usually takes the Addict about 18 months to complete.  Until this final disclosure in step nine, the Addict should be considered suspect – neither faithful nor unfaithful, neither honest nor dishonest, just suspect.  No matter how much checking or investigating his Spouse does before this, and no matter how much the Addict does or doesn’t disclose, the Spouse will and should naturally distrust the Addict to some extent.  Both should avoid the illusion of control, and embrace how powerless they are over themselves and each other.  This requires both Addict and Spouse to live one day at a time, not trusting themselves or each other, leaning only on God who works through the people, principles, practices, and prayers of recovery.

 Prior to final disclosure, other disclosures may be made by mutual agreement, such as when either the Addict or the Spouse discovers something.  Disclosure is very personal and painful.  It is not a “one size fits all” activity.  Very little practical guidance is given in the workbooks from Drs. Carnes, Laaser, and Schneider about it, and the same was true for my formal training.  So here are my thoughts below.  For the sake of simplicity, the addict is referred to as male, and the spouse as female.)

 

Remember these important facts and considerations about disclosure:

 

Consider the high cost of not disclosing.  Without full confession by the Addict, mistrust and disrespect go back and forth like a ping-pong ball, and the Spouse feels horrible either way. When she distrusts the Addict but he is still covering up, he treats her badly.  When the Spouse trusts the Addict, she immediately and inevitably disrespects herself, because someone has to be at fault for her pain.  Trusting the addict too soon often leaves the Spouse feeling like a nag, a fool, a stooge, a clown, or “the subject of every bad country song.”

 

Consider the high cost of premature disclosure.  It is likely premature when it is done without planning, supervision, or informed consent, and before he has completed steps 1-9 and tasks 1-19.  Such disclosures are typically very offensive to the Spouse, because they are saturated with defense mechanisms designed to minimize the Addict’s pain: denial, rationalization, excuses, minimizing, staying in his head to avoid emotions, projecting emotion and responsibility onto others, claiming credit for good intentions, vomiting emotion to avoid feeling it, claiming not to know better, claiming helplessness, playing dumb (“I don’t know”, “I don’t remember”), and  requesting the collusion of secrecy (“we mustn’t tell…”).   Such maneuvers are infuriating because they avoid the pain which the Addict needs to learn from his mistakes.  They perpetuate the Spouse’s experience that although the addict carries the lion’s share of the blame, she is carrying the lion’s share of the pain.

 

Consider the benefits to the Addict of timely, planned, structured, and supervised disclosure:

and amends), instead of two more backward (covering up and avoiding dialogue)

 

Consider the benefits to the Spouse of timely, planned, structured, and supervised disclosure:

 

       Process/Procedures for a Constructive Disclosure

  These procedures are not all appropriate for all cases.  These are given as a menu of options from which the Addict may want to choose.  They are not intended as a list of recommendations for every case, or as things that an aggrieved Spouse would always be appropriate to demand. 

A counseling professional needs to be present, to moderate the meeting, to support the Spouse primarily, and to correct either partner from communication that isn’t constructive.  (The Addict may also need to have his own sponsor or supportive guide present, if the Spouse agrees with the choice.)  For example, both spouses need to be guided to avoid harsh criticism (attacking partner’s character or motives), sarcastic mockery (either verbal or nonverbal), stonewalling (shutting down), and defensiveness (playing the victim, whining, yes-butting, killing the messenger, etc.) – these are what research has proven to be the four most maritally toxic forms of communication [Gottman’s Four Horsemen of the Apocalypse].  The moderating professional also needs to keep the conversation on task, and blessed with grace and truth.

The moderator may coach the Spouse in using what has been called the Shield of SAFEty:

  1. Support and Soothe yourself
  2. Affirm your Assets and Alliances
  3. Focus on Future hopes and recovery goals
  4. Engage Encouraging friends and family

The Addict needs to bring a written outline of what he is going to present, and to help everyone stay on task, a copy for each person who is there.  With each type of mistake that he confesses, each slip or relapse, he needs to say what harm he thinks he has done: who he has hurt, what he has taken from them, and what damage he has dumped on them  (see my outline for RELAPSE REPAIR below).

When he has completed this confession, he needs to report the inventory he has taken of what he has done, and of what he carries within him that caused these mistakes.  In effect, he needs to present his future sobriety plan in four circles:  the inner circle of what would constitute a relapse (behaviors that he believes he must never do again), the outer circle of what preventive devotional and recovery behaviors he is proposing to do in the future (including frequency and duration), the next inside circle of character defects and triggering mindsets (resentment, shame, insecurity, boredom, loneliness, horniness, exhaustion, self-pity, discouragement, failure, success, cockiness, rejection, etc.), and the final inside circle of slips to avoid and monitor (also called boundary behaviors, these actions increase temptation or trigger relapse).    For more details, see my handout on FOUR CIRCLES.

If you have disclosed to him in writing any particular betraying behaviors that would be for you a certain deal-breaker (cause you to put down a retainer with a divorce attorney), you need to give him the right to “plead the fifth” on this (“I wouldn’t tell you if I had, because I don’t want to divorce.”)

 

 

A MENU OF POSSIBLE AMENDS

 Emotional Amends

  1. If I get tempted or triggered into a slip (not a relapse), I will discuss it with my accountability partner, sponsor, or counselor, but not with my Spouse.
  2. Any further betrayals I recall from the past or commit in the future will be disclosed in the presence of the counselor like we are doing now.
  3. I will inform my Spouse about any changes in my diagnosis, treatment plan, or my recovery plan (4 circles). I will inform her within 24 hours of any relapse (best to tell my sponsor/therapist first).
  4. I will watch the kids two nights a week so Spouse can go to support groups.

Physical and Sexual Amends

  1. We will not shower, bathe, undress, or change clothes in front of each other.
  2. We will not sleep in the same bed/room.
  3. We will not have (unprotected) sexual relations for the following time period: _________
  4. I will neither solicit nor initiate any sexual touching, and will give whatever affection is clearly requested by my Spouse, without demonstrating any desire for more.
  5. I will demonstrate my physical safety by submitting to tests for STD’s whenever my Spouse requests, and she will get the results at the same time I do.

Amends for People, Places and Things

  1. I will involve my Spouse in deciding what gets shared with our children about my addiction, and have her beside me when this happens.
  2. I will protect all my electronic devices and our home from pornography and infidelity with filters and passwords that satisfy a third person.
  3. At church, I’ll respect the privacy of my Spouse, and not sit where I’d be a distraction to her.
  4. I will cut off contacts and access in my public and private life to anyone with whom I have cheated.
  5. I will allow my spouse to pick out new bedding I pay for (if I have cheated in our bed).
  6. In proportion to the money I have spent on my addiction, I will compensate my Spouse. This may involve putting a vehicle in her name, transferring money to her, or giving her part or full title to our house.  I may also decide to sign a legally binding agreement that will do similar things if there is ever another inner circle relapse (e.g., brief and covered up, or anything ongoing).  In the spirit of Numbers 5: 6-7, I may offer to compensate her more than what I say I spent on my addiction.

Amends of Recovery

  1. If not already completed, I will use counseling with someone trained in this field to expand my understanding of my responsibility for my marriage, my family, and my recovery from my addiction.  My Spouse will be included when we finalize an updated plan of my four circles.
  2. I will plan with her a schedule and format of how I report to her about my recovery, and how much I share about these behaviors in my four circles.  This will take the place of unplanned, spontaneous interrogations that are not by mutual consent, which have injured us both in our marriage.  This will involve specific behavioral reports, updated inventories and amends as needed, and the mutual open sharing of feelings about this report and how it affects us both.

 

Scriptures about Disclosure

 

Blessings promised to the honest person, the benefits of confession

John 8: 31-32  “You will know the truth, and the truth will set you free” from addiction

James 5:16  “You will be healed” from addiction, shame,self-centeredness

I John 1:8-9  “He will forgive our sins, and purify us from all unrighteousness”

Satan is closely linked with lying  (Matthew 27:63 and John 8:44)

Do you dare put yourself in Satan’s hands this way?

He wants to destroy you and your marriage:  see Proverbs 6:20 – 7:27

Natural and spiritual harm for the man who covers up 

Lying to your Spouse shows her hate and disrespect, like saying to her,

“You can’t handle the truth”  Proverbs 26: 28

You alienate yourself from God, your brothers and friends, and you wear

yourself out with the cover-up  Jeremiah 9: 2-9

People can develop an appetite for lies, so that they feel that they need them to survive

Psalm 62:4 about “delighting in lies”

Jeremiah 9:5 we’ve taught our tongues to lie

Lies come back to haunt you, because people don’t trust you anymore, and will tell lies

on you to get back at you.  You begin to believe your own lies.  You fool

others, and then their reactions fool you into gradually believing that your

false front is the real you.  (II Timothy 3:13 talks about “deceiving and being

deceived”)

You lose touch with your need for God:

“through deceit they refuse to know me, says the Lord”  (Jeremiah 9:6)

If that’s not bad enough, God can return the favor (Jeremiah 9:9 and Romans 1: 25-28)

  An Outline for Full Disclosure (Step 9)

10 Questions Wives of SA’s need to have Answered       

 

Any forgiveness God wants to give you through me cannot be received until you repent and confess.  Likewise until you repent and confess, you can’t be relieved of your thinking that your behavior hasn’t hurt me, or that I can’t forgive you.

  1. If I have disclosed to you in writing my greatest hopes and my greatest fears about this disclosure,

would you please assure me that you have heard and understood each one?  Do you share them,

or have any others to add?

  1. Have you ever had any sexually transmitted diseases? Are you willing to get examined now?
  2. Outline for me every type of addictive or disloyal behavior you have engaged in. For example,

sexual behaviors would include full sexual infidelity, nongenital romantic touch, sending

pictures, webcamming, romantic texting/calling, emotional infidelity, prostitutes/call girls, strip clubs/bars, massage parlors, love affairs, one-time encounters, pornography, and masturbation (list what was used to arouse/stimulate yourself).  Other addictive/disloyal behaviors past or potential would include any other addictions, including those to drugs/alcohol, other substances, activitities (sex, work, gambling, video games, etc.), and to people, including me or our friends or family members.  Include any other covered up behavior (e.g., financial losses or infidelity).

  1. For each behavior listed above, give a time frame (when it started, and when it stopped), its

frequency/duration (e.g., “averaged 45 minutes per episode, averaged four times a week”),

and its financial cost, including lost wages from neglected work.

  1. Given your answers above, how much has all this taken from our marriage, from me, from our

communication, from your desire for me, and from the love you have made to me?

  1. What good things do you think has your behavior taken from me (sexual desire, trust, friendship,

our children’s respect, etc.) and what bad things have you given me (damaged body image, bad

images of your misdeeds, shame, anger, fear, flashbacks of trauma, etc.)?

  1. What character flaws have been involved in your infidelities? Start with the biggest factors,

and use your own words for these traits and mindsets.

  1. Tell me briefly about your sexual history, how you came to learn about your body, women's

bodies, sex and love, shame and secrecy, and how your desires came to be twisted.  Explain

the process of your healing from all that has twisted your desires.

  1. What are you learning and doing now that will protect us from your slipping and relapsing

back into these things?  How long will that continue?  Does that include any “unless/until”?

  1. Have you given me a 4-circle recovery plan, and agreed to report on this to me every week

 

 

Which Details should be Included during

Full Disclosure of Sexual Betrayals?

         Spouses of sex addicts need to have their needs and wishes considered and honored when they are hearing a full disclosure of their partner’s infidelities and sexual misconduct.  Generally they need:

  1. To have a knowledgeable professional present to ensure that their own needs and the marriage’s needs are being met.
  2. To be told nothing but the truth without excuses (“it was only because…”) or minimalizing (“it was just/only…”).
  3. To be given all the truth and the details they can gracefully handle. The details that are considered necessary for the spouse and marriage that will not be withheld should include all details about:

1-  what the confessor knows that friends and family members are aware of

2-  what the children and grandchildren have been exposed to

3-  which other people were involved in these infidelities, and which were married

4-  if any of these persons still have relationships or contacts of any kind with either spouse

5-  if the disclosing partner may have exposed the spouse to any sexually transmitted diseases

6-  anything that occurred in the home, or in the business, or in any home, church or business

that  either spouse may ever be in again

7-  the rough amounts of time and money spent/lost on the addiction/infidelities/affair partners

8-  if and when any pregnancies resulted from the infidelities:  how they turned out, how many

resulted in births or abortions or miscarriages, and how many living children were born

9-  all the emotions the disclosing partner felt toward those involved, how much these feelings

were expressed, and what feelings the other person expressed toward both spouses

10-  information either true and false that was given about the spouse or the marriage

11-  how the confessor now regards each activity or relationship

 

12-  how each unfaithful relationship was ended:

the mode (phone, letter, text, email, face-to-face, etc.),

what record/confirmation was or wasn’t kept for this agreement,

the reasons given for breaking up,

under what conditions if any the relationship might ever resume,

the types of contact that would or wouldn’t still be allowed, and

the consequences promised for any forbidden contacts initiated by anyone.

  1. To be spared all the damaging, harmful details. The details that are not healthy for any spouse and marriage that will be withheld should include details about:

1-  details of fantasies (general types of fantasies and general content should be disclosed)

2-  physical qualities of others involved:  their height, race, hair color, age (unless they were under 18),  size of their attractive body parts, body type (“slender,  fat, will-tone, athletic,” etc.), or any information about how attractive the person was to the confessor

3-  where are the activities took place unless it was a location in 3.6 above

  1. To be given an option to hear certain details that might be hurtful to either omit or disclose. For example, spouses need to say in advance for each of the following if they want to be told ALL, NONE, MOST, or A FEW of the following details (please write one of these in each blank below):

________   contact information for the other people involved and/or their spouses

________   contact information for any children born of infidelities

________   what promises were made to other people involved

­________   how much feelings have lingered toward other people involved

________   (list any other information you specifically do or do not want in this disclosure)

Any disagreements about what would be helpful or harmful should be settled by a counselor.

  1. The confessing spouse needs to be allowed to finish the entire confession before any question and answer dialogue occurs. Likewise, the offended spouse needs to be able to express all her feelings once the confession is finished, and her spouse will given the same courtesy of letting her finish.  He will respond with only mirroring feedback that assures her that she has been heard, that her feelings have evoked similar sympathetic feelings in him, and that her feelings make sense to him (why she would feel that way).  Any decisions that need to be made about changes in lifestyle should be done at another time and place, after a good night’s sleep.  The counselor will close with prayer.

Dr. Paul Schmidt, CSAT   (502) 633 2860   mynewlife.com

SUBLIMATION

Sublimate your Sex Drive, Don't Suffocate It

One of the few times Freud was in agreement with his Victorian culture was when he taught the usefulness of sublimating the sex drive before marriage.  (His biographies all suggest he had to work hard at practicing what he preached on this score.)  The word sublimate comes from the same root words as sublime.  It suggests lifting something up over the threshold so it can get out and be free.  The urge to be creative in love (eros to the Greeks) can be set loose on a much higher and wider scale if not confined to sex.

In chemistry, sublimation means evaporating a solid or liquid for the purpose of releasing it from its impurities, after which it is allowed to settle back down into a newly purified and tangible state.  This is a beautiful picture of how sexual urges can be temporarily channeled into other outlets until they can be expressed in a purer and less diluted "sublime" form within a substantial marriage covenant.

Even in the physical dimension, sexual energy can be released by various forms of exercise, including working, jogging, sports, and body-building.  (Just remember Satan has a membership at the fitness center too, to infect you with lust of the eyes!)  Sexual energy can also be channeled away from achieving orgasm through pursuing any number of loving, creative, productive, humanitarian, religious, self‑improving, intimate, exciting and affirming outlets.  Use your imagination!

Just as a beam of light is revealed by a prism to contain many different colors, the sex drive is a complex impulse, and the urge for intercourse is only part of it.  Most sexual energy derives from satisfying other needs that hitchhike on the sexual desire — our needs to release tension, to feel more attractive, to express love, to feel self‑esteem, to get a spiritual high, to feel powerful and free, to get energized and excited, to feel close and intimate, to share affection, to feel younger, to be charmed, to make someone else happy, and to shut out the world for a while, to name a few.  If we find other ways to take care of these needs, the bark and bite of the sex drive will start wagging its tail like a little puppy.  The sex drive has been compared to a dog that needs to be fenced in for protection, but which also needs to be tamed, fed, loved, and trained to prevent biting its master.

I have found a simple way to remember some of these ideas.  Imagine yourself caught in a "love cage" and you want out.  There is the trap door of sexual fantasy and behavior which takes you down into further craving and dependency.  But there are six escape hatches in the ceiling of this trap.  They can take you up and out into freedom, which can be remembered by the phrase "Love CAGES."  Each door opens to set free a higher drive that has been caged up, and needs an outlet.  You do best in each situation to take the ways that offer the most fulfilling and immediate enjoyment:

  1. Love — show you care for your beloved in ways that meet some of the needs mentioned in the fourth paragraph above.  If you are still tempted, you can turn from your lover entirely and express by yourself or with other people those same needs, summarized and remembered this way:
  2. C — Creativity — express yourself in music, dance, art, writing, etc.
  3. A — Affection—with family, friends, hugs, sweet nothings,  and "I-love-you's".
  4. G — Giving — do something nice for others to give them joy.
  5. E — Energize through Exercise — competitive play can help here too.
  6. S — Spirituality — go into nature for a relaxing escape, or practice your religious faith.

Just as the brain is "higher" than the genitals, as human endeavors are higher than animal instinct, as people on earth are inspired by a higher calling from God, and as activities that affect many people over a long time require one to rise above the here and now to understand, so loving and creative urges can be lifted up and out of their sexual boundaries to find a much higher and wider expression.

MANAGING CHRONIC PAIN: 

STOCKING YOUR TOOL BOX

For the first time in my life last winter, I let pain whip me.  I panicked in an ER that wasn’t diagnosing or treating me.  I fought the pain and in my own eyes, made a big baby out of myself.  All that energy I put into pushing against what I couldn’t control (the pain and the ER) went right into the pain.  It kicked me in the butt, and turned me into one.  Never again.

Actually that was acute pain, which is nothing compared to chronic pain (3 months or more despite treatment).  Either one usually requires two or more of four approaches to pain management.

The first is neurology:  doctors can often resolve the source of the pain through surgery or anti-inflammatory medication.  If not they can usually eliminate or reduce the experience of pain through the second method, anesthesiology:  pain medicine in this culture, or if you prefer, alternatives like herbal remedies or acupuncture.

The third remedy for pain is physical therapy, which may include exercises or dietary changes by you, or manipulations by a chiropractor or a physical therapist.

When these three haven’t resolved the pain, you still have psychological pain management.  How does this work?

We all know that pain affects emotion, behavior, and beliefs about what’s happening and why.  But do you know that this works both ways?  These things that we control can all raise or lower your experience of pain.  These are your three sets of tools.

BELIEFS

Chronic pain can produce negative beliefs that can be overcome by embracing positive beliefs.  Discuss, meditate and deliberate on these thoughts until you believe them:

This too shall pass.  Thank the Lord I am forgive—this isn’t punishment.  God will heal me sooner or later.  Meanwhile, I can take this.  Thinking of others takes me out of the pain in my body.  Despite my disability, I am important to my loved ones.  I will bring good out of this bad situation.  I can be a blessing to those around me.  I am thankful for. . . .

ACTION

  1. Relaxation training. Picture vividly in your mind’s eye a beach or lake or relaxing spot in nature you have loved.  Feel the breeze, the sunshine, hear the birds.  Add to your imagination conversations with God or your loved ones.  (If the pain is real intense, imagine God feeling this pain with you, as when Jesus was on the cross.)  Stay in your happy place mentally as long as you can, and come back soon.

Or, take slow deep breaths, and instead of your pain, feel the freshness and calm in your lungs.

Or, tighten and then relax one set of your muscles at a time, and then repeat, eventually refreshing every muscle in your body this way,           and distracting you from the pain.

  1. Distract yourself by doing things that help others, and imagine or feel their appreciation.
  2. With your lifestyle, work to fill the voids of what you may have lost due to injury or illness causing the pain—job, money sex, social contacts, domestic functions.

MOOD

Your emotions can respond to the pain, or to your new behavior and new thinking about the situation.  The three biggest emotions to manage are fear, anger, and self-pity.  Look at them as dashboard warning lights to signal your need to change your focus.  How?

Go back to work on the Beliefs and Actions above, to hit the Mood, B-A-M!  This flips the magnifying glass you’ve been using to focus your mind on your pain and your problems, so that now they seem smaller.

This breaks the negative cycle of PAIN à DISABILITY à DISTRESS à PAIN.  You’ve created a cycle of your own:  BELIEF à ACTION à MOOD CHANGE, BAM! 

Join me in this resolving to train for pain:  by practicing this so we can do it under the duress of pain when it comes, instead of giving it energy by fighting it, we will embrace it as our teacher.  Then it will remind and motivate us to give ourselves an upgrade of the soul, an inner refreshment of what we can control, our beliefs, actions and moods.  And as icing on the cake, this will refresh and our relationships.

Dr. Schmidt is a psychologist life coach with offices in Middletown, Lexington, and Shelbyville (mynewlife.com). 

ARE YOU IN DEFIANCE OF MEDICAL COMPLIANCE?

 

Has your doctor told you that you are making yourself sick, that your pain or disability will continue to get worse until you change your lifestyle?  Perhaps you have had trouble complying with doctor’s orders about alcohol, cigarettes, street drugs, prescription pills, physical therapy, losing weight, getting exercise, eating a balanced diet, or changing your high-stress lifestyle.

If you read the rest of this article and get turned off, I hope you will at least have the courage and wisdom to ask yourself the question at the end of this article.  Meanwhile, if you have tried over and over without success to change your ways, if your loved ones have asked you repeatedly to stop what's making you sick, if you know deep down inside now that you are your own worst medical enemy (and perhaps also your family’s), these insights and suggestions are for you.

 

UP FRONT MOTIVATION

  1. Ask your doctor to predict your medical future, both if you do and if you don't shape up.  Ask for specifics, about months and years, about the predicted dates of losing this or that ability or freedom, and about how the doctor believes it will affect your friends and family one way or the other.

  1. Ask the doctor if there are any cost-effective ways to encourage or measure your compliance:  nicotine substitutions, weighing daily on a digital scale, blood or urine tests, physical therapy reports, new medications for alcohol abuse, etc.  Does the doctor know any other people who have made similar lifestyle changes, and would be willing to support you in this change of lifestyle?

  1. Share this information (every single detail) with your family and friends, and ask them to tell you how they will be affected over time by your choosing medical compliance, or on the other hand, your choosing continued unhealthy behavior. Give this article to them, so they know what you can do, and what they can do.  Another article is coming next week or soon, to guide them in how to help you.

  1. Make a written analysis of why this is so hard for you. Start by listing and then rank-ordering the situations that tempt you to unhealthy behavior. Consider the following – A.  Mental triggers:  dread, boredom, lack of hopes or goals, or unhealthy or unrealistic beliefs about God, your family, friends, work, health, control, revenge, entitlement, unconditional love, euphoria, nirvana, etc.  (You might need a friend or counselor to draw your thoughts out, and help you identify the sick ones.)  B.  Physical triggers:  being hungry, tired, on a caffeine or junk food high or low, etc.  C.  Emotional triggers:  feeling unattractive, scared, insecure, angry, hurt, shameful, discouraged, elated, embarrassed, jealous, craving something or someone, dreading or craving sex, etc.  D.  Situational triggers: the setting is too lonely, boring, structured, chaotic, stimulating, tempting, or you have failure, money in hand (or none), a tempting friend or group, etc.  E.  Relational triggers: being rejected, ignored, refused, criticized, patronized, suckered, ordered around, etc.   A and B arise within you, and D and E are external situations you run up against, but you also seek and provoke.  C comes from both inside and outside of you, but everyone is fully responsible for coping with their own emotions.

HEALTHIER BEHAVIORS

 

  1. List constructive alternative responses that will reduce your frustration and temptation in these situations.  For example, some people benefit from buying time (“I’ll think about this and get back to you”), prayer (the Lord's prayer, the serenity prayer, Google St. Francis’ “make me an instrument” prayer, write out your favorites), inspiring thoughts (Google AA slogans, list your favorite sayings and Bible passages, see the tab here for “New Proverbs”), calming behaviors (cardio or yoga exercises, deep breathing, muscle relaxation, visual imagery, visual and auditory relaxations and distractions), reviewing consequences (next section below).  Keep a list of these coping strategies on your person at all times.

BACKSIDE MOTIVATIONS

 

  1. Plan and imagine rewards and punishments.  Set up short, medium, and long-term goals for your behavior (the number of pounds lost, miles walked, weeks clean and sober, etc.).  Plan to reward yourself at each of these points in time, and plan with others how they can best reward these accomplishments.  (You may want to do this all by yourself, but this would be as foolish as a physician who tries to treat himself:  both of you would have a fool for a patient.)  So agree with two or three people on how they can react to you in ways that will help you stay on the right track, and report to them at regular intervals.  (You might want to ask if there is anything in their lives that they want to be accountable to you about in return.)  When you have had a bad day or time, remember that self-administered punishments (e.g., giving up TV shows, or doing household chores without being asked) work way better for stopping your unhealthy behavior than other people criticizing or punishing it.

  1. Ask your loved ones to follow your leadTell them as much of this as you can:  “When I've treated myself well, you treat me good too.  When I've been bad, just leave me alone, and don't help me with anything. Wait till I have shown a change of heart by admitting my mistake, punishing myself in some way, and asking you to help me start over. Meanwhile, just walk off-- no lecture, no further interaction, no hanging out in the same room together, and especially, NO EMOTION FROM YOU.  Let me feel all the emotional pain.  Seeing yours just gives me a temptation and excuse to mess up some more, and distracts me from my own painful emotions. I need my painful emotions to motivate my healthier behavior, not yours.  Whatever you need me for, find someone else for now.”

  1. Ask your loved ones to speak your love language strategicallyYou might have a different one, but the five most common love languages are:  words of affirmation, quality time, physical touch, receiving gifts, and acts of service.   Know what your favorite love languages are, and ask your significant other to speak them to you only when you have been taking good care of your health.  Otherwise, those parts of your loved ones go on strike.

            For the public good, an evolving copy of this article has been posted on my website given above, under the homepage tab of “Doctor’s Orders”.  I invite readers to send any suggested improvements for this piece to my email ([email protected]), because any help you can give may add years to someone’s life, and peace to someone’s home.  The same will go for my next column written for the friends and family members of people who are defying doctor’s orders for their health.

            One last question for you:  if you think you can still enjoy and manage your life successfully without following these suggestions, how would you ever know if you were wrong—what would it take to convince you?

 

 DRUG OR ALCOHOL ABUSE, SMOKING, POOR DIET/EXERCISE:

 

ARE YOU ENABLING SOMEONE TO DEFY DOCTOR’S ORDERS?

This article is for readers who have a loved one who refuses to follow doctor’s orders for recovery from a medical problem.  It assumes you have read first the article I wrote for your loved one, “Are You in Defiance of Medical Compliance?”  And like the first piece, if you read the rest of this article and get turned off, I hope you will at least have the courage and wisdom to ask yourself the two questions in the last paragraph.

Anyway, let’s call your loved one “Pat” (short for patient, and for standing pat).  You can initiate solution number one in the first article, by asking Pat to read it, and answer for you the questions it poses.  With or without Pat’s help, you can learn a lot, and find some new peace of mind in both these articles.

If your efforts to help Pat have been going on for years, you are probably doing Pat more harm than good.  If you are starting most of the conversations with Pat about unhealthy behavior, if you seem to be trying harder than Pat to produce healthy behavior in Pat, or if you are showing stronger feelings about Pat's unhealthy behavior then Pat is, these are clear signs that you are actually doing more harm than good. Your efforts to help encourage Pat’s healthy behavior are backfiring, because without your knowing it, Pat is likely to be using them to excuse or even provoke unhealthy behavior.

If your helping behavior is backfiring, and if you are a part of the problem and instead of the solution, the most accurate way to describe your help is to say that it is enabling Pat’s unhealthy habitsHere are twelve of the most common enabling behaviors to avoid:

Just imagine the time and energy you will be saving by not doing these things anymore!  So what would work to help Pat learn to stop unhealthy behavior and start making healthier choices?

 

What if Pat doesn’t do anything, or worse still, gets worse?  Remember that like surgery or remodeling, things often have to get worse before they get better.  Give it time.  Tell Pat that by treating Pat as someone who could change, you are showing that you respect and care about Pat more now.  Pat can use this same approach with the unhealthy friends in Pat’s life, by telling them, “I am giving you more of myself, now that I am taking better care of myself and inviting you to do the same.”

No matter what happens between you and Pat, one thing will be the same for both of your experiences.  If you change and make healthier choices, you will find that your social circles shift.  Imagine those who care about you as sitting in circular rows of seats around you, with the rows closest to you giving you the most time, communication and respect.  You will soon notice that people will start standing up and shuffling around to find more comfortable seats.  Some close supporters won’t like your new choices and will take seats further away from you.  But others will move in closer and take those seats, and your circle of closest friends and family will have some new faces before long.  They will help you see very soon that all of your efforts are worthwhile.

Two last questions for you:  if you have trouble making any of these changes, if you are scared to risk rejection by Pat, perhaps you have some unhealthy habits in your own life, and you need to read the first article.  If not, perhaps you have an unhealthy dependency on Pat.  If so, admit to your other family and friends that before creating a better life for Pat, you first need to get one for yourself.

Marijuana:

Thoughts on its Use, Abuse, and Legalization

by Paul Schmidt, Ph.D.

 

I have never really had a position or opinion on marijuana, and in recent weeks I have grown weary of this ignorance.  To prepare my thoughts on this subject, I have done three things.  First, I have obtained professional training as a certified addictions specialist from the International Institute for Addiction and Trauma Professionals.  Secondly I have spent several hours looking through the research on the effects of marijuana use (news flash:  it is profoundly inconclusive).  Finally, I have discussed the positive and negative effects of marijuana with over 100 people who have used it, and with almost as many of their loved ones who had their own opinions about how pot had affected these people for better or for worse.  I have also spoken with other mental health practitioners about what they have read, and what they have observed with the folks they have treated.

Depending on the situation and the person using it, any effect of marijuana may be considered positive or negative, beneficial or harmful.  Therefore I will just list the effects without judgment, starting with generally the most widely acknowledged, and proceeding to the less:

The most widely recognized positive uses of marijuana are with medical patients who are fighting chronic, debilitating, perhaps even fatal stress-fed conditions, such as cancer, Parkinsons, PTSD, ADHD, etc.  It also benefits neurotic, overly responsible people who need temporary assistance learning to loosen up in a recreational setting.  However it has not had good outcomes with people suffering from confusion and inner turmoil, such as schizophrenics and folks with mood disorders, because they become more withdrawn into their troubled selves.  Nor would it seem to be good for passive, disengaged individuals who are under-achieving in their financial and career lives, or for married people and parents who aren’t well connected or bonded with their significant others.

Compared to beverage alcohol, booze leads people initially to higher levels of social interaction and other purposeful activities.  Pot on the other hand leads its users to become more passive spectators, more likely to withdraw from social activities, at least from those people who don’t use marijuana.  In short, alcohol tends to make folks more active and passionate, whereas pot tends to make its users more passive and reflective.  Alcohol initially expands the intensity of whatever it is poured out onto, whereas marijuana puts a calming fog down on whatever it finds.  Pot therefore has a much better and far less damaging effect than alcohol does on people who are angry, or driving a vehicle.

Legalizing marijuana use is likely to have similar effects on society as legalizing gambling has had.  There will be more of it done, and less fear and shame for doing it.  It will be more popular with lower classes whose lifestyles evoke higher levels of anger, tension and stress.  Therefore it will raise more money for government and big business at the disproportionate expense of the lower and middle classes.

So how can you determine if your use of pot is having a more positive or negative effect on your life, and on those around you?  The answer is as simple as it is painful and challenging.  List four or five things that you most want to accomplish or experience in life.  (If you have trouble doing this, you might be getting TMW, “too much weed.”)  Then ask one or two adults who depend on you the most to answer the same question about you (to list four or five things they most want you to accomplish or experience in life).  Then exchange copies of your lists so that all of you are looking at the same expanded list of goals.  Finally everyone is given list of marijuana’s effects bulletized above, asked to consider its effects on all the various hopes and goals for your life, and to give a number from -5 to +5 on how they believe smoking pot will affect your chances of fulfilling each particular dream.  When you get everyone’s papers back, the numbers will pretty much answer your question.

Dr. Paul Schmidt is a psychologist life coach in Kentucky, the younger brother of vacationing columnist Dick Schmidt.  He can be reached at [email protected].

HOW TO QUIT SMOKING 

Wise people have had lots of trouble with nicotine.  Mark Twain said, “Giving up smoking is the easiest thing I’ve ever done in my life.  I ought to know.  I’ve done it a hundred times.”

Sigmund Freud died of a cancerous jaw caused by smoking cigars.  He was clearly aware of how his smoking caused and aggravated his condition, but he was unable to control his habit.  After most of his jaw had been removed at the end of his life, despite excruciating pain in each swallow, he propped open his jaw to allow him to keep on smoking 20 cigars a day right on up to his death.

Here are some of the most helpful tips for success at pitching the smokes.  With slight adjustments, this will work well for those who dip or chew tobacco as well.

  1. Don’t give up two bad habits at once.  If you abuse other substances like caffeine, drugs or alcohol, or if you have pain-killing escapist habits with activities like gambling, work, TV, or computers, these other habits should be monitored and moderated while you’re giving up nicotine, but you should schedule your recovery from these habits later, one at a time.  Just be careful not to increase another bad habit at the same time as you are decreasing the nicotine.
  2. Give yourself three strong positive reinforcers.  Do these for prevention, or when you want to smoke.  These are even more effective if you do all three at once!
  3. Use positive visual imagery. See yourself healthy, with white teeth, and doing things like hiking or playing ball with peers or (grand)children, which now you can’t breathe well enough to do.  Imagine how you’re now better than ever at lovemaking.
  4. Meditate on verbal affirmations. Write out and then regularly consider and speak aloud positive statements of self-talk, like these:  “I am a good person, so I’m good to my body.  I take care of my health so I can enjoy life.  I enjoy the freedom of saying no to this habit.  My family is so proud of me now.  I am also proud, that my body is obedient, and ready for life.  I look more attractive, especially when I smile.”  Add your own affirmations, and keep them with you to read regularly until you have them burned into your mind.
  5. Treat your body to natural highs. To replace cigarettes, take slow, deep breaths.  Nicorette gum or nicotine patches from the doctor can help in the early days or weeks.  Enlist your family as cheerleaders when you show them your daily progress in everything you’re doing differently, from a scorecard you keep on the refrigerator or closet door.  Listen to relaxing music (if you can afford them, get an I-pod, or a subscription to Sirius/XM).  Do systematic muscle relaxation (with one muscle group at a time, tense them up for five seconds or so, and then feel the pleasure as you let the tension out).  Ramp up the frequency and quality of activities like exercise and lovemaking, while deliberately enjoying the delightful endorphins (brain chemicals) they produce
  6. ake smoking as unpleasant as you can.  The ultimate disgusting experience that will teach you not to smoke has been called the “rapid smoking treatment.”  (This technique is not advised for patients with cardio-pulmonary conditions.)  This technique calls for you to sit down in a small closed room.  Then smoke your last cigarettes much faster than normal, inhaling fairly deeply every six or eight seconds.  Continue this until you absolutely can’t stand the smoke, and then right away break out and throw all the rest of your cigarettes away.  Whenever you think of a cigarette after that, think back on this experience to discourage your body’s cravings.
  7. Engineer changes in your social and smoking environments.  Get cigarettes out of your house and car.  Plan ways to spend the money you will save.  Put smoking friends and relatives to the loyalty test:  ask them to agree for the first three months not to smoke around you, invite you to smoke, or in any way undermine your confidence in what you’re doing.  Give them a copy of this article, and encourage them to quit with you.  Ask your non-smoking family and friends to be more available and encouraging to you, especially at first.  Tell everyone to pray and hope that you’ll be easier to live with instead of harder from day one, because that is often indeed the case.  If you don’t anticipate much support, get with a pastor or a counselor, and give them a copy of this article to guide your discussion.
  8. Consider hypnosis. It’s hard to get motivated to do unpleasant things.  The painful imaginations are more vivid, the affirmations and self-criticisms sink in deeper, the likelihood of doing the physically or socially unpleasant things is greater, and everything is just more effective if combined with hypnosis.  This is especially true for the 5 or 10 percent of the population that is especially suggestible for hypnosis.  (You’re likely one of these if you tend to get lost in movies and daydreams, and aren’t sure where you are for a moment sometimes when they end).
  9. Celebrate your mile markers.  It helps to plan special event rewards (movies, TV shows, meals, outings, purchases) at certain points in time, say 24 hours, 100 hours, 1 week, 2 weeks, and at 1, 2, 3, 4, 6, 9, and 12 months.  At one point of your choice, let your loved ones throw you quite the (smoke-free) party, one you’ve all planned before you quit as an incentive for you to stay with it.  After all, your new freedom, health, budget, lifespan, and yes physical attractiveness is a lot for all of you to celebrate!

Arguably the most research-based, successful program for smoking cessation was started at the University of Kentucky, and is available inexpensively at both UK and UofL:  Ask for the Cooper/Clayton program.  Throughout your recovery, studies say it helps to take one day at a time, praying each morning for the strength to stay off of tobacco, and thanking God each evening for another day of freedom.

Dr. Paul Schmidt (mynewlife.com) is a psychologist life coach with offices in Shelbyville, Middletown, and Lexington.

Questions?

Contact Me
Dr. Paul F. Schmidt