OPINION: CONQUERING THE SEX ADDICTION MONSTER
INSIDE BOOKS: STOPPING THE NOISE IN YOUR HEAD
BY CHRIS DONAGHUE, PhD, LCSW, CST
BY REID WILSON, PhD
Trauma and Sexuality GIRLY THOUGHTS WHAT THERAPISTS NEED TO KNOW ABOUT SEX SEXUAL HEALTH EDUCATION HARM REDUCTION
TREATMENT & RECOVERY
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Letter from the Editor
By Gary Seidler Consulting Executive Editor
What Therapists Need to Know about Sex (But No One Likely Taught Them)
National Advocacy Update for Addiction Programs and Professionals By Andrew Kessler, JD
By Robert Weiss, LCSW, CSAT-S Discusses treating sexually unfaithful and betrayed clients, lists the differences between sexual dysfunction and sexual addiction, and presents information on making referrals.
There’s No Place Like Home: How Unresolved Familial Trauma Can Emerge Around the Holidays
By Tian Dayton, PhD, TEP
36 How Trauma Numbs Sexuality: Girly Thoughts Running Rampant By Patricia O’Gorman, PhD Defines the notion of “girly thoughts,” provides examples of client concerns, and advises clinicians on how to address trauma exacerbated by girly thoughts.
Uncharted Waters: Navigating the Madness of Designer Drugs, Part II
By Maxim W. Furek, MA, CADC, ICADC
Conquering the Sex Addiction Monster
By Chris Donaghue, PhD, LCSW, CST
From Leo’s Desk
Prayer: What is it?
By Rev. Leo Booth
41 The Integration of Sexual Health Education in SUD Treatment By Archer Brock, MSW, Asia Brown, MFA, William McCadden, MSW, Alexis Rosenthal, MSW, and David A. Patterson Silver Wolf, PhD
Mindfulness in Recovery Revisited
By John Newport, PhD
The Integrative Piece Letting Go
By Sheri Laine, LAc, Dipl. Ac
Presents a review of current literature on sexual health education in treatment and describes program models. www.counselormagazine.com
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Counselor · December 2016
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CONTENTS Topics in Behavioral Health Care
Observations of the Opioid Epidemic
By Dennis C. Daley, PhD
Deciding on Outcomes Measures in Behavioral Health
Ask the LifeQuake Doctor
Stopping the Noise in Your Head: The New Way to Overcome Anxiety and Worry
Bridging the Worlds of Harm Reduction and Addiction Treatment: An Interview with Andrew Tatarsky, PhD By William L. White, MA
By Gerald Shulman, MA, MAC, FACATA
By Toni Galardi, PhD
Discusses Dr. Tatarsky’s early career, the development of harm reduction, and its benefits to addiction treatment.
From the Journal of Substance Abuse Treatment
By Reid Wilson, PhD Reviewed by Leah Honarbakhsh
Trauma Symptoms and Treatment Outcomes for Men and Women in Substance Abuse Treatment
ALSO IN THIS ISSUE Ad Index CE Quiz
By Merith Cosden, PhD, Jessica Larsen, PhD, Megan Donahue, PhD, & Karen Nylund-Gibson, PhD Explains differences between men and women with trauma and describes a study on those with trauma histories.
57 When Chaos Rules: Society’s New Addiction to Speed and its Impact on Treatment and Recovery By Stephanie Brown, PhD Describes how society’s addiction to going faster and bigger is detrimental to addiction recovery, provides case examples, and presents questionnaires for counselors and clients. 6
Counselor · December 2016
LETTER FROM THE EDITOR
Harm Reduction Finds its Place
he late G. Alan Marlatt may have been heartened to read William White’s interview with Andrew Tatarsky, PhD, in this issue of Counselor. An alcoholism researcher, Marlatt is still widely regarded the world’s leading proponent of the approach known today as “harm reduction.” For thirty years he was director of the Addictive Behaviors Research Center, an arm of the University of Washington in Seattle that nurtured a movement among therapists, holding that addiction treatment should take a more moderated approach than is common in traditional Twelve Step programs calling for complete abstinence.
in working with clients who are not totally committed to abstinence. While the prevailing wisdom is that those who meet the criteria for alcohol dependence are rarely, if ever, able to return to controlled drinking, it is also more widely accepted that abstinence is not always essential for people who drink too much but do not have serious problems. Like Marlatt, Dr. Tatarsky has for thirty years championed the integration of harm reduction for treatment of substance abuse (see page 46). Dr. Tatarsky describes a life-changing conversation with Marlatt in 1994: I was describing my quandary, seeing the limitations of traditional treatment and the success I was having in working with active drug users. Alan said to me in that conversation, “You’re doing harm reduction.” That was like my spiritual awakening and a major paradigm-shifting moment for me. Alan introduced me to harm reduction as an alternative framework for helping, which is really how I’ve come to see it. I saw harm reduction principles as having tremendously positive implications for psychotherapy, counseling, and substance abuse treatment.
G. Alan Marlatt, PhD
In his book Relapse Prevention (1985), considered a seminal work in the field, Dr. Marlatt drew a distinction between a lapse and a full relapse. He postulated that a lapse can be seen as a warning sign, not as failure, and that addicts can get back on track through counseling. While his approach gained some adherents, it has also been the subject of much debate and controversy. Marlatt’s position was, essentially, “We’ll help you, whatever your goal is. You want to quit, we’ll help you. You want to cut back, we’ll help you. We’re not going to shut you out.” This view is not shared by most traditional treatment programs—they aren’t interested
Today’s reality is that a harm reduction approach to substance abuse can and does exist side by side with more traditional forms of treatment. Back in the day, not many of us could have imagined there would come a time when our field might accept the idea that abstinence would not be the only acceptable goal of treatment. We live and learn. As Dr. Tatarsky says in this interview, there is a “paradigm shift and scientific revolution that is happening in our field right now.” The shift toward an integrative and collaborative treatment model can only be applauded, and we owe a debt of gratitude to trailblazers like Dr. Andrew Tatarsky and, of course, G. Alan Marlatt.
Consulting Executive Editor Counselor, The Magazine for Addiction & Behavioral Health Professionals, A Health Communications, Inc. Publication
National Advocacy Update for Addiction Programs and Professionals Andrew Kessler, JD
s opioids continue to dominate the policy agenda in Washington, much attention has been paid to the use of medication-assisted treatment (MAT). Whether it be methadone, buprenorphine, vivitrol or another medication, FDA-approved pharmaceuticals are becoming more and more of a centerpiece of federal policies aimed at curbing opioid abuse. Earlier this year, when President Obama released his FY 2017 federal budget, he asked for $1.1 billion in mandatory funding to fight opioid abuse and overdose—an article on this request appeared in this space a few months ago. Of this $1.1 billion, the president’s goal was to have 90 percent of these funds distributed to the states to assist in the expansion of MAT. 8
Counselor · December 2016
The major piece of legislation aimed at the expansion of MAT was the TREAT Act, written by Sen. Markey (D-MA). This legislation—parts of which became law when CARA was enacted—raises the number of patients that a medical practice can treat with buprenorphine. At the same time, the Department of Health and Human Services issued a new rule regarding the same restriction. The rule formerly in place allowed for a limit of one hundred patients; that has now been increased to 275 patients, almost tripling access. Of course, even though doctors can now treat more patients, challenges still exist. Still far too few practices have obtained a DEA waiver in order to be able to prescribe buprenorphine.
Also, directing and referring those in need to these practices remains a difficult task. CCAPP’s support for this expansion should be conditional, however. We support this line of treatment knowing that it is only effective when combined with cognitive therapies that are best provided by highly trained and educated SUD professionals. As prescribed by the Drug Addiction Treatment Act (“DATA 2000”), the following is recommended: “With respect to patients to whom the practitioner will provide such drugs or combinations of drugs, the practitioner has the capacity to refer the patients for appropriate counseling and other appropriate ancillary services” (2000).
CCAPP Yet a focus on such a capacity is misguided; this requirement for mere “capacity” can be fulfilled through simply having a telephone or functioning e-mail system in the prescribing physician’s office. We believe the spirit of the legislation—and the even the spirit of the Hippocratic oath that each physician takes—goes deeper. Medications are simply one part of a potentially successful SUD treatment and recovery protocol. Once they are prescribed, it is imperative that trained professionals monitor patients and work on a course of therapy that compliments the pharmaceuticals. Just as those suffering from diabetes cannot only take insulin but must also engage in other behaviors such as healthy eating and exercise, those recovering from an SUD disorder cannot rely solely on medication. A course of therapy designed by a team of professionals is irreplaceable. Making these recommendations a reality is a challenge. We must improve not only access to medications, but referral systems as well. These systems must take into account which professionals in a given area have the training, competencies, and resources to provide care, as well as the necessary cultural competencies to make that care effective. We must also invest in building a workforce that is numerous and capable enough to meet demand. Under this new proposed rule, the number of patients receiving MAT can conceivably double, and close to triple. According to the Bureau of Labor Statistics, our current SUD professional workforce is shorthanded at present, and bringing more patients into the fold will require an investment in a workforce that includes counselors, treatment experts, recovery experts, and a plethora of others (2015). We will require at least an additional twenty thousand professionals nationwide over the next five years, and it is our obligation to make sure they are trained to work with MAT consumers. It is our hope that agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and others find a way to make workforce development programs mesh seamlessly with the expansion of MAT.
at the agency and will be assisted in OPPI by another medical officer who specializes in substance use disorders . . . there will also be a nurse practitioner in the OPPI assisting the CMO,” the article states. The new CMO is Anita Smith Everett, MD, who was previously an associate professor of psychiatry at Johns Hopkins. The article also states that “SAMHSA is going to encourage the use of medications, not only in the treatment of opioid use disorders, but for alcohol use disorders as well” (Knopf, 2016). MAT is not necessarily the best course for every consumer, yet given its high success rate, its greater availability will be a valuable weapon in the war against SUDs. c Andrew Kessler, JD, is founder and principal of Slingshot Solutions LLC, a consulting firm that specializes in behavioral health policy and federal policy liaison for IC&RC.
There will be new oversights and innovations at the federal level. According to an article in Alcoholism and Drug Abuse Weekly, starting in September SAMHSA added a new structure focusing on medicine and medications, and a chief medical officer (CMO) within its new Office of Policy, Planning, and Innovation (OPPI; Knopf, 2016). “The CMO will head up all clinical activities
Bureau of Labor Statistics. (2015). Occupational outlook handbook, 2016–17 edition, substance abuse and behavioral disorder counselors. Retrieved from http:// www.bls.gov/ooh/community-and-social-service/substance-abuse-and-behavioral-disorder-counselors.htm Drug Addiction Treatment Act, 21 USC 801, § 3501 (2000). Knopf, A. (2016). Exclusive: SAMHSA creates new CMO position in medication-based restructuring. Alcohol and Drug Abuse Weekly. Retrieved from http:// www.alcoholismdrugabuseweekly.com/article-detail-print/exclusive-samhsa-creates-new-cmo-position-in-medicine-based-restructuring.aspx.
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There’s No Place Like Home:
How Unresolved Familial Trauma Can Emerge Around the Holidays Tian Dayton, PhD, TEP
olidays are filled with expectations that challenge even normal, happy families; the sheer volume of extra activities and celebrations can be both exhilarating and exhausting. This is the season for reaffirming relational bonds and commemorating connection of all kinds. But in contrast, family trauma is often characterized by a loss of connection. Because holidays stand for all that is filled with hope and togetherness, they can highlight what feels missing as well as what is there, making the gap between what is and what we wish were seem more pronounced. Words never spoken and feelings never felt can create a sense of estrangement from the core of what makes us tick as a family unit, particularly when there is an expectation to be in a holiday mood. And holidays are inevitably a time of imbibing, which for families that have dealt with addiction can add another layer of complication. 10
Counselor · December 2016
Comparing Our Insides with Other People’s Outsides
We’re all filled with images of the ideal or even the “normal” family approaching and during the holiday season. For most of us there’s a pressure to get together with family that there isn’t at other times of the year, and more than that, a pressure to be happy, grateful, and filled with joy at the opportunity to be with those we love. But if those we love have been the source of some of the greatest pain in our lives, then this pressure can become devastating. The pressure we feel from the inside and the pressure we feel from the outside coalesce, creating a cauldron of emotions that can be difficult to manage. And dysfunctional families have often not developed good skills of self-regulation or relational regulation; they may experience the kinds of emotional mood swings and unmanageability that relational trauma kindles. Approaching the holiday season we may find ourselves
trying to dispel memories of gatherings gone wrong, drunkenness, fights, doors slamming, and tears—disturbing recollections of festivities from the past that became explosive and painful. We may carry this unsettling mix of emotions, along with presents, ribbons, and bows, into family events. We’re torn between the holiday we wish for and the one we fear might happen. We’re confused about why we’re afraid of the people we love so much. We don’t know what to do with the resentment we carry over the family pain that has gone unacknowledged and unexpressed, that is vibrating beneath the smiles we’re holding in place somewhere across the bottom halves of our faces. We may look like (or sort of like) we’re holiday happy, but on the inside we feel like a fractured, cubist period Picasso: all our parts are more or less there, but in all the wrong places. We can feel distorted on the inside, our inner world threatening to leak out sideways at the slightest provocation.
NACOA Or maybe we’re choosing not to reconnect with family at all and are dealing with feelings of estrangement, guilt, and perhaps even relief around that. Whatever our situation, the holidays can act as a powerful trigger for the kind of unresolved pain that, without treatment, passes from one generation seamlessly into the next, finding ever more veiled ways of coming out.
been processed, understood, and left in the past where it belongs develops an afterlife; it seeps into the underground relationships in the present, becoming a part of what fuels new and often distorted growth. The past and the present become a tangled mass within us, and because of the repetitive tradition of holidays there is a pull to move back to our baseline of functioning, wherever we left it.
This is what we walk in the door with at a family gathering: a longing to be close and have fun with those we love and an equal dread and frozenness around what might happen. The Path of Pain
Relational trauma is not a one-time car accident; it isn’t a hurricane or an operation or something that has a clear beginning, middle, and end. It’s about the twisting of our inner world that we have to do to adapt to those close to us who are not acting anything like normal, or the shapes we bend into to stay connected, when another part of us is dying to flee or fight or simply to curl up into a little ball and hide. These are the patterns of intimacy that we learn in our traumatized family and carry into subsequent, intimate relationships. We long to be close but fear being close all at the same time. We mistrust deep connection, having experienced too many times how it has led to so much pain and hurt. And this is what we walk in the door with at a family gathering: a longing to be close and have fun with those we love and an equal dread and frozenness around what might happen. It’s the elephant in the room, the secret that everyone knows, the holiday cheer and fear that hangs in the room and is picked up on by all present, even the children. The hypervigilance that grows out of trauma makes us vulnerable to overreacting to things in the present that carry a pain-filled scent or overlay from
The Child Inside: From CoA to ACoA
the past. In other words, our fear of something going wrong might mean we overreact to slights that we’d otherwise let pass by. Our mistrust, our waiting for the other shoe to drop can actually become the other shoe dropping. Resentments fill us with the kind of judgment that does not allow new energy to flow in, and it prejudices our perceptions of others. Pain that has not
Children make sense of the world and their family members with the equipment that they possess at any given moment along their developmental continuum. This phenomenon is part of the family story and when that story gets revisited around a holiday tree or table, family members can regress in the blink of an eye to that place inside them that is calling the loudest to a level of maturity that is not necessarily equivalent to their current age, but rather represents a maturational arrest caused by family trauma. In some ways children who are overchallenged by early adversity can become mature beyond their years—little adults functioning on behalf of parents who are dropping the ball. But there are other ways in which these same children have not had their gradual needs for nurturance and safety adequately met.
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NACOA So the question is this: Do we recover and suffer the survivor’s guilt of getting healthy while the rest of the system is still mired in dysfunction? Or do we go down with the ship? Perhaps there is a third path, a deep recognition that the family we love and want may not be the family we have, but that we can enter consciously where possible and without the almost magical expectation that things will be as we wish. Because ultimately, healing this kind of pain has to be done person-byperson. The point of healing it is so that we do not unconsciously pass it down to another generation, so that we don’t let the pain of yesterday leak into and shape the relationships of today. To do They have had to grow up too fast and as a result they may have left significant parts of themselves behind. These forgotten childhood selves call to them on the inside, not in a voice that can be heard or even understood, but in a silent scream, a stage whisper, an invisible current of need and hurt that shoots through the atmosphere of a family gathering with the alacrity of an electrical storm. The sensation inside of family members can be both frightening and awesome. Frightening because they have all been here before and it ended badly, awesome because maybe this time someone will say the right thing instead of the wrong thing, maybe this time some magical deus ex machina will descend from the heavens and deliver, once and for all, an inspired resolution to this whole mess. Maybe it will make sense of why a family that loves each other has caused such consistent and overwhelming pain to those we are supposed to care about the most. The holidays cast a spotlight on family dynamics that may be problematic, creating a heightened reality for all present. Holidays present a script—“Be happy, love one another, connect”—but family members who carry buried and denied pain can experience themselves at these times like actors going through the motions: inauthentic, mouthing the words. There is an awkwardness that lingers in the air and a powerful but unrequited wish for something we feel we cannot have. 12
Counselor · December 2016
parents. These children need and deserve better efforts from society to protect, support, and empower them. They are in our pediatric clinics, in our schools, on our sports teams, and in our religious communities. They are the children of our clients, who do not know that they are not alone, that they are not to blame for the chaos and sadness and chronic fear they feel every day in their homes. These children can access the help that is available when the adults in their lives speak up and guide them to support groups in their schools, to a knowledgeable pediatrician, to the youth group in their church, to Alateen or to a caring recovering adult who will share the truth with them about addiction and who will help them understand that they and their whole family have a right to recover from the pain and anguish addiction has inflicted on them. In a civilized society the elders protect and support the young. It is time that we all step up and own our responsibility to the children right in front of us waiting for someone to say something that can help. c Tian Dayton, PhD, TEP, is the author of sixteen books, including The ACoA Trauma Syndrome, Emotional Sobriety, Trauma and Addiction, and The Living Stage. In addition, she has developed a model for using sociometry and psychodrama to resolve issues related to relationship trauma repair. Tian is a board certified trainer in psychodrama, sociometry, and group psychotherapy and is the director of The New York Psychodrama Training Institute.
this we need to take that beautiful and wise advice of the Twelve Step programs: “Detach with love.” Because any other way of detaching leaves us in pain and closes a door to healing that may or may not come in our families of origin, but can and will come in the families we create if we let it. Without rigorous help and dedication to recovery, traumatized families tend to live out legacies of pain, but this of course need not be the case. Help is always there if we can seek it out for ourselves and for our children. But first, we need to speak up about the great human rights crisis right in front of us: the millions of silently suffering children of alcohol- and drug-addicted
CULTURAL TRENDS pantheon” (Guarino, 2016). The journal Lancet noted that it appeared in London around 2007. Mephedrone has so far mostly thrived in Europe, particularly at British raves. Although it was banned in the UK in 2010, “by 2015 it was responsible for thirty-four deaths, up from twenty-two in 2014” (Guarino, 2016). In November 2011 mephedrone was categorized as a DEA Schedule I drug in the United States. Meow Meow falls under a category known as “chemsex” along with GHB and methamphetamine. “Chemsex refers to gay or bisexual men using drugs to facilitate sex with other men . . . it’s distinct from drug use which later leads to sexual activity: chemsex is where men take a certain drug or drugs because they are about to have sex” (Speed, 2016).
Navigating the Madness
of Designer Drugs, Part II
Mexxy is a new designer drug often taken for its hallucinogenic and dissociative effects. It is a chemical analogue of ketamine and the much stronger PCP, both classified as dissociative anesthetics. Street names include “MXE” and “rolfcoptor” and it is sold as pellets or as a powder that is either snorted or injected. The packaging often reads “research chemical” and “not for human consumption.” According to The Huffington Post UK, Mexxy “is the first so-called ‘legal high’ to be banned temporarily [in the UK] under Home Office powers, which can restrict a substance for up to twelve months while it is decided whether it should be made completely illegal” (Rickman, 2012). Mexxy has been sold since 2010 and is popular on the European club scene. The drug is relatively new to the recreational drug culture in the United States. Distortion or loss of sensory perceptions, dissociation of mind and body, and agitation have been reported.
K2/Spice (JWH-018, JWH-073, JWH-200)
K2 or Spice is about ten times more potent than naturally occurring THC, marijuana’s psychoactive ingredient. Clemson University’s John W. Huffman Meow Meow (Mephedrone) created the first synthetic cannabinoids Meow Meow is a synthetic cathinone in 1995. These were made for experimenthat is derived from khat. tal purposes but were diverted to Europe According to The Washington Post, first around 2004 as the brand “Spice.” In synthesized in 1929, Meow Meow is “a rel- 2009 Spice and K2 became popular in ative newcomer to the recreational-drug Canada and the US.
Maxim W. Furek, MA, CADC, ICADC
n my previous column I began discussing designer drugs and provided an overview of the first five in a list of ten. This column will conclude the list of today’s most frequently used and popular designer drugs.
CULTURAL TRENDS According to the Partnership for Drug-Free Kids, From January 1 to March 31, 2016, poison centers received reports of 862 exposures to synthetic cannabinoids, according to the American Association of Poison Control Centers. Poison centers received 2,668 calls about exposures to these drugs in 2013, 3,682 exposures in 2014, and 7,779 exposures in 2015. Synthetic cannabinoids are very different from marijuana. They can cause dangerous health effects, including severe agitation and anxiety; muscle spasms, seizures, and tremors; intense hallucinations and psychotic episodes; and suicidal and other harmful thoughts and/or actions (“Fifteen people,” 2016).
N-Bomb (2C-1, 251-NBOMe, 25C-NBOMe, 25B-NBOMe)
Also called “smiles,” the drug “is derived from mescaline, which occurs naturally in peyote cactus. The technical name of the substance is phenethylamine” (Prince, 2013). N-Bomb is sold as LSD (legal acid) or mescaline, usually in white powder form that can be snorted. It can be melted into chocolate candy, but can also be taken as a tablet, breath mint or drops. According to an article on Heavy.com, 2C-I-NBOMe is a derivative of the substituted phenethylamine psychedelic 2C-I, discovered in 2003 by Ralf Heim at the Free University of Berlin, and subsequently investigated by a team at Purdue University led by David Nichols. The chemical had no history of human use prior to being sold online as a designer drug in 2010 (Prince, 2013). N-bomb creates a hallucinogenic effect similar to LSD at extremely small dosages. Users report the negative effects and after-effects of the drug are worse than that of LSD or MDMA. It also mimics the effects of methamphetamine. It can cause irregular heartbeat, seizures, and foaming at the mouth. Effects of only a tiny amount of the drug can last for up to twelve hours or longer (FDFW, 2016).
NRG-1 (Naphyrone, O-2482, naphthylpyrovalerone)
Naphyrone, a cathinone derivative, is a stimulant drug sold as a white crystalline powder often called “NRG-1” or “Energy1.” The drug is consumed either by sniffing the powder or swallowing it wrapped in a cigarette paper, a technique known as “bombing.” NRG-1 is chemically related to pyrovalerone, once prescribed to treat lethargy and fatigue but discontinued because of concerns over potential misuse. NRG-1 emerged as a new legal high in the UK only months after the ban of mephedrone, a similar cathinone derivative. Effects of cathinones are euphoria, talkativeness, alertness, and feelings of empathy. Anecdotal reports of naphyrone indicate it can remain in the body for long periods and since it is a reuptake inhibitor of serotonin (implicated in body heat regulation) body temperatures can soar upwards of 107–108 degrees. Naphyrone has been found in molly (MDMA). 14
Counselor · December 2016
This is a new synthetic opiate believed to be one hundred times more powerful than fentanyl. Although it was developed decades ago as an experimental pain reliever, the most recent batch appears to have been manufactured in China. According to an article on FoxNews.com, Scientists at the University of Alberta developed W-18 in the 1980s as a potential painkiller. The drug is included in the “W” series, which ran from W-1 to W-32, and was used mainly for research. The CBC notes W-18 is the most powerful of the thirty-two in the series. No tests are available to detect it in urine or blood, which means it may already be taking an unknown toll on users if it’s being cut into other drugs—and perhaps are at least partly responsible for the escalating deaths attributed to heroin (Johnson, 2016). This drug may be the deadliest of the bunch. W-18 is extremely dangerous as it depresses the central nervous system, causing blood pressure to drop and heart rate and respiration to slow.
We are in uncharted waters. Prevention and treatment have become more difficult as global chemists alter chemical structures, designing new versions of older drugs. Users are ignorant of the effects and long-term consequences. Mental health and addiction professionals struggle to develop treatment strategies. Although there is cause for concern, education may be the first step in dealing with this crisis. c Maxim W. Furek, MA, CADC, ICADC, is an avid researcher and lecturer on contemporary drug trends. His rich background includes aspects of psychology, addictions, mental health, and music journalism. His latest book, Sheppton: The Myth, Miracle, & Music, explores the psychological trauma of being trapped underground and is available at Amazon.com.
“Fifteen people in Los Angeles hospitalized after using synthetic marijuana.” (2016). Retrieved from http://www.drugfree.org/ join-together/15-people-los-angeles-hospitalized-using-synthetic-marijuana/ Foundation for a Drug-Free World (FDFW). (2016). What is n-bomb? Retrieved from http://www.drugfreeworld.org/drugfacts/synthetic/what-is-n-bomb.html Guarino, B. (2016). The ‘chemsex’ scene: An increasingly popular and sometimes lethal public-health problem. The Washington Post. Retrieved from https:// www.washingtonpost.com/news/morning-mix/wp/2016/05/10/the-chemsexscene-an-increasingly-popular-and-occasionally-lethal-public-health-problem/ Johnson, J. (2016). There’s a new street drug with crazy potency emerging. Retrieved from http://www.foxnews.com/health/2016/04/22/ theres-new-street-drug-with-crazy-potency-emerging.html Prince, S. J. (2013). N-Bomb killer designer drug: Top ten facts you need to know. Retrieved from http://heavy.com/ news/2013/05/n-bomb-killer-designer-drug-top-10-facts-you-need-to-know/ Rickman, D. (2012). Mexxy, drug like ketamine, can produce ‘weird out of body effects.’ Retrieved from http://www.huffingtonpost.co.uk/2012/03/28/what-ismexxy-methoxetamine-ketamine-legal-high-home-office_n_1384521.html Speed, B. (2016). What is chemsex? And how worried should we be? NewStatesMan. Retrieved from http://www.newstatesman.com/politics/ health/2016/04/what-chemsex-and-how-worried-should-we-be
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Conquering the Sex Addiction Monster Chris Donaghue, PhD, LCSW, CST
e are now learning that addiction is truly about failed bonding—it’s a relational problem. Those deemed “sex addicts” are people missing meaningful relationships and who lack an understanding of healthy sexuality. They are seeking outside their relationships what is missing inside of them, such as good sex, sexual chemistry, love, connection, bonding or stimulation. We need to treat the real issues: relational boredom and deprivation, loneliness, fear of sex, and poor sexual health education. It’s not about the flawed concept of being “hooked” on sex or arousal. I have never treated anyone diagnosed as a “sex addict” who was currently in a truly meaningful, stimulating, and arousing sexual-romantic relationship. Most “sex addicts” just need better, sex-positive sexual education. The sex addiction diagnosis has become a waste paper basket for all creative sexuality, queer sex, and nonrelational, heteronormative sexualities. Most sexual “acting out” is really due to the instability and boredom of monogamy and the ownership model of marriage. Sex cannot be contained, as sexuality has no interest in our socially constructed norms for relationships or our cultural, sex-phobic laws about sex work use and pornography. The sex drive is one of the most powerful drives and does not care about socially constructed barriers such as monogamy and our privileging and valuing of sex only when within a committed relationship. Our diagnostic system within psychology flaunts this problem, as its entire job is to align clients with heterosexual, male, American norms of health. Sex addiction criteria and treatment is not a “view from nowhere with no politics” because all therapy is political, and no neutral therapy exists. We have to look at the founders of the sex addiction diagnosis and model for treatment to understand what anxiety or need their work is attempting to heal and protect, as we cannot split the creator from their creation. There remains a severe lack of actual, adequate, and advanced sex therapy, human sexuality, and sexology training in this bunch. The future of sex addiction treatment is highly fragile due to the field’s attempts to formalize a sustainable model of treatment. The “personhood” of the field’s current practitioners is one full of histories of sexual chaos and phobia that 16
Counselor · December 2016
bleed into their work and models of treatment. They project their own sexual anxieties onto their clients. Until the field of sexual compulsivity has therapists who are not afraid of their own sexuality, we will never have a treatment modality that doesn’t cause harm. Don’t valorize sex-phobia by calling it “health” or “sobriety” because sex must be encountered. Read the sex addiction criteria list—it’s all diversity shaming (focused on intercourse, monogamy, family-centered, and anti-nonhetero norm, solo sex, paid sex, and porn). These are all American hetero values, and they ignore other sexual minority norms and values. This is colonization, and it’s prejudicial. Minorities do not and should not honor cultural majorities defining for them how they should be. Sex addiction as a diagnosis and treatment carries a eugenic gaze and polices sexual diversity. This conversion and reparative therapy process, disguised as health, oppresses sexual minorities and sex radicals needlessly. My e-mail is frequently assaulted with invites to treatment centers, lectures, and programs that claim to “cure” porn use and BDSM interests, all of which require support and not shaming from clinical programming billed as treatment. The sex addiction diagnosis is the direct result of colonization and is not resistant to culturally bound sexual requirements and values. Sex addiction treatment then becomes about embedding the moral and social anti-sex status quo into the psyches of clients. What is deemed a problem to fix depends on norms of the culture and context. What hetero America calls “addiction,” other cultures and the field of sexology call “healthy pleasure.” The model lacks a vision for sexual health and sustainability of arousal and stimulation, all of which are the actual goals of sexual health. It is a historical, social, and moral product, and it is arbitrary. Diagnosis says nothing about the person or client and everything about the culture and individual prescribing this taxonomy. What many erroneously call “sex addiction” is actually sex without social rules. Sex is truly a “complex outcome of a tension between biological sexual possibility and cultural constraints” (Laumann, Gagnon, Michael, & Michaels, 2000). Sex drive isn’t concerned with socialization and the arbitrary boundaries culture has set around sexual behavior. The erotophobic psychology and faux science of sex addiction uses labels and diagnoses as surveillance to cope with
OPINION the continued tension of trying to determine a universal healthy sex. Sex is far too individual and contextual, with the impossibility of creating a universal or consistent operational definition. What may be healthy—which is a fully loaded political concept—for one individual in one context or culture may be unhealthy in another. One of my favorite shaming definitions for “sex addiction” provided by the sex addiction therapist camp is their statement that “healthy sex only takes place in a committed relationship.” If that were true, then most of Americans are sex addicts, as the majority of us are having sex without marriage or commitment. This is a great example of the overt pathologizing of any sex that isn’t marital, hetero or vanilla. Sex drive is one of most powerful human drives, and relationships and sex are a primary organizing principle within socialization. Biology demands reproduction and arousal, while culture provides options and limits around how it’s expressed. We have to recognize that arbitrary rules governing sex are major health risks. Boundaries are needed, but not around harmless sexuality. This is similar to the concept of virginity and selfworth, which states that when you have sex you “give something away,” which is another negative social construction about sex—yet another made-up theory to control the experience. It is sex shaming and an attempt to needlessly link confidently having sex with the fear of a mythic loss or reduction of self. The opposite is true. Sex can be a bridge to emotional bonding. It enhances us and allows for more intimacy, connections, and relationality in our lives. It can also lead to more relationships, as many have sex that leads to long-term healthy friendships. This is why healthy sex can occur outside of relationships. Many use sexuality as a way to build immediate intimacy and social connection. Many of the symptoms that are wrongly defined as a “sex addiction” are signs of a sexual-relational structure that is not working, mismatched sex drives or interests between partners, masturbation/ porn phobias or just plain old sex-hating. Watching porn and masturbating daily, sex with sex workers or cheating are not issues of a sexual addiction. Solo sex (masturbation) is good for self-soothing
and stress release, paying for sex can be highly arousing, and cheating may mean that one is not meant for monogamy or needs to end a current relationship. The sex addiction treatment field is quickly rendering itself irrelevant because it fails to provide a holistic perspective that can fully examine an individual’s sexuality without pathologizing nonnormative behaviors. The limited nature of the current treatment model is driving the collapse of itself as its inherent shaming tone and abusive clinical applications are no longer feeling good to clients and clinicians. The liberating voices of opposition from sexologists, sex therapists, and psychologists are driving the recognition of its limits and failures and, most importantly, freeing “sex addicts” from the dangerous edicts of the current sex addiction treatment model. The historical roots of the treatment model, the substance abuse model, and related Twelve Step programs are far from accurate or applicable to treat a healthy and omnipresent human drive. We all as humans must work to navigate this drive in a functional way and not split it off with a disease metaphor relegating sex to a place of shame and fear. The future of sex addiction requires a reconfiguring of the current operational definition, although nonexistent clinically and diagnostically as the addiction field and media have definitely agreed upon a shaming set of criteria. Perspectives that allow for deviation
from the current didactic, committed, hetero standard would need to be integrated to form a sustainable model for treatment of “problematic sexual behavior” (or as I call it, “sexuality”). Problematic behavior isn’t separate from sexuality. But the inherent flaw in a model of treatment is its attempt to objectify, concretize, and standardize behavior such as sexuality, which is highly subjective and situational, and definitions of health are bound within current culture and historical positioning. The history of sexology has shown us how the disorders and pathologies of the past have outgrown their labels and are now seen as both acceptable and healthy. Sex addiction’s attempt to delineate a healthy from unhealthy model of sex is impossible—it is a hopeless attempt to build a hierarchal ladder on solid ground that just cannot exist. Due to this, the sex addiction field will always fail to legitimize a consistent treatment model and definition of sexually addictive behaviors. c Chris Donaghue, PhD, LCSW, CST, author of Sex Outside the Lines, is a doctor of clinical sexology and human sexuality and specializes in individual and couples sex and marital therapy, as well as sexual compulsivity, sexual anorexia, sexual dysfunctions, and nontraditional sexuality, identities, and relationships. He also runs healthy sexuality therapy groups.
Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (2000). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press.
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FROM LEO’S DESK
What is it? Rev. Leo Booth
remember listening to a Cole Porter song called “What is This Thing Called Love?” and I then started to think about prayer. What is it? And does it work? If you have been following my columns in Counselor you will have noticed that I’m a critic of religious statements that sound great, but upon examination make no sense. Well, what I mean is that they make no sense to me! Over the years I have become attracted to a concept of spirituality that is both inclusive and pervasive, based upon a definition that suggests that spiritual people are essentially positive and creative. This includes people who are agnostic or atheist because it has been my experience that although such people are not religious, they are often amazingly spiritual. So, how do we make sense of this word “prayer”? What is it intended to do? What are we expecting? Is the traditional understanding of prayer working in our lives? After the recent tragedy that took place in Orlando, Florida, I heard constantly that we needed to pray for the victims, pray for those who were injured, pray for America. Now remember, these prayers are to be addressed to God after the tragedy took place. Are we asking God to stop more killings? Stop the injured from dying? Stop the terrorists killing or maiming more? Isn’t this understanding of prayer a little late? The tragedy has already taken place. It happened on God’s watch, on God’s time. And it would seem that God did nothing about it. The same was true for the tragedies of September 11, 2001, Pearl Harbor, Auschwitz or the killings of Christians and Muslims in the Crusades. And these are just big
Counselor · December 2016
FROM LEO’S DESK events; this does not include our personal tragedies and losses. If prayer is to influence God, it is seemingly not happening. And yet recently I heard that God saved a parking place for a lady at Ralph’s Super Market. I also heard that a drunk who had been suffering for years collapses, would you believe, outside an AA meeting! And of course there are the thousands of times I hear about how God gets people sober. Interestingly, God gets them sober, but many do not stay sober. The same “prayer stories” are to be found concerning cancer, getting a job, finding a loving relationship, and even making money. And yet God remains alarmingly detached from major issues like wars, famine, and natural disasters. None of this makes sense because it is nonsense. Only in religion, especially concerning religious practices, are we prisoners to ideas and a philosophy that was expressed hundreds of years ago. Here are a few of the things traditional religion teaches: • Everything happens according to God’s plan. • We are not in charge; God is. • Only through God’s grace do good things happen. • We are nothing. God is everything. • Prayer is requesting the good things in our lives.
inherently sinful creatures wholly incapable of doing anything good without God’s grace. This teaching was in part the result of Augustine of Hippo—also known as Saint Augustine—who famously said, “Give me what you command and command what you will” (2008/398 AD, p. 29).
I was thinking these thoughts when I first published my book, The God Game: It’s Your Move. In it I created the following prayer: Oh God, you have given me the power to determine my life. May I remember to include myself in my amends. May I never be afraid to reveal my anger or concern to those who have abused me. Today I know that I can never love you or others fully and healthily until I begin to love myself. With you as my partner and cocreator I am discovering all that is lovable and powerful within me. Thank you for guiding me as I reclaim myself (1994, p. 145).
From a comprehensive world point of view this philosophy and understanding of prayer is clearly not working. It makes no sense and desperately clutches at incidents that are so personal and cannot be verified.
A Different Approach
For many years I have wrestled with the question: Does prayer work? As we have seen in this article, I’m uncomfortable with the traditional approach to prayer. Indeed, I think it makes no sense. However, I believe there is another understanding of prayer that makes more sense. If the “Kingdom of God” (metaphorically speaking) is within, so is the window of prayer. When I pray—and I’m certainly not suggesting that God does not hear my prayers—the essential ingredient is that I hear my prayers and focus on the action needed to make things happen. For example, if I’m praying for a good job, then I need to search out the necessary qualifications required and fill out the application form!
I wrote this in 1994. Would I change anything? Not much. I would probably leave out the last sentence or change it to “in gratitude I reclaim myself.” I need to reread this book. Maybe you need to read it. c Leo Booth, a former Episcopal priest, is today a Unity minister. He is also a recovering alcoholic. For more information about Leo Booth and his speaking engagements, visit www.fatherleo. com or e-mail him at fatherleo@ fatherleo.com. You can also connect with him on Facebook: Reverend Leo Booth.
Booth, L. (1994). The god game: It’s your move. New York, NY: Stillpoint Press. Booth, L. (2016). A spiritual revolution. Counselor, 17(3), 20–1.
This reflects what I wrote in June’s column concerning a spiritual revolution (2016): We often hear in recovery circles that God is doing for us what we cannot do for ourselves. What exactly does this mean? Is it suggesting that God, at times, breaks into our personal lives and does something, or makes something happen, that does not require our involvement or cooperation? Some Christians are still, today, receiving the message that they are nothing without God’s grace. Do we really believe this? The theology of God’s grace has a history that involves the idea that mankind is “fallen,” and that we are
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Mindfulness in Recovery Revisited John Newport, PhD
ack in 2009 I published an article with Counselor titled “Mindfulness in Recovery.” At this point I would like to revisit this concept, drawing on my own experience in attempting to integrate mindfulness in recovery over the past eight years. I will begin by highlighting some key points from the earlier article. From the Buddhist perspective mindfulness is synonymous with awakening—awakening to the true nature of ourselves and the world around us. Truly awakening in mindfulness entails becoming fully present in the immediate moment, with heartfelt compassion for both ourselves and others. Mindfulness also entails a commitment to experiencing our immediate reality as it really is, not as we wish it were or fear it might become. Very importantly, mindfulness involves learning to step outside our usual frame of reference and dispassionately observe our thoughts and feelings, letting them go without attachment if we choose to do so. In his classic book Relapse Prevention, Marlatt expounds on potential applications of the acquired quality of mindfulness in maintaining one’s recovery from alcoholism, drug addiction, and other addictions (Marlatt & Donovan, 2005). He observes that regular practice of meditation is instrumental in cultivating mindfulness, which he defines as the capacity to observe the ongoing process of an experience while letting go of one’s sense of attachment to the content of each thought, feeling or image.
Counselor · December 2016
Extending this concept to relapse prevention, Marlatt discusses his experience in teaching alcoholics and addicts to mindfully “step aside” and simply observe the progression of a momentary craving for their drug of choice to a peak level of intensity, before gradually beginning to diminish on its own (1994). Using the analogy of dispassionately observing the rise and fall of waves in the ocean, he states that through continued application of mindfulness at the onset of an addictive craving, addicts gradually learn to step aside and simply notice this internal process as it arises, and then consciously choose to let it go. In a somewhat analogous manner, the relapse prevention model pioneered by Terrence Gorski entails coaching clients to become increasingly mindful of personal warning cues associated with imminent threat of relapse, and learn to use this increased awareness to defuse potential relapse triggers (Gorski & Miller, 1982). Mel Ash, author of The Zen of Recovery emphasizes how mindfulness can help clients avoid relapse through smoothing out life’s “bumps along the road.” In his words, “With mindfulness, the out-of-control roller coaster of your life will assume milder curves and gentler hills” (1993).
WELLNESS A Continuing Experience in Application of Mindfulness
Since moving to the beautiful Sonoran desert close to six years ago I have uncovered exciting new dimensions of mindfulness in my own life. In my morning walks along the desert trails I assume a child’s mind-set as I joyfully experience the presence of incredibly beautiful trees and various forms of cacti against the backdrop of the Pusch Ridge Mountains. This heightened awareness of experiencing the now moment has brought a whole new dimension of richness and enjoyment to my morning walks. Being far removed from the “buzz” of Southern California, I find it so much easier to fully commune with my natural surroundings. Not too long ago I began communing with the trees I encounter by consciously letting go of all thoughts as I gaze upon them, experiencing our shared sensation of intimate connection. Likewise, I enjoy communing with the rabbits, roadrunners, lizards, and other birds and animals I encounter on these walks. I’ve discovered that if you truly greet a bird or animal with a heartfelt sense of admiration, they will almost invariably stop to linger for a moment. In these encounters I believe they sense our common presence and choose to hang out with us. Two years ago my wife and I went down to the pound and adopted an extremely playful Chihuahua mix named Jack. His hilarious, nonstop antics and constant outpouring of love to both of us have immeasurably deepened our appreciation of the term “man’s best friend.” One morning while the three of us were walking in the park I said to Ann, “Hey, someone should write a book about this guy! Why don’t you take this on?” Her immediate response was, “You know John, I think you should write that book. You’re always writing these ‘save the world’ books, I’d love to see you write a ‘fun book’ for a change!” Well I accepted the challenge, invited Jack into my office when we got home, and we began cranking our joint literary project, The World According to Jack: A Dog’s-Eye View with Self-Help Advice for Other Dogs. Technically Jack is the author and I’m the senior assistant,
author, and business manager (we had a tug-of-war and I lost). I can’t begin to tell you what a totally joyful and enlightening experience it’s been to get inside that little guy’s heart and head everyday as our book progresses. We’re currently doing the finishing touches, have lined up a publisher, and anticipate the book’s release early next year.
Some Personal Thoughts
Before bringing this column to a close, I will briefly discuss a few points of departure from traditional trainings in mindfulness I have chosen to take over the years. Of course these are only my own opinions and observations; if whatever you are currently doing works for you, by all means stick with it! A basic tenet of mindfulness training in the Zen tradition emphasizes a rigorous regimen of meditation training designed to develop and hone one’s skills in one-pointed concentration. While I definitely attempt to employ one-pointed concentration in many aspects of my life, I also believe it’s healthy to occasionally let go and slack off a bit. I believe this particularly applies to overly compulsive types like yours truly, who become obsessed with virtually everything we focus our attention on. For this reason I tend to rebel against whatever comes across to me as an overemphasis on ritual and technique. In regard to meditation, for example, I believe that some instructors tend to overemphasize the mechanics entailed in right posture, right sitting, staring at a blank wall throughout the sitting, and so on. Personally I am very comfortable with sitting in a comfortable chair with a straight back, maintaining a reasonably upright posture with both eyes closed, while continuously focusing on repeating my mantra throughout the sitting. While I generally let go of any thoughts or emotions as I notice them, if an interesting insight pops up as part of this process I allow myself to spend some time reflecting on that concept. One aspect of traditional Zen meditation that is a definite turn-off is the classic exercise of walking meditation. At least in trainings I have attended,
in walking meditation we are instructed to fully focus our attention on the act of walking very slowly, while consciously focusing strict attention on the sensations in our feet as they touch and leave the ground. Maybe it’s me, but this exercise invariably leaves me feeling both stifled and bored as I perceive myself consciously overfocusing on an automatic movement I have never had to think about before. As I described earlier, I find that the experience of briskly and joyfully walking in a natural environment while fully taking in the scenery and other sensations associated with being fully immersed in my surroundings—viewing the world around me through the eyes of a child—provides an infinitely richer experience than anything I have ever encountered in classic walking meditation training. Not wanting to close on a negative note, I truly believe that cultivating the quality of mindfulness has profound applications in recovery from addictions, as well as in our daily lives. As a recovering obsessive-compulsive, however, I find it healthy to occasionally let go and step outside the box. When I choose to do this I often find myself swept away into an incredibly rich and awe-inspiring experience of spontaneous mindfulness! As always, feel free to share this column with clients and others who might benefit from the message. Until next time—to your health! c John Newport, PhD, is an addiction specialist, writer, and speaker living in Tucson, AZ. He is author of The WellnessRecovery Connection: Charting Your Pathway to Optimal Health While Recovering from Alcoholism and Drug Addiction. You may visit his website www.wellnessandrecovery.com for information on wellness and recovery trainings, wellness coaching by telephone, and program consultation services that he is available to provide.
Ash, M. (1993). The zen of recovery. New York, NY: TarcherPerigee. Gorski, T. T., & Miller, M. (1982). Counseling for relapse prevention. Independence, MO: Herald House. Marlatt, G. A. (1994). Addiction, mindfulness, and acceptance. In S. C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.), Acceptance and change: Content and context in psychotherapy. Reno, NV: Context Press. Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York, NY: Guilford Press.
Enjoy this sneak peek of Counselor's December 2016 Issue!