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Sex Addiction: Too Much of a Good Thing?

Written by Munis Topcuoglu, Editor at EHN Canada.

A valid definition and diagnostic criteria for “sex addiction” have long eluded experts because, historically, definitions and diagnostic criteria have either represented sexually oppressive cultural norms, or they have been vague and imprecise, requiring too much subjective interpretation. Cultural norms, oppressive or otherwise, are not valid bases for diagnostic criteria, because they have no scientific justification. The definition of “too much sex” has varied widely throughout history and currently varies widely throughout the world, and none of the definitions are supported by scientific evidence.

The following excerpt from the book Nymphomania: A History describes a historical example of the problem of diagnosing sex addiction based on cultural norms:

In the Victorian period, both doctors and patients who sought medical help believed that strong sexual desire in a woman was a symptom of disease. Self-control and moderation were central to the health of both men and women, but women’s presumably milder sexual appetite meant that any signs of excess might signal that she was dangerously close to the edge of sexual madness.

Another excerpt from Nymphomania: A History, illustrates the absurdity of Victorian doctors’ culturally biased understanding of the etiology of “nymphomania”:

Eating rich food, consuming too much chocolate, dwelling on impure thoughts, reading novels, or performing ‘secret pollutions’ [i.e. masturbation]… overstimulated women’s delicate nerve fibers and led to nymphomania.

Interesting to note, is that in the Victorian era, the male equivalent of nymphomania “satyriasis” existed in medical textbooks, but was almost never diagnosed in practice—because “a man wanting too much sex” was not really considered a thing. Fortunately, both science and culture have come a long way since then, and we are now able to understand sex addiction in more functional and less sexist terms.

Evidence-Based Definition and Diagnosis of Sex Addiction

If we make the effort, we can minimize cultural bias, and define and diagnose sex addiction based on evidence. The key element for deciding whether or not a person’s sexual behavior is problematic is determining whether or not their sexual behavior results in real negative outcomes. This is the most effective approach for identifying genuinely problematic sexual behaviors and it lays the groundwork for creating effective treatment programs for the people who have them.

Required criterion: negative consequences or endangerment

The necessary criterion for identifying sex addiction is that the person’s sexual behavior actually results in negative consequences or endangerment in one or more of the following ways:

Other signs of sex addiction: loss of control, frequency, consuming focus, and mood regulation

The following features can be signs of sex addiction when they result in negative consequences or endangerment:

The “other signs” by themselves are too subjective for diagnosis

The inability to control, reduce, or stop sexual behavior is only a sign of sex addiction when the person recognizes that the behavior has negative consequences or is unacceptably dangerous. Similarly, excessive frequency and repetition of sexual behaviors, or excessive focus on sex, can only be signs of sex addiction when the individual recognizes the negative consequences or dangers because, otherwise, “excessive” is merely cultural and subjective. It’s also important to note that, for similar reasons, engaging in sexual behaviors that others find offensive or disturbing does not, per se, indicate sex addiction.

What Is the Underlying Disorder?

Experts tend to agree that the problematic and uncontrollable sexual behaviors associated with sex addiction are usually the result of an underlying mental health disorder. They do not agree on which disorder is most often the cause, but the following is a list of possibilities:

Consequently, there does not exist an established standard process for how to treat sex addiction.

Understanding sex addiction as an attachment disorder

At EHN Canada, we find that nearly all of our sex addiction patients have underlying attachment disorders. Our experience has shown us that treating a patient’s attachment disorder is essential for helping the patient to overcome sex addiction, regain control of their sexual behavior, and have healthy and satisfying intimate relationships.

In adults, attachment disorders usually result in problems with intimate relationships that can include any of the following:

Hence, we understand that sex addiction is a relational and intimacy disorder and this understanding informs our approach to designing the most effective treatment programs to help patients overcome sex addiction.

Interactions with concurrent substance use disorders

Sex addiction and concurrent substance use disorders can interact in a number of different ways including the following:

At EHN Canada, we believe that it’s essential to understand how each patient’s sex addiction interacts with any substance use disorders that they may have. We address these interactions in the individualized treatment programs that we design for each patient. This approach allows us to create the most effective treatment programs according to each patient’s unique needs.

EHN Canada’s Sex Addiction Treatment Programs

Patients are admitted to our treatment programs based on screenings that evaluate the negative outcomes of their sexual behaviors and their persistence in engaging in those behaviors. Since we expect that problematic sexual behavior usually stems from an underlying attachment disorder, we analyze each new patient’s history of family relationships and family dynamics to learn about their attachment style. To allow us to further individualize our treatment programs to address each patient’s particular needs, we also screen for the following:

Ultimately, our goal is to develop a deep understanding of what the problematic sexual behaviors mean and signify personally for each patient, rather than try to understand the sexual behaviors in terms of any standard typology. We believe that this understanding allows us to design the most effective treatment program for each patient and reduces the influence of cultural bias.

Helping patients regain control of their sexual behaviors

EHN Canada treatment programs are designed to help patients regain control of their sexual behaviors. This begins with helping patients recognize and fully acknowledge the consequences of their problematic sexual behaviors. Next, we teach them how to identify and predict situations in which their sexual behaviors might have negative outcomes. We also teach patients how to identify triggers for their problematic sexual behaviors and how to address them in healthy ways. Throughout the process, we help patients with concurrent substance use disorders understand how their substance use disorders interact with their problematic sexual behaviors.

Whenever applicable, group education and therapy activities are conducted in small, intimate groups where patients can learn from each other in an environment free of shame and judgment. The following are some of the activities that help patients regain control of their sexual behaviors:

Teaching patients how to build healthy and satisfying relationships

Since we view sex addiction as a relational and intimacy disorder, our treatment programs include substantial education and therapy components focusing on interpersonal work such as effective communication, relationship building, and developing healthy attachments. Due to their interpersonal and experiential emphasis, our sex addiction programs involve more in-the-moment behavioral interventions compared to our other addiction and trauma programs.

Again, whenever applicable, group education and therapy activities are conducted in small, intimate groups where patients can learn from each other in an environment free of shame and judgment. The following are some of the activities that teach patients how to have healthier and more satisfying relationships:

Other elements of treatment programs

The following elements are included in some of our treatment programs or may be optional for patients:

Full recovery takes much longer than other addictions

A full recovery from sex addiction can take three-to-five years after completion of a treatment program. Therefore, long-term success depends on a patient’s commitment to participating in aftercare programs and to continue working on themselves after they complete one of our residential treatment programs.

EHN Canada Sex Addiction Treatment Programs

If you or someone you love needs help with sex addiction, please call us at one of our numbers below for more information or to enrol in one of our programs.

References

Groneman, C. (2000). Nymphomania: A History. New York, NY: Norton.

Krueger, R. B. (2016). Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD‐10 and DSM‐5 despite rejection of this diagnosis by the American Psychiatric Association. Addiction, 111(12), 2110-2111.

Ley, D.J. (2012). The Myth of Sex Addiction. London, England: Rowman & Littlefield.

https://en.wikipedia.org/wiki/Attachment_in_adults

When the Most Destructive Force in Your Life Is You, Then It’s Time to Reach out for Help

Opinion by Guest Writer
Written by Lorelie Rozzano, an internationally recognized author and advocate.

If you struggle with addiction as I have, you know the dark, hopeless place that exists on the other side of being high. It’s the thing that every addict tries to avoid—reality. Reality is the time and place when you’re not high or intoxicated and forced to face the consequences of your actions. For me, reality was the morning after. I’d lie in bed and remember all the horrible, embarrassing things I’d done the night before. I would replay each moment wishing I could turn back the hands of time and undo my humiliating deeds. To cope with my painful emotions, I sought relief through substance abuse and then the process would start all over again. I was baffled by my inability to use drugs and alcohol socially. I tried changing how much I used, what I used, and the places I used, but it didn’t help. Each time I consumed a substance, the consequences seemed to get worse. In spite of my good intentions, I continued hurting my family and my life was a mess.

At the time, I didn’t believe I was addicted. I didn’t know I was sick or that my thinking had changed. Addiction is sneaky. It starts with subtle shifts in your perception and behavior. The following are five ways it can play tricks on you.

(1) You’re in Denial

Denial is a primary roadblock to getting help. Denial makes things appear smaller than they are. Denial tells you your problems aren’t that bad. Denial says I’m not hurting anyone. Denial says I can quit whenever I want to. Denial protects you from facing the facts. Denial is dangerous as it minimizes warning signs and perpetuates the problem. No amount of pretending can make addiction go away.

(2) You Make Promises You Can’t Keep

You promise to show up on grandma’s birthday. Yes, you’ll pick up the kids after school. Of course, you’re coming home straight after work. But in spite of your good intentions, you’re unable to follow through. You can’t predict what might happen anymore. You’ve lost credibility. The more you try and control your addiction, the more it controls you. Every time you use the substance, you break hearts and hurt the people you love.

(3) You Manipulate Your Friends and Family

You lie to cover up what you’re doing. You tell people what they want to hear to get them off your back. You may pit parent against parent, or friend against friend. You know who to call when you need money. You’re good at fabricating excuses and making it seem like the problems in your life are never your fault. You blame others when cornered and manipulate your loved ones through guilt and fear tactics.

(4) You don’t tell anyone, but you’re scared, and you cope with your fear by using more

While using the substance was fun in the beginning, now it’s become work. Maintaining your addiction is a full-time job. When you’re not high, you feel fearful and anxious. The euphoric release you once found in the substance has disappeared. You’ve developed tolerance and need increasingly larger doses to produce the same physiological and psychological effects. You’re not using to feel high anymore; you’re using to feel okay and avoid withdrawal symptoms.

(5) You feel ashamed

You know your life is out of control, but you don’t know how to make it stop. You hurt everyone who loves you. Your best thinking is killing you. You can’t look in the mirror. You feel ashamed and avoid people. Shame is an uncomfortable, toxic emotion. Shame tells you you’re unworthy, unlovable, and inadequate. Shame says give up. Shame creates feelings of hopelessness and despair.

Take responsibility

While you’re not responsible for your addiction, you are responsible for your recovery.

Nobody wakes up and says “I’m going to be an addict.” But there is one choice addicted people make, and that’s how long they will stay sick. While addiction isn’t a choice, recovery is.

When the most destructive force in your life is you, then it’s time to reach out for help.

Good intentions followed by broken promises don’t mean you’re a terrible person. Substance use disorder is a progressive disease that if left unchecked can be terminal. But there is hope. Addiction is treatable. Recovery happens when you stop making excuses and start taking action. The key to wellness is breaking your silence and admitting you need help. There’s no shame in wanting to get better and the only way you can fail at recovery is to quit trying.

We Can Help You

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

Recovering from Sex Addiction: Getting out of the Storm and Back to My Life

Opinion by EHN Alumni
Written by Adam W, a recent graduate of the sex addiction program at Edgewood Treatment Centre.

Before I arrived at Edgewood to start working on my recovery from sex addiction, my life was like being in the eye of a tornado. That might be a tough analogy for someone to understand, but I was in the middle of a storm, with no way out. Everything around me was getting caught in the storm and I was simply waiting for it to take me away with it. I couldn’t find my own way out, and I certainly was trying to harm myself enough so that perhaps I wouldn’t wake up. I remember the feeling of despair and this heavy sadness.  When it was suggested I “go away” for a while, to take a break and heal—despite the tremendous arguments I had to not go—I simply gave up and said “okay.” 

I had lost my wife, been kicked out of my house, and had been removed from being a part of my kids’ lives. My family of origin stopped being involved with me, my business was crumbling, and my closest of friends had given up on trying to help. As typical of a pre-treatment story that is—it was and is my story. 

I quickly packed my personal belongings in Calgary and travelled to Edgewood, soon realizing that I was no longer alone in this storm. The men’s sex addiction group in my treatment program was a critical part of my recovery and healing. I could speak with men who could relate to the pain and shame associated with engaging in problematic sexual behaviours for many years. Although the group structure throughout the week was tremendous for unpacking a lot of stuff, the ability to really do the work in the confidence of men who were walking a similar path made me feel safe to express, accept, and move on from that part of my life. In previous treatments and therapy, I had never been able to explore my problematic sexual behaviours and the associated guilt, shame, and sadness that I held inside. If I had not addressed that pain, I would not have been able to grow and find my footing in recovery. 

Some of the highlights of the program at Edgewood include the sacredness of the room, the compassion from the other men, and the guidance from the sex addiction therapists. The ability to share my story, the unheard version of my life that I was unable to previously share in co-ed settings, with other men who were willing to do the same, was transformational in my healing and essential for my recovery.

I learned that the work, meetings, groups, walking with men in recovery, and service to others are all lifelong habits and commitments that I need to make daily to continue to enjoy the blessings of recovery and good mental and spiritual health. It’s not a destination but a journey of awakenings, blessings, and sharing and giving that allows me to enjoy my life today.

The opportunity to give back in some small way to this program, and to the men with whom I walked, is something I cherish and for which I am thankful.

With gratitude for being in recovery from sex addiction,

Adam W.

We Can Help You!

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

More Information About Our Sex Addiction Programs

You can also find more information about our sex addiction programs on our website:

Four Things You Need to Know About Fentanyl to Stay Safe

Fentanyl has been a problem in Canada for several years now and the situation is not getting any better. It feels like every day brings a new report about an overdose, an arrest, or a large shipment seized on its way to a Canadian city. Fentanyl is a synthetic opioid typically used to treat severe and chronic pain; for example, it is often prescribed for cancer patients. Understandably, digesting all the information from numerous news stories and constant buzz can be difficult, so here we are providing some quick facts about fentanyl in Canada.

(1) It’s Fast and Deadly

Fentanyl is 50 to 100 times more toxic than morphine and 100 times stronger than heroin. It’s so potent that you can overdose on as little as two milligrams. When ingested, it can reach your brain within minutes and cause respiratory failure. Many of the reported deaths have happened this way: someone takes half a pill, falls asleep and never wakes up.

(2) It’s Highly Addictive

Just like any other opioid, fentanyl is extremely addictive. Many users report craving it after just one use. Also like other opioids, regular users build a tolerance: they need to use more and more to get the same high, which is very dangerous with such a toxic drug.

(3) It’s Often Cut into Other Drugs

Fentanyl has been found in many other drugs like heroin, cocaine, and oxycodone. Often, people who think they’re buying oxycodone will really be getting Fentanyl. It has no odour or taste, and it’s invisible, so using a testing kit is the only way you can tell if it’s in your drugs.

(4) A Lot of People Are Dying

Given that you can overdose on an amount the size of two grains of salt, it’s not surprising that people are dying. This is especially true because many people are consuming fentanyl unknowingly through other drugs that are laced with it. People who do consume it intentionally, usually consume non-pharmaceutical street fentanyl produced by an amateur chemist. This implies that impurities and toxicity can be even higher than pharmaceutical fentanyl. Also, dealers often combine it with caffeine, meth, or heroin which increase the probability of a negative reaction or overdose. Vancouver has the highest rate of deaths from overdose in Canada, most of which are likely from fentanyl and other similar opioids like carfentanil. So far, this year (as of the end of September, 2018) there have been over 260 deaths from suspected overdose in Vancouver.

Safety Resources

TestKitPlus Fentanyl Testing Kit
Bunk Police Fentanyl Testing Kit
DanceSafe Fentanyl Testing Kit
How to get a naloxone kit if you live in BC

We Can Help You

If you would like to learn more about the treatment programs provided by EHN Canada, enrol yourself in one of our programs, or refer someone else, please call us at one of the numbers below. Our phone lines are open 24/7—so you can call us anytime.

The Facts, Effects and Dangers of Benzodiazepines

Benzodiazepine Abuse Epidemic

Benzodiazepines are a prescription medication that is commonly prescribed by a physician for individuals with legitimate medical conditions such as:


Yet, individuals across North America are obtaining these prescription drugs illegally and therefore are abusing these drugs to obtain the side effects that one experiences using them.

There is a serious epidemic occurring in the United States and is quickly spreading into Canada. According to a recent report released in 2013 from the International Narcotics Control Board, Canada is now the second- largest per capita consumer of prescription opioids, behind the U.S.

As stated by Health Canada, “In 2012, about 1 million youth, aged 15-24 years, reported having used a psychoactive pharmaceutical in the past year.” As a result of this research, Health Canada is looking for ways to raise awareness among parents and youth about the health risks of marijuana and prescription drug abuse.

Serious prescription drug abuse is taking place in Canada. Many youth are taking drugs what they believe to be MDMA, Molly and other designer drugs but in fact are a concoction of illegal and unidentifiable ingredients.

Here is Bellwood’s first mini blog series entry on the various prescription drugs that are being abused by many Canadians of all ages:

What are benzodiazepines?

Benzodiazepines are a group of prescription medications used to produce sedation and muscle relaxation. Through their effect on the Central Nervous System, they have the ability to lower anxiety levels. They are milder than other tranquilizers and are commonly prescribed by medical doctors to treat anxiety, agitation, insomnia, muscle spasms and seizures.

Benzodiazepines are categorized as short-acting, intermediate and long-acting. Short and intermediate-acting benzodiazepines are usually used to treat insomnia while longer-acting ones are used in the treatment of anxiety and alcohol withdrawal.

Benzodiazepines have often been called the most widely prescribed group of drugs in the world and the biggest selling drugs in the history of medicine with worldwide sales in excess of $21 billion in 1999. An estimated 60% of users of tranquilizers and sleeping pills suffer a mixture of adverse effects and withdrawal after 2 – 4 weeks of use (including therapeutic dose levels) due to tolerance and addiction.

Commercial Names: Ativan, Halcion, Librium, Valium, and Xanax
Street Names: Candy, Downers, Benzos, Rowies, Sleeping pills, Tranks, Date Rape Drug, Club Drug

How are benzodiazepines used?

Benzodiazepines mostly come in the form of pills although they are also available through injection. When taken orally, benzodiazepines must first be metabolized by the liver in order to exert their effects. This method results in approximately 50% of the drug undergoing first-pass metabolism, which lessens its effect. Injection bypasses the metabolism and results in a stronger effect.

How do benzodiazepines make you feel?

The effect of benzodiazepines depends on many different factors such as a person’s height, weight and dosage. Some common immediate effects include a feeling of relaxation, drowsiness, decrease in energy levels, mental confusion, dizziness and short-term memory impairments.
Long-term users may experience further effects such as a lack of energy and interest in doing every day activities. They may feel irritable, nauseated, and have headaches and experience loss of libido. Long-term use of benzodiazepines may also lead to depression.

What are some possible side effects of benzodiazepines?

Side effects caused by benzodiazepines may include drowsiness, dizziness, upset stomach, blurred vision, headache, confusion, depression, euphoria, impaired coordination, changes in heart rate, hypotension, trembling, weakness, amnesia, grogginess, dreaming or nightmares, chest pain, and vision changes. Benzodiazepines share many common effects with alcohol and barbiturates.

What causes the effects?

Benzodiazepines act to prevent or inhibit neurons in the brain from firing neurotransmitters. This occurs because benzodiazepines increase the release of a chemical called GABA – the primary inhibitory neurotransmitter in the brain – which serves to inhibit the release of other neurotransmitters.

How long do the effects last?

Duration of the effects of benzodiazepines depends on whether they are short, intermediate or long acting. Short acting benzodiazepines have a half-life of less than 12 hours while long-acting ones have a half-life of 24 hours or more. However, duration of apparent effects is usually considerably less than that. For most benzodiazepines these effects wear off within a few hours. However, the drug can continue to exert subtle effects within the body, which becomes apparent through withdrawal-related side-effects.

Are benzodiazepines addictive?

It is very easy to become dependent on benzodiazepines in as little as four weeks. Dependence develops sooner in people who take higher doses of the drug. Abrupt discontinuation of the drug or a drastic reduction of dosage results in withdrawal symptoms. Some of the withdrawal symptoms may be identical to those for which the medication was originally prescribed. Most common withdrawal symptoms from discontinued use of the drug are increased anxiety, depression, autonomic instability, insomnia and sensory hypersensitivity.

Are benzodiazepines dangerous?Effects Of Benzodiazepines

When used in prescribed dosages, benzodiazepines are relatively safe. Overdose of benzodiazepines rarely results in death; however, concurrent use with other drugs or alcohol can lead to death. Benzodiazepines are also highly addictive and rapid discontinuation of the drug can lead to convulsions and seizures.

Treatment for Benzodiazepine Addiction

A person with chronic abuse usually requires the assistance of a doctor or specific drug rehabilitation centre. Bellwood Health Services can help individuals recover through a specialized, comprehensive and client-centred treatment program for prescription drug addiction. Our recovery care is based on a medical and holistic treatment model – an ddiction treatment approach that addresses an individual’s physical, psychological, social and spiritual well-being. Our team of caring professionals works closely with the individual and the family to provide counselling and treatment to meet the individual’s needs.

A good starting point is to call and speak with one of Bellwood’s addiction specialists. They can help identify an individual’s specific needs, discuss options, and next steps to help stop the cycle of addiction in a safe manner.

References:

https://www.webmd.com/mental-health/addiction/benzodiazepine-abuse

https://www.emedicinehealth.com/benzodiazepine_abuse/article_em.htm

https://www.addictionbyprescription.com/facts.php

https://www.drugs-forum.com/forum/showwiki.php?title=Category:Benzodiazepines

https://www.benzo.org.uk/manual/bzcha01.htm#6

https://www.aafp.org/afp/2000/0401/p2121.html