Preventing Relapse

(Chapter 10 from "Treating Alcohol and Drug Problems in Psychotherapy Practice")

“It’s easy to stop smoking- I’ve done it hundreds of times.” When Mark Twain made this humorous remark, he was referring to the problem of relapse as applied to his own nicotine addiction. In this one simple statement he described a major dilemma encountered by people trying to overcome addictions; specifically, that stopping an addiction in the short term is relatively easy and not nearly as difficult as staying stopped over the long term.  In other words, quitting may be fairly easy, but staying quit tends to be a more formidable challenge. Many addicted individuals are able to stop for a few days, weeks, or months (sometimes even years), but many if not most fall back into using again despite their best intentions to quit for good. This experience is so common among addicted persons that it is safe to say that one of the most distinguishing features of an addiction- whether to drugs or something else- is the proclivity for relapse, especially during the weeks and months immediately following cessation of use.

Click here to read full version of this chapter

Stimulant Drugs and Sex

Many stimulant users report that their use of cocaine or methamphetamine is strongly associated with sex. Male users in particular report that stimulant drugs increase their libido and decrease their sexual inhibitions. Stimulant drug use may engender compulsive masturbation, prolonged sexual encounters involving numerous partners, promiscuous sex, and unsafe sex practices.  In addition, the disinhibiting effects cocaine or methamphetamine opens the flood gates to sexual adventurousness leading some users to engage in sex acts they either do not find appealing or are too inhibited to try when not high on stimulant drugs. For example, only under the influence of cocaine or methamphetamine do some heterosexual engage in homosexual fantasies and behaviors (Washton, 1989b; Rawson et. al., 2002).

The combination of stimulant drug use and sex, two extremely potent reinforcers, creates a “super high” that is more addicting than the drug use alone. Individuals who experience these potent effects become addicted not only to the drug, but to the combination of the drug-induced high and the highly charged drug-induced sexual experiences. For these individuals, drugs and sex are inseparable. 

Click here to read the full version of this chapter

The Addictive Personality

We hear a lot about the "addictive personality," and it is true that certain traits increase one's chances of becoming addicted to something. For instance, if you are painfully shy and self-conscious and a particular drug makes you feel more relaxed and sociable, chances are you're going to want to use it again and again—setting the addictive process in motion.

It's easy to think that the personality trait itself (painful self-consciousness, in this case) is what causes the addiction, but the problem actually goes much deeper than that. The inner disease that makes us so vulnerable to addiction seems to originate in our belief system, for the beliefs we hold about ourselves, others, and the world around us determine to a large degree our feelings, personality, and outward behavior. In other words, if a person did not hold certain beliefs about himself, he would not be painfully self-conscious to begin with.

Click here to read the full version of this chapter

Ingredients of the Integrative Treatment Approach

(Chapter4 from “Treating Alcohol and Drug Problems in Psychotherapy Practice”)

The integrated approach to treating substance abuse is a model we have evolved over many years of working with patients in institutional settings and in our office practices. Regrettably, and despite the fact that studies on the treatment of substance abuse have demonstrated convincingly that no one method of treatment is better than all others, the addiction field continues to be split into opposing factions, each claiming superiority of their own approach.  Our clinical experiences have taught us to steer clear of dogmatic approaches claiming to be the single best method for treating substance abuse. We are by no means the first to acknowledge or write about the importance of a more flexible, integrated approach , but the addiction treatment system in some parts of the country has been slow to move beyond rigid adherence to the disease model and reliance on harsh confrontational tactics. Although in recent years motivational and other individualized client-centered approaches have been incorporated increasingly into addiction treatment programs in both public and private sectors, a welcomed change indeed, many individuals who make contact with traditional treatment programs still encounter a confrontation-of-denial  “one size fits all” approach.

Click here to read the full version of this chapter