Sugar consumption and addiction fits the classic DSM criteria for substance dependence, including increased physical tolerance; substance taken in larger amounts than intended (whom among us hasn’t eaten an entire bag of cookies or chips?); persistent desire or repeated unsuccessful attempt to quit; use continues despite knowledge of adverse consequences; adverse effects on work, relationships and social functioning; and physical withdrawal symptoms (such as headache, fatigue, irritability and poor concentration).

However, the physiological, mental and emotional effects of sugar addiction on a person frequently mimic other disorders, further muddying the waters in terms of accurately identifying the real culprit. Common symptoms from a sugar high or crash look very much like classic anxiety and depression, and a host of other disorders, including:

• Nervousness
• Exhaustion, weakness

• Faintness, dizziness, tremors, cold sweats
• Drowsiness
• Forgetfulness, confusion
• Constant worrying, unprovoked anxiety
• Craving for sweets or alcohol
• Heart palpitations, rapid pulse
• Indecisiveness
• Lack of coordination
• Lack of concentration
• Muscle twitching and jerking
• Sighing and yawning
• Irritability
• Depression
• Headaches
• Insomnia
• Internal trembling
• Numbness
• Crying spells
• Leg cramps
• Blurred vision
• Itching and crawling skin sensations
• Unconsciousness (The Mood Cure, Julia Ross, 2002)

How many DSM-IV-TR diagnoses could we make out of this list? ADHD? Depression? Anxiety? PTSD? Alcohol intoxication? Psychosis due to Substance Abuse? Yes, yes and yes. This sugar-fueled wild goose chase can lead many-a clinician down a dead-end path. We think we’ve rooted out the problem when a client quits cocaine, only to experience ongoing symptoms as they pound their Red Bull and donut-shop fare.

It’s time to broaden the lens and look at the whole picture of health and illness. A few facts to start: Sugar consumption in America has skyrocketed to disturbingly unhealthy amounts. “We ate 25 pounds of sugar a year in 1900. We now eat over 125 pounds a year, five times more sugar a year than we did then. We also eat lots more starchy white flour products (white bread, bagels, pasta), which act almost exactly like sugar in the body” (The Mood Cure, Julia Ross, 2002).

The insidiousness about this addiction is that sugar is literally hidden everywhere, making a simple trip to the supermarket a veritable minefield of stealthy toxins, waiting to wreak havoc on our wellbeing. Jarred marinara sauce, salad dressings and even whole wheat crackers harbor sugar in their ingredient list, going by such aliases as sucrose, glucose (any –ose, actually), evaporated cane juice, corn syrup, turbinado and malt.

Yes, I’m being a bit overly dramatic in my verbiage, mostly to make a point about the far-reaching effects of sugar on our bodies and minds. And for good reason. Here’s a brief tutorial on what happens when we consume sugar in any form.

Any sort of sugar or carbohydrate (simply, a substance that breaks down into glucose) triggers your pancreas to release insulin to “remove the excess carbohydrate from your bloodstream and store them as fat. The insulin sweeps away most of the amino acids out of your bloodstream, along with the carb. Only one amino gets left behind – tryptophan – and it goes right to your brain, unimpeded by the other aminos that usually get crowded out” (The Mood Cure, Julia Ross, 2002).

This pleasure-producing amino acid is highly addictive, so naturally we want more. This begins a nasty cycle of consuming too many calories and too few nutrients, for which the body must pull from its reserves to assimilate the glucose into the blood and cells. This depletion leaves you feeling…depleted – low energy, low mood, poor motivation – and needing a quick fix.  You can see how the language of addiction is the same here as it is for alcohol and drugs.

Dr. Mark Hyman, a pioneer in the field of Functional Medicine details the mechanics of a sugar addiction in the making:

“Eventually we become resistant to all this insulin in our blood, just as we would become resistant to a drug. The body needs more and more of it to do the same job it once did with far less. So our insulin production system spirals out of control, pumping ever more into our bodies.

All this insulin tells us we are starving (that’s literally the message our bodies get), so we crave foods with high-sugar content – the very same foods that caused the problem in the first place.” (The UltraMind Solution, Dr. Mark Hyman, 2009)

But the bad news does not end with endless cravings (as if that weren’t bad enough). The list of physical problems that result are long and, quite frankly, depressing: “Excess sugar (especially the devilish white stuff) robs your body of minerals, lowers your precious pH, rots your teeth, wigs out your pancreas, feeds candida, fires up inflammation, osteoporosis, diabetes, and cancer, stresses your nervous system and adrenals, and screws with normal hormone function. It also makes you feel crappy after the initial jolt subsides. Sugar taxes your immune system and is highly addictive” (Crazy, Sexy Diet, Kris Carr, 2011).

Some of the precious vitamins sugar robs from your body are the good-mood-essential B vitamins. Absent these critical nutrients, we are more susceptible to depression and anxiety, as well as PTSD and obsessive-compulsive behaviors (The Food-Mood Solution, Jack Challem, 2007).

So what do perennial sweet favorites contain that makes them so irresistible? Let’s start with chocolate:

“Chocolate contains not only plenty of sugar, but at least five drug-like substances: theobromine, caffeine, salsolinol, PEA, magnesium, and amandamide (a marijuana-like brain chemical). All are either stimulating or opiate-like. This extraordinary collection of psychoactive ingredients explains a great deal about chocolate’s super-addicting allure.

Sugar, especially combined with chocolate, forces a rise in endorphin levels. It is the ultimate ‘pleasure’ drug food, but many people can attest to the addictive pleasure of bread and cheese as well” (The Mood Cure, Julia Ross, 2002).

Long-term exposure to sugar in all its forms continually wears down the body until new physical and emotional issues surface. The biggest havoc sugar wreaks is creating a hospitable environment for cancer to grow and proliferate. “Healthy cells love oxygen; cancer cells don’t. Their clunky anaerobic metabolism produces a lot less energy. So to stay alive, cancer cells need a bigger fuel supply. What’s the best way to get quick fuel? Sugars and carbs!” (Crazy, Sexy Diet, Kris Carr, 2011).

As if cancer wasn’t enough to worry about, the issue that will stop most people in their tracks is right under their noses. Literally. I’m talking about good old-fashioned fat. Insulin is a fat-storage hormone, so it not only tells you to eat more empty calories than you need, but it then holds on to them in the form of fat – and won’t let go. So it is literally insulin that is making you fat and keeping you fat.

But wait! There’s more! “It makes your blood sticky and more likely to clot, leading to heart attacks and stroke” (The UltraMind Solution, Dr. Mark Hyman, 2009). It increases inflammation (the source of all pain and disease) and oxidation in our bodies, which increases your odds for Alzheimer’s. It also disrupts healthy sex hormone functioning, which contributes to infertility and unwanted hair growth.

The inflammation of the brain’s cells and neurons contributes to dementia and even autism. Additionally, sugar feeds the “bad bugs” in our gut: parasites, yeast and toxin-producing bacteria. Symptoms from these bugs can mimic many mood disorders, as well as physical symptoms seemingly unrelated to the stomach (The UltraMind Solution, Dr. Mark Hyman, 2009).

Dr. Hyman relates a story about a six-year-old girl who came to him with OCD, aggressiveness and suicidal ideation:

“She loved sugar and refined pastries and carbs… The bacteria and yeast [in the stomach] literally ferment the sugary, starchy foods in the diet, producing ‘auto-intoxication’ with alcohol – a by product of this process. Violent, aggressive behavior so commonly seen in drunks can occur from alcohol produced by yeasts in the gut. I wonder if this little girl had a little auto-brewery in her belly…

The cure was a gluten- and dairy-free whole foods, organic diet; some cod liver oil; magnesium; methylation helpers like B₆, B₁₂, and folate; a multivitamin; and some probiotics…[and] antibiotic to clear out the bad bugs in her gut, followed by an antifungal. [S]he transformed into a well-behaved little girl. Her aggressiveness, negativity, and hopelessness were gone” (The UltraMind Solution, Dr. Mark Hyman, 2009).

And this is just one of hundreds of thousands of anecdotes from integrative doctors and clinicians who looked a little deeper to find what was causing the symptoms that are typically treated “topically” – as Dr. Hyman describes it: “Name It, Blame It, Tame It” – treated them at the root level and saw complete amelioration of symptoms.

Fortunately, treatment for sugar addiction is fairly straight-forward: go cold turkey on sugar, and flood your body with oxygen-producing, nutrient-dense and -rich foods, such as dark, leafy greens, veggies of all sorts, low-glycemic fruits and grains, as well as proteins, such as eggs, fish, turkey and chicken, nuts and beans and a lot of water. Certain nutritional supplements can also help restore depleted vitamin and mineral deficiencies, and are typically recommended. If all symptoms do not clear after a couple of weeks consistently following this plan, clients may need to be test for adrenal fatigue and thyroid issues, both of which can be taxed when insulin works too hard for too long.

But while the treatment is not complex, the ability to successfully complete it can be very challenging. This makes finding a holistically-trained doctor or health counselor to assist in the process especially important. And the rewards for breaking sugar addiction are well worth the effort: increased energy, reduced cravings, effortless weight loss, increased mental clarity and elimination of many physical, mental and emotional side effects. Sweet.

It is estimated that 5% of the general population are compulsive gamblers. Of those, one-third are women.*

Research shows that women begin gambling later in life, closer to age 30 or 35, versus men, who may begin in their teenage years. Even with a later start, according to Reuters Health (2000), women are at greater risk for gambling compulsively and become addicted to gambling three times quickly than males. As a result of women gambling later in life, the onset of becoming addicted happens more rapidly and, much like building tolerance to alcohol, women build tolerance to gambling, leading to compulsivity.

How does gambling become compulsive? Signs and symptoms include:

• Thinking excessively about gambling
• Increasing how often she talks about her past gambling experiences
• Gambling as a response to her negative feelings
• Attempting to gain back her financial losses
• Lying to family members or others regarding the extent of her gambling
• Committing illegal acts, such as forgery, fraud, theft or embezzlement to finance her gambling
• Hiding her gambling activities
• Feeling restless or irritable when she is unable to gamble
• Increasing the amount of money so she feels a rush of euphoria
• Attempting to stop or cut back her gambling behaviors

Of the one-third of the population who gamble compulsively, 95% of women gamble to escape from:

• Chronic pain/health problems
• Loneliness/isolation
• Boredom/lack of leisure
• Grief and loss
• Abuse
• Domineering spouse/relationship issues
• Emotional issues (depression, stress, empty nest, lack of identity, fear of death, loss of loved one) **

Women who are compulsive gamblers typically enjoy gambling on games of chance (lottery, slot machines, bingo, poker machines) versus games of skill (blackjack, pool, sports). Games of chance are truly games based on a random chance. Games of skill are also based on random chance, but one can practice and improve, which will then increase his or her probability of winning. Those women who are escape gamblers gamble on games of chance because these games truly allow her to escape into the game or the machine. Women discuss how the machine becomes her “friend”; “the machine is always there”; “it never lets me down, even when I’m losing.” As she gambles, she is able to block out everything around her and it becomes just her and her “friend.”

Online gambling is also an increasing concern. Researchers report that out of the estimated 30-40 million online gamers, women represent 50.2%. Not surprising, since this allows women to escape from reality from the comforts of her home, giving her the sense she is not being neglectful of family or other duties. Online gaming provides a safe, controlled, comfortable environment where she maintains a sense of power and identity. However, this is not her reality; the addiction gives her the sense this is her reality. As she continues in this false reality, the compulsion and addiction escalates and progresses to destruction.

As we continue to investigate the depths of women and compulsive gambling, the majority of these women also suffer from other mental health issues. Approximately 80% suffer from depression, 73% from anxiety and 52% from alcohol or other substances or other addictive behaviors. According to the Women’s Addiction Foundation, as many as one in five women who have a serious gambling problem have considered suicide, and 15%-24% of them have attempted suicide. Of all the addictions, gambling has the highest rate for attempted suicide. This is a direct result of the desperation and hopelessness one experiences as a result of his or her financial consequences.

While gambling can have devastating effects on those who it conquers, there is recovery and hope. Recovery begins when she takes her first step to admitting her problem and verbalizing a willingness to make changes in her life. This takes courage. Recovery is finding balance in her life between her physical wellbeing, her emotional wellbeing and her spiritual wellbeing. Finding support through self-help programs and/or professionals and family can assist her in finding her balance and recovery. She will face her reality and begin working toward changing her reality to experience health, happiness and enjoying life.

*New Jersey Council on Problem Gambling

**Arizona Council on Problem Gambling

Twitter, Facebook, MySpace, LinkedIn and multiple other sites all provide options to stay connected, stay informed and meet others with similar likes and interests. However, there is also a darker side to social media that is becoming more and more recognized in its role in the breakdown of relationships, particularly marriages.

In a recent article in the UK newspaper The Guardian, it was reported that attorneys in both the UK and the USA report an increasing number of divorces in which social media was indicated as a major cause in the breakdown of the relationship. In fact, one in five attorneys surveyed reported it was a growing issue with their clients. In the UK, as many as 33% of divorces filed indicate that inappropriate Internet use through social media sites was a cause of the breakdown of the relationship.

People can become addicted to communication online, which is not all that different from addiction to other types of “normal” behaviors. Research shows that the pleasure that is obtained by these online communications can actually trigger neurological changes in the brain, particularly in the need for the “feel-good” chemicals. The ability to talk anonymously to others online poses a problem, but so does the ability to create an online persona that may be very different than reality. This addiction to a fantasy world or alternate reality may be a result of unhappiness, chronic negativity, lack of self-esteem or the inability to have a real-world relationship.

Talking online allows that person to feel desired, sexy and connected, which, in turn, releases those “feel-good” chemicals in the brain, serotonin and endorphins, among them. The more that online interactions occur, the more the brain wants that reward again, causing the cycle to continue and resulting in withdrawal from the real world and reliance on the virtual world found online.

Of course, the drug companies have developed and distribute medications that are helpful, even life-saving if properly administered to patients. But abuse runs rampant in the system, especially in pain clinics. This abuse is especially prevalent in Pain Management where “Pill Mills” have popped up around the country. Doctors treat patients for pain. Most of the doctors and complaints are legitimate; people suffer maladies and injuries that only opiates can temper. The problem is that most doctors are not savvy about addiction. How often we have heard stories from drug-dependent patients who were advised by their primary physician that when they had finished running the course of Vicodin or Oxycontin or Percocet, the patient would be able to simply wean off these narcotics? But more often than not they cannot do this. Patients become dependent on these meds very quickly (often between three and four days) and stopping is simply not easy.

Many doctors, never having experienced withdrawal, are ill-informed, so patients are treated without an exit strategy. It’s a bit like our troops in Afghanistan: Once in, how do we get them out? Once in the patient’s system, once the brain’s chemistry has been changed, how do we get them out? How do we deal with the cravings for these drugs once addicted? Patients will commonly experience profound urges to take these medications for weeks or months after they have stopped taking them. The drugs will call to them, consume their thoughts. The urge becomes obsessive.

Common, too, is the patient abusing the quantities of the medication. They start at a given dosage level, but soon become dependent on the euphoric sensation. They take at first one pill more than ordered…then two, three, four at a time. The continued ability to reach the same euphoric levels become more difficult and it becomes necessary to take more and more. This is physical dependence in the making. Often, the doctor is forced to stop prescribing these medications. Then, typically, the patient goes doctor shopping until he finds another physician, unfamiliar with the patient’s treatment history, who will provide him with another prescription. The new doctor has no way of determining a patient’s real pain level. She can look at an MRI or X-ray and see the damage, but it gives the doctor no indication of how much it hurts. Some patients are treatment-savvy and build medical histories, knowing full well that their charts will enable doctors to readily supply them with the drugs they need to get high.

Any doctor who has her own practice is familiar with the “Drug Rep.” The Drug Rep (Representative) is a drop-dead gorgeous 22-year-old female decked out in a sharply cut, smart-looking pin-striped business suit. Two years ago, she was a popular sorority sister at the local university. She was recruited for her first job by a major pharmaceutical company to represent their “product” by carrying the message to doctors from office to office. The message is contained in a satchel filled with drug “samples.” Thirty years ago, she would have been snapped up out of Phi Delta Kappa to American Airlines or Pan Am. She would have worn a similar smart suit, but with wings on her collar instead of a “Phizer” name card. If the drug rep was wheeling her sample bag through an airport waiting room rather than a doctor’s waiting room, she would be virtually indistinguishable from yesteryear’s “Stew.”
Naturally, the drug rep has her counterpart in good-looking, hunky guys in pin-striped suits, GQ profiles, sporting pearl-white, Cheshire-Cat grins. They, too, carry drugs in their briefcases — samples of new product — for sleeplessness, anxiety, depression or pain. They will leave these gifts for the doctor to dispense freely to the patients. The thinking is that patients will try their wares and come back for more. First one’s free! Sound familiar?

Is this payola? You’re damn right it is. Pharmaceuticals are big business in the United States and around the world. They lobby Congress as they grease healthcare providers up and down the food chain.

And then we have the Internet — the revolution in technology that has changed the face of health care. Because the government does not require it and the drug companies and pharmacies do not insist on it, there is no way to track or enforce the sale of drugs on the Web. The benefits of the Internet are obvious: The flow and access to any kind of information imaginable is so vast and so immediate, it boggles the finite human mind. Travelers in cyberspace are privy not only to any and every kind of medical knowledge and direction to healthcare, but to the dark side of The Force as well. By simply filling out a brief medical history which, more importantly than anything else includes a credit card number, and pressing the send button, any man, woman or child can be prescribed sleeping medication, erectile dysfunction drugs or opiates (most commonly Vicodin) “legally” by an unseen “doctor.” This doctor (who does not ask to see his patients and may reside in South Africa or Sri Lanka) has all the information he needs to Fed-Ex the applicant a month’s supply of his or her drug of choice. Often these drugs are resold to others in need at inflated prices.

Why isn’t our government regulating the flow of these drugs into our homes, our communities? Drug lobbyists see that Congress makes cheap prescription medications from Canada difficult, if not impossible to get. The barrier is set up to protect our home-grown pharmaceutical companies who have a financial strangle-hold on Americans in need (especially the elderly) of legitimate drugs. Much is made today of the illegal alien problem. But our borders are porous in many ways. What comes and goes is always dictated by the almighty dollar rather than the needs of the individual. Free trade is neither free nor trade as we understood it, but rather a cyber black market in goods and services that shock the imagination.
The greatest attraction for online drug shoppers is anonymity: no one knows. A prominent attorney will steal upstairs to his home office while his wife and children are sleeping and order a month’s supply of Hydrocodone. The wife is surprised to find her husband home early the following day. When the doorbell rings, he races to intercept the Fed-Ex or UPS package before disappearing with it behind locked doors. Yes, no one knows…or so he thinks. True, his wife and neighbors, children and business colleagues do not see him consume 12 pills throughout the course of the day. But they do notice when he slurs his words in the office. His wife notices when he smokes endless packs of cigarettes and has trouble keeping his eyes open at 9 p.m. He may hang around the house over the weekend, but when his kids need him, Daddy just isn’t there anymore. Yes, he’s anonymous, but he’s also a zombie. To learn more, visit www.recoveryadvocatesusa.com for more information.

Gray areas in the field of addictions contain soft addictions. On the surface, these soft addictions may appear as a bad habit, and they often do begin as such. However, the motivation and the continuation of engaging in these bad habits can foster an environment where addiction can manifest. The following are a few activities that can start as a bad habit and move into the realm of addiction.

•    Emailing
•    Chatting Online
•    Texting
•    Talking On the Phone
•    Caffeine
•    Nail-Biting
•    Hair-Pulling
•    Watching T.V.
•    Gossiping
•    Procrastination
•    Shopping
•    Smart Phones

Any of these activities is harmless in moderation. Many of these activities are a common occurrence in the day-to-day activities of a large portion of the population. None of these activities are illegal, but dependence on these items can lead to an addiction.

When Casual Use Turns To Abuse
The world we live in creates an environment where bad habits are easily formed. Individuals find themselves with not enough hours in the day and not enough money in the bank. Habits are formed when the behavior creates a reaction that the individual finds pleasing. Once a person feels that he or she is relaxed, numb, preoccupied or that their problem has been fixed by an activity, that person will continue to engage in that behavior. For example, if someone feels stressed or that his or her life is out of control, the escape of chatting online with the virtual aspect of another human being creates a sense of comfort. Thus, the individual will start to turn toward chatting online to alleviate any pain and discomfort they experience.

While chatting online may seem harmless on the surface, the motivation behind the behavior is where the danger exists. The motivation behind any action is entwined with the person’s “why”: Why are they developing a bad habit? Are the consequences of the bad habit being ignored? Is more time spent thinking about the habit? This pre-occupation is taking time away from activities that should be a higher priority. The individuals engaging in the bad habit are avoiding pain and swallowing their fear. By avoiding the core issue that is causing discomfort, they are not in a position to work on their issues. This avoidance leads down a slippery slope toward being dependant on the bad habit.

When Abuse Turns to Dependence
Abuse of a substance or an activity can turn into mental and physical dependence. When that line is crossed, the behavior is leading toward addiction. The crucial differences between abuse and dependence can include the following qualities:

•    More time spent on the habit and less time spent on important activities (food, sleep, work, school).
•    Tolerance: The body becomes tolerant of the amount of a substance or the length of time spent engaging in an activity. As the body grows accustomed, more and more is needed to attempt to achieve a desired result.
•    Withdrawal: The mind and body begin to experience extreme signs of discomfort if the person doesn’t engage in their habit.
•    Emotional and Physical Effects: This can include extreme mood changes, drastic changes in sleeping habits and physical discomfort when the habit is stopped.

Physical and mental dependence are the final stage before an individual becomes addicted.

When Abuse Turns to Addiction
Addiction is a combination of a physical and a mental need for a drug of choice. Soft addiction can result in dire consequences, which can be physical and financial. Spending the majority of one’s time engaging in an active addiction leaves little time for anything else – the addiction becomes the focal point. The addicted individual does very little except concentrate on his or her addiction, thinking about how to acquire and fund the addiction.

While all of an individual’s time and funds are used to support their addiction, everything else gets pushed to the wayside. Families can be left devastated, jobs can be lost and bills do not get paid. In extreme cases, this can lead toward being destitute. The road to these consequences may seem excessive, but they do occur. For instance, if an addict is spending all of his or her time, energy and money sitting at a computer chatting in chat rooms, that person is prevented from having a fulfilled life. However, with any type of addiction, recovery is possible.

How Are Soft Addictions Treated?
Soft addictions are treated in a similar fashion to hard addictions. The first step is being aware of it and desiring a change – this element of surrender is crucial. There are fellowships, 12-Step programs, therapists, counselors and recovery coaches who are trained to help. These professionals have the tools necessary to empower the addict to move toward sobriety and recovery.

In being aware and pro-active, if someone discovers that he or she is beginning to lean on bad habits to cope, he or she has the opportunity to deal with those issues head-on. This creates an environment of healing that is safe and productive. By frequently taking inventory of one’s life, many bad habits can be dealt with before extreme consequences can occur.

Soft addictions come in many forms, but they often begin as a bad habit that quickly becomes a crutch. The core issue that needs to be examined is the motivation behind the need for the habit. Fear, escape, denial, a false sense of control and a desire to numb emotional feelings can all fuel negative activities. Once the harmful issues are treated, the need for the bad habit will dissipate, but this is always a work in progress for the addict and the trained professional. These bad habits can be replaced with healthy habits, tools to cope and an increased self-awareness. This is the place where addiction can be bravely faced and recovery becomes possible.

Women may be just as vulnerable to sex addiction as men.

Sex addiction is a problem that involves any pattern of uncontrollable sexual behavior that is secretive, shaming, or abusive. Sexual addiction is characterized by the terrible messes the behavior creates — lost jobs, ended relationships, arrest, disease, and death. It is a pernicious disease that flourishes in secrecy. There are some general distinctions between the way sex addiction presents in men and women, however, the etiology behind addictions in both sexes is likely the same: early wounding, traumatic experiences, and negative core beliefs.

Negative core beliefs are the genesis and fuel for acting-out behavior. From these core beliefs come the cognitive distortions that allow addicts to justify and rationalize acting out. According to Patrick Carnes, the sexual addict’s core beliefs are:

1. “I am basically a bad, unworthy person.”
2. “No one would love me as I am.”
3. “My needs are never going to get met if I have to depend on others.”
4. “Sex is my most important need.”  (I)

With a commitment to getting help through therapy and the 12-step program, addicts will soon have experiences that counteract those beliefs. For example, by adhering to a sexual sobriety plan, addicts in recovery quickly report that they no longer feel bad or unworthy. Likewise, the 12-step program is a “come as you are” program, so the core belief that they are unlovable quickly diminishes. The third core belief, “My needs are never going to get met if I have to depend on others,” is eradicated by the inherent structure of the program, which involves people reaching out to others, making phone calls for support, and going to fellowship. Many addicts in 12-step programs report that for the first time they have the experience of getting their needs met by others. Finally, through a commitment to a period of planned celibacy, people realize that sex is not their most important need. In fact, they learn that they have other, more important dependency needs, such as comfort, validation, and friendship.

Kelly McDaniel, author of Ready to Heal, has adapted Carnes’ core beliefs to include the confusing cultural messages that are at the heart of women’s addictive and compulsive sexual behavior. These four cultural beliefs are:

1. I must be good to be worthy of love.
2. If I am sexual, I am bad.
3. I am not really a woman unless someone desires me sexually or romantically.
4. I must be sexual to be lovable.

These beliefs compel a woman to compromise her interests and values in the pursuit of sex and romance, which are the primary ways she knows to get love. She may not know how to communicate her wants and needs to another, or even know what they are in the first place. She may struggle with setting boundaries and find it difficult to say no, constantly taking on responsibilities to the point of exhaustion or resentment. Her compulsive need to be liked makes her avoid confrontation and direct expression of anger. Instead, she might resort to passive aggression as a way to regain some sense of power and to vent her bottled feelings. These patterns fit a term called codependency, which is a partner to addiction and a common struggle for many women. While common, codependent behaviors left unchallenged can devolve into more destructive patterns, especially if a person has suffered abuse or trauma in childhood.

In a study of male and female sexual addicts (Carnes 1991), Patrick Carnes found that addicted women tended toward “behaviors that distort power – either in gaining control over others or being a victim.” Many of these women gravitated toward stripping, prostitution, or sadomasochism. They might engage in relationships where the men were “one-down” or perceived to be beneath them. Or they might have sex with men who degraded or devalued them, reenacting the early trauma of childhood. The men in the study tended to “objectify their partners and require little emotional involvement.” Some examples of objectifying behaviors are anonymous sex, prostitution, pornography, exhibitionism, and frotteurism (II).  In both genders we see addicts inappropriately eroticizing unacknowledged rage. Sexual addicts are often victims of childhood sexual abuse, physical abuse, pathological, or benign neglect. As children they weren’t allowed to express their feelings about being mistreated, neglected, or were in a family where feelings weren’t talked about. Their sexual behavior was a way of self-soothing in the face of unimaginable pain or numbness. As adults they are stuck in the same maladaptive behaviors that, as children, helped them to survive. Because they never learned to voice their outrage, hurt, and sadness, they act out these feelings sexually.

While a cognitive-behavioral, task-centered approach is the standard of care for assisting people to get sexually sober, women and men have different treatment needs. Research shows that females have stronger empathy centers in the brain, are more verbal, and have stronger processing areas for facial expressions and gesture. One study shows that women tend to be empathizers, while men tend to be systemizers. Males and females have both of these capacities, which can be stronger from person to person depending on nature and nurture (Simon Baron-Cohen, 2005). Males tend to analyze the underlying rules of the 12-step program, so they seem to get their treatment underway quickly. They will often intuitively figure out how the system works and are happy to take direction toward the goal or result of their sexual sobriety. Females, however, will leave treatment if they don’t feel attuned to. Females seem to require a higher level of empathy from the therapist, which means that treatment should focus on paying keen attention to her emotions and thoughts and responding appropriately. It may take the female sex addict a while before she is willing to participate in a 12-step program or group therapy.

The old belief that sex addiction is a male problem is outdated, and clinicians need to be able to spot the signs in women and be aware of the different treatment needs of this population. Through effective treatment, a woman begins to feel good about her body, experience sexual pleasure for herself and self-love. A woman is ultimately seeking her personal power, and her capacity to love and be loved. The key to sexual healing for a woman is that she turns toward the pursuit of self-knowledge in order to find her strengths instead of losing herself to others. When a woman begins to integrate her sexuality with self-knowledge and personal power, she reports experiencing the force of love that leads to a whole and complete self.

References:

I.  Patrick J. Carnes

II.  Carnes, Patrick J. “Gender Differences in Normal and Sexually Addicted Populations”, Am J Preventive Psychiatry & Neurology, 3:1, Spring 1991, pp.16-27

This paper appeared in Phi Kappa Phi Forum 2005 (Special issue on the Human Brain)
The Essential Difference: the male and female brain By Simon Baron-Cohen, Cambridge University (page 1)

This article was based on material by the author that first appeared in Gregory, R, (ed) Oxford Companion to the Mind (2nd edition, 2004) Oxford University Press. The author
was supported by the MRC UK during the period of this work.

This problem is easy to caricature. Ignore the multifactorial underpinnings in many patients with chronic pain. Find a simple biological explanation for the patient’s symptoms. If nothing turns up on a brief history or physical examination, do an MRI, which will reveal some sort of abnormality in almost everyone. If a simple treatment doesn’t work – preferably a procedure that pays well – keep doing it over and over and prescribe a lot of opiates and sedatives.

Certainly many patients with chronic pain do well with a simple biomedical perspective – spinal stenosis, hip or knee osteoarthritis, postherpetic neuralgia, and diabetic neuropathy are good examples. In a small percentage, a purely emotional cause is found. Every pain management practitioner can cite dramatic cures they’ve achieved in patients nobody else could help, using their unique therapeu¬tic approach. One must be diligent to rule out subtle metabolic causes of pain, such as osteomalacia, vitamin B12 deficiency, heavy metal poisoning, and polymyalgia rheumatica.

More often, physicians and patients alike become frustrated because no cause is apparent. What does one do when there is no clear diagnosis or identifiable treatment for the pain? As a rule, the pathology underlying the pain is either obvious (postherpetic neuralgia or diabetic neuropathy) or obscure. For example, “more than 85% of patients who present to primary care have low back pain that cannot reliably be attributed to a specific disease.”*

Instead, chronic pain is a system. One finds a complex interplay of injury, physical illness, emotions, behavioral style, preexisting emotional trauma, lifestyle, deconditioning, and maladaptive coping responses.

The following points illustrate chronic pain as a multidimensional issue:

• Workers compensation claims representatives and nurse case managers will tell you that the worker who sustains an injury typically had been a marginal employee who struggled to function on the job long before the injury occurred.
• Best estimates place the incidence of borderline personality disorder (BPD) at 50–60% among pain patients. BPD can be thought of as inability to cope with normal life stresses. Maladaptive coping responses create extreme emotional dysregulation, frequently to the point of the patient becoming overwhelmed. Borderline patients crave opiates and sedatives, which almost always worsen psychiatric symptoms. Primary addictive disorders are common.
• Estimates put the incidence of child physical or sexual abuse among chronic pain patients at 50–60%.
• Studies show that psychotherapy (i.e., simple talk therapy) is ineffective in most patients with chronic pain. But teaching patients effective coping strategies and self-soothing approaches has solid scientific support for efficacy.
• The most common maladaptive coping strategy is to fully retreat from the pain. Excessive rest due to fear of the inevitable flare-ups leads to deconditioning, which itself worsens pain.
• Loss of a productive role in the family and the sense nobody takes them seriously further aggravates suffering and social isolation. Major depression is common and frequently overlooked.
• Although most pain practitioners agree that true addiction is uncommon, prescription opiate addicts brag about how easy it is to trick doctors into prescribing controlled drugs. Opiate misuse short of addiction is common.

It can be difficult to distinguish a purely somatoform disorder – where behavioral factors are the sole cause of physical symptoms – from situations where emotions merely contribute to the development, expression, or resolution of a physical illness. For instance, while peptic ulcer was once thought of as being purely caused by stress, later research revealed that Helicobacter pylori caused 80% of ulcers. However, four out of five people infected with Helicobacter pylori do not develop ulcers. An expert panel convened by the Academy of Behavioral Medicine Research concluded that ulcers are not merely an infectious disease and that mental health factors do play a significant role. One possibility is that stress diverts energy away from the immune system; thereby stress promotes Helicobacter pylori.

Codependency is common among those who present with physical symptoms combined with behavioral issues. Once thought to be limited to spouses and relatives of alcoholics and addicts, codependency can in fact follow many forms of psychological trauma. Particularly if childhood abuse or neglect continued over a long period of time, sequelae can manifest both physically and psychologically.

Codependents define themselves through others. Relatives, friends, and external events dictate their identity, self-esteem, feeling safe in the world, and ability to be soothed when emotionally distressed. This “external locus of control” leads them to try to control others and to express neediness beyond the typical human desire for closeness and connection.
Other characteristics of codependency include denial, low self-esteem, over-compliance, and trying to control everything in their lives. Childhood traumas remain hidden from others due to the shame surrounding the traumatizing events or because the patient does not recognize the events as abnormal or extreme. Because they have such a well-developed denial system and their focus is always outside themselves, they are completely unaware of how their illness/pain relates to their emotional experience. The secondary gain of attention and nurturing in chronic pain/illness may be the only way in which these patients can get the emotional nourishment they desperately want but have no means of requesting in a straightforward manner. In addition, codependents characteristically find it difficult to say “no” to others; their personal boundaries are poorly developed at best. Illness or chronic pain thus comes to the rescue. It relieves them of their self-imposed burden by making it impossible to meet the needs of all the “others” for whom the codependent feels responsible.

In addition, alexithymia (literally the inability to find words to describe one’s emotions) often plays a role in chronic pain. Alexithymia encompasses a cluster of cognitive and affective characteristics, including difficulty identifying and communicating feelings, trouble distinguishing between feelings and somatic sensations of emotional arousal, an impoverished and restrictive imaginative life, and a concrete and reality-oriented thinking style. A lack of introspection is typical in this population. As a result, they believe that any uncomfortable experience is always caused by an external force that must be identified and eliminated.

How can a skilled physician take into account all these myriad perspectives? Why does Dr. Gagné arrive at a new diagnosis in two-thirds of his patients with chronic pain? A comprehensive evaluation is key to understanding the various systems involved:

• The history should start with how and when the symptoms began. What was the mechanism of injury, if any? What sort of diagnostic and therapeutic endeavors ensued, and what were their results?
• What sort of physical therapy has the patient had? Was it largely passive (heat, massage, ultrasound) or active (strengthening, stretching, endurance, and balance exercises)? Passive therapy is usually much less effective.
• What medications does the patient take now, and what have he or she tried in the past? What was the result of taking these drugs?
• Regarding current symptoms, how many different kinds of pain can the patient distinguish? More than three different types and locations of pain suggest an emotional overlay.
• For each type of pain, what are its location (using surface anatomy), severity, quality, and aggravating or relieving factors? How does it vary by time of day?
• The Present Illness should include reviews of rheumatologic and neurological symptoms, sleep pattern, and functional capacity.
• Psychiatric screening is critical, including questions about prior psychiatric hospitalization or serious illness, suicidality, self-injury including cutting, mood, eating disorders, and childhood abuse.
• Addiction screening must be more than “have you ever had a problem with drugs or alcohol?” One should ask about history of using each major category of drug and whether the patient has ever been treated for addiction or experienced consequences from using.
• Physical examination should include orthopedic and neurological function and muscle tenderness or “trigger points.” Lab tests should be sufficient to rule out common metabolic causes of pain.

The evaluation outlined above is lengthy but can be scheduled in two to three sessions, if needed.

Many physicians aren’t comfortable trying to assess psychological aspects of chronic pain. If a referral is made to a psychologist, a psychological evaluation and testing may provide essential information regarding the patient’s overall psychological functioning and emotional/behavioral factors affecting physical symptoms.

If a patient is referred for psychiatric or psychological intervention, it should be understood that traditional talk therapy might not be helpful beyond the comfort of supportive therapy. More useful are interventions that empower the patient, thus moving the locus of control from a strictly external position (believing I have no power or authority in my life) to a more balanced view of internal vs. external loci of control. These interventions are mostly ways to train patients in needed coping skills. Examples include assertiveness training, boundary development (self and others), and cognitive behavioral therapy to counteract catastrophizing and generally negative self-talk. Especially with borderline personality disorders, dialectical behavioral therapy helps enhance emotional regulation and reduce self-injurious behaviors such as cutting. In cases of prior abuse or neglect, trauma resolution therapy reduces dissociative episodes and symptoms of hyperarousal. Helpful education regarding the mind-body connection can be undertaken in therapy or by assigning appropriate reading. †

One must also consider using antidepressant or other psychiatric medications. Though pure serotonin reuptake inhibitors offer no added pain relief, serotonin-norepinephrine reuptake inhibitors can dramatically reduce pain symptoms. Benzodiazepines characteristically worsen emotional dysregulation, whereas in those with personality disorders, atypical neuroleptics may help patients regain emotional control.

In patients on chronic opiates and sedatives who are not doing well, discontinuing controlled drugs is often astonishingly helpful – and weeds out those seeking secondary gains from controlled drugs. Opiates and sedatives are especially problematic in patients with psychiatric disorders, because they worsen psychiatric symptoms. Buprenorphine can be extremely helpful in reducing opiate misuse, and sometimes it can eliminate opiate hyperalgesia and dramatically improve physical and psychiatric distress.

In the past few years, inpatient chemical dependency programs skilled in treating dual addiction and psychiatric disorders have found that their approach has proved extremely helpful in those with chronic pain. These programs combine a structured milieu, physical rehabilitation, expert medication management, and heavy emphasis on skills training. (By contrast, programs offering a strict 12-step approach usually have little to offer those whose primary concern is pain.)

If you’re treating patients whose diagnosis is unclear, who have not responded to straightforward measures, such as switching to appropriate medications, and who have failed active physical therapy, what can you do? Several steps might be helpful:

1. A conservative neurologist or rheumatologist can help rule out occult illness.
2. Consider psychiatric or psychological evaluation by a practitioner skilled in chronic pain.
3. A well-trained psychologist can teach effective coping skills as outlined above.
4. One of the more effective treatments is “functional restoration”: aggressive physical therapy that ignores pain and addresses loss of function and physical fitness. But the therapist works within the patient’s limitations and helps them pace activities and minimize flare-ups.
5. If the patient is especially challenging and has sufficient financial resources, consider one of the comprehensive inpatient programs to further evaluate and treat the pain syndrome.

A brief clinical vignette illustrates the benefit of a comprehensive approach.

Bill was a police officer injured on the job. Despite equivocal evidence of lumbar disc bulging or herniation, he underwent multiple procedures without benefit and wound up on high-dose opiates. Pain migrated all over his back. Evaluation revealed myofascial pain without evidence of underlying pathology. Six weeks of treatment at the Canyon at Peace Park (where Dr. Gagné is affiliated) addressed medication and emotional issues, and his pain completely resolved.

* Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007, 147:478–491. Also, see the superb review of the diagnosis and treatment of central-processing pain disorders: Clauw DJ. Fibromyalgia: an overview. Am J Med 2009, 122:S3–S13

† The following resources present a detailed discussion of this topic: The Body Bears the Burden by Robert C. Scaer, M.D., Healing Back Pain: the mind-body connection by John Sarno, M.D.

Clearly, her daughter is pulling away, which can be one of the hallmarks of addiction, depression, or an adolescent trying to form an identity. When you think of addiction, you think of drugs, alcohol, or even an eating disorder. But what about the newest addiction affecting teenagers: Celebrity Addiction? This phenomenon has nabbed one-third of Americans and is linked to depression, anxiety, body-image problems, and addiction.

In no way is this author comparing the ravages of substance abuse to celebrity worship, but it is important to look at today’s teenagers with a different set of eyes. According to recent studies, many adolescents believe that emulating the lifestyle of their favorite celebrity is one of the only ways to form an identity and if they don’t reach the same level of stardom, they will become “nobody.”

There is also a dramatic shift in the way teenagers perceive success. In fact, research reveals that teenagers would rather surround themselves with celebrities or become one, rather than becoming a more intelligent human being. In addition, it is showing that having these fantasy relationships with a celebrity stimulates the production of opioids, chemicals in our brain that make us feel better. It is no wonder we are raising a generation of adolescents, for example, who would rather become a famous actress like Paris Hilton rather than a presidential nominee like Hillary Clinton.

This type of value system was seen at the Grammy Awards a few years ago. You have to wonder what it means when musician Amy Whitehouse is singing “no, no, no”, refusing to go to rehab to deal with a drug addiction and becomes a huge Grammy winner. What does this tell our teenagers? It sends out the message that it is appealing to be in the throes of a drug addiction. Or what about Lindsay Lohan being the first story on the Today Show with regard to her jail sentencing for several probation violations related to her issues with alcohol? Does she deserve to be the first story on a major television network?

Teens not only mimic the clothes, jewelry, and cosmetics celebrities use, but now increasingly see addiction as glamorous. Joanne Barron, National Outreach Director for Insight Treatment Center for adolescents says, “Unfortunately, too often what we see or hear about celebrities has to do with a lifestyle of excess — smoking, drinking or drug use, constant parties, and sexually acting out.”

This is not necessarily new in popular culture. Many musicians and actors have died tragic deaths from addiction, and many more will die in the continuing drug epidemic. Musician Janis Joplin glamorized drugs in the 1960s and died at age 27 of a drug overdose. And what about Timothy Leary and his famous quote, “Turn on, tune in, drop out”? Last year we viewed a barrage of specials portraying the very disturbing life of Michael Jackson and Corey Haim. Their lives were viewed more times than true news-worthy stories.

Adolescence is often a time of soul searching and finding an identity. It can also be a very vulnerable and impressionable time. However, today’s identity formation has crossed the line. Teen idolization is even turning into a medical issue. Teens are undergoing surgery to have lips like Angelina Jolie and carving dimples in their chins to look like John Travolta. Has the media gone too far?

“Whether we like it or not, celebrities are role models for teens. For many years, we have seen the influence of pop culture on our youth. Ever since television and movies became mainstream in America, teens have tried to emulate the speech, dress, and behavior of their favorite celebrities,” says Barron.

Scientists have found a correlation with celebrity worship and depression and anxiety. Which comes first, the proverbial chicken or the egg, or does it matter? Does depression lead to addiction or does addiction lead to depression? The bottom line is there has been an epidemic of teenagers who believe they are entitled to become famous and will become famous during the course of their lives. Maybe mimicking the drug addictive behavior of celebrities is the closest thing they will ever come to being a celebrity or knowing one.

Of course, there are numerous causes of addiction, such as trauma, a genetic predisposition, peer pressure, or a divorce or significant loss in a loved one’s family. However, the media normalizing celebrity addiction by sensationalizing where the latest actor is going to rehab does not help in reducing the problem; it only reinforces it.

One of the other difficulties many adolescents face today is eating disorders. Television, Hollywood, magazines, and the Internet portray slender women much more often than the majority of women with normal body types. They then develop distorted images of what a body should be based on what the celebrities portray. “Once these idolized perceptions are accepted as truth, thought distortions may develop, which can lead adolescent girls into self-destructive behaviors, such as eating disorders, self-injurious behaviors, excessive exercising, and other destructive behaviors,” reports Buck Runyan, the COO of the Center for Discovery, an eating disorder treatment program.

How can we prevent our teens from idolizing these tragic figures of fantasy and deception? How can we reduce substance abuse and eating disorders among teens? Self-esteem is one of the buzz words of this century. Lack of self-esteem can increase the odds that your teen will look for numbing-out methods to suppress their discomfort, pain, and frustration during this time. When children are comfortable in their own skin, they can reach inward for well-being and strength, rather than becoming reliant on outside sources to dull their senses. Having an open dialogue with your teen without judgment or criticism allows your teen to feel more comfortable sharing issues, such as substance abuse, peer pressure, and sex with you. They will feel heard and understood, which will allow them to trust you with their deepest demons. Otherwise, they look for validation somewhere else, potentially joining groups or gangs where drugs and alcohol is the norm.

Another solution to this growing epidemic might be getting to know our neighbors more closely to feel part of a community, rather than having to look outside our neighborhoods for a sense of belonging. Creating deeper bonds within our own circles might alleviate the need to search outside for validation. Perhaps reducing the number of reality television shows on the air might diminish the problem. Reality television reinforces the idea that it is easy to become famous, and that we are entitled to this fame and fortune. Teens believe becoming famous is a cure-all for life’s challenges.

This pandemic of celebrity addiction is on the rise and needs to be squashed. Our society is in the midst of raising a generation of narcissists whose only sense of self is around entitlement and becoming famous. Healthy relationships will be replaced with illusory celebrity relationships that lack intimacy and real connections to others, and teens will continue to seek temporary relief from substance abuse and celebrity worship to ward off the pain that normal adolescence brings.