Drugs Sex and Recovery is now available on Amazon

Drugs, Sex and Recovery is now available on Amazon.

Workbook Cover

The new workbook cover.  Scheduled for 10/1/12 release.

Sexuality and Chemical Health

http://www.associatedcontent.com/article/8021059/how_chemical_dependency_can_impact.html?cat=5

Click on the title for an interview on the Yahoo.com pages

Sex, Shame, Fear, Recovery, Hope, Life

I was keenly reminded how difficult it is to talk about sexual health issues in general and sexual compulsivity in particular. For many individuals, the first steps toward discussing sexual issues are shaped by shame, embarrassment, fear and guilt. I can not stress enough how NORMAL these feelings are when opening up a new area of growth. While it is easy to say, I also know how many of these thoughts and feelings are irrational, based in cultural messages that “sex is bad,” and a general aversion to addressing sexuality.

Even though these reactions are normal, I’m also aware how important it is to start the process of talking about your sexual health concerns. My experience suggests that sexuality is at the core of many of the most important aspects of our life. For many people in recovery, sexuality is the last issue to be addressed. At the same time, it is often the last issue counselors want to (and in some causes are trained) to address.

In almost every situation when someone starts the process of addressing sexuality, the reaction eventually has been positive. The energy “protecting” the shame is released allowing the energy to be directed toward life giving actions. New possibilities are created allowing the individual to life a new life.

What do you need to start the process?

The Pain of Sexuality

I am keenly reminded of the pain many people experience in the realm of sexuality. This pain is from a variety of sources including the typical sources of abuse, shame, and guilt. But, the sources of pain can include social, familial, cultural or religious messages. A major concern is when the external messages become internalized and the individual replicates and reinforces the painful messages in a tighter and tighter circle within him or her self. Once this pattern begins, the pain takes on a life of its own, leading to feelings of hopelessness, desperation and profound isolation. For me, this is perhaps the saddest part of the pain.

The process of healing this pain is beyond the scope of a simple blog entry. The short summary is the process requires much work, and support. My clinical work, and blog writing is about helping people in the healing process. To highlight three starting points, I would encourage you to:

1) Give yourself permission to be a sexual being. Sexuality is a normal, vital, and positive aspect of your life. Having an experience of sexual health is remarkably liberating and affirming.

2) Reach out for support. Using your support network best facilitates the process. The network can include friends, family or professionals such as your therapist, spiritual guide, or other providers.

3) Feel the pain. You cannot avoid the pain; this only intensifies the pain. Paradoxically, the only way to resolve the pain is to go through the pain. A recent encounter involved working with someone in the healing process. At one point, the release of the pain resulted in surprisingly intense sobbing session. The level of wailing can best be described by imagining a 4-year-old toddler who wails after his/her finger has been accidentally slammed in a car door. Witnessing this from a normally stoic grown adult highlights the profound pain.

There is a saying in the workout/gym/weightlifting community: No pain, no gain. Not so surprisingly, this platitude applies to healing the pain of sexuality. When this process is complete, you can experience peace and acceptance. And, you have the potential for great love.

Finding a sex therapist

Recent events reminded me how difficulty it is to find a clinician with skills in the area of sexuality. I thought it might be helpful to highlight a few strategies to find a clinician who specializes in sexuality. I forget the difficulty many clients have in talking about sexuality. I’ve been in the field for 16 years at this point; sometimes it feels like all I do is talk about sex. (Is it possible to talk about sex too much?) Client’s will often say, “I’ve never told a previous therapist about this…..” and then go into an story regarding their life, sexual history, acting out, or assault.

1) Advocate for yourself. Check out a number of websites, including SASH.NET and AASECT.ORG. (For example, between the two websites, about 15 clinicians are listed in the Minneapolis/St. Paul area.). Call your insurance company for referrals to see clinicians experience working in sexual matters.

2) Call. Most clinicians will take a 10-15 minute phone call to see if an initial interview should be set. Be direct and open in the phone call. This is not the time to beat around the bush. Use the time efficiently. Put your issue out there. I’m struggling with Internet porn. I’ve been sexually assaulted. Do you work with clients in this area? What is a summary of your treatment approach? Do you have any resources available on the web?

3) Ask for referrals. If the clinician responds no, ask him/her for referrals. Repeat the process until you have 1-3 clinicians who you might want to meet.

4) Set-up a meeting. Some clinicians will have free 1/2 hr sessions, others don’t. The intake interview is as much for you as it is for the clinician. Feel free to ask questions to the clinician as well. How busy are you? What is your training/experience in this area? How many clients have you worked with on this topic? The more forthright you will be, the more likely you will find a clinician who can help in your recovery.

Remember, the therapist is there for you, not you for the therapist.

Sin is doing something wrong; Hell is staying in something wrong.

As individuals move forward in recovery, I hear enough stories of being not being able to stay clean. In psychological terms, we might describe this as failure and make reference to the stopping the acting out cycle as we move forward. In 12-step language we might describe this as relapse, and highlight the powerless needed to stop the addiction. In spiritual language, we might recognize this as sin and the need to seek forgiveness. Each of the different frameworks helps us understand the same behavior through a different lens.

Using the spiritual framework, my personal definition of hell builds on the concept of sin. If sin is doing something wrong, hell is staying in something wrong. I encounter individuals who after a relapse, enter into shame spirals, emotionally abuse themselves, and forever put themselves in negative place. For many of these individuals, they punish themselves much more than I or anyone else could ever punish them. And in my mind, the individuals are in a self-imposed hell distinguished as helplessness, frustration, and hopelessness.

When I met an individual in this self-imposed hell, I encourage them toward self-forgiveness. I ask them to if they would treat others they way they are treating themselves (a reverse Golden Rule). And I encourage them to “be gentle with yourself.” Recovery from drugs and stopping the sexual acting out cycle requires accountability that is respectful and leads toward forgiveness and healing versus shame, fear, and the ongoing experience of a personal hell.

Integrity in the recovery proces. Meaning what you say and saying what you mean

A few weeks ago (March 13) I talked about the role of discernment. Discernment is the process of deciding, choosing, and uncovering for yourself what is at your core and your personal truth. As part of the discernment process, integrity is essential. A quick definition of integrity is meaning what you say and saying what you mean. And for most people in the depths of addiction and compulsivity, all integrity has been lost. Trust of you by another person is built on your integrity. Early in the process, integrity is absent. Two recent examples in my practice highlight the importance of integrity.

A client who I hadn’t seen for many years let me know he celebrated 9-months free from meth use. In offering congratulations, I asked how was he able to stay sober. His response was “I discovered I wasn’t being honest about stopping. Yeah, I told you I wanted to stop, but I was still glamorizing the drug and sex.”

Another client talked about a recent use of pornography. He said “I’m not able to stop viewing porn. Oh, by the way, my wife thinks pornography is a problem, but I don’t. “

Both examples highlight the role and difficulty of integrity. Only when you’re transparent about who and what is important in your life, can you build integrity. It is imperative that you be radically honest in the process. Tell everything to your support network. If you engaged in a behavior, say so. Minimizing is a failure of integrity and feeds the acting out cycle. Sharing every interior/secret thought helps uncover the multiple rationales behind your behavior. Saying you want “A” because your partner wants “A” is a failure of integrity. Being honest about what you want, for example, reduces resentment.

Building integrity requires recognizing the disconnect between what you say and what you do, and then completing the steps toward honesty. It requires work, and conflict may ensue. There are ways to recognize the level of integrity in your life. Think about the following:

1) When someone asks, “How are you today?” do you respond with a bland response or with integrity? “It’s a good day” or “It’s a bad day.”

2) When you engage in a conversation about where to eat, for example, do you put your opinion out there, or simply “go along?”

3) When you struggle with a goal, are you sure that it is YOUR goal. Are you ready to put the work toward reaching the goal? For example, do you really want to loose the 15 lbs, or are you simply bowing to the pressures of culture saying you should when you really don’t want to do what is necessary regarding diet and exercise.

4) When your partner says, “stop that” do you agree with his/her request, or do you go along with the request to avoid conflict? For example, I agree to no porn. Or, I agree to engage in sex today.

Recovery and balance

“The quest stands upon the edge of a knife. Stray but a little and it will fail. But hope remains, if friends stay true.” Tolkien, Fellowship of the Ring.

The quest for sexual health, for recovery, for life is a journey requiring balance. And yet, balance is the aspect that is missing the most. Until balance is discovered, recovery is at risk. It doesn’t take much to push the individual off the edge resulting in damage, hurt, and pain both for the individual and his/her network.

Individuals in early recovery struggle with the concept of balance. Regardless of the type of compulsivity/addiction, an individual losses balance in their life. Like a spinning top, an addict’s life is spinning more and more out of control until it crashes. When the addict picks up the banner of recovery, he or she may start the recovery with the same fervor of the addiction. Instead of 90 in 90, they go to 90 in 90 volunteering as trusted servant, 8 sponsors and by day 90 have 3 sponsees. There is a move from multiple sexual acting out to absolute abstinence that denies the sexuality of the individual. This spinning top of “recovery” continues until a relapse occurs because of the lack of balance.

Three strategies for developing balance are:

1) Develop a plan.
As you start the recovery process, with your treatment team and support network it is important to develop a recovery plan. In that plan you need to define what recovery will look like for the next 90-180 days. Components of the plan include arrangements addressing living, treatment, relationship, and aftercare aspects of recovery. Obviously a higher level of structure and insight into the plan are important.

2) Follow the plan.
Once you have the plan, FOLLOW the plan. If you and your team develop a plan that you don’t like, say so at the beginning. If you agree to the plan, follow it. This sounds obvious, but I’ve seen plenty of plans that are not followed leading to a relapse.

3) Follow the plan.
What, he just said that. Too often, people will change the plan because they don’t like it. I encourage people in early recovery to stick to the plan unless there is imminent danger. Yes, it may be work, uncomfortable, or disliked. But sticking to the plan is about addressing the factors leading to the relapse. Making quick changes is a warning sign. Changes that are reactive are a concern. Changes that are reflective are possible when discussed. When changes are necessary, the changes need to be reviewed with your support network and treatment team.

When should I get into a relationship?

I was asked a question about the right time to get in a relationship for someone who struggles with sexual compulsivity. Obviously the only answer I can give is depends. I do have some benchmarks that I want a client to consider: if you answer “no,” or “maybe” to any of the benchmarks below, I don’t think you’re ready. Ultimately it is up to the you, the client, to consider when it is the right time to get into a relationship.

Benchmarks to consider:

1) Are you aware of your acting out cycle? This requires you to understand the components of the acting out cycle, different ways you act out, and the underlying factors associated with the acting out cycle. If you don’t understand the words in this benchmark, I don’t think you’re ready to be in a relationship. (An example as a HINT: You’re aware of the thinking errors and subsequent feelings of shame that result from a history of sexual abuse and how they contribute to your chemical use and/or sexual acting out.)

2) You’ve addressed the major issues contributing to the acting out cycles in #1. My workbook has a list of 22 major issues that often need to be addressed. These are listed elsewhere in the blog or at the website for the workbook. (See table of contents). While I don’t think these issues have to be completely resolved, I do recommend that you have a basic understanding of how they impact your life.

3) Do you have prevention plans to address the topics in #1? Each feeling, thinking error and high-risk situation needs a basic prevention plan.

4) Are you open to a conversation about your history with your potential partner? If you’re not willing to share your history with him/her, you risk setting up the trap of secrecy and the subsequent trust issues. Repeatedly I’ve shared that my bias is full disclosure. Timing and support (usually in couples therapy) is important at this point.

5) Are you aware of your sexual interests, relationship needs, intimacy goals, and able to communicate these to your partner? Is this sharing mutual?

6) Are you talking about all of these benchmarks with your support network and your potential partner?

While these may seem easy benchmarks to read, I know that the underlying work is substantial. Perfection isn’t required, but in the end understanding the substance of these benchmarks will help you strengthen the relationship.

Abuse, Sexual Health and Recovery

Recent discussions have keenly reminded me of the tremendous affects of abuse on sexual behavior, mental health, and chemical dependency recovery. I refer the reader to other entries in the blog regarding extended conversations about types of abuse. Here I simply want to acknowledge the big three: sexual, physical and emotional. While these are helpful labels, they are far from black and white. I also think of abuse in terms of overt (recognizable) and covert (hidden). The experience of sexual abuse has so much shame associated with it that we never talk about it. The Hollywood version of abuse hides the experiences of innuendo, harassment and manipulation. People often recognize when they are physically hit, but clients also recognize the concept of “the look” or the statement “wait until your father gets” home. Both experiences introduce the experience of unease, of fear, to outright terror suggesting linkages to abuse. The experience of emotional manipulation belies the difficulty in defining emotional abuse.

I encourage my clients to think about the following indictors. If you know you’ve been abused, I ask you to think about which symptoms are present. If you don’t know you’ve been abused, I ask clients to consider which symptoms are often present. What types of experiences trigger the symptoms? If there are patterns to the experience, I encourage the individual to look further into the issue.

Some consequences/indicators that trigger further work include:

• Displays agitation or anger, uncontrollable behaviors, tantrums.
• Displays anxious behaviors (nail biting, teeth grinding, rocking, etc.).
• Often belittles self (“I’m bad, naughty, evil, etc.”).
• Resists authority or desperately tries to please because they fear repercussions.
• Exhibits excessive guilt.
• Shows fear of a particular person or place.
• Thoughts involve themes of sexual acts, torture, bondage, humiliation and/or abuse.
• Hurts others sexually or physically.
• A child mimicking adult sexual behavior (such as intercourse, French kissing, etc.)
• A child having age-inappropriate sexual knowledge.
• Increased chemical use.
• Increased sexual behavior.
• Individual has lots of fears.
• Shows inappropriate emotions or no emotions at all.
• Fearful others hate them, are angry, want to hurt them, punish them or kill them.
• Fearful someone is “after them” or going to hurt them; wary of strangers.
• Has low self-esteem.
• Struggles with forming or maintaining friendships.
• Engages in self-destructive behaviors; intentionally inflicts harm on self.
• Appears to be “in a fog.”
• Experiences excessive mood swings.
• Suicidal thoughts, statements or gestures

Recovery from abuse is a bit of a process. I highlight the broad themes here.

1) Find Safety. If you are in immediate or ongoing danger, you’ll need to be in a safe place. There are treatment programs, and/or shelters available for this area. Look for Domestic Abuse or Sexual Violence programs in your local area.
2) I encourage you to find a therapist/professional help. My experience is that this can be a significant process for many clients. For clients who have severe experiences, the treatment process is rather entailed.
3) Once stable, tell your story. And then tell your story again and again. Group support/therapy is helpful. The decrease in shame, fear and isolation that occurs through group can be powerful. Understanding that “I’m not alone” and “Someone understands” is a powerful source of hope. I often have clients complete an “abuse history” describe the life history of abuse. Lest that scare you, remember the next step.
4) Take it slow. This is a long process. Sharing your story once is only the start. Moving forward sometimes requires 3 steps forward, 2 back. I start the assignment on the abuse history by focusing on 4 events: “Describe 4 (or whatever number) events.” Or, simply acknowledging “I’ve been abused” is the first step.
5) Identify triggers. Once you know your history, understand what triggers flashbacks and struggles in your current daily functioning. You’ll need to develop plans to address the triggers.
6) Move forward. What do you want your life to look like? This is hardest place to get to in therapy. The level of fear and lack of hope will need to be resolved prior to this place.
7) Put a plan in place. Follow the plan. Developing healthy intimacy and health sexual expression is in of itself difficult. My last two posts describe this process.
8) Journal, Journal, Journal. Journaling is both for the therapy process, as well as reminders of your progress. When frustrated, recognizing where you’ve been, what you’ve come through, and where you’re going is helpful. Some clients “beat” themselves up because they can’t talk to everyone at a party because they are uncomfortable. A journal can highlight how simply getting to an event is amazing progress. Journaling doesn’t have to mean writing; given technology this can include video recordings, or art or other forms of expression.

Unlinking Sex and Drugs

Yesterday I posted a strategy for addressing sexual health issues. Today, I wanted to highlight the strategy can be useful for unlinking sex and drugs.

It is important to be aware how the linkage between sex and drug shows up. For some people, they need a drug to help them with sex. A number of people might use alcohol or pot, or other “downer” to help them address the anxiety they feel around sex. To help move toward sexual behavior, they ingest the drug to calm down.

For others, particularly meth users, the power they feel as a result of the drug creates such (false) feelings of self-esteem that they go overboard in the realm of sexual behavior. Meth as a sex drug has been documented elsewhere; what hasn’t been talked about is struggle with unlinking sex and drugs. I’ve worked with enough people who struggle and describe stories where months and years after their last use, any sexual behavior triggers euphoric recall on drugs. Many of their fantasies include drug use. When masturbating, the only way they “get-off” is by including chemical use in their thoughts. This is a major issue regarding recovery and sexual health

In all the examples above, the desire is to unlink the relationship between sex and drugs. In many ways, the strategy highlighted yesterday (SEE BLOG, 12/29/09) is the same strategy. I provide a few nuances here to clarify the process.

1) Start slow as well. Review the process as described.
2) When you move through the process, it is important to “tell on yourself” when you experience the linkage of sex and drugs. This will not be a quick process, but it is a matter of talking through the experiences as they occur. With your support system, be as descriptive, thorough, and honest as possible. The goal is to put everything on the table. In the process, you might discover something you need to address in your overall recovery.
3) As you move through the various stages, when you experience the linkage I would encourage you to take a break. For example, perhaps when you are making out with someone, and you experience the linkage of sex and drugs, it would be helpful to stop for a while. The experience may seem frustrating, and it probably will be. The key is to talk it through, including talking how you are experiencing the linkage. This also includes talking with your partner BEFORE the process as well. As I mentioned yesterday, couples therapy and support group for both you and your partner may be necessary.

Small Gifts and the Persistence of Recovery

My office away from my office away from my home is Bruegger's Bagels in Uptown Minnesota on Lake and Humboldt. I'm "well-known" by the staff, who often treat me like "Norm" from the sit-com "Cheers." My Diet Coke is poured and ready by the time I make it to the register! (Thanks Guys!)

While working on a presentation (which I will post on Thursday), a client I haven't seen in nearly two years stopped by out of the blue and said hi. I had heard bad things --bad relapse, bad consequences, and the like. He filled in the missing blanks and acknowledges significant recovery --the longest in a while.

I took away from the conversation two important things.

First, the power of awakening. Whether you use spirituality, 12 steps, religion, or CBT, there is a moment of choice. In that moment, I choose "A" or I choose "B." And these moments are often small (I call them pivot points), but the long-term impact is significant. I heard in his story the moment of choice. I heard in that moment a choice to live. He started to create a new future.

Second, often in my role as a clinician, I never hear about the long-term impact of my work. I am humbled to hear and accept his gratitude for our work together. When clients "disappear" I do find myself concerned; I'm also constrained that I'm not able to follow-up. The update is appreciated. In his update, I'm re-affirmed in my comment to sexual health and the work I choose to do.

Staying Sober: Tips to stay on the wagon

Dear Dr. Weston I noticed on your bio that you work at Pride Institute so I thought you might have some ideas to help me. I've been in and out of recovery for the last 6 years and just haven't been able to stay clean. I've been sober for about 9 months now, I go to my meetings, but I'm getting way too close to relapsing again. Got any help?

Although your dilemma is bigger than what I can tackle in a simple online article I believe there are two immediate things you can do that may begin to help you.

• First, you need to identify the "payoffs" of using drugs.
• Second, identify ways to get these "payoffs" in healthy ways.

Pay attention to the payoffs of your continued using. Counselors do a good job identifying the "consequences" of use. I'm sure you can identify your laundry list of horror stories about what has happened as a result of your use. All behavior is goal focused, including drug use, so I think it is important to focus on the payoffs of using as well. Someone who is using has a belief that a real or perceived payoff will result from the drug use. As you can probably recognize, the payoff is usually temporary.

I think about payoffs on three levels.
The primary level of payoff is the result of the actual drug use. For example, I'm bored and have nothing to do. Getting "high" is something fun to do, at least for a while.

A secondary payoff refers to an outcome that also happens. It might be a helpful consequence of the use. Many meth users experience significant weight loss as an outcome. For individuals struggling with body image, when they start to get sober they struggle with the weight gain.

The third type of payoff is difficult to recognize. It's also important to think strategically. The following example might be helpful. This level of payoff doesn't make sense to those watching on the outside, but on the inside, the payoff is that ongoing use gives the person the illusion that they are in charge of how messed up their life is. "I know drugs are bad, and that's why my life is so messed up." The outcome is that "I'm to blame." What makes this type of thinking so dangerous is the use of the fact that when a person's life is out of control, it is justification for additional drug use.

Finding healthy ways to get the payoffs

Primary Healthy Payoff
Looking first at the primary level payoff, we need to talk about filling your time with healthy friends, sober fun and other personally meaningful activities. You have to develop plans and social networks where you can have healthy fun without using. Additional Healthy Payoffs

If, for example, body weight becomes a problem, developing a healthy body image is also part of the treatment plan. If you are self-sabotaging your recovery because of low self-esteem, it's important to address the belief that you have no control in your life. A person needs to get a sense of an internal source of power. In my opinion, these three payoffs require a lot of work and effort. This is why therapy may be helpful.

If you find that you continually relapse, professional help might be necessary.

The question I'd like to hear about is "What healthy ways have you developed to get your needs met?"