August 2014 Newsletter

The recent death of Robin Williams is incredibly sad. As always, when a celebrity dies, especially when substance use is somehow involved, there is a lot of talk about the dangers of drug use and how addiction so often leads to death. I have a slightly different take on the issue: life long substance use disorders, where there is a constant battle against relapse - are usually the sign of something severe that underlies the SUD.

In this case, it seems, the monster below the surface was unresolved pathological depression. Of course, that mixed with an alcohol use disorder is a recipe for disaster. But the alcohol is an adjunct - it is both the (temporary) solution, and the (long-term) catalyst. It is not the primary disease.

I often see how by focusing on the SUD the real pathology is missed. Each relapse brings around renewed focus on the SUD rather than sparking the question: "Well, we know that SUDs die a natural death in most cases, unless there is a contributing factor, this person is not getting better, so what is the contributing factor, and how do we resolve that?"

It is sad that complex problems get reduced to the simple statement "Oh, he was an alcoholic".

In this newsletter I bring together some information from different types of addiction and drug use. When put together much of the research seems to be stating the obvious and, in my opinion, addiction looks more like a learning disorder or adaptive process and not a primary disease of the brain. It seems that Maia Szalavitz agrees with me.

We look at Marijuana and brain changes and schizophrenia, methamphetamine and brain changes, porn and brain changes, internet addiction (and brain changes), Tom Hovarth and SMART Recovery, the results of the Global Drug Survey. I hope you enjoy, and please feel free to comment! Please click HERE to find out more about the Cape Town Recovery Film Festival 2014.

Sex, Drugs, and No Control

Sex as Addiction and the Treatment Thereof

There is much controversy around the use of the term "sex addiction." This article gives a brief overview of the arguments against this term, and then shows some of the aspects as to why sex may indeed be an addiction and how it may be treated. There is certainly a need for further research in this area before anything definitive can be proclaimed, but perhaps the study of behaviours that present as addiction can give us further insight and understanding of exogenous addictions.

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According to the DSM-V Sex Addiction is not a diagnosable condition. Sexual addiction was mentioned in the DSM-III-R, but disappeared in the DSM-IV, threatened a come-back in the DSM-V but has now been discarded. Sex, however, has long been described as addictive. In the late 1800s Freud described masturbation as the “original addiction.” Rado in the 20’s described addiction as “compulsive” and made the reward/pleasure/sex link. We saw words such as nymphomania (Ellis) and the clumsy “Don Juanism”(Stoller). In the 70’s Mac Dougall spoke of “addictive sexuality”. It was originally proposed that sex be included under the heading of addiction in the DSM-5, and then that was discarded and the idea of hyper-sexuality was introduced as a possibility. Eventually none of these proposals was accepted, and so sexual addiction has ceased to exist, according to the DSM, that is.