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.

Addiction Information January Newsletter

Introduction

Welcome to the first Addiction Information Newsletter. The object of this newsletter is to give you a monthly overview of what is happening in the world of addiction across a number of fields. You can subscribe to this newsletter and receive an e-mail version by joining our mailing list. Your suggestions are most welcome, and articles for the website or that you would like to have linked to this newsletter can be directly submitted to me by e-mailing shaun.shelly@yahoo.com.

In this issue:

The Motivated Addict, Dual-process models, CBT Ineffective?, Drug Policy, Brain Structure, Meth Psychosis, Transcriptional Mechanisms, Nepicastat & 18-MC Trials, Neuroscientist Marc Lewis, Dr Frankenstein's Cure and "beating addiction"

CBT Doesn't Work for Heroin Addiction?

Study Suggests Buprenorphine is enough. I Disagree.

In the January 2013 edition of The American Journal of Medicine there is a clinical research study conducted by members of the Yale University of the School of Medicine entitled: A Randomized Trial of Cognitive Behaviour Therapy in Primary Care-based Buprenorphine. (Fiellin, et al., 2013). In the abstract for the study, the stated objective was “To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence.” The abstract concludes: “Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioural therapy.”

In the Press.....

   

PRISON NO CURE FOR ADDICTION: EXPERT
By simone.williams
2013-01-15 09:00   
HARSH penalties for drug-related crimes do more harm than good.

This is according to Shaun Shelly, Addictions Programme Manager of Hope House Counselling Centre in Military Road, Retreat. In his opinion, the Drug Watch campaign by LeadSA, and editorial comments and letters in the local press seem to all be praising criminal sanctions for drug addicts encouraging harsher penalties. He complains his letters to the press have been ignored by editors.

Medication in Recovery

IMPORTANT: This article deals with treating post-detoxification addicts who have been weaned from their drug of choice under medical supervision and those who don’t have a co-morbidity that presents an immediate danger to themselves or others. I am also not talking about those who are on a supervised substitution or aversion program. We must also accept that there is a minority amongst us for whom a life free of medication is an unrealistic goal. We should recognise this and not exclude these people from the recovery process.

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Many have come to accept addiction as a disease, and one of the down-sides of this belief is that addiction can be easily treated via pharmacological interventions. Accordingly, many recovering addicts are dealing with their symptoms via medical intervention. I think this is a mistake. Here’s why:

The neurobiological underpinnings of addiction.

A brief overview of our current understanding of the neurobiological processes that underlie addiction.

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It is only recently that the idea that addiction is a brain disease has begun to be accepted by the general population. The disease model was at the centre of the AA/NA message long before it became accepted by even the medical field. As we make advances in neuroscience we are finding that many of the conclusions drawn from anecdotal evidence have, in fact, a sound neurobiological basis. There is indeed a strong neurological underpinning for addiction, and in this essay I will summarise the current understanding of this.

The Common Reward Pathway

The common reward pathway for substances of abuse, specifically relating to neuroanatomy and neurophysiology.

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Although substances of abuse have varied and diverse primary targets and acute effects neurochemically, research has shown that almost all substances of abuse lead to an increase in dopamine in the mesocorticolimbic dopaminergic system. The understanding of this common reward pathway is important as it could (i) lead to the development of a single medication that works for various classes of substances of abuse in addiction treatment; and (ii) give a better understanding as to why all those suffering from addiction experience similar psycho-social devastation in spite of the variety of drugs of choice.