Addiction as a “Chronic Disease”

by Joshua Hoe

When people hear that addiction is a disease they often assume that addicts will get treatment and be healed.

In other words, they assume that like with Cancer or Malaria, the addict will get some Chemo or take some Antibiotics and be healed. In “addiction-land,” the treatment everyone expects addicts to take before being healed is called Rehab.

This plays out pretty much the same way in the press over and over again, usually with celebrities or sports figures.

Most recently, talking heads on every sports channel in the world spend hours bemoaning how “stupid” Josh Gordon (formerly of the Cleveland Browns) is for failing a drug test after being suspended for a year.

Didn’t he learn anything in rehab (it must be his fault since he got treatment) and how could he be so stupid as to relapse RIGHT before his reinstatement by the NFL was once again possible.

What an idiot!

Except, addicts know that it is exactly times like sobriety anniversaries or major new opportunities that people relapse. Sometimes, often times even, the stress created by these looming events is a trigger.

Addicts don’t relapse because they are “idiots” they relapse because they are addicts.

The “Chronic” Disease Metaphor

I have long suggested that what is needed, for a cleaner understanding of what addicts go through, is not a disease metaphor for addiction. Instead, I have suggested that what is needed is a “Chronic Disease” metaphor for addiction.

(I do understand that proponents of the disease model use disease literally, but I am talking about how people translate that and create a parallel between addiction as a disease and other diseases that they already understand).

Basically, Addiction is more like Diabetes than like Malaria.

Like with people with diabetes need insulin, addicts need daily maintenance (calls, HALT inventories, meetings, therapy, medidation, exercise etc.).

At any time, any addict who messes up their maintenance program can relapse (just like messing up insulin maintenance can send any diabetic into shock).

How we conceptualize addiction matters, in the political discussions on the subject of addiction during this election cycle multiple candidates have referred to giving addicts second-chances before applying criminal sanctions for use of substances.

But, if an addict isn’t ready to recover and/or doesn’t have a good maintenance program (we call it a program of recovery) that addict is almost guaranteed to face relapse (and Rehab is not a method for continual maintenance although it can be very helpful to addicts in getting clean and creating a good maintenance plan).

Not because they are stupid, or because they are morally bankrupt, because they are doing a poor job of maintenance (just like a diabetic forgetting to take insulin).

Perhaps more important, even if an addict has been sober for years (sometimes even decades) they will always be at risk of a relapse if their maintenance program fails. It is a chronic disease.

The sooner people understand that relapse is not a moral failing and that addiction is a chronic condition, the sooner the treatment of addicts will improve.

I have not heard many people call people in diabetic shock “idiots.”

Do you disagree with the idea of addiction as a chronic disease? Let me know what you think, leave a comment!

Being Reflexive About the Shame Monster

by Joshua Hoe

shame cycle

Shame has a very specific and important productive purpose, it exists to help you build bulwarks up against bad behaviors. As you get closer to doing something bad, you feel increased shame, which hopefully prevents you from continuing your path toward bad behaviors.

When you have actually done something bad, shame tells you not to do it again, that you should not WANT to engage in that kind of behavior. Shame is one of many of our tools to protect ourselves from doing the wrong things (It works in concert with our other emotional tools like our flight or flight response etc.).

But, for addicts, shame cuts much deeper. For me, I spent so much of my time wallowing in shame that it seemed impossible to ever feel morally “clean” again. And that is the root of the problem, once shame stops being productive it starts becoming part of our justification cycle.

We feel so bad, and so full of shame, that the only answer seems like acting out (and through acting out temporarily feeling “good” again). Our justification voice tells us,

“You are so awful, so shameful, there is no hope for you, this is who you are.”

Self-Awareness + Questioning Your Shame

One trick I have learned to use is engaging in dialog with myself about my shame. When I notice that I am starting to “wallow” I ask myself one simple question:

Is this shame serving a productive purpose?

I am not saying it is easy to dismiss feelings of shame. I am not saying that it is easy to engage in objective and logical conversation with yourself. I am saying that with practice, it gets easier and easier to realize that you can engage in internal dialog about issues like this.

I am saying it becomes easier to recognize the shame that is productive and dismiss the type of shame that contributes to your addictive cycle.

I hope this helps you in your own struggles against shame.

Humility through Prayer

by Joshua Hoe

Person praying against a evening sky

Sorry, been taking some time to recharge my brain. It can be hard to keep up the pace of writing “new” recovery posts.

As many of you know, I am a “sex addict” (part of “that” deep dark corner of the recovery world).

My sex addiction functions something like this:

1) Something upsets me (makes me feel insecure or emotionally vulnerable

2) I see someone attractive

3) I sometimes stare or store up that memory for acting out.

Even though I have not acted out in nearly 6 years, I still confront everything on that list prior to “acting out” on a regular basis.

Refining Prayer

One thing that helps me when I am triggered is to “pray” for the person that I see who is attractive.

When I first started in recovery, I would pray for her as part of an attempt to connect myself to her as a person instead of as an object of lust.

It may sound crazy, but recovery from sex addiction (for me) is a constant battle over forcing myself to recognize people as human beings instead of just as bodies and faces.

This is really about my insecurity turning into narcissism. I feel better and safer when the world revolves around me. The emotional distress lessens when I start to see the world as confined to only my range of vision.

When I reduce the world to only what I can see.

People are always more than I can see.

And that is one of the problems I found in praying “for” someone else. It became another way of being paternalistic or of externalizing the problem so that it was their problem (and not mine).

So I refined my approach to prayer in the moment of my lust.

My New Prayer

Now when I am confronted by lust or the fantasy of being the center of a universe full of beautiful people for my gaze:

I pray for me.

I pray that I remember that when someone is “beautiful” it is not “for me”

I pray that I remember when someone dresses sexy, they are not dressing that way “for me.”

It is rarely about me at all.

And I pray that I realize that it is okay that I am not really that important in the global scheme of things.

I pray that I remember it is “of God” to be humble.

I am trying to redefine my relationship to myself and the universe.

How do you deal with your struggles with lust? How do you pray? How have you found humility in moments of weakness? I would love to hear your thoughts, leave a comment!

What “Relapse Is Part Of Recovery” Means

by Joshua Hoe

Sometimes people ask me why I say (or what I mean by) “Relapse Is Part Of Recovery.”

Here is what that statement (I hope a radical statement) means to me:

* There is no one path to recovery – it took my twenty years (or more) to find the right tools and right support to get sober

* Some people don’t get sober in one try. In fact, the majority of people I know in recovery did not hit one “bottom” and become magically healed

* Some people who are sober for decades lose sobriety. Often people who have radically improved recovery still act out occasionally. But almost always, much less than they did before they found recovery.

Mostly it means that recovery is an ongoing process and not a “cure.”

Why do I feel this so passionately?:

* Most of the legal edifice still sees response to addiction through a lens of personal responsibility and tough love. Shame and isolation are the largest triggers for most addicts and no evidence suggests that hard-line approaches work.

In fact, most evidence shows that the War On Drugs and War on Addiction have been a MASSIVE failure and that the best response is a Harm Reduction approach.

* The world is talking about a political opening for reforms, but most of the offered reforms seem absurd to me. Why?

They are all based on a magic bullet + tough love approach to the problem

What do I mean by this?

People assume that they have solved addiction by sending a person to rehab.

Once they have been to rehab, you have shown you care and given them a chance, but now it is “on them.”

Most of the reforms suggest something like – sentencing that forgives a first-time non-violent offender.

But what happens when they relapse?

Back to personal responsibility, shame, isolation, prison, and tough love.

TRUTH:

* For most addicts – one trip to rehab, going to a 12 step program, and attending therapy will not cure them.

Odds are good that it will help a great deal, in fact, it might massively reduce their acting out (but it might not).

But, even in the best case scenario, that does not mean it is now “back on the addict” again. Addiction is not a moral failing.

This does not give addicts a license to commit crimes while addicted, but it does mean that being addicted should not be a crime.

One thing we 100% know is that nobody knows what makes people quit.

Nobody, not the experts, not the recovered, not the media.

* Tough Love approaches are almost always a disaster – You will hear anecdotal evidence of people who were “saved” by tough love, but what those people never reveal is the trail of human wreckage left behind in tough love’s wake.

But, what this style of recovery does is give non-addicts an excuse to cut ties and treat addicts as if they are socially dead.

“We Tried,” they say.

But what you tried, was something very unlikely to work because isolation and shame are prime triggers for acting out behaviors.

What you tried was unlikely to work because addiction is a disease, and it is not “cured” by personal responsibility.

In fact, and here is the part nobody wants to hear, it is not “cured” at all.

It is managed and coped with over a lifetime. Just like diabetes is managed and coped with over a lifetime. But the good news, is that with therapy, 12-step meetings, sometimes medicine, and support, it gets better. The baseline for better is not zero.

What you tried also often does great harm, just look at the decades of tough love torture Sheriff Joe Arpaio has gotten away with in Arizona.

Has his keeping addicts in tent cities, wearing pink t-shirts that mock their struggles, kept in the 120 degree heat outside all day and all night solved addiction in Maricopa County (I used to live in Maricopa but if you want to read more about this read Johann Hari’s excellent book Chasing The Scream)?

I will not get behind any of this so-called “reform – movement” until people start listening to the science and research not the politics (and start making sense).

To me, this is all just more of the same.

Let me know what you think about the sentencing reform movement, about tough love approaches, and about if relapse is part of recovery. The only think missing from this post is your voice, leave a comment!

Addiction Is Not Economics (Response to AEI)

by Joshua Hoe

I have several “addiction” related searches that I have Google Alerts do for me automatically every day and one of them is about “addiction research” (I like to keep up on whatever newly released studies come out etc.).

I was surprised to see one of the first results yesterday was an article from Sally Satel and Scott Lilienfield in a publication of the American Enterprise Institute.

I was surprised most because the AEI doesn’t do much writing on addiction, it is primarily known for writing about political issues from a more pro-free market and supply side economics slant.

Ms. Satel however is a practicing Psychiatrist and lecturer at Yale (certainly more of an expert on the medical side of things than me) who clearly has a economic/political slant to her work (one of her books is sub-titled “the case for compensating organ donors” for example).

So, after reading her article, I was no longer surprised. Ms. Satel clearly believes in bringing market pressures to bear on the question of addiction. I feel, to some extent, that her argument is the Tail Wagging the Dog.

The Economics Of Straw People

Ostensibly, her beef is with the disease model of addiction. She says:

“The model “continues to be questioned” not because the linkages between addiction and biological processes hadn’t always been well established. But rather because those linkages only show, as anyone would expect, that the brain is involved with drug addiction. The linkages do not, per se, make the case that addiction is best defined as a brain-based phenomenon. Indeed, we fully expect more details about the biology of addiction to be uncovered in the near future. But that won’t make it anymore a brain disease than it is now. But first, it is surely true that addiction is both associated with and leads to brain changes. So what does that mean? It means that brain alterations associated with addiction can make it more challenging for addicts to make certain choices, but those changes do not come close to eradicating the capacity to choose.”

I actually agree with much of that. I have my own issues with the Disease Model, and I think she correctly identifies (as other neuroscientists like Marc Lewis have) that correlation does not justify causation.

But then she takes another step, Dr. Satel says:

“Volumes of research show that most people who are addicted respond to incentives and consequences, such as small cash payments, opportunity to participate in work programs, threat of an overnight jail stay.”

Now we are uncovering her true agenda.

Rational Economic Choice – Building The Strawperson

Dr. Satel then, hyperlinks two of her other articles which explain her argument in more depth. In the link to her 2010 article in something called AJOB Neuroscience she says:

“The mechanical simplicity of the “brain disease” rhetoric has a seductive appeal that obscures the considerable degree of choice in addiction, as Buchman and colleagues note. Consider the daily routine of addicts. They rarely spend all of their time in the throes of an intense neurochemical siege. Most heroin addicts, for example, perform
some kind of gainful work between administrations of the drug. In the days between binges, cocaine addicts make many decisions that have nothing to do with drug-seeking. Should they try to find a different job? Kick that freeloading cousin off their couch? Attend a Narcotics Anonymous meeting, enter treatment if they have private insurance, or
register at a public clinic if they don’t? These decisions are often based on personal meaning.

This attempt to connect addiction to rational choice economic models is more than a bit misleading in several ways:

* People who believe addiction is a brain disease do not think addicts become zombies (like on the Walking Dead) incapable of anything but pushing for a fix. They believe, from what I have read, that choice is constrained not foreclosed

* This description of the process is wrong. Most experts describe addicts moving most often from normal life, to triggering events, to acting out behaviors.

This is a pretty important set of distinctions, because it proves both that the disease model is not inherently at odds with her position and also that what she is describing is a bit self-serving in terms of her larger argument.

In other words, IMHO, Ms. Satel is building a bit of a straw person argument to fit her position here.

She continues:

“Many autobiographical accounts by former addicts reveal that they were startled into quitting by a spasm of self-reproach (Lawford 2008): “My God, I almost robbed someone!” or “What kind of mother am I?”

Look, what we don’t want to do is to replace one flawed model that puts too much weight on one group of contributory factors with another model that does the exact same thing.

Personal Responsibility (Tough Love)

And this is where the real agenda is uncovered.

Ms. Satel continues:

“But incentives do work in addicted patients, as clinical trials of a strategy called “contingency management” show. The standard trial compares addicts who know they will receive a reward for submitting
drug-free urines with matched addicts not offered rewards (Silverman et al. 2001). In general, the groups that are eligible to be rewarded with, for example, cash, gift certificates, or services are about two to three times more likely to turn in drug-free urines compared with similar counterparts who were not able to work for such incentives. In drug courts (a jail-diversion treatment program for nonviolent drug offenders), offenders are sanctioned for continued drug use (perhaps a night or two in jail) and rewarded for cooperation with the program. The judge holds the person, not his or her brain, accountable for setbacks and progress.”

This is a really important argument to talk about now because virtually all of the so-called “sentencing reforms” people are considering around the subject of addiction include a combination of exactly these carrots and sticks.

The problem here is that she doesn’t have to prove that incentives can be effective tools anymore than proponents of the disease model have to prove that addicts have been turned into helpless zombies.

Addiction doesn’t make you helpless, it makes it harder to resist your behaviors or substances when you encounter emotional triggers. The disease model does not mean addicts are doomed to never saying no to their substances or behaviors anymore than saying Diabetics are incapable of modifying their relationship to sugar.

This difference is critical because the question is not can addicts resist or defy their urges (her assumptions about the disease model aside, nobody I have read believes people are helpless in the face of addiction). The problem is that a program of personal responsibility, incentives, and tough love won’t account for one huge problem.

Relapse is part of recovery.

Traditional tools of recovery, personal responsibility, economic incentives, all work at times, but no research suggests that they work 100% of the time. The point is, that personal responsibility and free will do not account for 100% of what addicts face.

Look, I totally get that the world does not operate the way we want it to at all if we start believing that people are not ultimately responsible for their decision-making. This is what most conservatives and free-marketers are really afraid of – the idea that personal responsibility can be destabilized as the essential foundation of law.

But, the point of the disease model is not to destabilize the entire basis for law and economics. The point is to say that the tables are tilted against addicts as they encounter triggers on a hourly, daily, and weekly basis throughout their lives.

The point is that addicts are not morally failing when they lose those battles. As someone who has actually gone to prison over actions related to my addiction, I have always explained it like this:

I am morally responsible for everything I have done while addicted, but my addiction itself is not a moral failing.

This does not mean addicts are incapable of moral failings when acting out, just that using itself is not a moral failing.

This may seem like splitting hairs, but I do think there is space for both novel approaches to addiction (like using economic incentives) and traditional tools within the disease model.

And, most important, a strategy of harm reduction is almost always superior to a policy of retribution unless crime beyond using a substance or engaging in a personal behavior happens.

The danger with throwing the disease baby out with the bathwater is that the novel approaches and the traditional tools combined will be unlikely to end “addiction” in any addict. Nor are they likely to prevent all relapses in any addict.

This is troubling because what society tends to do is throw up their hands whenever someone relapses (see Johnny Manziel) and say “well we sent them to rehab so it’s on him now.” Or “We gave her economic incentives, and she failed, so it’s on her now.”

My suggestion is to use every tool possible (including economic incentives), to hold everyone accountable legally for “crimes” they commit (not including using a substance or engaging in a behavior that hurts nobody else directly), and to decriminalize and use harm reduction techniques whenever possible.

At the end of the day, I disagree with Dr. Satel’s description of the disease model because it seems to start from political and not scientific assumptions and because it seems to concoct a straw person disease model to serve those political purposes.

At the same time, I fully realize that Dr. Satel is a professional and I totally respect her expertise.

What do you think about the articles by AEI and Dr. Satel? Let me know, leave a comment!

Tradition 5: Carrying Is Not Bludgeoning

by Joshua Hoe

who are you worried about your ego or your sponsee's recovery meme by Joshua Hoe

At a meeting I attend we listen to CD’s of presentations from national conventions periodically.

This week we listened to a CD that made me almost lose my mind.

It was about the third and fifth traditions.

I agreed with the speaker entirely about his interpretation of the Third Tradition. We can not choose who joins or attends meetings, the only requirement for membership is a desire to stay sober.

What drove me nuts was the speakers interpretation of the Fifth Tradition.

Pleading The Fifth

This speaker, after finishing up the third tradition, started in on the fifth tradition.

In case you are not as familiar with the traditions, here it is:

“Each group has but one primary purpose – to carry it’s message to the alcoholic who still suffers.”

He spoke of there being a natural tension between the third and fifth tradition we should embrace.

He suggested that the message is “YOU SHOULD STAY SOBER”

He spoke of how we should expect our sponsees and the members we know to remain sober, and when they do not remain sober – we should not act as if it is okay.

He said sponsees fire sponsors by not remaining sober – and how sponsors are just doing the right thing by leaving sponsees who relapse alone.

He made an analogy between punishing a child for bad behavior and how you should treat an errant sponsee.

I wanted to vomit.

Why I Vociferously Disagree

What we carry is our experience, strength, and hope – not shame or judgement.

Some reasons that I disagree with a more aggressive definition of T5:

1. The biggest triggers for most addicts are Shame and Isolation/Abandonment

2. NO experts know why people quit – NO studies no why people quit – YOU don’t know why people quit (I don’t know why people quit)

3. Addiction (and relapse) is NOT a moral failing. We want sobriety for ourselves and for the people we sponsor, but we don’t punish or shame people for relapse.

4. Our message is that there is HOPE

When people do something immoral or that puts people at risk when they act out, they should face the consequences of their actions. However, relapse is a part of recovery.

I humbly suggest that the frustration we feel when we face someone who has struggled for years to remain sober is more about us than it is about them.

I humbly suggest that we should not try to CONTROL others with machiavellian schemes. To me, this is the essence of compulsive obsessive disorder and co-dependence.

We are a tool, a resource, maybe even a model – NOT a disciplinary device.

It might make us feel better to act like people choose relapse and to disobey us, but the truth is, they want to quit too.

It took me decades of relapse and an arrest to get sober.

Pretty sure I would not have found Jesus by being abandoned by my sponsor of group.

Recovery is a message of hope for a sane and happy future, not a club to wield against those that do not recover “quickly enough” for us.

The 5th step says carry our message, not use our message to bludgeon other addicts.

What do you think of the 5th step? What does it mean to you? I would love to hear your opinions, leave a comment!

Deck Chairs On The Addiction Titanic

by Joshua Hoe

There has been a TON of press recently about how the skies have opened up and real reform is coming to liberalize the nations approach to addiction and criminal justice.

IMHO most of what I have seen so far is utter nonsense. With one exception, Bernie Sanders (alone) says that addiction is a public health and not a criminal problem.

All of the other proposals I have seen still consider addiction a Moral Failure.

All of the other proposals I have seen still treat all but the most benign “addicts” through the lens of being criminal justice problems.

This promised summer is nothing but a Prague Spring.

Hillary Clinton

Here is one version of what HRC has said about addiction:

“We also must prioritize treatment and rehabilitation — rather than incarceration — for low-level, nonviolent drug offenders. Over half of state prison and local jail inmates suffer from a mental health problem, and up to 65 percent of the correctional population meets the medical criteria for a substance use disorder. I will ensure adequate training for law enforcement for crisis intervention and referral to treatment. I will also direct the attorney general to issue guidance to federal prosecutors on prioritizing rehabilitation and treatment over incarceration for people who commit low-level, nonviolent crimes and also suffer addiction or mental health problems.”

More specifically, she seems to suggest the same deferred judgement type approaches favored by the GOP in general. As near as I can tell (from this and what she has said in the debates) she wants drugs to remain criminalized, for people to have non-criminal sentences for a first low-level offense, and more rehab and treatment in prisons and jails.

Lots of reasons I disagree with this type of approach:

* People do not relapse because of a moral failing and addiction is not a moral failing, it is a public health and not a criminal problem.

* People should 100% not get a free pass for crimes committed while acting out.

However, part of the problem is it is criminal to use most substances (aside from prescription drugs – a whole different addiction issue).

In other words, as long as you continue to make drug use itself a crime, you probably will not have much of a revolutionary effect.

Drug use should NOT be a criminal act. No matter if it is low-level or high level.

* Even more disturbing HRC is not even for relaxing Marijuana laws in virtually any cases. If she cannot even see why legalizing Marijuana is necessary, she is not going to have much of an effect.

This might seem a bit odd, given I am a recovery blogger. I do not think jail or prison helps anyone recover (and I have been there – so I have some experience on this subject).

To be 100% honest, her answers at the Nevada Town Hall on the drug question were shocking to me, she is very hard line on drugs:

Donald Trump and Ted Cruz

As near as I can tell both of these candidates believe the answer his border security and better interdiction. They both seem to prefer a punitive approach to drugs in general, although many years ago Trump was for Marijuana legalization.

This will only increase demand and has never, even in the harshest years of enforcement, stopped people from getting drugs.

Here is what the spokesman for the DEA says on the matter:

“Payne declined to discuss the 2016 candidates’ focus on security to combat the drug crisis. But he noted: “It’s about addiction.… We’ve gotta reduce demand. We’re cops, we go after bad guys, but you’ve got to have a multifaceted approach,” Payne said. No matter how much is taken off the streets, the crackdown has little effect on the flood of readily-available drugs, Willard said. “We need to shrink the pool of addiction,” he said. “That’s how we’re going to stem this tide — it’s not going be through law enforcement efforts. He laughs and covers his face with both hands when discussing whether a big border wall would stop New Hampshire’s drug crisis, as Trump and Cruz claim.”

Marco Rubio

Marco Rubio is even farther right, he is for enforcing Federal Laws on States who liberalize Marijuana laws. However, he has been a bit more understanding in the treatment of addiction (at least in the case of Heroin):

“Marco Rubio has called for a broader approach to combating the heroin epidemic, arguing that the issue deserves to be treated as a “medical condition.” There’s a stigma associated with addiction, says Rubio, who earlier this month co-sponsored a bill called the Comprehensive Addiction and Recovery Act. With an eye on the link between prescription painkillers and heroin addiction, the bill would strengthen prescription drug monitoring programs; it would expand disposal sites for unwanted medications; increase the availability of naloxone among first responders; increase treatment resources for the incarcerated; and expand prevention and education efforts.”

Bernie Sanders

Pretty simple, he thinks addiction is a medical and not a criminal problem.

The ONLY truly radical (and meaningful) response to the problem is ending the war on drugs and making addiction about health and treatment NOT about criminal justice.

Most all of the research I have seen suggests that Harm Reduction is much superior to criminal justice approaches to drugs.

The drug war only increases demand pushing prices higher and creating the need to protect supply. Never once, has intercepting supply or increasing interdiction interfered with supply.

Oh, and enforcement of the WOD’s and the high prices created by enforcement are the cause of virtually all of the violence.

Congress

The problem with most all of this supposed “reform” is that it misses the point.

Many of the reforms to sentencing, IMHO are only moving deck chairs on the criminal justice Titanic. Much of this sounds good, but as The Intercept explains:

“As Michelle Chen noted in a piece for The Nation, “Reform initiatives like rehabilitation and employment programs focus on making ‘corrections’ less punitive. But they maintain the political framework of ‘redeeming’ bad people, rather than dismantling antisocial systems.” Chen points out how a “treatment industrial complex” could, and is already, replacing the prison industrial complex. She adds, “Many of the dollars expected to be ‘saved’ from shuttering prisons may simply be funneled into privatized ‘alternatives to incarceration’ like parole programs and halfway houses.”
Not only is this shift well underway, I’d submit it is among key conditions enabling the political will to reform prisons to arise. As Foucault said with haunting prescience in 1975: “Criminal psychiatry and psychology risk becoming the ultimate alibi behind which the prevailing system will hide in order to remain unchanged. They could not possibly suggest a serious alternative to the prison system for the simple reason that they owe their origins to it.” Prison reform, even the abolition of brick-and-mortar prisons, is about the crucial goal of removing humans from cages. As an end, even this is insufficient if we are not in the business of setting people free.”

And as The Intercept concludes (probably the truest thing I have read in a LONG time):

“If we truly are moving away from mass incarceration, we should remember that criminal justice does not rely on prisons to alienate and oppress. It relies more fundamentally on the category of “criminal,” and who gets to fall into it. It is a category that needs drastic undoing, not reforming.”

As long as addiction is seen as a criminal problem, as a moral failing, addicts will continue to face harsh consequences including shame and social dislocation (two of the largest triggers for acting out).

What we need is a revolution, not a better looking bridge on the US Titanic. Don’t believe the hype.

The Porn Problem + Sexual Addiction

by Joshua Hoe

Todd Weiler is making arguments for the regulation of pornography.

Lets get one thing out of the way first, even if regulations or laws are passed because of State Representative Todd Wieler’s crusade against pornography they will be struck down by the Courts.

Because First Amendment.

But, a good deal of what he is trying to say is important.

It is troubling that so much pornography is available to anyone at the click of a mouse, no matter how old they are or what problems they are struggling with.

And, often, you don’t even need a mouse. Even reputable newspapers and online journals have click bait displaying very racy pictures all over the online page.

There number of people becoming desensitized to intimacy through pornography is a HUGE number.

Millions of people are borderline or fully becoming addicted to online porn (as has been reported by experts for years).

I have a friend in the cable industry and he says, by far, the biggest amount of pay-per-view activity is around porn.

And it is not just on cable.

Most browser histories in the world would reveal the same thing after a simple search.

And, what about just normal everyday internet behavior, look at the click bait in the article I linked above (ironic?).

And, as Whitney Cummings did such a great job explaining in her recent HBO special, male expectations of women’s behaviors are often driven by porn (often starting at a young age).

There are certainly many people who have no problem dealing with porn, and for many it can be a healthy expression of sexuality. I am not pro-censorship at all.

But, for lots of people, it is a problem.

Trying to avoid triggers is a constant effort for all sex addicts. Very hard to manage when every publication and every poster depicts women as sexual objects (either explicitly or as a click bait tease).

The Best Answers We Have

So, people struggling with these issues do have answers, although I really doubt that laws will ever be changed to limit pornography to a greater degree.

So what can we do?

1) Socialize boys to appreciate that women are more than sex objects

I am approaching this from a hetero perspective because I am not educated to how porn functions with young gay men and women (or trans).

Porn is partially attractive because it allows us to imagine women that fulfill all of our sexual desires without demanding respect or requiring intimacy from us.

I believe if we socialized sexiness to encompass subjectivity, this would be less of a problem.

I think the answer is in removing the fallback where it occurs to us to think of people as anything other than people.

I believe very strongly that we should object verbally whenever a woman (or man) is depicted only as an object and not as a subject.

If we are raised to be turned off by women who are not at the same time both subjects and objects, fantasy images based in objectification will have no power.

When they are shown as sex parts or not given a voice, we should say something.

I try to do it every single time.

I even type it out on social media when I see offensive memes.

Even if and when people get mad.

Reducing people to manageable docile bodies is a huge part of the problem in our brains. The more we see people as active and with a voice in their own lives, the harder it is to create fantasies of people as docile and easy-to manipulate objects.

People to know, not bodies to use for sex.

2. Remember, The Goal Should Be Intimacy Not Sex

Intimacy and sex are very different things.

Sex, when the purpose is connecting with and celebrating a connection with a partner, can be very much about intimacy.

But, when the sex is more about release. When you are with someone mostly because their body excites you. When you could, aside from how they look, substitute any other body or any other face and not change the importance of the sex. Those are probably not intimate sexual encounters.

Unfortunately, we are raised to think that sex is about the physical act MUCH more than it is about finding intimacy between two particular people.

For me, it has been very helpful to be suspicious of my own motives when I am thinking about WHY I am trying to get to know someone or trying to look at pictures or a movie.

Sex for sex’s sake has become much less important to me over time and with age.

It also helps to try to think of the person in the picture more as a person and less as a sexual object.

I usually start by asking myself questions about other things the girl in the picture might be interested in or hobbies that she might have.

By doing this, I start making myself see each image as a person more than as a sex aid.

Finally, I remind myself that beautiful people are not beautiful for ME.

Part of my problems are based in narcissism, the more I remind myself that the world does not exist for me. That I am not the center of everyone else’s universe. The better I feel (strangely enough).

3. Practice Avoidance When Possible

Whenever you can avoid porn, avoid porn.

I don’t even watch movies that might trigger or agitate me.

When I am surprised in movies or on television, I literally close my eyes.

I try to find articles without click bait if possible and try to enter into a discussion with myself about my specific research goals whenever I do encounter click bait.

It requires discipline, and sometimes I have to call someone and talk. But, practice helps.

4. If you Are Struggling, Find Places You Can Discuss Your Struggles

Yes, many people can handle click bait and porn, but for those that it causes problems. There is a reason most major Western traditions focus on sharing.

Therapists want you to talk.

Priests want you to confess.

12 Step Programs want you to share.

The reason is that isolation is the enemy. We don’t do well in our own heads. We don’t do well when we are keeping our feelings inside.

Find a community of people you can share your struggle with. There are a large number of “S” programs available.

You can also find therapists who specialize, or have been trained in, sexual addiction.

In my experience, finding a specialist can make a massive difference when it comes to sexual issues.

Tolerance: How Recovery Gets Easier

by Joshua Hoe

Recovery: Does it Get Easier meme created by Joshua Hoe

Does recovery get easier? The short answer is yes, but the story is not that simple.

When I was in my early 20’s I developed some serious food allergies.

At first, I had no idea what was causing my pain.

It would manifest itself in incredible stomach pain and eventually in painful diarrhea that would come in waves.

Not pretty, not pleasant.

Often it would hit me in public places, and I had to run for the nearest public restroom.

Did I mention: Not pretty, not pleasant.

So, the first few times I experienced this reaction, I was sure it was going to kill me, the discomfort was as bad as anything I had experienced before (and I had experienced some serious pain before).

At first the pain was unbelievable, almost entirely unmanageable, and was even worse (in some ways) because I had no idea what as causing it.

Eventually I figured out it was caused by food and then through the process of elimination, I figured out what foods caused my problems and I learned what to avoid.

Eventually, I even went to a specialist and got the details (food allergies and irritable bowel).

Unfortunately, the foods and spices I am allergic to are so common, that even when I try to avoid them, I can accidentally be exposed in a restaurant. When this happens, I get sick all over again.

For instance, one of my allergies is to garlic powder.

Hard to know when something does or does not have garlic powder.

Anyway, enough feeling sorry for myself, my point is that when I have the reaction now, even though it is exactly the same, I experience it as less catastrophic.

Over time, I have gotten used to the pain levels and the discomfort, what felt like it was killing me before is now just damn uncomfortable.

I developed a tolerance for even that high level of pain through experience.

And, because I had experienced it before, I knew what to expect and it became intellectually manageable.

Tolerance and Recovery

Usually, when we talk about tolerance in recovery it is to describe how we build up a tolerance for a specific drug or acting out behavior. But, this time, I want to talk about tolerance in the context of emotional withdrawal.

I am often asked by other addicts if “recovery gets easier?”

If you are wondering why I told that long story about allergies it is because recovery, at the beginning, is a lot like when I first had that allergic reaction.

It often felt entirely impossible, painful, unmanageable.

I myself often wondered if I could keep going.

Recovery literature always promises that it will get easier over time.

And I will confirm that it does get easier, much like dealing with my allergies got easier.

I identify the triggers earlier and handle them in more mature ways, so I encounter addictive urges less often.

However, I do sometimes still feel them, and they are as strong as ever. But for the same reasons as with my allergies they don’t bother me as much or feel impossible to handle anymore.

It is not heaven, but it is manageable. I don’t mean that I can control and enjoy my addiction, I mean that through a strong period of recovery life becomes more manageable.

The Importance Of Maintaining Recovery

This is where the neat analogy/metaphor starts to break down.

With my food allergies I only had to avoid triggering foods and get to the place where I could emotionally get my head around the pain. Over time, as I got used to the pain level, it became less devastating.

Addiction recovery works in many of the same ways but requires more than just avoidance and tolerance.

I am certainly more capable of handling the urges now, but part of what makes the pain tolerable is having places to talk about what I am feeling. I know that absent my meetings, my talks with my sponsor, or my tools I would be right back where I started.

This is not a program I can graduate from, it is a way of life. Recovery is a pathway, to me it is a guide for better living.

What has been your recovery experience? How has it gotten easier for you? Would love to hear your experiences, leave a comment!

Recognizing Sexual Crisis As Tragedy Not Farce

by Joshua Hoe

meme saying "sex addiction" and "addiction is serious business" created by Joshua Hoe

Two days ago in my home state of Michigan, a man flipped his car while he was trying to simultaneously drive while masturbating and watching porn.

Thank God he did not take anyone else down with him.

But it saddened me a great deal to hear the tenor of most of the press commentary.

As usual, it was all a big joke.

It wasn’t and ins’t a joke to me.

Been there myself, I suspect I know the surreal helplessness he was likely feeling.

What I Felt – Empathy

I know how low you can get, how sadly and desperately compulsive addictive behaviors can become.

I have been there, wondering (always after the fact) how I could have done something so against my beliefs, so gross, and so not what I wanted to do at all.

I would be willing to bet the farm that, at the time, this person was close to 100% miserable.

To normal folks, his “accident” probably sounds like a joy ride, but very little joy was happening before or during that fateful car ride.

What I mostly feel is empathy:

* I remember everything seeming normal and healthy and gradually progressing farther and farther from whatever “normal” is.

* I remember acting out after 8 hour sessions with no idea how or why it all happened

* I remember knowing something was “wrong” but not really knowing what to do about it and feeling powerful compulsions to continue

The good news, there are answers, people can find recovery – faith – and a community of people that care.

But, I also know that but for the grace of God, I could have been this person.

What I Felt – Shame

Virtually every story I saw about this made a joke out of what happened.

I get that when, as a society, we have a hard time trying to process information we often use humor as a coping mechanism. But far too often, we make jokes just because we are cruel.

The same people that laugh when someone trips over their own feet, or the people who make fun of people in pain tend to dominate the humor when things like this happen.

I certainly remember the reaction in junior high school when someone had the audacity to drop something loudly in the cafeteria.

Our first reactions are too often not very compassionate.

We probably look at virtual all sexual dysfunction as evidence of socio-pathology (and therefore fair game), but this is rarely the case, only a very small percentage of people struggling with sex are sociopaths.

And, even when it turns out that someone is a sociopath, by definition – sociopaths are “built that way” – not doing it from a sense of cruelty per se.

And even in these cases, we should look at what happens as truly tragic for everyone involved, especially the victims. We should try to find our place in the problem, and do our best to try to auto-correct to try to prevent problems in the future.

But I sincerely doubt that, in this example, we were dealing with a sexual sociopath.

And in this case, the perpetrator was luckily (but sadly) the only victim.

This was a real human being struggling with a terrible problem who is now dead.

His epitaph will always be a punchline. Who knows what potential he offered the world but for his struggle? Who knows the good things he did in his life outside of his addiction.

Millions of people in this country struggle with sexual dysfunction. Most studies that I have seen suggest that the number is increasing rapidly as the internet helps fuel access to the worst forms of human sexual behavior.

Whitney Cummings was not wrong on her recent HBO special by calling out the excesses of contemporary male sexual desire.

However, we do ourselves few favors by responding to our own basest nature to respond to sexual problems.

One of the problems with how we, as a society, treat sexual “problems” is we almost make it a catch-22 for anyone struggling with compulsive or unhealthy sexuality to get help.

You are told your whole life that there is nothing worse than sexual problems.

When someone gets caught or found out, they are socially shamed so completely that they are often erased as social human beings.

When people with these problems are depicted in the media, they are either shown as monsters or as the biggest jokes in the world.

* If you are confused by what I am saying, odds are you have never been on the phone trying to figure out how to ask for a sexual addiction specialist through your insurance without letting your whole HR system become alerted to what you are struggling with.

* If you are confused by what I am saying, odds are you have never been watching a movie mocking a fictional character struggling with exactly what you are struggling with.

* If you are confused by what I am saying, odds are you have never been shocked, amazed, and confounded by the terrible advise non-specialist therapists give to people struggling with sexual problems.

What I feel, and felt, every time I saw another social performance of sexual dysfunction was shame.

* Shame that pushed my deeper and deeper into isolation

* Shame that made me less and less likely to ask for help for fear that people would find out – that people would know my secret shame.

When you watch a story like this one unfold and wonder how someone could have done something so absurd, so dangerous, or so immoral you might look to how long the person has been trying to deal with the issues on their own.

In almost every instance, I would make a bet that it was for a long time.

Social shame is often where sexual dysfunction starts and the continuation of shame (in all addicts) protects the addictive cycle from proper healing and care.

By pushing dysfunctions underground we make them worse.

The worst thing we can do is create no safe spaces for people to exist comfortably in. A close second is making even getting help so frought with risk that nobody wants to get help.

What I Felt – Concern

Now, all of that said, I also feel concern.

We sex addicts, and all addicts, need to remember that what we are fighting is a life and death struggle. Not just a life and death struggle for us, but also for others.

Drunk drivers who are alcoholics kill people, people whacked-out on drugs are often involved in violence, gamblers lose money families counted on, and this person could have killed anyone who was driving on that same road with him.

Recovery matters.

Getting help matters.

No matter what social stigma you face, if you are struggling, getting help is a moral imperative.

Survival often depends on it.

When I was in prison, I would estimate that 80% of the people I met (no matter what crime they were actually doing time for) struggled with addiction.

Old AA veterans say addicts are looking forward to the Asylum, Prison, or the Grave without recovery. They are most likely correct, that certainly applies to me.

I send my condolences to his family.

I hope we find a way to have a more mature discussion of sex as a society. I am not hopeful, but I hope.

Until then, I know some things do work, if you are struggling, get to a S-12 Step Meeting, take the risk and find a therapist who specializes, and read whatever you can from reputable sources on the subject of sex addiction!

I know that for me, just walking into that first meeting and sharing my story for the first time made all the difference in the world.

Thanks for reading my rant, if you have any constructive experiences to add to this discussion, please feel free to leave a comment!