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The best thing one can do when it is raining is let it rain.

  • Henry Wadsworth Longfellow


The Merriam-Webster dictionary defines detachment as a “lack of emotion or of personal interest.” Many of us strive for this experience in order to try to escape that which is painful, frightening, or out of our control. “If I could just not care so much,” we think, “then I would be okay.”


But how could we possibly strive to not care, when caring is at the essence of what makes us human? It seems at the core of our very nature, and in fact, people who are fully detached are frightening in their lack of empathy and compassion. Those who are not psychopathic but desperately seek detachment frequently become involved in addiction or addictive behaviors as they attempt to force their minds and hearts into an unnatural place of escape.


The author John Burnside describes this problem eloquently. “To imagine that one can simply withdraw, and somehow achieve peace, or wisdom, or detachment, is a mistake,” he states. He goes on to write that “to practice detachment one must be in the world, in the chaos of emotions and needs and conflicts that make up ordinary life. If the world is sometimes disappointing, so be it: a just life is one that must be lived in the midst of disappointment.”


Here Burnside gets at something similar to what the 12-step program Alanon terms “detachment with love.” Alanon is a program which originally arose out of a need for family members and friends of alcoholics to learn how to live healthy lives in spite of the pain of having someone in their life suffering from alcoholism. It has since become a place where many seek help to become free from any type of codependency.


When Alanon members speak of “detachment with love,” they are talking about responding to the world with choice, rather than acting from anxiety; in other words, being responsible for ourselves and to ourselves, rather than attempting to control others around us. From this perspective, we cultivate the ability to care deeply about a another person without being controlled by or invested in how another person responds to us. We remain attached, but not overly so.


The great sage Maharishi Mahesh Yogi explained misunderstanding about detachment as an attempt to force the mind into disinterest, rather than as a natural outcome from cultivating a different experience of life. He explains that the mind remains attached to things or experiences as long as it remains unfulfilled, but as soon as it becomes contented, attachments to lesser experiences lose their charm and the mind naturally becomes detached from them. In other words, a person becomes detached from a hut when they move into a mansion. Transcendental Meditation is the technique he offered as a way for the mind to move naturally into a state of both fulfillment and witnessing; ie detachment.

When speaking about detachment, the teacher and Buddhist monk Thich Nhat Hanh stated that “detachment and calm give us a larger space, inside and outside of us. This space, we can also offer it to those we love.”
An example of this would be the ability to forgive. The act of forgiveness is the practice of letting go of the suffering caused by someone else’s wrongdoing (or even our own); a practice that repairs relationship and also allows us to become free from pain. Without inner fulfillment, and the space created from detaching with love, it’s hard let go of that suffering and forgive. In this way and many others, the space we create through detachment with love, and the ensuing freedom it provides, allows us to be more fully loving, and ultimately more deeply attached.

Samantha Smithstein, PsyD


The Most Wonderful Time For a Beer: 10 tips to control holiday drinking

The holidays can be a time of festivities, joy, family, and friends. It can also be a time of stress, material consumption, and lots of drinking. As someone anonymously put it, “What does alcohol have to do with Christmas? One makes the other bearable.” Whether at the company party or over dinner with the family, the holiday season introduces many opportunities to drink. In fact, according to the Distilled Spirits Council, the distilled spirits industry makes more than 25% of its profits between Thanksgiving and New Years.

For some, the added stress of the holidays or painful memories about family can trigger compulsive drinking (as well as other compulsive behaviors). For those who already engage in problematic drinking, the stress can worsen drinking behaviors.

Abstinence from all alcoholic beverages may be the best strategy. But for those who don’t want to abstain or who simply want to be mindful of how much alcohol they consume, moderation is key.

Tips for moderating:

  1. Drink on a full stomach. Pair your wine or beer with delicious cheeses. Don’t forget snacks when planning a cocktail party. Plan for dinner before heading to the company holiday party.

  2. Plan your night before you start drinking. Think about how many hours you will be partying and set a limit for how many drinks you’d like to consume. Remember it takes approximately one hour to metabolize one drink. And one drink is probably less than you think: a 12 oz beer, a 5 oz glass of wine, or 1.5 oz of 80 proof liquor. Tell someone supportive about your plan—a spouse, friend, coworker, or family member. Ask them to check in with you halfway through the night to help keep you accountable.

  3. Count your drinks. If you’re drinking beer, keep the bottle caps in your pocket or purse to help you keep count. Keep pennies in your left pocket and move one over to your right pocket each time you have a cocktail. Send yourself a text each time you get a new drink.

  4. Drink a full glass of water between each alcoholic beverage. Keep yourself hydrated and keep hangovers at bay!

  5. Dress up a non-alcoholic beverage like a cocktail. Cranberry juice with a lime looks just like a Cape Cod. Same goes for Sprite and soda water. If you’re drinking beer, refill your bottle with water. No one will know the difference! Here are some tips from bartender Mike Hagan.

  6. Lighten up! Turn that glass of wine into a spritzer with some soda water. Go for that 3% beer! Instead of a shot of tequila, how about adding some ice and ginger ale? If you start with a cocktail, consider switching to beer. The lower alcohol content will be absorbed more slowly.

  7. Arrive late to the event or leave early. Seeing others sloshed may motivate you to moderate. And it will likely be very entertaining! Make an intention to mingle for 30 minutes before you order a drink at the bar. Set the tone for the night.

  8. Sip, don’t gulp your drink. Go ahead, get snobby about it. Describe the notes of that IPA on your nose (“Ah, yes. It smells of a warm summer day frolicking in the grass.”)  and on your palette (“And tastes of toasty, roasted hops.”) Make believe you have a blog about artisanal cocktails and write a mental review of each drink you have. Be mindful about the experience the drink is creating for you. Is it sweet or sour? Cold or room temperature? Does it conjure memories?

  9. Pay attention to self-talk. Are you trying to convince yourself to drink more because “it’s the holidays” and you “deserve it?” Check in with yourself before each drink. Do you really want another one? Will it get in the way of any plans you’ve made for the rest of the evening or tomorrow?

  10. Don’t forget to have fun! Focus on your friends, family, coworkers, and the setting. Let the experience engross you. Dance!

This should go without saying, but please do not drink and drive. It is estimated that 1,200 people will die this holiday season due to drunk or buzzed driving. Always designate a sober driver or make other arrangements to get home after a night of drinking.

If you think you have a drinking problem or are struggling with moderation, there are many ways to get help. The National Institute of Alcohol Abuse and Alcoholism offers information and resources on their website. Find a therapist who specializes in evaluating and treating substance abuse to understand your best treatment option. You can also find support at Alcoholics Anonymous and Moderation Management meetings in your area.

The holidays may be a stressful time, but they are also a wonderful time to share with the people you love—including yourself. Make the most of this time with those you care about. Create an intention to connect with someone over the holiday; that may even be yourself.

Jennifer Fernandez, PhD

How to Overcome Barriers to Forgiveness

This article was written by Linda Graham, MFT and was reprinted with her permission.

It’s hard to let go of the suffering caused by someone else’s wrongdoing. What barriers stand in the way of forgiveness—and how can we overcome them?

Laurie and Jamie sat in my office a few months ago, locked in an impasse all too common in couples therapy. The previous week, Laurie discovered that Jamie had done the seemingly unforgivable: He had had a brief fling with the new administrative assistant in his office while Laure was out of town visiting her ailing father. Jamie was genuinely remorseful, but he also carried a grudge of his own about Laurie’s repeated overspending on their credit card, despite his many requests to stay within their agreed upon budget.

We all know how painful it feels to suffer these kinds of hurts, betrayals, or abuse—and to have this pain harden into lasting grudges or resentments. I’ve spent 20 years helping couples like Laurie and Jamie recover a sense of trust after they have violated their vows or broken their agreements. In that time, I’ve found that helping people understand each other’s underlying motivations is crucial to repairing a rupture between them.

But I’ve also learned that helping people forgive each other is essential, even when there is good reason to resist. Indeed, study after study has suggested that being unable to forgive these past wrongs can wreak havoc on our mental and physical health.

Forgiveness is the practice of letting go of the suffering caused by someone else’s wrongdoing (or even our own). It does not mean excusing, overlooking, forgetting, condoning, or trivializing the harm or jumping to a premature or superficial reconciliation; it doesn’t necessarily require reconciliation at all. Instead, it involves changing our relationship to an offense through understanding, compassion, and release. Two decades of social psychology research have repeatedly demonstrated the emotional, physical, and social benefits of forgiveness. True forgiveness repairs relationships and restores inner well-being.

Yet we often find it hard to let go, forgive, and move on. According to research, even when we can feel compassion and empathy for the person who harmed us, we can remain stuck in fear or hostility for days, months, even years.

Why is something so good for us so hard to do? That’s the questions Ian Williamson at New Mexico Highlands University and Marti Gonzales at the University of Minnesota have explored through research on the psychological impediments to forgiveness.

In a recent study published in the journal Motivation and Emotion, Williamson, Gonzales, and colleagues identify three broad categories of “forgiveness aversion.” Traditionally, ideas for helping one person to forgive another have implied either expanding one’s empathy or compassion for the offender or “distancing,” not taking things so personally. But their research on forgiveness aversion suggests another approach: Forgiveness comes not necessarily by appealing to kindness or compassion but by addressing the victim’s fears and concerns. Williamson and Gonzales’ research suggests how to work with perceived risks to forgiveness and to move toward forgiveness in a safe and genuine way.

Below I offer a brief tour of the three barriers to forgiveness, along with ways to overcome them, drawing on research and my own clinical experience with hundreds of couples and individuals. Understanding these barriers to forgiveness can be very useful to clinicians and to anyone who has ever struggled to forgive—in other words, most of us.

Barrier #1: Unreadiness

The first block is “unreadiness,” which Williamson and Gonzales define as an inner state of unresolved emotional turmoil that can delay or derail forgiveness. People can feel stuck in a victim loop, ruminating on the wrongs done to them by another person or by life, and be unable to shift their perspective to a larger view, to find the meaning, purpose, lessons, and possibilities for change from the events.

Who is most likely to experience unreadiness? Williamson and Gonzales found that people’s tendencies to be anxious and ruminate on the severity of the offending behavior reliably predicted an unreadiness to forgive. People showed more reluctance to move toward forgiveness especially when they held a fear that the offense would be repeated,

How can we overcome the barrier of unreadiness?Williamson and Gonzales’ research validates the folk wisdom that “time heals all wounds” and establishes the importance of not rushing the process, not coming to forgiveness too quickly. Certainly the passage of time is an important factor in helping people get some distance from the initial pain, confusion, and anger; it helps the offender establish a track record of new trustworthy behavior and helps the victim reframe the severity of the injury in the larger context of the entire relationship.

Over the three months that I worked with Laurie and Jamie, I saw them confront and ultimately overcome the barrier of unreadiness. In taking that much time, Laurie was able to place Jamie’s transgression in the context of a 17-year marriage that had already survived even greater challenges than Jamie’s one night of out-of-bounds behavior. And over time, Jamie was able to trust the turn-around in Laurie’s spending habits, relaxing his vigilance about her every move.

Tips to Overcome Unreadiness

1. Recall the moment of wrongdoing you are struggling to forgive. “Light up the networks” of this memory by evoking a visual image, noticing emotions that arise as your recall this memory, notice where you feel those emotions in your body as contraction, heaviness, churning. Notice your thoughts about yourself and the other person now as you evoke this memory. Let this moment settle in your awareness.

2. Begin to reflect on what the lessons of this moment might be: what could you have done differently? What could the other person have done differently? What would you differently from now on? When we can turn a regrettable moment into a teachable moment, when we can even find the gift in the mistake, we can open our perspectives again to the possibilities of change, and forgiveness.

Barrier #2: Self-Protection

The second block to forgiveness is “self-protection”—a fear, very often legitimate, that forgiveness will backfire and leave the person offering forgiveness vulnerable to further harm, aggression, violation of boundaries, exploitation, or abuse.

Who is most likely to experience self-protection? People who have experienced repeatedly harmful behavior, and lack of remorse or apology for that behavior, are most likely to resist forgiving the offending party, according to the research by Williamson and Gonzales. In fact, they found that even the strongest motivation to forgive—to maintain a close relationship—can be mitigated by the perceived severity of the offense and/or by a perceived lack of sincere apology or remorse. Refusing to forgive is an attempt to re-calibrate the power or control in the relationship.

According to their study, one of the hardest decisions people ever face about forgiveness is: Can I get my core needs met in this relationship? Or do I need to give up this relationship to meet my core needs, including needs for safety and trust? The ongoing behavior of the offender is key here. If the hurtful behavior continues, if any sense of wrongdoing is denied, if the impact of the behavior is minimized, if the recipient’s sense of self continues to be diminished by another, or trust continues to be broken, or the victim continues to be blamed for the offender’s behavior—if someone experiences any or all of these factors, then forgiveness can start to feel like an impossible, if not a stupid, thing to do.

How can we overcome the barrier of self-protection?“Victims may be legitimately concerned that forgiveness opens them up to further victimization,” write the researchers. “Intriguingly, when people perceive themselves to be more powerful in their relationship, they are more likely to forgive, perhaps because they have fewer self-protection concerns in their relationships with their offenders.”

In other words, people sometimes have understandable fears that offering forgiveness will be (mis)interpreted by the offender as evidence that they can get away with the same behavior again. People very often need to learn they have the right to set and enforce legitimate boundaries in a relationship. Forgiveness can also involve not being in a relationship with the offender any longer or changing the rules and power dynamics for continuing the relationship.

Only when Laurie stopped her overspending and came to respect Jamie’s limits on their monthly budget could Jamie relax his need for self-protection and offer genuine forgiveness for Laurie’s past transgressions. When Laurie could again trust the sincerity of Jamie’s remorse and apology over his betrayal, and trust that indeed the behavior would never happen again, she could relax her need for self-protection and forgive.

How to Set Limits

1. Identify one boundary you’ve been reluctant to set with the person you are struggling to forgive.

2. Clarify in your own mind how setting this limit reflects and serves your own values, needs, and desires. Reflect on your understanding of the values and desires of the other person. Notice any common ground between the two of you; notice the differences.
3. Initiate the conversation about limits with the other person. Begin by expressing your appreciation for him or her listening to you. State the topic; state your understanding of your own needs and of theirs.
4. State the terms of your limit, simply, clearly, unequivocally. You’ve already stated the values, needs and desires behind the limit; you do not have to justify, explain or defend your position. State the consequences for the relationship if this limit is not respected.
5. Negotiate with the other person what behaviors they can do, by when, to demonstrate that they understand your limit, the need for it, the benefit of it.
6. At the end of the specified “test” period, discuss with your person the changes in the relationship, if the limit was respected, or the next step in consequences if the limit is not respected. You may have to repeat this exercise many times to shift the dynamics in your relationship.

Barrier #3: “Face” Concerns

The third block is “face” concerns—what we might call the need to save face in front of other people and protect one’s own public reputation, as well as avoid threats to one’s own self-concept—i.e, feeling that “I’m a pushover” or “I’m a doormat.”

As social beings, we’re primed to not want to appear weak or vulnerable or pathetic in front of other people. We will protect ourselves from feeling inner shame in many ways, which may include a reluctance to forgive. Researchers have also found that hanging on to a grudge can give people a sense of control in their relationships; they may fear that forgiveness will cause them to lose this “social power.” If our concerns about saving face foster a desire to retaliate or seek vengeance rather than forgive, we may need to re-strengthen our inner sense of self-worth and self-respect before forgiveness can be an option.

Who is most likely to experience face concerns? People who feel their self-worth has been diminished by the offense, or who experience a threat to their sense of control, belonging, or social reputation, or even feel a need for revenge, are more likely to experience the face concerns that could block forgiveness. “To the extent that victims fear that they may appear weak by forgiving, and are concerned with projecting an image of power and interpersonal control, they should feel more averse to the prospect of forgiving,” write the researchers.

How can we overcome the barrier of face concerns? Very often people who have been hurt by another need to recover their own sense of self-respect and self-worth to create the mental space where forgiveness looks like a real option. We need to develop and maintain an inner subjective reality—a sense of self—that is independent of other people’s negative opinions and expectations of us. Good friends, trusted family members, therapists, or clergy can be very helpful in functioning as a True Other to someone’s True Self—they’re figures who can help generate a more positive sense of self.

How to See Yourself

1. Sit comfortably, allowing your eyes to gently close. Focus your attention on your breathing.

2. When you’re ready, bring to mind someone in your life in whose presence you feel safe. This person could be a dear friend, a therapist, a teacher, a spiritual figure, your own wiser self.
3. Imagine yourself sitting with this person face-to-face. Visualize the person looking at you with acceptance and tenderness, appreciation and delight. Feel yourself taking in his or her love and acceptance of you.
4. Now imagine yourself being the other person, looking at yourself through his or her eyes. Feel that person’s love and openness being directed toward you. See in yourself the goodness the other person sees in you. Savor this awareness of your own goodness.
5. Now come back to being yourself. You are in your own body again, experiencing the other person looking at you again, with so much love and acceptance. Notice how and where you feel that love and acceptance in your body – as a smile, as a warmth in your heart – and savor it.
6. Take a moment to reflect on your experience. You are recovering a positive view of your own self again. Set the intention to remember this feeling when you need to.

Laurie and Jamie had kept their struggles private from friends or family, so they didn’t have strong face concerns about social reputations. But they did need to move beyond the shaming-blaming behaviors prevalent when they first came into couples therapy. They had to work on not taking things so personally and on feeling appreciated and worthy in each other’s eyes again before they could move toward forgiveness.

Forgiveness is not easy. It takes sincere intention and diligent practice over time. But overcoming reluctance, even refusal, to forgive can be facilitated by understanding these specific aversions to forgiveness, and by implementing strategies to address these barriers skillfully.

Originally published at Greater Good.

How Does Addiction Happen?

This article was written by Jennifer Fernandez, PhD, from the Pathways Institute.

Although we don’t fully understand addiction, there are lots of theories that attempt to explain it. The most popular one is the disease model. It explains that addiction has a biological origin that causes changes in the brain. This model also accounts for the heredity of addiction, or genetic predisposition. Studies of twins who have been separated at birth show that they are likely to develop addictions, despite growing up in different home environments.

You may have also heard addiction described as a hijacker of the reward center of the brain. Brain imaging studies show that overuse of drugs or compulsive behaviors “hijack” the reward system and can lead to changes in the brain that make it difficult to experience pleasure as one did before.

Then there’s the self-medication hypothesis. It posits that people use drugs to help them cope with physical and/or emotional pain. It helps explain why people turn to specific drugs or compulsive behaviors to help them deal with things like depression, chronic pain, trauma, or grief.

But the best way to explain addiction is as a biopsychosocial phenomenon. We know that addiction has a biological component. It causes temporary and permanent changes in the brain and body. We also know there is a psychological component: an inability to cope with distressing emotions. The social component of addiction is related to peer culture, as they influence what you use, how you use it, or how (not) to deal with your emotions.

In the question about nature versus nurture, the answer might just be nature and nurture. Drugs affect us biologically and we may even be genetically predisposed to those effects. In addition to that, your parents, family, friends, or lovers may have modeled addictive behaviors or inability to cope with emotions in a healthy manner.

Jennifer Fernandez, PhD

Warning: Being Bad Can Feel So Good

Recently, researchers Nicole Ruedy, Francesca Gino, Celia Moore, and Maurice Schweitzer, at the University of Washington, the London Business School, Harvard and the University of Pennsylvania published an article titled The Cheater’s High: The Unexpected Affective Benefits of Unethical Behavior in the The Journal of Personality and Social Psychology.

Conventional theories of moral behavior and decision making assume that unethical behavior triggers negative emotions, and indeed, when participants in the study were interviewed before the study, they themselves reported an expectation that if they were to act unethically, they would feel guilty about it. These theories help support the idea that we are internally motivated to do the right thing, because it makes us feel bad not to.

But when put to the test, so to speak, the people who cheated actually experienced an immediate boost in emotion, which the researchers termed a “cheaters high.” The researchers went on to say that once people have this experience, it may be difficult to resist future unethical behavior, especially when someone can “derive both material and psychological rewards” from the behavior.

Those of us working in the field of “process addictions” or compulsive behaviors (such as compulsive stealing or sexual behavior, gambling, compulsive eating, etc) are certainly not surprised by these results – it validates the behavior we see all of the time. Indeed, many of the people we see are they themselves flummoxed by their own behavior – they don’t understand why they continue to repeat a behavior they don’t feel good about and goes against their morals, beliefs, and even self-image, and wreaks havoc in their lives.

The short answer, which these researchers have validated, is that they do it because in the moment it feels good. It gives the person a boost and if that person is feeling depressed, anxious, having difficulty coping, can’t assert what they need and want in a healthy way, etc. this little boost is a way to escape all of that, for a moment. And the escape works, which is why when all of the negative feelings return (which they always do, in addition to the feelings of shame due to the behavior), eventually the desire to do it again comes back, and thus the compulsion is born.

This important study helps to explain how and why motivation, behavior, and feelings don’t always align with morals and values. It also helps to make a case for treatment for people who compulsively repeat these behaviors; they need help with a transformation that will give them a deeper, longer-lasting experience of happiness, so they can give up the “boost” of the “cheater’s high.”

Samantha Smithstein, PsyD

Not Getting Clean: It’s A Killer

In his recent book Clean, author David Sheff writes about addiction treatment and why it fails to help so many addicts. The idea for the book came out of his struggles helping his son with his addiction, which led to further research on the state of addiction treatment in the U.S. In a recent article on, he started his article by stating that:

Every year in the U.S., 120,000 people die of addiction. That’s 350 a day.”

He goes on to write that “A growing body of evidence has proved that addiction isn’t a choice subject to willpower but a brain disease that’s chronic, progressive and often fatal.” He then writes that in spite of this, there are a shocking number of treatment programs which do not use techniques that are based on research on effectiveness. He writes that it is crucial that people need to find and utilize these programs which “use therapies that have proved effective in clinical trials, including cognitive-behavioral therapy designed to train addicts to recognize and interrupt the cues that trigger the relapse mechanism; motivational interviewing, a therapy approach widely used to treat many psychological disorders that helps addicts engage in treatment; contingency management, which essentially rewards addicts for clean time; and psychopharmacology.” These treatment programs can also include “alternative” therapies that have been proven effective, such as meditation, acupuncture, and animal-assisted therapy.

Importantly, he goes on to say that “most researchers agree that no single therapy is appropriate for every addict. Often they’re used in concert. An effective treatment regimen may include AA, but only for those patients who are open to it.”

One of the most important points that he makes is about how unregulated rehabilitation is, and how widely the programs vary.  He writes:

Currently there’s a chasm between these and other evidence-based treatments (EBTs) and rehab programs. Every day addicts fall into it, and many never make it out. Most people in need find themselves in the same frustrating position I was in when I was desperate and overwhelmed, shopping for programs and doing the best I could to navigate an unnavigable system that’s also largely unregulated. In many states, anyone can open a rehab program — no licenses or accreditation are required.

This is slowly changing. More people are being educated about the fact that addiction is a disease and therefore requires treatments based on the medical model. The more consumers are educated and demand EBT, the more the billion-dollar rehab industry will adapt and offer it. That is, the industry will adapt or it will die and be replaced. In the meantime, those who need treatment must do the best they can to find programs that offer EBT. The place to start is by receiving an assessment from a psychologist or psychiatrist who is trained in addiction medicine. … A competent doctor can determine the severity of addiction and the presence or lack of co-occurring psychological disorders and prescribe the next step. It may include a brief intervention, therapy, psychopharmacology, an inpatient or outpatient program that offers quality care or a combination of these things.

Sheff’s points are crucial and a matter of life or death for many. For some addiction programs, even “certifications” are simply designed by people who had theories rather than based on research and/or outcome studies. His plea for standard of care for addiction is critical – for the health and well-being, and even life or death, of so many.

Samantha Smithstein, PsyD

(Re)Defining Justice

Restorative Justice is a process to involve, to the extent possible, those who have a stake in a specific offense and to collectively identify and address harms, needs, and obligations, in order to heal and put things as right as possible.”

– Howard Zehr, 1990

Restorative (or Reparative) Justice is based on the Native American principle that criminal behaviors are offenses against human relationships and that after these behaviors are committed, there are both dangers and opportunities:

  • The danger is that everyone emerges further alienated, more damaged, disrespected, disempowered, feeling less safe and less cooperative.
  • The opportunity is that injustice is recognized, equality is restored and the future is clarified. So that participants are safer, more respectful, and more empowered and cooperative with each other and society.

Restorative justice is a process designed to try to “make things as right as possible” for everyone involved.  That includes: repairing what has been broken, making society safer, attending to needs related to the behavior, and making amends.

Traditional criminal justice seeks answers to three questions: What laws have been broken? Who did it? and What do the offender(s) deserve? Restorative justice instead asks: Who has been harmed? What are their needs? Whose obligations are these?

Restorative Justice can take place in a diversity of settings, including neighborhood courts, schools, therapy groups, and nations. The 12-step community has also attempted to address the need for restoration through steps 8 and 9: making a list of the persons harmed and making direct amends to such people whenever possible. Making amends is different from an apology – one is simply an acknowledgement and expression of regret, whereas the other attempts to create restoration. Sometimes people also talk about “living” amends, which has to do with choosing to live differently so as to not create more harm.

Restorative Justice, or making amends, doesn’t require forgiveness. Forgiveness is a step that the victim(s) may or may not be able or willing to choose. Instead, Restorative Justice seeks to restore and heal, so that everyone may move forward less broken, and more whole.

Samantha Smithstein, Psy.D.

Is Sexual Addiction a Real Addiction?

By M. Deborah Corley, PhD, LMFT, LCDC, LSOTP, CSAT, CMAT
Co-owner/founder of Santé Center for Healing (

The acceptability of a vast range of sexual behaviors in the United States reflects our changing society in which every form of expression of sexual behavior is available to anyone with access to the Internet. But even those who do not use the Internet for viewing sexual materials, engaging in sexual conversations, or arranging meetings for sexual purposes, anyone who has access to mainstream media has been exposed to explicit coverage of sexual behaviors in the news or in prime time television and movies. Strip clubs have moved from the backroom into multimillion dollar establishments and are available in every state in the union. However, engaging in one or several of these types of behaviors does not make someone a sex addict. Sexual addiction like any addiction – it is not so much about the type or amount of behavior, but about the impact the behavior has on someone’s life. For people who are finding it hard to control their sexual impulses, many fear they are sex addicts but are not sure if it is a real addiction or what to do about it.

Although it was in 1980 that a very famous researcher and clinician from Johns Hopkin University, Dr. John Money, proposed that sex addiction existed, it was later in the early 1980’s that Dr. Patrick Carnes really began the conversation about whether sex addiction was a disorder or not. Sex addiction has been used synonymously with sexual compulsivity, sexual dependency, and excessive sexual desire and hypersexual disorder and the discussions about the definition have been ongoing for the past thirty years. In the past year, the American Society of Addiction Medicine (ASAM) took the lead in the debate about whether sexual addiction is really an addiction. ASAM set about to define addiction with a focus on what happens in the brain for an addict and they included what mental health professionals refer to as process or behavioral addictions like sex, gambling, and Internet use.

ASAM defines addiction as a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by an inability to consistently abstain, impairment in behavioral control, and craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. (ASAM, 2012)

The criteria most recently proposed for the DSM-V (Diagnostic and Statistical Manual, sort of the psychiatrist’s encyclopedia of mental health disorders) contains aspects of the criteria mental health professionals have been using for some time now in addiction treatment center sand private practices all over the United States. Basically, criteria requires the behavior must be occurring over a period of at least six months – so it is not about just an affair or two, or two weeks of looking at pornography on the Internet. There is a persistent and pervasive pattern of behavior in which a person is not able to control their sexual fantasies, urges, and/or behaviors despite negative consequences to self or others. The person spends excessive amounts of time seeking or engaging or recovering from the sexual activity and generally uses the behavior as away to cope with anxiety, depression, or emotionally distressing situations. And the behavior can’t be the result of drug use or another medical condition like a brain injury. (APA, 2010)

Most people report that the behavior started in adolescence. Women sex and love addicts report more sexual abuse as children than do men but more men have the disorder than women.In a recent study of women sex and love addicts, exposure to pornography as a child was the greatest predictor of sexual addiction, even more than sexual abuse. The most common behaviors reported in studies of sexual addicts includes masturbation with the use of pornography, followed by sex with a consenting adult, and then cybersex activities on the Internet.

Studies done in the recent past have identified how both women and men put themselves and others in harm’s way. Women sex addicts also tend to stay in relationships after they become abusive as compared to other women. Women sex and love addicts report higher numbers of unplanned pregnancies, terminated pregnancies, depression, suicide attempts, and infertility problems than do non-addicted women. Both women and men report an average of 15 different sex partners in a year, unprotected sexual encounters, and higher rates of sexually transmitted infections than non-addict groups so in many ways sex addiction is also a public health problem. Other behaviors often reported by sex addicts that have caused a variety of negative consequences includes use of prostitutes, multiple affairs, viewing pornography on Internet at work, having sex with employees, and heterosexual men having sex with other men.

The good news is that sexual addiction can be treated. There are several screening tests that can be used to help identify people that meet the criteria for sexual addiction (see list at end of article.) People in the early stages of the disorder have had success by attending 12-step meetings for sex addicts or group therapy specifically for sexual addiction. (Individual therapy can be very helpful however, group therapy lets an addict be with peers who are dealing with the same issues and thereby has access to others who can be supportive as well as hold the addict accountable for his or her actions.) When people have combined other addictive behavior like alcohol or other drug use with sexual addiction or have had the disorder for a long time and have a long history of secret keeping or trying without success to stop, more intense therapy is often needed like that offered in intensive outpatient programs or in a residential setting where a safe environment helps the addict have enough time in therapy, support, and accountability to learn other ways to manage emotional distress and life’s challenges.

Some behaviors that have severe negative consequences include illegal behaviors. Sexual offenses are beyond the scope of this article, but the addiction model has also been found useful for those who have engaged in sexual offending behaviors. Family therapy is an important component to any addiction treatment. Family members, especially spouses/partners have been betrayed by the addict through his/her behavior. Support of a family member can be significant in an addict’s path to recovery. Yet being supportive when a person has been betrayed is difficult, so everyone in the addict’s immediate support system needs a chance to heal and learn to respond in a healthy way to the addict’s behaviors. Therapy and mutual help groups are also beneficial for family members.

Sexual addiction is a complicated disorder that deserves additional research to clarify
who is most at risk and the most effective treatments. This will take time. As we learn more, it is
important to see that people who suffer from this disorder get the help that is needed. If you have questions about sexual addiction, the Pathways Institute would be happy to answer them for you. Additionally, SASH (Society for the Advancement of Sexual Health) is a national organization devoted to helping sexual addicts and their families find help ( For other assessment, treatment information, referrals, or copies of recent research articles, you can contact

Screening tests:
Sexual Compulsivity Scale (Kalichman & Rompe, 1995. Available at
W-Sexual Addict Screening Test ( (for women)
Hypersexual Behavior Inventory (
Internet Sex Screening Test (

M. Deborah Corley, PhD, LMFT, LCDC, LSOTP, CSAT, CMAT is co-founder and co-owner of Santé Center for Healing, a residential treatment center for addictions near Denton, Texas. She serves as clinical consultant to the Santé treatment team. She won the 2008 Merit Award from Society of the Advancement for Sexual Health (SASH), the 1999 Carnes Award for outstanding achievement in the field of sex addiction and was the co-recipient with Dr. Schneider of the Clinician’s Most Valuable Article Award by the American Foundation for Addiction Research in 2003 for their work on disclosure. She is the past president of the Board for SASH and a clinical member of the American Association of Marriage and Family Therapists. Licensed both as an addiction treatment specialist and marriage and family therapist, Deb has over 30 years of experience working with and conducting research on addictive disorders and high risk families. As an international speaker in the US and Canada, her focus on treatment of addictions, trauma resolution, disclosure, interpersonal neurobiology and meeting attachment needs is well received. In addition to Disclosing Secrets and Surviving Disclosure, she is co-author of Making Advances: A Comprehensive Guide to Treatment of Female Sex and Love Addicts.

Corley, M. D., & Delmonico, D. (2011). Closing the gap: Results from the women’s sexuality
survey on female sex and love addicts. Presentation at Society for the Advancement of
Sexual Health Conference, LaJolla, CA.
Corley, M. D. & Hook, J. N. (2012). Women, female sex and love addicts, and use of the
Internet. Sexual Addiction and Compulsivity, 19, 53-76.
Corley, M.D. & Schneider, J.P. (2012). Disclosing secrets: An addicts guide to when, to whom,
and how to much to reveal. Tucson, AZ: Recovery Resources Press. Available at
Langstrom, N. & Hanson, R. (2006). High rates of sexual behavior in the general population:
Correlates and predictors. Archives of Sexual Behavior, 35, 37-52.
Reid, R., Carpenter, B. & Lloyd, T. (2009). Assessing psychological symptom patterns of
patients seeking help for hypersexual behavior. Sexual and Relationship Therapy, 24, 47-
Reid, R. et al. (2012). Report of findings in a DSM-5 trial for hypersexual disorder. Journal of
Sexual Medicine,
Reid, R., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric
development of the hypersexual behavior inventory in an outpatient sample of men.
Journal of Sexual Addiction and Compulsivity, 18(1), 30-51.
Schneider, J. P. & Corley, M. D. (2012). Surviving disclosure: A part

This is your brain on dope(amine)

Dopamine is a neurotransmitter responsible for movement, pleasure, motivation, and cognitive processes, such as learning. For the purposes of understanding its role in addiction, let’s concentrate on pleasure and motivation.

Whenever we do something that propagates the advancement of our species, dopamine is released in order to motivate repetition of the action. When we sleep, eat, and have sex dopamine is released in our brain and the message is, “That was great, do it again!” We also release dopamine whenever we find something pleasurable. Be it 18th century poetry, heroin, or Radiohead, our brain will release dopamine to encode the stimulus as something that brings us pleasure.

Dopamine not only serves to categorize the good things we encounter in life, it also programs our pre-frontal cortex (the part of the brain involved in judgement and decision making) to alert us when the pleasurable stimulus is available. If your brain cells could talk, it might sound something like, “OMG! There’s a flyer on that lamppost for a Radiohead concert. Go look at it!” In other words, we become hyperaware of opportunities for engaging in behaviors that bring us pleasure. In fact, a study on people with alcoholism found they were more likely to spot alcoholic beverages in a busy photograph than people who don’t have problems with alcohol.

When we consume substances, it makes us feel good because our brains release dopamine, but drugs elicit a higher amount of dopamine release than is necessary. This is part of what causes experiences of euphoria and feeling high. Sometimes the amount of dopamine released is so great, the chemicals in our brain become unbalanced and we may experience hangover or withdrawal. In time, our brain regains chemical equilibrium. However, if one abuses substances, the brain may develop a tolerance (meaning the person needs to use greater amounts to get high) or dependence on the substance as a source of dopamine. If one becomes dependent on a drug, it may take some time for the brain to regain equilibrium and the person may experience extreme physical discomfort and emotional distress when they aren’t using. The period of re-calibration depends on the amount, type, and frequency of the drug used. For this reason, it’s always a good idea to be under medical supervision and receive support from friends, family, and a mental health professional if you’re dependent on a drug and want to stop or decrease your use.

The mechanism of tolerance is also evident in impulse control disorders, such as sex addiction, kleptomania, and compulsive gambling. Although it doesn’t appear that persons with an impulse control disorder undergo the same intensity of withdrawal that persons addicted to substances experience, there can certainly be a period of re-calibration of dopamine receptors during which a person feels irritable and agitated after stopping a behavior.

Based on the information presented here, we can conclude that we are all hard-wired to potentially become addicts and you may be asking yourself, “If this is true, why do some people become addicted and others don’t?” This is a really good question and the answer is “We don’t really know.” We can predict the likelihood of someone becoming an addict based on factors such as first age of substance use and family history of addiction, and we know that a lack of social support and coping strategies (especially when coupled with mental illness) can also lead to addiction, but there is no conclusive answer to date.

The best ways to prevent addiction are to educate yourself about the substances you use (or to abstain from substance use altogether) and to be mindful about the choices you make. If you have a mental illness, ensuring that you are getting appropriate treatment and maintaining social support are good preventative measures.

Jennifer Fernandez, PhD

We Admitted We Were Powerless

The very first step of every 12-Step program begins with these words – an admission of powerlessness. For many people, that very first step makes participation in a 12-Step program very difficult and with good reason: powerlessness is an uncomfortable feeling and not one that most people seek out or admit to.

In fact, most of us spend a great deal of energy, time, and effort attempting to try to control things and other people in our lives. We work hard to try to create a life of happiness, as we should. However, these efforts often involve trying to gain control over something we don’t have control of, like an addiction. Other times, the efforts involve trying to change or control other people who are in our lives. And understandably, because the people in our lives – their choices and behaviors – affect us; sometimes profoundly.

But when we stop and look at how effective our efforts are to bend others’ actions to our will – when we really examine how well our efforts to control things go – we find that, in fact, we cannot figure out a way to make others be or do what we want. We discover that using all of our efforts to control someone so they don’t cause us pain doesn’t, in fact, protect us. As the program of Alanon says: we don’t cause the behavior of others, we can’t control it, and we can’t “fix” it. Trying to do so simply makes our life feel unmanageable and increases our unhappiness.

Acknowledging that we are powerless is not about acknowledging that we are weak. Instead it acknowledges what is true, and allows us to focus on the things that we can control and the person who we can help: ourselves. Acknowledging the ways we are powerless also allows us to be more accepting of others, and to find a more peaceful way of being in the world and in relationships.

Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing. Helen Keller

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