THE MARRIAGE & FAMILY INSTITUTE

If you or someone you love has an alcohol problem, this is the first step in recovery.

How do you know you have an alcohol problem?

Michigan Alcoholism Screening Test (MAST)

Please answer YES or NO to the following questions:

1.    Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people).   (No, 2 points)

2.    Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?  (Yes, 2 points)

3.    Does your spouse, a parent or other significant other ever worry or complain about your drinking?  (Yes, 1 point)

4.    Can you stop drinking without a struggle after one or two drinks?  (No, 2 points)

5.    Do you ever feel guilty about your drinking?  (Yes, 1 point)

6.    Do friends or relatives think you are a normal drinker?  (No, 2 points)

7.    Are you able to stop drinking when you want to?  (No, 2 points)

8.    Have you ever attended a meeting for Alcoholics Anonymous?  (Yes, 5 points)

9.    Have you gotten into physical fights when drinking?  (Yes, 1 point)

10.  Has drinking ever created problems between you and your spouse, a parent, or significant other:  (Yes, 2 points)

11.  Has your spouse, a parent, or other significant other ever gone to anyone for help about your drinking?  (Yes, 2 points)

12.  Have you ever lost friends or dates because of your drinking?  (Yes, 2 points)

13.  Have you ever gotten in trouble at work because of your drinking?  (Yes, 2 points)

14.  Have you ever lost a job because of drinking? (Yes, 2 points)

15.  Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?  (Yes, 2 points)

16.  Do you drink before noon fairly often?  (Yes, 2 points)

17.  Have you ever been told that you have liver trouble?  Cirrhosis?  (Yes, 2 points)

18.  After heavy drinking, have you ever had delirium tremors (DT's) or severe shaking, or heard voices or seen things that weren't really there?  (Yes, 2 points)

19.  Have you ever gone to anyone for help about your drinking?  (Yes, 5 points)

20.  Have you ever been in a hospital because of your drinking?   (Yes, 5 points)

21.  Have you ever been a patient in a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was part of the problem that resulted in the hospitalization?  (Yes, 2 points)

22.  Have you ever been seen at a psychiatric or mental health clinic or gone to any doctor, social worker or clergyman for help with any emotional problem, where drinking was part of the problem?  (Yes, 2 points)

23.  Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages?  (Yes, 2 points)

24.  Have you ever been arrested, even for a few hours, because of other drunken behavior?  (Yes, 2 points)

Now add up your YES points.  You have just taken the most widely used screening questionnaire for detecting alcoholism. It is called the Michigan Alcoholism Screening Test (MAST). A score of five or more puts you in the alcoholism category.  Although some clearly non-alcoholic individuals will score five or above, this is unusual enough to make the test useful for screening purposes.

Alcoholism is a chronic, progressive, relapsing brain disease. Five percent of Americans die of alcoholism. Alcoholism has a genetic component. Forty percent of alcoholism is caused by genetic factors and sixty percent by factors we don't understand. If we take identical twins, separate them at birth and raise them completely separate from each other, if one twin becomes an alcoholic, there is a 40% chance that the other twin will also become an alcoholic. Alcoholism runs in families. If you have an alcohol problem it is very likely that other members of your family are addicted.

Can I quit drinking on my own?

• Four percent of alcoholics stay sober for the next year if they try to quit on their own. Fifty percent of alcoholics stay sober for the next year of if they go through treatment.
• Seventy percent of alcoholics stay sober for the next year if they go through treatment and regularly attend Alcoholics Anonymous meetings.
• Ninety percent of alcoholics stay sober for the next year if they go through treatment, regularly attend Alcoholics Anonymous meetings, and go to aftercare once a week.
• Ninety five percent of untreated alcoholics die of alcoholism.  

What kind of treatment do I need?

There seems to be no difference in outpatient and inpatient treatment in regard to patient outcome, but there is a thirty percent dropout rate in outpatient treatment compared to a ten percent dropout rate in inpatient treatment.

How do I get my loved one into treatment if they don't believe they have a problem?

This is very common because the alcoholic uses defense mechanisms to protect him or herself from the painful truth. No one likes to think they are sick and so they minimize, rationalize and deny the problem. This not only happens in the alcoholic but in everyone intimately involved with the alcoholic. That is why this is a family disease.

Addictions Treatment

Drug addiction is a complex but treatable brain disease. It is characterized by compulsive drug craving, seeking, and use that persist even in the face of severe adverse consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. In fact, relapse to drug abuse occurs at rates similar to those for other well-characterized, chronic medical illnesses such as diabetes, hypertension, and asthma. As a chronic, recurring illness, addiction may require repeated treatments to increase the intervals between relapses and diminish their intensity, until abstinence is achieved. Through treatment tailored to individual needs, people with drug addiction can recover and lead productive lives. The ultimate goal of drug addiction treatment is to enable an individual to achieve lasting abstinence, but the immediate goals are to reduce drug abuse, improve the patient's ability to function, and minimize the medical and social complications of drug abuse and addiction. Like people with diabetes or heart disease, people in treatment for drug addiction will need to change behavior to adopt a more healthful lifestyle. In 2004, approximately 22.5 million Americans aged 12 or older needed treatment for substance (alcohol or illicit drug) abuse and addiction. Of these, only 3.8 million people received it. (National Sruvey on Drug Use and Health (NSDUH), 2004 ) Untreated substance abuse and addiction add significant costs to families and communities, including those related to violence and property crimes, prison expenses, court and criminal costs, emergency room visits, healthcare utilization, child abuse and neglect, lost child support, foster care and welfare costs, reduced productivity, and unemployment. The latest estimate for the costs to society of illicit drug abuse alone is $181 billion (2002). When combined with alcohol and tobacco costs, they exceed $500 billion including healthcare, criminal justice, and lost productivity. Successful drug abuse treatment can help reduce this cost; crime; and the spread of HIV/AIDS, hepatitis, and other infectious diseases. It is estimated that for every dollar spent on addiction treatment programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some outpatient programs, total savings can exceed costs by a ratio of 12:1. Basis for Effective TreatmentScientific research since the mid-1970s shows that treatment can help many people change destructive behaviors, avoid relapse, and successfully remove themselves from a life of substance abuse and addiction. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. Based on this research, key principles have been identified that should form the basis of any effective treatment program: No single treatment is appropriate for all individuals. Treatment needs to be readily available. Effective treatment attends to multiple needs of the individual, not just his or her drug addiction. An individual’s treatment and services plan must be assessed often and modified to meet the person’s changing needs. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. Counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction. For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use. Treatment does not need to be voluntary to be effective. Possible drug use during treatment must be monitored continuously. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection. As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care. Effective Treatment ApproachesMedication and behavioral therapy, alone or in combination, are aspects of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen, addressing all aspects of an individual's life, including medical and mental health services, and followup options (e.g., community- or family-based recovery support systems) can be crucial to a person’s success in achieving and maintaining a drug-free lifestyle. Medications can be used to help with different aspects of the treatment process. Withdrawal: Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted withdrawal is not in itself "treatment"—it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated. Treatment: Medications can be used to help re-establish normal brain function and to prevent relapse and diminish cravings throughout the treatment process. Currently, we have medications for opioid (heroin, morphine) and tobacco (nicotine) addiction, and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Methadone and buprenorphine, for example, are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, these medications block the drug's effects, suppress withdrawal symptoms, and relieve craving for the drug. This helps patients to disengage from drug-seeking and related criminal behavior and be more receptive to behavioral treatments. Buprenorphine: This is a relatively new and important treatment medication. NIDA-supported basic and clinical research led to the development of buprenorphine (Subutex or, in combination with naloxone, Suboxone), and demonstrated it to be a safe and acceptable addiction treatment. While these products were being developed in concert with industry partners, Congress passed the Drug Addiction Treatment Act (DATA 2000), permitting qualified physicians to prescribe narcotic medications (Schedules III to V) for the treatment of opioid addiction. This legislation created a major paradigm shift by allowing access to opiate treatment in a medical setting rather than limiting it to specialized drug treatment clinics. To date, nearly 10,000 physicians have taken the training needed to prescribe these two medications, and nearly 7,000 have registered as potential providers. Behavioral Treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. Behavioral treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as:  Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs. Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families. Motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment. Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs. Residential treatment programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the re-socialization of the patient to a drug-free, crime-free lifestyle. Treatment within the criminal justice system can succeed in preventing an offender's return to criminal behavior, particularly when treatment continues as the person transitions back into the community. Studies show that treatment does not need to be voluntary to be effective. Research from the Substance Abuse and Mental Health Services Administration suggests that treatment can cut drug abuse in half, reduce criminal activity up to 80 percent, and reduce arrests up to 64 percent.*  *The National Treatment Improvement Evaluation Study (NTIES): Highlights. DHHS Publication No. (SMA) 97-3159. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Office of Evaluation, Scientific Analysis and Synthesis, 1997, pp. 241–242.

These are the steps you may need to take to help an Alcoholic you love:

1. You need to treat yourself first. Go to Al-anon and get into counseling yourself. Alcoholism is an illness that you can't conquer on your own. You need help. You have probably been helping the alcoholic or addict drink or use drugs by covering-up for them or “enabling” their addiction--this has got to stop. Once you get support, and know what to do, then you can act.

2. Allow us to help you carry out an intervention. Don't try and do this yourself, it's too complicated and risky.

3. With your counselor's help, gather together an intervention team. This is a group of people who have been adversely affected by the person's drinking or drug use (family, friends, employer, coworkers, clergy, doctor, etc.) Talk about the problem and how it has adversely affected you. Agree that the drinking is a serious problem and treatment is necessary. Gather people who are willing and able to intervene. Remember, this will save the alcoholic's life. Don't choose people who are weak or who have an alcohol problem. Chose people who are strong enough to tell the alcoholic the truth.

4. Have each person write the alcoholic a letter detailing exact situations where the alcoholic's drinking hurt them. Then state that they want the alcoholic to go to treatment and then list what they are going to do if the alcoholic refuses. They could say they are not going to protect the alcoholic from the consequences of their drinking anymore. The employer may discharge the alcoholic, the spouse may move out, the children may not let the alcoholic be alone with the grandchildren, etc. These consequences need to be specific and the person willing to carry though.

5. Allow us to help you choose a good treatment center that takes your insurance and make sure they have a bed open.

6. Practice the intervention with one of the members of the intervention team playing the patient. Make sure that the professional runs the meeting and everyone tries to be gentle and loving. Expect the alcoholic to be defensive, that's how the illness works. Everyone tells the alcoholic how much they care and why they want him or her to go to treatment.

7. Pack the patients bag and have transportation to the treatment center ready.

8. Pick a time when the alcoholic will be sober, usually in the morning, and take them to a neutral facility so you can meet privately. Don't use the alcoholic's home.  

9. Carry out the intervention being honest and loving.

10. The intervention is over when the person agrees to go to treatment or the professional believes that the meeting has served its purpose. Most interventions take about an hour and ends in the person going to treatment, but sometimes the best you can do is plant the seeds of the truth that hopefully will grow later. No intervention is wasted if the truth comes out.

Sexual Addiction

The term sexual addiction is used to describe the behavior of a person who has an unusually intense sex drive or obsession with sex. Sex and the thought of sex tend to dominate the sex addict's thinking, making it difficult to work or engage in healthy personal relationships.

Sex addicts engage in distorted thinking, often rationalizing and justifying their behavior and blaming others for problems. They generally deny they have a problem and make excuses for their actions.

Sexual addiction also is associated with risk-taking. A person with a sex addiction engages in various forms of sexual activity, despite the potential for negative and/or dangerous consequences. In addition to damaging the addict's relationships and interfering with his or her work and social life, a sexual addiction also puts the person at risk for emotional and physical injury.

For some people, the sex addiction progresses to involve illegal activities, such as exhibitionism (exposing oneself in public), making obscene phone calls, or molestation. However, it should be noted that sex addicts do not necessarily become sex offenders.

Behaviors associated with sexual addiction include:

• Compulsive masturbation (self-stimulation)
• Multiple affairs (extra-marital affairs)
• Multiple or anonymous sexual partners and/or one-night stands
• Consistent use of pornography
• Unsafe sex
• Phone or computer sex (cybersex)
• Prostitution or use of prostitutes
• Exhibitionism
• Obsessive dating through personal ads
• Voyeurism (watching others) and/or stalking
• Sexual harassment
• Molestation/rape

Generally, a person with a sex addiction gains little satisfaction from the sexual activity and forms no emotional bond with his or her sex partners. In addition, the problem of sex addiction often leads to feelings of guilt and shame. A sex addict also feels a lack of control over the behavior, despite negative consequences (financial, health, social, and emotional).

Treatment Focus

Treatment will focus on two main issues. The first is the logistical concerns of separating you from harmful sexual behavior in the same way drug addicts need to be separated from drugs.

Accomplishing this might require inpatient or residential treatment for several weeks. An inpatient setting protects you from the abundance of sexual images and specific situations or people that trigger compulsive sexual behavior. It’s simply harder to relapse in a structured and tightly controlled setting. Sometimes, you can succeed in an outpatient setting with adequate social, family and spiritual support.

The second and most difficult issue involves facing the guilt, shame and depression associated with this illness. It takes trust and time with a competent therapist to work through these emotions. If you are very depressed, the best treatment might be an inpatient residential setting where professionals can monitor and properly manage your symptoms.

12-Step Programs

Twelve-step programs, such as Sexaholics Anonymous, apply principles similar to those used in other addiction programs, such as Alcoholics Anonymous and Narcotics Anonymous. However, unlike AA, where the goal is complete abstinence from all alcohol, SA pursues abstinence only from compulsive, destructive sexual behavior. By admitting powerlessness over their addictions, seeking the help of God or a higher power, following the required steps, seeking a sponsor and regularly attending meetings, many addicts have been able to regain intimacy in their personal relationships.

Cognitive-Behavior Therapy

This approach looks at what triggers and reinforces actions related to sexual addiction and looks for methods of short-circuiting the process. Treatment approaches include teaching addicts to stop sexual thoughts by thinking about something else; substituting sexual behavior with some other behavior, such as exercising or working out; and preventing the relapse of addictive behavior.

Interpersonal Therapy

People addicted to sex often have significant emotional baggage from their early lives. Traditional “talk therapy” can be helpful in increasing self control and in treating related mood disorders and effects of past trauma.

Group Therapy

Group therapy typically consists of a health care professional working with a group of between six and10 patients. Working with other addicts allows you to see that your problem is not unique. It also enables you to learn about what works and what doesn’t from others’ experiences, and draw on others’ strengths and hopes. A group format is ideal for confronting the denial and rationalizations common among addicts. Such confrontation from other addicts is powerful not only for the addict being confronted, but also for the person doing the confronting, who learns how personal denial and rationalization sustained addiction.

Medication

Recent research suggests that antidepressants may be useful in treating sexual addiction. In addition to treating mood symptoms common among sex addicts, these medications may have some benefit in reducing sexual obsessions.