After recent revelations that former congressman and New York mayoral candidate Anthony Weiner continued sexting on social media sites after apologizing for his indiscretions, many have been quick to accuse him of being a consummate liar and a person of poor moral character who should be punished for his actions. Is it possible that Mr. Weiner is exhibiting the telltale signs of an addicted person needing treatment?

While there remains controversy as to whether sexual compulsivity is truly a disorder, his behavior clearly displays symptoms similar to a substance use disorder.

The most notable characteristic of any addiction is loss of control over the behavior in question. I have discussed this in detail in a previous blog, entitled What is Chemical Addiction? Few would argue that Mr. Weiner made a conscious choice to place his political life in jeopardy, as well as his marriage and overall reputation. Why would he continue such damaging behavior with evidence available in the public domain to prove his misconduct? We could cite many public figures, including sports celebrities and movie stars, who have placed their careers and exorbitant salaries in jeopardy by compulsive behaviors, most frequently involving compulsive substance use. The answer is loss of control over the behavior despite the evident negative consequences. A recent article in the Sunday edition of the New York Times dated July 28, 2013, asked why cigarette smokers continued to smoke despite knowing the serious risks to their health. The author, Eyal Ert, an expert in behavioral science, argued that smokers have a personality flaw involving poor self-control. Mr. Weiner seems to exhibit a similar lack of self-control over his behavior, suggesting the need for treatment.

Other characteristics of addiction (for which we lack information as it relates to Mr. Weiner) include preoccupation with the behavior and strong cravings for the behavior. It is my belief that Mr. Weiner would likely prove positive for these criteria as well, if he were to honestly confront this issue. Is it fair then to assume he lacks moral character, or should we consider that he is suffering from a debilitating disorder that needs to be addressed by trained professionals?

Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.

In the recent publicity related to the death of yet another celebrity due to drug use, Glee star Cory Monteith, People Magazine wrote a piece suggesting that 30 days of inpatient treatment for substance use disorders may not be enough treatment, and recommended extended care for up to 90 days in sober living facilities.  While I believe this to be a step in the right direction, even 90 days is usually not enough treatment support to adequately curtail a disorder that is commonly believed to be an incurable and chronic condition.

Medical professionals would never suggest short-term treatment for other conditions considered incurable, such as diabetes and hypertension, but would insist that they be adequately contained with ongoing monitoring and medication,.  So why is the treatment of substance use disorders any different?

Sure, there are recovery support groups available in the community that provide adequate long-term support, such as Alcoholics Anonymous, SMART Recovery, and Women for Sobriety, but these self-help meetings are not for everyone who has suffered from substance-related disorders. Often, people need ongoing professional help and support through counseling, relapse prevention skills, and the provision of one of the growing number of addiction medicines used to help block the euphoric effects of drugs or reduce the cravings for these substances.

While I am not suggesting long-term inpatient treatment, I believe in long-term outpatient treatment to arrest these disorders.  Studies have shown that participation in even a once-weekly supportive intervention could significantly increase the prevention of relapse to substance use.  These supportive meetings can be group sessions or individual sessions.  These meetings can take place face to face, or even be held online in the form of videoconferenced sessions, chat discussions, email therapy, or phone sessions.

I personally lead weekly long-term group sessions for recovering addicts and alcoholics.  Some of the members have been attending for over 10 years.  Is it a coincidence that the 15+ individuals who have attended these sessions weekly for years have maintained consistent sobriety?  I think that ongoing support is essential for maintaining sobriety.  Why hasn’t the rest of our society caught on yet?  Thirty days at an inpatient facility may be the start of treatment, but it is certainly not THE treatment.  Let me know your thoughts on the subject.

Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.  He can be reached at nlessa@chat2recovery.com.

Today, Chat2Recovery was featured on The Fix!

The Fix is the world’s leading website about addiction and recovery, featuring a daily mix of breaking news, exclusive interviews, investigative reports and essays on sober living.

View the article here and let us know what you think in the comments!

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered to be the ”bible” of classification and diagnostic criteria for mental disorders. After a wait of approximately 13 years since the revised Fourth Edition, the DSM-5 was released on May 18th. I will briefly detail some of the changes to the category of Substance Use Disorders.

In the previous edition, Substance Use Disorders (SUDs) were divided into two separate diagnostic entities: Substance Abuse and Substance Dependence. Substance Abuse was considered less severe than Substance Dependence. For a further explanation of these two diagnostic entities, please read my January 2013 blog, “What is a Substance Use Disorder?”  In the new edition of the DSM, these two diagnostic entities have been eliminated and replaced with the term Substance Use Disorders on a severity continuum with three levels: mild, moderate, and severe.

There are now 11 symptom criteria to assess for each individual presenting with the possibility of an SUD. In the new edition, a person needs at least two criteria for a SUD diagnosis. In the previous edition, a person needed only one symptom criterion to meet the diagnosis of Substance Abuse. These symptom criteria must be present within the past 12 months and lead to “clinically significant impairment or distress.” They are:

1. ______ is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control _____ use.
3. A great deal of time is spent in activities necessary to obtain ______, use _____, or recover from its effects.
4. Craving, or a strong desire or urge to use ____.
5. Recurrent _____ use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued _____ use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of _____.
7. Important social, occupational, or recreational activities are given up or reduced because of _____use.
8. Recurrent _____ use in situations in which it is physically hazardous.
9. ____ use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by _____.
10. Tolerance, as defined by either of the following:  
    1. A need for markedly increased amounts of _____ to achieve intoxication or desired effect.
    2. A markedly diminished effect with continued use of the same amount of ____.
    3. Withdrawal, as manifested by either of the following:
       1. The characteristic withdrawal syndrome for ____
       2. ____ is taken to relieve or avoid withdrawal symptoms.

Severity of an SUD is now determined by the number of symptom criteria present over the past 12 months. In order to have a diagnosis of a “Mild Substance Use Disorder,” the patient must have met the above criteria for 2 to 3 symptoms. For a diagnosis of “Moderate Substance Use Disorder,” the patient must meet 4 to 5 symptom criteria. For a diagnosis of “Severe Substance Use Disorder,” the patient must meet 6 or more symptom criteria.

While the newly merged diagnosis of Substance Use Disorder seems to be perceived as an improvement, primarily due to greater simplicity of diagnosing, I am not such a fan. As you may have read in my previous blog on “What is a Substance Use Disorder?” I see Substance Abuse and Substance Dependence as two distinct entities with clear differences. I have previously written that Substance Abuse is essentially a pattern of inconsistent loss of control over a substance or substances, whereas Substance Dependence exhibits a more consistent pattern of loss of control. I believe the difference goes beyond severity factors, toward a more distinct pattern of use. I have often found that individuals who have met the criteria for Substance Abuse have difficulty relating to the individual who is considered Substance Dependent. Time will tell whether this newly merged diagnostic entity improves our work or hinders it.

Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.  He can be reached at nlessa@chat2recovery.com.

Periodically, I will highlight the main points of books and articles that I have read and strongly endorse related to spirituality, self-growth, and recovery. The first of these is The Art of Happiness: A Handbook for Living, co-authored by His Holiness the Dalai Lama and Dr. Howard C. Cutler, a psychiatrist. This book, initially written in 1998, is now in its tenth anniversary printing and on many lists as one of the best books about spirituality ever written.

For those unfamiliar with the Dalai Lama, he was born Tenzin Gyotso in 1935, and is thought to be reincarnated from the 13^th Dalai Lama.  He is considered the head of state and spiritual leader of Tibet.  In 1959, he was forced to escape Tibet by a brutal Chinese invasion, and has been in exile ever since, living in India.  In 1989, he was awarded the Nobel Peace Prize for his nonviolent struggle for the liberation of Tibet.  He has authored more than 72 books.

This book is structured as a comparison of the Dalai Lama’s Buddhist understanding of mental health issues and human well-being with our current scientific understanding of the same issues in Western culture.  What struck me was how deeply the Dalai Lama focuses on training our minds to find happiness and how closely associated that view is with cognitive therapy as we presently understand it.

The Dalai Lama believes that we can train ourselves to be happy, much as we can train for any other skills.  He believes that “the purpose of our existence is to seek happiness.”  He also believes that, with inner discipline, even profoundly unhappy people can undergo a transformation of attitude, outlook on life, and approach to life. He writes that happiness is determined more by one’s state of mind than by external events.

The factors involved in this transformation of attitude begin with education.  We must learn how negative emotions and behaviors are harmful to us, and how positive emotions are helpful to achieving happiness.  “If you seek happiness, you should seek the causes that give rise to it, and if you don’t desire suffering, then ensure that the causes and conditions that give rise to it no longer arise.”  After learning about positive and negative emotional states, our next task is to clearly identify different mental states and make a distinction, classifying them according to whether they lead to happiness or not.  For example, hatred, jealousy, and anger are harmful.  Kindness and compassion are definitely very positive. A genuine inner transformation occurs by systematically training our minds to deliberately select and focus on positive mental states and challenge negative ones.  Developing self-discipline within one’s mind is the essence of the Buddha’s teaching.  This same training occurs in cognitive therapy, in which we challenge the negative thoughts that lead to negative emotional states and develop skills to transform our thinking from negative thoughts to positive ones.

“When our life becomes too complicated and we feel overwhelmed, it’s often useful just to stand back and remind ourselves of our overall purpose, our overall goal.  When faced with a feeling of stagnation and confusion, it may be helpful to take an hour, an afternoon, or even several days to simply reflect on what it is that will truly bring us happiness, and then reset our priorities on the basis of that.  This can put our life back in proper context, allow fresh perspective, and enable us to see which direction to take.”

The Dalai Lama spends a considerable amount of time discussing the strong association between happiness and the practice of compassion. Dr. Cutler goes on to report that researchers on human happiness identify compassionate service to others as one of the key characteristics shared by many of the world’s happiest people.  “When we help others, the focus of our minds assumes a broader horizon within which we are able to see our own petty problems in a more realistic proportion.  What previously appeared to be daunting and unbearable, which is what often makes our problems so overwhelming, tends to lose its intensity.”  He goes on to claim that love, affection, closeness, and compassion bring happiness.

This is a book that I strongly recommend for those who suffer with unhappiness, depression, and anxiety. However, reading is only a first step towards transforming one’s life.  One must ask oneself the following questions:  How important is it for me to change?  Am I ready to commit to a new way of thinking and behaving?  Am I ready to take the actions necessary for change to occur?  If you can answer these questions fully in the affirmative, you are clearly on the way to transforming your life and achieving happiness.

Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.  He can be reached at nlessa@chat2recovery.com.