The media love stories like Tiger Woods and his lady friends. Sex sells, it always has. Unfortunately, the media rarely care whether they are portraying an issue accurately, it is more about soundbites and sales. I know, because I used to get interviewed quite often for addiction-related stories when I worked for a large university teaching hospital. My 20 minute interviews would get slashed to 10 second clips on the nightly news. I have come to realize that it is not their fault, it is the way of news in our soundbite culture. But topics like addiction and what has happened with Tiger deserve more than soundbites. Addiction is an incredibly complex problem with no simple answers. It seems that despite this fact, the media have attempted to reduce Tiger’s problems to a diagnosis of sex addiction. In the clip below they interview a sex addict who provides evidence that sex clearly is an addiction, and that his experiences are similar to Tigers, check it out (and then keep reading):

Here is my own commentary about sex addiction and Tiger’s problems:

• Far too much time is spent debating whether specific behaviors should be called addiction. The reporters above point out that many do not consider sex addiction a real psychiatric disorder because it does not exist in the current verision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). But the DSM is a socially-constructed diagnostic guide that is in the process of completely revamping the section dedicated to the diagnosis of addiction. Turns out we got it wrong for the past couple of decades! In my opinion, debates about whether people can be “addicted” to be specific objects (porn, food, internet, cell phone use) get us nowhere. For years therapists have treated patients with significant problems related to all these things, which usually come in packages of behavior. Our focus should be on understanding addiction as a relationship problem, not an object-specific problem.
• How should we understand Tiger’s behavior? If addiction is about relationships, then we see that his pursuit of women  has been about something other than just sex. Any therapist in the country who has spent time dedicated to the topic of sex addiction (Patrick Carnes, Jennifer Schneider, Robert Weiss) will say that sex addiction is not about sex. It is about intimacy and emotional connection, or the lack thereof. As humans we are wired for relationships, but adverse childhood events (and trauma throughout life) lead to the avoidance of emotional experiences necessary for healthy emotional development. The result is a person like Tiger becomes an adult doing his best to negotiate the complexities of adult relationships with the emotional/relationship/intimacy skills of a child. No wonder he looks like a deer caught in headlights at news conferences.
• As a person neglects their internal emotional world, very often the emotional energy (which has to go somewhere) gets displaced into academic mental activities or sports. It is not coincidental that many who suffer from addiction and untreated trauma are professional athletes or have professional careers requiring brain power and academic credentials.  A number of news commentators have pointed out that when Tiger came on the pro scene at age 19 his life never was the same. I would add that prior to the age of 19 his life was very different from other kids, how else was he able to go pro at 19? I am not an expert on Tiger Woods and have no knowledge of the events in Tiger’s early life that influenced his present behavior. And in truth, I don’t care, they are not my business. Each person’s past is their own.
• We need to realize that we (even those who work in the media and are taking shots at him) are not so different from Tiger. On some level, we all struggle with past traumas, maintaining intimate relationships, sex, and developmental constrictions. And at times we all have engaged in excessive behaviors that help us disconnect from the world and our emotional pain (like even watching a bit too much professional sports). Sure, we may not have millions in the bank, be the world’s greatest golfer, or have the ability to act out in the ways he has, but just like Tiger, we all have our own life challenges. The real question is whether we are deepening our awareness of our shadow side, and doing the work necessary to own it, integrate it, and evolve our own mental/emotional health.

One final thing. Understanding why Tiger did what he did is very different then letting him off the hook. Let me be clear, I am not attempting to justify his behavior or say his acting out was not his fault. He needs to take responsibility for what he has done, and realize how his actions have hurt a lot of people. But we in society are so quick to judge others, and in a sick way relish watching those on top take big plunges. Instead of buying into the soundbite entertainment value of Tiger’s pain, we could benefit a lot more by exploring how his fall is a mirror for aspects of our own life.

I understand why Beautiful Boy is a #1 New York Times bestseller. It’s a very moving and insightful account of one father’s journey through his son’s addiction, a journey millions of parents have made. David (the author) does not hold back. His writing is powerful, emotional, lucid, and honest. He loves his son Nic to the ends of the earth, there is no doubt about that. Nic is more than just a beautiful boy, he is everything to David. And why wouldn’t he be, he is his son, even when high on methamphetamine and other drugs. At times I laughed, other times I cried. I did not want to be reminded that as a parent there are limits to my ability to protect my son. But it is one of the gifts of the book.

It is often overwhelming reading David’s account of his son’s addiction, and his tireless pursuit to save him. At one point in the book he asks the question: What would you do if a family member were addicted to this drug? He receives many answers from addiction researchers, drug abuse counselors, interventionists, friends, teachers, and members of Al-anon. He leaves few stones unturned, and in the end, realizes that no one person has all the answers. He must decide for himself how to deal with his son’s addiction (and his own addiction to his son’s addiction). I could not agree more. At the same time, I could not help but get frustrated by some of what he was told, and even more, by what he was not told. Here is my answer to David’s question.

Help for David

• I would utilize the Community Reinforcement and Family Training (CRAFT) approach for dealing with Nic and his addiction. When compared to the two approaches most discussed in the book (Al-Anon and doing an Intervention), CRAFT has been shown in clinical trials to be significantly more effective. In one trial, CRAFT resulted in 64.4 percent of addicts entering treatment compared to 22.5  for Interventions and 13.6  for Al-Anon. I would add that if it were me, I would likely skip Interventions, but utilize Al-Anon with CRAFT since there are many positive benefits to connecting with others who are going through similar challenges.
• For family members and friends trying to help an addicted loved one, the end result is most often perpetual trauma. David at one point says, “I have been so traumatized by his addiction that the surreal and the real have become one and the same.” There are many references throughout the book that support the painful fact that trauma pervades not only Nic’s life as an addict, but his father, family, and likely some friends. It is also a sad truth that good trauma therapy is hard to find, and rarely done to any significant degree in substance abuse treatment. For David, who clearly has engaged in a lot of therapy, I would want to explore the degree to which these therapies sufficiently addressed trauma. I have explored this topic in a paper I wrote about treating trauma, as well as in a section about core issues. Understanding trauma and its treatments are as complex as addiction, if not more so. One of my favorite trauma authors recently came out with a new book that I believe should be read by anyone who has experienced trauma, and in my book, that includes us all: 8 Keys to Safe Trauma Recovery. This is tough work, not for the faint of heart. But something tells me that after what David has been through with his son, trauma work would be a walk in the park.

Help For Nic

• David says towards the end of the book, “rehab isn’t perfect, but it’s the best we have.” I am not surprised he reached this conclusion given that when you go searching for help, it is really the only answer. Treatment works. Research says it does, even if you have to go multiple times. And Nic is a testament to this outcome: he goes to many residential (and outpatient) programs and does well for sustained periods of time following treatment before he relapses. I too believe in treatment, but also believe strongly that current treatment practices fall short of what is possible and necessary for long-term success.
• This entire website is dedicated to helping you understand the solution to addiction. My answer for Nic (and David) is summarized in the top five things you should know about addiction and the solution to addiction. David is right when he says in the book that there is no one right path for anyone, but there are specific things that can make a difference in whether a person continues to go through life cycling in and out of treatment, or progresses beyond their addiction.
• For Nic, among the most significant factors that will likely influence his future outcomes is the degree to which his developmental deficits and constrictions are addressed. Among the best frameworks for understanding how to assess development is Stanley Greenspan’s six developmental levels (or stages) of the mind. The deficits and constrictions resulting from early traumas, as well as drug abuse, can be healed over time utilizing developmentally-based psychotherapies. Although meth and other drugs of abuse can result is significant brain changes that impact emotional development, this type of therapy is really the best we have. Unfortunately, in my experience, it is not taught in graduate schools, is completely unknown in residential treatment facilities (and even if it was known, the therapy is done over years, not months or 28 days), and requires significant skill in delivery. It also is the right therapy following trauma resolution work. The good news is that there are some gifted therapists in most places that can do it, it just may require some effort finding them.
• David correctly writes that his son has a chronic, relapsing medical condition that will require long-term care. Yet sadly, it appears that Nic’s care has suffered from our treatment system being a patchwork of acute-based programs, where aftercare is self-help meetings and ”working a program.” Nic needs to stop going in and out of treatment, and instead engage in treatment for many years. The evidence is in the book. When he is in treatment and working his program he does very well, until he stops working his program and relapses. “Working a program” is a 12-step construct that does not include the work I believe is critical to long-term success (see previous bullet point). Staying in treatment for years makes sense when you understand that it is outpatient (not residential), involves resolving underlying drivers of addiction like trauma, is adapted to changes in development over time, and includes the exploration of more than just pathology, like the idea of Me to We. If we are to successfully help people move beyond addiction, we must get outside the black box of traditional addiction treatment and utilize what we know from a variety of fields (e.g., systems science, positive psychology, ecopsychology, education). We can and we must do better, for Nic, and everyone else that suffers.

I want to add that Nic published his own book about his experiences abusing methamphetamine and other drugs, called Tweak. I look forward to reading it in the near future, and hearing his side of the story.

One final comment is related to how David ends the book. He says “I believe we need an all-out war on addiction modeled on the war on cancer.” He goes on to suggest what such a campaign would look like, the funding it would require, and the benefits it could bring. He adds that a research network like that set-up for cancer could test out many promising addiction interventions, including new medications. The good news is that it has been done, and has been bridging the gap between practice and research for many years now. It is the National Drug Abuse Treatment Clinical Trials Network. Check it out.

There are many things I struggle to manage in my life, including time, food (or more correctly my weight), exercise and making sure my dog gets her heart medicine every eight hours. I have other vices as well, but what links all of these things together is that they are ongoing issues that come and go in my life. At times I eat healthy, exercise regularly, and use my time well. Yet at other times I find myself scarfing down junk food, skipping workouts all together, and feeling like a mouse on a never-ending treadmill.

Addictive behavior is similar in that it also comes and goes to varying degrees over time, it is not a constant. Although some can find permanent solutions to end particular behaviors (“I just stopped smoking and never went back to it”), for most people, even if one behavior goes away, another usually takes its place perpetuating the problem of addiction just in a different form. Because objects of addiction can also come and go, it is easy to see why dealing with addiction can become so hard – different addictions, different times, different problems, but most often sharing many underlying traits. As a result, I believe that the most humane way of dealing with addiction is by utilizing a management approach that aims to decrease harm for all behaviors over time, and improve ones quality of life. Too often I see people going in and out of treatment, attempting desperately to put a lid over the behavior and banish it forever, only to get depressed and frustrated when it returns in its original form, or surfaces in another addiction. So how do we manage behavior? Whether it’s addiction or giving my dog her pills, I have found four key things that make a difference:

Awareness: You cannot manage anything if you are not aware of it and how it plays out in your life. Awareness is not so easy these days because we are bombarded from every side with people vying for our attention. But you must increase your awareness of the behavior you wish to change if you have any chance of success. How do we do this? (1) utilize reminder messages on your computer, phone, on sticky notes, put them on electronic calendars that email you reminders, set alarms to go off at critical times, (2) talk with someone about the behavior on a regular basis and process your progress – could be a therapist, friend, pastor, mentor, coach, spouse – who does not really matter so much as just having an ongoing connection and doing it, (3) utilize a form of meditative practice to help clear away psychic junk and make more room to help you stay aware of what is truly important to you, and (4) set-up your environment in such a way as to increase awareness: find new routes to work that avoid high-triggery places, get rid of the extra refrigerator in the garage where you store beer, add things that you want to focus on instead of the addiction like an easel for painting, a musical instrument, or perhaps a pet if you don’t have one.

KISS: Yes, the tried and true Keep It Simple Stupid (OK, maybe the stupid needs to go) applies to managing behavior change. The more complicated you make it, the less likely you will succeed. Simple means we don’t try to change too many things at once, and we do our best to find the simplest and easiest way to accomplish our goal. Earlier this year I significantly changed my diet and felt great. More energy, better sleep, all the things promised from this new way of eating materialized. Yet a few weeks later I was back to my normal, disappointed that I could not maintain what I started. But I shouldn’t have been. I changed too much too fast. We humans live so much by habit, and the many routines our brains lock into very often determine our behavior even when we desperately want to behave differently. In a recent post I mentioned how the environment also sets us up, particularly for making it difficult to eat healthy. We have to be begin by making small incremental changes that support new brain connections, new habits. Change is a process with many different drivers, the key is finding the one that works best, and just staying on the road.

Statistics. For many statistics is a foreign language, existing in a country you never want to visit. But in truth, we live statistics every day of our life. We read sports statistics, check weather reports, listen to stock updates, and hear percentages thrown around in the news. Statistics is the science of making effective use of data, and in the case of managing behavior, there are many things that can be helpful to track over time: days abstinent, relapses, weight, money lost, time spent on particular activities, etc. We track things because of our limited ability to keep a lot of this in our head, to remember the specifics. Keeping a record of progress provides a clear indication of how well we are staying on the road. It provides us feedback that is critical to successful change. Our tracking methods can be as simple as keeping a tally on a notepad, or creating more elaborate outcomes on spreadsheets. I have seen a number of those struggling with addiction get very caught up in statistics, particular days abstinent, where relapses become devastating events instead of opportunities for growth and learning. Statistics should always be used to help us grow, learn, and better manage our behavior over time.

Social Support: You’re aware of what you want to manage, you put a program in place that is simple, easy to stick with, and does not change too much too fast, and you begin to track your progress. The final key and perhaps the most important is understanding that managing any behavior change we make is embedded within the social systems in which we exist: family, school, work, clubs, self-help groups, church, sports, neighborhoods. We are social creatures by nature and influenced greatly be those around us. Successful change requires taking stock of our social connections, both those that support our change and are positive, and those that clearly contribute to perpetuating problems we wish to stop. I have said many times that addictions are ultimately about relationships, and the goal is to replace unhealthy relationships with objects with healthy relationships with people. This is an ongoing process of learning how our past relationships influence our present ones, and how we can heal past wounds and emotionally mature in a way that allows to both receive and give love.

As we begin a new year (and a new decade), many of us will set goals to better manage behaviors in our life. Whether the desire is to reduce drinking, drug use, or have a more fulfilling relationship with food or sex, we stand a much better chance of succeeding when we utilize the above four keys. Happy New Year!