Understanding the Definition of Health Related Fitness

Being a Health and Fitness Professional, it is my job to understand terms and definitions which are commonplace to this industry, as well to keep abreast of evolving trends. Through my experience, I have found that a number of terms deserve a little more clarification than that which they are granted.

Aside from clarifying the definition of Health Related Fitness, this article intends to shed some light on a few of the associated terms, and to show their respective distinctions.

Is it simply all in a name?

The fitness world seems to use the concept Health Related Fitness like a generic fitness principle – interchangeable with others like “Physical Fitness”, “Health and Fitness” or simply “Fitness.”

While all of these terms can be included under the broad term Health and Physical Fitness, they individually refer to different aspects – both generic and specific. Unfortunately, references to these and other fitness-related terms are often vague, while consistency in their intended use is meager at best; there is a kind of “generally accepted” use for them, but individuals often rely on own interpretation, and this can lead to confusion.

With that said, does Health Related Fitness simply infer fitness by means of good health? Not quite. That is why we need to understand a little more behind these words before digesting the definition.

How did the term Health Related Physical Fitness come about?

That is a good question. One could probably ask what is this concept all about – can we not simply use the terms “Fitness” or “Physical Fitness” instead?” Why Health “Related”?

The main reason stems from the fact that most health and fitness terms are used inconsistently and often refer to different concepts or notions. Subsequent to the 1996 report from the US Surgeon General (Physical Activity and Health; a report of the Surgeon General), there was a move to try and address the alarming rise in obesity levels among the general American public. Studies and initiatives required standardization among clinicians, health practitioners and fitness trainers to grapple with the task at hand. Enter “Health Related Physical Fitness”, a working term to address the general state of health among the public.

The definition of Health Related Fitness

According to the American College of Sports Medicine (ACSM), the main authority in this field, ineffective definitions with unclear and subjective wordings, as well as definitions containing terms which themselves require defining, have contributed to confusing the term “Physical Fitness.”

There exists no reliable guide for Health and Fitness Professionals to measure “Physical Fitness”, because the term has been so loosely and inconsistently defined. It is therefore that one should consider the concept of Health Related Fitness. The definition therefore centers on the 5 Components of Physical Fitness which relate to “good health.” These Components are:

Cardiorespiratory Fitness
Body Composition
Flexibility
Muscular Strength
Muscular Endurance

On the other hand, Skill Related Fitness Components are:

Balance
Reaction Time
Coordination
Agility
Speed
Power

According to the Centers for Disease Control and Prevention (CDC), the definition of Physical Fitness emphasizes the difference between Health Related Physical Fitness and Athletic Ability Physical Fitness. Its point-of-departure is the “health” of the US nation, which is often referred to as the “public health perspective.” In that respect, the 5 Health Related Fitness Components are more important than those related to Athletic Ability (or Skill Related Components).

Although the concept of Health Related Fitness has an integral association with “good health”, the 5 Components are addressed individually by health professionals to allow for their measurement.

Now that we have a deeper understanding of the term, what purpose does it serve?

Continuing from where the definition left off, the objective of measuring the 5 Components is to advise clients about their own particular Health Related Fitness, and to use data obtained from the tests to design appropriate exercise programs which can then be evaluated.

The 5 Components contribute evenly to make up a holistic Health Related Fitness, which is of direct interest to the health of the ordinary citizen, in that the concept is normative. In other words, it is a standard which allows for consistent application.

It is therefore important for those working in the health and fitness industry not to mistake “overall physical fitness” with “Health Related Physical fitness.”

To conclude, let us consider this distinction between Physical Fitness and Health Related Fitness

One needs to bear in mind that regular physical exercise can improve overall Physical Fitness, as well as Health Related Fitness. However, overall fitness is a generic term and is up to subjective interpretation, while Health Related Fitness can be assessed.

The distinction therefore, between these two terms, exists in that Health Related Physical Fitness can be measured according to a set of established comparative norms.

This is where the “rubber hits the road.” The guidelines set out by the ACSM enable health professionals to work with clients to assess and measure their response to exercise and prescribe appropriate exercise programs. A client’s progress can then be monitored and adjusted where necessary in order to obtain the desired fitness goals.

Cleto Tirabassi is a certified Fitness Trainer with the International Sports Sciences Association (ISSA).

His work centers on the “sensible approach” to Health Related Fitness, which entails the use of practical, flexible and sustainable methods to achieve optimal levels of health and physical fitness.

His clientele belongs mostly to the group he calls “average everyday people”, who in short want to be in excellent shape, yet still lead a conventional life.

Based in Rome, Italy – he is dedicated to guiding the individuals he works with to realize their health and fitness goals. He also understands that the health and fitness industry is constantly evolving and therefore maintains a close watch on trends in his field of expertise.

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How to Choose Quality Nutrition Supplements

It is hard to discern the truth about the nutritional health supplements available on the market today. How do you know which of the nutritional vitamin supplements to pick? Some of the questions I believe are important are the following:

Questions regarding Nutritional Health Supplement choices:

*Is this a quality nutritional health supplement that will meet my nutritional demands, does it work?

*Is this a fair price for this specific nutritional health supplement?

*Is this vitamin supplement going to make me feel better or is it going to just fill a need for my body, will I notice a difference?

*What is the difference between grocery store nutritional health supplements and physician distributed nutritional supplements?

*How long do I need to take this particular nutritional health supplement?

Is this a quality nutritional health supplement that will meet my nutritional demands, does it work?

As far as the quality of any given nutritional health supplement it is important to choose quality. You would not choose to eat produce that is spoiled or rotten so why would you choose a supplement that you do not know how it was manufactured or where the ingredients come from? There are a lot of nutritional health supplements on the market that contain a lot of fillers and synthetic ingredients that can put stress on the body just trying to process them, namely the digestive tract, kidneys and liver.

Is this a fair price for this specific nutritional health supplement?

The prices for quality nutritional health supplement are going to be a little higher because they are made with quality ingredients. I often warn patients against getting the bargain two for one price at the grocery store for glucosamine chondroitin because when I ask them to bring it in all I see is those two ingredients. There are often times when the body needs synergistic nutrition (other nutrients) in order to fully utilize the nutritional health supplement you are taking. The body is very complex and it is important to know you are supporting it correctly. Total Joint Relief by Nutriwest has all the synergistic nutrition in order to support the joints. I also cringe when there is a sale on the fish oils. Please know that it is easy for fish oils to go rancid and this is not something you want in your body. High quality fish oils are a must. My favorite is Metagenics EPA/DHA Extra Strength Enteric Coated. These are quality fish oils in a great ratio and enteric coated which greatly minimizes or completely eliminates any burping up of the fish oils.

Is this nutritional vitamin supplement going to make me feel better or is it going to just fill a need for my body, will I notice a difference?

Depending on how severe your nutritional vitamin deficiency is and how important that nutrient is to the body will depend on whether or not you will feel a difference on that particular nutritional health supplement. The fact is the fruits and vegetables we eat only have a fraction of the nutrients they use to due to depleted soils. Therefore to support your diet with quality nutritional health supplements is a must to remain healthy. You can also look to family genetics to see if you need support in a particular area of your health.

What is the difference between grocery store nutritional health supplements and physician distributed nutritional supplements?

The nutritional health supplements exclusively sold by physicians or health practitioners are referred to as nutraceutics, pharmaceutical grade nutrition or high-grade quality nutritional supplements. They are more concentrated, have better manufacturing processes and have been proven to work through studies and patients. These nutritional health supplements are also mostly sold through physicians so the patient can be monitored for any side effects. So it is of utmost importance that you read any and all contraindications to any of the quality nutritional supplements you purchase.

How long do I need to take this particular nutritional health supplement?

The duration of taking the supplements will depend on the nutritional health supplement you choose and how severe the illness or deficiency. There are great testing methods that are now available to determine what your needs are. They are not the blood tests normally done in your medical doctors office, they are specific tests to determine if you are deficient in certain minerals, vitamins, fatty acids, amino acids and antioxidant levels. With this information you will be given timelines and dosages for taking your specific nutritional health supplements. However, as a basic support program I would include the following listed below as a minimum nutritional health supplement program and then use other more specific nutritional health supplements for other needs or concerns that need addressed. For example: Ultrameal Plus by Metagenics to bring down cholesterol or triglycerides and Core Level Lung by Nutriwest after an upper respiratory infection or for damaged caused by smoking. Most people do not realize that when you get sick and take a drug, although the illness is no longer showing symptoms your body is still in repair and most likely needs some quality nutritional health support to continue to heal that area and or tissues. This is a great way to work with traditional medicine.

Basic Nutritional Health Supplementation:

*Multivitamin/Mineral Complex

*Omega 3 essential fatty acids

Or you can get both of the above in the Wellness Essentials Men or Women

*Digestive enzymes

*DSF, otherwise know as De-Stress formula, an absolute patient favorite at our office. Supports important nutrients your body depletes during times of prolonged and acute stress.

Advice On Sports Nutrition Supplements

Have you wondered how your favorite athletes do their workout? Or what kind of exercises they perform, what kind of food they eat or how do they manage to relax under pressure situations? Probably you don’t care about all this because what matters for you is their performance in the sport. But it doesn’t mean that they don’t take care of themselves like we do.

In fact, athletes need to monitor their lifestyle very closely and keep their health conditions at par with their competitors; not just by eating right food items but also by consuming supplements.

Supplements are an integral part of athletes’ diet. It is required to have an enhancement of their endurance, and also to increase or, if not increase, at least maintain the appropriate muscle mass to be able to improve size and strength.

One of the most important parts of any sports nutrition is protein supplements. Without these supplements, athletes would not be the way they are at present. However, contrary to what most people think, diets jam-packed with protein do not necessarily build up muscle strength.

Building up muscle strength would be the job of regular physical activity. So if you want those big muscles you have to do exercises, not necessarily at gyms but could be also at your residences, daily. The key factor here is regularity. What you can achieve with steady and regular exercises may not be possible with a high profile but an irregular one.

Sports nutrition supplements need high levels of protein, which you can get from protein-rich foods. Enumerating all those food item will be a total waste of space in this article.

But to make you aware of the basics, here are a few of the foods that are rich in protein. There is fish, poultry and dairy products, and these are the foods you usually get your protein from because some sources of protein are high in fat and also in calories. So basically, you must take note of which sources are high in fat and which are not.

Even though nutrition supplements are useful, there are many reasons because of which sports nutrition experts discourage use of such supplements. One of the reasons is that these supplements can put a strain on your liver and kidneys.

Other reasons include high amounts of nitrogen in the nutrition supplement, which will only be excreted from your body as urea. But it is not as easy nor is as safe as it sounds because this said excretion often causes fluid imbalance, which leads to dehydration.

Another problem with sports nutrition supplements that have high amounts of protein from animal sources is that there are higher risks of heart diseases due to the high fat intake associated with such nutrition.

One more disadvantage of sports nutrition supplements is that there is a huge tendency that you will ingest amino acids that are capable of interfering with other amino acids, which results in a metabolic imbalance.

Beware of sports nutrition supplements that have high amounts of amino aids because it can cause gout; diarrhea and stomach cramping that can rank from mild to severe pain.

Even though sports nutrition supplements are being discouraged by sports nutrition experts, Bricker Labs, a sports nutrition supplement manufacturer, still does a lot of research, developments and marketing in this area.

Bricker Labs has over thirty years to blame for their success in their provision of sports nutrition supplements. They do not apply to sports nutrition only too, but also to weight loss, diet, health and other nutritional aspects.

It’s because of their experience in the field of sports nutrition and also because of their choice of perfectly safer ingredients in developing the nutrition that you would not like to consider any other manufacturer for your sports nutrition supplements. So what are the ingredients they use and how are they safer than those that other manufacturers use?

They make us of the L-Carnitine, which is mainly used for weight loss, energy and also for having a healthy heart function; Colostrums, which gives your body a healthy immune system function and also gives your body an improved stamina and also for an easier recovery in almost all cases; Vandayl Sulfate, which is capable of growing your muscles and also has the ability to define your muscles; Protein, everyone knows what protein is for and that is for sports nutrition, and also for health and muscle growth.

Another component is called Creatine, which is used for sports nutrition and muscle growth but it also involves bodybuilding at this time; HCA or Garcinia Cambogia, are for losing weight and suppressing your appetite; and last but certainly not the least, Vitamin B-12, is for overall health and nutrition.

All these ingredients mixed proportionately make the right sports nutrition. And an adequate dose of such nutrition gives the athlete required energy and muscle strength. Now you know what keeps an athlete going!

11 Points For Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges mental-health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental-health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform..

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental-health and substance use performance measures that will be used to improve delivery of mental-health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental-health and substance use services and include mental-health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

Mental Health Stigma

Despite the increase in publicity surrounding mental health and mental health issues, there is still a lack of understanding about mental health in general. For example, a research survey published by the government “Attitudes to Mental Illness 2007” reported that 63% of those surveyed described someone who is mentally ill as suffering from schizophrenia, and more than half believed that people with mental illness should be kept in a psychiatric ward or hospital. Overall the results showed that positive attitudes to people with mental health had actually decreased since 1994 which is worrying indeed.

Amazingly, many people still don’t understand that mental health problems affect most of us in one way or another, whether we are suffering from a mental illness ourselves or not. If we bear in mind that a quarter of the population are suffering from some kind of mental health problem at any one time, then the chances are, even if we personally don’t have a mental illness, we will know someone close to us who does, so it is our responsibility to understand what mental illness is and what can be done about it.

Many people with mental health problems will often feel isolated and rejected and too afraid to share their problems with others purely because of the way they might be perceived. This lack of understanding means they are less likely to get the kind of help and support they need and are in danger of slipping even further into depression and mental illness. People need to understand that mental illness need not be a barrier to a better quality of life and that help is available and that most people with a mental health problem can regain full control over their lives if they get the support they need.

A new guide to mental health

The Royal College of Psychiatrists has produced a new guide to mental health which was published in November 2007 and is aimed at informing the general public about what mental illness is and is a big step towards tackling the stigma that is still attached to mental illness.

The guide is written in an easy to understand format and over 60 mental health experts have contributed to it. The Mind: A User’s Guide contains chapters that cover a whole range of mental illnesses and includes a section on how the brain works, how mental illness is diagnosed, and how to cope with it.

A Scottish survey

In Scotland, a national survey of public attitudes to mental health Well? What Do You Think? (2006) was published in September 2007 and highlighted that although people living in socially deprived areas have a higher incidence of mental health, the level of stigmatisation is still no lower than in other areas. This suggests that being confronted with mental illness is not enough to change the attitudes towards it.

There are also gender differences too. According to the Scottish survey, men with a mental health problem were more likely to be treated with suspicion than women and were also more inclined to avoid social contact with someone else with a mental health problem. Even out of those who displayed a positive attitude towards people with mental health problems, many said they would be reluctant to tell anyone if they had a mental health problem themselves which just goes to show that there is still fear surrounding other peoples’ perceptions of mental health.

A CIPD Survey

A recent study conducted by the Chartered Institute of Personnel and Development and KPMG consultants surveyed over 600 employers and reported that doctors are not doing enough to help people with mental health problems return to work and that this is costing the business world billions of pounds. For example, only 3% of the participants rated doctor support as “very good”.

It may be that doctors really don’t know what else to offer someone suffering from depression and anxiety other than drugs and time off work. Even more worrying was the fact that 52% of employers maintained that they never hired anyone with a history of mental illness which serves to perpetuate the stigma. On a more positive note, of those that did hire someone with a mental health problem, more than half said the experience had been “positive”.

Changing attitudes

A lot is being done by governments and organisations to try to change public attitudes towards mental health but is it enough? Until we all recognise that mental illness doesn’t discriminate, it can affect any one of us at any time regardless of our age, gender or social background, the stigma attached to mental illness is likely to persist.

Mental illness doesn’t discriminate, it can affect any one of us at any time regardless of our age, gender or social background, and yet the stigma attached to mental illness still persists. Although a number of government initiatives, awareness campaigns and organisations have been set up specifically to tackle mental health stigma and change our attitudes towards mental health in general, there is still a long way to go.

It is therefore up to each and every one of us as individuals to make sure we are well informed and understand the issues involved because only when the public are fully aware of the facts will mental health stigma become a thing of the past.

Understanding Addiction and the Simplicity of Cure

First let me explain what addiction is. Addiction is frequently being compelled to indulge in a behaviour that offers short-term relief, but long term damage in any area of your life (heath, relationships, finance and work to name just a few areas). The important word here is compelled.

Addiction is a difficult challenge to overcome. Not because the addictive behaviour is hard to break once the addict realises they have an addiction, but because addiction is shrouded in denial, preventing the addict from seeing their behaviour with clarity.

Denial is created by the addict in a bid to protect them from the loss they perceive they will endure if they give up the addictive behaviour or substance. Perceive is a very important word here because the addict actually does not gain anything from their addiction at all. Their addiction gradually and systematically destroys every area of the addicts life until all that is left is the addiction. As each area of the addicts life is slowly destroyed, the addict clings more and more to the addiction because the addiction is perceived to be a pleasure. The key to breaking any addiction is to break the cycle of faulty thinking that keeps the addict enmeshed in this cycle. So the good news is, addiction can be overcome a lot easier than we all think possible.

First let us explore addiction itself. All addiction has exactly the same roots regardless of the substance or behaviour that makes up the addiction. So addiction could be to substances such as alcohol, drugs or food, or it could be to behaviours such as gambling or shopping. All addictions are there to serve the same purpose, which is to change the way the addict feels. All addiction is masking unresolved pain.

This is how it works. The addict has a feeling. Now the feeling could be good or bad. A good feeling will lead the addict to celebrate. If they are addicted to food, they will celebrate by eating. An alcoholic will have a drink. A gambler will treat himself to a little flutter. If the addict has a bad feeling, they will indulge in the addictive behaviour to try and make themselves feel better. This is the paradox of addiction. One cure for all feelings! So, as the addictive behaviour continues it naturally gathers momentum (I will explain why in a moment) and becomes a bigger and bigger part of the addicts life. In extreme cases, if allowed to continue, it becomes the only thing in the addicts life.

Addictions naturally gather momentum for numerous reasons. The first reason is that the addict perceives that they gain some kind of reward from their addiction. This is never the case. If you enjoy something, you can take part in the activity and feel better for having done it afterwards. An addict usually feels worse following the addictive behaviour. A drinker will have a hangover, a shopper will feel guilt about the bills they now have to pay, an emotional eater will feel guilt about their latest binge etc. As discussed earlier, addicts indulge in their addictive behaviour to change their emotional state. Once the bad feelings surface after their latest indulgence, what is the first thing you think they will want to do? Yes! They will indulge once again in their addictive behaviour in order to get rid of their unwanted feelings. This is obviously a downward spiral.

The second reason why addictive behaviour gathers momentum is because it is used as a coping mechanism but in addition is used as a celebration (initially anyway. Once the addiction really takes a grip there is no longer the desire for celebration). Usually, if we are healthy and balanced, we have a number of ways to alter our emotional state. A few examples are, take a hot bath, meditate, read, relax and watch a movie, chat with friends etc etc. The addict stops looking for new ways to resolve challenges and ease stress. They use their addiction for immediate gratification. This gives the addict fewer and fewer coping mechanisms, as the addiction becomes a bigger and bigger part of their lives.

The third reason addiction gathers momentum is if the addiction is to a substance rather than a behaviour. If the substance is physically addictive, this causes further complications in the cycle of addiction as the body starts to crave the substance and will react (withdrawal symptoms) when the substance in question leaves the body.

The forth reason addiction gathers momentum is tolerance. Our bodies are amazing and intricate machines. If you are addicted to nicotine or alcohol, try and think back to the first time you smoked or drank. The taste was disgusting! You felt sick and dizzy and your body produced all kinds of unpleasant feelings. It did this because you were poisoning it! It was a warning. Now nature is very clever. Your body assumes over time, that if you are constantly poisoning it, you are doing so because you have no other option. So in order to make you more comfortable, it stops producing warning signs. This means that in order to get any ‘benefit’ from the drug of your choice, you have to take more of it. Your body then once again reacts to warn you. You ignore the warning, so your body decides to stop warning you because it assumes you have no other option than to poison yourself so you have to increase the dose. This is called tolerance. Obviously, with each increase in dosage, the body comes under more stress as it tries to cope. As the body comes under more and more stress our health and well-being becomes more and more compromised. Again, a very painful downward spiral.

So we now come to the point where we can explore how to overcome an addiction. As previously stated, it is not the addiction that is the difficulty; it is the addicts perception of their addiction that is the challenge. If the addicts perception changed, the addiction could be overcome with relative ease. The addict feels helpless to overcome their addiction because they perceive their addictive behaviour as being precious to them. This is denial. It is this denial that needs to be addressed and then the addiction can be resolved because the addict can see clearly that the addiction is not serving them. It is in fact doing the opposite. It is destroying them. The strongest addiction is actually psychological addiction rather than physical addiction. Physical addiction can usually be resolved after a few days of detoxification. If physical addiction were the strongest element of addiction, then it would follow that after a few days of detoxification, you would be free. As we all know, this is not the case. Psychological addiction is the root and is caused by faulty thinking and denial. Change the thinking and the addiction no longer exists because it is no longer ‘needed’.

If you think you have a physical addiction, please seek help because you may need a supervised detoxification programme. For addictive behaviours, your first step is to admit you have a problem. You do not have to hit rock bottom to overcome an addiction. People hit rock bottom because they fear their life without their addictive behaviour so much that they continue with the behaviour until they have nothing left. I promise you. Life without addiction is wonderful. It is faulty thinking that is telling you otherwise!

Beneath addiction is often unresolved emotional pain. If you have suffered any type of trauma in your past, please go and seek help now to resolve it. Avoiding emotional pain will not help you. You have to learn to walk through emotional pain. Don’t allow your past to dictate your future.

Addiction often also masks a feeling of lack of purpose. Addiction can allow someone to ‘opt out’ of life and sit on the fence just observing from a distance. We all have skills and gifts to share with the world. You are no exception (although you may feel as if you are). Trust me, you have a purpose. Decide today that you are going to commit to finding and living that purpose.

As I said before, addiction often masks emotional pain. If you have suffered trauma in the past, get help today to resolve that trauma, and then resolve to make meaning out of your suffering. There are probably thousands of people who have suffered a similar trauma who could really benefit from your help even if it is just hearing your story.

Addiction also exacerbates emotional pain. As you try to navigate life through the eyes of your addiction, you create more challenges for yourself. Your behaviour creates feelings of helplessness and guilt. This has a prolific effect on your self-esteem, which then needs to be medicated further with your addiction of choice. Be kind to yourself. Try and think back to things that used to give you pleasure. Slowly introduce those things back into your life. And don’t beat yourself up if you try to quite and then relapse, doing that will only make the journey more difficult.

And finally, as a Homeopath, I have dealt with many clients with addictive behaviours. I have listed below a few remedies that may help with your addiction. Remedies should be 30c potency and should be taken 3 times a day until you start feeling better. Once you start feeling better, only take another remedy when you start feeling worse.

Nux Vomica

Take this remedy if you work hard. You may worry about work, eat unhealthy food and drink alcohol to cope. You may be bad tempered and stressed.

Arsenicum Album

Take this remedy if you feel anxious and restless. You may be off your food or you may have a large appetite. You may feel sick at the sight or smell of food. You are exhausted but will still get things done. You like everything in its place.

Carcinocin

Take this remedy if you like to be perfect. You may have had abusive or strict parents when growing up. You may have had to take on adult responsibility as a child. You need to be a ‘good girl’ ‘good boy’.

Natrum muriaticum

Take this if you find it hard to share your problems with people. You like to cry alone. You don’t like people to get too close. You may like salt. You dwell on past disagreements or negative situations. You find it hard to forgive. This is also good for past unresolved grief/loss.

Pulsatilla

Take this if you feel you bend and sway to gain peoples love and approval. You can be needy and clingy. You may weep a lot. You don’t like being on your own.

Sulphur

Take this if you have a philosophical approach. You may think more than you ‘do’. It is also good to restore energy where energy is depleted due to toxic liver.

Avena sativa

The Energy Healing Power of Natural Medicine

Natural medicine is a system that uses a variety of therapeutic or preventive health care practices such as homeopathy, naturopathy, chiropractic, and herbal medicine. Alternative medicine is also known as traditional, naturopathic, natural or holistic medicine. Proponents of alternative medicine are not refuting the validity of discoveries in and the practical uses of conventional medicine, but are merely trying to put some things into perspective. Due to the widespread interest in natural medicine along with the disappointment and disenchantment with Western medicine, many people, especially in the United States and Europe, where conventional medicine has taken a dominant foothold, are seeking the advice and treatment from naturopathic physicians. These practitioners include herbalists, acupuncturists, naturopaths, chiropractors, and others, who advocate preventative health measures as well as recommend wholesome foods and nutritional supplements for their patients and clients. Considering the growing popularity and effectiveness of alternative health treatments and products, certified and licensed professional practitioners of such medical practices should be given their rightful and respectful place in medical society. Natural medicine has been proven not only to be safe, but more effective than Western medicine in treating many chronic illnesses such as diabetes, hypertension, asthma and many other diseases as well

The history of Natural Medicine and its roots can be traced back thousands of years to ancient cultures such as India and China. Ayurvedic (E. Indian) and Chinese medicine, along with their diagnostic and herbal systems, are still used in these countries extensively, as well as in the United States, especially in Europe, where alternative medicine is well respected. Chinese herbal medicine has a documented history of over 2500 years in China, and is now widely used by practitioners all over the world. It has been legally practiced in the United States. since the mid seventies by licensed acupuncturists. Homeopathy is also a well-known form of alternative medicine discovered in the 18th century by German physician Samuel Hahnemann, but was practically stamped out in the U.S. in the late nineteenth century by the American Medical Association. In 1938, though, the U.S. Food, Drug, and Cosmetic Act finally recognized homeopathic pharmacopoeia as the legal equivalent of allopathic medicine.

Another more contemporary and popular form of herbal medicine, called Western herbalism, can be traced back about two hundred years in America. Samuel Thomson, born in 1769, is considered the father of Western herbalism. He discovered over sixty different medically effective native plants by clinical testing, and on the basis of these findings, devised a theory of disease and botanical drug action. Randy Kidu, D.V.M., Ph.D., writes in his articled entitled A Brief History of Alternative Medicine: “The history of herbal medicine is interesting because herbs have been a part of our diet and pharmacy since man began roaming the earth. Coprophytic evidence (seeds and other plant part(found in preserved fecal pellets) points to herbal use by cavemen. Early herbalists practiced their trade since before recorded history in all parts of the world including China, Egypt, Greece, Rome, Africa, England, the Americas, and Europe. Many herbs are also mentioned in the Bible. Today, based on sheer numbers of folks who use one form of herbal medicine or another, it remains the most-used medicine worldwide.”

Twenty-five hundred years after the advent of allopathic medicine, modern medicine is still grappling with the idea that herbal medicine could be an effective treatment, and not just quackery, although thousands of years of recorded history has proved its efficacy. A new model of understanding in medicine needs to be incorporated into the existing allopathic model. Because of the growing popularity and effectiveness of natural medicine, practitioners may eventually be given their deserved place in medical society. The incorporation of natural medical practices into the existing model of conventional Western medicine, including the training of new medical doctors, is now called Complimentary Medicine. In order to solve our health problems, this modern paradigm for treatment in medicine must be promoted. This can only truly emerge when bias, self-interest, greed and discrimination is discarded and diverse medical knowledge is promoted and shared, not only between university trained scientists and medical doctors, but among Alternative Medicine practitioners, philosophers, metaphysicians, and other intelligentsia of society as well.

Online Pharmacies and Telemedicine

Not a day goes by when our email inboxes do not fill with advertisements for prescription drugs. Many of these emails promise to deliver drugs of all classes by overnight courier without a prescription. While there are legitimate online pharmacies, and the practice of telemedicine or cyber-medicine is gaining acceptance, this change in the way medicine is being practiced is rocking the foundations of the medical establishment. Being able to consult a doctor online, and obtain prescription drugs delivered to your doorstep by UPS has broad social and legal implications. The Internet facilitates making drugs available to those who may not be able to afford to pay US prices, are embarrassed to see a doctor face-to-face, or are suffering from pain, the treatment of which puts most doctors in direct conflict with the ‘war on drugs’ but on the other hand there is the question whether these pharmacies make drugs available to recreational drug users without the oversight of a licensed medical practitioner.

The Need for Alternatives

Medical care in the US has reached a point where it is expensive and impersonal which has caused the consumer to become generally unsatisfied with the medical establishment as a whole. Examples include the huge differences between the cost of drugs in the US and Canada, long wait times in US pharmacies, and poor service in general. Perhaps realizing this, US customs appears to tolerate the millions of Americans that visit Canada every year to buy their medications, as for the most part, these ‘drug buyers’ are elderly American’s that can’t afford the high cost of filling their prescriptions in the US.

Rather than to travel to Canada or Mexico millions of Americans are now turning to the Internet for both their medical needs. Telemedicine (or cyber medicine) provides consumers with the ability to both consult with a doctor online and order drugs over the Internet at discounted prices. This has resulted in consumers turning to online pharmacies for their medical needs, and in particular pharmacies with a relationships with a physician, which allow the consumer to completely bypass the traditional brick and mortar pharmacies, with the added benefit of having their physician act as an intermediary between the consumer and the pharmacy. According to Johnson (2005) this is as a result of consumers becoming very dissatisfied when it comes to dealing with both brick and mortar pharmacies and medical practitioners. As Johnson, notes, “Consumers are more likely to know the name of their hairdresser than their pharmacist.” When Johnson (2005) rated the various professions within the health care system, he found that pharmacists had the lowest interaction with their patients than did any other group. Today, as a result of this “consumers are buying 25.5 percent of their prescriptions online, opposed to 13.5 percent of which are picked up at a brick and mortar pharmacy” (Johnson 2005).

Drugs and Society

What has brought so much attention to online pharmacies is that it is possible to obtain just about any drug without a prescription online. Many of these prescriptions are for legitimate purposes purchased through an online pharmacy because the buyer is too embarrassed to visit the doctor or for other reasons including the unavailability of FDA approved drugs to the consumer. These drugs may include steroids that due to their misuse and being classed as a classed a category three drugs, are seldom prescribed by physicians. These drugs have a useful purpose to those suffering from any wasting disease such as AIDS, they also play a role in ant-aging (FDA, 2004).

The Doctor Patient Relationship

Today a visit to a doctor is generally brief, much of the triage it is done by a nurse or a nurse practitioner with the doctor only dropping in for a few minutes, if at all. In many cases the patient is seen by a nurse practitioner. One of the arguments against telemedicine or perhaps a better term is cyber-medicine, is that the doctor does not have a physical relationship with the patients and thus is in no position to make a diagnosis, and thus can not legally prescribe drugs.

Ironically when one compares the work up that one has to go through to consult with an online physicians and compares this to a face-to-face visit with a brick and mortar doctor, one finds that the online physician, in many cases, has a better understanding of the patient’s medical condition than does the doctor who meets face-to-face with the patient. In most cases before an on-line a doctor prescribes any type of medication they insist on a full blood workup they may also require that one has additional tests performed, for example.

The AMA, the federal government, and various states claim, however, that it is illegal for a doctor to prescribe drugs without a valid doctor-patient relationship. While there are no laws at present that outlaw online pharmacies, various states have enacted legislation, or are in the process of enacting legislation to prohibit a doctor from prescribing drugs to a patient that they have not seen face to face. Some states also require that the doctor that prescribes the drugs be licensed in their state. This alone could hamper the development of cyber-medicine. According to William Hubbard (2004), FDA associate commissioner “The Food and Drug Administration says it is giving states first crack at legal action, though it will step in when states do not act” (FDA, 2004).

Internet Pharmacies

The reason that email boxes around the country fill up with offers to supply drugs of all kinds, at reduced prices, without prescriptions, and more is because people buy them as the billions of dollars the drug companies are making each year attest to. The Internet has become the drug store of choice for many.

Categories of Internet Pharmacies

Internet pharmacies are generally acknowledged to be comprised of the following five categories:

Internet pharmacies can be divided up into five different categories, as follows:

Licensed online pharmacies with a no medical affiliation.

Licensed online pharmacies with a medical affiliation

No record online pharmacies (NRP)

International online pharmacies (IOP)

Licensed compounding pharmacies

The licensed online pharmacies with a no medical affiliation are of course Drugstore.com, CVV, and others. They all require a prescription from a licensed doctor that the patient has a doctor patient relationship with. The prescription can be called in by the doctor.

The licensed online pharmacies with a medical affiliation often depend on a broker. The broker collects your medical information, and then assigns your case to one of their networked physicians. Many of these networked physicians are willing to prescribe pain killers as they believe that it is only through the use of these drugs that some people can live a harmonious life.

A Government Accountability Office (GAO) Committee on aging held in June 2004 found that “Unlicensed international pharmacies do not require a prescription, and are generally located off shore.” No prescription pharmacies can be found all over the world. Many of these sites have come under controversy as in some cases all it takes to have that prescription delivered to you by next day air, is to fill out a questionnaire online.

A study conducted by Henkle in 2002 to ascertain how easy it would be to obtain drugs over the Internet found that “37 of the 46″ pharmacy required a prescription from a licensed doctor. The emphasis was on the prescription and not on the doctor. Henkle (2002) in fact notes that some sites offered to recommend a doctor.” Henkle (2002) was able to obtain prescription drugs from nine sites outside the US during the study, without a prescription.

Online pharmacies with a doctor affiliation

There are a number of online pharmacies, with a medical affiliation is that take great pain to differentiate themselves form unlicensed overseas pharmacies. These pharmacies, stress that they are “American based companies that provides consumer’s easy access to FDA approved online prescriptions over the Internet and are quick to point out that “An online consultation can be just as relevant as an in-person consultation.” It is interesting to note that many of these online pharmacies also point out that “While they are committed to making access to online prescriptions easier, they believe that the Internet can not replace the importance of regular doctor visits to fully evaluate your health and any medical conditions.” Many of these online pharmacy sites also makes a wealth of drug information available on its web site that enables the consumer to educate themselves on drugs that may have been prescribed. The Internet has for all intensive purposes is quickly replacing the brick and mortar base physician as a patient’s primary health care provider.

A sales pitch, of course, or is it? Most of the legitimate online pharmacies ensure that they comply with state and federal regulation. The doctors are licensed in all 50 states and their pharmacies are too. These legitimate Internet pharmacies cater to those that are looking for a better price; for some it comes down to making the choice of eating cat food on crackers in order to afford their medications because of the high US drug prices. In other cases patients resort to cyber-medicine to avoid the embarrassment of having to deal with a physician or pharmacy that may be judgmental. Many of these online pharmacies will arrange a consult with a licensed, medical doctor over the phone and will then fill the prescription accordingly.

According to Henkel (2000) “More and more consumers are using the Internet for health reasons” and references a study carried out by a market research firm Cyber Dialogue Inc., “that found that “health concerns are the sixth most common reason people go online” (Henkel 2000).

For many people a trip to the pharmacy is an ordeal. In some cases the local pharmacy may also be located in the closest town which may mean a long drive if one lives in a rural community. Online pharmacies provide a means through which their prescriptions can be delivered conveniently and quickly. Being online also allows the consumer to shop for the best prices, an important factor if one is living on a pension.

The Internet has also created a more aware user. It is not unusual for a consumer to research drugs on the Internet. A consumer may have seen a TV or magazine advertisement advertising a new drug. Ultimately, the Internet also provides the consumer the opportunity to enter into a doctor patient relationship that may in fact be more legitimate than the doctor who makes a physical appearance. Further information on doctors that practice telemedicine can be found at: http://www.becomeone.com

It is interesting to note, as discussed previously, that consumers are becoming dissatisfied with the care and treatment they receive from both brick and mortar physicians and pharmacies. Zanf (2001), references a study by Lang and Fullerton that “Identified four factors related to outpatient pharmacy services: professional communication, physical and emotional comfort, demographics, and location and convenience.” All of which are contributing factors as to why more and more consumers are resorting to cyber-medicine.

The Dark Side

There is also a dark side to the Internet pharmacy, as previously discussed, spam email touting the availability of any prescription drug one could want, without a prescription, is something everyone is familiar with has reached epidemic proportions.

From Ambien, and of course Viagra to more powerful drugs such as Oxycontin, you can have it all. Over night shipping is available in most case, or so these emails proclaim.
In some instances this pharmacy spam originates from unscrupulous individuals who have no intention of delivering the drugs, realizing that very few people, if any, will complain about the non delivery of an illegal drug through the mail.

In other cases the drugs are sent without a prescription from countries where that particular drug may legally be sold without a prescription, or at least the laws are more relaxed. Valium, for example, is sold over-the-counter in Taiwan.

According to Crawford (2004) “Consumers who purchase drugs online thinking that they are they are getting the same drugs as they would from their local brick-and-mortar pharmacy are being misled, and as a result are putting their health, and eventually their lives at risk” Crawford cites examples of Internet pharmacies supplying drugs that were under strength, contaminated and mislabeled (Crawford 2004).

According to Won (2005) Drug-industry executives think the Internet and mail-order operations will be the biggest source of counterfeit drugs over the next five years, according to a report released today by Ernst & Young. According to James G Dickinson (2005):

The federal government in July shut down an alleged illegal Internet pharmacy for selling counterfeit drugs and issued a warning on other counterfeits found to have been sold in Mexican border pharmacies to individual patients from the U.S. The Internet pharmacy had sold more than $7 million in counterfeit Viagra and other prescription drugs over the past five years, according to the San Diego Union-Tribune. The San Diego-based operation required individuals to complete a $35 “doctor consultation” survey before receiving the prescriptions, but the survey was never shown to a health professional to evaluate whether a safety risk existed, the paper says (Dickson, 2005).

In a separate action, the FDA warned Americans about counterfeit versions of Merck’s cholesterol drug Zocor and generic Carisoprodol – used for treating musculoskeletal conditions – that had been imported from Mexico by individual Americans (FDA, 2005).

Over the last year patients suffering from pain, and other conditions that they are reluctant to see a doctor face-to-face, have had the option of consulting a doctor online. The ability to consult with a doctor online, and then to receive drugs as a result has come under much controversy. This has for the most part been as a result of not adequately screening patient’s records, or ordering from unregulated overseas pharmacies.

The Internet – a new way of marketing

Not all Internet pharmacies are illegitimate, however, and there are many pharmacies that provide the consumer with a legitimate prescription by overnight service. My last prescription came by mail. The whole transaction was completed over the Internet. It was a prescription that my doctor had given to me personally, however. As discussed, what constitutes a doctor patient relationship is at the crux of the online pharmacy debate. This of course has implications as to what constitutes a legitimate prescription. What constitutes a legitimate prescription is a hotly debated topic.

The Future

As noted, being able to consult a doctor over the phone, and then have one’s prescription filled by an Internet pharmacy is convenient for many people. As the American population ages, more and more people will have trouble getting to the doctors office, not to mention driving to the pharmacy. Clearly safeguards are needed if cyber-medicine is to raise the quality of medical care available to Americans. The online pharmaceutical industry has taken a number of steps to ensure that consumers are protected against unscrupulous online pharmacy operators including the certification of online pharmacies.

According to Henkel (2000) “One way consumers can ensure the quality of an online pharmacy is to look for the Verified Internet Pharmacy Practice Sites (VIPPS) seal.” According to Henkel (2000) any site bearing this seal has gone through a rigorous series of quality checks which are part of the Verified Internet Pharmacy Practice Sites program. Unfortunately as Henkel (2000) notes, “Because VIPPS certification is fairly new and voluntary, only a few sites have been certified so far.” Recognizing the problem of ‘rouge’ pharmacies, SquareTrade, has also implemented a program to protect consumers from ‘rouge’ pharmacies. According to SquareTrade, “The Licensed Pharmacy program verifies that your business is a pharmacy in good standing. Verified pharmacies can display the Licensed Pharmacy Seal on their websites – distinguishing themselves from unverified and rogue pharmacies.”

If these safe guards are not put in place, and legislation is enacted that makes it illegal to obtain a prescription from an online pharmacy based on an online consult, the black market for drugs will continue to thrive. Customs by its own admission only catches approximately 2% of all illicit prescription drugs that enter the US.

Negating the fact that through technology, one could enter into a doctor patient relationship that may be affordable. Security, as some have suggested could be accomplished through the use of video cameras and biometric scanners which would cut down on the number of fraudulent prescriptions written. Measures like these would put the convenience of using an online pharmacy out of the reach of those without the technology. One could also not prevent consumers from using off shore online pharmacies. While the FDA is presently trying very hard to get the Canadian government to enact legislation that would prohibit the export of drugs from Canada by mail it appears that the profit that results from the sale of drugs is causing the legislation to stall. As one Canadian pharmacy owner noted, however “We will just move to the UK.”

Ironically, the Canadian’s are offering to crack down, not because of any concerns relating to the sale of drugs online, but because Canada controls drug prices, making them far cheaper than the same drug in the US. The Canadian authorities are planning on cracking down “arguing that the system was created to help Canadians, not Americans.” The drug industry itself has gone so far as to black list Canadian pharmacies that sell to American customers over the Internet. With all the paranoia relating to terrorism there is a concern that any drug coming in from another country may be contaminated. There are no instances on record of a consumer having received a contaminated drug from Canada (Matthews, 2003).

Even more ironically with all the talk about the dangers of drugs purchased from overseas, some legitimate companies are now being forced to buy from other than US sources because they have been black listed by US drug manufactures (Matthews, 2003). Mathews (2003) goes on to illustrate this by pointing out that “Canadian suppliers, in particular, that have been blacklisted, are now turning to sources in Europe.” Mathews (2003) notes that while for the most part these European sources are legitimate and make a high quality drug. In some cases, however Mathews et al. (2003) note that the pharmacies are having to go ‘farther a field’ to find product.

Conclusion

While there need for controls to be put in place to regulate the practice of both medicine online and Internet pharmacies, we also need to acknowledge that science and technology has furthered the practice of medicine, and that the Internet will further it yet.

The Internet has the potential of expanding medical care to those that may not routinely seek it, or are too infirm to travel to the doctor’s office. While the present trend appears to be to make it illegal for a doctor to prescribe drugs without seeing the patient face-to-face there is also a move to establish rules and regulations that ensure that patients receive quality care over the Internet. Unfortunately medicine and politics have become so intertwined and doctors have inadvertently become unwilling agents in the war against drugs.

One can’t turn back the clock though, and according to Larkin (1999) “At a July 30 US Department of Commerce hearing on the benefits and risks of ‘drugstores on the net’, the question was examined.” The main issue was how to shutdown the online pharmacies run by unscrupulous individuals, while still fostering the legitimate online pharmacy business in order to both promote commerce and still protect the consumer (Larkin, 1999). According to Larkin (1999) “What’s new here is not the practice of pharmacy, but the way we communicate with and inform customers.

Perspectives on Sexual and Reproductive Health

Health is the foremost priority of each and every human being. But when it comes to sexual health people get careless and do not give it much importance especially in developing countries. According to World Health Organization sexual health is influenced by a complex web of factors ranging from sexual behavior and attitudes and societal factors, to biological risk and genetic predisposition. It encompasses the problems of HIV and STIs/RTIs, unintended pregnancy and abortion, infertility and cancer resulting from STIs, and sexual dysfunction.

Sexual health is a state of physical, emotional, mental and social well-being and is not merely the absence of disease, dysfunction or infirmity. Sexual health needs great concern as it in not a matter of physical health but also has a psychological aspect. Sexual activity requires a positive and respectful approach as it involves relations as well as pleasure. Sexual violence is a terrible experience that causes both physical and psychological problems. When women face sexual assault it is causes great pain and anguish. Sexual assault as rape causes them to get pregnant and as they are not prepared for it face health problems mostly due to mental strain.

A person’s individual health also affects the sexual health of that person. If a person is suffering from some chronic illness or mental health it affects the sexual life and further reproductive health. It is always better to take consultation from health providers about a person’s sexual health, as it is not only the individual’s health but an individual’s family health that affects his or her sexual life.

It is necessary to be aware of ones sexual health as it can lead to serious problems especially when there is a risk factor of sexual infection. In developed countries although the sexually transmitted diseases are less among adults the number is increasing with the teenagers. So it becomes necessary to come up with sexual health programs to create awareness among the adolescence. The number unplanned pregnancies are more in teenager as they are not completely educated about the use of contraceptives.

Sexual health has been considered as a part of the reproductive health, the emergence of HIV/AIDS, of sexual and gender-based violence as such proper care should be given to one’s sex life. People should opt for safe sex. They should be aware of risks involved with sexual activity. In most countries adolescents face problems when it comes to using contraceptives due to various reasons as inadequate knowledge, difficulty in getting the proper service, money problem and social factors. Social factors are major issues for teens as well as women in backward countries. They neglect sexual health due to conservative attitude and thus face sexual health related problems. “According to the World Bank, a full one-third of the illness among women aged between 15 and 44 in developing countries is related to pregnancy, childbirth, abortion, reproductive tract infections, and human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS).” Gender inequality and indiscrimination among women in developing countries has lead to innumerable sexual health related cases. The number of HIV/AIDS patients is more in such countries. It has become necessary to increase sexual and reproductive health programs in such countries to create awareness among women about the risk factors associated with sexual activity.

Help For the Partners of Sex Addicts

Frequently Asked Questions (FAQ’s)

· What is sex addiction?

Sex addiction is an obsessive relationship to sexual thoughts, fantasies or activities that an individual continues to engage in despite adverse consequences. These thoughts, fantasies or activities occupy a disproportionate amount of “psychic space”, resulting in an imbalance in the person’s overall functioning in important areas of life, such as work and marriage. Distress, shame and guilt about the behaviors erode the addict’s already weak self-esteem.

Sexual addiction can be conceptualized as an intimacy disorder manifested as a compulsive cycle of preoccupation, ritualization, sexual behavior, and despair. Central to the disorder is the inability of the individual to adequately bond and attach in intimate relationships. The syndrome is rooted in early attachment failure with primary caregivers. It is a maladaptive a way to compensate for this early attachment failure. Addiction is a symbolic enactment of deeply entrenched unconscious dysfunctional relationships with self and others.

While the definition of sex addiction is the same as that of other addictions, sexual compulsion is set apart from other addictions in that sex involves our innermost unconscious wishes, needs, fantasies, fears and conflicts.

Like other addictions, it is relapse prone.

· How do I know if my partner is a sex addict?

Sometimes, it’s difficult to know whether someone close to you has an addiction. The addict might hide the addictive behavior or you might not know the warning signs or symptoms.

Here are some of the signs and symptoms:

* Staying up late to watch television or surf the Web.

* Looking at pornographic material such as magazines, books, videos and clothing catalogs.

* Frequently isolating themselves from spouses or partners, and doesn’t inform them of their whereabouts.

* Are controlling during sexual activity or have frequent mood swings before or after sex.

* Are demanding about sex, especially regarding time and place.

* Gets angry if someone shows concern about a problem with pornography

* Offers no appropriate communication during sex

* Lacks intimacy before, during and after sex, and offers little or no genuine intimacy in the relationship

* Does not want to socialize with others, especially peers who might intimidate them

* Fails to account for increasing number of toll – 800 or 900 – calls

* Frequently rents pornographic videotapes

* Seems to be preoccupied in public with everything around them

* Has tried to switch to other forms of pornography to show a lack of dependency on one kind; concoct rules to cut down but doesn’t adhere to them

* Feels depressed

* Is increasingly dishonest

* Hides pornography at work or home

* Lacks close friends of the same sex

* Frequently uses sexual humor

* Always has a good reason for looking at pornography (Psych Central.com).

· Why can’t he/she control his/her sexual behavior?

It’s important for you to know that your partner is not volitionally involved in these behaviors so you can begin to understand and, perhaps, forgive. Most addicts would stop if they could.

It’s been said that of all the addictions, sex is the most difficult to manage. This syndrome is a complex mixture of biological, psychological, cultural, and family-of-origin issues, the combination of which creates impulses and urges that are virtually impossible to resist. Despite the fact that acting them out produces considerable long-term negative consequences, the addict simply cannot resist his/her impulses. Individuals who are highly disciplined, accomplished and able to direct the force of their will in other areas of life fall prey to sexual compulsion. More importantly, people who love and cherish their partners can still be enslaved by these irresistible urges.

Research has also shown that the inability to control sexual impulses is associated with neurochemical imbalances in the norepinephrine, serotonin and dopamine systems. The use of certain anti-depressants (SSRI’s) has thus shown to be very effective in treating the impulse control problems of many sexual compulsives.

Biological predisposition contributes and combines with psychological factors. One of the reasons the “erotic haze” is so compulsory is that it is an unconscious but maladaptive way to repair earlier disturbed, anxiety-laden relationships. It shores up an inadequate sense of self which results from these early-life interpersonal abandonments, intrusions and misattunements.

This combination of biological and psychological factors results in an “affective disorder” in the sex addict. Feeling of depression, anxiety, boredom and emptiness are quickly alleviated by immersing oneself in an imaginary world that provides novelty, excitement, mystery and intense pleasure. Sex addiction is better than Prosac. It heals, it soothes, it contains, it provides a “safe place” free from the demands of actual performance, and it gives an illusory sense of belonging. The sense of empowerment in the illicit sex act rectifies “holes in the soul” and lifts the addict from feelings of inadequacy, insufficiency, depression and emptiness into a state of instant euphoria.

Relinquishing this very special (but delusional) mental and physical state can result in a sense of withdrawal which may include mood swings, inability to concentrate and irritability. These symptoms usually disappear in therapy as the sense of self is solidified and he finds more creative ways to deal with uncomfortable feelings.

· What are the effects of cybersex addiction on the relationship?

Effects of sex addiction on the sex addict’s partner can be numerous, encompassing a wide range of emotions and reactive behaviors. The sexual codependent’s experience is similar to, but not thoroughly identical to, a codependent person in a relationship with a substance abuser. A codependent partner of a drug addict or alcohol, for example, may manage to understand and even sympathize with her partner’s alcohol problem due to the lesser social condemnation.

But a compulsive addiction that involves engaging in sexual activities on the computer or outside of the home inflicts a psychic injury of ultimate betrayal. Sexuality goes to the heart of who we are.

Arguable, one purpose and outcome of cybersex is to detach and disconnect sexual experience from real relationships in life. Cybersex’s primary stimulus to autoerotic behavior produces profound disconnection of the sexual experience from relationship context and meaning. Compulsive viewing of pornography, for instance, in no way supports or fosters intimate, attachment-linked sexual gratification, anchored in emotional connection, intimate responsiveness and relationship fidelity.

Cybersex addiction reinforces a non-intimate, non-relational, and non-demanding sexual experience — a detached, disconnected physical arousal geared to the self-engrossed preoccupation typical of addictive sexual behavior. Cybersex entrenches emotional, psychological and spiritual/existential disconnection of sexuality from relationship context. Entrance into the “erotic haze” that encompasses the sex addict induces sexual arousal, climax and resolution without real relationship attentiveness, responsiveness, or commitment – the key dimensions of a loving attachment.

The behavior directly undermines trust in the couple’s relationship. Thus, the sexual dynamics depicted in cybersex are inherently detrimental and destructive to secure attachment that is essential to a sense of trust in the relationship.

It is also reasonably anticipated that a husband’s deception and lying – the existence of a “secret world” apart from the primary relationship is an overlapping, yet also separate detrimental influence upon relationship trust.

For some women, this lack of trust in their husband’s word – leads to uncertainty about the “substance” of the man they married, uncertainty about his true identity and a change in their perception of his identity – that of seeing him as fundamentally untrustworthy and of disreputable character. Thus, their internal model of their husband changes.

Others may feel that the husband is unable to fulfill marital expectations of emotional intimacy and companionship. They talk about not trusting that their husband would fulfill the role of being someone who could provide emotional support. They feel unable to turn to their husbands for this emotional support for different reasons: fearing she would trigger a relapse; feeling rejected because of his involvement in computer sex; sensing her husband’s inability to provide emotional support; being shamed by a husband’s angry or dismissive response from her attempts to reach out for support and companionship; or resolving that her husband was emotionally preoccupied with his own struggle with addiction.

The addict’s use of cybersex causes self doubt and lowered self esteem in the spouse. These women feel they aren’t pretty enough or skinny enough, or whatever. In any event, the feel that they are not what their husbands want. Some feel that if they were more sexually desirable, he wouldn’t have this problem. Sometimes, in a frantic effort to compete with unreal women on the internet or with prostitutes, they go to extremes with cosmetic surgery, breast implantation, excessive exercise – in the mistaken belief that if she can lure him back sexually and her husband would stop being interested in pornography and the marriage could be redeemed.

Some spouses feel that her husband’s use of internet pornography is a direct attack on her self-worth. They start doubting themselves. They doubt their self-worth. They start doubting the things that used to make them feel special and meaningful. Because if she had any meaning, why was he doing what he’s doing?

The wife is often stunned, confused, and in extreme pain upon discovery of the sexual/cybersex addiction. Anger and resentment can be overwhelming. For many partners, the addict’s betrayal can precipitate trauma that resembles post-traumatic stress disorder.

A wife can believe that sex is the most important way to express love, so her partner’s sexual acting out can leave her feeling deeply inadequate and unlovable.

Within the union, the partner’s low self-esteem can contribute to anxiety and fear of being abandoned. Often she will set aside her moral values and tolerates participating in sexual behaviors with her partner which are unacceptable or even repugnant to her. She feels too unworthy to have solid sexual boundaries. She mistakenly believes that she can stop his acting out if she satisfies his (insatiable and unrealistic) sexual needs.

A surprisingly common effect reported by many partners – after the shock of discovery -is the feeling of losing one’s mind. Obsessing about the details of the sex addict’s betrayal, repeatedly confronting her partner with “evidence” of infidelity and being told she’s “crazy” or “just jealous” results in a loss of focus and an inability to concentrate. Fear and anger aggravate the condition. Furthermore, there is an element of intense shame for both addict and sexual codependent attached to sexual addiction, especially if his interests involve an object, cross-dressing, dominance and submission or children. She isolates herself from friends, family and community due to her shame, which provides fertile ground for depression. In some situations, the partner is brought to a point of absolute despair.

Some maladaptive strategic responses the sexual codependent may engage in as a means of coping include excessive alcohol consumption, food binges, excessive house cleaning, and overtime career activity; acts that can serve as distractions from her distrust, pain and hostility. Distractions, of course, provide only a temporary and false “relief” and often create more problems than they solve.

When the partner’s anger and resentment are suppressed over a period of time, they eventually explode in a volcano of rage, blame, and furious criticism of the sex addict.

The explosion of frustrated emotions can open a door to enormous guilt and remorse, so the partner may forgive the addict’s offenses and not stand clear in setting boundaries for herself. The result is an unfortunate snare for the couple, in which the partner unwittingly enables the sex addict to carry on with his unacceptable pattern of sexual acting out.

The converse is true regarding the emotional influences on the wife. She may turn inward, withdraw, stay silent and distant. This can include withdrawing from any sexual activity with the addict. These stonewalling behaviors can ignite strong feelings of shame and rejection in the sex addict. In a way, the partner succeeds in punishing the sex addict through these behaviors. But the price of this punishment may be a return to his active addiction as a way to deal with conflict at home.

A tremendously debilitating effect on the partner is to assume all responsibility for the addict’s sexual acting out, and even for all of the problems in the relationship. The sex addict may exploit this to his advantage, perpetuating self-doubt within the partner.

For example, the partner may confront her spouse with evidence of a transgression, like a credit card charge to a hotel, but the sex addict is skillful and experienced in deception. He will boldly challenge the partner’s credibility, suggesting she see a “shrink” for being so paranoid and suspicious of him. He can persuasively feign righteous indignation, causing his partner to distrust her own instincts and perceptions, even in the face of tangible evidence.

The self doubt can plague the partner, aggravating her confusion and contributing to the feeling of “losing my mind”. Not wanting to continue to feel “crazy”, she may retreat into denial, the basic and most fundamental defense mechanism for both partner and addict. When in denial, she will believe the addict’s lies, however far-fetched they may be. She will accept the unacceptable. Whichever lies the sex addict offers to cover up his addiction, she is compelled to “not rock the boat” in order to assuage her abandonment fears.

· What are the characteristics of a sexual codependent?

Firstly, let’s consider what codependency is. Codependency is an overworked and overused word and definitions can be confusing. At core, it revolves around a deep fear of losing the approval and presence of the “other”. This underlying fear can result in manipulative behaviors that overfocus on maintaining another person’s presence and approval. Control, obsequiousness, anger, caretaking, and being over-responsible are among the behaviors that can be the manifestations of codependent behavior. Because of dysfunctional family-of-origin issues, codependents learn to react rather than respond to others, take responsibility for others, worry about others, and depend on others to make them feel useful or alive.

Codependence also refers to the way events from childhood unconsciously produces attitudes and behaviors that propel people into destructive relationships in the present. The self worth of the codependent comes from external sources. They need other people to give them feelings of self-worth. Codependence is a particular relationship with one’s self in which the person doesn’t trust his or her own experiences. Lacking the inner boundaries necessary to be aware of and express their true wants, feelings, goals and opinions, they are “other-validating”. Having only a reflected sense of self, they constantly seek affirmation and validation from other people because they are unable to endorse and validate from within. “Self-validating” people are able to do this. Co-dependents often focus on an addict’s sobriety as a way to achieve a precarious sense of self- consolidation. Sadly, their behavior often perpetuates the loved one’s addiction.

Codependent people believe they can’t survive without their partners and will do anything they can do to stay in the relationship, however painful. The fear of losing their partners and being abandoned (once again) overpowers her ability to make decisions in her own best interests. The thought of addressing the partner’s addiction can be terrifying: they may be frightened of igniting the partner’s anger which can result in feeling emotionally flooded by (childhood) fears of loss.

The sexual co-dependent suffers from additional symptoms: driven by the potential loss of the relationship, which she sees as identical with her very identity, some women engage in sexual activities with their partners that they find distasteful or even morally repugnant – all in an effort to keep him home and happy. However, this type of fantasy-based acting out may not be based on her real sexual needs and desires and opens the way to turning his partner into yet another object. Certain kinds of sexual acting out can turn sex into another fix for him. The partner senses this, making her sense of sexual betrayal even more poignant.

In couples where one partner is ciphering off his erotic energies from the primary relationship, there are invariably problems with the couple’s own sexual expressiveness. He becomes sexually demanding. She expresses her resentment about this by not being sexually responsive. He may lose erotic interest in her, as she never lives up to the thrill of fantasy-based sexual enactments. The sense of having a person-related, intimate sexual encounter may diminish. Erotic expression between the couple can easily dry up, leaving the sexual co-addict feeling even more diminished as a woman and as a person.

Sexual co-dependents have an inordinate need to get the information straight. “Detectiving” is a common activity: checking his computer, looking up names and numbers, or desperately looking for scraps of paper with numbers written on them. One client even invited a prostitute her spouse had frequented into her home because she wanted to know the details. The need-to-know provides the partner with a way to check up on her own reality (“Am I crazy or is this really happening?”) and provides her with a sense of much-needed (although illusory) sense of mastery over an out-of-control situation. Especially in light of the addict’s continual denial, the co-addict has a need to provide “evidence” to ensure her soundness of mind — a ploy that rarely works and is exceedingly exhausting.

The final distinction between sexual co-addicts and other co-dependents is the shame associated with this “secret”. Sex as an addiction is rarely discussed in “polite society” and there is a huge social stamina associated with it. Sexually addicted clients often tell me that they’d rather be alcoholics or drug addicts. The stigmatization of this compulsion almost ensures that the sexual co-dependent will want to hide or to provide a good “front” to deal with feelings of shame and despair. She may become socially isolated because she can’t discuss the situation with friends. Depression easily enters into an emotional environment of isolation and shame. Keeping secrets about important dimensions of life ensure that the issues underlying them will not be healed.

· What’s involved in therapy for someone who is the partner of a sex addict?

There is hope. The pain the sexual co-dependent experiences is normal. Learning a partner is sexually addicted can be devastating and debilitating. The betrayal triggers a myriad of strong emotions. Feelings of anguish, despair, rage, hopelessness and shame may overtake her. She may feel alone in unchartered territory, wondering “Where do I go from here?”

Psychotherapy is extremely important. Be sure to find a therapist conversant with these issues. What should happen in your therapy?

Treatment for sexual codependence can become a process of continued growth, self-realization and self-transformation. Working through feelings of victimization can lead to a new sense of resiliency. Going through this process can be an avenue to discovering meaning and to building stronger self-esteem. Challenges faced can elevate one to a higher level of well-being. A sense of serenity and peace from the appreciation of having worked through this process may occur.

Lessons not learned in the family-of-origin can be now be learned and worked through: appropriate self-esteem, setting functional boundaries, awareness of, acknowledgment of and expression of one’s personal reality without undo fear of retaliation, and taking better care of one’s adult needs and wants while allowing other adults to take care of theirs are all potential gains to be made in therapy and recovery.

Internal and external boundaries will be strengthened. Strong external boundaries will ensure that you will not again put yourself into a victim role. A sense of having internal boundaries will open up new avenues of healthy intimacy as you will know who you are and be able to hear who another is. At the heart of healthy intimacy is the ability to share your real self with another and be available when someone else shares his real self with you.

The sexual co-depenent may find she no longer needs to bend herself into a pretzel to accommodate others. Rejection or disapproval may be unpleasant, but not devastating. Compromising personal integrity in order to get external approval and validation will cease. With increased self-knowledge comes the ability to Self-validate while still being in a relationship. Self esteem will be generated by her behaviors rather than the approval or validation from others.

Finally, time and energy spent on preoccupation and control of the addict can be used to attend to emotional support for the children, to recommit to and obtain increased satisfaction from work, to meet new people, and to develop new recreational activities.

· How can I possibly forgive him?

Despite the fact that it may seem impossible, forgiveness is a critical part of recovery for the partner of a sex addict. To forgive is not to forget. Forgiving means being able to remember the past without experiencing the pain all over again. It is remembering — but attaching different feelings about the events, and it is a willingness to allow the pain to have decreased relevance over time. Understanding the pain, compulsion and despair that the sex addict has undergone from sexual compulsion can open avenues to compassion.

To forgive is important primarily for oneself, not for the person one forgives. The opposite of forgiveness is resentment. When we resent, we experience the pain and anger all over again. Serenity and resentment cannot coexist.

The process of forgiveness begins with acknowledging that a wrong has been done to you. You have to recognize that you have strong feelings about what happened and you need to feel and process those feelings. You are entitled to be angry or hurt. Ideally, you can share those feelings with the person who has hurt you in couples counseling. If that is not possible, then you can share the feelings with your therapist or support group. After that, you can choose whether to stay in a relationship with that person. In either case, forgiveness does not imply permission to continue hurtful behaviors. As part of your own treatment, you need to decide which behaviors you can accept in your relationships and which you cannot.

The primary goal of forgiveness is to heal yourself. In a partnership affected by sexual addiction, forgiveness is aided by evidence of the partner’s changed behavior and commitment to treatment. These are also elements in rebuilding trust. For many couples, forgiving and learning to trust again go hand in hand. Both take time, making amends, continued treatment and steady, continual, trustworthy behavior on the part of the addict.

After the acting out has stopped, it’s critical to not use his past behavior as a “hook” to punish or manipulate him. When a desire for revenge exists, you have not forgiven, and you see him in one dimension (“Bastard”). The capacity to see him as a whole person (he’s not just a sex addict, he’s many things) will help you move forward. Couples therapy will help you move toward a sense of him as a multidimensional person with on-going issues.

· I’m incredibly frustrated that he/she won’t tell the truth. Even when I present “evidence”, he denies his sexual acting out. How can I ever trust a man who so blatantly lies to me?

Sex addiction thrives in secrecy. Addicts will go to any length to protect their double life. Denial, (“Don’t Even Know I’m Lying”) plays a huge part in any addiction process. The reality of the acting out is protected from the conscious mind. If the addict is unaware of the truth, how can he tell you?

The very thinking process of the addict becomes impaired as he becomes immersed in the denial process, giving way to the minimization of the extent of his behavior. This connects with “rationalization”: i.e. “I’m not really cheating” – “All guys do this” – “I’m not hurting anyone” – “I work hard so I deserve some pleasure.” This combination of denial, minimization and rationalization makes it extremely difficult for him to know the truth.

More complexing is the phenomenon of “dissociation”, or “The Dr. Jekyll and Mr. Hyde” syndrome. Dissociation is a clinical process that characterizes multiple personality disorder. While I’m not saying the sex addicts have MPD, I am suggesting that some of the same characteristics of that disorder are shared. One side of the personality protects the other side from the truth. Some level of dissociation is in every man who has a “double life”. Each side of the personality has different values, goals, beliefs and needs that conflict with the other side.

This is why, when the sexual acting out is finished, the addict feels so distressed and shameful. Mr. Hyde does the acting out and Dr. Jekyll experiences the remorse.

When the addict is acting out, he has feelings of being disconnected from himself and his environment. Clients speak of “the bubble”, the “erotic haze”, “zoning out”, and “feeling apart from myself and watching myself from afar “, of feeling “foggy” or “not feeling like a real person” Losing track of time is common as is feeling outside oneself as both an observer and a participant. Emotions are numbed; the fantasy creates an alternate reality which obscures the truth of “what is”.

Once in therapy, a primary issue that arises is a feeling of a fragmented sense of self or being unsure of his identity. Therapy will help him get to the bottom of hidden parts of himself that he may not have fully understood or been able to control until treatment starts to work. Only by getting in touch with hidden parts of himself will the full realization of his talents and strengths be realized and fulfillment in his personal relationships can begin to unfold.

· I don’t see how our relationship can survive the emotional pain and chaos of his sexual addiction. Have other couples been able to work through these issues? How have they done it?

When at least one member of a couple is sexually addicted, restoring trust and building intimacy can be very difficult. These couples must work as hard on their recovery together as a couple as they do on their individual recoveries.

One of the great challenges to recovery from sexual compulsivity is restoring or building an intimate relationship with a committed partner. Many existing relationships are seriously impaired and often don’t survive because of sexual acting out. The partner of the sex addict’s ability to trust is obviously damaged. The psychodynamic and behavioral issues underlying sexual addiction contribute to obstacles to overcoming and building intimate and committed relationships.

The good news is that we have seen from our experience that not only is it possible to repair, rebuild, or newly build a committed relationship, but the level of emotional and physical intimacy that comes from working on these issues together is sustaining, gratifying and growth-producing for each member of the couple.

· How can couples counseling help us?

Most couples who come for couples therapy after discovery are in a high state of reactivity, with communication being limited to blame/defense. There is a high degree of projection (seeing the things you like least about yourself in your partner) and a small degree of self-focus. The tendency is to react immediately and emotionally, with no time given for reflective thinking. One task of the therapist is to create a safe, non-volatile space by gradually guiding each person to commit to self-focus which reduces blame and defense.

The therapist will do some psychoeducational pieces on sex addiction and co-addiction to normalize each person’s feelings and further reduce blame. Nothing can be done about the quality of the marriage unless each person commits to a personal program of recovery: an “S” meeting for the addict, and COSA or S-Anon for the co-addict. The couple can come out of the shadow of shame about living with sex addiction through identifying with others who have gone through similar experiences. Here, finally, they find people they can talk to about what they’ve been hiding from family and friends. Regular attendance at meetings gives structure and accountability to the life of the sex addict. A co-addict who works on the steps with a trusted sponsor is renewing her commitment to focus on herself and her own issues, renouncing her focus and pre-occupation with the addict.

Sex addicts and sexual codependents usually have never experienced healthy bonding with and nurturing from their parents. This impairs their ability to have successful bonding and separation in subsequent relationships in adult life. The therapist might construct a “genogram” which is a graphic depiction of three generations of each person’s family. It shows psychiatric and physical problems throughout the generations such as alcoholism, divorce, hospitalizations,etc. The genogram also reveals the quality of family relationships, indicating where there was enmeshment and where there was distancing. With a clear understanding of family-of-origin issues, the couple can understand themselves and each other and develop awareness of what triggers are coming from the past.

Couples counseling enables the couple to reach a point of mutual interdependence in which both partners have lives outside of the relationship, but also feel committed to it. The partners need each other, but are comfortable with independent lives of their own. Over time, each develops a new sense of “Self”-in relationship.

Both members of the relationship are encouraged to accept mutual responsibility for the dysfunction in the relationship. As long as one partner is blaming the other for all of their couple problems, progress will be slow. Recounting the history of the relationship will be a part of this process. How have each other’s addictions and co-addictions affected the relationship? What consequences have been experienced? What strategies have the partners tried to heal themselves that haven’t worked? What are the repetitive arguments and fights? What is the nature of the collective shame in the relationship? How does each partner trigger the other’s issues?

Each individual in the couple learns how to exchange instant gratification for the joy of ongoing intimacy. Sexual addict/codependents find that this intimacy and the trust, mutual understanding, and the emotional/spiritual/physical closeness it creates from having done the work can be qualities that few couples ever experience.