As if I didn’t spend enough time on facebook, there’s now a social networking and support site for people in recovery. In The Rooms is only a few months old, but it’s quickly gaining popularity among men and women in recovery from drugs, alcohol, food, gambling, and sex addiction. If you’re in recovery, check it out.
For my book, America Anonymous, I sat down a week after Christmas with a handful of women who were part of an online support group for compulsive shoplifters. The news was not good. Two had relapsed over the Holidays—one had stolen a pair of kids’ earrings from Target, and another had swiped a calendar from a kiosk at the mall. They all said that Christmas is the hardest time of the year.
“I was in a bad mood, and it’s never a good idea for me to shop when I’m in a bad mood,” said Kate, a stay-at-home mom in her thirties who shoplifted the earrings. “I was resentful that I had to be doing the shopping in the first place. I resent that women always have to be the shoppers! If it’s Christmastime or someone’s birthday, does the guy go in the car and buy the last-second card? No, he gets his girlfriend, wife, or mother to do it. Obviously that doesn’t excuse my shoplifting, but that was the mood I was in.”
The woman at the table with the longest period of “sobriety” from shoplifting was Joan, a veterinarian in her forties who hadn’t stolen anything in three years. She credits her success to one pragmatic decision: she mostly stays out of stores. “Online shopping is my savior,” she said.
Over the course of our lunch, the women alternated between referring to their shoplifting as a problem, a moral failing, and an addiction. One young woman named Sarah—who, ironically, had been in recovery from shoplifting the shortest time—seemed the most comfortable calling it a true addiction, probably because of her experience in AA.
“This is an addiction unlike any other,” she told the group several times, although the others didn’t seem convinced.
“I don’t know,” Kate said. “I guess I sort of see it as an addiction, but mostly I still feel like it’s a bad behavior. But it’s crazy what I’m willing to risk. When I shoplift I’m risking my family. I’m risking my friends finding out. I’m risking going to jail. And I still do it.” (Kate has been arrested three times for shoplifting and has been caught and let go another eight, usually after a reprimand and an order never to come back.)
“That’s addiction,” Sarah said. “That has to be addiction.”
Joan chimed in. “There’s definitely still a feeling that I have that it’s a moral wrong.”
“I was never really comfortable calling it an addiction until I read some books about it,” Linda told us. “I mean, I am powerless over it, so in that way it feels like an addiction.”
But no one at the table seemed comfortable calling themselves a shoplifting addict. “That has such a bad connotation,” Sarah said. “I don’t mind saying I’m an alcoholic and an addict, but I don’t think I would be as comfortable saying I’m a shoplifting addict.”
Across the table, Joan nodded in agreement. “I think it’s probably true that I’m a shoplifting addict,” she told us, “but I would never call myself that in front of other people. They would probably think I was offering up an excuse for my behavior, instead of taking responsibility for the fact that it’s wrong. I don’t think that way about alcoholics, but I do think that about shoplifters. It’s amazing how hard I am on myself.”
Here is what we know about shoplifting, which costs retailers about $13 billion a year to shoplifters (and an additional $19 million to retail theft): Some shoplifters are professional thieves or drug addicts who sell the stolen goods for money. Others are thrill-seekers or occasional shoplifters who usually grow out of it or quit for good if they’re caught. But many are compulsive and longtime shoplifters who can’t seem to help themselves. About two-thirds of this group are women, says Terry Shulman, the founder of Kate’s online recovery community and the author of the book Something for Nothing: Shoplifting Addiction and Recovery. While some balk at calling the latter group addicts, Shulman argues that some shoplifters fit the criteria for addiction.
“An addiction is something a person has difficulty stopping on his or her own, one where there’s an escalation of the out-of-control behavior, and where there are feelings of withdrawal or preoccupation when not engaging in it,” he says. “That fits drug addicts, and it fits thousands of shoplifting addicts I’ve talked to.”
But as with other behavioral compulsions, there are powerful forces lobbying against understanding shoplifting as a true addiction. Retailers, for one, don’t want people who steal from their stores to be thought of as addicts who are powerless over their actions. And judges have little patience for shoplifters who cry addiction. In one case, Shulman testified for a woman who was caught shoplifting shortly after suffering a miscarriage. The judge became apoplectic at the suggestion that the woman was suffering from an addictive compulsion. “My wife had four miscarriages, and she doesn’t go and shoplift!’” the judge fumed, according to Shulman. “And it’s because of people like you that the shirt on my back costs so much!’”
Jon Grant, a shoplifting and gambling researcher at the University of Minnesota, studies the judicial system’s ambivalence regarding addiction. “With all addictions,” he told me, “a person’s free will is greatly impaired, but the law doesn’t want to entertain that. I find that fascinating. The law entertains it with other mental illnesses, but it draws the line at addiction. I always hear, ‘Aren’t you just trying to excuse bad behavior?’ That knee-jerk reaction really goes to show that addiction is still not seen as a real or serious illness. Why shouldn’t someone’s addiction be considered as a mitigating factor, especially in sentencing?”
There’s a good piece today in The New York Times about what may be included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, considered the Bible of the mental health field.
“The process has become such a contentious social and scientific exercise that for the first time the book’s publisher, the American Psychiatric Association, has required its contributors to sign a nondisclosure agreement,” Benedict Carey writes in The Times. “The debate is particularly intense because the manual is both a medical guidebook and a cultural institution. It helps doctors make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment.”
Due out in 2012, the DSM-V will be critical to framing our understanding of addiction. Will behaviors like compulsive overeating and sexual addiction be included? In my book, America Anonymous, I write about the battle to get sex addiction into the DSM:
Nowhere in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, published in 1994) is there a diagnostic criteria for sexual addiction or sexual compulsion.
There is “no scientific data to support a concept of sexual behavior that can be considered addictive,” Chester Schmidt, chair of the DSM-IV Sexual Disorder Work Group, wrote at the time. Schmidt told me that what is called sex addiction is more likely a symptom of other psychological problems like depression, obsessive-compulsive disorder, or bipolar disorder.
But believers in a sex-addiction diagnosis point out that for many years, doctors and psychiatrists similarly dismissed alcoholism, refusing to accept that it was a serious problem in itself, not merely a symptom of something else. The psychoanalytic view of addiction in the first half of the 20th century was that “alcoholic drinking and addictive drug use were not primary disease entities, but symptoms of neurotic conflict or underlying psychosis, or manifestations of a disordered personality,” William White writes in Slaying the Dragon. Treat the underlying psychosis, the theory went, and the addiction will go away.
Psychoanalysts at the time linked alcoholism to a plethora of psychological problems, including “primary maternal identification,” “fear of castration,” and “latent homosexuality.” “Every drinking-bout is tinged with homosexuality,” announced one psychoanalyst. Remarkably, this belief had currency into the second half of the 20th century.
According to Harry Tiebout, one of the first psychiatrists to see addiction as an illness in its own right, the biggest problem with relying on psychoanalysis alone was that the patient rarely stopped drinking long enough for any of the deeper therapeutic work to happen. “In rather doctrinaire fashion,” he once wrote, “we persisted in treating the alcoholism as a symptom which would be cured or arrested if its causes could be favorably altered. The drinking was something to be put up with as best as one could while more fundamental matters were being studied. The result of this procedure was that very few alcoholics were helped.”
As William White put it, Tiebout believed that alcoholism was “a symptom that had itself become a life-threatening, primary illness.” Most believers in a sex-addiction diagnosis now believe the same thing about compulsive sexuality. Fueled by an unwavering belief in their cause, and confident that large-scale studies of sex addicts—including brain scans—will prove that sex addiction is real, they hope to get some version of the disorder into the DSM-V.
To do that, they know they’ll need to convince both the psychiatric community and the general public that sex addiction is more than just a metaphor, a pop-psychology diagnosis, or an attempt to explain away recklessness and perversion.
Advances in neuroscience may help in that endeavor. Five or ten years ago, Dr. Peter Martin, a psychiatrist and the director of the Division of Addiction Medicine at Vanderbilt, would have dismissed any comparison between sexual compulsivity and alcoholism or drug addiction. Drugs and alcohol are foreign substances. Sex is natural—a basic biological drive critical to our survival as a species. Clearly, Martin thought, a case of apples and oranges.
But using MRI technology, Martin began studying how people’s brains react to sexually arousing images. What he found has radically changed his perspective on addictions. Now he believes that “there are many behaviors, including sex, that appear to be driven by the same brain mechanisms that drive addictions to drugs like cocaine and heroin.” University of Pennsylvania psychologist Anna Rose Childress agrees, telling the journal Science that sex addicts resemble cocaine addicts and probably share a problem with brain “inhibitory circuitry.”
Still, the science of sex addiction is in its infancy, and those hoping to further study the brains of sex addicts struggle to get the funding they need. “People don’t exactly throw money at you when you say you want to study sex addiction,” says addiction researcher Patrick Carnes. “And in the end, getting sex addiction in the DSM is not going to just be about science and empirical evidence. The concept of sex addiction makes so many people uncomfortable, so it’s really going to take a public relations and education effort to get it seen as a serious disorder. Because if we as a culture really accept the idea of sex addiction, then we’re going to have to look at a lot of things we don’t want to. We’ll have to talk openly about what constitutes healthy sexuality, which will invariably bring morality and religion into play. We’ll have to look at gender roles, at how we treat women, at childhood sexual abuse and trauma, at how we use sex and relationships to make ourselves feel worthy and lovable, and at the way anonymous sex has been normalized in gay culture. Sex addiction really has something to offend everyone.”
Among the most offended are some sexologists who see sex addiction as a moralistic construct that portrays human sexuality as something dirty and shameful. Some addiction-treatment professionals, meanwhile, worry that equating sex addiction and drug addiction will detract from their efforts to have alcoholism and drug addiction fully accepted as diseases. And some feminists and victims-rights advocates worry that an official sex-addiction disorder could be used by sex offenders or philandering men to claim that they didn’t have control over their actions.
It’s unclear if a “sex addiction made me do it” defense has ever actually worked, except on an episode of ABC’s “Boston Legal.” There, Shelley Long played a self-described nymphomaniac who compulsively hired male escorts, got arrested, claimed to be powerless over her thundering libido, flirted shamelessly with the judge, and got off (so to speak).
According to the 2008 Monitoring the Future report released this week, seven out of the ten top drugs being abused by high-school seniors are legal prescription or over-the-counter medications. While the number of young people who abuse illegal drugs continues to decline, it’s clear that they’ve simply switched to drugs that are easier to get, won’t land them in jail, and give them nearly as powerful a high.
The report found that 15.4 percent of 12th-grade students reported nonmedical use of legal medications, including 11 percent who misused Vicodin and 4.7 percent who misused Oxycontin. Prescription amphetamines, sedatives, tranquilizers, and the attention-deficit hyperactivity disorder medication Ritalin also were among the most popular drugs of abuse among high-school seniors, along with over-the-counter cough medications.
And it’s not only young people who’ve made the switch. In my book, America Anonymous, a heroin addict in his 30s from South Boston told me, “People are getting addicted to FDA-approved drugs more than illegal drugs now. With pharmaceuticals, you know what’s in them, and you know you’re going to get a great high. Look at Anna Nicole Smith. She could have had any drugs she wanted, but what was her choice? Methadone and benzos.”
1) Barack Obama, who has struggled to quit smoking and was often seen chewing Nicorette gum on the campaign trail, pledges to abide by the White House’s smoking ban.
2) Study finds that in 2006, more than 1.7 million emergency room visits were associated with some form of substance misuse or abuse.
3) Former Rep. Jim Ramstad (R-Minn.), a recovering alcoholic and recovery advocate who has devoted much of his career to fighting for greater access to addiction treatment and is rumored to be on Barack Obama’s shortlist for Drug Czar, is encountering resistance for his past opposition to needle-exchange programs and medical marijuana.
4) Shopping addict steals $100,000 from employer.
5) Check out this great New York Times piece by Jim Atkinson about being a recovering alcoholic and surviving the holidays.
In my Advocate cover story about the Massachusetts congressman, Barney Frank talks about his boyfriend, gay weathermen, Prop. 8, Barack Obama, why he’s so grumpy, why he doesn’t use email, why he shouldn’t be blamed for the subprime mortgage crisis, and why marijuana-decriminalization advocates aren’t better organized (“They’re all off smoking dope!”).
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