I graduated high school at age 18 and went to college. When I graduated from school, I also graduated from the sports teams and all the friends I was so accustomed to. Isolation got very bad.

That year I started dating a girl. I drank with her from the beginning and found that I could do anything she or I wanted to do sexually if I was under the influence. I didn't even like her much, but the sex made me feel grown up and masculine. These were new feelings that I was searching for.

I found that in college, homework was not assigned every night and classes met only two or three times per week. It was possible to pull all-night study sessions before exams. I did not get involved in any college sports or activities. Drinking started to occur during the week days. Getting served alcohol was easier now also. I found a place in nearby New Jersey that did not ID people. It wasn't that far away from the conservative liquor control state of Pennsylvania. And after all, even if it was a long trip, I was willing to go to any length.

My anxiety got worse at this time. I constantly felt anxious. I had no male friends to play sports or identify with. Guys in college all seemed to be busy with their own life. The school I went to was about 75% female and it seemed that none of them wanted to associate with me either. I became nervous when I was not drinking. I drank more to feel calm. Little did I know that booze was causing a great deal of my anxiety. I felt very uncomfortable on the day after a heavy load. Feeling this "uneasiness" around others caused me to drink again the next day.

I felt like I was on the outside looking in for a good part of my life. The lack of enough alcohol and drugs made that feeling worse. I tried to drink more to make me feel good again only to have the problems seem much worse the next day.

I crashed my car into a telephone pole on one of my many reckless drunken driving sprees. This was my first real trouble with alcohol. I was lucky the police did not or could not charge me due to technicalities. Although I broke my right hand, I was sure to drink again within a few days. I needed alcohol to feel what I was thinking. I drank to feel happy, to feel sad, to feel depressed, and to feel angry. Alcohol had become my emotions.

next: Chapter 3: Alcohol Conquers the Mind
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Online auction sites: addictive or just great shopping?

As online auction stocks boom and bidders' tales of great buys find their way to cocktail parties, some psychologists worry that online auctions may be addictive. For most users, auction sites are simply a place to find collectibles or rare and unusual items at a good price. But for a few, they evoke a high that can lead to financial and psychological despair.

On a good day, day of bidding, New Yorker Ian Carmichael snagged a $1,200 Harmon Kardon amplifier for just $349. On a bad day, shipping charges for sought-after computer network cards actually exceeded the cost of the cards themselves.

Carmichael, a computer technician for a multimedia company, claims he's an online auction addict, but more likely he's just a computer-savvy buyer who spends too much time online. Inspired by an article last year in Wired, the hip digital culture magazine, Carmichael started bidding and hasn't stopped. His habit may be a bit excessive -- Carmichael shops four hours a day -- but he limits his bidding to deals on electronics.

What makes an addict?

So what would push Carmichael, or any other auction-goer, over the edge to addict status?

Most psychologists agree that to be labeled an addict, one must experience a specific set of behavioral problems. In "Internet addiction: Does it really exist?" a chapter of the 1998 book "Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Implications" (edited by Jayne Gachenbach; Academic Press), Mark Griffiths, a psychologist at England's Nottingham Trent University, recognizes the six "core components of addiction":

• the addictive activity becomes the most important part of the addict's life - the experience of a "high"
• the need for increasing amounts of the particular activity to achieve the same euphoric effect
• the tendency to revert to extreme behavior even after years of abstinence
• withdrawal symptoms such as irritability and
• conflict (with others, other activities -- such as one's job -- or within oneself).

But whether online auctions, or online use, can be labeled an addiction is no simple matter.

"My colleagues are divided," says Maressa Hecht Orzack, a psychologist who in 1996 founded the Computer Addiction Service at McLean Hospital in Belmont, Mass. At McLean, the psychiatric unit for Massachusetts General Hospital and a teaching facility for Harvard University, Orzack treats patients for online addiction. One of those patients, snared by the web of online auctions, is, she says, in "fairly bad shape" and has run up "a phenomenal debt." "This man I'm treating doesn't eat regular meals," she says. In fact, she adds, he goes online not only to buy goods, but to try to resell those for which he is now in debt. So, while he ought to get off-line, he's staying online all night. Such behavior certainly sounds like an addiction, but some experts are hesitant to give it an official label.

"Some people say that it's an impulse-control disorder [like gambling] ... Other people say it's a symptom," Orzack says. "I don't care what it is ... something happens to these people and they have to be treated."

Others are more cautious about throwing around any specific terminology. "I prefer to think of it as a symptom of some other psychological difficulty," says John Suler, professor of psychology at Rider University in Lawrenceville, N.J., and a practicing psychotherapist and cyber-psychology researcher.

Putting the current debate aside, the notion of Internet addiction can be traced to the 1980s. Yet an addiction to online auctions is truly a late-'90s phenomenon. Some tie it to the recent surge of Web-based auction companies on the stock market.

Like an eating disorder

Orzack, who is approaching her 19th year at McLean, treats online auction addiction as if it were an eating disorder: She sets up strict schedules of reasonable computer use for her patients. Her therapy is based on the idea that one's thoughts determine one's feelings. "I'll ask people, 'What is it that you think before you hit the computer ... what are your thoughts?' "

Like Suler, she finds that overuse of the Internet can often be traced to other psychological problems, including depression and loneliness, and low self-esteem.

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Computers are now so much a part of everyday life that it's easy to understand how people could become addicted. "You can't in this day and age ask anyone to not work on the computer," says Orzack. "There are an enormous number of reasons why computers are great and why they offer up opportunities to people."

But there are those who go overboard with computer use -- and with use of online auctions. Kimberly Young, an assistant professor of psychology at the University of Pittsburgh at Bradford, and the founder of the Center for Online Addiction, claims that online auction addiction most closely resembles pathological gambling. The auction method satisfies the addict's need for control and provides "immediate gratification." The high of bidding brings the addict back, and the cycle repeats itself. "It's the excitement of winning the prize. People want the rush," Young says.

Young says she receives 12-15 calls a week from addicts looking for information or help, and her center's Web site thoroughly explores all the symptoms and warning signs (compulsively checking e-mail and always anticipating going online, for example) and also offers self-diagnostic tests.

Not yet official

In the mainstream psychological community, Internet addiction, or its subset, online auction addiction, is not yet recognized by the field's authoritative handbook, the "DSM-IV" ("Diagnostic and Statistical Manual of Mental Disorders"). "How is it [online use] different from television or radio?" asks Dr. Clark Sugg, a psychiatrist at the William Alanson White Institute, a psychoanalytic institute in Manhattan. The Net may be very compelling but "I haven't had a lot of patients coming to the institute claiming they're addicted."

Sugg suggests that cyber-psychologists like Young may be trying to carve out a niche for themselves. "It's a way of making a name for yourself in a field that's overpopulated," he says.

For now, Young appears to be the only psychologist specifically offering Internet addicts online help, either through private chat rooms or e-mail. Others, like Orzack, insist that the treatment of online addiction take place off-line, in a traditional, face-to-face therapy setting. As Orzack puts it, "I'm licensed in Massachusetts, not cyberspace."

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next: Are You a Compulsive Online Gambler?
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Now we are going to talk about compulsions, or rituals. We've already explained how rituals tend to persist because they provide temporary relief from your obsessions. But the solution can be as bad as the problem. Rituals can begin to take more and more of your time, and eventually dominate your life.

Ultimately, getting rid of your OCD symptoms means giving up the rituals. For now we propose that you temporarily delay the goal of ridding yourself completely of the compulsions, so that you can focus your efforts on specific, smaller modifications. Little changes. Reachable goals, to prepare yourself for successful resistance in the future.

In this section, we will describe four techniques you can use to start to prepare yourself to give up the rituals. The fifth self-help technique we will present will help you stop ritualizing altogether.

The first four self-help practices can be applied while you work on letting go of your obsessions. Or, if you'd prefer, you can first work on your obsessions and then start changing your compulsions.

Now let's look specifically at the techniques. This material is also covered in Chapter 6 of the self-help book Stop Obsessing!.

There are no rules as to which you should try first or which will work better for certain rituals. However, when you chose one technique, give it enough opportunity to work for you. Don't simply dismiss a method because it isn't helpful the first few times.

We know just how much courage it takes to challenge your obsessions and compulsions. These symptoms can be powerful, and a tentative commitment for change will not be enough. Winning the battle requires that you be persistent in following a new plan of action. Again and again, people with OCD have proven that they can improve their lives dramatically by actively following through on their decision to give up their obsessions and compulsions. You too can join them by searching inside for strength and determination.

There's no need for you to tackle your problem alone. If you are hesitant to begin the program, or if you start losing your momentum after a few weeks, then seek the help of a trained mental health professional, find out if there is a local support group for OCD, or ask a friend to help you implement the self-help program.

Best of luck in your commitment.

Stopping Your Obsessions Self-Help

• Self-Help Practice 1
• Self-Help Practice 2
• Self-Help Practice 3
• Self-Help Practice 4
• Self-Help Practice 5

Self-Help Practice 1: Postpone Ritualizing to a Specific Later Time

We have already discussed how to postpone your obsessions. Many of the same principles apply to compulsions as well.

Postpone Your Ritual

1. Mentally agree to pay attention to your ritual.
2. Choose a specific time in the future when you will return to it.
3. As that time arrives, either start ritualizing or consider postponing the ritual to another specific time. Whenever possible, choose to postpone.

If you have more than one ritual, select one you think might be the easiest to postpone. Then the next time you feel compelled to ritualize, delay it for a specified length of time. This is a mental ploy that will help you resist the ritual successfully because it requires resistance for only a short period of time. How long you postpone the ritualizing is a judgment you make based on what you think you can accomplish. Sometimes waiting thirty seconds is all you can tolerate. Other times, postponing for half a day is possible.

But please remember: that urge is just going to grab you. It's going to hit you instantly, and all you will be able to think about is ritualizing.

You've got to drive a wedge between your urge and your action. Even stopping for thirty seconds is a worthwhile effort. Thirty seconds! It's not that long! Really focus on getting any length of time to pass before you impulsively ritualize.

This practice will help in two ways. First, you will begin to tolerate longer periods of distress instead of instantly reducing the discomfort through ritualizing. Second, successful postponement will enhance your sense of control.

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Like anxiety and distress, urges to ritualize decrease on their own over time, as long as you don't act on those urges. If you succeed in postponing the compulsive actions for several hours, you might discover that you no longer feel so compelled to engage in them when your selected time to ritualize arrives. Through this experience, you begin to believe that there may be other ways besides ritualizing to reduce your distress. Letting time pass and becoming distracted by other thoughts and feelings can decrease the urge to ritualize. As time goes by and your urge to ritualize diminishes, you will gain a sense of perspective, and with that perspective comes a greater sense of self-control.

If you postponed ritualizing from, say, 8:00 A.M. to 10:00 A.M. and you still experience the urge, try to postpone it again. Say to yourself, "I'll wait until noon and see how I'm doing then." If you can continue postponing, your urge will eventually fade away. If you cannot postpone again, apply one of the following two practices: either think and act in slow motion during the ritual, or change some other aspect of your ritual. We'll talk about these choices next.

Self-Help Practice 2: Think and Act in Slow Motion During the Ritual

Another way to change your ritual pattern is to purposely slow down the thinking and physical movements that occur during the ritual itself.

Perform the Ritual in Slow Motion

1. Select one ritual (typically a checking behavior)
2. Slow down your thinking and physical movements during the ritual
3. Pause at several points to take a calming breath and let go of tensions
4. When ready, let go of the ritual completely and tolerate the distress that follows

There are two major benefits to this practice. First, when you are distressed you often feel tense, pressured, and rushed. By slowing down your thoughts and actions, you decrease the intensity that accompanies the ritualizing. Without that intensity, the ritual may not be as compelling and consequently will lose some of its power.

The second significant benefit of slowing down during a ritual is that you will remember more of the details of your action. Have you noticed times, just after you've completed a ritual, when you can't quite remember how well you ritualized or if you ritualized enough? You feel safe momentarily but seconds later start doubting whether you carried out your ritual adequately. This probably led you into another round of rituals. As you physically and mentally slow down, you can better remember the details of your actions. Since this technique provides you with a stronger memory of your actions, it will reduce your doubts.

Slow-motion practice can be used with many behavioral rituals. It is especially effective with checking rituals since it seems to reduce this doubt about your actions. For instance, if you wish to practice slow-motion checking of a door, approach the door slowly, pause a few moments to take a Calming Breath while you casually study the lock. As your hand reaches the lock, notice the sensation of the metal on your fingers. If it is a dead bolt lock, then turn it ever-so-slowly. Listen for the "click" as the bolt drops into place. As soon as you hear it, pause for a moment. Hold your hand in place for fifteen more seconds while asking yourself, "Is this door locked?" When you respond, "Yes," drop your arm slowly and then slowly walk away.

When you practice this slow-motion procedure, be sure to incorporate either the Calming Breath or Calming Counts. By interspersing them several times throughout the practice, you can help keep your physical tension at a minimum. This, in turn, will help your concentration and your memory. Listen to the tape entitled "Practicing the Breathing Skills" to remind yourself of these brief relaxation techniques.

Self-Help Practice 3: Change Some Aspect of Your Ritual

When choosing this practice, you decide to change any of a variety of characteristics within your compulsive pattern. To do so, you first need to analyze the specific manner in which you ritualize.

Change Some Aspect of the Ritual

1. Select one ritual
2. List all its characteristics (specific actions, order, repetitions, physical stance, etc.)
3. Begin altering some elements of your ritual
4. Practice those changes regularly over the next few days
5. Every three or four days, modify the ritual pattern again
6. When ready, let go of the ritual completely and tolerate the distress that follows

Choose one ritual and analyze its characteristics. Take a pencil and paper and jot down all the specific details you can think of. Describe your exact motions and thoughts, in the order they occur. After you've done this then go back and consider the following characteristics. List the particulars of your ritual based on each of these categories:

• your specific actions
• specific thoughts you have
• the order of the action
• the number of repetitions needed, if any
• the particular objects you use
• how you stand or sit during the ritual
• how you're feeling, and
• any triggering thoughts or events.

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Look over your list. Just look at how many different opportunities you have to make a small change in your ritual. Each item you listed offers another opportunity. Begin altering some elements of your rituals, and practice those changes regularly over the next few days. This process will be the beginning of bringing this seemingly involuntary behavior under your voluntary control - not by totally stopping the ritual but by consciously manipulating it.

Here are some examples:

Change the order in which you ritualize. For instance, if when you shower you start by washing your feet and methodically working your way up to your head, reverse your order by beginning with your head and working your way down.

Change the frequency. If counting is part of your ritual, alter the numbers and the repetitions you require to complete the ritual. If you always do ten sets of four counts, do twelve sets of three counts. If you must put three and only three packs of sugar into your coffee cup, the put two half packs in and throw the rest away.

Change the objects you use. If you wash with a particular soap, change brands. If you tap your finger in repetitions on your calculator, tap the table just next to the calculator instead.

Change where or how you ritualize. If you have to dress and undress repeatedly, do each set in a different room. Change your posture during the ritual. If you always stand while ritualizing, then sit. If you always have your eyes open, then try your compulsion with your eyes closed.

These are just a few examples. For each component of your ritual, there are as many ways to modify it. Be creative in your ideas for small changes.

There are three benefits to this practice.

First, as is true for the other two practices in the section, you will be able to alter your compulsions without the great difficulty involved in trying to stop them altogether.

Second, by changing important aspects of the ritualistic pattern, you are likely to break the powerful hold of the rituals. You might find out, for instance, that the ritual brings temporary relief even when not performed perfectly. Hence, you introduce flexibility into the pattern. This disruption in the ritual is the beginning of its destruction.

Third, this practice enhances your conscious awareness of when and how you perform your rituals. When you are ready to completely give up ritualizing, this awareness will enable you to recognize the first signs of your urge to ritualize and to stop yourself just before you automatically begin to do so.

Here's an example of how one person applies this technique. We'll call her Ruth. Ruth was a twenty-four-year-old housewife who repeated actions in order to circumvent bad luck. Her rituals were pervasive, involving almost all daily activity. There was hardly a time that she didn't ritualize or worry that she wasn't ritualizing. For example, when cleaning countertops or washing dishes, Ruth became stuck squeezing the sponge in several sets of ten.

In her practice of changing the ritual, she continued squeezing the sponge, but now with each squeeze she passed the sponge from one hand to the other. This change caused considerable distress for Ruth, since she feared that the new routine would fail to protect herself and her loved ones. Nevertheless, she was determined to implement the change. After two weeks, instead of squeezing the sponge, Ruth started a new routine on her own. Now she simply tossed the sponge in the air from one hand to the other ten times. Soon thereafter she was able to resist the urge to squeeze altogether and could clean the counter in a normal manner.

You can see that this practice requires that you create new habits. These new actions are incompatible with your tendency to keep your original rituals unchanged. It is impossible to keep rigid rituals and at the same time continue to change them. This is why it is important to implement this practice. Changing your rituals is a big step toward giving them up entirely.

Self-Help Practice 4: Add a Consequence to Your Ritual

Sometime you will find that you have just performed your ritual without any conscious expectation. In those situations it is impossible for you to postpone or change the ritual, because it's already done! In other times, you know you are about to ritualize, but you feel helpless to postpone or change the pattern.

In these situations, one simple change that can greatly increase your awareness is to add a consequence every time you ritualize.

Add a Consequence to Your Ritual

1. Select one ritual that has been difficult to interrupt through postponing or modifying.
2. Commit yourself to performing a specific consequence after each time you ritualize
3. Select a consequence (put $1 in a jar, walk 30 minutes after work, call a support person, etc.)
4. As your awareness increases prior to the ritual, practice postponing or changing some aspect of the ritual
5. When ready, let go of the ritual completely and tolerate the distress that follows

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With this practice, you need not change how or when you ritualize. But each time you do ritualize, you must then perform some additional task. Choose a task totally unrelated to any of your compulsive tendencies and also something that requires you to disrupt your normal routine. Decide to drive to a park and pick up trash for an hour, do some kind gesture for someone you are angry with, practice the piano for forty-five minutes, or hand-copy ten poems from book. Ideally, the consequence you choose will also be one that has some redeeming value. One we use often is exercise - such as taking a brisk walk for thirty minutes.

If these sound like disruptive, time-consuming tasks it's because they are supposed to be! But don't consider them as punishment; they are simply consequences you have added to your ritual. To be effective, the consequences must be costly.

Because they are costly in time and effort, after some practice you will become aware of the moment you are about to ritualize, and you will hesitate. You will pause to think about whether it is best to start ritualizing, because if you do ritualize, you'll also have to start in on this not so pleasant consequence. This moment of hesitation gives you an opportunity to resist the compulsion in order to avoid that costly consequence.

For example, let's say you must check the stove every time you leave the house for work in the morning. You tend to get stuck touching each knob six times before you walk out the door. Later, when you are on the front porch, you doubt whether the stove is off, and back you go for another round of checking. Several weeks ago you began to use the slow-motion practice every time you checked. This has worked so well that now you check the stove only once and never touch the knobs. But each day, standing out on the front porch, you still become doubtful and must return to the stove for a second quick check "just to be sure."

This would be a good time to implement a consequence. Decide that, starting tomorrow, each time you check the stove again, touch a knob while checking, or even glance at the knobs again while walking through the kitchen, you must take a brisk thirty-minute walk as soon as you come home from work. This means you take a walk before doing anything else: no stopping at the store on the way home; no having a snack after you get home. Just put on your walking shoes and go, regardless of whether it's hot and muggy, raining, or snowing. Soon you will be thinking twice before stepping back inside from the porch "just to make sure."

This technique will work in the same way whether you are a washer who wants to stop washing your hands an second time, a hoarder who wants to stop collecting meaningless materials, or and order who wants to stop straightening up repeatedly. If the consequence you choose does not have this intended effect after numerous trials, then switch to a consequence that seems a little more costly.

Self-Help Practice 5: Choose Not to Ritualize

This, of course, is the option you will continually take as you gain full control of your rituals. Yet it requires determination. You must have a long-term commitment to overcome your problem in order to counterbalance the immediate urge to ritualize. You must be willing to suffer short-term distress in order to achieve your goal of freeing yourself from your symptoms.

Choose Not to Ritualize

1. Expose yourself to the object or situation that stimulates your urge to ritualize
2. Choose not to perform the ritual
3. Practice tolerating the distress until it subsides

All of the previous techniques in this section promote your ability to refrain from ritualizing and help prepare you for this option. Each aids in developing the important position of choice. Working with any of the other options first - Postponing, going in slow motion, changing some other aspectof the ritual, or adding a consequence - helps you choose this last option with less anxiety, stress, and effort than if you used it first. Instead of saying, "I have to stop this," you are much more likely to feel, "I'm ready to stop this."

To decide not to ritualize is to decide to face your anxiety directly, to stop protecting yourself from your distressful feelings through your compulsive behavior. You are willing to feel anxious if that's necessary. In fact, that is a lesson you will learn through your practice of this option. You will discover you can manage your discomfort. To find this out, you will go toward your anxiety instead of away from it.

The best way to do this is to voluntarily initiate contact with whatever it is that brings on your urge and then withhold your rituals. If you have an irrational fear of contamination, touch things you believe are contaminated. If you are afraid you might leave the stove on accidentally, then purposely turn it on and leave the house for half an hour. If you have to have a perfectly clean house, then mess up several rooms and leave them that way for several days at a time. Only through this practice can you discover that your distress passes and so does your urge. Chapters 7 and 8 of Stop Obsessing! provide specific instructions on how to stop your rituals.

But you don't simply have to grit your teeth and bear your distress. Remember to practice relaxation techniques. Use the Calming Breath and the Calming Counts to help let go of your tension. In The Stop Obsessing! Tape Series we provide you with our tape called "Generalized Relaxation and Imagery". This tape will help you let go of your tensions and enjoy twenty minutes of peace and quiet. Because this is a generalized relaxation tape, some people listen to it every day. But another good time to listen to it is when you are resisting your rituals and noticing that you are feeling anxious. Following the tape will help you calm down.

Relaxation is not your only option during these times. In some of these situations, when your tension is high, you won't feel like sitting quietly and listening to a tape. During those times, be sure to refocus your attention on some other task that will hold your interest, like talking to a supportive friend or taking a brisk walk.

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What's it going to take to get better? There are four challenges that lie in front of you as you begin to face your obsessions and compulsions:

Challenge 1: Be determined to conquer this problem. This is a tough problem to overcome. You really need to spend some time making sure that you're ready and willing to go through short-term suffering for long-term gain. You need determination because you have to take the risk to experiment with behaviors that are totally opposite of what you would tend to do in these situations. You're going to have short-term doubts, and you have to be willing to overcome those short-term doubts and have a kind of faith in this approach.

The second challenge as you begin is to gain the perspective that your worries are excessive, or irrational. The symptoms that your worries produce are so powerful and so disturbing that you get distracted by them and believe they represent true concerns. I am asking you to begin to practice a new belief, and it is this: when these obsessions occur, the content of the obsessions is irrelevant. It is meaningless, it is purposeless. Your obsessions represent an anxiety problem. The topic of your anxiety is not the issue, even though your anxiety leads you to believe that it is.

This is not an easy task to accomplish when you are dreading that you might pass on deadly germs, kill your own child or cause a terrible accident. Nonetheless, I am asking you to step away from those thoughts, to get perspective on them, and say, "Wait a minute, I have an anxiety disorder. What is an anxiety disorder all about? It's about anxiety, not about this content."

Try not to get into a battle of logic in your head. If you try to convince yourself of how illogical your worries are, you may become very frustrated, because you'll have a hard time being certain about anything. You'll always find a thread of doubt you can follow. So don't get caught in this trap of logic. Instead, keep stepping back mentally and saying, "I need to be addressing my anxiety, not this specific topic".

Your OCD is going to encourage you to do just the opposite. It's going to push you to think this is all about whether you really locked the door. Or it will get you to try to reassure yourself that you did actually make the appropriate decision. Or that you have not contaminated something. You'll work hard to get the right reassurance. And it's totally the wrong thing to be doing... You are falling right into the clutches of OCD. So this is a very important challenge to meet: address your symptoms of anxiety, not your fearful thoughts. Don't be fooled!

The third challenge as you begin: consider that ritualizing is not the only way to reduce your anxiety. Most people with this problem believe that if they don't ritualize, they will remain distressed forever. If you share this belief, you must be willing to challenge it in order to discover that there are other ways to reduce your distress. It will be extremely difficult to give up your compulsions unless you are willing to experiment with new behaviors. You need to be willing to explore options to ritualizing.

Do you remember the old joke of the guy who every morning gets up at 6:00 and stomps around the outside of his house. His neighbor finally comes out and says, "What in the world are you doing? Every morning, I look out my window when I'm fixing my breakfast, and there you are in your bathrobe stomping around the house." The guy says, "Oh, well, I'm keeping the elephants away."

"Elephants? There are no elephants in this neighborhood."

And the first man says, "See how well it works!"

So, he never challenges his belief. That's what people do. They say: "The ritual was the only way I could possibly have shaken loose of my terrible distress, and I need to keep using it."

To resist your compulsion is really a courageous thing to do. Because you are having to resist this powerful belief that something terrible is going to happen if you do.

The fourth and last challenge is: decide to accept your obsessions instead of resist them. This is the toughest of all four, and it is the most important. This one is the basis of all the self-help interventions we'll talk about. Because the more you resist your obsessions, the stronger they become. It's as though your solution to the problem actually increases the problem. You resist the symptom, and it persists.

So you need a new inner voice that says, "It's OK that I'm obsessing right now." This is not saying, "it's OK in the next 20 minutes to do it"; it's not saying, "I'm going to continue to do it." But I am asking you to say, "It's OK that I just had that thought." I know that sounds like a crazy thing to say. You are trying desperately to rid yourself of these terrible thoughts, and I instructing you to accept them! Accepting the obsession generally looks like a bad idea to people.

But what's the other choice? The other choice is to say, "It's terrible that I had that thought." And what's the reaction that you're going to have physiologically when you make that statement? That statement's going to produce more anxiety.

I agree, of course, that the end result is to get rid of that obsession. That's everyone's objective. But the technique that you use and the end result are different. That's why it's called paradox, which means opposite of logic. And that's why you have to have faith. First, you're going to accept this obsession, and then you're going to manipulate it. Why are you going to do it in that order? Because that's how it works best. So there's a big, big leap of faith here when you accept your obsession. But if you will really dedicate yourself to experimenting with this approach for several weeks, I think you will discover its benefits.

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Let's review these four challenges again, first with how people generally think about this problem, and then with how I am encouraging you to think as you begin your self-help program.

The first challenge: People say, "I'll always be controlled by this problem." You want to shift it over to, "I'm now determined to conquer this problem."

The second position is: "I believe my obsessional concerns are accurate." I want to shift that one over to: "My obsessions are exaggerated and unrealistic." The third one: "Rituals are the only way to reduce my distress." Shift that to, "there are other options to reduce my distress." The fourth one: "I must stop these obsessions" is the problem stance. Shift this to, "I accept these obsessions."

How would you apply this fourth challenge? When you begin obsessing and worrying, you typically react emotionally to those thoughts and images, by becoming anxious and afraid. That compels you to ritualize. The first place to start practicing is anytime you begin to obsess. Take that opportunity to focus on the idea of permitting the obsession to exist in that moment. Work on not being afraid of the obsession and not being mad at yourself that you just had the thought. Wouldn't that be great, to not get distressed at those momentary worries, to not think that they mean anything.

Let me tell you a story. When my children were infants, I would carry them in my arms as I walked around the deck of our home. Every once in a while, I'd stand at the railing, looking at the beautiful scenery out in the woods, and then I'd have this flash: I'd see myself accidentally dropping my child two stories down from the deck, and there she'd lie on the ground, dead. And then I'd see myself jump over the edge to kill myself out of my shame that I'd just killed my child. But I'd break my neck instead, and end up being humiliated and shamed for what I just did to my son or daughter.

And then I'd step away from the edge of the deck.

It was the same with my kids as toddlers. I'd be reading in the living room while one of my kids was playing in another room. Then I'd notice that all was quiet. On a number of occasions I would then think, "Oh, my God, he's swallowed a penny and he can't breathe, and he's passed out..." And I'd get up and quickly move to the other room to check on my child. There he'd be, quietly and safely drawing on the wall with crayons. Now, I'm sure I've have had those kinds of fantasies over 40 times. Each one took about two or three seconds, with slight variations.

What is the difference between what I experienced and what someone with OCD experiences? There are many similarities. The difference is not about the thoughts that we have but in how we interpret those thoughts and images. I would say, "I know what that's about, and that's no big deal." I'd say, "That's because I'm a new parent. It's my mind's way of reminding me that I need to protect these fragile children. I know I'm not really about to accidentally drop my kid."

People with OCD might say, "Oh, my God, I had the thought of killing my daughter? Why did I think that? I'm not sure I can trust myself. I might accidentally do that." They decide to doubt their ability to stay in control.

So this is where you begin in your self-help program. Confront your interpretation that the content of your obsessive thought means something terrible about you. I want you to downgrade each obsession to a kind of momentary glitch in your thinking. The thought doesn't mean anything. You had a fearful thought, and you got scared by it. That's all. When I saw in my mind the image of my child lying on the floor not breathing, I became momentarily scared, and my heart raced. That's an expected reaction. It's like sticking your finger in the wall socket and getting shocked. That's all it is. And that perspective is what you should work toward.

When you notice your obsessions, choose to have them. As soon as you choose to have your obsessions, they're no longer involuntary. Remember that the definition of an obsession includes that it is involuntary. So as you begin to accept your obsession, as soon as you choose to have it then that involuntary thought is now voluntary. And you've begun to change the nature of the problem.

This is the direction I am going to take in this self-help program. I am not asking you to stop obsessing right now, or to stop ritualizing. I am asking you to change some smaller components of the pattern. You're going to disrupt the pattern by various means. You're going to modify your obsession in little ways. You're going to add things to your ritual. In this way you can gradually learn about your ability to control your symptoms

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Researchers find strong evidence of genetic influence in developing bipolar disorder.

Bipolar Disorder Runs in Families

Bipolar disorder is often considered a condition that reflects genetic influence. A new twin study reveals just how genetic the disorder is.

If one identical twin develops bipolar disorder, the likelihood of the other twin developing the condition is 85 to 89%. The high probability of double trouble comes not from the environment the twins inhabited together while they were developing but from the genes they share, reports a team of British and Canadian investigators. Only 15% of instances of bipolar disorder can be attributed to factors specific to individuals or to their unique life experiences outside the family of origin.

What's more, the genetic loading for bipolar disorder is restricted to liability to mania.

Interestingly, the study also demonstrates that unipolar depression is not simply a less severe form of bipolar disorder. Only 10% of twins with unipolar major depression had a co-twin with bipolar depression.

Nevertheless, there is some genetic overlap; susceptibility to bipolar disorder seems to make sufferers susceptible to unipolar depression as well. Fifty percent of the co-twins with bipolar disorder also had unipolar disorder.

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Important scientifically proven principles and components of an effective drug treatment program.

1. No single addiction treatment is appropriate for all individuals. Matching treatment settings, interventions,  and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.
2. Treatment for an addiction needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.
3. Effective addiction treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems.
4. An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture.
5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs (see pages 11-49). Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community. (Approaches to Drug Addiction Treatment section discusses details of different treatment components to accomplish these goals.)
7. Addiction medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alpha-acetylmethadol (LAAM) are very effective in helping individuals addicted to heroin or other opiates stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opiate addicts and some patients with co-occurring alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (such as patches or gum) or an oral medication (such as bupropion) can be an effective component of treatment. For patients with mental disorders, both behavioral treatments and medications can be critically important.
8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder.
9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment (see Drug Addiction Treatment Section).
10. Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions.
11. Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. The objective monitoring of a patient's drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual's treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring.
12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Counseling can help patients avoid high-risk behavior. Counseling also can help people who are already infected manage their illness.
13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence.

Sources:

• National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

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Multidimensional Family Therapy (MDFT) for Adolescents is an outpatient family-based drug abuse treatment for teenagers. MDFT views adolescent drug use in terms of a network of influences (that is, individual, family, peer, community) and suggests that reducing unwanted behavior and increasing desirable behavior occurs in multiple ways in different settings. Treatment includes individual and family sessions held in the clinic, in the home, or with family members at the family court, school, or other community locations.

During individual sessions, the therapist and adolescent work on important developmental tasks, such as developing decisionmaking, negotiation, and problem-solving skills. Teenagers acquire skills in communicating their thoughts and feelings to deal better with life stressors, and vocational skills. Parallel sessions are held with family members. Parents examine their particular parenting style, learning to distinguish influence from control and to have a positive and developmentally appropriate influence on their child.

References:

Diamond, G.S., and Liddle, H.A. Resolving a therapeutic impasse between parents and adolescents in Multi-dimensional Family Therapy. Journal of Consulting and Clinical Psychology 64(3): 481-488, 1996.

Schmidt, S.E.; Liddle, H.A.; and Dakof, G.A. Effects of multidimensional family therapy: Relationship of changes in parenting practices to symptom reduction in adolescent substance abuse. Journal of Family Psychology 10(1): 1-16, 1996.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

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Anti-anxiety medications aren't the only way to treat high anxiety. Discover alternative treatments for anxiety, stress and panic attacks.

• Natural Alternative Treatments for Anxiety and Stress
• Alternative Treatments for Anxiety and Panic Attacks
• Non-Medication Treatments for Anxiety and Panic Attacks
• Top Ten Alternative Remedies For Anxiety
• Restorative Yoga for True Relaxation
• Coping With Trauma When Living With A Mental Illness
• Important Information About Herbal Treatments
• Harmful Substances in Herbal Products

 

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Erectile dysfunction (ED) is the inability of a man to attain and/or maintain an erection sufficient for sexual activity. Fortunately, most men who have ED only lose the ability to have satisfactory erections. In other words, for most of these men, penile sensation is normal and the ability to have an orgasm and ejaculate remains. Today, there are several treatment options available to men suffering from this disorder. For most men, the initial treatment will be an oral medication such as . If this treatment is unsuccessful, second-line treatment options are ordinarily considered. These include using a vacuum erection device, intraurethral medication or penile injection therapy. If these second-line treatments fail or if the patient and his partner reject them, then the third-line treatment option, penile prosthesis implantation, is considered.

What are penile prostheses?

Penile prostheses are devices that are implanted completely within the body. They produce an erection-like state that enables the man who has one of these implants to have normal sexual intercourse. Neither the operation to implant a prosthesis nor the device itself will interfere with sensation, orgasm or ejaculation.

What are the different types of penile prostheses?

There are two erection chambers (corpora cavernosa) in the penis. All penile prostheses have a pair of components that are implanted within both of these erection chambers. The simplest penile prostheses consist simply of paired flexible rods that are usually made of medical-grade silicone, and produce a degree of permanent penile rigidity that enables the man to have sexual intercourse. These devices are either malleable or inflatable. A malleable rod prosthesis can be bent downward for urination or upward for intercourse. Inflatable penile prostheses are fluid-filled devices that can be inflated for erection. They are the most natural feeling of the penile implants, as they allow for control of rigidity and size.

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The inflatable devices have fluid-filled cylinders that are implanted within the erection chambers. Tubing connects these cylinders to a pump that is implanted inside the scrotum, the sac that contains the testicles. In the simplest of these inflatable devices, the pump transfers a small amount of fluid into the cylinders for erection, which then transfers out of the cylinders when erection is no longer needed. These devices are often referred to as two-component penile prostheses. One component is the paired cylinders and the second component is the scrotal pump.

Three-component inflatable penile prostheses have paired cylinders, a scrotal pump and an abdominal fluid reservoir. With these three-component devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.

What does penile prosthesis implantation involve?

Penile prostheses are usually implanted under anesthesia. Usually one small surgical cut is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. No tissue is removed, blood loss is small and blood transfusion is almost never required. A patient will typically spend one night in the hospital.

Most men have pain after penile prosthesis implantation for about four weeks. Initially, oral narcotic pain medication is required and driving is prohibited. If men limit their physical activity while pain is present, it usually resolves sooner. Men can often be instructed in using the prosthesis for sexual activity one month after surgery, but if pain and tenderness are still present, this is sometimes delayed for another month.

What are the complications of penile prosthesis surgery?

Infection occurs in 1 to 5 percent of cases. This is a significant complication because in order to eliminate the infection, it is almost always necessary to remove the prosthesis. In 1 to 3 percent of cases, erosion occurs when some part of the prosthesis protrudes outside the body. Erosion often is associated with infection and removal of the device is frequently necessary.

Mechanical failure is more likely to occur with inflatable than with rod prostheses. The fluid present inside the prosthesis leaks into the body; however, these prostheses contain normal saline that is absorbed without harm. After mechanical failure, another operation for prosthesis replacement or repair is necessary if the man wants to remain sexually active. Today's three-component inflatable penile prostheses have about a 10 to 15 percent likelihood of failure in the first five years following their implantation.

Frequently asked questions:

Is penile prosthesis implantation covered by insurance?

Although all third-party payers do not cover penile prosthesis implantation, most including Medicare do if the prosthesis is implanted to treat erectile dysfunction caused by an organic disorder.

Will a penile prosthesis interfere with urination?

It normally does not.

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Dear Stanton:

I have been clean and sober in NA and AA for over 10 years, relapsed into chronic heroin addiction for 6 years prior to that. I am 36 now, have been involved in the 12 steps since the age of 20...so lots of meetings. Funny thing is, I now have no access to meetings, haven't been for 10 months, haven't gone mad or depressed, am a senior executive with a lovely home life. Still don't drink because I am terrified I will descend back into hell. I am not the same person I was, love my life, respect myself, have a hold on spirituality and my moral code, surely I can enjoy a champagne toast or lovely wine with dinner. I am sick and tired of attending events and not joining the evening, pretending I really don't want a drink, when in fact I would love one. Dinners and celebrations are just hell for me, because I get resentful not being able to enjoy. I don't want to wipe myself out, get drunk, bury my feelings, would simply like to enjoy the meal compliment of good wine, or unwind with my peers.

I will forever be grateful for AA and NA, I would truly be dead by now, and feel a certain obligation to carry the message, which I always would, but can I move on now? That is the question. My friends in the program tell me because I was so chronic in addiction, I would have a good chance of reverting. I have seen many do that, with as much going for them as me.

Any thoughts? Were you ever an alcoholic or addict yourself? Do you see the merit in AA and NA for as long as it works?

Look forward to your response.
Ellen

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Dear Ellen:

I can't tell you that AA/NA didn't help you -- either it did, or it was there for you when you got better. Either way, it deserves your appreciation. How you proceed from here on in is still for you to determine. Obviously, you have found, continued 12-step attendance is not necessary for you.

The issue of whether you can break your AA abstinence vow is more complicated, but it is still up to you, of course, and many do. Oddly, even some people who support and encourage controlled drinking rule it out for successful AA members. I don't. Although perhaps AA is better suited for those who will achieve stable abstinence compared with those who are capable of achieving moderate drinking, there is also some overlap between these groups. And you are very different, as you know, at 36 from how you were at age 20.

The very most important thing for you to understand is that, whether or not you can be a successful holiday "toaster," or a moderate drinker of any type, you can always be sober. You have shown that you have the impulse for that. Any experimenting with drinking you do will provide you with feedback about what is possible, and you can use this information constructively — in other words, even if "tippling" is not for you, you will see that you should resume abstinence as your best strategy for now. And, you know what? Even if abstinence works at 36, that's no guarantee it will be best at 45. Human beings have that "power" — that capacity for growth.

Here is the story of one man — also a heroin addict as well as alcoholic — who not only did what you hope to do, but actually continues to attend AA!

Best,
Stanton

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Hello to you,

This is not a question per say, but a thank you for your website, to know I am not alone in my feelings, thoughts, and actions over the last year. I read what Ellen wrote to you and it was as if I were hearing my own words.

I got sober at the age of 23; an addict and alcoholic I very much was. I saw no other way of life for myself. AA saved my life, and the foundation for my life and for my spirituality rests in the heart and arms of AA. Over a period of 7 years I grew into the person that I am today, and continue to grow in spirituality and in mind, and continue to use the tools that AA gave me, taught me, etc. At 30 years old though, I truly believed that I was a different person than I was at 15, 19, 22, and 23. I somehow, through the grace of God, fixed within me what was broken. After debating, talking to others, and truly thinking for about a year of going back out...I did. I have found that I do not drink in the same way as I once did, or for the same reasons, and certainly not as frequently. I was so scared to go back out because the fear of loosing everything I had gained in the last 7 years was very strong, as they teach you in AA...everything that was going through my mind about wanting to drink again, or feeling like I could drink again...was exactly what they said I would be thinking. I now feel that I am in a catch 22 though, because the part of AA that I do miss is the fellowship, the family...that whole part of it. But I do not have a desire to stop drinking and nor do I feel that alcohol has any control over my life. I am wondering if there are others out there like myself, others who have gone back out after extended sobriety and after working the steps, and have found that alcohol does not affect them like it once did, yet they still miss the fellowship of AA. If so, can you tell me how to contact such a group or such people?

Thanks again,
Kara.

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Dear Kara:

Thank you for sharing. It does seem lonely where you are at. But, as indicated by Ellen, obviously there are others. My best suggestion is to seek fellowship among people who are most like you as you are now. You will find some of them share backgrounds of compulsive behavior like you have experienced, although probably not in exactly the same form. But you will serve yourself best by representing yourself most clearly as who you are now.

Very best,
Stanton

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