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What is The Relationship Model of Addiction?

What is an intervention?

What is 'emotional withdrawal'?

Why do some people get addicted while others do not?

How do we tell whether someone is addicted?

What is The Relationship Model of Addiction?

The Relationship Model of Addiction™ (TRMA™) combines mindfulness-based principles and practices, cognitive behavioral therapy and self-psychology. TRMA focuses on the mental, emotional, psychological and relational aspects of addiction.

Addiction is not a disease. Addiction is a relationship with a means of relief of pain from unmet emotional needs. Means of relief include, substances, process addictions or activities including porn, sex, gambling, as well as with in relationships with other people, as is the case with love addiction and codependency.

Relationships that fail to provide adequate emotional nourishment are the spawning ground of addiction. When our need for love does not get met in those relationships we depend on for emotional nourishment, there is pain. The need to relieve the ever-growing backlog of pain is the underlying driving force of addiction and is what shapes the addict’s life and relationships. The relationship with a means of relief becomes a primary and all-consuming relationship, which make the formation of other relationships near impossible, which therefore leads to increasing isolation and pain; a vicious cycle.

Less or no pain = Less, or no need for relief = No addiction; and far less susceptibility to becoming addicted.

Recovery is a transitional journey out of non-emotionally nourishing relationships and into emotionally nourishing ones. The Three Stages of the recovery journey are: Breaking-up with the means of relief; Developing the Relationship with Self is Stage II and becoming proficient in the arts of dating, relating and connecting is what is supposed to happen in Stage III – Creating Emotionally Nourishing Relationships (relationship training). And then there are ‘the intangibles’ – your mindset, level of commitment and fire in your belly, which could make to most difference.'s relationship training takes you from disconnection to connection, to our Selves, others and the world.

What is an intervention?

An intervention is a step-by-step, rehearsed process whereby significant others confront the addict about his/her addiction and need for immediate treatment. Significant others meet with the therapist for an assessment and to guide the process. The interventionist provides psycho-education about addiction and codependency. Then each family member recollects events that provide irrefutable evidence of the consequences of the addiction. Then the confrontation -- an outpouring of love long overdue and affirmation that they will no longer stand by helplessly watching the addict self-destruct.

Why do some people get addicted while others do not?

Evidence suggests a strong correlation with genetics – a history of addiction in one’s family of origin or prior generations ¬– and/or biochemical factors (a chemical reaction in the brain that brings about extraordinary relief and strong cravings). However, the number of exceptions makes us wonder whether there are other factors. There are many who, given their family background, are at extremely high risk, yet who do not become addicts. Conversely, there are those without a history of addiction in their family who do become addicts.

From the standpoint of healthy relationships, or the lack thereof, we can better understand why some people are more predisposed than others and some are less. The key variable is the existence of emotionally nourishing relationships, both in the past and in the present. When one has sources of emotional sustenance, as opposed to being or having been emotionally deprived, there would be less of a need (for relief), the initial high wouldn’t hold the same irresistible charm, and there would be no incentive to get involved in yet another non-emotionally sustaining relationship.

Perhaps the simplest explanation is that when the right person discovers the source of relief, whether substance or activity, a dependent relationship is established. The right person is anyone whose level of pre-existing pain is high enough to potentiate an extraordinarily gratifying experience, discovery. Anyone could become addicted at any time, depending on the level of pre-existing pain; and there is no way to tell who is more or less predisposed.

Susceptibility is often a matter of timing as well -- how much one needs relief at any given point in time. Is a person’s level of pre-existing pain increased in the face of recent events and stressors? There are certain conditions that make one more susceptible. Someone whose self-esteem is low to begin with would be more at risk than someone whose self-esteem is relatively high. Someone who is stressed out on the job or is in a deteriorating relationship is obviously more at risk than someone who looks forward to going to work and who is in a stable relationship. People who are struggling with depression, anxiety, or post-traumatic stress are more at risk.

On the other hand, when someone’s level of pre-existing pain is fairly well managed or not high, and that person is relatively stable and emotionally fulfilled, we wouldn’t expect getting high to become a life-changing event.

How do we tell whether someone is addicted?

Usually where there is smoke there is fire. First you look at irrefutable indications or objective evidence of a problem or problems, i.e.
health, relationships, occupational, academic, legal or financial problems; and can include personality and behavioral changes and
increasing diminishment of functioning over time.

You want to get a sense of the the extent the person's life revolves around a mind/mood altering chemical or activity, and the person’s life has been impacted or changed.

When there is marked evidence of problems or diminishment of functioning, an addiction or relationship with a means of relief becomes highly likely, and its severity to be assessed further, preferably by an addiction specialist.

When there are few or no objective indications, it becomes much more difficult to know whether someone is addicted. When there is a lack of irrefutable evidence, the tendency is to discount the existence of an addiction. “If there are no problems or consequences, there must not be an addiction.” One might wonder whether it even matters at that point.

In order to make a diagnosis at the earliest point possible, before the addiction reaches its destructive potential, you have to look at what I call 'subjective criteria' – manifestations of denial. This may be when there are obvious problems (addiction related or otherwise), but the person is not willing or able to even entertain the possibility of an addiction or any other problems.

Take the case of a relatively high-functioning addict who claims not to be addicted, and sees no ill effects. S/he claims to be using the substance recreationally but it becomes apparent that his/her recollection of facts regarding amounts and frequency are inconsistent (selective recall). It becomes further apparent that the person is making an effort to conceal, cover up, minimize or justify his/her use to him or herself and to other people.

It finally becomes apparent that this is a denial-laden story. At this point, a bell rings and we know.

The rule of thumb is that wherever there is denial, there is dependency – otherwise, there would be nothing to deny. One doesn’t exist without the other.

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What is therapy like i?

Because each person has different issues and goals for therapy, therapy will be different depending on the individual. In general, you can expect to discuss the current events happening in your life, your personal history relevant to your issue, and report progress (or any new insights gained) from the previous therapy session. Depending on your specific needs, therapy can be short-term, for a specific issue, or longer-term, to deal with more difficult patterns or your desire for more personal development. Either way, it is most common to schedule regular sessions with your therapist (usually weekly).

It is important to understand that you will get more results from therapy if you actively participate in the process. The ultimate purpose of therapy is to help you bring what you learn in session back into your life. Therefore, beyond the work you do in therapy sessions, your therapist may suggest some things you can do outside of therapy to support your process - such as reading a pertinent book, journaling on specific topics, noting particular behaviors or taking action on your goals. People seeking psychotherapy are ready to make positive changes in their lives, are open to new perspectives and take responsibility for their lives.

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What about medication vs. psychotherapy?

It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness. Working with your medical doctor you can determine what's best for you, and in some cases a combination of medication and therapy is the right course of action.

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Do you take insurance, and how does that work?

To determine if you have mental health coverage through your insurance carrier, the first thing you should do is call them. Check your coverage carefully and make sure you understand their answers. Some helpful questions you can ask them:

  • What are my mental health benefits?
  • What is the coverage amount per therapy session?
  • How many therapy sessions does my plan cover?
  • How much does my insurance pay for an out-of-network provider?
  • Is approval required from my primary care physician?

Confidentiality is one of the most important components between a client and psychotherapist. Successful therapy requires a high degree of trust with highly sensitive subject matter that is usually not discussed anywhere but the therapist's office. Every therapist should provide a written copy of their confidential disclosure agreement, and you can expect that what you discuss in session will not be shared with anyone. This is called “Informed Consent”. Sometimes, however, you may want your therapist to share information or give an update to someone on your healthcare team (your Physician, Naturopath, Attorney), but by law your therapist cannot release this information without obtaining your written permission.

However, state law and professional ethics require therapists to maintain confidentiality except for the following situations:

* Suspected past or present abuse or neglect of children, adults, and elders to the authorities, including Child Protection and law enforcement, based on information provided by the client or collateral sources.

* If the therapist has reason to suspect the client is seriously in danger of harming him/herself or has threated to harm another person.

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