For each area below, we've explained the problem and outlined common symptoms. Then we've desribed "state of the art" treatment methods. Although your problems may feel overwhelming to you, there are counseling approaches that can help you restore balance and happiness to your life.

››  Substance Abuse
››  Eating Disorders
››  Sex Addiction

Substance Abuse

Description of the Problem
Since virtually the beginning of our existence, humans have sought methods of altering their everyday consciousness in pleasurable and unusual forms through the use of natural or synthesized drugs and alcohol. And since the beginning of this phenomenon, a small percentage of those who use these substances have developed problems of overuse/abuse, addiction, and/or dependence. At IPG, we take a somewhat unconventional stance in defining substance abuse problems. We have no set definition of what constitutes recreational versus harmful use, and thus we treat each individual situation uniquely. Even if you have been mandated to treatment by your employer or by the court system, we make no assumptions about your "problem" until your situation has been thoroughly investigated. For example, if you have to obtain treatment because you have been convicted of driving while under the influence of alcohol, we may discover that you indeed are addicted to alcohol. On the other hand, you may be an inexperienced drinker who does not yet understand the extent to which even small amounts of alcohol can impair reflex response times and judgments of speed. Your employer may insist upon treatment after a random urinalysis either because you are a recreational user of marijuana - or because you are dangerously dependent upon cocaine. Unlike many professionals in the addiction field, we diagnose and treat these situations entirely differently.

There is no simple, easy way to define substance abuse problems, because different drugs (and we include alcohol as a "drug") have different addictive potentials and each person has a unique pattern of use. Even "daily use," considered by many to be a sure indicator of a "problem," is not a certain sign: daily use of heroin, for example, is quite different from drinking one or two glasses of wine with dinner. Some symptoms of substance abuse and dependence are:

• compulsive use: feeling out of control, using a drug even when you don't really want to or know you shouldn't
• physical addiction, characterized by intense discomfort or even life-threatening reactions when you are unable to use your substance of choice
• developing health problems due to substance use
• finding that substance use - obtaining it, using it, thinking about it - dominates your daily life
• developing financial problems due to substance use
• finding your substance use is harmful to your relationships, job, or other aspects of living

Treatment Approaches
Just as we have a unique definition of substance abuse problems, we have an equally unusual and varied approach to treatment. Unlike Great Britain and most western European countries, United States drug treatment policy is dominated by an abstinence-only approach. At IPG, we believe this is a mistaken and costly attitude. Research on drug and alcohol abuse consistently shows that the vast majority of problem users are unable or unwilling to benefit from abstinence-only models, and that most people who overuse eventually control their use with or without treatment. If this is true, then it is foolish to not offer help to people who want to control, reduce, or otherwise modify substance use. Substance misuse is not a moral defect nor an absence of willpower; recent advances in "brain science" suggest that prolonged heavy use of many drugs results in neurochemical changes that make control of drug/alcohol using behavior extremely difficult.

Therefore, at IPG we use a number of different treatment approaches. All of our substance abuse counseling is based on a "Stage Model" of addiction. According to this model, which applies to all unwanted habits, people are at different points of readiness to change at different times, and the entire cycle of habit control and relapse may need to be repeated several times before someone "conquers" their habit. Moreover, each stage carries with it different implications for treatment. For example, most people with a troublesome habit spend a long time in what is called "Pre-contemplation," which could also be called "denial." Many clients who come to treatment because someone else wants them there are in pre-contemplation. If you are in this stage, counseling must consist of dispensing educational information and gently helping you examine your behavior and identify motives to change. On the other hand, if you are in the "Action" stage you need concrete behavioral strategies for abstinence or controlled use, and if you have "Relapsed" we will support and encourage you to return to your action strategies and teach you relapse-prevention techniques for the future.

In many cases, we refer clients ready to deal with substance abuse problems to traditional abstinence-only treatment plans, including 12-step programs, as an adjunct to psychotherapy. We keep meeting lists for 12-step programs available, will encourage you to find temporary and permanent sponsors, help refer your loved ones to collateral meetings, and help you to use the various "steps" in your own individualized way.

However, we also work with people for whom the abstinence-only model is inappropriate. In keeping with our client-driven philosophy, we help clients identify the best goals for them, which do not always involve total abstinence. We employ approaches to help people control their use without total abstinence ("moderation management"), or to reduce the damage to themselves and others from substance abuse ("harm reduction"). While abstinence is a practical goal for many, when individuals can't totally abstain, or choose to attempt controlled use, our job is to help people limit or transform their addictive behaviors to less destructive levels. For example, we may teach techniques to someone who overuses alcohol to limit alcohol consumption to 3 or 4 drinks a day instead of 12, or a cigarette smoker to limit their smoking to 5 cigarettes instead of a full pack. In working with someone who "shoots up" drugs but is not ready to stop, we might explain how to clean needles safely to avoid contracting HIV, hepatitis C, and other diseases. These approaches are very controversial in the United States, but we believe it is unethical to not help those with substance abuse problems simply because they refuse or are unable to attain total abstinence.

Medication is sometimes helpful in the treatment of substance use, and when it is helpful we will refer clients to detoxification programs, methadone maintenance centers, or to pharmacologists who can monitor use of drug antagonists, anti-depressants, and other of the more recently developed pharmaceutical agents used to help curb urges or block the action of mood-altering substances.

Eating Disorders

Description of the Problem
Over the last few decades, eating disorders have risen to troublesome levels in the United States. Compulsive over-eating has affected both men and women of all ages, and anorexia and bulimia have become disturbingly common among teens and young adults, especially in women. Increasingly, researchers in this field are noting the biological roots of these behaviors and, particularly for compulsive over-eating, establishing more realistic goals for treatment. Compulsive over-eating creates extreme psychological pain for the sufferer and, when nutritionally unsound, may be associated with health problems as well. This pain is made all the worse by the common misconception that over-eating is simply a failure of willpower. Anorexia, or the restriction of food to below-subsistence levels, similarly is extremely dangerous; of all mental disorders, it has one of the highest rates of death for those afflicted. Bulimia, commonly known as "binging and purging," can take the form of induced vomiting, overuse of laxatives, or both. Bulimia can be life threatening at times, and it can produce lasting dental problems, ulcerations of the throat, and other medical complications. Common denominators of all eating disorders are secrecy, shame, and self-hatred. Sufferers frequently hide their problems even from their significant others, blaming themselves in an imitation of social attitudes.

Treatment Approaches
Because we believe that eating disorders are deeply rooted in biology as well as having environmental influences, we know that admonitions to use willpower do nothing but drive the person with an eating disorder deeper into secrecy and shame; people with eating disorders are not in control of their behavior. If you have an eating disorder, it is our job to help you regain control to the extent you can, but it is also important to help you set realistic goals. For example, most experts in the eating disorders field believe that a loss of ten percent of body weight is a rational goal for compulsive overeaters. Therefore, part of our treatment approach if you have this problem will be to discourage you from thinking you should conform to a "weight chart" or to look like a supermodel. We use what is called a "non-diet" approach, and we will encourage you to focus on body fitness instead of weight and help you learn to love your body even if it is bigger than you have been told it should be. Anorexia and bulimia can be difficult-to-break habits with frequent relapses before total remission is attained, so we encourage clients with these disorders to change by degrees if necessary and to focus on improvement rather than blaming themselves for lapses.

Like our treatment of substance abuse, many of the methods we use to help people with eating disorders are behavioral. We might help you design a food plan, weigh-in at our office, or plot out methods to cope with "trigger" situations like eating out in a restaurant or being with people who comment on your eating habits.

Most eating disorders include a strong cognitive component as well. People who have these problems are plagued by unpleasant intrusive thoughts about food and eating, which has caused these disorders to be compared to obsessive-compulsive disorder (OCD). In addition, anorexics and bulimics often have body-image perceptions that are so distorted they seem almost "crazy." We help bring unrealistic body image back to normal and help with "thought-stopping" of unwanted food thoughts. If you suffer from compulsive over-eating, even if you are successful in reducing your weight by ten percent, you may still have to accept having a larger than average body, and so we will work to help you feel beautiful in the body you have despite prevailing cultural norms. For all eating disorders, we try to gently re-focus you on health rather than looks; being fit is more important than being thin. When appropriate, we will help you make connections between your eating behavior and other issues in your life, present or past. We also refer to support groups like Overeaters Anonymous, to local groups for anorexia and bulimia, to nutritionists, and, in extreme cases, to residential programs for anorexia and bulimia.

Our belief that many eating disorders have biological roots informs our methods in other ways. We are realistic about weight loss and gain and help you set goals for yourself that may not fit within "official" weight guidelines. As with substance abuse, we take a "harm reduction" approach: e.g., we don't encourage diets, which create health problems, but instead will help you incorporate exercise into your life to make you more fit; if you can't gain weight we will help you make a food plan that at least meets your basic nutritional needs. We will also help you explore medical possibilities for treatment, such as use of certain antidepressants to help decrease the intrusive food and body image thoughts associated with anorexia and bulimia.

Sex Addiction

Description of the Problem
The assessment of sex addiction can be very difficult, and it is a controversial issue among sex counselors. Sometimes what is diagnosed as sex addiction is actually a symptom of another illness, such as bipolar disorder. More often, people are labeled sex addicts because they do not conform to traditional sexual values - they have multiple sex partners, their sexual interests are nonstandard, etc. This is an area where personal and cultural biases can creep into treatment easily. But it is also true that some people are compulsively driven to sexual behaviors that can impair and even destroy the quality of their lives and seriously hurt those around them.

The symptoms of sex addiction may include:

• engaging in sexual behaviors of which you personally disapprove
• engaging in sex even when you don’t want to, i.e. compulsivity
• jeopardizing and/or harming your job, your relationships, and/or your health by your sexual behavior
• engaging in sexual activities that expose you to possible arrest
• escalation of sexual behavior, e.g., finding that it takes more and more frequent contacts, or more extreme contacts, to ‘satisfy’ you. For example, you may be a gay man compulsively having unprotected risky sex with multiple partners; or a heterosexual man unable to control his use of 900 numbers; or a heterosexual woman driven to ‘pick up’ strange men and go to their homes for sex.

Treatment approaches
The most important part of treatment is diagnosis, and nowhere is this more true than when dealing with sex addiction. At IPG we will help you assess whether your concerns about your behavior are indications that you have an addiction or simply reflections of what others think or what society wants you to do. If your behavior is compulsive, the first line treatment approach will usually consist of cognitive behavioral therapy, some type of group interaction, whether a twelve-step group or a counseling group or other type of support group for sexual addiction, and quite possibly psychotropic medication. Medication can help lessen the frequency of urges to ‘act out’ and thoughts about acting out, thus giving you a bit more control over your impulses. Just as substance abuse treatment is often enhanced by group support, so is counseling for sex addiction: feeling that you are struggling along side of others with the same problem is comforting, and other addicts will often notice when you are in danger of relapse long before anyone else can.

Cognitive-behavioral counseling will help you clarify your reasons for stopping the addiction, strengthen your resolve, and set your goals. Goal-setting is particularly difficult for sex addiction, since few people want long-term celibacy, so total abstinence is not possible; and there is no one definition for ‘healthy’ sexual behavior, so goals are totally individualized. We will help you analyze what your sex addiction “did for you": often your sexual behavior substituted for other kinds of intimacy, served as a tension release, or perhaps boosted your ego, and once you identify these things you can find healthier ways to get your needs met. We also work closely with your partner/spouse if you are currently in a relationship you want to salvage; we can help educate loved ones, help with what is often a deep sense of betrayal on the part of the mate, help find out how his or her needs can be met in a way that is healthy for you as well. Since many of our therapists have training in sex therapy, we are uniquely suited to help sex addicts build a positive sexuality as well as to do sex therapy for couples in which one person is an identified sex addict.