Category: Conditions

It’s notoriously difficult to quit smoking, especially since it’s such a habitual part of everyday life. However, the physical and emotional effects of nicotine dependence are less than desirable, and you may have decided it’s time to put a stop to them. If you’ve tried unsuccessfully to quit before, you may feel understandably frustrated.

Did you know that there are rehabs and retreats specifically designed to help you stop smoking? Some treatment regimens can even help alleviate the effects of withdrawal. When you’re ready to quit for good, you can get the support you need from experts.

Deciding to Stop Smoking

There are many reasons why people decide to stop smoking, and yours may be personal to you. These might include health concerns, high costs of tobacco products, smoking bans at work or at home, or maybe you’re a parent concerned about the well-being of your children. Understanding your motivations can help you stay focused.

The good news? You don’t have to do it alone. Plenty of addiction professionals help people stop smoking, and yes—you can even go to rehab for this.

Treatment Options for Nicotine Dependence

Fortunately, there are many effective treatments that can help you quit smoking, ((Abuse, N. I. on D. (–). What are treatments for tobacco dependence? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-are-treatments-tobacco-dependence)) including behavioral therapies and medications. Regardless of which treatment method you choose, it’s important to consider your own needs and reasons for smoking. Per the National Institute on Drug Abuse (NIDA)’s Tobacco, Nicotine, and E-Cigarettes Research Report, “some people smoke to avoid negative effects of withdrawal while others are more driven by the rewarding aspects of smoking.”

Determining why you smoke can help you choose a treatment approach designed to address that issue.

Residential Rehab

Smoking addictions can be very serious. You may be tempted to dismiss the severity of this condition, simply because cigarettes aren’t as taboo as some other substances. However, the accessibility of a drug doesn’t make it any less dangerous. And several rehab centers treat nicotine dependence.

During inpatient treatment, you can engage in a variety of therapies designed to help you quit smoking, permanently. Before you choose a specific program, know that many rehab centers permit residents to smoke. If being around cigarettes is a trigger for you, it’s important to find a rehab center that can accommodate your needs.

Cognitive Behavioral Therapy (CBT)

This form of therapy helps patients determine why they smoke, and teaches them skills and coping strategies they can use to avoid smoking, even when faced with difficult situations.

Motivational Interviewing (MI)

Motivational interviewing helps patients determine where their ambivalence about quitting smoking is coming from, and increases their motivation to create a healthier lifestyle.

Remote Help: Phone, Web, and Apps

There are various ways to get help for quitting smoking without attending an in-person treatment program. For example, every state in the U.S. has free “quitlines” that people can call and receive support from a counselor, such as 800-QUIT-NOW.

In addition to telephone calls, people can sign up for mobile text messages that provide motivation and advice for quitting smoking. ((ABROMS, L. C., AHUJA, M., KODL, Y., THAWEETHAI, L., SIMS, J., WINICKOFF, J., & WINDSOR, R. A. (2012). Text2quit: Results from a pilot test of a personalized, interactive mobile health smoking cessation program. Journal of Health Communication, 17(Suppl 1), 44–53. https://doi.org/10.1080/10810730.2011.649159)) Messages may include information related to smoking and relapse prevention, as well as motivational texts from other ex-smokers and medication reminders. You can also use interactive components, such as a cigarette tracking feature and a craving trivia game. One study found that the number of people who were still abstinent 6 months after quitting smoking almost doubled in the group using Text2Quit, ((Text2quit: Mobile-based intervention for smoking cessation. (2017, March 7). Recovery Research Institute. https://www.recoveryanswers.org/research-post/text2quit-mobile-based-intervention-for-smoking-cessation-2/)) as opposed to the group that didn’t receive any texts at all.

Another similar text messaging service, run by the National Cancer Institute, is called SmokefreeTXT, and lasts for 6-8 weeks. They even offer a program specifically for vets called SmokefreeVET, in which texts are tailored to veterans, in addition to ones personalized to moms and teens. An example of one of these texts, according to the Smokefree website, ((Frequently asked questions | smokefree. (n.d.). Retrieved from https://smokefree.gov/tools-tips/text-programs/faqs)) looks like this: “Cravings can be triggered by seeing other people smoking. Spend time in places where smoking isn’t allowed. Try malls, museums, or the movies.”

One app by Smokefree, called quitSTART, ((Quitstart | smokefree. (n.d.). Retrieved from https://smokefree.gov/tools-tips/apps/quitstart)) is a personalized program that sends tips, motivation, and challenges based on your smoking history. It teaches you to manage negative feelings, what to do if you relapse, how to deal with cravings, and more. This app is best used before you actually quit—it’ll send you information to help you stop smoking in anticipation of your quit date.

Medications

Several different medications are proven to be effective treatments for nicotine dependence. ((Abuse, N. I. on D. (–). What are treatments for tobacco dependence? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-are-treatments-tobacco-dependence))

• • Nicotine replacement therapy (NRT): NRTs reduce or eliminate uncomfortable nicotine withdrawal symptoms and cravings by triggering brain receptors normally affected by nicotine. NRTs come in different forms, such as the transdermal patch, gum, and lozenges, and are available over the counter. You can also purchase an inhaler or nasal spray with a prescription. They are all equally effective, and even more so when the transdermal patch is used with another NRT, especially when the treatment is taken beyond 12 weeks. NRT is estimated to boost quit rates by 50-70%.
  • Bupropion: This antidepressant stops the reuptake of 2 neurotransmitters, dopamine and norepinephrine, and also releases them. Studies show that it’s just as effective as NRT.
  • Varenicline: This medication triggers the same brain receptor affected by nicotine to minimize cravings. There is evidence that it works better than just 1 NRT alone, and studies also suggest that it’s more effective than bupropion.
  • Medication combinations: Research shows that combining medications may be the most effective approach for people who want to quit smoking. For example, one study gathered data from research literature and determined that using both varenicline and the NRT transdermal patch together worked better than varenicline alone.
  • Precision medicine: Pharmacogenetics aims to help health professionals tailor medications to the genetics of the individual, and may help you quit smoking. For example, some gene variations make people metabolize nicotine differently. ((Lerman, C., Schnoll, R. A., Hawk, L. W., Cinciripini, P., George, T. P., Wileyto, E. P., Swan, G. E., Benowitz, N. L., Heitjan, D. F., Tyndale, R. F., & PGRN-PNAT Research Group. (2015). Use of the nicotine metabolite ratio as a genetically informed biomarker of response to nicotine patch or varenicline for smoking cessation: A randomised, double-blind placebo-controlled trial. The Lancet. Respiratory Medicine, 3(2), 131–138. https://doi.org/10.1016/S2213-2600(14)70294-2)) People who metabolize nicotine at a faster rate smoke more, are more dependent, and find it more difficult to quit.

Mindfulness

In mindfulness-based sessions, ((Abuse, N. I. on D. (–). What are treatments for tobacco dependence? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-are-treatments-tobacco-dependence)) patients learn how to “increase awareness of and detachment from sensations, thoughts, and cravings that may lead to relapse.” They learn how to notice the thoughts that arise related to cravings and change them to be more tolerable. They’re also taught methods to help them deal with negative emotions in a healthy way, without the use of tobacco products.

Tobacco Use and Your Mental Health

Smoking often co-occurs with other psychiatric disorders, ((Aubin, H.-J., Rollema, H., Svensson, T. H., & Winterer, G. (2012). Smoking, quitting, and psychiatric disease: A review. Neuroscience and Biobehavioral Reviews, 36(1), 271–284. https://doi.org/10.1016/j.neubiorev.2011.06.007)) such as substance use disorder or depression. Depression and schizophrenia, in particular, are associated with higher tobacco use due to their sensitivity to its desired effects, such as better concentration and cognition, relief of stress and feelings of sadness, and pleasurable sensations. Data suggests that between 70-85% of people with schizophrenia also smoke tobacco. ((Abuse, N. I. on D. (–). Do people with mental illness and substance use disorders use tobacco more often? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/do-people-mental-illness-substance-use-disorders-use-tobacco-more-often)) However, new research also indicates that stopping tobacco use may actually help alleviate negative mental health symptoms, ((Minichino, A., Bersani, F. S., Calò, W. K., Spagnoli, F., Francesconi, M., Vicinanza, R., Delle Chiaie, R., & Biondi, M. (2013). Smoking behaviour and mental health disorders—Mutual influences and implications for therapy. International Journal of Environmental Research and Public Health, 10(10), 4790–4811. https://doi.org/10.3390/ijerph10104790)) especially if it’s coupled with mental health care.

Nicotine dependence is more likely in people with anxiety, depression, and substance use disorders. ((Abuse, N. I. on D. (–). Do people with mental illness and substance use disorders use tobacco more often? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/do-people-mental-illness-substance-use-disorders-use-tobacco-more-often)) In addition, they may be more prone to relapse when faced with stress or uncomfortable feelings. However, new research shows that tobacco use is correlated with poor behavioral and physical health in people with mental disorders, and that quitting smoking will lead to an overall better quality of life.

If you use tobacco regularly and also have a substance use disorder, you may be wondering whether you should try to quit both at once. Studies show that receiving treatment for both nicotine dependence and substance misuse does not negatively impact either case, ((Smoking interventions can help individuals in addiction treatment quit cigarettes, although questions remain about cessation effects on treatment outcomes. (2019, April 21). Recovery Research Institute. https://www.recoveryanswers.org/research-post/smoking-cessation-addiction/)) and another study found that they were actually both improved when patients were offered monetary rewards during addiction treatment. ((Quitting cigarettes in addiction treatment? (2017, March 8). Recovery Research Institute. https://www.recoveryanswers.org/research-post/quitting-cigarettes-in-addiction-treatment/))

Smart Strategies for Long-Term Abstinence From Smoking

Learn Your Triggers (And How to Deal With Them)

It’s easy to be triggered or socially pressured to smoke, even years after you’ve quit. In order to stay abstinent from smoking, ((How to stay smokefree | smokefree. (n.d.). Retrieved from https://smokefree.gov/stay-smokefree-good/stick-with-it/how-to-stay-smokefree)) it’s important to learn your triggers, or situations that entice you to smoke. For example, stress is a trigger for many people. In this instance, you’d want to devise a plan that consists of healthy behaviors that can alleviate stress, such as exercise. You can help learn more about these skills and coping mechanisms in CBT.

Have a Plan for When Cravings Hit

You should also come up with other activities you can do when cravings hit that prevent you from smoking. For example, you can go for a walk, engage in an enjoyable hobby, or call a friend. And remember—the longer you go without smoking, the fewer cravings you’ll experience.

Take Time to Reward Yourself

Don’t forget to reward yourself for not smoking. Quitting smoking is hard—there’s no doubt about that—so it’s important to celebrate and treat yourself to things you enjoy, like the movies or cooking classes. Take time to look at how far you’ve come.

Social Support is Important

Social support is crucial when quitting tobacco use. You may want to choose designated friends or family members that you can call when you feel like smoking again, and they can help you remember your reasons for abstaining from tobacco. A peer or mentor that has quit smoking in the past can be an invaluable source of support.

Technology Can Help Too

Sign up for an app or texting service like the ones described above, or see our article on finding online treatment for more resources.

Live a Healthier, Smoke-Free Life

Although it can be difficult to quit smoking, there are many different resources available that can help, making the process much easier. You can replace your smoking habit with activities that boost your mental and physical health, like exercise and therapy. In turn, these healthy hobbies can help you stay abstinent and help prevent relapse.

When you’ve decided it’s time to quit, know that there are many different programs that can help. See program highlights, pricing, insurance information, and more in our directory of smoking cessation rehabs.

Reviewed by Rajnandini Rathod

In our accelerating world, it can be hard to keep up. It’s no wonder that some people turn to prescription stimulants to cope. Drugs like Adderall, Ritalin, Dexedrine, and Concerta —sometimes called “smart drugs” or “study drugs”—can be very helpful for people with ADHD, narcolepsy, and major depression, when taken as prescribed. But if you’re vulnerable to addiction, they can quickly get out of hand.

If stimulants are having a negative impact on your life, you may need treatment for a substance use disorder. Recovery is possible for anyone—even people who began taking stimulants for an underlying condition. You can work with a team of providers to find a more sustainable way to manage your other symptoms, while still moving beyond the cycle of addiction.

Treatments for Stimulant Use Disorder
A variety of therapies are proven to be effective in combating smart drug addiction. Most treatment plans focus on behavior and mental health, because stimulant addiction can be hard to treat with medication. According to a review from the U.S. Department of Veterans Affairs, there are currently “no accepted FDA-approved pharmacotherapy treatment options available” for stimulant use disorders. ((Chan, B., Kondo, K., Ayers, C., Freeman, M., Montgomery, J., Paynter, R., & Kansagara, D. (2018). Pharmacotherapy for stimulant use disorders: A systematic review. https://www.ncbi.nlm.nih.gov/books/NBK536789)) Despite this, patients can engage in a variety of treatments, including psychotherapy and behavioral therapy.

Contingency Management

Contingency management is a behavioral treatment for stimulant misuse. ((Substance Abuse and Mental Health Services Administration. Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series 33. SAMHSA Publication No. PEP21-02-01-004. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-02-01-004.pdf)) It provides patients with tangible rewards to incentivize recovery. For example, you might get a certain number of vouchers for attending therapy, or testing negative for substance use. This strategy is shown to reduce cravings and risky behaviors.

Motivational Interviewing (MI)

Motivational interviewing is not a type of therapy, per se. Instead, it’s a conversation style that can be adopted by any healthcare provider, including doctors, nurses, and counselors. This client-centered approach puts the patient in the driver’s seat. Rather than forcing you to accept a specific form of treatment, your clinician will make space for you to process feelings of ambivalence, trusting that you know what course of action is right for you. Evidence suggests that motivational interviewing can decrease the duration and quantity of patients’ stimulant use. ((Substance Abuse and Mental Health Services Administration (SAMHSA): Treatment of Stimulant Use Disorders. SAMHSA Publication No. PEP20-06-01-001 Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2020.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of 1:1 talk therapy that identifies and modifies harmful thinking and behavior. In this treatment approach, you’ll work with a counselor to develop healthier responses to the impulses that aren’t serving you. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), CBT helps patients decrease the quantity and frequency of their stimulant use, ((Substance Abuse and Mental Health Services Administration (SAMHSA): Treatment of Stimulant Use Disorders. SAMHSA Publication No. PEP20-06-01-001 Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2020. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-06-01-001_508.pdf)) and decrease risky sexual behaviors.

Because medical interventions aren’t always helpful for patients with stimulant addiction, your plan of care will probably focus on behavioral modalities. But if you have a co-occurring disorder, like ADHD, the recommended treatment approach may be more complex.

Stimulant Misuse and Co-Occurring Disorders

Stimulants are most often prescribed to treat attention deficit hyperactivity disorder (ADHD), ((Abuse, N. I. on D. (2018, June 6). Prescription stimulants drugfacts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/prescription-stimulants)) and may also be used to treat narcolepsy or depression. When used correctly, they can be very effective. However, their high risk of abuse can be dangerous for people who are vulnerable to developing addictions. And furthermore, some experts are concerned that these study drugs are being overprescribed.

While the opioid epidemic has been the center of most addiction therapy legislation and research in recent years, the rising trends in the use of prescription stimulant addiction and mortality ((Piper, B. J., Ogden, C. L., Simoyan, O. M., Chung, D. Y., Caggiano, J. F., Nichols, S. D., & McCall, K. L. (2018). Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLoS ONE, 13(11), e0206100. https://doi.org/10.1371/journal.pone.0206100)) paint a concerning picture. And much like opiates, stimulants have a high risk of diversion ((Piper, B. J., Ogden, C. L., Simoyan, O. M., Chung, D. Y., Caggiano, J. F., Nichols, S. D., & McCall, K. L. (2018). Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLoS ONE, 13(11), e0206100. https://doi.org/10.1371/journal.pone.0206100))—being sold or given away by a person with a prescription, and subsequently taken by someone else. Whether or not you have a prescription for stimulants, their overuse can be extremely dangerous.

Neurochemical Effects of Stimulant Abuse

Stimulants increase levels of neurochemicals norepinephrine and dopamine, ((Sofuoglu, M., & Sewell, R. A. (2009). Norepinephrine and stimulant addiction. Addiction Biology, 14(2), 119–129. https://doi.org/10.1111/j.1369-1600.2008.00138.x)) boosting the speed at which the brain communicates. The result is increased physiological activity and reduced time for messages to travel from the brain to the body and back. In the short term, this makes many people feel alert and energized.

Based on your exact brain chemistry, though, you may have a different reaction to study drugs. For instance, if you have ADHD and take an appropriate amount of Adderall, it should alleviate your symptoms and help you focus. Whether or not you have this diagnosis, overusing a stimulant can have negative effects. ((Substance Abuse and Mental Health Services Administration. Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series 33. SAMHSA Publication No. PEP21-02-01-004. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-02-01-004.pdf))

Unfortunately, tolerance to smart drugs builds quickly. The effect of stimulants on dopamine ((Yanofski, J. (2011). The dopamine dilemma—Part ii. Innovations in Clinical Neuroscience, 8(1), 47–53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/)) is so volatile that, in some cases, this can happen within a matter of hours. Most users require increasingly larger doses over shorter periods of time to achieve the same result.

According to SAMHSA, stimulant overuse can also cause dangerous side effects ((Substance Abuse and Mental Health Services Administration (SAMHSA): Treatment of Stimulant Use Disorders. SAMHSA Publication No. PEP20-06-01-001 Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2020. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-06-01-001_508.pdf)) like “panic attacks, hostility, paranoia, psychosis, and even violent behavior.” These side effects can be signs of a serious addiction. And if you first started using stimulants because of another diagnosis, you might need to consider alternative treatment in order to begin recovery.

ADHD and Stimulant Misuse

Scientists believe there is a complex relationship between ADHD and substance use disorders. ((Mariani, J. J., & Levin, F. R. (2007). Treatment strategies for co-occurring adhd and substance use disorders. The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 16(Suppl 1), 45–56. https://doi.org/10.1080/10550490601082783)) According to one study, these 2 conditions frequently co-occur in the same patients. And although prescribed stimulants are the primary treatment for ADHD, these medications can interfere with recovery from substance misuse.

If you have both of these diagnoses, it’s important to work with a team of healthcare providers who have experience with co-occurring disorders. Together, you can weigh the risks and benefits of different treatment options. If you do use medication to control your ADHD, you may need to be monitored for signs of addiction even after you complete the initial phases of treatment.

Depression and Stimulant Misuse

While stimulants can be prescribed for people with major depression, they’re far from the only treatment option. If you’re in recovery from a stimulant use disorder, you may be a better candidate for other prescriptions. Many people with depression see improvement with SSRIs, SNRIs, and other non-addictive medications.

Narcolepsy and Stimulant Misuse

Because of the neurological processes involved with narcolepsy, it’s highly unlikely for these patients to develop substance use disorders. And since narcolepsy is commonly treated with stimulants, ((Turner, M. (2019). The treatment of narcolepsy with amphetamine-based stimulant medications: A call for better understanding. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 15(5), 803–805. https://doi.org/10.5664/jcsm.7788)) people with this condition often have prescriptions for these drugs of abuse. This ease of access can be a risk factor for addiction, either for them or the people around them.

Risk Factors for Stimulant Addiction

Many people who misuse stimulants start by taking them as prescribed. ((Compton, W. M., Han, B., Blanco, C., Johnson, K., & Jones, C. M. (2018). Prevalence and correlates of prescription stimulant use, misuse, use disorders, and motivations for misuse among adults in the U.S. The American Journal of Psychiatry, 175(8), 741–755. https://doi.org/10.1176/appi.ajp.2018.17091048)) Over time, as your tolerance goes up, you may be tempted to increase your dose without medical supervision. This is just one of several risk factors for developing a stimulant misuse disorder.

Academic Pressure

Stimulants are known as “smart drugs” because of their prevalence among college students. ((Trudeau, M. (2009, February 5). More students turning illegally to “smart” drugs. NPR. https://www.npr.org/2009/02/05/100254163/more-students-turning-illegally-to-smart-drugs)) There’s a great deal of research connecting substance misuse and the need—or perceived need—for academic enhancement. One study found that students with low confidence in their academic abilities were at especially high risk for misusing prescription stimulants. ((Looby, A., Beyer, D. L., & Zimmerman, L. (2015). Non-medical prescription stimulant use: Investigating modifiable risk factors. Addiction Research & Theory, 23(2), 143–147. https://doi.org/10.3109/16066359.2014.946411)) Another suggested that college enrollment was a risk factor for stimulant abuse ((Herman-Stahl, M. A., Krebs, C. P., Kroutil, L. A., & Heller, D. C. (2007). Risk and protective factors for methamphetamine use and nonmedical use of prescription stimulants among young adults aged 18 to 25. Addictive Behaviors, 32(5), 1003–1015. https://doi.org/10.1016/j.addbeh.2006.07.010)) in and of itself.

Family History

Experts believe there may also be a genetic component to this diagnosis. In one study, researchers reported that “stimulant drug users with a family history of substance abuse ((Just, A. L., Meng, C., Smith, D. G., Bullmore, E. T., Robbins, T. W., & Ersche, K. D. (2019). Effects of familial risk and stimulant drug use on the anticipation of monetary reward: An fMRI study. Translational Psychiatry, 9(1), 1–12. https://doi.org/10.1038/s41398-019-0399-4)) are eight times more likely to develop an addiction than those without a family history.”

It’s important to remember that substance misuse is complex. While genetics may play a role in addiction, they’re far from the only factor. Adverse life experiences can also be risk factors for any substance use disorder, including stimulant addiction.

Intimate Violence

Researchers have linked stimulant abuse with intimate violence. For example, one report found that women with a recent history of sexual assault have a “significantly higher” risk of stimulant misuse. ((Riley, E. D., Shumway, M., Knight, K. R., Guzman, D., Cohen, J., & Weiser, S. D. (2015). Risk factors for stimulant use among homeless and unstably housed adult women. Drug and Alcohol Dependence, 153, 173–179. https://doi.org/10.1016/j.drugalcdep.2015.05.023)) Experts believe that people who receive trauma-informed care after assault may be at a lower risk of developing addictions. However, more research is required.

If you’ve been sexually assaulted, you can get support from the Rape, Abuse & Incest National Network (RAINN). Call the National Sexual Assault Telephone Hotline at 800.656.4673 to access these services.

Reasons for Recovery

Although everyone’s recovery journey is unique, people struggling with stimulant addiction often have certain experiences in common. Many seek recovery after passing their threshold for living with its consequences. As painful as that moment can be, it also has the potential to be inspiring.

In an anonymous survey of people in recovery, one respondent describes how his stimulant misuse damaged his mental health. ((Spencer, L. P., Addison, M., Alderson, H., McGovern, W., McGovern, R., Kaner, E., & O’Donnell, A. (2021). ‘The drugs did for me what i couldn’t do for myself’: A qualitative exploration of the relationship between mental health and amphetamine-type stimulant (Ats) use. Substance Abuse: Research and Treatment, 15, 117822182110608. https://doi.org/10.1177/11782218211060852)) “I hated myself,” he says, “all that self-loathing and… self-hatred. I thought everybody hated me.” After receiving treatment, he now feels “grateful that I hit that rock bottom and I realized I’d had enough.”

Of course, this experience isn’t universal—rock bottom is not a prerequisite to getting sober. And, you may be vulnerable to relapse even after attending rehab or stimulant misuse. When you do start treatment, your clinical team will help you prepare a treatment plan that guides you through the first stages of recovery and includes considerations for relapse prevention as you re-enter your daily life.

It may seem intimidating now, but the first step is the hardest. And you don’t have to do it alone. There are plenty of dedicated professionals with experience helping people just like you successfully recover from prescription stimulant addiction.

For more information on treatment options including facilities, specialized programming, accreditations and more, see our directory of rehabs that treat prescription drug addiction.

Reviewed by Lisa Misquith

Treatment-resistant depression (TRD) has the same symptoms as depression, but with a more complex and challenging recovery process. And those very symptoms can make it difficult to seek help.

Although the journey to recovery from treatment-resistant depression can feel daunting, there are a growing number of treatment options available. And the more you know about your diagnosis, the more easily you can manage your symptoms and get the care you need.

Defining Treatment-Resistant Depression
Although it’s similar to major depressive disorder in many ways, treatment-resistant depression has its own set of clinical characteristics. ((Fabbri, C., Hagenaars, S. P., John, C., Williams, A. T., Shrine, N., Moles, L., Hanscombe, K. B., Serretti, A., Shepherd, D. J., Free, R. C., Wain, L. V., Tobin, M. D., & Lewis, C. M. (2021). Genetic and clinical characteristics of treatment-resistant depression using primary care records in two UK cohorts. Molecular Psychiatry, 26(7), 3363–3373. https://doi.org/10.1038/s41380-021-01062-9)) Specifically, TRD is defined as depression with symptoms that are not alleviated after trying 2 or more treatment options (medications) for at least 6 weeks each. Despite the myriad medical and behavioral options for treating depression, many people still struggle to find an effective treatment. ⅓ of people with major depression have TRD. ((MacDonald, A. (2010, December 9). New insights into treatment-resistant depression. Harvard Health. https://www.health.harvard.edu/blog/new-insights-into-treatment-resistant-depression-20101209891))

If you think you may have this diagnosis, you’re likely already familiar with the symptoms of major depression. ((What Is Depression? (n.d.). Psychiatry.Org. https://www.psychiatry.org/patients-families/depression/what-is-depression)) As stated by the American Psychiatric Association, the condition’s classic signs are as follows:

• feeling sad or having a depressed mood
• loss of interest or pleasure in activities once enjoyed
• changes in appetite — weight loss or gain unrelated to dieting
• trouble sleeping or sleeping too much
• loss of energy or increased fatigue
• increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
• feeling worthless or guilty
• difficulty thinking, concentrating or making decisions
  thoughts of death or suicide

If you’re thinking about suicide, get help right away. You can call the National Suicide Prevention Lifeline at 1-800-273-8255 to talk to someone, 24/7.

While these criteria are well understood, researchers are still exploring their underlying causes. Most people understand depression to be related to chemical factors in the brain. And research has confirmed that, even more than major depression, treatment-resistant depression has a genetic basis. ((Fabbri, C., Hagenaars, S. P., John, C., Williams, A. T., Shrine, N., Moles, L., Hanscombe, K. B., Serretti, A., Shepherd, D. J., Free, R. C., Wain, L. V., Tobin, M. D., & Lewis, C. M. (2021). Genetic and clinical characteristics of treatment-resistant depression using primary care records in two UK cohorts. Molecular Psychiatry, 26(7), 3363–3373. https://doi.org/10.1038/s41380-021-01062-9))

Genetics aren’t the only cause of this illness. There are also a number of environmental factors that may contribute to depression ((Factors that affect depression risk. (2020, August 28). National Institutes of Health (NIH). https://www.nih.gov/news-events/nih-research-matters/factors-affect-depression-risk)) —and it’s not just physical health. It has been associated with more frequent use of screens (cell phones, computers, etc.), and a lack of access to green space. High levels of air and noise pollution can also exacerbate symptoms. On the other hand, activities that guard against depression include confiding in other people, being part of a sports club or gym, and getting adequate sleep.

But there’s no quick fix for mental health. Even if you sleep for 8 hours a night and go to the gym every day, you may still experience depressive symptoms. And TRD can make you vulnerable to other conditions, like substance use disorders.

TRD and Substance Use Disorders

According to a 2019 study, patients with treatment-resistant depression are at a higher risk for developing addictions ((Brenner, P., Brandt, L., Li, G., DiBernardo, A., Bodén, R., & Reutfors, J. (2019). Treatment‐resistant depression as risk factor for substance use disorders—A nation‐wide register‐based cohort study. Addiction (Abingdon, England), 114(7), 1274–1282. https://doi.org/10.1111/add.14596)) than those with more easily treated major depressive disorder. And the reverse is also true: patients with substance use disorders may be more susceptible to developing TRD, ((Brenner, P., Brandt, L., Li, G., DiBernardo, A., Bodén, R., & Reutfors, J. (2020). Substance use disorders and risk for treatment resistant depression: A population‐based, nested case‐control study. Addiction (Abingdon, England), 115(4), 768–777. https://doi.org/10.1111/add.14866)) even after they seek help.

These findings have serious implications for the recovery process. If you have a history of either one of these conditions, you may be at risk of developing the other. And if you’re showing symptoms of both, you might want to consider treatment for co-occurring disorders.

Residential rehabs that offer this type of treatment may take a more nuanced approach. For example, you might work closely with your providers to develop an individualized plan of care. Depending on your exact program, you may have more or less say in which types of therapy you engage in during your stay.

Types of Therapy for Treatment-Resistant Depression

By definition, it’s challenging to find treatment for TRD. But remission is still possible. A growing body of research suggests that some therapies may be highly effective for patients with this diagnosis.

Medications

To be diagnosed with TRD, you must have tried at least 2 types of medication with little to no effect. Depending on which prescriptions you’ve taken so far, it may be worth continuing to experiment. For example, you might start by taking an SSRI (like Prozac) and then switch to a non-SSRI (like Wellbutrin). Some studies show that the act of switching medications may improve the symptoms of TRD. ((Philip, N. S., Carpenter, L. L., Tyrka, A. R., & Price, L. H. (2010). Pharmacologic approaches to treatment resistant depression: A re-examination for the modern era. Expert Opinion on Pharmacotherapy, 11(5), 709–722. https://doi.org/10.1517/14656561003614781))

Ketamine Therapy

Ketamine therapy is an increasingly popular treatment for depressive disorders. A growing body of research supports the idea that ketamine may be especially effective for patients with treatment-resistant depression. ((New hope for treatment-resistant depression: Guessing right on ketamine. (n.d.). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/about/director/messages/2019/new-hope-for-treatment-resistant-depression-guessing-right-on-ketamine)) This medication is normally administered in a controlled environment, facilitated by a psychotherapist and a medical team. During each session, you’ll receive an infusion of ketamine and enter a trance state, in which you may be able to process and accept difficult emotions. You’ll have time to talk about your experience afterward, either in a group or 1 on 1 with your therapist.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a comparatively new therapy for treatment-resistant depression. ((Yan, J. (2008). Fda approves new option to treat major depression. Psychiatric News. https://doi.org/10.1176/pn.43.22.0002)) During a TMS session, a series of magnetic pulses are used to stimulate the brain. According to the American Psychiatric Association, “the procedure, which is noninvasive and painless, is conducted in the outpatient setting. Unlike electroconvulsive therapy (ECT), patients need no anesthesia or sedation.”

Studies show that TMS causes noticeable improvement in patients with treatment-resistant depression. ((Somani, A., & Kar, S. K. (2019). Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: The evidence thus far. General Psychiatry, 32(4), e100074. https://doi.org/10.1136/gpsych-2019-100074)) Preliminary data suggest that this modality may be especially effective when combined with other approaches, like ongoing medications and psychotherapy.

Psychotherapy

Talk therapy, or psychotherapy, is a broad category. It includes modalities like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal psychotherapy, and more. Talk therapy is helpful for most mental health conditions, including treatment-resistant depression. However, different patients may benefit more from some specific types of therapy than others. Work with your provider to assess which format will best meet your needs.

Chris Aiken, MD, explains that talk therapy has “a slightly larger effect than pharmacotherapy” for patients with treatment-resistant depression. ((New answers for treatment-resistant depression. (n.d.). Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/view/new-answers-treatment-resistant-depression)) This modality offers patients ongoing support, and can dynamically respond to challenging situations in a way that medication just can’t. If you’re dealing with a sudden life change—like the loss of a job or relationship—you can easily schedule an extra session with your therapist. Changing or upping your medication is a much longer process.

Studies show that psychotherapy can amplify the effects of other TRD treatments, ((Bronswijk, S. van, Moopen, N., Beijers, L., Ruhe, H. G., & Peeters, F. (2019). Effectiveness of psychotherapy for treatment-resistant depression: A meta-analysis and meta-regression. Psychological Medicine, 49(3), 366–379. https://doi.org/10.1017/S003329171800199X)) such as pharmacotherapy (the use of prescription meds). And although more research is needed in this area, most rehab programs already invite patients to engage in more than one therapeutic modality.

Combined Approaches to Recovery

Recovery is a complex process. During treatment, you’ll work closely with a team of providers to find the treatments that work best for you. Experts believe that a combined approach, including multiple modalities at once, is the most effective way to heal from TRD. ((Cowen, P. J., & Anderson, I. M. (2015). New approaches to treating resistant depression. BJPsych Advances, 21(5), 315–323. https://doi.org/10.1192/apt.bp.114.013847))

Although treatment-resistant depression is a mental health condition, it can also impact your physical health, your relationships, and every other area of your life. Because of this, you may benefit from working with a variety of providers, such as a psychiatrist, a talk therapist, an art therapist, a medical doctor, and more. As you try various modalities, remember that there’s no single right answer. You might need to experiment with a few different combinations before finding the right fit.

How to Know When to Try a New Treatment

When you begin healing from any condition, whether it’s mental or physical, it’s important to track your symptoms carefully. For TRD, you can do this by journaling, using a mood tracker, or even making a spreadsheet to track how different behaviors affect your emotions. Working with healthcare providers is extremely important during this process. Your medical team—which may include an MD, therapist, psychiatrist, or other experts—will be able to refer to their notes, providing objective insight into your progress over time.

Trying New Medications

If you decide to try taking antidepressants for TRD, ((Antidepressants. (2009). V.A. Healthcare Network Upstate New York. https://www.mentalhealth.va.gov/coe/cih-visn2/Documents/Clinical/Depression_Specific_Tools/Antidepressant_Medications.pdf)) it’s absolutely essential that you follow your prescriber’s directions. Brain chemistry changes slowly, and it can be hard to know whether a new treatment is working unless you give it adequate time to take effect. Research suggests that it takes at least 4 to 6 weeks on a new medication before you start seeing results. That being said, everyone’s brain chemistry is different, and your experience here will be unique. Make sure to work closely with your provider to manage any side effects, and get their advice before changing or going off your meds.

Choosing the Right Therapist

When you’re working with an expert in any field, whether they’re a therapist or a plumber, it can take time to find the right fit. If you’ve been seeing a therapist for some time without noticeable results, don’t be afraid to look for a new provider. That being said, don’t jump ship just because it doesn’t feel good. The work of therapy may not be easy or fun; the question is whether it’s helping you make positive, sustainable changes in the rest of your life.

Environmental Factors

Because depression often has environmental causes, it can be helpful to see how your mood changes based on external factors. For example, do you feel worse in rainy weather, or when you don’t have time to see friends? In some cases, you can make behavioral changes to manage these symptoms, like investing in a sun lamp or rearranging your schedule. However, you’re unlikely to stop encountering common triggers. If life’s ongoing challenges have less of an effect on your mood as you continue treatment, it’s a sign that you’re on the right track.

Healing from TRD is an Opportunity

As painful as treatment-resistant depression can be, the process of healing can teach you a great deal. If you can, try to cultivate an attitude of curiosity about yourself and your healing journey. Doing this can help you commit to recovery, instead of being frustrated that you haven’t yet reached a certain goal.

When you try several different types of therapy, you’ll learn about yourself from every angle. People are complex, powerful, and multifaceted. That includes you. As you get to know yourself better, you may find that recovery is a creative act. For people with TRD, it means more than finding the right pill. Instead, this is the process of building a better and more fulfilling life.

With the proper support, you can absolutely heal from this condition. To connect with programs that offer treatment for TRD, you can browse our list of rehab centers here.

While benzodiazepines can effectively treat many conditions, they’re also highly addictive. It’s unfortunately common for patients to begin by taking these drugs as prescribed, and ultimately develop substance use disorders.

The process of recovery from substance abuse looks different for every patient. With benzos, it’s particularly important to seek medical treatment in order to mitigate the effects of detox. And even after your body begins to heal, you may benefit from continued mental health care. Because benzos are used to treat such a wide variety of diagnoses, many patients with this addiction need to develop new skills in order to manage their underlying mental health concerns.

Why Patients Start Misusing Benzos

Benzodiazepines have a number of medical benefits. They may be prescribed for patients with insomnia, generalized anxiety disorder, social anxiety disorder, insomnia, seizure disorders (like epilepsy), and more. Some of the most commonly prescribed benzos are Ativan, Halcion, Klonopin, Valium, and Xanax.

Their short-term use can be very helpful for some patients—including those in recovery from other substance use disorders. For other patients, though, the risks associated with benzos outweigh the benefits. ((Benzodiazepines: Uses, types, side effects, and risks. (2020, October 13). https://www.medicalnewstoday.com/articles/262809)) Although benzodiazepines provide short-term relief, their long-term use can produce serious side effects.

You can develop a tolerance to the sedative effects of benzodiazepines ((Vinkers, C. H., & Olivier, B. (2012). Mechanisms underlying tolerance after long-term benzodiazepine use: A future for subtype-selective g a b a a receptor modulators? Advances in Pharmacological Sciences, 2012, e416864. https://doi.org/10.1155/2012/416864)) relatively quickly, which makes their misuse more tempting to some patients. When your tolerance goes up, you need a higher and higher dose to achieve the desired result. If you’re vulnerable to addiction, this pattern can escalate quickly.

Among all the people who take them, 17.1% have misused benzodiazepines ((Abuse, N. I. on D. (2018, October 18). Research suggests benzodiazepine use is high while use disorder rates are low. National Institute on Drug Abuse. https://nida.nih.gov/news-events/science-highlight/research-suggests-benzodiazepine-use-high-while-use-disorder-rates-are-low)) at some point. And the manner in which they’re prescribed may contribute to that. Some experts are concerned that benzos are being overprescribed, ((Are benzodiazepines the new opioids? (n.d.). Yale Medicine. Retrieved from https://www.yalemedicine.org/news/benzodiazepine-epidemic)) as more and more patients are diagnosed with anxiety. And because they can be prescribed by primary care doctors, and not just psychiatrists, some patients take them without additional mental health treatment.

If your doctor doesn’t specialize in treating addiction or other mental health concerns, you may not receive adequate supervision after being given a prescription for benzos. This is especially dangerous for patients who are vulnerable to developing substance use disorders.

Risks of Benzodiazepine Use and Misuse

Some patients may be more susceptible to developing an addiction to benzos. For example, experts believe that “women may be particularly susceptible to abusing benzodiazepines to manage anxiety.” ((McHugh, R. K., Votaw, V., Bogunovic, O., Karakula, S. L., Griffin, M. L., & Weiss, R. D. (2017). Anxiety sensitivity and nonmedical benzodiazepine use among adults with opioid use disorder. Addictive Behaviors, 65, 283–288. https://doi.org/10.1016/j.addbeh.2016.08.020)) Although more research is needed, some data suggest that in fact, benzos may be more harmful than helpful for patients with severe mental health conditions, including anxiety. ((Brunette, M. F., Noordsy, D. L., Xie, H., & Drake, R. E. (2003). Benzodiazepine use and abuse among patients with severe mental illness and co-occurring substance use disorders. Psychiatric Services, 54(10), 1395–1401. https://doi.org/10.1176/appi.ps.54.10.1395))

Using benzodiazepines long-term also carries significant risks ((Johnson, B., & Streltzer, J. (2013). Risks associated with long-term benzodiazepine use. American Family Physician, 88(4), 224–226. https://www.aafp.org/afp/2013/0815/p224.html)) —even when they’re taken as directed. In particular, benzos can lead to “substantial cognitive decline” which does not resolve within 3 months of detox. They are also associated with a higher incidence of car accidents and—for older adults—hip fractures.

Even in the short term, these drugs are potentially dangerous. For example, benzodiazepines amplify the effects of alcohol, ((Linnoila, M. I. (1990). Benzodiazepines and alcohol. Journal of Psychiatric Research, 24 Suppl 2, 121–127. https://doi.org/10.1016/0022-3956(90)90043-p)) and vice versa. Experts caution that “many anxious patients may take advantage of that fact,” intentionally mixing the 2 substances to numb their symptoms of anxiety. This incautious use of benzos can put you at risk of overdose. And overdosing on benzos to the point of toxicity ((Kang, M., Galuska, M. A., & Ghassemzadeh, S. (2022). Benzodiazepine toxicity. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482238/)) can induce a coma, cause respiratory depression (trouble breathing), and may even be fatal.

But the knowledge of these risks is not always a deterrent to misusing substances. After developing an addiction, many patients need expert support in order to recover. Fortunately, there are many treatments for substance use disorders, and some have been specifically designed to treat benzodiazepine misuse.

Benzodiazepine Addiction Treatment

The process of healing from a substance use disorder is unique for every patient. When you’re ready to begin recovery, you can choose from a variety of treatment options. You may have different needs depending on the severity of your condition, how long you’ve used these drugs, and your other health concerns.

Tapering and Detox

If you’re actively misusing benzos, it’s important to talk to your doctor before you begin detox. Because you can become physiologically—not just psychologically—dependent on these medications, you may experience withdrawal when you stop taking them. Some patients are at risk for developing benzodiazepine withdrawal syndrome, ((Pétursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction (Abingdon, England), 89(11), 1455–1459. https://doi.org/10.1111/j.1360-0443.1994.tb03743.x)) which can be extremely dangerous. If possible, it’s best to go through detox under close medical supervision.

If you started taking benzos as a prescription for a co-occurring disorder, like anxiety, it can be especially hard to imagine life without them. Your medical team may be able to prescribe you non-addictive medications to treat the symptoms of withdrawal, and/or to treat your underlying symptoms.

Pharmaceutical Treatment for Benzodiazepine Dependence

During recovery from benzo misuse, medication can be helpful ((Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152–155. https://doi.org/10.18773/austprescr.2015.055)) in a number of ways. In a detox program, for example, your doctor may taper down your dose of one type of benzodiazepine, and temporarily replace it with a similar medication. “A common approach is substituting these shorter half-life drugs, such as alprazolam, with longer half-life drugs, such as diazepam.” Over time, your medical team will most likely support you in stopping use of all benzos.

Other prescriptions, such as anti-nausea medications, may help alleviate the physical discomfort of withdrawal. And after your body stabilizes, a psychiatrist may help you find the right medication to treat your ongoing mental health needs.
Not every person can or should rely on the long-term use of pharmaceuticals, however. And whether or not medication-assisted treatment is a good fit, many patients benefit from engaging in therapeutic modality at the same time.

Psychotherapy (Talk Therapy)

Psychotherapy can be extremely valuable during any stage of recovery. In particular, patients with an addiction to benzos may benefit from cognitive behavioral therapy (CBT). In this type of talk therapy, patients learn skills that help them navigate difficult thought patterns or other triggers. Some studies suggest that patients who are treated with CBT during withdrawal from benzodiazepines ((Morin, C. M., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallières, A. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. The American Journal of Psychiatry, 161(2), 332–342. https://doi.org/10.1176/appi.ajp.161.2.332)) may reach a state of abstinence more quickly.

Some experts also recommend motivational interviewing (MI) to manage benzo misuse. ((Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152–155. https://doi.org/10.18773/austprescr.2015.055)) In this approach, any healthcare provider—including a therapist, psychiatrist, or even a medical doctor—helps the patient navigate feelings of ambivalence. However more research is needed into MI’s effectiveness in treating benzodiazepine addiction. One review found that there is little evidence to support the idea that MI hastens recovery. However, the researchers cited the poor quality of available data, recommending further inquiry.

Talk therapy of any kind can offer you deeper insight into your mental health. For example, you may have begun misusing benzos in response to trauma or in the attempt to self-medicate another diagnosis, like anxiety. A skilled therapist can help you develop healthier and more sustainable ways of coping with your ongoing symptoms.

Long-Term Recovery from Benzo Addiction

Long-term recovery looks different for every patient. Even after detox and residential rehab, you may benefit from ongoing support. Many people engage in ongoing talk therapy, join support groups, and continue taking prescriptions to manage their mental health.

Over time, you can develop healthier coping mechanisms. However, if you have a history of addiction, you may always be at risk of relapse. Because of this, it’s important to structure your life in such a way that you’ll have support during challenging times.

To take the first step in your recovery journey, you can browse our list of rehabs that treat benzodiazepine misuse.

Reviewed by Rajnandini Rathod

Bipolar disorder can be overwhelming. Like any mood disorder, this diagnosis can impact your relationships, your work, and your emotional well-being. But it’s possible to live a full and meaningful life, even with such a serious diagnosis. You can achieve this by finding mental health treatment that meets your unique needs.

About 2.8% of the population is diagnosed with bipolar disorder ((Bipolar disorder. (n.d.). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/statistics/bipolar-disorder)) (once called manic-depressive disorder). And 83% of those cases are classified as severe. However, these numbers do not reflect cases that go undiagnosed. This condition is also frequently misdiagnosed as schizophrenia or borderline personality disorder (BPD). And without the proper diagnosis, finding treatment is a challenge.

If you have—or think you may have—bipolar disorder, you can start by learning more about its symptoms. And with that information, you’ll be better equipped to talk to a treatment professional about what to do next.

Understanding Bipolar Disorder

Bipolar disorder may be caused by a combination of factors. ((Causes—Bipolar disorder. (2021, February 11). Nhs.Uk. https://www.nhs.uk/mental-health/conditions/bipolar-disorder/causes/)) You might be genetically predisposed to developing it, even if previous generations of your family were never diagnosed. It may also be related to a neurochemical imbalance. Some experts believe it can be caused or made worse by traumatic experiences.

This diagnosis is characterized by “intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes,” according to the American Psychiatric Association. Bipolar disorder is differentiated from other mood disorders ((What Are Bipolar Disorders? (n.d.). American Psychiatry Association. https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders)) based on how long each episode lasts. The term “bipolar” leads some casual observers to believe that the associated mood swings are simply highs and lows. But that’s far from the reality of living with BPD. There are 3 complex mood states associated with this condition:

Mania

Although manic episodes ((Administration, S. A. and M. H. S. (2016, June). Table 11, dsm-iv to dsm-5 manic episode criteria comparison [Text]. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t7/)) include an elevated mood, they aren’t necessarily associated with happiness. Instead, this state often includes sleeplessness, anxiety, irritability, and disproportionate anger. It can also cause impulsivity, which may lead to excessive spending, promiscuity, or substance misuse.

Depression

Depressive episodes mimic the symptoms of major depression. Those symptoms may include fatigue, oversleeping, trouble concentrating, over- or undereating, and suicidal ideation. It is a common misconception that depression is simply extreme sadness. Although patients may feel sad during episodes of bipolar depression, they may also feel numb or disconnected from the world around them.

To qualify for a diagnosis of bipolar disorder, ((Bipolar disorder | nami: National alliance on mental illness. (n.d.). Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder)) the “depressive symptoms that obstruct a person’s ability to function must be present nearly every day for a period of at least two weeks.” These symptoms may last longer than 2 weeks, but over time they must be interspersed with other emotional states, including mania, hypomania, and/or periods of a normal mood. If those swings are not present, the patient may instead be showing signs of major depression.

Hypomania

Patients with bipolar disorder are also prone to a 3rd emotional state: hypomania. This mood is often characterized as a less severe version of classic mania. Patients still show energy, impulsivity, and other signs of mania; however, their symptoms are less overwhelming. And unlike mania, “hypomania does not cause a major deficit in social or occupational functioning.” ((Dailey, M. W., & Saadabadi, A. (2022). Mania. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK493168/)) By definition, it lasts for at least 4 days, whereas mania lasts for at least a week.

Types of Bipolar Disorder

Based on the frequency and severity of the patient’s mood states, bipolar disorder may be classified in 1 of 3 ways. This classification helps determine which type of treatment is most appropriate.

Bipolar Disorder I

Bipolar disorder I ((Bipolar disorder | nami: National alliance on mental illness. (n.d.). Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder)) includes severe manic episodes, lasting for at least 7 days.

Patients with this condition also experience depressive episodes that may last for weeks at a time. In extreme cases, hospitalization can be necessary.

Bipolar I patients may also experience episodes of psychosis, in which they lose touch with present reality. With bipolar psychosis, “symptoms tend to match a person’s mood. During a manic phase, they may believe they have special powers. This type of psychosis can lead to reckless or dangerous behavior.” Partly because of this symptom, bipolar I is considered more severe than bipolar II.

Bipolar Disorder II

Bipolar disorder II ((Bipolar ii disorder | johns hopkins psychiatry guide. (n.d.). Retrieved from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787046/all/Bipolar_II_Disorder?refer=true)) is more often associated with depressive episodes than mania. Patients with this condition experience similar swings, but their mania is both less severe and less frequent. Some experience depressive episodes interspersed with hypomanic episodes, without ever showing symptoms of mania.

Cyclothymic Disorder

Patients with cyclothymic disorder (or cyclothymia) ((Parker, G., McCraw, S., & Fletcher, K. (2012). Cyclothymia: Cyclothymia. Depression and Anxiety, 29(6), 487–494. https://doi.org/10.1002/da.21950)) also cycle between depression and hypomania. However, this condition includes less severe symptoms than other forms of bipolar. It can also take much longer to get an accurate diagnosis. Patients must experience mood swings for at least 2 years, without ever meeting the exact criteria for bipolar I or bipolar II.

Living With Bipolar Disorder

It’s important to remember that bipolar disorder is a medical diagnosis, and not a reflection of a person’s character. Like any other diagnosis—from diabetes to depression—it can have a huge impact on your ability to function. And in addition, the events of your life may make symptoms more or less severe. Patients may have difficulty navigating regular activities as a result of this condition.

Important Life Events

Trauma is linked to the development of many psychiatric conditions, including depression, anxiety, and a number of mood disorders. Bipolar is no exception. Experts agree that “​​childhood trauma in all its subcomponents appears to be highly associated” with BPD. ((Aas, M., Henry, C., Andreassen, O. A., Bellivier, F., Melle, I., & Etain, B. (2016). The role of childhood trauma in bipolar disorders. International Journal of Bipolar Disorders, 4(1), 2. https://doi.org/10.1186/s40345-015-0042-0))

After developing the diagnosis, various life events may bring on severe mood swings. Both traumatic events and extremely positive experiences may be risk factors for bipolar mood swings. ((Apa psycnet. (n.d.). Retrieved from https://psycnet.apa.org/record/2009-09047-018)) Research has found that “bipolar patients are highly sensitive to reward, and excessive goal pursuit after goal-attainment events may be one pathway to mania. Negative life events predict depressive symptoms, as do levels of familial expressed emotion.”

Career

When even positive events can trigger your symptoms, it may be difficult to maintain an upward trajectory. For that reason, bipolar disorder interferes with some patients’ ability to work.

One study on the effects of BPD on work performance ((O’Donnell, L., Himle, J. A., Ryan, K., Grogan-Kaylor, A., McInnis, M. G., Weintraub, J., Kelly, M., & Deldin, P. (2017). Social aspects of the workplace among individuals with bipolar disorder. Journal of the Society for Social Work and Research, 8(3), 379–398. https://doi.org/10.1086/693163)) found that “Occupational disability is one of the most problematic impairments for individuals with bipolar disorder due to high rates of unemployment and work impairments. Current evidence indicates that social stressors at work—such as social isolation, conflict with others, and stigmas—are common experiences for employed individuals with bipolar disorder.”

These social stressors can make or break a patient’s success in the workplace. And for people with bipolar, social support is especially impactful throughout the healing process.

Community Building

Strong relationships are uniquely important for people with this condition. Data suggests that for people with bipolar disorder, social support may be directly linked to the severity and frequency of symptoms. ((Johnson, L., Lundström, O., Åberg-Wistedt, A., & Mathé, A. A. (2003). Social support in bipolar disorder: Its relevance to remission and relapse: Social support in bipolar disorder. Bipolar Disorders, 5(2), 129–137. https://doi.org/10.1034/j.1399-5618.2003.00021.x))

According to experts, “empathy and understanding from another person can make it easier to cope with bipolar disorder. ((Owen, R., Gooding, P., Dempsey, R., & Jones, S. (2017). The reciprocal relationship between bipolar disorder and social interaction: A qualitative investigation: bipolar disorder and social interaction. Clinical Psychology & Psychotherapy, 24(4), 911–918. https://doi.org/10.1002/cpp.2055)) Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode.” A loss of social support, on the other hand, can trigger either mania or depression.

When your diagnosis has such a great impact on so many aspects of life, it can be hard to disentangle your symptoms from normal emotional reactions. And remember, not all healthy reactions are positive. For example, it’s perfectly healthy to experience anxiety if you have to switch jobs. Patients with bipolar disorder may struggle to stay present with that anxiety, instead of tipping into a manic episode. Without support, these challenges can lead to unhealthy coping mechanisms, including addiction.

Bipolar and Substance Use Disorders

There is a high prevalence of substance abuse among people with bipolar disorder. ((Levin, F. R., & Hennessy, G. (2004). Bipolar disorder and substance abuse. Biological Psychiatry, 56(10), 738–748. https://doi.org/10.1016/j.biopsych.2004.05.008)) This may be an attempt to self-medicate by regulating unstable moods, and/or a response to symptomatic impulsivity. ((Swann, A. C., Dougherty, D. M., Pazzaglia, P. J., Pham, M., & Moeller, F. G. (2004). Impulsivity: A link between bipolar disorder and substance abuse. Bipolar Disorders, 6(3), 204–212. https://doi.org/10.1111/j.1399-5618.2004.00110.x))

Also, experts believe there may be “a shared neurobiology between bipolar disorder and addictions.” ((Stokes, P. R. A., Kalk, N. J., & Young, A. H. (2017). Bipolar disorder and addictions: The elephant in the room. The British Journal of Psychiatry, 211(3), 132–134. https://doi.org/10.1192/bjp.bp.116.193912)) If this is true, it would mean that people with a diagnosis of bipolar are neurologically predisposed to substance use disorders. Much more research is needed on this subject, however.

Because bipolar disorder may be related to neurochemical imbalances, ((Maremmani, I., Perugi, G., Pacini, M., & Akiskal, H. S. (2006). Toward a unitary perspective on the bipolar spectrum and substance abuse: Opiate addiction as a paradigm. Journal of Affective Disorders, 93(1), 1–12. https://doi.org/10.1016/j.jad.2006.02.022)) substance use of any kind can have a direct impact on your symptoms. That’s true of both addictive behavior and appropriate use of prescription medications. Because of this concern, it’s absolutely vital for patients to find clinicians who have experience with this diagnosis.

If you have both bipolar disorder and a history of addiction, you may benefit from a rehab for co-occurring disorders. These programs address the whole picture of each patient’s diagnoses, rather than treating their symptoms individually.

Healing from Bipolar Disorder

Bipolar disorder is considered a chronic condition. Once you receive this diagnosis, it will probably continue to apply for the rest of your life. That being said, bipolar can absolutely go into remission, and some patients go for long periods of time between manic, hypomanic, or depressive episodes. With appropriate care and management, you can significantly improve your quality of life.

While there are a number of ways to treat bipolar disorder, ((Bipolar disorder | nami: National alliance on mental illness. (n.d.). Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder/Treatment)) most patients benefit from a combination of therapy and medication. During treatment, you’ll work closely with your providers to decide which options are best for you. Certain modalities are proven to be extremely effective.

Psychotherapy

Talk therapy is a powerful way to begin healing from almost any mental health diagnosis. With this approach, you’ll develop a 1-on-1 relationship with a provider. Therapy sessions will take place more often during inpatient treatment—sometimes even daily. Outside of rehab, it’s more common for patients to meet with their therapists once a week. However, your specific therapist may suggest you see each other either more or less often.

This modality allows patients to work through difficult feelings in a safe context. Therapy can work as a release valve, in which you can express extreme feelings without jeopardizing other relationships. It’s your therapist’s job to hold space for you, no matter what you think or how you feel. You can safely and ethically set aside any concern that they’ll judge you negatively for having mood swings.

Research has demonstrated that therapy is extremely important for people with this condition. Experts write that “psychotherapy, when added to medication for the treatment of bipolar disorder, ((Swartz, H. A., & Swanson, J. (2014). Psychotherapy for bipolar disorder in adults: A review of the evidence. Focus (American Psychiatric Publishing), 12(3), 251–266. https://doi.org/10.1176/appi.focus.12.3.251)) consistently shows advantages over medication alone as a treatment for bipolar disorder. There are many different types of psychotherapy. If you attend an inpatient program, the team at your facility will help you choose which modality best suits your needs.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) teaches you how to change your thought patterns ((What is cognitive behavioral therapy? (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral)) using practical, repeatable strategies. For example, you might learn to recognize when you’re having a disproportionate emotional reaction. In those moments, CBT skills can help you ground yourself in the present moment, and respond from a calmer place.

Data suggests that this type of therapy is especially helpful for patients with certain conditions. Specifically, CBT “has a positive impact on patients with bipolar disorder ((Chiang, K.-J., Tsai, J.-C., Liu, D., Lin, C.-H., Chiu, H.-L., & Chou, K.-R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PLoS ONE, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849)) in terms of reducing depression levels, improving mania severity, decreasing relapse rates and increasing psychosocial functioning.”

Psychiatry and Medication

Medication can be hugely beneficial for people with bipolar. Specifically, psychiatrists often prescribe lithium, lamotrigine, or antidepressants like Prozac. Because this condition is thought to be a neurochemical imbalance, these treatments may be necessary even if talk therapy proves helpful.

However, it’s also important to consider the relationship between bipolar and substance use disorders. Even with a prescription in hand, some patients may be tempted to fall back into unhealthy patterns. In order to avoid this, it’s extremely important to stay in close communication with your mental health team about your medication use. For some, having access to a prescription of any kind may be a trigger. If that’s the case for you, be sure to ask your therapist about substance-free treatment options.

Finding Balance With Bipolar Disorder

With extreme emotions, introspection can be difficult. Some patients with bipolar disorder struggle to find clarity, or even to ask for help. If these symptoms resonate with your experience, know that you have the right to reach out. It’s important to get the care you need.

Because bipolar disorder touches on so many aspects of life, it can be difficult to imagine what healing would look like. Remember that, no matter how severe your symptoms may be, no emotion lasts forever. Over time, you can and will feel differently. And, with the right support, you can even feel consistently better. It’s absolutely possible for clients with bipolar to live rich and meaningful lives.

To learn more about your options and take the first step towards healing, see our directory of mental health treatment centers for information including conditions treated, therapies offered, pricing, and more.

Reviewed by Rajnandini Rathod

Sex and love are important aspects of a full life. However, both can be addictive. And it can be hard to distinguish between sustainable and toxic relationships. But, like any other type of mental health condition, healing is always possible. And there are many ways to treat sex and love addiction.

What is Sex/Love Addiction?

This condition can “take several forms — including (but not limited to) a compulsive need for sex, extreme dependency on one person (or many) and/or chronic preoccupation with romance, intrigue, or fantasy.” You may benefit from treatment for sex and love addiction ((Do i belong? (n.d.). SLAANY. Retrieved March 29, 2022, from https://www.slaany.org/do-i-belong)) if you exhibit some or all of the following characteristics, as defined by Sex and Love Addicts Anonymous (also called The Augustine Fellowship):

1. You lack healthy boundaries, and you quickly become sexually involved with or emotionally attached to people you don’t know.

2. You fear abandonment. As a result, you repeatedly return to painful and destructive relationships, growing more isolated from friends and loved ones over time.

3. Because you fear emotional and/or sexual deprivation, you compulsively pursue romantic relationships, sometimes engaging in more than one at a time.

4. You confuse love with neediness, sexual attraction, pity, and the need to rescue or be rescued.

5. You feel empty and incomplete when you are alone.

6. You sexualize emotions such as stress, guilt, shame, anger, and fear.

7. You use sex as a substitute for nurturing, care, and support.

8. You use sex to manipulate others.

9. You are often distracted by romantic or sexual obsessions.

10. You avoid taking responsibility for your own life by attaching yourself to people who are emotionally unavailable.

11. Your life is ruled by emotional dependency, romantic intrigue, or compulsive sex.

12. You avoid feeling vulnerable and mistake sexual intimacy for emotional intimacy.

13. You idealize and pursue other people, and then blame them for not meeting your unrealistic expectations.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is unclear on its definition of sex and love addiction, which may be a barrier to treatment for some patients. However, some experts believe that it’s possible to diagnose hypersexual or compulsive sexual behavior ((Krueger, R. B. (2016). Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD-10 and DSM-5 despite rejection of this diagnosis by the American Psychiatric Association. Addiction, 111(12), 2110–2111. https://doi.org/10.1111/add.13366)) by using criteria from other sources, such as the International Classification of Diseases, 11th Revision (ICD-11). The ICD-11 includes a code for “other sexual dysfunction not due to substance or known physiological condition,” which may be used for patients with a sex and/or love addiction.

In part, this condition may be hard to diagnose because it’s difficult to distinguish between “real love” and unhealthy attachments. Many substance use disorders are equally hard to define. For example, it’s common for people to develop opiate use disorders after taking prescribed medications for very real physical pain. If you’re not sure whether you have this condition, you can start by learning how to recognize healthy vs. unhealthy interpersonal dynamics.

Recognizing Healthy and Unhealthy Relationships

If you have a sex or love addiction, you may feel like you don’t have control over your own life. It can seem as if your value or emotional stability are tied to the highs and lows of your relationships. And if your relationships are especially volatile, it can be difficult to focus on your other goals.

Every relationship has its ups and downs. But those patterns aren’t always extreme, and they shouldn’t derail every aspect of your life. And this condition, like any other, describes the experience of one individual person—not a relationship dynamic.

You have control over your own behavior. That doesn’t mean you’re to blame for toxic relationships. It does mean that you can make changes that will improve your life. If you’re addicted to sex and love, you can get help. That may mean ending a relationship that doesn’t serve you, especially if you’re partnered with someone who has a similar condition.

If you’re concerned you may have a sex or love addiction, you can take stock of your interpersonal dynamics. If you have some unhealthy relationships and some healthy ones, you may need to reconsider who you want to be close with. However, if most or all of your relationships include unhealthy patterns, it’s likely that your behavior is contributing to that fact.

Healthy Relationships

In a healthy relationship, ((Healthy relationships: Definition, characteristics, and tips. (n.d.). The Berkeley Well-Being Institute. Retrieved March 29, 2022, from https://www.berkeleywellbeing.com/healthy-relationships.html)) partners share mutual trust and respect. Each person sets boundaries that are appropriate for them, as an individual. When someone gets hurt, healthy partners face the problem together. Nobody’s perfect, which means that no partnership is perfect. But in healthy and sustainable relationships, partners are committed to working through difficulties as a team. You might not get your needs met 100% of the time, but you shouldn’t feel as though your partner is actively preventing you from achieving your goals.

Toxic Relationships

As the concept of “toxic relationships” continues to gain attention, this phrase is sometimes used unfairly or inaccurately. Not every unhappy relationship is toxic, and not every toxic relationship is abusive. However, toxicity is a sign that something needs to change.

Dr. Lillian Glass, who says she coined the term in 1995, explains that a toxic relationship ((How to tell if you’re in a toxic relationship. (n.d.). Time. Retrieved March 29, 2022, from https://time.com/5274206/toxic-relationship-signs-help/)) is “any relationship [between people who] don’t support each other, where there’s conflict and one seeks to undermine the other, where there’s competition, where there’s disrespect and a lack of cohesiveness.”

Whether you are causing harm, being harmed, or simply paired with a person who can’t meet your needs, you are capable of making changes. And while it’s important to understand the root cause of the issue, blame is often unhelpful.

Speaking to TIME Magazine, mental health expert Dr. Kristen Fuller says, “people who consistently undermine or cause harm to a partner — whether intentionally or not — often have a reason for their behavior, even if it’s subconscious.” This does not diminish the impact of harmful actions. She adds that “toxic relationships are mentally, emotionally and possibly even physically damaging to one or both participants.

Abusive Relationships

There’s a fine line between toxic and abusive relationships, and there are many different types of abuse. ((Types of abuse. (n.d.). Love Is Respect. Retrieved from https://www.loveisrespect.org/resources/types-of-abuse/)) According to Love is Respect, a project of the National Domestic Violence Hotline, “People often assume physical violence when they hear about abuse, but that’s not always the case. Dating abuse is a pattern of behaviors used to gain or maintain power and control over a partner — physical violence is just one example of such behavior.” Their website goes on to categorize some of the most common forms of abuse as follows:

• Physical abuse
• Emotional and verbal abuse
• Sexual abuse
• Financial abuse
• Digital abuse
• Stalking

If you are experiencing any type of abuse, you can get help immediately. Call the National Domestic Violence Hotline at 1.800.799.7233 to speak with an expert.

It can be hard to escape an abusive cycle for any number of reasons. This is especially true for people with sex and love addictions, who may have trouble leaving at the first signs of danger. You may feel trapped due to practical concerns, such as financial dependence or being isolated from other friends. And abuse can also cause neurochemical symptoms of addiction.

Neurochemical Impact of Sex and Love Addiction

Even healthy romantic love can affect neurochemistry. ((Uddin, M. (2017). Neurochemistry of Love: Can Romantic Love Truly be Addictive? 21(e113). https://www.walshmedicalmedia.com/open-access/neurochemistry-of-love-can-romantic-love-truly-be-addictive-2378-5756-1000e111.pdf)) And if you’re in an unhealthy relationship, or if you exhibit addictive behavior in your relationships, this can become more extreme. Researchers have found that the neurochemical patterns of sex and love addiction are very similar to those of other substance use disorders.

In one framework, experts describe romantic love as being “literally addictive.” ((Earp, B. D., Wudarczyk, O. A., Foddy, B., & Savulescu, J. (2017). Addicted to love: What is love addiction and when should it be treated? Philosophy, Psychiatry, & Psychology : PPP, 24(1), 77–92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378292/)) In fact, there are so many “similarities between addictive substance use and love- and sex-based interpersonal attachments, from exhilaration, ecstasy, and craving, to irregular physiological responses and obsessive patterns of thought, that a number of scientific theorists have begun to argue that both sorts of phenomena may rely upon similar or even identical psychological, chemical, and neuroanatomical substrates.”

This data suggests that people with sex and love addictions may become caught up in the same cycle as other substance users. In this process, the patient’s reward system is activated by the use of a substance, making it hard to change unhealthy behavior. This can continue to happen despite negative consequences, including physical ailments and damaged relationship dynamics. One study, comparing sexual addiction to cocaine addiction, ((Sunderwirth, S., Milkman, H., & Jenks, N. (1996). Neurochemistry and sexual addiction. Sexual Addiction & Compulsivity, 3(1), 22–32. https://doi.org/10.1080/10720169608400097)) found that the former, “although more complex than drug addiction, is not fundamentally different.” And like any other substance use disorder, sex and love addiction also has a behavioral component.

Codependency and Love Addiction

Many people with sex and/or love addictions, among other diagnoses, exhibit codependent behavior. In a direct quote from Mental Health America, the characteristics of codependency ((Co-dependency. (n.d.). Mental Health America. Retrieved March 29, 2022, from https://www.mhanational.org/co-dependency)) are described as follows:

• an exaggerated sense of responsibility for the actions of others
• a tendency to confuse love and pity, with the tendency to “love” people they can pity and rescue
• a tendency to do more than their share, all of the time
• a tendency to become hurt when people don’t recognize their efforts
• an unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship; to avoid the feeling of abandonment
• an extreme need for approval and recognition
• a sense of guilt when asserting themselves
• a compelling need to control others
• lack of trust in self and/or others
• fear of being abandoned or alone
• difficulty identifying feelings
• rigidity/difficulty adjusting to change
• problems with intimacy/boundaries
• chronic anger
• lying/dishonesty
• poor communications
• difficulty making decisions

If you engage in some or all of these behaviors, you may be showing signs of codependency. That doesn’t mean you’re a bad person, and it doesn’t mean that your feelings are invalid. It does, however, mean that you might need help in order to heal.

You can begin recovery even if your partner or loved ones aren’t ready to do their own work. And fortunately, there are a number of established methods for treating codependency as a symptom of sex and love addiction.

Treatment for Sex and Love Addiction

Sex and/or love addictions can have a hugely negative impact on your relationships. Because of this, some patients may benefit from attending inpatient rehab when they first enter recovery. By removing yourself from potentially harmful situations, you may gain valuable insight.

As helpful as it can be, residential treatment isn’t a realistic option for everyone. But many of the approaches used by rehabs are also available in outpatient settings. For example, you may be able to start recovery by scheduling an appointment with a local therapist.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a style of talk therapy in which patients learn practical skills to reconsider unhealthy thought patterns. Many people with sex and love addictions see great improvement from CBT. ((George, M., Maheshwari, S., Chandran, S., Rao, S. S., Shivanand, M. J., & Sathyanarayana Rao, T. S. (2018). Psychosocial intervention for sexual addiction. Indian Journal of Psychiatry, 60(Suppl 4), S510–S513. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_38_18)) Specifically, you might engage in behavioral exercises and exposure therapy designed to help you navigate triggering situations and practice responding in a healthier way.

Motivational Enhancement Therapy

Motivational enhancement therapy ((George, M., Maheshwari, S., Chandran, S., Rao, S., Manohar, Js., & Sathyanarayana Rao, T. (2018). Psychosocial intervention for sexual addiction. Indian Journal of Psychiatry, 60(8), 510. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_38_18)) is a “client-centered intervention which helps in modification of behavior by helping subjects in identifying and resolving the ambivalence toward a change in self.” With this approach, you’ll collaborate with a therapist to create “treatment plans and set attainable goals.” This approach empowers patients to take control of their own recovery process. ((George, M., Maheshwari, S., Chandran, S., Rao, S. S., Shivanand, M. J., & Sathyanarayana Rao, T. S. (2018). Psychosocial intervention for sexual addiction. Indian Journal of Psychiatry, 60(Suppl 4), S510–S513. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_38_18))

Psychodynamic Therapy

When most people think of talk therapy, they picture psychodynamic therapy. ((Psychodynamic therapy: Definition, approach, focus, and more. (2020, September 30). https://www.medicalnewstoday.com/articles/psychodynamic-therapy)) You’ll meet with a provider 1-on-1, discussing your life and strategizing ways to improve your behavior and relationships. This modality helps patients to “reduce current anxiety, depression, guilt and to improve social adjustment.” However, it’s important to note that “there is no evidence for this as a solitary treatment” for sex and love addiction; ((George, M., Maheshwari, S., Chandran, S., Rao, S. S., Shivanand, M. J., & Sathyanarayana Rao, T. S. (2018). Psychosocial intervention for sexual addiction. Indian Journal of Psychiatry, 60(Suppl 4), S510–S513. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_38_18)) patients should use it as one part of a combination approach to healing.

Medications for Sex and Love Addiction

Although some psychiatrists may prescribe certain non-addictive medications for people with sex and love addictions, ((Fong, T. W. (2006). Understanding and managing compulsive sexual behaviors. Psychiatry (Edgmont), 3(11), 51–58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945841/)) “there are no US Food and Drug Administration (FDA)-approved medications for compulsive sexual behaviors.” Any pharmaceutical treatment for this condition should take place in addition to other forms of therapy.

However, in combination with other modalities, medication may help you begin to heal. For example, antidepressants are known to decrease libido, which may help with some of your symptoms. And mood stabilizers, such as lithium, can curb impulsive behaviors, including compulsive sexual behavior.

Support Groups

Self-help groups, including 12-Step support groups, are “associated with successful outcome[s]” for patients with sex and love addictions. ((George, M., Maheshwari, S., Chandran, S., Rao, S. S., Shivanand, M. J., & Sathyanarayana Rao, T. S. (2018). Psychosocial intervention for sexual addiction. Indian Journal of Psychiatry, 60(Suppl 4), S510–S513. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_38_18)) Because of this, most patients who seek help for these conditions are referred to such groups. The best-known support groups for this condition are Sex and Love Addicts Anonymous (S.L.A.A.) ((I’m a newcomer, is s. L. A. A. For me? – Sex and love addicts anonymo(S. L. A. A.)us. (n.d.). Retrieved March 29, 2022, from https://www.slaafws.org/newcomers/)) and CoDA (Codependents Anonymous). ((New to coda? (n.d.). CoDA.Org. Retrieved from https://coda.org/newcomers/))

Both S.L.A.A. and CoDA are 12-Step groups. All 12-Step groups are faith-based fellowships, modeled after Alcoholics Anonymous, in which members are encouraged to follow 12 specific steps toward continued recovery. They also provide a safe space for members to process their emotions and connect with people in similar situations.

The skills you learn in a 12-Step group won’t “fix” you, or make your condition disappear. Instead, members focus on developing the tools they need to navigate triggers that may arise in the future.

Learning to Love Yourself

Living with a sex and/or love addiction is a challenge. It may have an impact on all your relationships—not just romantic or sexual partnerships. And you may struggle to set appropriate boundaries in all areas of your life.

However, unlike many substance use disorders, it’s not realistic to simply swear off all relationships. A person in recovery from alcohol addiction can decide they’ll never go back to a bar. But most people with a love addiction will need to continue navigating interpersonal relationships.

As you heal from sex and/or love addiction, you’ll learn how to handle complex emotions and situations in a healthy way. This process can be daunting, but it can also be joyful. By learning how to respect your own boundaries and meet your own needs, you can begin to create an even more meaningful life.

If you recognize these symptoms in your own life, you can learn more about rehab programs that treat sex and love addictions here.

Reviewed by Rajnandini Rathod