Congratulations! You’ve made one of the best decisions you can make: asking for help. Whether you’ve decided to get help to control or moderate your use of alcohol or substances, or whether you’ve decided you want to be entirely abstinent, or whether you just want to explore the role that addiction might play in connection to an underlying depression, anxiety, stress, or self-esteem issue, you are being proactive in trying to find someone who can help you. Acknowledging that you need help is never easy, but it’s one of the best things you can do for yourself. Finding the right addiction therapist is just as important as making the decision to get help.

Before determining whether the treatment provider is “expert” enough, you have to decide what type of practitioner you would like to consult. Addiction treatment often involves working with a combination of professionals. Probably the most comprehensive place to start would be to meet with an addiction psychologist for a complete evaluation. However, there are several other types of therapists with the necessary and sufficient experience to get you on your way. It is important to know the differences between these sorts of treatment providers.

People often will begin their search for addiction treatment by consulting an “addiction psychiatrist” or “addiction psychologist.” In actuality, these are two very different kinds of professionals. Knowing the difference is essential. Furthermore, the professions of psychotherapist, social worker, and counselor all have different specialties, and their focus and breadth of treatment can vary considerably. In most instances, their credentials are much less important compared to their experience and the connection you can establish with them. Most therapists would likely agree that the most curative factor in the psychotherapeutic relationship is the rapport that develops between therapist and person in therapy. So while you’re looking for someone you can afford, you are also looking for someone with whom you can connect.

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What Is an Addiction Psychiatrist?

An addiction psychiatrist is a medical doctor who specializes in treating people with addictive and mental health issues primarily with medicines such as antidepressants, antipsychotics, and medications that help to treat underlying mental health conditions and comorbid issues. While there are many psychiatrists who don’t prescribe medications much and focus primarily on therapy instead, most psychiatrists manage medications and work closely with psychologists and other therapists who will provide the talk therapy treatment. Subsequent psychiatric appointments following an evaluation tend to be short, about 20- to 25-minute med checks; they are mostly concerned with how a person is adjusting to a drug regimen, minimizing side effects, and gauging effectiveness.

Most importantly, an addiction psychiatrist has special training in prescribing medications to help individuals who are struggling with their substance use. It is important to work with an addiction psychiatrist and not just a general psychiatrist when you are trying to determine the nature of your relationship with drugs and alcohol and considering making behavioral changes. An addiction psychiatrist can prescribe medications to help you detox or withdraw from drug and alcohol use, and they can also prescribe medications to help you with cravings, which could avert relapse.

What Is an Addiction Psychologist?

An addiction psychologist, on the other hand, is a doctor but not a medical doctor. Addiction psychologists are trained mental health professionals who can help you explore the role that addiction plays in your life. An addiction psychologist can help you become more aware of your thoughts, feelings, and behaviors, and teach you different ways of dealing with problems through therapeutic approaches such as cognitive behavioral therapy, motivational interviewing, mindfulness-based relapse prevention, 12-step facilitation treatment, and community reinforcement and family training.

Additionally, addiction psychologists let you talk your way through a problem and help you get to the heart of the issue so you can make the necessary changes that will improve your life for the long haul, and not just put a bandage on a major wound. A typical appointment with a psychologist is 50 to 55 minutes.

Other Professionals Who Can Help

There are other types of addiction therapists in addition to psychologists who might be helpful, including social workers and licensed professional counselors. Social workers may have their master’s or doctorate, while licensed professional counselors may have only a master’s-level education, though both are trained in mental health issues to varying degrees. Social workers in particular are trained in obtaining the best social agency support services, and they tend to take a social and networking approach to the treatment of mental health issues.

Psychotherapists may have any of the above degrees or none at all. A psychotherapist is sometimes a catch-all for someone who practices talk therapy, but the therapist may or may not be adequately trained according to the standards of another professional degree or certificate. For example, a psychiatrist or psychologist may describe themselves as a psychotherapist, but so too can a recovery coach or Joe Shmoe because he’s been a “spiritual advisor” ever since he was electrocuted while trying to repair his garage door. That said, many psychotherapists do receive comprehensive training, but it is important that you vet their experience, training, and credentials, as you should with any other therapist. (GoodTherapy.org does this work on your behalf as it has strict educational and training requirements for membership.)

Certified addiction counselors and certified alcohol and drug counselors are just a few of the titles bestowed to professionals who are counselors but not at the educational or academic level of psychiatrists, psychologists, or social workers. Often, these titles vary slightly according to state board guidelines, which can be somewhat less standardized from state to state. They may be no less qualified to treat you, but it is important to see someone who is licensed in his or her professional field. Ideally, your clinician would be qualified as both an addiction counselor and as a licensed mental health professional.

Finding the Right Addiction Therapist

Now that you know the differences between professionals, let’s talk about how to find the right addiction therapist for you. There are two common ways to find a psychiatrist and/or psychologist: (1) research local addiction professionals online, or (2) identify an addiction therapist who is recommended to you by another professional, friend, or family member. Both are perfectly legitimate ways to begin your search for the best match.

Once you think you have found someone, follow these steps to determine if they are competent, credible, and a good match for you. First and foremost, check their credentials to see if they are who they say they are. Make sure they have the associated degree of the professional discipline you personally are looking for. The professional you go to should be licensed, and the license should be up to date and clearly indicated on his or her website or profile listing.

If you think you found someone but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting.

Secondly, whether you want to see an addiction psychologist, psychiatrist, counselor, or psychotherapist, you should determine what expertise the person has in the field of addiction. This can be daunting because, across disciplines, there is no standardized way of determining one’s expertise in addiction. For example, while psychiatrists can be board certified in addiction medicine, addiction psychologists might obtain their proficiency by having (1) additional certification as a certified alcohol and drug counselor, (2) by being a member of the American Psychological Association Division 50 Society of Addiction Psychology, or (3) by having conducted research and published articles on addiction. Moreover, addiction counselors may have a certification through a state board, yet they may lack the background and training that a psychologist receives in mental health issues. This is important because half of all individuals who are diagnosed with a lifetime prevalence of addiction will also be diagnosed with a lifetime prevalence of another comorbid mental health diagnosis. Furthermore, one might not want to see a psychiatrist who specializes in medication management and may not have as much training and experience in the various treatments involving the talk therapies.

Third, check reviews online. There are excellent therapists who don’t yet have reviews online, perhaps because they haven’t had an online presence or because it’s just not ethical to ask for reviews. Many psychotherapists will have colleagues write reviews for them, which is a helpful way of getting recommendations. One bad review can affect someone’s listing significantly, so look carefully at all the reviews to be fair.

Fourth, review the professional’s website and other sites where their practice might be listed to see that they offer “evidenced-based” or “best practices” treatment. While these buzzwords have quite frankly become passé and obsolete as they have been co-opted by marketers, you want to be sure that your therapist at least knows about the most up-to-date evidenced-based treatment approaches. Ask what treatment the professional uses that is evidenced-based, or ask for an opinion on something you’ve learned about, like harm reduction, 12-step facilitation, motivational interviewing, or mindfulness-based stress reduction or relapse prevention.

Fifth, have a phone conversation to see if you feel some sort of connection to your addiction therapist. This may be a feeling of confidence or an inexplicable bond of initial trust, but in either case, feeling secure with your addiction therapist is crucial. It is completely appropriate to say you are shopping for a therapist and that you’d like to speak on the phone to ask some questions or let the person know what is going on to see if it even makes sense to set up an appointment. This also allows the therapist to gauge whether you’re a good fit for him or her, and if not, to offer a referral.

Sixth, make a follow-up appointment where you can meet the person face-to-face and see if your initial instinct was correct. It is also reasonable to meet once or twice before you decide whether to commit to working with the person while you develop a treatment plan together. Remember, most importantly, you are looking for someone you connect with. You and the professional should both believe that the therapist can help. You are looking for someone you can afford, someone with whom you can feel comfortable, and someone you believe can help you.

If you’re lucky, you may get all these steps right on the first try, but many people do not. If you think you found someone, but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting. Often, the difficult experience you are having with the therapist is related to the reason you are in therapy to begin with. In other words, the conflict or problems you are having with your therapist may be the sorts of problems you have in other relationships and could be driving addictive or compulsive behaviors, and now you have an opportunity to work through those issues with a therapist who is trained to help you see your role in the relationship and in other, more important relationships. This is a wonderful opportunity to learn about yourself.

If your therapist shies away from this sort of dialogue, they will not be helpful to you. Sometimes, the match is just not right and you have to find another therapist. The right person is out there; you just might have to work a little harder to find that person.

Conclusion

In summary, because addiction treatment is a unique field, it is essential that your addiction therapist have a solid background in mental health and not just expertise in addiction. Since many of those with a substance use issue in their lifetime will also meet the criteria for another mental health condition, it is clear that these comorbid conditions are interrelated and may fuel each other. This is why it is so important that your therapist be an expert in both domains. When you seek help for addiction, you may experience issues such as depression, anxiety, trauma, attention-deficit hyperactivity, and relationship problems. Addiction therapists who are not licensed, such as recovery coaches and interventionists, can have an important role, but only when mental health professionals who are licensed are supervising and quarterbacking the treatment.

Once you’ve found an addiction therapist who is a good fit and you begin to understand your addiction issues—medical, psychological, and otherwise—you may feel as if a big weight has been lifted off of your shoulders. While most individuals considering stopping or reducing their drug or alcohol use are loath to imagine their lives without the use of alcohol or drugs, many recovering individuals report that their lives are vastly improved and that that their worst days in recovery are far better than their best days using.

When your gambling gets out of control, it can be extremely destructive and devastating to you and to those with whom you associate. Because a gambling addiction develops over time, you, your friends, and family members may not notice that your behavior is compulsive or getting out of hand. However, just because you gamble and enjoy gambling a lot does not mean you are addicted to it.

There are ways to determine whether certain behaviors and activities related to your gambling suggest that you are enjoying a recreational activity or if your gambling has become a compulsive habit with potentially serious consequences. As an addiction psychologist and certified addiction counselor in Pennsylvania, which recently bested New Jersey in combined gambling revenue for 2012 and 2013, many people come to me to find help sorting through the interrelated mental health issues that may fuel gambling behavior in order to determine whether they have a mild gambling problem, a major compulsive and pathological issue, or just an expensive hobby that is all in good fun.

It’s rare, but possible, to develop a gambling addiction after your very first gambling experience. When problems develop, they usually progress over time. Many people participate in social gambling for years with no problems. More frequent gambling or life stressors can contribute to social gambling becoming a serious problem. Most casual gamblers can stop gambling when they have to because of losses; they can set a loss limit and easily follow it. People with a compulsive gambling problem feel strong urges to keep gambling to recoup their lost money. When gamblers are betting to chase losses, things can tailspin out of control, gamblers can lose touch with reality, and the issue can manifest in severe and exacting consequences. Over time, this issue can become more and more destructive.

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For many compulsive gamblers, gambling is about the thrill, not the money. Some begin to take bigger risks and place larger bets to keep getting more of a thrill; this can take a financial toll. When a gambler is trying to recoup losses, lives can be destroyed. Many folks with whom I work recount that their bottom was when this shift happened and they realized that they were gambling in the hope they could get back their losses.

A gambling addiction, unlike drug or alcohol addictions, often has no obvious physical signs or symptoms. Many people with problematic gambling habits deny that they have a problem. They minimize the problem or refuse to admit that their gambling is out of control. They often gamble in secrecy, not allowing friends and family to know about their behavior. They may lie, keep secrets, sneak around, or completely withdraw socially. They do this to make it difficult for anyone to interfere with or confront them about their detrimental behavior.

An important part of recovery from a gambling issue is to expose the gambler’s secrets—extra credit cards, hidden cash, unaccounted-for time, lies about income, etc.—over time to the right, supportive people at the right times. A therapist is a great start, and meeting other people who are recovering from gambling addiction can help a person to feel understood, supported, and guided into long-term recovery.

Just as substance abuse is characterized by uncontrollable urges to consume a particular substance, causing negative consequences to the addicted person and those around the person, a gambling addiction is characterized broadly by tendencies to gamble in ways that cause damage to the person who is gambling and those associated with that person. The urge to gamble can be especially overwhelming during episodes of stress or depression. A person may use gambling as an unhealthy way to cope. As the problem develops and becomes stronger, a gambler may become overly focused on gambling (gambling-seeking) and getting money to gamble.

What Are the Risk Factors?

Certain factors may put you at greater risk for becoming addicted to gambling or having a harder time stopping. These include substance abuse (alcohol abuse is common), mood (often depression) or personality issues or attention-deficit hyperactivity (ADHD); age (younger and middle-aged); sex (women gamblers usually start later in life and tend to have depression, anxiety, or bipolar and can become addicted quicker, although these differences are disappearing); family influence (having a parent with a gambling issue increases your chances); certain medications such as those which treat Parkinson’s and restless leg syndrome (RLS), called dopamine agonists, may have a rare side effect that results in compulsive behaviors, including gambling; and certain personality characteristics such as being highly competitive, a workaholic, restless, or easily bored.

The National Council on Problem Gambling, referring to a Harvard study, estimates that two million (or 1% of) U.S. adults meet the criteria for compulsive gambling in a given year. Another four million to six million do not meet the full diagnostic criteria for compulsive gambling, but meet at least one of them and are experiencing problems due to their gambling behavior. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of gambling disorder is made when someone meets at least four of the following nine criteria in a 12-month period:

1. Tolerance: Needing larger wagers to experience the same “rush” (similar to the “rush” felt by drug users).
2. Withdrawal: Restlessness or irritability when attempting to reduce or cease gambling.
3. Loss of control: Repeated unsuccessful attempts to cut down or stop on his/her own.
4. Preoccupation: Frequent thoughts about gambling experiences, whether past, future, or fantasy.
5. Escape: Gambling to improve mood or escape problems.
6. Chasing: Trying to win back gambling losses with more gambling.
7. Lying: Hiding the extent of the behavior by lying to friends, family, or a therapist.
8. Risked a significant relationship: Gambling despite damaging or losing an important relationship, job, or other significant opportunity.
9. Bailout: Turning to friends, family, or a third party for financial assistance resulting from gambling activities.

Do You Have a Gambling Problem?

As with drug and alcohol abuse, it is often an indication that you have a problem if you are wondering whether you have a problem. If you are losing time from your everyday activities because you are gambling or thinking about gambling; spend more time gambling than you intended to; are gambling to escape worries or stave off boredom or loneliness; or spent money you needed to pay your bills or other expenses, you likely do have a gambling problem.

Are your friends and family expressing concern? They might be recognizing the ways in which your gambling is affecting you before you are. The sooner you seek help and treatment, the less damage to your finances, relationships, and work you will have to repair.

Would you like to stop? The first step to getting well is to accept that you have a progressive issue. It is so much easier to change when we want to, at least a little bit, and so much harder to change when we have to.

Quitting for a while or taking a break is a good indication that you have control over your gambling. It’s possible for some compulsive gamblers to go into remission where they gamble less or not at all. Without professional treatment, though, they will usually relapse.

Like other addictions, a gambling issue may wax and wane or come and go, just as different drugs become more in vogue depending on the zeitgeist. Many people who see me for addiction like to think of their compulsive behavior as the whack-a-mole game people play at carnivals. You can whack the mole, but it’s connected to something else and it will pop up again. It might pop up as a different gambling game, drug use, alcohol use, or shopping or food addiction. Whether it pops up in Atlantic City, Philadelphia, Las Vegas, or in a casino near you, gambling is here to stay, and so, too, is addiction. We must learn to live with these tendencies and become curious about how they work and what purpose they serve for us as individuals, our cultures, and society. With increased awareness and understanding, we can learn how to help ourselves and those we love and care about.

For help with an addiction issue, find a therapist.

As a clinical psychologist and certified addictions counselor, I see husbands, wives, and partners in individual or couples therapy on a daily basis grappling with the decision to leave or divorce their spouse or partner. Therapists have long referred to the three “A’s” of divorce as legitimate reasons to consider ending a relationship when the behavior of one’s partner is clearly destructive, abusive, or there is no reason to believe it will improve. Psychologists have suggested that the top three reasons for divorce are abuse, addiction, and affairs.

Researchers have long reported that financial problems are the top area of conflict for most couples, and that communication is the second most-cited reason for marital discord. While that may be true, these problems pale in comparison to the severe and devastating consequences resulting from abuse, addiction, and affairs.

When people ask me whether they should leave their partner or initiate divorce proceedings, very often it is because of one of the above. Any one of these issues, in and of itself, can be severe enough to make the answer to this question simple, yet it is an intensely personal and complex choice and the decision must be made in the context of careful consideration for oneself, one’s family, and the state and federal laws pertaining to the behavior. It is of utmost importance that, when faced with a partner who is engaged in these behaviors, one consults a professional and receives support, education, and counseling.

These are not decisions that should be made in a vacuum—or alone. As the social creatures and pack animals that we are, we have evolved over time to need and rely on social supports to better understand ourselves and the situations in which we find ourselves. Seeking help and support is a necessary, if not sufficient, first step in making the right decision for ourselves when coping with addiction, affairs, or abuse.

Many people do recover. While keeping safety in mind first and foremost, any one instance of the three “A’s” may be something that couples can bounce back from if they receive enough help and support.

[fat_widget_left]One person with whom I worked found that she began to have feelings for a man she met online who was living in another state. She had no physical relationship with this man, but she continued to be connected with him for two years in what she later determined to be an emotional affair. When she and her husband finally entered couples therapy, she was able to confess her feelings for this man and her “emotional infidelity,” and end the affair promptly. She was able to work on what led her to stray from her husband and to articulate the ways in which she felt she was not getting her needs met at home and in their relationship, and they were able to make changes in order to save their marriage.

Another case of forgiving a violation of the three “A’s” involved a couple in which the man was physically abusive. He would block his wife’s exit from a door when she wanted to leave the house, jealously hack into her email, listen to her phone messages, and place restrictions on when she could go out and with whom she could spend time. At one point, he shoved her and she fell, almost bumping her head on a coffee table. While these are considered abusive behaviors in most states and punishable by law, the couple was able to learn about the definition of abuse—physical, sexual, and emotional—and the man fully engaged in individual and group counseling. He found a local therapist who ran groups for men with anger and physical abuse problems, enrolled in that program, and worked hard on himself for two years to save his marriage and family.

Often, couples enter counseling when marriages are on the brink and it becomes clear that one or both partners need individual counseling before the couples work can be successful. This last case is an obvious example where individual therapy would be essential at the start. The husband in this instance began individual therapy and conjoint group therapy, focusing on anger management and coping skills. Most importantly, he was able to identify and stop the abusive behavior, and the couple was able to resume their progress in couples counseling. After significant time and work, they were able to salvage their relationship and the marriage. This involved the wife’s ability to forgive and trust her husband again, of course, but also the husband’s ability to express his anger toward her in a more acceptable, healthy, and helpful way. The wife certainly needed her own individual therapy before she was even close to being willing to begin the couples counseling.

Addiction may be no different from affairs and abuse in this regard. When one’s addiction is severe, it is clearly grounds for ending a relationship or getting a divorce, but by no means is this always the case. When a husband, wife, or partner adequately addresses his or her drug and alcohol issues or other addictive issues, such as shopping addiction, gambling, or love or sex addiction, a couple can recover from the hurt, shame, and consequences of the addictive behaviors.

Many people are familiar with the quote, “We’re not responsible for falling down, but we are responsible for getting back up.” This is a wonderful analogy for the “disease” model of addiction. If you are walking along, don’t see a hole, and you fall in it, it isn’t your fault. It is, however, your responsibility to get up, to get out of the hole or ask for help. An individual with an addiction is not responsible for having the disease. It is sometimes a hereditary illness, a brain disease characterized by chronic relapse with psychosocial, biological, personal, and cultural origins. However, once someone knows that they have an addiction, they are responsible for picking themselves up, getting treatment, avoiding people, places, and things associated with their addiction, and working a program of recovery involving therapy, meetings, and the use of a support network such as a 12-step fellowship.

A few important things to remember: The three “A’s” and the behaviors surrounding them need to cease right away. In some cases this can be a work in progress, but in others it can’t. Physical, sexual, and emotional abuse needs to stop immediately. Some of these behaviors are obviously illegal and nonnegotiable. There is no way to continue an affair and work on one’s marriage at the same time. Individuals need a comprehensive assessment and evaluation to determine the appropriate level of care and to engage in the level of treatment and support that will keep them and others safe. After this is determined, if treatment is not working adequately and that level of treatment is deemed insufficient, then the individual will need to step up his or her treatment to a higher level of care.

Often, separation is a good idea as couples learn about the addiction, affairs, or abuse. A healthy separation can enable individuals to focus on their treatment and come together as needed when both are ready. This sort of separation enables both parties and their family to recognize that recovery is an individual’s responsibility and it is also a family affair. Whether children or extended family know explicitly about what is going on, to be sure, they are all affected. So when an individual begins recovery, so too does the family, and each member of the family may need support and/or counseling.

It is a spouse’s or partner’s responsibility to communicate to his or her partner what is acceptable and what is not. It is also incumbent on a spouse or partner to become educated about the law, about the disease of addiction, and to learn as much about the psychological underpinnings of the three “A’s” and these sorts of behaviors as possible. It is a partner’s responsibility to communicate as clearly as possible about what he or she believes is going on and to insist that his or her partner get help.

Rarely is anyone able to work through these sorts of problems without the support of professional help. Finding someone to help you and your spouse these days is very easy, however. GoodTherapy.org’s therapist directory is a great place to start. You can also contact your local city or state psychological society or association. Speak with a physician or friend you know who has been in counseling and ask them or their therapist for a referral. Most local therapists are willing to consult at no charge over the phone to help you determine if they might be a good match for you or your spouse.

Many mental health professionals consider the three “A’s”—addiction, affairs, and abuse—sufficient reason to leave a partner. This blog addresses lower-level offenses related to the first two. While most couples can overcome low-level indiscretions in any area of the three “A’s,” when multiple indiscretions occur or the degree of severity is greater, it may be time to throw in the proverbial towel. As couples grapple with why one partner cheated or entered the depths of alcoholism or drug addiction, they need to evaluate the patterns of relating they have become used to, the interpersonal dynamics they engage in, the dances they dance, and the issues they may have brought into the relationship. One theme that consistently emerges is the degree to which couples are honest with each other. How much do they divulge? How important is it to tell the truth? Do you really need to tell your partner everything?

In Alcoholics Anonymous, we hear people say, “We are as sick as our secrets.” Family addiction therapists are fond of saying that there are no family secrets. By this, they mean that even when we believe that other family members don’t know a certain secret, that secret still has an impact on everyone in the family. If individual members don’t know the specifics of the secret, they are still impacted by it and sense or experience it unconsciously—and that can affect the whole family. I work with patients who learned in their twenties or later in life that they were adopted, that their parents were once married to an abusive spouse, or that they have a sibling they never knew, among other revelations.

I’ve also become aware of the extent to which sober and recovering clients keep things from their partners. Even in relatively healthy relationships, there appears to be a fair amount of small-scale concealment and deception, though the extent of the infractions often is debatable. Several clients I see—coincidentally or not, all men—have reported engaging in exercise cheating. What’s that, you ask? Exercise cheating, essentially, is exercising and not telling your partner, or not revealing how much or what type of exercise one engages in.

Even I have been guilty of cheating on my wife. A few years back, as I was setting up my new Philadelphia office, I decided to buy a painting by an artist that my wife and I liked. My wife studies art history, and I thought she would appreciate that I was acquiring a painting by a Temple University master’s graduate. And while $650 is no small chunk of change for this sort of thing, I thought it was a great investment for my new office. I thought I would surprise her with the purchase. Instead, she was angry. “You art cheated!” she cried as soon as she saw it. She was genuinely annoyed that I had not consulted with her on a purchase of this magnitude. Whether I was right or wrong in purchasing something of that cost for my office was not the issue. What is important is my partner’s perceived betrayal and need for dialogue, negotiation, and consultation.

Many hypothesize that cheating behavior is related to vestiges of evolutionary differences among men and women. While this theory would be a gross generalization in today’s society, it suggests that it was more adaptive in an evolutionary way for men to cheat than for women to cheat. Assuming evolution prioritizes any behavior designed to propagate one’s genes, men may benefit from spreading their genes in a quantity-focused way. Women, meanwhile, have long gestation and nursing periods which may temporarily move them to be more devoted and committed to their offspring. Thus, they benefit from finding a better quality mate. In other words, women are biologically, or at least evolutionarily, better at taking care of their young, especially in early developmental stages. Most people agree, and research appears to back this up, that most men think about sex more frequently than women do. While both men and women want to find a quality mate, men may be more inclined to seek quantity than women are.

According to this evolutionary perspective, neither men nor women want their mates to cheat because a mate who cheats may have more offspring, which in turn means that mate is less likely to care for the original partner’s offspring and more likely to leave and care for his or her new offspring. It is in a man’s evolutionarily best interest not to alert his partner to the fact he is cheating. Any behavior—sexual or not—that results in producing healthy offspring is powerfully reinforced to the extent that it aids in propagating an individual’s genes. So, infidelity and hiding that infidelity through the processes of natural selection and evolution can become more prevalent over time.

A fair question would be whether cheating sexually is related at all to other types of cheating. Just because a partner doesn’t tell a mate where he or she is going and what he or she is doing doesn’t mean that an affair is happening, and it doesn’t mean that a tendency toward nonmonogamous behavior is the cause of disingenuous behavior in the context of the couple. In fact, the point of this article is to lessen the impact of minor violations of the honesty contract. Putting small indiscretions of dishonesty in an evolutionary context may allow couples to see this behavior as resulting from the natural instincts of the animals we are. What is important, though, is that as humans we have the capacity to dialogue. This is precisely what can keep our natural tendencies in check. Speaking honestly to our partners about our needs and wants, while often challenging, is the hallmark of a healthy relationship.

Smoking gun example: A client once described an interaction he had with his wife after she busted him for smoking pot in the garage. She smelled the smoke even as he vehemently denied he had been smoking marijuana. When she found his metal pipe, still warm, he stuck to his story. “The lie just came out,” he explained later. “I was so used to it.” He eventually was able to talk about why he lied and why he has often felt the need to cover things up. It had nothing to do with infidelity, but was instead linked to his history of struggling to feel good about himself, to be able to ask for help with his emotions feelings and thoughts and to find purpose and meaning in his life. Beginning to discuss these issues with his wife and therapist helped him think more carefully about his tendency to lie and cover his tracks. He became better at advocating for himself and negotiating with his partner in a more healthy way.

Honesty is important in recovery from any mental health issue, whether it be depression, anxiety, or stress, but it is especially important in recovery from addiction and substance use because of the strong tendencies to hide, deny, and minimize one’s behaviors. Seeing an addiction psychologist or other specialist is an important first step in understanding one’s self. It is in this therapeutic relationship that a quick foundation can be set for the basis of an honest dialogue with one’s partner, friends, and family. Rebuilding relationships with those we love and who love us is essential to recovery from addiction. Understanding ourselves and the reasons we might cheat and lie can enable us to pause just long enough to ask ourselves whether we really want to go ahead with the behavior or if we might be able to rely on those close to us to help us through the difficult times. Honest communication with the people in our lives is the only way we can become and stay sober or make meaningful and lasting changes in our lives.

In my practice as an addiction psychologist, it’s probably the most common question I encounter; when it comes right down to it, it’s what most people who are struggling with alcohol really want to know:

“How can I control my drinking or drug use?”

Only a small minority of people come to my practice with the expressed agenda of stopping their drinking altogether. Most seeking psychotherapy for alcohol dependence, misuse, or abuse have experienced some consequences due to their drinking and would like to minimize or stop those consequences but do not want to give up their drinking entirely.

For some drinkers, controlled drinking or moderate drinking is an option, and for a small portion of the population, about 5%, controlled drinking is nearly impossible. While many people believe “once an alcoholic, always an alcoholic,” many people diagnosed with alcoholism can learn to control their drinking and become social drinkers again. That said, if you have been diagnosed with alcohol dependence, most addiction psychologists, psychiatrists, physicians, social workers, and addiction counselors would strongly recommend abstinence. This is always a very personal decision that should be made with careful consideration of the risks and benefits of drinking versus abstinence.

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If one has never exhibited signs of alcoholism, then controlled drinking, a technique or approach that is a form of harm reduction, is a reasonable yet delicate first step. If one wants to pursue this approach, it is best not to go it alone. Talking to an addiction psychologist or other addiction professional can guide you through some generally recommended techniques.

Notice Feelings and Set Limits

Most addiction therapists will recommend two basic procedures that may differ in numerous ways but have the same central premise. The first is that you cut back your use of alcohol in whatever way you decide and that you then pay attention to what thoughts and feelings emerge. The idea here is that alcohol serves to mediate feelings by numbing, dulling, or blocking them entirely, and when you reduce your use or even stop drinking, your feelings will come back. As this happens, it is often recommended that you keep a journal or that you talk to your friends, family, partner, or therapist about these thoughts and feelings.

The well-known acronym “HALT” captures this eloquently. HALT stands for Hungry, Angry, Lonely, and Tired. These are the types of feelings people will experience as they reduce their alcohol or drug use. It reminds us to halt, or stop, and pay attention to what we need. Somehow, we have to cope with those feelings or risk relapse. If you are hungry, then eat. If you are angry, then tell someone, vent, exercise, pound a pillow, or express your anger in a healthy way. If you are lonely, then surround yourself with friends or start the process of finding new ones if all your friends drink. If you are tired, then sleep. Many people with alcoholism have an inability to take care of themselves, and learning this new skill in recovery is essential even with such basic behaviors as eating and sleeping.

A second basic tenet to alcohol counseling for people who are attempting moderate or control their drinking is to pick an amount of alcohol that they will not exceed and to stick with it. The National Institutes of Health recommend that, to maintain “low-risk drinking,” men consume no more than four drinks per day and no more than 14 per week. For women, the number is no more than three per day and seven per week. My personal belief is that this is fairly generous; a man can drink four beers while at a party on Friday or Saturday night, three or four during the football game on Sunday, three or four at bowling or poker night with the guys, and still have two or three with his partner on another day during the week.

When we can learn to stop at the “buzz,” we are well on our way to having our relationship with alcohol fully in check. For most people, three or four drinks make them feel tipsy or buzzed. Alcohol is a central nervous system depressant, yet the initial effects of alcohol in these amounts are more stimulating and euphoric feeling. People tend not to get into serious trouble from these amounts, but since the initial effects feel good, many people continue to drink past these amounts, assuming more alcohol equates to more good. It does not. It takes time for alcohol to work itself into your system, so people don’t realize how drunk they are getting, and in larger amounts alcohol has a depressing effect. The alcohol you drink today can make you feel depressed days and weeks later, and these small amounts can contribute to depressive feelings over time. Rarely has anyone come into my office with concerns about alcohol abuse because of drinking three or four drinks a few times a week.

Other Useful Techniques

To stick to the above drinking goals, there are other moderate drinking techniques that you can employ, such as avoiding hard alcohol and sticking to beer. Beer has lower ethanol content, and the carbonation can fill you up, so it tends to take longer to drink. Switching from alcohol to nonalcoholic drinks and back can slow you down as well. Holding a drink with lime or lemon may deter others from thinking you are not drinking an alcoholic mixed drink, and they may be less likely to offer you another drink. Remember, you are more aware that you are not drinking your normal amount or that you have reduced your consumption, and others probably aren’t even aware that you made any changes.

One technique to help you be honest with yourself is to take four coins (or as many coins as you are planning to have drinks that night) and place them in your back pocket. Each time you take a drink, move one of the coins into your other pocket. This may be more important if you are planning on drinking larger amounts of alcohol, and many of the people I work with start out reducing their drinks per setting with numbers more like from 10 to five or six, for example, so counting drinks becomes more important. This way, when your coins run out, you can be sure not to exceed the previously determined limit that you imposed on yourself.

Many addiction therapists recommend one drink per hour as another way of limiting oneself. Since alcohol leaves the bloodstream at about .02 blood alcohol content (BAC) per hour, this will most likely keep your BAC at a reasonably safe level. In using this technique, it is recommended that you discuss your upper limit with a certified addiction professional or addiction psychologist.

It goes without saying that it’s important to pay attention to drink equivalents. A typical shot equals one 5-ounce glass of wine, which equals one 12-ounce standard beer. If your favorite bartender is pouring your drinks and he knows you are a big tipper who likes to drink, you might need to have a brief conversation with him. Believe me, bartenders are used to these conversations, and they will not hold it against you. In fact, most bartenders will be very respectful and discreet and will keep an eye out for you thereafter. If your buddies are trying to get you drunk, that’s another story. Watch how much they pour. A Long Island Iced Tea counts for three drinks, not one.

Don’t Try to Drink Away Emotional Pain

While I consider myself to be an open-minded therapist, what would an alcohol blog be without a major caution? Here’s my warning: Don’t drink when you are sad, anxious, lonely, worried, or in any negative feeling state. These are times when you should figure out healthy ways of coping. If you drink during these times, you are at high risk for using your drinking as a crutch.

What happens if you can’t control your alcohol use with these techniques? After trying these techniques and determining your level of success, you should be able to assess whether you can be a social drinker. To the extent that you break any of the rules that you set up as an experiment and exceed these drinking limits with resulting consequences, then it is time to reconsider lowering your upper drinking limits and decreasing the frequency, quantity, intensity (alcohol content), or duration of your alcohol use.

If you are wondering whether you have a drinking problem, please read Do I Really Have a Drinking Problem?

An addiction psychologist or other psychotherapist specializing in addiction can help you answer any questions or develop a plan that, over time, will enable you to understand the role that alcohol plays in your life and make decisions about what, if any, changes you are ready to make. You don’t need to figure this out on your own. It takes courage to seek help for alcohol use. If you are reading this, you are well on your way to understanding yourself better and getting what you want and need in life.