Many people assume they need to consume Alcohol to have Good Sex?

For most Americans, consuming alcohol seems to be part of our cultural heritage. We drink at weddings, funerals, birthdays, and pretty much to celebrate anything and everything. We learned from a young age by watching our parents and other adults, that drinking is a sign of maturity. Many people, especially young adolescents, expect that alcohol use will lower tension and anxiety and increase sexual desire and pleasure in life (Seto & Barbaree,1995). About 1 in every 7 adults in the United States meet criteria for alcohol dependency, according to a large NIMH epidemiological study (Grant, 1977). Men are four times more likely than women to be heavy drinkers and are twice as likely to be alcohol abusing or alcohol dependant.

Most males and many females find it difficult to imagine not drinking any alcohol at least on weekends and find it almost impossible to think of having sex without previously having a few drinks. These fundamental values appear to be deeply embedded in our culture. Somewhere along the line, we got the message that we need alcohol to have good sex.

Does Alcohol Enhance or Hurt our Sexual Performance?

I recently heard a stand-up comedian refer to the term, Whiskey Dick when describing his friends who had drank too much and had difficulties with orgasm even while using Viagra. Shakespeare once said that excessive drinking, provokes the desire but takes away the performance. Alcohol reduces inhibitions and gives us a mellow feeling. It makes us more relaxed and more talkative. It can make shy people fe//el confident and bold. These effects can facilitate our sexual desires by developing our social skills. However, these positive effects are only present in the early stage of intoxication i.e. when weve consumed 1-2 drinks (assuming you havent already developed a tolerance for alcohol).

Sexual Impotence

On the other hand, alcohols negative effects on sexual performance have been widely documented. Men and women who have several drinks may find it very hard to achieve orgasm. Difficulties with achieving orgasm after alcohol consumption can be understood because alcohol dilates small blood vessels all over the body so that there is less engorgement of blood in the sexual organs. This leaves the penis flaccid or only partially erect so that sexual penetration is difficult. Women may find that they have decreased vaginal lubrication making sexual intercourse unpleasant and sometimes painful (Raff, 2006). Impotence is the constant inability of a man to maintain an erection for sexual purposes. It is estimated that impotence affects over 30 million men in the United States (NIHCS, 1992).

Masters and Johnson, identified alcohol as a common factor in impotence in their monumental work on human sexual inadequacy. Alcohol damages the central nervous system and destroys brain cells, and if the damage is prolonged enough, it can result in irreversible sexual impotence even while a person is sober. Alcohol is also a factor in loss of sexual control or premature ejaculation. Even a couple of beers before sex can spoil a man's erection and ruin his ejaculatory control. Up to 80 percent of men who drink heavily are believed to have serious sexual side effects, including impotence, sterility, or loss of sexual desire. Heavy drinking over a long period of time can irreversibly destroy testicular cells, leaving men with shrunken testicles. Both sexual drive and sexual capacity can be damaged. Alcohol also suppresses testosterone levels even in social drinkers by suppressing the secretory activity of the Leydig cells (Flatto, 1990).

Alcohol and High-Risk Sexual Behaviors

A history of heavy alcohol use has been correlated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners (e.g., injection drug users, prostitutes), and the exchange of sex for money or drugs (Windle,M.,1997). There may be many reasons for this association. For example, alcohol can act directly on the brain to reduce inhibitions and diminish risk perception (MacDonald,T.K.,2000).

However, expectations about alcohols effects may exert a more powerful influence on alcohol-involved sexual behavior. Studies consistently demonstrate that people who strongly believe that alcohol enhances sexual arousal and performance are more likely to practice risky sex after drinking (Cooper,M.L.,2002). Some people report deliberately using alcohol during sexual encounters to provide an excuse for socially unacceptable behavior or to reduce their conscious awareness of risk (Derman,K.H.,1998). According to McKirnan and colleagues (McKiran,D.J.,2001), this practice may be especially common among men who have sex with men. This finding is consistent with the observation that men who drink prior to or during homosexual contact are more likely than heterosexuals to engage in high-risk sexual practices (Avins,A.L.,1994).

Alcohol and AIDS

People with alcohol use disorders are more likely than the general population to contract HIV (human immunodeficiency virus) - the agent that causes acquired immunodeficiency syndrome (AIDS). Similarly, people with HIV are more likely to abuse alcohol at some time during their lives (Petray,N.M.,1999). Alcohol use is associated with high-risk sexual behaviors and injection drug use, two major modes of HIV transmission.

What are signs of problem drinking?

The primary signs of problem drinking are: Having health, legal, social, academic or financial problems as a result of drinking. For example, missing class or work because of drinking or hangovers, not be able to have fun or express oneself without drinking, fights or problems with roommates or significant others, spending excessive amounts of money on alcohol, blackouts/passing out, trips to the ER, being defensive when someone mentions your drinking, needing to drink more to achieve the same effects (tolerance), frequently drinking with the primary purpose of getting drunk, and/or repeatedly driving under the influence. These are only guidelines and each case is different. If you're concerned about your drinking or a friend's drinking, get more information!

Screening for Alcohol Dependence

Screening tools are available to assist counselors and therapists with diagnosing alcohol abuse and dependence such as the SMAST below.

Short Michigan Alcoholism Screening Test (MAST)

1. Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.)

2. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking?

3. Do you ever feel guilty about your drinking?

4. Do friends or relatives think you are a normal drinker?

5. Are you able to stop drinking when you want to?

6. Have you ever attended a meeting of Alcoholics Anonymous?

7. Has drinking ever created problems between you and your wife, husband, a parent, or other near relative?

8. Have you ever gotten into trouble at work because of drinking?

9. Have you ever neglected your obligations, your family, or your work for two of more days in a row because you were drinking?

10. Have you ever gone to anyone for help about your drinking?

11. Have you ever been in a hospital because of drinking?

12. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages?

13. Have you ever been arrested, even for a few hours, because of other drunken behavior?

Individuals that answer Yes to three or more questions indicate probable alcoholism, two yes answers indicate probable alcoholism, and fewer than two yes answers indicate that alcoholism is not likely (Selzer, M., Winokur, A. & Van Rooijen, C.; 1975).

Note: If after reading the above, you started rationalizing to yourself, Well, I can stop drinking anytime I want to, but I usually stop when I run out of money. (As my old graduate professor use to say) STOP BULL-SH#%ting yourself and go see a certified alcohol counselor.

Co-morbidity & Alcohol Dependence

Alcohol abuse and dependence are among the most destructive of the psychiatric disorders (Volpicelli, 2001). Addictions such as alcohol dependence and other addictions as a rule do not develop in isolation. Over 37 % of alcohol abusers suffer from at least one coexisting addiction and/ or mental disorder (Rovner, 1990).

Individuals can shift from one addiction to another or sustain multiple addictions at different times. The National Co-morbidity Survey (NCS) that sampled the entire U.S. population in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), roughly 50% had a diagnosable Axis I mental disorder at some time in their lives. This surveys results indicated that 35% of males will at some time in their lives have abused substances to the point of qualifying for a mental disorder diagnosis, and nearly 25% of women will have qualified for a serious mood disorder (mostly major depression). A significant finding of note from the NCS study was the widespread occurrence of co-morbidity among diagnosed disorders. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more additional disorders. These persons with a history of three or more co-morbid disorders were estimated to be one-sixth of the U.S. population, or some 43 million people (Kessler, 1994).

Poor Prognosis

We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions such as alcoholism are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private treatment programs (for example) relapse within the first year following treatment (Gorski,T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?

New Proposed Diagnosis

Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictions and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.

To assist with resolving this problem a multidimensional diagnosis of Poly-behavioral Addiction, is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of alcohol and substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.

Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship.

In addition, there is a 12 - month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.

New Proposed Theory

The Addictions Recovery Measurement Systems (ARMS) theory is a nonlinear, dynamical, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. Multiple influences trigger and operate within high-risk situations and influence the global multidimensional functioning of an individual. The process of relapse incorporates the interaction between background factors (e.g., family history, social support, years of possible dependence, and co-morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, cravings, motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in an individuals behavior can result in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous little interactions.

The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individuals develop to any one form of treatment to a single dimension of their lives, because the effects of an individuals addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individuals primary addiction. The ARMS theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individuals life dimensions in addition to developing specific goals and objectives for each dimension.

The ARMS acknowledges the complexity and unpredictable nature of lifestyle addictions following the commitment of an individual to accept assistance with changing their lifestyles. The Stages of Change model (Prochaska & DiClemente, 1984) is supported as a model of motivation, incorporating five stages of readiness to change: pre-contemplation, contemplation, preparation, action, and maintenance. The ARMS theory supports the constructs of self-efficacy and social networking as outcome predictors of future behavior across a wide variety of lifestyle risk factors (Bandura, 1977). The Relapse Prevention cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the ARMS theory.

Conclusions

Considering the wide range of alcohol abuse and sexual behaviors in our world today, one should always take into account an individuals ethnic, cultural, religious, and social background prior to making any clinical judgments, and it would be wise to not over-pathologize in this area of Dependency. However, since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning - poly-behavioral addiction needs to be identified to effectively treat the complexity of multiple behavioral and substance addictions.

Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively manage poly-behavioral addiction?

The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individuals comprehensive life-functioning progress dimensions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individuals develop to any one form of treatment to a single dimension of their lives, because the effects of an individuals addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient.

Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individuals primary addiction. The ARMS theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individuals life dimensions in addition to developing specific goals and objectives for each dimension.

Partnerships and coordination among all service providers, government departments, and health insurance organizations in providing treatment programs are a necessity in addressing the multi-task solution to Alcohol Abuse and Poly-behavioral addictions. I encourage you to support the addiction programs in America, and hope that the (ARMS) resources can assist you to personally fight the War on poly-behavioral addiction.

References

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Boscarino, J.A.; Avins, A.L.; Woods, W.J.; et al. Alcohol-related risk factors associated with HIV infection among patients entering alcoholism treatment: Implications for prevention. Journal of Studies on Alcohol 56(6):642653, 1995.

Cooper, M.L. Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Journal of Studies on Alcohol (Suppl. 14):101117, 2002.

Dermen, K.H.; Cooper, M.L.; and Agocha, V.B. Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. Journal of Studies on Alcohol 59(1):7177, 1998.

Dermen, K.H., and Cooper, M.L. Inhibition conflict and alcohol expectancy as moderators of alcohols relationship to condom use. Experimental and Clinical Psychopharmacology 8(2):198206, 2000.

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MacDonald, T.K.; MacDonald, G.; Zanna, M.P.; and Fong, G.T. Alcohol, sexual arousal, and intentions to use condoms in young men: Applying alcohol myopia theory to risky sexual behavior. Health Psychology 19(3):290298, 2000.

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McKirnan, D.J.; Vanable, P.A.; Ostrow, D.G.; and Hope, B. Expectancies of sexual escape and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse 13(12):137154, 2001.

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Selzer, M., Winokur, A. & Van Rooijen, C.; A self-administered Short Michigan Alcoholism Screening Test. Journal of Studies on Alcohol, 36, 117-126, 1975.

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About the Author:

James Slobodzien, Psy.D., CSAC, is a Hawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings. He is an adjunct professor of Psychology and also maintains a private practice as a mental health consultant.

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