Why We Should Talk about Sex: A California Program Allows for Frank Discussion of the Link between Sexual and Substance-Using Behaviors

By Miranda, John De; Brock, William | Addiction Professional, July-August 2009 | Go to article overview

Why We Should Talk about Sex: A California Program Allows for Frank Discussion of the Link between Sexual and Substance-Using Behaviors


Miranda, John De, Brock, William, Addiction Professional


Individuals entering addiction treatment are usually asked a lot of questions as part of the initial assessment process. Family history, alcohol and drug use, employment and criminal justice involvement are routine data elements used to build a profile of the new client. Many treatment units also seek information about sexual practices, but often limit this information to questions designed to determine the client's risk for sexually transmitted diseases including HIV/AIDS.

[ILLUSTRATION OMITTED]

For example, federally funded programs that utilize the Government Performance and Results Act (GPRA) data collection instrument ask about the nature of sexual contacts in the past 30 days (i.e., vaginal, oral, or anal), and follow up with additional questions about whether the contacts were unprotected, were with an injection drug user, or were with someone who is HIV-positive or has AIDS.

We know that many individuals entering treatment are conflicted about sexual activities and behaviors in which they have engaged. We also know that shame is a key component in initiating and perpetuating addiction to drugs and alcohol. We are beginning to understand that without addressing problematic sexual behavior and the shame attached, the likelihood of relapse triggered by sexual behavior is high. Despite this linkage, however, traditional treatment procedures tend to avoid the sexual domain.

For example, the Addiction Severity Index (ASI) is perhaps the most widely used questionnaire designed to elicit information from those entering addiction treatment. The ASI includes nearly 200 data elements that cover the medical, employment, drug/alcohol, legal, family and psychiatric domains. Missing are any questions regarding the client's sexual functioning or satisfaction.

Included in the ASI are items of arguably minor significance, such as:

* Have you experienced trouble understanding, concentrating or remembering?

* Have you ever been charged with shoplifting or vandalism?

* With whom do you spend most of your free time?

The ASI's only question about sex asks if the client has been the recipient of forced sexual advances or acts.

Direct approach

At Stepping Stone of San Diego we have learned that addressing sexual behavior and sexual shame are important elements in providing comprehensive addiction treatment and in laying a solid foundation for long-term recovery. Our experience indicates that a thorough understanding of a client's sexual behavior and psychological "comfort'' level with that behavior are as important as understanding the client's drug use patterns, psychosocial triggers and significant relationships.

We thus have adopted a "sex positive" approach to treatment, creating a non-judgmental environment in which a client is encouraged to explore sexual desires and behavior with the dual goals of eliminating feelings of shame and reducing activities that place the individual at risk. To this end, each client participates in our Discovering Sexual Health in Recovery (DSHR) program, which is designed to explore connections between addiction and sexual behavior. The 12-week format includes didactic presentations, personal experiential exercises and facilitated process group interactions leading to the following outcomes:

* An understanding of expectations and boundaries while participating in a treatment/recovery program with a sex positive philosophy;

* Heightened self-awareness about the relationship between one's addiction and the role played by sexual behavior and shame in the development and maintenance of problematic drug and/or alcohol use;

* Comprehensive knowledge about human sexual functioning and the ability to assess levels of risk associated with specific behaviors and activities; and

* A relapse prevention plan that specifically addresses each client's sex/risk profile and incorporates both avoidance and compensatory strategies. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Why We Should Talk about Sex: A California Program Allows for Frank Discussion of the Link between Sexual and Substance-Using Behaviors
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.