Best Treatments for Sexual Dysfunction, Addictions-Alcoholism
Sexual Dysfunction Addictions Alcoholism Cure?
Treatments for Sexual Dysfunction For the host of problems that generate sexual dysfunction, including fear of sexuality, lack of sexual pleasure, and premature ejaculation, the treatments of choice, as we saw in, are those that are based on the work of Masters and Johnson (1970). Indeed, no psychological treatment program, with the exception of systematic desensitization for phobias, has been quite as successful as the Masters and Johnson therapy regimen.
They have reported that better than 80 percent of nearly 800 people who entered their two-week treatment program were greatly improved, and that nearly 75 percent of them maintained that improvement after a five-year follow-up. Similar findings have been reported by other workers who have evaluated these techniques (Hartman and Fithian, 1972; Kaplan, 1974). See my Treatment recommendation below.
Treatments for Addictions The addictions-alcoholism, obesity, smoking, and drug dependence-are difficult to treat. The solid treatment techniques that are available for phobias, compulsions, depression, and sexual dysfunction are not yet available here. For the soul of addiction is temptation, rather than fear and incompetence, and temptation does not seem to yield to either the rational reasoning of cognitive therapies, the control of behavioral treatments, or the insight of global psychodynamic ones.
Most treatment programs, whether conducted by professionals or nonprofessionals (such as Alcoholics Anonymous, Weight Watchers, TOPS, or Day Top Village for drug addicts), experience two overlapping problems: drop out and relapse.
Those who drop out of a treatment program almost always fail to change. And those who go through a treatment program but then resume old habits often suffer slights to their sense of hope and efficacy. This corrosion of hope and self-efficacy makes them unavailable for further treatment for a considerable period of time. Thus, in this area, researchers have begun to describe their techniques as "more effective" rather than "very effective," their typical gains as "modest rather than impressive," and their outcomes as "variable rather than consistent" (Mahoney and Mahoney, 1976).
ALCOHOLISM The treatment of choice for most of the addictions is abstention. But unfortunately, abstention is more easily recommended than achieved and, as a result, a multiplicity of behavioral and cognitive approaches to the addictive disorders have been suggested. For alcoholism, a program called Individualized Behavior Therapy for Alcoholics (lETA) seemed especially promising. In contrast to most other programs, the goal of this program was not complete abstinence, but rather controlled drinking. Clients were encouraged to select alternative behaviors to drinking, especially for drinking that occurred under stress. Once selected, those alternatives were carefully rehearsed, in the hope that they would become habitual and eventually replace drinking. lETA recognized that it was probably impossible to eliminate drinking entirely for most alcoholics, and sought rather to control it by reducing intake and ultimately, its effects. The original results were heartening. Those who were encouraged to control their drinking reported significantly more abstinent days than those for whom the treatment goal was total abstinence (Sobell and Sobell, 1976; 1980). But early on, some writers suggested that the apparent success of the IBTA program might be due to the enthusiasm of its practitioners (Nathan, 1980), an observation that makes sense in light of our earlier observations of the "common ingredients of treatment." Later reports were even more pessimistic, casting serious doubt on the original findings themselves, and suggesting that those findings might have resulted from insufficient follow-up of those who participated in the lETA program (Pendery, Maltzman, and West, 1982; but see Marlatt, 1983, for a more supportive view).
AA Treatments that evoke enthusiasm, hope, and commitment from participants are seen again in the help provided by Alcoholics Anonymous (AA). AA describes itself as "a fellowship of men and women who share their experiences, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism." By the time an alcoholic makes first contact with AA, he or she has already acknowledged that alcohol is a problem-an enormous first step. Subsequently, two members of AA meet with the alcoholic and invite him or her to join the group. The group stresses self-help, underscoring that the alcoholic controls the drinking problem, and not vice versa. It offers group support during the struggle to control drinking, and hope-for after all, many of the other members of the group were once alcoholics and are now entirely abstinent. And while receiving support from others enables one to better control the urge to drink, giving support to people with similar problems serves much the same purpose. Indeed, in looking back over the AA experience, reformed alcoholics rate altruism and group cohesiveness as two of its most helpful aspects (Emrick, Lassen, and Edwards, 1977).
Data on the effectiveness of AA, as well as the drop-out rate, are sparse and hard to come by, but what is available suggests that AA is better than no treatment at all...