Summary of Sex, Drugs, Gambling, & Chocolate: A Workbook for Overcoming Addictions by Dr. A. Thomas Horvath (Impact Publishers, 1998)

Dr. A Thomas Horvath accomplishes a rare feat in Sex, Drugs, Gambling & Chocolate: he quotes Aristotle more than any other thinker. For a mainstream psychologist such as Horvath – a past president of the American Psychological Association’s Division on Addictions – this is a welcome surprise. In the recommended readings appendix, he gives Aristotle’sNicomachean Ethics high praise:

“With apologies to Aristotle and scholars, this might be the original ‘self-help book.’ It considers happiness, virtue, intellectual virtues, friendship, pleasure, and related topics. It suggests that virtue is a mean between extremes… and that although pleasure, honor and wealth have been proposed as the means of happiness, the contemplative life is superior. His observations remain relevant and brilliant over two millennia later, suggesting that what is fundamental about being human has changed little in that time.” (p. 215)

As one studies Horvath’s cognitive-behavioral approach to addictions, one can see why he is so sympathetic to Aristotle: their philosophies of the passions are basically identical. For Horvath, as for Aristotle, the human person has an intellect capable of contemplating the truth, and a will by which a person chooses which good to seek. The person also has sensitive appetites – such as desire for an absent good – that are capable of being ordered by reason and the will, but are not inherently so. He defines addictions as any behavior in which some good is chosen because of strong desires (“cravings”), despite the fact that the costs outweigh the benefits. This definition implicitly contains an Aristotelian anthropology.

The real usefulness of this work, however, goes beyond bringing Aristotle’s name into modern cognitive-behavioral therapy. Horvath provides two great services to his readers. First, he addresses the common problem of treating addictions as diseases one is powerless to change, rather than habits that are deeply rooted but still workable. Second, he shows with great lucidity, using insights from modern addictionology, how to progress from incontinence to continence to virtue.

Overcoming Addictions

People become involved with addictive behaviors because they initially experienced something positive in them, and then they used these behaviors regularly enough for the involvement to become a habit. Over time, this habit becomes a way of coping with other problems in their lives, and may end up becoming their preferred way of coping with problems, even though objective evidence suggests that it doesn’t work well due to the costs involved. These costs eventually outweigh any benefits of involvement; it is essential for people to be sincere about them, and to learn to bring them more clearly to mind.

Before addressing craving, Horvath has a chapter on other ways of addressing the problems in people’s lives; if the addictive behavior is to stop, the person must learn other ways of coping with their problems. Primarily this entails overcoming isolation and being able to receive the help one needs from other people, not from the addiction. One section from Chapter 6 bears quoting:

“Suppose that you use your addiction to cope with loneliness and anxiety. Do you think that this is the only way to do it? Don’t other individuals, who do not use addition, find other ways to cope with loneliness and anxiety?

For instance, if you are lonely, you can work on learning how to be a better friend and learning how to meet others so that you can get to know them. As you know more about being a friend and meeting others, you can keep looking for potential friends….”

His stance consistently helps people overcome the sense of helplessness inherent in addictive behaviors.

In chapter 7, he says, “I believe that anyone can moderate any addiction, given the right circumstances.” Moderate, here, is intended to mean, “continue to use, but with moderation,” as distinct from total abstinence. His standpoint is purely as an addictionologist: he does not enter into moral questions. For instance, he does support the idea that anyone can drink alcohol moderately, in the right circumstances; by saying this, he does not intend to scandalize the devout Muslim, for whom it is always forbidden to drink alcohol. One of the reasons for not attempting moderation, but going directly for abstinence, is that the cost of a single lapse is excessively high; if the behavior in question violates a person’s beliefs, this qualifies as a behavior that must be extinguished, not moderated.

The difficulty with focusing on circumstances to moderate or extinguish a behavior lies in the fact that circumstances are often not completely in one’s control. This fact leads to the need for another approach: self-control. Every addicted person still exercises some degree of self-control in their addiction, even when they are at their most “out-of-control.” Horvath gives several examples:

“the two-pack-a-day mother who won’t smoke around her kids, the 12-beers-a-day man who won’t drink at work, the gambler who will not go to the casino when mom is visiting, the homeless person who will not steal from a charity (in order to buy street drugs), the coke user who craves more but won’t pawn personal possessions to get more money, the sex addict who won’t touch anyone in his family.” (p. 112)

All of these individuals demonstrate some degree of self-control that is based on their deeper goals and values. They could all increase their self-control, he argues, by

“connecting even more with these goals and values. That connection is the foundation of any type of self-control… To know one’s own values, and to let them guide behavior, even if sacrifice is involved: this is a recipe for overcoming addiction. It may even be a recipe for happiness.” (p. 113).

Self-control is made difficult by cravings, which are strong desires that urge one to engage in the addictive behavior. One must learn to identify cravings, and to understand them well. They do not occur all the time; their occurrence is to some degree predictable. They arose from experiencing the pleasure of addiction; in time, if the experience ceases, so do the cravings.

One of the most important chapters in the book, Chapter 9, begins with the following summary of points about cravings:

“Cravings are time-limited. If a craving is not acted upon, it goes away. Cravings are uncomfortable, but not painful. Craving does not fundamentally interfere with your ability to make decisions. Cravings cannot force you to act on them. Craving in itself, if not acted on, is harmless. Despite the harmlessness of craving, in severe addiction we act on craving as if our survival depended on it” (p. 135).

This chapter is crucial in differentiating the cognitive-behavioral approach from the Twelve Step approach; it is also the most useful in teaching people how to overcome their own desires. Along with the next chapter, “Coping with Craving,” it forms a psychological primer on mortification, applied particularly to the passion of desire, though the same principles would allow one greater freedom from any emotion.

Chapter 10 outlines various ways of dealing with cravings. One technique, aversive conditioning, is psychologically sound, but is best left to professionals to administer. The rest are common-sense, and are part of every successful way of coping with cravings. The first two steps are for beginners:

These steps are useful, and they certainly reduce harm, but they have their drawbacks. Substitution “keeps an equation alive: craving = do something to make it go away.” Avoidance leaves one living in fear of craving, for one has learned to prevent strong desires from occurring but not how to conquer them when they do occur. For these reasons, neither of these steps are long-term strategies for success. “In order to overcome addiction you need techniques for experiencing but not acting on craving until it dies away” (p. 152).

There are three additional strategies that do not have these shortcomings:

Finally, he gives some advanced coping strategies. These should be used with caution, once a person is confident that they can deal with the cravings. They are:

Finally, Horvath ends this useful chapter with a warning about an ineffective method that is very commonly used, and which can seem to resemble some items above: the person tries to drive the craving out of their mind, thinking, “I’m not going to think about this craving!” (p. 162). Of course, to say, “I won’t think about X” is to think about X. It is as if the person is trying simultaneously to push the craving out of his mind and denying to himself that any craving is taking place. Denial is the most primitive and the most perilous of coping mechanisms. One has to learn to be sincere in order to be successful.

The book’s final two chapters help a person to build a new life without their addiction, and to know when they have finally conquered it. He also deals with slips and relapses (the latter being more prolonged; slips are also called “lapses”). Horvath argues that slips can usually be seen coming well before they occur. A person may start to go closer and closer to places associated with the addiction, or with friends associated with the addiction. Citing another well-known work on addiction, Relapse Prevention by Marlatt and Gordon, he says:

“Behaviors that lead in the direction of the slip, but which may be rationalized at first, are known by several acronyms: AIDs (Apparently Irrelevant Decisions), SIDs (Seemingly Irrelevant Decisions) or SUBTLE (Seemingly Unimportant Behavior That Leads to Errors). What they all mean is that with practice and a willingness to watch for it, you can usually ‘see trouble comin’ from a long ways off’” (p. 200).

Again, sincerity with oneself is a key component of a successful struggle.

Conclusion

As a general workbook for addictions, Sex, Drugs, Gambling & Chocolate is highly recommendable. Care should be taken when applying the suggested techniques to addictions with moral dimensions, particularly when speaking of “provoking cravings;” but given this caveat, the book can be of great service to many who suffer from these disorders — and those who try to help them.