•  If I came to you with an addiction problem, how would you begin to help me?
The place to begin is to understand the benefits of the addiction. For instance, do you drink to enjoy socializing, to relax, to forget something, to fit in with others, or for some other reason? Once you understand what the addictive behavior does for you, you can begin to find a replacement for it, or realize you can live without it. Chapters 3 and 4 focus on understanding the benefits of the addiction.

•  Is there anything wrong with someone wanting to believe in a higher power, and thinking their addiction is a disease?
There is nothing wrong with either of these beliefs, if they work for you. I do not attempt to talk anyone out of these beliefs. However, if these beliefs don't seem accurate, or are not working well, alternative perspectives are available, and are effective for many. Chapters 1 and 2 introduce some alternative perspectives.

•  Is attempting moderation dangerous, especially if someone has crossed over the line into alcoholism or addiction?
The terms "alcoholic" and "addict" are only useful from a 12-step or disease perspective. From the perspective I am presenting, there is no "line" to cross over. Addictive behavior is a matter of degree. At what point is someone "rich" or "fat"? Each of us could have our own definitions of these terms.

I have seen many individuals get overly focused on whether the term addict or alcoholic fits them. They lose sight of the crucial issue: solve the problems you have, regardless of what their level is or what you call them. If you are doing too much of a good thing, it makes sense to cut back. If cutting back doesn't work, then stopping makes sense. These are highly personal decisions, and only you can make them.

If you believe that you have a disease, and that consuming even a little of your addictive substance sets off an uncontrollable sequence of behavior, then attempting moderation obviously makes no sense. However, if it's not a disease, then attempting moderation makes great sense.

Take a "hard core drug addict" and give him some of his favorite substance. Then offer him more, but put a gun to his head. If he takes more substance, you will pull the trigger. Will he take it? By comparison, tell someone to sit awake in a chair for two weeks, without falling asleep, or you will pull the trigger. Everybody dies under this scenario.

The two scenarios illustrate the difference between a voluntary and involuntary behavior. At a certain point the body takes over, and you fall asleep. The body does not take over and make you use. Whenever it is important enough to you, you can control your behavior. When you have no compelling reason to be in control, you may feel "out of control," but you would gain control instantly if the circumstances changed enough. The longer you are involved in addiction, the less likely you are to be influenced by outside circumstances (whether people get upset with you, whether you lose your job, etc.). But probably a gun to the head influences everyone (who is not suicidal)!

A discussion of moderation, and choices in recovery, occurs in Chapter 7, and elsewhere in the workbook.

•  Why don't you use the terms "alcoholic" or addict"?
If you find these terms helpful, use them. But they are all-or-none labels that distort the reality that there are as many ways to have addictive behavior problems, and to change them, as there are individuals. It is not necessary to use these labels in order to change. I encourage my clients merely to recognize that they have had some problems. If they want to prevent future problems, we work on doing that.

•  How does someone cope with cravings?
The fundamental facts about cravings are that they are time limited, cannot force you to act (even though you may feel they do), and are not harmful (although they may be distracting). Most craving techniques involve some form of reminding yourself of these facts, and the advantages of not using, until the craving goes away. In the first days of change you might have frequent, strong and lengthy cravings. Over one to two months they diminish substantially in frequency, strength and length. In one to two years they may be gone entirely or nearly so. After a year, if you had a 1 (on a 10 point scale), which came up once a month, and lasted several seconds, how much of a problem would that be? Chapters 8, 9 and 10 present techniques for coping with craving.

•  What's the proof that what you write about is more effective than going to AA meetings?
AA meetings are effective for some people, but not most. If AA (and related groups) were so effective, why do we still have so many addiction problems? Surely by now everyone has heard of AA. Many people won't even attend AA, but maybe they would try out a different approach.

The scientific proof of AA's effectiveness does not exist. The US Secretary of Health and Human Services has written: "The effectiveness of AA has not been scientifically documented." (Alcohol and Health, 1990, page 265).

The techniques offered in Sex, Drugs, Gambling & Chocolate have been shown to be effective with a wide range of individuals with addictive behavior. The National Institute on Drug Abuse has written: "Behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community." (Principles of Drug Addiction Treatment, 1999, page 4) These are the same issues that are covered in the workbook.

•  Why aren't scientifically supported addiction treatments more widely available? If they were, would it make any difference in the recent rise in substance abuse?

I believe that scientifically supported addiction treatment would be more available if existing treatment programs would be more open to learning about them. Unfortunately, most US programs are dominated by individuals who believe that AA is the only way. In how many other aspects of healthcare is an approach that was developed in 1935 still the primary modality? I believe that if we had more addiction treatment options available, more people might seek them, resulting in fewer addiction problems.

•  Are activity addictions really the same as a substance addiction? After all, don't those substances have a big impact on the user?
Clearly substances have a chemical effect on the body. However, so do the chemicals that are released internally when, for instance, a gambler gets a "high" from gambling. It is not necessary to choose whether substance addictions are the same or different than activity addictions. They are similar in some ways, and different in others, just as individual cocaine users are similar in some ways, and different in others. The idea behind the workbook is that the methods of overcoming addictive behavior are essentially the same regardless of whether it is a substance or an activity. However, even though the change process is the same, it doesn't mean that the effects of the addiction are the same.

•  How does someone build and maintain motivation to change?
Motivation to change is primarily built on the perception that I have something to lose if I keep up the addictive behavior. It is amazing how much some people are willing to lose for an addiction, but most get to the point where they don't want to lose any more, and take control of themselves. I help my clients identify what they have lost, and what they will soon lose if they continue. What to do at that point is up to them. Most try stopping, moderating, or at least cutting back to less harmful involvement.

Chapter 5 focuses on identifying the costs of addictive behavior. If there is little or nothing to lose, then the term addiction has little meaning. If you are dying from cancer and need morphine for pain, what would you think of the physician who refused to provide the dose you need because you might become "addicted" to it?

•  Because addictive problems can be so severe, doesn't someone need to make a spiritual change as part of overcoming addiction?
In the process of changing an addiction it may be necessary to make major changes, including spiritual ones. However, it may only be necessary to make minor changes. Each individual is different.

The one-size-fits-all spiritual approach of AA is also clearly not going to work for everyone. There are many approaches to spirituality. Although in AA you are free to choose what/who your higher power is, how that higher power acts is prescribed in the 12 steps. If your understanding of a higher power is different from how the 12 step higher power is supposed to act, the 12 steps are not appropriate for you. Your spirituality may not even contain a higher power (e.g., some Eastern religions, some humanists).