Addiction and Recovery

29Nov 2017

Why Do Men Become Sexual Predators?

8 Causes of Sexual Harassment, Coercion and Assault

By Richard J. Loebl, LCSW, BCD

Sexual assault and harassment is nothing new – it didn’t start with Al Franken, Roy Moore, Matt Lauer, Charlie Rose, Donald Trump, or Bill Cosby. The numbers are astounding. A recent ABC/Washington Post poll shows that 33 million women have been sexually harassed at least once in their lifetime. Another study reported that 50% of all women, and 20% of all men, have been sexually harassed. The victims usually feel humiliated and degraded – and many are scared and suffer symptoms of PTSD (Post-Traumatic Stress Disorder), anxiety and depression.

The vast majority of sexual predators are men. Only a small minority of these men are famous. Based on the numbers alone, you probably know someone who is or has been a sexual offender. But why do men mistreat women in this manner? What are the causes of sexual harassment and assault? Is this a type of sexual addiction?

First and foremost, there is no typical profile of a male sexual predator. And sexual harassment and assault is not the result of misplaced sexual gratification – it’s not really about sex at all. Also, contrary to public statements made by numerous politicians and men in show business, it’s not a “mistake”. Alcohol and drug use often contribute to this behavior, but it doesn’t cause men to act out sexually. And the good news is that good parenting, education, and counseling for men can be effective in preventing and curtailing this serious problem.

8 Causes of Sexual Harassment and Assault

I’ve grouped together 8 primary causes of sexual harassment and assault based on a large number of research studies. Most men do not fit neatly into any one of these categories. Rather, there are multiple causes of sexual misbehavior. And these 8 factors are often interrelated: For example, there is overlap between male privilege in a patriarchal society and issues related to power and control.

1. Patriarchy – A patriarchy is a male dominated society. Most contemporary western societies are patriarchal, and the United States is no exception. In these societies men hold most of the power – in government and politics, and in control of most economic and legal systems. In spite of the rise of feminism over the past 30-40 years, we are still a male dominated country – perhaps even more so after our last presidential election. There is a traditional male code in our society that is still quite prevalent. This mostly unspoken code dictates that men have certain “privileges” that correspond to an exaggerated sense of masculinity. Also referred to as “machismo,” the male code promotes power and control over women while disregarding responsibility and consequences. In a patriarchal society, women are often viewed as sexual objects – and the goal is to subdue and conquer women sexually. The sex industry in the United States is just one example – prostitution rings and pornography are generally dominated by men. Our patriarchal culture clearly provides a fertile breeding ground for sexual harassment.

2. Power & Control – Closely related to patriarchy, studies show that power and control are major factors in most incidents of sexual harassment and assault. In these cases, the unwanted sexual advances are an act of intimidation and domination. Men in power positions often assert their “male privilege” because they believe they can get away with it. These men may operate on the belief or fantasy that the victim may actually enjoy their sexual aggression. They most certainly do not – female victims of harassment and abuse are traumatized, and usually need treatment for the resulting conditions of PTSD, anxiety and depression. And when you look below the surface, many of these powerful men are deeply insecure and need to be in control of women to assert a sense of competency – even to be admired. Counseling for men who act out sexually due to feelings of inadequacy or shame can be highly effective.

3. LATE Men – I’ve identified a large group of men in our society who are psychologically and emotionally under-developed. I refer to these men as the LATE Men – adult men who function as Lost, Angry Teens. These men tend to self-sabotage at home and at work, and they are relationally and sexually immature. Sexual acting out and misbehavior usually begins during adolescence, and the LATE Men fail to develop appropriate adult relationship skills. I’ve worked with LATE Men over 40 years of practice, and many of them have harassed women sexually. For more information about the LATE Men, see my articles at

4. Cultural/Historical – Another reason why men mistreat women sexually is that they always have. It’s built into our history and our culture, and it’s a self-perpetuating phenomenon. Biologically, men are larger and stronger than women, and are “programmed” for sexual conquest (the instinct for preservation of our species). Culturally and historically there was a lack of negative social and legal consequences, and predatorial men were able to get away with sexual mistreatment of women. Each generation of men learned from the last that men are sexually entitled. A set of shared myths and beliefs developed that supported this behavior (for example, women secretly like to be pursued in this blatant, sexual manner; and they just “play hard to get”).

5. Parental/Familial Influence – Male children are rarely held to the same level of standards that are applied to young girls in the family. For example, teenage girls tend to be supervised and controlled to a greater extent than male teenagers. A daughter who is sexually provocative or aggressive is much more likely to be controlled and punished than a sexually aggressive boy. The patriarchal male code is quite insidious. The vulnerable female child is closely guarded and protected. The male child is encouraged to hide or disguise his vulnerability, and to be tough, strong, and powerful. Their vulnerability goes underground, along with their compassion and empathy. Male children often learn to mistreat women by watching their fathers (also brothers, uncles, and grandfathers). And their fathers are often missing in action (they work all the time, and when they’re home they don’t show up as highly functioning mature adults). These young boys may also witness other types of violence or abuse against women that legitimizes sexual misbehavior.

6. Aggrieved Entitlement – Sociologist Michael Kimmel coined the term aggrieved entitlement. He explains that America was always the land of opportunity – and American men were entitled to jobs, a loyal wife and family, and “…positions of unchallenged dominance. And when we are told we are not going to get them, we get angry.” (Angry White Men, 2013, Persus Books Group) Today, many men are angry that women are becoming more empowered, taking their jobs, and demanding equal and fair treatment. They’re angry that women can get men to buy them drinks, dinner, and expensive weddings – and these same women have the power to reject them (or make more money). A type of reactionary contempt and hostility toward women develops, often to compensate for their feelings of inadequacy. These feelings contribute to the goal of humiliating and hurting women through sexual harassment and assault.

7. Personality Traits – Certain personality types or traits are associated with sexual harassment and assault. Specifically, narcissism and antisocial (sociopathic) personality types. In both types of personality there is a lack of compassion, empathy or remorse. The narcissist is fundamentally self-centered – his needs come first. The antisocial personality type disregards the rights of others – he lies, cheats, steals, and he is recklessly aggressive and dangerous. These men objectify women, often believing that female victims are somehow responsible for their own abuse or harassment. Many narcissistic men have a core self – one they are not conscious of – that feels inadequate or worthless. And the sexual mistreatment of women magically affirms their proud sense of masculinity. A common example today is men who coerce women into watching them masturbate (such as Louis C.K. and others). These men want to be seen and admired to boost their fragile egos. Counseling for men with these personality traits is critically important, and can be quite effective.

8. Sex & Love Addiction – Many clinicians believe that most sexual harassment and assault is caused by, or at least closely associated with sexual addiction. Epidemiological studies show that somewhere around 5-15% of adult men engage in compulsive sexual behavior. Some experts in this field believe the numbers are much higher. There is no doubt that many men demonstrate an inability to control their sexual urges, regardless of potential or actual negative consequences.

Counseling for Men Who Mistreat Women Sexually

The biggest difficulty is getting men into treatment. First, most of these men are in a state of denial (or they seriously minimize the significance of their actions). And openly discussing their behavior would probably result in overwhelming shame that would be unacceptable to most men (on top of their pre-existing feelings of inadequacy). Usually, it requires intervention by an aggrieved spouse, girlfriend, or employer.

Couples therapy can open the door to individual counseling for men who act out sexually. In either case, the goal is to heal the wounds from childhood and to teach men how to deal with feelings and relationships in a healthy, mature adult manner.

At our Center, we believe that all men contain within them the capacity to be loving, compassionate, responsible husbands, fathers, friends and co-workers. Counseling for men who mistreat women is necessary and effective. For further information, or to schedule an appointment for consultation, please contact us today

22Dec 2015

Illus-GroupTherapy“This Group Saved My Life”

By Richard J. Loebl, LCSW, BCD

When I was a 19 year old college sophomore, struggling with relationship problems and depression, I tried group counseling at my university counseling center. It’s been over 40 years, and I clearly remember one group session that brought me to tears. The therapist pointed out my disconnection from others in the group, and it changed my life. I realized how I protected myself emotionally with a rigid defensive façade, and the group helped me to feel safely connected in my vulnerability with others.

Now I’m the therapist, and I’ve been running counseling groups for a long time. Last month I was surprised and touched by a comment made by a 51 year old woman at the end of one our group counseling sessions. She gave me a big hug and told me “This group saved my life.” She had struggled with addictions, childhood trauma (abuse and abandonment), and serious relationship problems most of her adult life. With group support and feedback she got her life on track, and she’s become an informal “leader” in the group and her community.

Three weeks later, a similar comment was made by a member of my weekly men’s therapy group. One night after group he told me that “This group changed my life.” Over the past few years, this 46 year old man has been in individual therapy, marriage counseling, and has attended personal growth workshops. He told me he’s learned more about himself and has made more positive changes as a result of group counseling than everything else combined.

Why is group counseling so effective? What exactly happens in therapy groups, and how do they work?

Types of Group Counseling

There’s an almost endless variety of therapy groups. Some of the most common types include:

o Men’s groups, with a special focus on men’s issues and life roles. Anger, shame, and relationship challenges are often discussed. Men supporting and encouraging other men is an emotionally powerful, rewarding experience.

o Women’s groups often focus on relationship issues, self-esteem, anxiety and depression, and life balance issues.

o Mixed adult group counseling (male and female) – Relationships, depression, anxiety, addictions.

o Couples groups – Small groups of married couples (relationship issues).

Group Counseling Methods

o Process groups – My preferred method for conducting therapy groups is also considered to be the most effective in creating long-lasting change. Process refers to what actually happens in the group itself (in contrast to content – the topics people talk about in the group). The focus is on the here and now – the interactions between group members. What happens in group is an accurate reflection of what happens outside of group. The group becomes a “living laboratory” that reveals authentic feelings, behavior and styles of interaction. Process also provides an opportunity to practice new, more constructive ways to deal with feelings and relationships in the present.

o Experiential groups – Such as psychodrama and personal growth groups. Structured exercises encourage members to learn about themselves and others through actual experience. These exercises are often used with process-oriented group methods. Exercises include role playing, guided imagery, and the use of art and music to facilitate awareness and reflection.

o Client-centered and psychodynamic – These traditional therapy groups are less structured, free-flowing client discussion groups. The therapist provides personal and interpersonal insights and facilitates positive and supportive client interactions. Process group methods are frequently used in these groups.

o Problem solving and skill building – These focused groups usually address specific problem areas such as interpersonal conflict or avoidance, anger management, social skills, and others.

How Does Group Counseling Help?

Group counseling often provides benefits that are unlikely to occur in individual therapy. Group members are frequently surprised by how rewarding the group experience is. Group members are supportive, understanding, and honest in their feedback. They often have ideas and solutions counselors or therapists may have overlooked. There’s a wider range of perspectives, and group members often encourage and empower each other to make positive changes. Another important benefit is that group counseling is considerably less expensive than individual therapy.

Research studies have identified many “curative factors” in group counseling. Irv Yalom, M.D. is one of the most authoritative experts in group therapy, and he identifies the 12 most important curative factors in group psychotherapy:

1. Helping others – improves self-respect and reduces negative self-focus

2. Sense of belonging and acceptance by the group – feeling connected and understood by others

3. Universality – “we’re all in the same boat”; “I’m not that different from others”

4. Learning from the way others see us – how we come across to other people

5. Relationship skills – learning how to get along better with others; trust; vulnerability

6. Guidance – from group members and the therapist

7. Emotional release – expressing feelings and speaking one’s truth in a safe environment

8. Modeling behavior – learning new methods for dealing with feelings; learning new behavior and styles of interaction from others in group

9. Learning from the re-creation – we tend to re-create our patterns of behavior and reactions (often learned during childhood) with new people in a group

10. Insight – learning about our rigid opinions and attitudes, why we feel and react toward others

11. Hope – from watching others solve problems and make progress in their lives

12. Acceptance – of the realities in life that all of us face together (unfairness; loss; emotional and physical pain; loneliness; and the need to take responsibility)

We currently have openings in our men’s group, and we’re forming a new women’s counseling group. Contact us today for more information, or to talk to a therapist about joining one of our groups.

27Mar 2015

Illus-ManWoman VectorBy Richard J. Loebl, LCSW, BCD


The Debate

Can someone really be addicted to sex and love? We hear almost every day about the infidelities of famous people, internet affairs, sexting, sexual assault, and the preponderance of porn. Most recently Bill Cosby, the beloved comedian and father figure, was in the news every day. And in the recent past, entertainers like Kanye West and Michael Douglas, sports figures like Tiger Woods, and politicians like Arnold Schwarzenegger and Anthony Weiner. Are they addicted, obsessed, or just misbehaving?

The general concept of addiction is still widely debated, even among health care professionals. Is addiction a disease, a social problem, or an issue of morality? Love and sex addiction is even more controversial than drug or alcohol addiction. For example, everyone literally needs love and sex – these normal, human needs are hard wired in the human brain. Can you really differentiate between addiction and the normal need for love and sex? There is also debate concerning the traditional medical model – or disease model – of love and sex addiction. Is sex and love addiction a disease, or could it result from the lack of social connectedness in our tech-driven modern society? This debate will likely continue for many years to come. The way we define addiction may be helpful to those who need supportive guidance in dealing with these problems.


The dictionary (Merriam-Webster) defines addiction as “… a strong and harmful need to regularly have something or do something.” That would seem to apply to many men and women who are obsessed with love relationships or with multiple sexual partners, pornography, and online hookups. The “strong need” is obvious, and the harm results from broken marriages and relationships, emotional turmoil, wasted time and money, and sexually transmitted disease.

The disease model of addiction is described by the American Society of Addictive Medicine. The ASAM defines addiction as “… a primary, chronic disease of brain reward, motivation, memory and related circuitry.” They go on to say that “Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.” While the notion of “chronic disease” may be debated, there seems to be no doubt that many people cannot abstain from compulsive sexual behavior and obsessive love relationships. And the resulting emotional and relational problems are well known – along with minimizing or denial of the problems.

The 12 Step program SLAA (Sex and Love Addicts Anonymous) defines sex and love addiction as the “…addictive compulsion to engage in or avoid sex, love, or emotional attachment.” There are SLAA meetings every day all over the country and internationally. Tens of thousands of SLAA members would agree with this definition. SLAA members also report the following behaviors, typical of sex and love addicts (for more information, see

  • Having few healthy boundaries, we become sexually involved with and/or emotionally attached to people without knowing them.
  • Fearing abandonment and loneliness, we stay in, and return to, painful, destructive relationships.
  • We confuse love with neediness, physical and sexual attraction, pity and/or the need to rescue or be rescued.
  • We sexualize stress, guilt, loneliness, anger, shame, fear and envy.
  • To avoid feeling vulnerable, we may retreat from all intimate involvement.

Based on my 40 years of experience as an addictions professional and licensed psychotherapist, it’s quite clear that many people experience a loss of control over romantic and sexual urges. The specific definition doesn’t matter when people can’t stop or manage these urges. And there’s ample evidence that these obsessions and compulsions result in a pattern of negative consequences – emotionally, physically, legally, and in relationships.


If you believe you or someone you care about may have a sex and love addiction, now is the time to make an informed decision and take action. These steps are recommended:

  1. Assessment – This is the time for open and honest self-reflection. If you believe you may have a sex and/or love addiction, you may want to start with a self-test (such as Or contact us today for a private, confidential consultation. Shame is a core issue for people who struggle with this type of addiction. It’s important to let go of judgment and recrimination.
  2. Discussion – If you’re concerned about a spouse, lover, or friend, approach the subject in a gentle, non-threatening, and non-judgmental manner. Invite an open discussion with the goal of getting help in the spirit of partnership.
  3. Intervention – If discussion results in denial or avoidance, and the problem continues, it’s time to intervene. This could be an informal process of confrontation (non-judgmental, but firm), or a more formal process that may involve a counselor or intervention specialist. With love and respect, it’s time express your concerns openly – and possibly to indicate consequences if the person refuses to get help.
  4. Treatment – Outpatient counseling or therapy is the treatment of choice for sex and love addictions. Our Center specializes in treatment for sex and love addiction. Group therapy is usually recommended, along with individual and couple therapy. It’s also important for significant others to get their own help and support. A full commitment to abstinence is required (a “bottom line” regarding compulsive behaviors that must be discontinued in order for treatment to be effective). Effective treatments will address intimacy and attachment issues, the longing for connection and love, and childhood trauma (abandonment and abuse). Regular attendance at SLAA meetings is highly recommended.
19Mar 2015

By Richard J. Loebl, LCSW, BCD

For hundreds of years addiction to alcohol or drugs was considered by most people to be a moral failing or a sin against God. By the 20th century, the medical model of addiction was established by the American Medical Association, and endorsed by psychologists, social workers, counselors, and Alcoholics Anonymous. Attitudes began to shift, and many people today believe that addiction is a disease (although many others still judge addicts as morally or spiritually corrupt).

In his fascinating and controversial new book Chasing the Scream: The First and Last Days of the War on Drugs, Johann Hari argues that “…almost everything we have been told about addiction is wrong…” (An article based on his book can be found online at The author describes the misguided and failed War on Drugs, and he makes a compelling case for supporting a new model of addiction. He concludes that alcohol and drug addiction is an adaptation to socially impoverished circumstances, not a disease, and certainly not a problem of morality. The drugs have addictive qualities, but the drugs do not cause addiction.

Mr. Hari bases many of his conclusions on the work of Dr. Bruce Alexander, a psychology professor, research scientist, and author. Dr. Alexander conducted studies that show how addiction is a social problem – not a disease or moral disorder. His research has been validated by other scientific studies. In these experiments, animals were confined in environments where they were socially isolated from other animals, and deprived of their normal, healthy surroundings. These animals developed an addiction when they had a choice between 2 containers of water: one laced with opiates or stimulants, and another vessel with normal, untainted water. When the very same animals are moved to normal, social environments, they prefer the water that does not contain drugs. And the same results occur with human beings in a variety of real life circumstances (such as returning war veterans and post-surgical patients who are prescribed opiates for pain).

There is ample evidence now to conclude that the medical model of treatment, based on the addictive qualities of drugs themselves, is short sighted and ineffective. The implications for effective alcohol and drug treatment are quite clear, and should include:

o Warm and welcoming treatment environments.

Treatment facilities for alcohol and drug clients are often bleak, colorless and uncomfortable. These settings often result in negative emotional reactions in patients and may even contribute to relapse.

o Caring and compassionate counseling staff.

Counselors and therapists in addiction and rehab programs are often over-controlling and confrontational, with a tendency to “pathologize” clients (that is, they often view the clients as “sick” and treat them from a position of superiority and judgment). Alcoholics and drug addicts who are rigidly controlled, demeaned and criticized for their behavior only feel worse about themselves, and will receive little benefit from treatment.

o Social and emotional connection.

The vast majority of addicts have suffered rejection, alienation and trauma in their lives (including childhood neglect, abandonment and abuse). Treatment programs and counselors will only be effective when they address these emotional wounds, and help their clients connect to their feelings in a healthy manner. Clients must be treated with respect and open, non-judgmental acceptance. Social and relationship skills need to be taught by counselors and reinforced by organized program activities.

o Secure housing and subsidized employment.

A majority of clients in residential or inpatient alcohol and drug rehabilitation programs, and many others in intensive outpatient programs have limited resources or ability to live independently. Hari visited countries like Portugal, where drugs have been decriminalized, and funds from their failed war on drugs were redirected to housing and jobs for addicts. In countries like Portugal and Great Britain, addiction has fallen by as much as 50%.


Alcoholics and drug addicts can and do recover, often with the support of other addicts in programs like Alcoholics Anonymous and Narcotics Anonymous. The debate about the medical model and the disease concept of addiction is likely to continue for a very long time. We need to learn from programs and countries with impressive records of success. This success is based on compassionate care, concern, and love – not on control, judgment and punishment. And as Mr. Hari reminds us, we also need to “…talk about social recovery – how we all recover, together, from the sickness of isolation that is sinking on us like a thick fog.”


16Dec 2014

How do you know if you or a loved one has a sex addiction? This is not an easy question to answer without an assessment from a trained professional. Sex addiction is not the same as infidelity. Affairs do not automatically point to a sex addiction, but relationships with multiple partners can be one sign that you or a loved one has a sex addiction.

At the Relationship Center of South Florida we have the tools and expert training to accurately diagnose and treat sex addiction in its many forms. We also treat the partners of those with a history of sexually obsessive and compulsive behaviors, as well as how the disease impacts the couple and the family.

The diagnostic process to pinpoint and gauge the severity of a sex addiction is comprehensive and objective. PATHOS is a brief self-assessment tool that can help in the process of identifying out-of-control sexual compulsivity.


1. Do you often find yourself preoccupied with sexual thoughts? [Preoccupied]

2. Do you hide some of your sexual behavior from others? [Ashamed]

3. Have you ever sought help for sexual behavior you did not like? [Treatment]

4. Has anyone been hurt emotionally because of your sexual behavior? [Hurt others]

5. Do you ever feel controlled by your sexual desire? [Out of control]

6. When you have sex, do you often feel depressed afterwards? [Sad]

A positive response to just one of these questions indicates the need for additional assessment. Two or more indicates the likelihood of some type of sexual addiction. Honest answers will help you in decision-making moving forward.

This is not a comprehensive assessment, but rather a tool to help determine if more exploration and assessment is called for. Please contact The Relationship Center at 561-955-6090 if you have any questions and would like to speak with a trained sex addiction therapist, or to schedule a consultation for you or a loved one.

25Nov 2014

This is a basic checklist frequently used by counselors and therapists to begin to determine whether alcohol and/or other drug abuse may be an issue in someone’s life:

1. Frequent Intoxication

Is the person frequently high or intoxicated?

Do many recreational activities center around drinking or other drug use – including obtaining, using and recovering from use?

2. Social Setting

Does the peer group encourage alcohol and drug use?

Is the person socially isolated from others and is substance use occurring alone?

Is the person reluctant to attend social events where alcohol or drugs won’t be available?

3. Intentional Heavy Use

Are “social” or “party drugs” used along with prescribed medications?

Does the person use more than is safe in light of other medications they may be using, or because of compromised tolerance due to illness or disability?

Does the person have an elevated tolerance as evidenced by the use of large quantities of alcohol or drugs without appearing intoxicated or high?

4. Symptomatic Drinking/Using

Are there predictable patterns of use which are well known to others?

Is there reliance on chemicals to cope with stress?

Has the person made lifestyle changes – yet the amount of use has stayed the same or increased? (e.g., changed friends or moved to another area)

5. Psychological Dependence

Does the person rely on chemicals as a means of coping with negative emotions?

Does the person believe that pain can’t emotionally be coped with without medication?

Does the person display obvious guilt about some aspect of their use of alcohol or drugs?

6. Health Problems

Are there medical conditions which decrease tolerance or increase the risk of substance abuse problems?

Are there medical situations or conditions which are aggravated by repeated alcohol or drug use?

Did the person ever suffer from an accident or disability while under the influence, even if it is denied by the person?

7. Job or School Problems

Is the person unemployed or underemployed? Falling behind in school? Dropped out? Getting poor grades?

Has the person missed work or school, or gone to work late due to alcohol or drug use or withdrawal?

Does the person blame or justify drinking/drugging because of school or work-related problems or difficulties?

8. Problems with Significant Others

Has a family member, friend or loved one expressed concern about the person’s use?

Have important relationships been damaged or lost due to chemical use?

9. Problems with Law or Authority

Has the person been in trouble with authorities or arrested for any drug or alcohol related offenses?

Have there been instances when the person could have been arrested but wasn’t?

Does the person seem angry at “the system” and at authority figures in general?

10. Financial Problems

Is money being spent in a manner not easily accounted for?

Does the person frequently miss making payments when they are due?

Does the person seem to struggle with affording basics or with saving money?

11. Belligerence

Does the person appear angry or defensive but does not seem to know why?

Is the person angry or defensive when confronted about chemical use?

12. Isolation

Does increasing isolation (emotional and/or physical) suggest heavier substance use?

Is the person giving up or changing social and family activities in order to plan for, obtain, use, or recover from substances?

One or more of these symptoms does not automatically indicate a substance abuse problem. Rather, a pattern of difficulties across a range of functioning is the indication that you or a loved one is struggling with an alcohol or other drug abuse problem.

Let us help you determine if you or someone you care about has a substance abuse issue or dependency. We can also find the right treatment option – one that fits your finances, insurance coverage, lifestyle and commitments, for your individual needs. Please contact us today to set up an appointment with one of our addictions specialists.

28Jan 2014

In 1955, the American Medical Association declared that alcoholism was a disease. In the early 1970’s the topic was still hotly debated. The Rand Corporation sponsored a major study which indicated that alcoholics could learn to practice “controlled drinking.” Many studies since then determined that controlled use led to relapse and addictive patterns in the majority of cases. Today, the disease model of addiction is widely accepted. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) includes alcohol and drug dependence and abuse. Addiction is generally characterized by tolerance and withdrawal. Tolerance is a need for increased amounts of the substance over time. Withdrawal from the substance results in a variety of physical and psychological symptoms.

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