Some things I learned at the 2018 Annual Conference on ADHD

2018 ADHD Conference.png

I recently attended the 2018 Annual International Conference on ADHD, co-hosted by CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), ADDA (Attention Deficit Disorder Association), and the ACO (ADHD Coaches Organization). The experience was amazing - the content, the people, everything. Four days of material, broken into six simultaneous tracks for Mental Health Clinicians, Physicians/Psychiatrists, Coaches/Organizers, Educators, Parents/Caregivers, and adults with ADHD. Gloriously overwhelming!

Of course, I was only able to attend the presentations that were most relevant for my ADHD Coaching and Professional Counseling practice(s). And some that were simply interesting for myself as a lifetime ADHD’er. I took copious notes, and have distilled what I think are some of the most important points to share.

Some overarching points:

For adults, ADHD is a productivity disorder. Clinically speaking, it is a chronic disorder of inhibition and self-regulation. It is NOT about simply “sitting still and paying attention”. Rather it is about regulating critical psychological functions such as motivation, focus, attention, emotions, and behaviors.

Put another way, ADHD is a disorder of life management. (see below for examples)

Two unfortunate paradoxes were presented:

  • ADHD is a stress producing disorder, and excessive stress makes managing ADHD harder

  • People with ADHD have a harder time succeeding with self-improvement; with the development of the exact skills they need in order to survive with ADHD.

Two basics that everyone should know:

  • The causes of ADHD are no longer unknown. ADHD is a neurodevelopmental disorder, with clearly established neurobiological underpinnings, neurochemical imbalances (dopamine, norepinephrine, etc), specific impaired neural networks, and genetic etiologies (70% heritability).

    • Things that do NOT cause ADHD: Bad parenting, anything related to breastfeeding, too much screen-time, learning to walk too late, dishonest marketing by drug companies.

  • Most children do NOT “grow out of it”. Research now indicates that 60% - 80% of people carry their ADHD into adulthood (throughout their entire lifespan). Sadly, less than 20% of adults with ADHD who were not diagnosed as children, will ever be diagnosed or treated. Actually, this is tragic, and you’ll understand why after you read the next section.

ADHD bites its own tail because its harder to do the things we need to do to manage ADHD.
— Mark Bertin, MD

Keynote Speaker: Russell Barkley, PhD

Dr. Barkley is the worlds leading researcher on ADHD. He has published literally hundreds of academic/scientifc articles, almost 100 textbook chapters, and dozens of books. Dr. Barkley is not in the camp of ADHD as a “gift”, and was a particularly heavy-hitter on the topic of the painful realities of adult ADHD:

  • “Across all of our results, one thing seems abundantly clear – ADHD in adults is a significantly impairing disorder, associated with numerous difficulties in virtually every domain of major life activity.”

  • “Whether one studies functioning in education, occupation, social relationships, sexual activities, dating and marriage, parenting and offspring, psychological morbidity, crime and drug abuse, health and related lifestyles, financial management, or driving, ADHD can be found to produce diverse and serious impairments.”

  • “As such, ADHD impairments are more substantial than are those seen in other disorders most likely to present to outpatient mental health clinics, such as anxiety disorders, dysthymia, and major depression.”

If those points weren’t heavy enough, these should be:
ADHD is a public health disorder, not just a mental health problem.
• ADHD rivals autism in the stress burden on parents.
• ADHD as a quality-of-life threatening illness!

His keynote was largely focused on presenting the findings of his recently completed long-term study of people with ADHD. His bottom line finding was shocking and profound: Undiagnosed people with ADHD have a lifespan 10+ years shorter than average!

ADHD is not a disorder of not knowing what to do…its a disorder of not being able to do what you know.
— Russell Barkley, PhD

ADHD & the DSM-5

It’s pretty well agreed that, despite the fact that there are 50,000+ scientific articles published on the subject, the APA missed the proverbial boat in regards to getting ADHD correct in the DSM-5. In fact, the APA has proven to be pretty good at pooch-screwing in general (for example, see my article on their handing the topic of Behavioral Addiction, wherein I illustrate how they actually formally posited in the DSM-5 that asian males with “internet connected computers” are the most likely people in the world to develop a gaming disorder!!) Accordingly, many conference presenters had very little positive to say about the APA’s handling of the disorder.

Here are some fun facts they pointed out:
• In 1994, the APA added “Hyperactivity” to the name, but removed it as a required criteria (huh?).
• The word “Impulsivity” isn’t even mentioned in the list of criteria for “Hyperactivity and Impulsivity”.
• Problems with Emotional Regulation aren’t addressed at all, despite their being a key impairment.

I could go on and on, however, I’ll just say that while the APA purported to update the diagnosis to better include adults, they didn’t do a very good job of it. Here are specific thoughts from some of the masters in the field:

Some thoughts from Russell Barkley, PhD:

The DSM-5 requires that impairments are present in two or more settings, and they list school/work, and home as the only examples. Unfortunately, this ignores many important domains of major life activities that comprise adult adaptive functioning. Example domains of major adult life activities that current criteria fail to reflect include:

•   General functioning within the community (eg. legal, social, driving, chemical use/abuse)
•   Financial management
•   Parenting and child-rearing
•   Marital functioning
•   Routine health maintenance activities (eg. self-care)

Some thoughts from Dr. William Dodson, MD:

The DSM criteria are only behavioral and observational, and they neglect critical aspects of ADHD such as:
•   Cognition and Thinking Styles
•   Emotional Regulation
•   Psychosocial Maturation
•   Interpersonal Relationships
• Sleep

Plus, the name ADHD downright stinks. The AD is incidental - the problem isn’t a deficit of attention, it is a problem with attentional engagement on demand.
— William Dodson, MD

On the topic of Dual Diagnosis

It is well known that there is a high rate of comorbidities with ADHD. It was very interesting to learn, however, that all the co-morbidities aren’t necessarily alway correct. Specifically, the following was discussed at the conference:

  • There is a 50% comorbidity reported between ADHD and anxiety. Oftentimes, however, the stress of living with ADHD often creates its own anxiety, and is not a distinct diagnosis. Although many practitioners treat the anxiety first, it should be the other way around. (source: William Dodson, MD)

  • What is mistakenly diagnosed as co-morbid Depression is often actually frustration and demoralization at repeated failure and falling short of potential. This is frequently triggered by negative life events, is shorter than 2 wks duration, and is relieved by finding new interests. 50% of co-occurring depressions resolve with stimulant medications alone (ie. no added antidepressants). (source: William Dodson, MD)

People with ADHD have genetic markers that make them more susceptible to PTSD after experiencing a trauma.
— Mark Bertin, MD

Regarding ADHD medications

ADHD medications are not a “crutch”, and there are numerous misunderstandings, bordering on memes and myths about ADHD medications (stimulant medications in particular). Here are some important take-aways from the conference:

  • “Drug Holidays” hurt, not help. ADHD is a 24-hr disorder, and should be treated accordingly.

    • See above DSM-5 section for other domains impaired beyond simply work and school. Just because someone doesn’t have to study/do homework/goto the office/work on a project/etc doesn’t mean they don’t need optimal access to their ability to organize, not procrastinate, not be overwhelmed, better manage their impulses and emotions, etc. It was the consensus option (among the medical doctors) that prescribing practitioners who still advise “only take your ADHD meds when you need to study or concentrate” should get updated training on ADHD.

  • The European Consensus Statement on the Treatment of Adult ADHD recommends the daily use of stimulant medications, as does the white paper/consensus statement by the NIH (link pending).

  • Stimulant medications do not increase anxiety (when properly dosed).

    • 23 studies actually found that stimulant medications are almost always associated with significantly lower levels of anxiety.

  • There are only 4 true side effects from stimulant medications (when properly dosed): appetite suppression, insomnia, stomach ache, & headache.

  • Life is harder without meds, or if they aren’t right.

    • The “or if they aren’t right” refers to the rampant mis-prescribing of Adderall (especially non extended release) by prescribers. Methylphenidate, not amphetamine, is the first-line drug for adult ADHD. Further, standard release formulations should only be used when “absolutely necessary”. That comes from authorities such as the NIH, WHO, AMA, APA, and the European Consensus Statement on the Diagnosis and Treatment of Adult ADHD. Nonetheless, probably 80% of the clients that come to me for ADHD Coaching and/or Counseling are being prescribed Adderall. And probably 50% of them are on standard release…

  • ADHD is the most treatable disorder in psychiatry.

    • This claim, made by multiple psychiatrists specializing in ADHD, is based on the high efficacy of ADHD stimulant medications.

  • ADHD stimulant medications are safer than aspirin. This statement was made in the ADD & Loving It? documentary by Dr. Ned Hallowell, expert ADHD psychiatrist and co-author of one of the seminal books in the field (Driven to Distraction). He backed up this seemingly bold statement by comparing the fatality rates of the two medications.

Medication levels the neurobiological playing field, and allows adults with ADHD to learn and develop the skills they ned to succeed.
— Beiderman & Spencer, 2002

ADHD and Addiction

This was my talk, and I am super-honored that they accepted my proposal. The topic is critical, as research indicates that up to 50% of people seeking treatment for addiction also have ADHD. Most haven’t yet been diagnosed or treated, and have instead been attempting to compensate by self-medicating with chemicals and/or behaviors (gambling, porn, internet gaming, etc). I go into great detail about the neurobiological overlap between the two disorders, and focus on both chemical and behavioral addictions. I presented for 75-mins, so I won’t try cover it all here, and will instead distill it down to two sets of myths.

First, I talked about 3 Myths about ADHD & Addiction:

  1. Myth: Stimulant medication treatment of ADHD in childhood can lead to addiction later in life.

    • False. In fact, most research has found the opposite -that ADHD stimulant medication has a protective effect for children, drastically reducing the risk of developing a SUD later in life.

  2. Myth: Long-term use of stimulant medication will lead to addiction.

    • Incorrect. There have been no valid studies showing that stimulant medications (properly prescribed) lead to addiction in people with ADHD (properly diagnosed).

  3. Myth: People with ADHD will eventually abuse their stimulant medication.

    • Not true. Neurotypical Brain ≠ ADHD Brain. Ask anyone with ADHD if they enjoy being a given too large of a dose of their meds. Overwhelmingly, the answer is NO. Our brains are wired differently, and we don’t get “high” from the meds. Instead we go into either “Zombie Mode” or “Starbucks Syndrome”.

I also talked about 3 Myths about Addiction Treatment for people with ADHD:

  1. Myth: We don’t need to screen for that.

    • Wrong. Based on the huge co-morbidity between ADHD & SUD, there should ALWAYS be a screening.

  2. Myth: People with ADHD must discontinue their stimulant medication while in treatment for addiction in order to get sober.

    • Wrong again! According to the NIH, subject matter experts at Harvard, and other formal published position papers (such as the International consensus statement on screening, diagnosis and treatment of substance use disorder patients with comorbid attention deficit/hyperactivity disorder), concurrent treatment is the recommended practice. Don’t let addiction treatment centers tell you otherwise, as they are flat wrong (and oftentimes causing multiple forms of iatrogenic harm).

  3. Myth: People with ADHD and history of substance abuse will be unable to safely use their medication to manage their ADHD symptoms after they become sober.

    • Wrong yet again. Multiple studies show that the risk for relapse is actually reduced.

Consistent with findings in untreated ADHD in adults, untreated ADHD was a significant risk factor for SUD in adolescence. In contrast, pharmacotherapy was associated with an 85% reduction in risk for SUD in ADHD youth.
— Biederman, J., et al. (1999). "Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder." Pediatrics, 104(2): e20-e20.
ADHD medication was not associated with increased rate of substance abuse. Actually, the rate during 2009 was 31% lower among those prescribed ADHD medication... Also, the longer the duration of medication, the lower the rate of substance abuse.
— Chang, Z., et al. (2014). "Stimulant ADHD medication and risk for substance abuse."

Keynote Speaker - Jessica McCabe.

Einstein-McCabe fish quote.jpeg

Her closing keynote speech on Sunday was MINDBLOWING. Equally mindblowing was sitting in a room full of a thousand people (or so) all becoming simultaneously teary-eyed.

Her talk was titled “Getting fish out of trees, one brain at a time”. I had no idea what this meant, until I saw the following slide (I pirated this picture; I assume she’d be ok with it). To fully appreciate the point, read the first half, pause and let it sink in before reading the second.

Her point is profound, on multiple levels. For those who don’t have ADHD, never underestimate the depth of shame that results from living a life of continuously making small mistakes, and being repeatedly told (explicitly or subtly) that you wrong, stupid, weird, lazy, or whatever.

Her TedX talk below isn’t her talk from the conference (obviously), but it covers much of what she had to say. She even talks about fish in trees (although she presented it better at the conference, IMHO). For readers who aren’t familiar with Jessica, she is an amazing layperson contributer to the field via her highly watched YouTube channel How To ADHD. The video linked to the right is her most popular talk, viewed over 1,000,000 times.

In conclusion…

Ok, I actually don’t have a fancy conclusion. In true ADHD style, I’ve become tired of writing (it took me an entire weekend to put this together). I do want to acknowledge that there there were TONS of other speakers at the conference, covering TONS of other related topics (such as parenting children with ADHD, teaching students with ADHD, or the many techniques for and benefits of ADHD Coaching). My apologies to anyone from the conference whose work I didn’t reference, (or whose work I may have accidentally misstated).

For those who are interested in learning more about the conference, you can follow these two links (one and two) to download many (but unfortunately not all) of their handouts and/or presentations. There was so much awesome stuff there that I haven’t even mentioned (lots on mindfulness, updates on CAM (complementary alternative medicine), and more).

So, I’ll end here now, with the following quote from the conference:

In the history of calming down, no-one has ever calmed down, by being told to calm down.
— (I forgot who said this, but it resonates deeply)

Source: some things learned at the 2018 ADHD ...

2-year Specialty Practice Update (2017)

I am excited to announce the two-year anniversary of my boutique counseling and coaching practice for men and young-men in the Athens area.  While my practice was initially narrowly focused as a men’s-only, private pay, Behavioral Addiction (sex, porn, and Internet in particular) specialty practice, I have since made some expansions and adjustments to better meet the needs of people in our area. For example:

Age-range: My primary focus is still on men and young-men, I now also work with adolescents as young as mid/upper high-school (~16yo). 

Insurance: I am still primarily a private-pay practice (with a sliding scale available), however, I am now paneled with United Healthcare, and am in the process of applying to BlueCross/BlueShield of Georgia. 

Other scope expansions:

Professional/Life Coaching: I am currently engaged in training for my Board Certified Coach (BCC) credential, as I have found males to sometimes more open to "coaching" then they are "counseling" or "therapy".

Adult ADHD: As a lifetime ADHD'er, I am particularly suited to work with persons struggling with this complex disorder. In addition to offering a clinical approach to addressing core issues such as shame and low-esteem, a cross-focus of my BCC is in ADHD Coaching, allowing me to provide a skills-based and task-oriented approach to Adult ADHD.

Problematic Sexual Behaviors (PSBs): In addition to my ongoing extensive training for the Certified Sex Addiction Therapist (CSAT) credential, I have a Specialist in Problematic Sexual Behaviors (S-PSB) training certificate. While the sex addiction model has much utility and validity, it is not a universal model. I am trained to utilize a broader range of approaches to treat clients with PSB's.

Trauma training: I have attended both EMDR Level 1 and Brainspotting Phase I trainings to help address the trauma and stress component that sometimes underlies the problem of compulsive sexual behaviors and other life issues.

Career/Academic Counseling: My unique professional and academic background (corporate IT Director (MBA) turned DUI defense attorney (JD) turned clinician (PsyD-LPC)) has proven useful for working with clients in life transitions. By utilizing a combination of existential and career counseling with life coaching, I have helped clients struggling with failure-to-launch issues, academic uncertainties (both graduate and undergraduate), and mid-life crisis to find their identity and direction.

Online Counseling & Coaching: I am a Distance Credentialed Counselor (DCC) enabling me to provide online sessions for clients who are unable or unwilling to attend in-person counseling or coaching sessions. I have delivered counseling services for clients around the state, and have provided addiction coaching (Internet & SUD) for clients around the world.

More about me:

Professional service: I currently serve on the Board of Directors of 2 non-profit professional associations. I am Co-Chair of the Training Committee for the Society for the Advancement of Sexual Heath (SASH), and am co-developing a curriculum to teach other professionals how to identify and work with PSB's using multiple approaches. I additionally serve as the Chair of the Ethics Committee for the Licensed Professional Counselors Association of Ga (LPCA). I also advocate for the Counseling profession on the State level (licensing board, legislature.). I briefly served as the clinical coordinator for the Western Judicial Circuit Felony Drug Court (FDC).

Academic Publications: In the academic realm, I have co-authored one textbook chapter (The Neurobiology of Sex Addiction) and one journal article (The Neuroscience of Internet Pornography Addiction). I have another of each in press at the moment (journal article on Internet Addiction & the DSM-5, and a textbook chapter on the Etiology of Sex Addiction. I continue to maintain expert knowledge on Behavioral Addictions, especially those related to the Internet (porn, gaming, shopping/spending, gambling, social networking, etc.).

Public Presence: I have given conference presentations on the topic of Internet and Pornography Addiction, and was an invited speaker to a College of Charleston forum on the impact of pornography upon the life and relationships of college students. I am proud to have been interviewed for a BlogTalkRadio podcast, as well as to have been interviewed for and quoted in two articles (one online/print, one online only 3-part series (1, 2, 3)) regarding my areas of expertise.

            I enjoy working with a wide range of clients, and am excited to continue on this professional journey. My practice is on the East Side, across from the YWCO. I operate on standard business hours (Mon-Fri, 8-5), and am currently taking new clients. I am open to referrals, and look forward to continue building my reputation as a local expert in these specialty areas.


Todd L. Love, PsyD, JD, LPC
545 Research Dr, Ste.B
Athens, GA 30605

How does the AASECT discounting of Sex & Porn Addiction affect the 12-step community?

On 11/29/2016, the American Association of Sexuality Educators, Counselors, & Therapists (AASECT) released a formal position statement on Sex & Porn Addiction.  The official AASECT position reads as follows:

AASECT recognizes that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors. AASECT recommends that its members utilize models that do not unduly pathologize consensual sexual problems. AASECT 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.

Extracting the core of the statement, AASECT:

  1. ...does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder

  2. ...does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge.

  • Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy

Both of AASECT's two primary statements, along with their conclusion, are problematic - for multiple reasons.

On its face, the first statement in their formal position is about how the problem should be diagnostically categorized; or, to be more specific, about how it should NOT be categorized.  An unfortunate problem with the statement, however, is that it is being headlined as “Sex Addiction & Porn Addiction DO NOT EXIST”.  This statement is based on multiple logical fallacies, and is an overreach when also considering that AASECT is not a scientific research organization, but rather an advocacy group and certifying body for people in the field of sexual health; Sex Therapists (clinicians), Sexuality Counselors (e.g., an HIV counselor), and Sexuality Educators (teachers).  As such, AASECT is not qualified to countermand actual scientific organizations such as the American Society of Addiction Medicine (ASAM), a professional medical organization, who maintains an academic/medical journal on the topic of addiction, and offers an Addictionology Board Certification/Fellowship for medical doctors only. ASAM’s detailed interpretation of the science can be found in their formal definition of addiction, which includes sexual behaviors as able to activate addiction neurocircuitry.  Unfortunately, AASECT relies on the logical fallacy of “appealing to authority”, by putting its name on such a pronouncement. Furthering the problem is the fact that the AASECT statement is being bandied around the media with overbroad application. For example, “Are Sex Addiction and Porn Addiction Really a Hoax? According to the experts. (Maybe.)

Their second statement is equally problematic; that AASECT “... does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge”.  What does this mean?  Parsing the language, they are stating that sex addiction training & treatment methods are not “...adequately informed by accurate human sexuality knowledge”.  Keeping in mind again that AASECT is not a scientific or research organization, but rather a collection of “sexual health advocates”, it is not necessarily surprising that their focus is on “human sexuality knowledge”.  Regardless, their apparent intent is to undermine/discredit the formal sex addiction training programs, the clinicians they have certified, and private treatment programs ("rehabs”).  I understand the concerns behind this perspective, and for the purposes of this particular blog post I will not address the professional side of the debate, as it is being addressed elsewhere, such as by multiple professional organizations (IITAP, APSATS, SAT), non-profits such as PornHelp, Fight The New Drug, and blogs on sites such as PsychCentral, Psychology Today, and LinkedIn. What I am addressing here is the fact that while attacking/discounting training organizations, other clinicians, and private rehabs, AASECT also uses over-broad language, and cognitive distortions (i.e. "black & white thinking") by discounting all “treatment methods”.  In fact, it raises a huge baby/bathwater problem that I will discuss below.   

The stated conclusion of the AASECT pronouncement is that they consider that “…problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process…cannot be … a standard of practice for sexuality…therapy”. I actually agree 100%. I don’t think a sex addict should seek help from a sex therapist any more than I think someone suffering with vaginismus should seek help from a sex addiction therapist!  So, what is the concern I am raising here?  The following….

Where does the AASECT statement leave the 12-step programs?

While the AASECT position statement acknowledges that “…people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors”, AASECT also states that operating from a sex addiction-therapeutic model is unhelpful, if not downright harmful.  Ian Kerner, AASECT’s Chair of PR, stated in a recent Playboy articleThe position statement does not make a comment about [...] usefulness of the metaphor of addiction for revealing, describing or finding hope for change.”  I disagree.  The problem is that there is a tremendously robust 12-step community that has formed around the problem of compulsive/out-of-control sexual behavior that uses the addiction model. These are free & peer-based meetings.  In a recent CNN article he wrote, Ian himself acknowledges awareness of the fact that "In any given week, there are well over 1,000 Sex Addicts Anonymous meetings across the United States.” Sex Addicts Anonymous (SAA) is but one of multiple 12-step programs for sex addiction, and to be specific, their International Service Office recently reported that SAA has 1,716 weekly meetings registered. Sex & Love Addicts Anonymous (SLAA), another example of a highly active and well attended sexual addiction recovery fellowship, also has daily support meetings all around the world. So, how does saying “sex addiction isn’t real” and “current treatment models are insufficient” not translate to have the following direct negative application: 

The AASECT blanket statement discounts/disenfranchises the literally thousands upon thousands of people who self-identify as sex-addicts, their families, and all those who find relief via 12-step programs!

Denouncing other professionals and organizations is one thing, but it’s entirely another to make an over-broad statement that has a reasonable interpretation of invalidating the thousands upon thousands of successful peer-based programs. What does the AASECT statement say to the thousands of active 12-step programs for sex addiction and their active members? Their words have so much potential to cause more harm than good, as, put together, the AASECT statements essentially say: 

  1. You regular attendees aren't really sex addicts
  2. You are doing it (recovery) wrong by going to meetings and working the steps.

AASECT stated that the purpose of the position statement was to “establish standards of care supported by … public health consensus and the rigorous protection of sexual rights for consumers seeking treatment for problems related to consensual sexual urges, thoughts or behaviors.” How does blanket invalidation of thousands of successfully recovering people (and their families) protect consumer sexual health and sexual rights?

I think it is important to remember that Sex Addiction & Porn Addiction are no more about sex than alcoholism is about alcohol. One doesn't need to be trained in the details of ethanol in order to work with alcoholics. Similarly, one doesn't need to be trained in the intricacies of the human sexual response cycle in order to work with a recovering sex addict. These are peer-based programs; aka, "people helping people."

So having said all this, I have a question for AASECT: What do you expect to happen now? Should these meetings disband? Continue meeting despite existence invalidated by your “professional organization?” Should the thousands of people living fundamentally altered for-the-better lives start their transformations over? I think AASECT owes it to the recovering community to provide an answer!


I encourage those hundreds of thousands of people who self-identify as “sex addicts” or “porn addicts”, who attend the thousands of 12-step S-meetings, and who have found meaningful life change as such, to not be discouraged by AASECT. If it is working for you, STICK WITH IT! Despite the fact that increasing numbers of major media outlets are running these harmful stories, if self-identifying as a “sex addict”, and/or working the 12-step program is making positive change in your life, STICK WITH IT!!

Disclaimer: This post was written by me as an individual. I am not affiliated with any 12-step programs, nor does the content necessarily represent the views of any professional organizations with which I am affiliated. -T.Love

How to Configure your iPhone/iPad for Porn Blocking

The third and final piece of this solution is to configure your portable device.  The instructions below apply to all iOS devices (iPhone, iPad, iPod) running current or recent versions of the iOS, however, I will refer to iPhones for the remainder of this post.

Configuring your iPhone for Porn Blocking  

First, make sure the iPhone is tethered to a specific Apple ID. This is done by entering an Apple ID (and password) during initial setup.  This creates an Activation Lock that is a critical component of the solution.

Second, in the Settings app, scroll down and click to iCloud settings

Click "Backup" and make sure "iCloud Backup” is ENABLED.
Similarly, click “Find my iPhone” and make sure it is DISABLED.

Next, goto Settings -> General -> Restrictions.

Apple provides a very user-friendly walk-though on how to get to this point. Have the accountability parter enter and verify a passcode. 

In the first section/window, "ALLOW" - disable the following:

iBooks Store  
Installing Apps

Next, scroll down to the "ALLOWED CONTENT" section and make the following changes

Music, Podcasts and News -> Disable/Uncheck "Explicit"
Movies ->
(choose your own ratings)
TV Shows -> (choose your own ratings)
Books -> Disable/Uncheck "Explicit Sexual Content"

SIRI -> Disable/Uncheck “Explicit Language” and “Web Search Content

Websites: -> (click-on and go to this page)
This is where the rubber hits the road. The iOS now allows multiple types of filtering via three options:

1. All Websites - No filtering

2. Limit Adult Content:

This option uses Apple’s own web filtering technology, which I know nothing about, but am willing to wager that it is insufficient for stifling a determined Internet porn addicts efforts. In its defense, however, it does allow a limited amount of customization. Beyond the reliance on whatever formula apple uses to evaluate websites, this feature provides the ability to “ALWAYS ALLOW” and “NEVER ALLOW” websites.  This is similar to the “Always Allow” and “Always Block” settings within K9 (respectively). Refer to my previous post regarding the logic.

->To enter sites into either of these categories, click/check "Limit Adult Content" and  click "Add a Website" under the appropriate subsection. (Note: The "Always Allow and Never Allow" subsections only appear when "Limit Adult Content" is checked).

3. Specific Websites Only - This is, by far, the most robust option, as it is a “white-list” design.  A white list means everything is blocked, except for XYZ specific (white-listed) sites.  As such, it is my recommendation for the development of a secure solution. By default, Apple lists some very innocuous sites in their white list - Disney, Apple, Discovery, etc., however you can add sites to via the following steps:

To manually add other websites, click/check "Specific Websites Only", which will result in “ONLY ALLOW THESE WEBSITES" appearing below, and click "Add a Website". 

Next, click on "Restrictions" at the upper-left of screen to return to the main Restrictions window, and continue scrolling down the window to make further adjustments.


Twitter & Facebook -> “Dont Allow Changes” (assuming they are a problem, which they likely are) 


Accounts -> Don't Allow Changes  (Note: This disables access to the iCloud settings, so it will need to be unchecked in the event that iCloud settings changes on this device are required).

--> At this point, the phone itself will be configured. There is one more step, however, that must be taken on the user's computer. 

Configuring iTunes to support solution 

The final critical piece of the solution is a setting contained within the iTunes program on the computer. So put the phone down and go to the computer. Launch iTunes program.*** Make sure iPhone is connected to the Mac. Click on the iPhone icon when it appears in iTunes. Stay in the first window ("Summary") and scroll to the BACKUP section. Check "Encrypt iPhone backup" and enter the accountability partners password.

About the solution

At this point, one might ask, "Doesn’t this critically handicap the utility of the smartphone?” The answer is, NO.  I won’t go into the quite technical details regarding network layers and whatnot, but suffice it to say that this ONLY blocks websites. As such, all other smartphone capabilities are fully functional. For example, ALL the iCloud features are still available (email, calendaring, contacts, notes, photo-stream, etc). Additionally, the applicable expansion of these features to other email platforms (Gmail, Live, Exchange, Yahoo, etc) also remains intact.

LIMITATION: Most apps continue working under this configuration. I say most, because a few apps will initially have trouble with this configuration.  This is because some apps still draw their data through embedded web browsers, which means the traffic is blocked by the white-list.

The new News app built-in to iOS 9 is an example of this. You can read headlines, but if you try to click on most any story, it will attempt to access the content through a browser window, which will be blocked.  The WebMD and apps both also do this. 
Fortunately, there is a solution for this issue.

The solution is to manually add the websites when the problem arises. You will usually know when this is happening because when a site is blocked a solid white window will appear containing the following message: "You cannot browse this page at "<site name>" because it is restricted." Followed by the solution, an "Allow Website" button/link. Clicking the link will add the site to the white-list, allowing it to be accessed in the future. Of course, this requires a one-time entry of the administrator's password, but once it is done the app should function properly.

Updating/Installing Apps

This solution requires the disabling of open access to the App Store. As such, the user will not be able to update apps, nor install new ones, while under this configuration.  Of course, important updates to apps are regularly released, and validly needed new apps are periodically released. As such, the user will need to occasionally ask their accountability partner to temporarily enable this access to the app store. To do so, follow the steps below. (Be sure to re-disable access when you are done).

Settings -> General -> Restrictions -> Installing Apps (off/on)

Final Note

As with the other two components of this solution (securing the mac and configuring K9), this is an imperfect and iterative solution. Technology is ever changing and advancing, and there will be periodically be changes to make.  As such, be prepared for the fact that that this solution will create occasional inconveniences. Don’t allow these inconveniences to be an excuse to avoid the entire solution.  If you are considering this solution, it is likely because you have determined that you need help creating a barrier between yourself and unending, mind-numbing, adult content on the internet. Do it and stick with it! 

Update 04/31/2019:

As of iOS 12, the above steps no longer work. The concepts are the same, however the new "Screentime" feature requires a different set of steps. I'll do my own write-up eventually, but in the meantime, here is a link to a good set of instructions from Covenant Eyes

If you think you know of ways around the above, please do not post them publicly in the Comments section. Instead, email them directly to me. While it may seem tempting, I think it could be considered universally rude to offer a spoiler where none is wanted. Thanks for your understanding.

Configuring K9 Web Protection for Internet Filtering

<This is the second of a three-part post about how to lock your Apple products for porn filtering purposes. This particular post is about how to install and configure a web filtering program on the computer.>

There are multiple solutions available for content filtering on your computer; Net Nanny, Norton Family Premiere, WebWatcher, MCafee, etc.  Unfortunately, the most often overlooked option is, in my experienced opinion, the best product: K9 Web Protection.

K9 is a FREE product. Yes, free!  Why free? Two reasons:  First, Bluecoat, a corporate Information Security firm, officially offers K9 free as a part of their "Corporate Social Responsibility" program.  Very cool and progressive. Second, having as many users as possible accessing one of their flagship products (the sophisticated technology behind the K9 web-filter) allows them to build a better high-end corporate product.  

I’ve used all of the other programs, and found holes in each of them; sometimes gaping holes.  In fact, I once called in an issue to technical support for one of the above products, and was told by one of their support engineers “umm ya, I guess thats a big hole. Please don’t tell anyone about it.”  Hmm.  Wasn't worth the $xx yearly fee. As such, K9 is my recommendation, and the following are my recommended steps for a secure configuration of K9 on your Mac:


Prior to configuration, you will need to download and install the application.  It is CRITICAL that you use your accountability partner’s email address for the license request. Do not register the product with an address that you have access to.   
If you do not know how to install an application on your Mac, you can find basic instructions on how to do so here, and somewhat more detailed instructions here (pages 15-19)

Next, go to the “Configure K9 Web Protection” icon located in your Launchpad (or in the “K9 Web Protection” folder in your Applications list). I have found that the default settings for K9 are insufficient, and below are my recommended customizations. Note that this will change per user and per need.  

TIP: Remember to click “Save” at the bottom right of each screen after making any changes.

Web Categories to Block

Choose CUSTOM and then the following:
Under “Commonly Blocked Categories”, select the following:
Adult/Mature Content
Intimate Apparel/Swimsuit
Open Image/Media Search
Peer-to-Peer (P2P)
Proxy Avoidance
spyware/malware sources

Under “Other Categories”, select the following:
Chat/Instant Messaging
Pay to Surf
Personal Pages/Blogs, 
Remote Access Tools
Search Engines/Portals
social networking
Software Downloads

Time Restrictions

(I dont use any, but this may be helpful for some)

Web Site Exceptions

This allows you to block and/or allow specific sites. 
Always Block” - This is helpful for someone who struggles with a particular site that is not included in the K9 categories. I recommend, at minimum, including the following, as it is a required step for the iPhone management, which I will discuss in that section:

Other possibilities: Some people may need to add in order to prevent access to the available erotica. Others may want to block or, at minimum, (to prevent access to the repository of pictures).

Always Allow” - There will be sites that a person legitimately needs to access that are blocked by default. At minimum, the following two are required in order for the Mac to function properly: (required to access the iTunes Store) (required to allow the App Store to download updates)

Other suggested additions to consider: and - (allowing google analytics, ad tracking, etc.) and - to allow LinkedIn and - if user needs to access online Microsoft functionality

Finally, at the very bottom of the window, select “Blacklist Without Password"

Blocking Effects

Select “Show Admin Options"
Select “Show https blocks"

URL Keywords

It is often helpful to list here any particular terms that lead to problematic sites, thus allowing an extra layer of protection against sites that may not be included in the block list. To pick a random example, someone with a shoe fetish may want to enter shoe* (* allows for varients such as shoe, shoes, etc).

Safe Search

Select all options

Other Settings

Select all options
<note: "Supervisor Mode" button is located here, discussed below>


Make sure the accountability partner’s email is listed, not the user's.

Making Changes:

Click on the “Configure K9 Web Protection” app icon to launch the setup window. Have the accountability partner enter their password, then go to "Other Settings", and click on "Enter Supervisor Mode”.  Choose a time window for which you want the machine to be unlocked (60 mins is max), and then make sure you click on the Enter Supervisor Mode link after selecting the time.  This will allow temporary unblocked access to the web. This is useful when troubleshooting problems or making changes. A few examples would be when someone needs to validly download software, or validly needs temporary full access to google or other websites otherwise blocked. 

Two Main Limitations:

First, note that K9 is a filtering/blocking software only, and does not have accountability reporting features. Some people prefer (and are able) to have full access to the internet as long as they know that their traffic is being logged and will be regularly reported to their accountability team (ex. Covenant Eyes). People with more entrenched impulse control/addictive challenges, often do not find that to be a strong enough solution, as they often default to an “I’ll do it now and deal with the consequences later” mode.  As such, this solution is for them.

Second, the loss of open access to Google (or other search engines) makes modern internet life very difficult, however, having unfettered access to google is often dealbreakingly problematic for those with compulsive Internet use problems.  Fortunately, K9 has a solution to this; K9 Safe Search. While not as robust as full access to Google, K9 Safe Search provides managed search engine functionality. I have found it to be a good compromise.

Finally, I don't consider it a full "limitation", but note also that Bluecoat discontinued official technical support for the K9 product a few years ago, which is understandable as it's a free product.  It appears, however, that they do seem to keep the K9 product itself updated; via both beta and gold releases (don't worry if you don't know what this means).  

Long-Term Management/Use:

Set realistic expectations. There WILL BE sites that come up as blocked that are validly needed, as well as problematic sites that are not included in the above blocking configuration. Be patient and add them as you go (see steps below). As with the Mac itself, this is a dynamic and iterative process. 

<The next post is part 3 of this three part series on how to lock your Apple products for porn filtering purposes.>

If you think you know of ways around the above, please do not post them publicly in the Comments section. Instead, email them directly to me. While it may seem tempting, I think it could be considered universally rude to offer a spoiler where none is wanted. Thanks for your understanding.

How to configure your Mac for web filtering

<This is the first of a three part series on how to lock your Apple products for porn filtering purposes. This particular post is about how to configure your physical machine and operating system (OS).>

The Need & Solution

As a long-time power user with a former professional career in IT (roles ranging from support to engineering to management), I have spent years testing and developing solutions to create an optimal environment to secure against unbridled access to the internet.  The newer variable of smartphones made things even more complicated, as the solution had to be expanded to include coverage for both.  For example, machines running Microsoft Windows can be secured, however the Windows phone OS cannot be secured.  My experiences have yielded the Mac + iOS device (iPhone, iPad, iPod) combination as the optimum, if not only, solution.  The below is the first of a three part series on how to configure this combination. 

Configuring your Mac

I do not use the Parental Controls features built-in to Mac OS X, as I have found them to be insufficient and unfortunately problematic.  Instead, I have developed the following solution for creating a secure, yet fully-functional, operating environment.  There are four key components to securing your Mac in regards to limiting access to web content:

First, set a firmware password. Click here for detailed steps on how to do this. 

Second, create properly leveled user accounts. There needs to be a minimum of two user accounts; a STANDARD account for the primary user, and an ADMIN account for the accountability partner. Also make sure the guest user is disabled.  Click here for detailed steps regarding configuring user accounts. 

Note that the above steps are basically the same for the latest versions of OS X (Mavericks, Yosemite, El Capitan), however the options are slightly different for Mountain Lion

Third, disable "Find My Mac". Goto System Preferences -> iCloud and then scroll towards the bottom of the list and make sure "Find My Mac" is NOT selected.

Fourth, Install and configure K9 Web Protection. This is a somewhat detailed process, so I have created a separate blog post for it. 

Fifth (optional):  If you are using a VM software (if you don’t know what this means then you probably don't have to worry about it), then you need to make changes there too. For example, using Parallels Desktop go to Preferences -> Security and select "Require a Password" to all options listed . Make sure the padlock is closed when you are done.  Additionally, if you are using a VM, make sure the network configuration is set to “Shared” with the host OS. This eliminates the need to separately install K9 on the VM.

A few important things to note:

The administrator password will be required when you need to make future system level changes, install/update software, etc.

There are two basic options here. Option A is to have the administrator enter their password whenever required. 

TIP:  If you only have time-limited access to your accountability partner, it may be helpful to create a To-Do list in order to make sure you get it all done at once. "I need to update my Adobe Flash Player, install Microsoft Office, and make multiple adjustments to my K9. Can you come over and stay for about 30 mins to help with this?"

Option B is to temporarily adjust the primary user's account level from Standard to Administrator.  To do this, click on the padlock icon at the bottom of the Users & Groups widow (in System Preferences), and enter the accountability partners name and password in order to unlock this section. Then select primary the user account and check “Allow user to administer this computer”. When you are done making changes, the accountability partner will need to login and restore the users Standard mode by reversing the above steps.  Honesty and discipline is required here.

TIP:  I’ve found that it's often required to click the box twice in order to deactivate the “Allow user to administer this computer” checkbox. Also, once done, make sure the padlock icon at the bottom of the page is locked. 

Accept that PATIENCE and TOLERANCE is required for living with a Mac configured this way.

Technology is ever changing and advancing. As such, this solution is an iterative process, and there will periodically be new updates to install, configurations to make, printers to add, etc. So be aware that this will create occasional inconveniences. For example, as previously mentioned, an administrator password is required for many system level changes, some seemingly minor and unrelated to the present goals such as Energy Saver or Printers & Scanners. Don’t allow this inconvenience to be an excuse to avoid the entire solution.  If you are considering this solution, it is likely because you have determined that you need help creating a barrier between yourself and unending, mind-numbing, adult content on the internet. Do it and stick with it!

If you think you know of ways around the above, please do not post them publicly in the Comments section. Instead, email them directly to me. While it may seem tempting, I think it could be considered universally rude to offer a spoiler where none is wanted. Thanks for your understanding.

Press Release regarding Ashley Madison fiasco

I am currently serving on the Board of Directors of a national organization that recently issued the following press release (see below).  I am properly trained and available to assist people in the Athens area with issues stemming from this issue:

Help and Guidance Offered to Those Affected by the Ashley Madison Data Breach

For Immediate Release

Contact:  Todd Love, PsyD, JD, LPC

September 1, 2015

Ardmore, PA – We recently saw more than 30 million email addresses of users of the infidelity website Ashley Madison go viral. More are expected to be released.  The Society for the Advancement of Sexual Health (SASH) recognizes the serious impact resulting from the release of this personally identifying information. Many people personally affected by this situation are experiencing feelings of fear, shame, anger and other extremely difficult emotions.  The release of this information is resulting in serious negative consequences for many people, include severe marital discord, job loss, social humiliation, harassment and other serious difficulties.  There have even been reports of people taking their own lives as a result of the emotional devastation caused by this incident.

SASH strongly encourages people who are affected by this incident to seek counseling from appropriately trained health professionals who can offer assistance in coping with this situation.  Such assistance can be provided by psychotherapists, individual counselors, marriage and family therapists, sex therapists, pastoral counselors and other providers.  SASH maintains a searchable list of its members who are available to provide such assistance. SASH members are available to provide assessment, referral and treatment options.

SASH firmly believes that some people who frequently use sites such as Ashley Madison may have an underlying problem with addictive, compulsive or poorly controlled sexual behavior. A person who repeatedly engages in sexual behavior that violates his or her value system and commitment to others has a problem that is best addressed in a serious and comprehensive manner.  

Counseling and other forms of professional support can also be very helpful for the partner of a person who has engaged in sexually deceptive behavior.  The profound shame, fear, disorientation, rage and grief experienced by people who learn that they have been betrayed can be extremely difficult to manage, especially when this behavior has occurred over a lengthy period of time.  SASH strongly encourages people to reach out for help in such difficult circumstances.   

SASH encourages people with such problematic sexual behavior to seek professional assistance in addressing this issue as well as any other contributing factors.  SASH members are available to provide assessment, referral and treatment options.

The Society for the Advancement of Sexual Health is a nonprofit multidisciplinary organization dedicated to scholarship, training, and resources for promoting sexual health and overcoming problematic sexual behaviors.  Founded in 1987 and now headquartered in Ardmore, PA, SASH is a 501 (c) 3 Non-Profit Professional Association and a recognized leader in the dissemination of educational and clinical information to clinicians and allied professionals in the intervention and treatment of problematic sexual behaviors.
Dr. John Giugliano, President of SASH adds “We’re very proud of our organization and the opportunity to serve our colleagues and the general public in the compassionate treatment of problematic sexual behavior and addiction”.

For more information, including the ability to contact experts available to speak in public or media forums about this or any other issue related to problematic sexual behavior, go to

Social Networking/Facebook Addiction

Social Networking Addiction / Facebook Addiction

Many people, including therapists and medical doctors, mistakenly consider addiction to be about dysfunction in the brains pleasure center.  This is incorrect.  Although it may seem like a semantic difference to the uninitiated, addiction is about dysfunction in the reward center of the brain.  The reward center serves the evolutionary purpose of releasing a feeling of satisfaction after a certain action is taken.  For example, eating a full meal or having sex. Being rewarded for these activities was registered as rewarding, thus leading humans to repeat the behavior and continue the species. The disease of addiction hijacks that process, and addicts are actually seeking the reward response rather than the pleasure response when craving their addictive substance or behaviors.  Addiction is a disease of learning and memory, and the addicts brain learns that certain behaviors (including drinking or drugging) lead to activity in their reward circuit. (note that this is a simplified and partial explanation of the medical explanation of addiction.  Full coverage of this topic is beyond the scope of this conversation).

I call this the "gold star system gone awry".  In other words, the look on a child's face when they are awarded a gold star for doing whatever positive and desirable thing that they did in order to achieve the star is an example of the healthy exercise of this brain circuitry.  I use this reference because I think it facilitates the easiest to understand example of behavioral addictions.  In fact, understanding the "gold star system gone awry" makes social networking/FaceBook addiction seem almost obvious.  Imagine the same child who thrived under the gold star system is now an adolescent (or adult) who has discovered social networking.  Constantly checking for an update, post, feedback, thumbs up, etc. provides continuous activation of the reward circuitry.  Do it enough and the system breaks.  That person is now compelled to obtain social networking feedback in order to maintain what has become a normal level of activity in their reward center.

The above is a highly simplified (and partial) explanation of the addictive process.  Listed below are some highly detailed academic articles on the topic:

Social networking generally (Andreassen & Pallesen, 2013; Emre & İŞBULAN, 2012; Karaiskos, Tzavellas, Balta, & Paparrigopoulos, 2010; Kuss & Griffiths, 2011; Salehan & Negahban, 2013; Weiss & Samenow, 2010),

Facebook specifically (Andreassen, Torsheim, Brunborg, & Pallesen, 2012; Carmody, 2012; Griffiths, 2012; Kittinger, Correia, & Irons, 2012; Koc & Gulyagci, 2013; Rosen, Whaling, Rab, Carrier, & Cheever, 2013).

The Development of SLPAA

As stated in the original post, SLPAA is a new fellowship in progress currently under development and being piloted in Athens, GA. Its development is best explained via the following brief references to what many consider the two primary "S" fellowships (i.e. Sex Addiction 12-Step programs)*:

Sex Addicts Anonymous (SAA) - The original sex addiction fellowship.  It is a very strong fellowship and has helped countless people. 

Sex & Love Addicts Anonymous (SLAA) - A similar fellowship to SAA, however it has the key difference of acknowledging "love addiction" as distinct from "sex addiction".  Their answer to the question "What is the difference between SAA and SLAA?" posted on the FAQ section of their website is as follows: "We are all Twelve Step programs focusing on sexual addiction. S.L.A.A. includes love addiction, relationship, and sexual anorexia" (SLAA, 2014).

Sex, Love, & Pornography Addicts Anonymous (SLPAA) is designed to follow the same evolutionary model, bringing "pornography addiction" up to parity with "sex addiction" and "love addiction".  This is an important, but yet largely unacknowledged distinction.  There is a great article addressing this difference on the website titled"Porn Addiction is Not Sex Addiction--And Why It Matters".     

Many people, frequently Millennial's, who do not relate with the concept of or identify as a "sex addict" or "love addict".  If you ask them about pornography problems, however, they will be quick to say "OMG yes, I'm a total porn addict!  Where do I go?"  SLPAA is being designed to meet that need.  

DISCLAIMER: SLPAA is not affiliated with the private counseling practice of Dr. Todd Love. Rather, the information about this fellowship is being hosted on this website as a service to the recovery community. 

(Updated Oct 28, 2015.)


SLPAA Athens is now SAA Athens

Sex, Love, and Porn Addicts Anonymous (SLPAA) was a new 12-step fellowship piloted in Athens, GA in 2014-2015.  Unfortunately, the group disbanded after ~18 months due to a loss of meeting space.  The model was a success, however, and interested persons are free to download the readings via the following links:  Meeting Format, 12-Steps, Guidelines for Sharing, Sobriety & Chips.

Fortunately for the recovery community, a Sex Addicts Anonymous (SAA) group has taken its place.  The Downtown Athens SAA group meets on the grounds of Emmanuel Episcopal Church (498 Prince Ave) at 7:00PM on Mondays.  The group meets in the small brick bldg, on the north side of Prince, located between the church and the small white cottage with a sign "Thrift Store."  Parking is behind the brick building. Please enter from the rear, or parking lot side. All are welcome, regardless of race, creed, gender, or sexual orientation. For questions, you can contact the group directly.


DISCLAIMER: Neither SLPAA nor SAA are affiliated with the private counseling practice of Dr. Todd Love. Rather, the information about these fellowships are being hosted on this website as a service to the recovery community. 

(Updated December 17, 2016.)