The Addiction Matrix And How To Get Out of It

The Whack-A-Mole Phenomenon in the Treatment
of Severe Substance Use and Eating Disorders
“I was told I had to have substance treatment before I could come
to the eating disorders program.”
“I was told I needed eating disorders treatment before I could
get treatment in the alcohol program.”
“When my eating disorder gets stabilized, that’s when I start using again.”
Have your heard this before? Historically, the approach to the treatment of people who present with both eating disorders and substance use disorders has been to identify the “primary” issue, be it substance or eating disorder, and focus treatment on stabilizing one before moving on to the other issues of concern. This approach makes some sense, as it is in line with the overall approach to medical

triage the acute, most pressing issue before moving on to the next. Until recently, the diagnostic manual for mental disorders has organized the approach to mental  health patients similarly, using a five axis system where Axis I identified the disorder necessitating the primary focus of treatment and axes II-V were seen as conditions requiring less urgent attention. This explains the historical approach to treatment of patients who present with co-morbid conditions. Typically, when a patient presents with both severe eating and substance use disorders they are treated as stated above. The outcome of this is the stabilization of one disorder, only for the other to relapse and need stabilization, (the “whack-a-mole” phenomenon). The problem with this approach is that ultimately people conclude “There is no place that fits me; I’m not wanted”.

It has been increasingly apparent, due largely to clinical research and education, that treating eating disorders and co-morbid substance use disorders in parallel is warranted for better outcomes. Parallel treatment of eating and substance use disorders requires a treatment team that has specialty training in both eating disorders and substance use disorders. Treatment of eating and substance use disorders is best conducted in a program that has the infrastructure to  safely manage both. AA/NA groups, ability to test for substance use as well as to follow lab values during treatment is paramount in safely managing the complexity of stabilization when a substance use disorder co-occurs with an eating disorder. This explains why many programs do not feel equipped to do so and turn patients away.
The Eating Disorders Center at Silver Hill Hospital is adept at managing people who come to us for help with stabilizing and managing their eating disorder, as well as their substance use disorders. The “Whack -a-Mole” phenomenon stops here!
Patients of mine have had great success at Silver Hill located in Connecticut. Here in New York I address this syndrome in my private practice. Give a call to talk further. 212-769-8902

3 Tips for a Happy Marriage

With the American Psychological Association reporting that roughly 40 to 50 percent of couples that marry eventually end up getting divorced, it isn’t uncommon to want to do what you can to ensure your marriage lasts. So, if you want to take the extra steps to help your marriage be a successful one, here are three tips:

Tip #1: Create Rituals That You Do Together.

While it is always a good thing to have some “you” time, it is also important to have some “together” time. As a couple, it is understandable that you will have challenges: in-laws, money management, communication, etc. However, it is vital that you do something on a regular basis that will bond you as a couple. This can be anything from something as simple as getting together each morning for a coffee or marking off every Saturday night for a special date night. The important thing is that you do it together and you make it a ritual.

Tip #2: Check in With Each Other Daily.

One of the many reasons that couples grow apart is because they stop communicating. This can be for a number of reasons, but it is important that couples don’t lose that open line of communication throughout their marriage. There are several times of day that you have should check-in, including right when you both get home from work, at the dinner table, or at bedtime. Regardless of the time that you choose to do it, you can talk about how your day was, talk about something that has been bothering you, appreciate something about one another, and even ask one another about a hope that you have for the near or distant future.

Tip #3: Disconnect From the Office When at Home.

Constant use of smartphones is among the numerous reasons that couples fight nowadays, especially when it is tied to work. As a general rule, if your boss is calling you at home, it isn’t good news. Also, if you are working from home, it is because there is a crisis and a serious deadline to meet. This causes stress on your relationship because you are frustrated and more irritable than usual. Therefore, it is important that you try to limit your workload at home as well as your work calls. Also, set a time each night that you will turn your laptop and phone off so that time with your significant other is uninterrupted.

Unfortunately, despite both of your efforts, there may come a time that something happens in your marriage that warrants the need for couples counseling. When this happens, it is important to take the time to interview several counselors until you find one that you both feel comfortable with. Counseling can be a long journey, so it is crucial that you find someone that you feel you can trust. If you have questions or would like more tips on keeping your marriage a happy one, check out my website and contact me directly at

Shakespeare Explains the 2016Election


In the early 1590s, Shakespeare sat down to write a play that addressed a problem: How could a great country wind up being governed by a sociopath?

The problem was not England’s, where a woman of exceptional intelligence and stamina had been on the throne for more than 30 years, but it had long preoccupied thoughtful people. Why, the Bible brooded, was the kingdom of Judah governed by a succession of disastrous kings? How could the greatest empire in the world, ancient Roman historians asked themselves, have fallen into the hands of a Caligula?

For his theatrical test case, Shakespeare chose an example closer to home: the brief, unhappy reign in 15th-century England of King Richard III. Richard, as Shakespeare conceived him, was inwardly tormented by insecurity and rage, the consequences of a miserable, unloved childhood and a twisted spine that made people recoil at the sight of him. Haunted by self-loathing and a sense of his own ugliness — he is repeatedly likened to a boar or rooting hog — he found refuge in a feeling of entitlement, blustering overconfidence, misogyny and a merciless penchant for bullying.

From this psychopathology, the play suggests, emerged the character’s weird, obsessive determination to reach a goal that looked impossibly far off, a position for which he had no reasonable expectation, no proper qualification and absolutely no aptitude.

“Richard III,” which proved to be one of Shakespeare’s first great hits, explores how this loathsome, perverse monster actually attained the English throne. As the play conceives it, Richard’s villainy was readily apparent to everyone. There was no secret about his fathomless cynicism, cruelty and treacherousness, no glimpse of anything redeemable in him and no reason to believe that he could govern the country effectively.

His success in obtaining the crown depended on a fatal conjunction of diverse but equally self-destructive responses from those around him. The play locates these responses in particular characters — Lady Anne, Lord Hastings, the Earl of Buckingham and so forth — but it also manages to suggest that these characters sketch a whole country’s collective failure. Taken together, they itemize a nation of enablers.

First, there are those who trust that everything will continue in a normal way, that promises will be kept, alliances honored and core institutions respected. Richard is so obviously and grotesquely unqualified for the supreme position of power that they dismiss him from their minds. Their focus is always on someone else, until it is too late. They do not realize quickly enough that what seemed impossible is actually happening. They have relied on a structure that proves unexpectedly fragile.


The above article appeared in the October 8, 2016 edition of The New York Times. It was written by Stephen Greenblatt, professor at Harvard University and the general editor of the “Norton Shakespeare.” I thank him for sharing his keen psychological and literary perspectives on the current election.

Relationship Counseling: Some Rules of the Game

Navigating the contours of relationship issues can be quite difficult. Whereby in an individual’s session we have one complicated persona to process, in a relationship counseling session we have two individuals who not only bring their unique set of issues to the table, but also arrive in a fairly defensive position fueled by anger and disappointment with their partner.


There are a few important points that I like to make during our initial session in order to begin this difficult process. First, I remind the couple at hand that their job isn’t necessarily to agree with one’s partner (obviously they don’t or we wouldn’t be sitting here in the first place,) but the job is to hear their partner. We must begin with the concept that our partner feels they are either aggrieved or at least not being heard and it is our job to make sure that we actually hear what our partner is saying even if we don’t agree with them on a number of the issues. The value of knowing that our significant other acknowledges our feelings gives validity to the endeavor that lies ahead.


Secondly, we must remember why we are here at this relationship counseling session to begin with. It cannot be a battle of convincing the other that they are wrong and only we are right. It must be about listening and finding a common ground for moving forward.


Finally I remind each couple who comes to my office that I am not here to save their marriage/relationship but rather that I am here to help the two of them find their truth. Sometimes I get a puzzled look with that statement but as the work progresses they come to realize that we are here for the two of them and not for the concept of a relationship which cannot exist unless the couple does their work to understand what their individual needs are and that of their partner as well. Only then can the possibility of a truly healthy relationship come to fruition.


I have 20 years of experience dealing with couples, both heterosexual and gay and have been vetted by as an expert in the field. I have also contributed to two books on relationships that are listed in my biography. For more info check out my website


Psychotherapy for the LGBT Community


Over the years being a Psychotherapist who practices in New York City, I have built a large and diverse clientele of both straight and gay patients. Although the basic tenants of psychotherapy are the same for all people throughout the life cycle I find that the issues confronting the LGBT community are particularly unique.


Growing up we all have role models and individuals that we idolize being either our immediate family or adults and peers me meet along the way. We also have an ever more vivid media presenting figures that we begin to idolize and develop sexual attractions to as well. For young boys and girls who are innately gay this becomes a confusing time. Identifying with our peers is an important part of development but what if the roles that we are told to play don’t quite feel right? How are adolescents supposed to navigate this mine field of emotions as they try to please both their parents and peers as well as themselves? This is the difficult part that all of us need to process in order to have a healthy integrative life. For the gay man and women embarking on psychotherapy exploring this difficult journey presents a unique set of conflicts which makes our work truly sui generis…..unique unto itself.


As an experienced psychotherapist who has been in practice for close to 20 years I have found that gay and questioning patients find a thoughtful and supportive atmosphere in my office where we get to question the basic assumptions of one’s lives and find healthy pathways to self love and respect.


Defense! Defense! A relationship is not a football game!

One of the main barriers to great communication in any relationship is when one or both partners get defensive. Since good conflict resolution is born out of great communication skills, you need to learn how to recognize defensive behaviors when you talk to your partner. How can being defensive affect your relationship, and what can you do to replace defensiveness with constructive conversation?

Strong Defense, Weak Communication

Sometimes, you might not even notice yourself becoming defensive during a conversation. The need to defend against outside attack is built into the human body as a survival mechanism. However, people who struggle to control their defensiveness often anticipate a battle when there is none, escalating a normal conversation to an argument because a statement was taken as an attack. The conversation then moves away from solving the issue at hand, and instead becomes a conflict about communication styles, hurt feelings, and personality differences. When the small issues that happen on a daily basis are set aside by a defensive response, there are more fights and fewer resolutions.

Steps To Change

The first step to stop defensive behavior is to recognize it in yourself. Defensiveness is like a reflex for many people, so it means you’ll actively bite your tongue when you are approached by something sensitive and craft a response that is more communication-friendly. You might have to try the following exercises:

  • listen fully to what your partner is trying to talk to you about. Defensive reactions can happen over the smallest things. For example: your partner says, “Have you moved my cars keys again? I need to–” and you interrupt with, “Well, it’s not like you always put things back where they go!” This exchange cuts off the conversation and escalates it into a conflict, and you never find out what your partner actually is trying to say.
  • taking a break. If you are trying to have a serious discussion, but you feel yourself preparing for battle, so to speak, tell your partner that you need ten minutes or an hour to calm down so that you can be ready to talk without getting defensive.
  • agree when you can. When your partner says, “When you move my keys from the hook, I can never get to work on time,” respond with something like, “You’re right, I don’t always remember to put the keys back when I borrow your car.” You might have a good reason for not returning the keys, but your partner doesn’t know that. Cooperating from the get-go helps your partner feel like you are willing to work together for a solution. Agreement also opens the door for explanations, like, “The last time I used your car, the baby was crying all the way home, so I didn’t think about putting your keys away because I was distracted. They’re probably still in my purse.”


Obviously, this is a fairly simplistic example that I am using strictly to make a point. Most conflict does raise the stakes with more serious issues. If you and your partner are still struggling with defensiveness in your conversations, talk to a marriage counselor for more help and communication tools.  To learn more, contact me. I will be happy to talk with you.  Howard Rossen.