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Definition of Erectile dysfunction Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Erectile dysfunction is sometimes called as “impotence”. The term "erectile dysfunction" can mean the inability to achieve erection, an inconsistent ability to do so, or the ability to achieve only brief erections. Ayurveda defines Erectile dysfunction or ED as follows. Sankalpapravano nityam priyaam vashyaamapi sthreeyam || na yaathi lingashaithilyaath kadaachidyaathi vaa yadi | Shwaasaarthaha swinnagaatrshcha moghasankalpacheshtitaha || mlaanashishnashcha nirbeejaha syodetat klaibyalaxanam | This means even though a man has a strong desire to perform sexual act with a cooperative partner, he can not perform sexual act because of looseness (absence of erection) of his phallus (penis). Even if he performs sexual act with his determined efforts he does not get erection and gets afflicted with tiredness, perspiration and frustration to perform sex. Physiology of erection The two chambers of penis (corpora cavernosa,) which run throught the organ are filled with spongy tissue. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and semen runs along underside of the corpora cavernosa. Due to sensory or mental stimulation, or both, the erection begins. Due to impulses from brain and local nerves the muscles of corpora cavernosa relax and allow blood to flow in and fill the spaces of spongy tissue. The flow of blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the chambers, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection recedes. In ayurveda physiology of erection and ejaculation is described as follows Vrishunow basthimedram cha naabhyuuru vankshnow gudam| Apaanasthaanamantrasthaha shukra mootra shakrunti cha|| The “apaanavayu” one of the five types of vayu is located in the testicles, urinary bladder, phallus, umbilicus, thighs, groin, anus and colon. Its functions are ejaculation of semen, voiding of urine and stools. Shushruta explains the process of erection and ejaculation as When a man has desire (iccha) to have sex, his response to touch increases (Vayu located in skin causes flow of signals from skin to brain, thus causing sensation of touch). This causes arousal or “harsha”. Arousal or Harsha intensifies actions of vayu and at this moment highly active vayu liberates the teja or heat of pitta. Thus tejas and vayu increase body temperature, heart beat and blood flow causing erection. Causes of ED Erection requires a sequence of events. Erectile dysfunction can occur when any of the events is disturbed. Nerve impulses in the brain, spinal column, around the penis and response in muscles, fibrous tissues, veins, and arteries in and around the corpora cavernosa constitute this sequence of events. Injury to any of these parts which are part of this sequence (nerves, arteries, smooth muscles, fibrous tissue) can cause ED. Lowered level of testosterone hormone: The primary male hormone is testosterone. After age 40, a man's testosterone level gradually declines. About 5% of men that doctors see for erectile dysfunction have low testosterone levels. In many of these cases, low testosterone causes lower sexual interest, not erectile dysfunction. The whole male body responds to testosterone. Even sushruta has illustrated about this response of body to the element “Shukra” . He has said "yatha payasi sarpistu goodashchekshow raso yatha shareereshu tatha shukram nrinaam vidyaadhbishagwara." This means the shukra (the element which helps in reproduction) is present all over the body. This can be explained with the following examples: 1. The ghee is present in milk in an invisible form. This is extracted from milk using many processes. 2. The sugar is present all over the sugarcane. It is extracted by subjecting the sugarcane to number of processes. Same way shukra is present all over the body. But the cream of shukra (semen) comes out of the body only during the process of ejaculation. But this process of ejaculation needs a joyful union of mind and body. Decrease in production of “Shukra” causes erectile dysfunction. Over exertion - physically and mentally: Working for long hours in office, mental stress at office and home, short temperedness ,insufficient sleep cause erectile dysfunction. These causes are explained in ayurveda as "shoka chintaa, bhaya, traasaat .... " which means that erectile dysfunction or Impotence occurs due to grief, fear, anxiety and terror. Strained relationship with sexual partner: Erectile dysfunction also occurs when there is a disliking towards sexual partner. Ayurveda describes this as "naarinaamarasamjnatwaat..." means disliking for women. Diseases that cause Erectile dysfunction: Neurological disorders, hypothyroidism, Parkinson's disease, anemia, depression, arthritis, endocrine disorders,diabetes, diseases related to cardiovascular system also become reasons for erectile dysfunction.. According to ayurveda the diseases which cause erectile dysfunction are "Hritpaandurogatamakakaamalashrama..." - Heart diseases, anemia, asthma, liver disorders, tiredness. Apart from these the imbalance in tridoshas also cause impotence or erectile dysfunction. Consumption of medicines, drugs and tobacco: Using antidepressants, tranquilizers and antihypertensive medicines for a long time, addiction to tobacco especially smoking, excessive consumption of alcohol, addiction to cocaine, heroin and marijuana cause erectile dysfunction. In ayurveda texts these causes have been said in brief as "rukshamannapaanam tathoushadham" - "dry food, drinks and medicines" cause impotence or erectile dysfunction. Trauma to pelvic region: accidental injury to pelvic region and surgeries for the conditions of prostate, bladder, colon, or rectal area may lead to erectile dysfunction. These causes are mentioned as abhighata (trauma), shastradantanakhakshataha (injury from weapons, teeth and nail.) in ayurveda. Other reasons: Obesity, prolonged bicycle riding, past history of sexual abuse and old age also cause Erectile dysfunction. Ayurveda describes the cause of impotence or erectile dysfunction due to old age as follows. "diminution of - tissue elements, strength, energy, span of life, inability to take nourishing food, physical and mental fatigue lead to impotence." Remedies for ED ED is treatable at any age. The total treatment in for impotence is called as “Vajikarana therapy” in ayurveda. As this therapy increases the strength of a man to perform sexual act, like a horse, it is called 'Vaajikarana'. ('Vaaji'=Horse.) Vaajikarana therapy leads to • Happiness. • Good strength. • Potency to produce healthy offspring. • Increased span of erection. Eligibility for vajikarana therapy. 1. The vajikarana therapy should be administered to persons who are between 18 to 70 years of age. 2. These therapies should be administered only to a self controlled person. If this therapy is administered to a person who does not have self control, he becomes nuisance to society through his illegitimate sex acts. Psychotherapy Decreasing anxiety associated with intercourse, with psychologically based treatment helps to cure ED. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated. Same treatment is illustrated in ayurveda. It has been said “A woman who understands a man and is liked by him, along with erotic environment act as best aphrodisiac.“ Drug Therapy Numerous herbal preparations are mentioned in Ayurveda to treat ED or impotence. It has been said that people who have strong sexual urge, who want to enjoy sex regularly have to consume these preparations regularly to replenish the energy, vigor, stamina and strength. These preparations also supply the nutrients which are necessary for production of semen. Ayurveda tips to overcome ED 1. Consuming herbal preparations to rejuvenate the reproductive organs. 2. Massaging the body with a herbal oil which gives a relief from physical exertion and also acts as aphrodisiac. 3. Practicing Yoga and Meditation to overcome mental exertion and to cope up with stress. 4. Sleep at least for 8 hours a day. 5. Avoiding the consumption of alcohol, tobacco, heroin etc. 6. Exercise regularly. 7. Avoid hot, spicy and bitter foods. 8. Favor sweets, milk products, nuts and urad dal. 9. Add little ghee in your diet. 10. Give a gap of four days between two consecutive intercourses homemade pnis enlargement penis elargement patch penis enlargement surgeries top rated penis enlarement pills vimax penis enlargement secret penis enargement operation best penis enhancement pills penis enlargment pill pro solution

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A fiery debate has long raged in the medical profession on whether male menopause actually exists and what, if any, is its effect on male sexual performance. The questions are many. If it really does exist, at what age will it begin to affect their sexual performance? What precautions can be taken to avoid its arrival and are there treatments to help reverse it? If it's real, how does it differ from female menopause? It's a no-brainer that men go through sexuality changes as they age, just as women do. The erection-on-demand performance they enjoyed as teens is no longer the case at age forty. Little by little as they age, men begin to notice changes in their sexual performance as the urge for sex also lessens. As they age, it takes longer for men to get an erection to come on and the penis requires more direct stimulation to get and stay aroused. The erection may also be angled, rather than straight and rigid and ejaculation may not be as forceful. Also, the time it takes between erections gets longer. Rather than physical, the decrease in a man's sexual performance could also be due to psychological factors like a mid-life crisis. His waning sexual performance could be blamed on any number of external factors. It could be due to lack of interest in an aging wife who isn't the babe she was ten years ago, the stress of work, demands of growing children, or financial difficulties, even worries about caring for aging parents. So how do you differentiate between a mid-life crisis and male menopause? A mid-life crisis is more a problem of psycho-social adjustment, meaning it may have nothing to do with a man's sex life. However, male menopause is distinctly physiological in nature, similar in many ways to female menopause. Because frequently men can have both physical and psychological factors affecting them, the line between male menopause and mid-life crisis becomes hazy. Although menopause is most often associated with women, men experience a different type of menopause or 'life change.' Where women cease to menstruate and usually can no longer get pregnant, men can continue to father children. Symptoms of menopause in both men and women are similar and can sometimes be just as overwhelming. As reported in Andrology: The Science of Dysfunctions of the Male Reproductive System, approximately 40% of men between 40 and 60 will experience some degree of lethargy, depression, irritability, mood swings, hot flashes, insomnia, decreased sex drive, weakness, loss of both lean body mass and bone mass, making them susceptible to hip fractures, and difficulty in attaining and sustaining erections (impotence). Testosterone (male sex hormone) stimulates sexual development in male infants, bone and muscle growth in adult males and also controls sex drive and male sexual performance. The levels of testosterone diminish gradually after age 40. In healthy males age 55, the amount of testosterone is significantly lower than 10 years earlier, and by 80 decreases to pre-puberty levels. In 1944 what is now described as male menopause was reported in a key article written by two American doctors, Carl Heller and Gordon Myers. Comparing symptoms with that of female menopause, they did a blind controlled trial showing the effectiveness of testosterone treatment. But like many pioneering efforts their findings were vastly unreported due to men being unwilling to accept that they could have 'menopause,' while men with genuine symptoms and sexual dysfunctions were often told it was a mid-life crisis or just in their heads. Around the same time testosterone therapy had come into disrepute in the public eye due to athletes misuse and abuse. So the concept of male hormone replacement therapy for male menopause symptoms, impotence, or sexual performance problems wasn't very well received. Added to that, the hype about side effects and the tie between prostate cancer and hormone replacement further negated its acceptance by many men. Only after HRT (Hormone Replacement Therapy) became popular and produced desirable results for women, providing tangible improvement in symptoms and 'age reversal' in post-menopausal women, did men begin to take notice and jump on the bandwagon, not wanting to get left behind their female counterparts. penis enlagement doctor penis enargement surgeries penis enlagement technique enlargement manhattan penile surgeon best penis enlargement pill plus vig rx sex vig rx penis enlargement pills product penis elargement photo

Many people assume they need to consume Alcohol to have Good Sex? For most Americans, consuming alcohol seems to be part of our cultural heritage. We drink at weddings, funerals, birthdays, and pretty much to celebrate anything and everything. We learned from a young age by watching our parents and other adults, that drinking is a sign of maturity. Many people, especially young adolescents, expect that alcohol use will lower tension and anxiety and increase sexual desire and pleasure in life (Seto & Barbaree,1995). About 1 in every 7 adults in the United States meet criteria for alcohol dependency, according to a large NIMH epidemiological study (Grant, 1977). Men are four times more likely than women to be heavy drinkers and are twice as likely to be alcohol abusing or alcohol dependant. Most males and many females find it difficult to imagine not drinking any alcohol at least on weekends and find it almost impossible to think of having sex without previously having a few drinks. These fundamental values appear to be deeply embedded in our culture. Somewhere along the line, we got the message that we need alcohol to have good sex. Does Alcohol Enhance or Hurt our Sexual Performance? I recently heard a stand-up comedian refer to the term, “Whiskey – Dick” when describing his “friends who had drank too much and had difficulties with orgasm even while using Viagra. Shakespeare once said that excessive drinking, “provokes the desire but takes away the performance.” Alcohol reduces inhibitions and gives us a mellow feeling. It makes us more relaxed and more talkative. It can make shy people fe//el confident and bold. These effects can facilitate our sexual desires by developing our social skills. However, these positive effects are only present in the early stage of intoxication i.e. when we’ve consumed 1-2 drinks (assuming you haven’t already developed a tolerance for alcohol). Sexual Impotence On the other hand, alcohol’s negative effects on sexual performance have been widely documented. Men and women who have several drinks may find it very hard to achieve orgasm. Difficulties with achieving orgasm after alcohol consumption can be understood because alcohol dilates small blood vessels all over the body so that there is less engorgement of blood in the sexual organs. This leaves the penis flaccid or only partially erect so that sexual penetration is difficult. Women may find that they have decreased vaginal lubrication making sexual intercourse unpleasant and sometimes painful (Raff, 2006). Impotence is the constant inability of a man to maintain an erection for sexual purposes. It is estimated that impotence affects over 30 million men in the United States (NIHCS, 1992). Masters and Johnson, identified alcohol as a common factor in impotence in their monumental work on human sexual inadequacy. Alcohol damages the central nervous system and destroys brain cells, and if the damage is prolonged enough, it can result in irreversible sexual impotence even while a person is sober. Alcohol is also a factor in loss of sexual control or premature ejaculation. Even a couple of beers before sex can spoil a man's erection and ruin his ejaculatory control. Up to 80 percent of men who drink heavily are believed to have serious sexual side effects, including impotence, sterility, or loss of sexual desire. Heavy drinking over a long period of time can irreversibly destroy testicular cells, leaving men with shrunken testicles. Both sexual drive and sexual capacity can be damaged. Alcohol also suppresses testosterone levels even in social drinkers by suppressing the secretory activity of the Leydig cells (Flatto, 1990). Alcohol and High-Risk Sexual Behaviors A history of heavy alcohol use has been correlated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners (e.g., injection drug users, prostitutes), and the exchange of sex for money or drugs (Windle,M.,1997). There may be many reasons for this association. For example, alcohol can act directly on the brain to reduce inhibitions and diminish risk perception (MacDonald,T.K.,2000). However, expectations about alcohol’s effects may exert a more powerful influence on alcohol-involved sexual behavior. Studies consistently demonstrate that people who strongly believe that alcohol enhances sexual arousal and performance are more likely to practice risky sex after drinking (Cooper,M.L.,2002). Some people report deliberately using alcohol during sexual encounters to provide an excuse for socially unacceptable behavior or to reduce their conscious awareness of risk (Derman,K.H.,1998). According to McKirnan and colleagues (McKiran,D.J.,2001), this practice may be especially common among men who have sex with men. This finding is consistent with the observation that men who drink prior to or during homosexual contact are more likely than heterosexuals to engage in high-risk sexual practices (Avins,A.L.,1994). Alcohol and AIDS People with alcohol use disorders are more likely than the general population to contract HIV (human immunodeficiency virus) - the agent that causes acquired immunodeficiency syndrome (AIDS). Similarly, people with HIV are more likely to abuse alcohol at some time during their lives (Petray,N.M.,1999). Alcohol use is associated with high-risk sexual behaviors and injection drug use, two major modes of HIV transmission. What are signs of problem drinking? The primary signs of problem drinking are: Having health, legal, social, academic or financial problems as a result of drinking. For example, missing class or work because of drinking or hangovers, not be able to have fun or express oneself without drinking, fights or problems with roommates or significant others, spending excessive amounts of money on alcohol, blackouts/passing out, trips to the ER, being defensive when someone mentions your drinking, needing to drink more to achieve the same effects (tolerance), frequently drinking with the primary purpose of getting drunk, and/or repeatedly driving under the influence. These are only guidelines and each case is different. If you're concerned about your drinking or a friend's drinking, get more information! Screening for Alcohol Dependence Screening tools are available to assist counselors and therapists with diagnosing alcohol abuse and dependence such as the SMAST below. Short Michigan Alcoholism Screening Test (MAST) 1. Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.) 2. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking? 3. Do you ever feel guilty about your drinking? 4. Do friends or relatives think you are a normal drinker? 5. Are you able to stop drinking when you want to? 6. Have you ever attended a meeting of Alcoholics Anonymous? 7. Has drinking ever created problems between you and your wife, husband, a parent, or other near relative? 8. Have you ever gotten into trouble at work because of drinking? 9. Have you ever neglected your obligations, your family, or your work for two of more days in a row because you were drinking? 10. Have you ever gone to anyone for help about your drinking? 11. Have you ever been in a hospital because of drinking? 12. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages? 13. Have you ever been arrested, even for a few hours, because of other drunken behavior? Individuals that answer – Yes to three or more questions indicate probable alcoholism, two yes answers indicate probable alcoholism, and fewer than two yes answers indicate that alcoholism is not likely (Selzer, M., Winokur, A. & Van Rooijen, C.; 1975). Note: If after reading the above, you started rationalizing to yourself, “Well, I can stop drinking anytime I want to, but I usually stop when I run out of money.” (As my old graduate professor use to say) STOP BULL-SH#%ting yourself and go see a certified alcohol counselor. Co-morbidity & Alcohol Dependence Alcohol abuse and dependence are among the most destructive of the psychiatric disorders (Volpicelli, 2001). Addictions such as alcohol dependence and other addictions as a rule do not develop in isolation. Over 37 % of alcohol abusers suffer from at least one coexisting addiction and/ or mental disorder (Rovner, 1990). Individuals can shift from one addiction to another or sustain multiple addictions at different times. The National Co-morbidity Survey (NCS) that sampled the entire U.S. population in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), roughly 50% had a diagnosable Axis I mental disorder at some time in their lives. This survey’s results indicated that 35% of males will at some time in their lives have abused substances to the point of qualifying for a mental disorder diagnosis, and nearly 25% of women will have qualified for a serious mood disorder (mostly major depression). A significant finding of note from the NCS study was the widespread occurrence of co-morbidity among diagnosed disorders. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more additional disorders. These persons with a history of three or more co-morbid disorders were estimated to be one-sixth of the U.S. population, or some 43 million people (Kessler, 1994). Poor Prognosis We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions such as alcoholism are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private treatment programs (for example) relapse within the first year following treatment (Gorski,T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions? New Proposed Diagnosis Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictions and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals’ life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable. To assist with resolving this problem a multidimensional diagnosis of “Poly-behavioral Addiction,” is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of alcohol and substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences. Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 - month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously. New Proposed Theory The Addictions Recovery Measurement System’s (ARMS) theory is a nonlinear, dynamical, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. Multiple influences trigger and operate within high-risk situations and influence the global multidimensional functioning of an individual. The process of relapse incorporates the interaction between background factors (e.g., family history, social support, years of possible dependence, and co-morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, cravings, motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in an individual’s behavior can result in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous little interactions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual’s primary addiction. The ARMS’ theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension. The ARMS acknowledges the complexity and unpredictable nature of lifestyle addictions following the commitment of an individual to accept assistance with changing their lifestyles. The Stages of Change model (Prochaska & DiClemente, 1984) is supported as a model of motivation, incorporating five stages of readiness to change: pre-contemplation, contemplation, preparation, action, and maintenance. The ARMS theory supports the constructs of self-efficacy and social networking as outcome predictors of future behavior across a wide variety of lifestyle risk factors (Bandura, 1977). The Relapse Prevention cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the ARMS theory. Conclusions Considering the wide range of alcohol abuse and sexual behaviors in our world today, one should always take into account an individual’s ethnic, cultural, religious, and social background prior to making any clinical judgments, and it would be wise to not over-pathologize in this area of Dependency. However, since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning - poly-behavioral addiction needs to be identified to effectively treat the complexity of multiple behavioral and substance addictions. Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively manage poly-behavioral addiction? The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual’s comprehensive life-functioning progress dimensions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual’s primary addiction. The ARMS’ theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension. Partnerships and coordination among all service providers, government departments, and health insurance organizations in providing treatment programs are a necessity in addressing the multi-task solution to Alcohol Abuse and Poly-behavioral addictions. I encourage you to support the addiction programs in America, and hope that the (ARMS) resources can assist you to personally fight the War on poly-behavioral addiction. References Avins, A.L.; Woods, W.J.; Lindan, C.P.; et al. HIV infection and risk behaviors among heterosexuals in alcohol treatment programs. JAMA 271(7):515–518, 1994. Boscarino, J.A.; Avins, A.L.; Woods, W.J.; et al. Alcohol-related risk factors associated with HIV infection among patients entering alcoholism treatment: Implications for prevention. Journal of Studies on Alcohol 56(6):642–653, 1995. Cooper, M.L. Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Journal of Studies on Alcohol (Suppl. 14):101–117, 2002. Dermen, K.H.; Cooper, M.L.; and Agocha, V.B. Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. Journal of Studies on Alcohol 59(1):71–77, 1998. Dermen, K.H., and Cooper, M.L. Inhibition conflict and alcohol expectancy as moderators of alcohol’s relationship to condom use. Experimental and Clinical Psychopharmacology 8(2):198–206, 2000. Fromme, K.; D’Amico, E.; and Katz, E.C. Intoxicated sexual risk taking: An expectancy or cognitive impairment explanation? Journal of Studies on Alcohol 60(1):54–63, 1999. George, W.H.; Stoner, S.A.; Norris, J.; et al. Alcohol expectancies and sexuality: A self-fulfilling prophecy analysis of dyadic perceptions and behavior. Journal of Studies on Alcohol 61(1):168–176, 2000. Grant, B. F.: Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: Results of the National Longitudinal Alcohol Epidemiologic Survey. J. Stud. Alcoh., 58(5), 464-73., 1977. MacDonald, T.K.; MacDonald, G.; Zanna, M.P.; and Fong, G.T. Alcohol, sexual arousal, and intentions to use condoms in young men: Applying alcohol myopia theory to risky sexual behavior. Health Psychology 19(3):290–298, 2000. Malow, R.M.; Dévieux, J.G.; Jennings, T.; et al. Substance-abusing adolescents at varying levels of HIV risk: Psychosocial characteristics, drug use, and sexual behavior. Journal of Substance Abuse 13:103–117, 2001. Maslow, C.B.; Friedman, S.R.; Perlis, T.E.; et al. Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990–1999. American Journal of Public Health 92(3):382–384, 2002. McKirnan, D.J.; Vanable, P.A.; Ostrow, D.G.; and Hope, B. Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse 13(1–2):137–154, 2001. Petry, N.M. Alcohol use in HIV patients: What we don’t know may hurt us. International Journal of STD and AIDS 10(9):561–570, 1999. Purcell, D.W.; Parsons, J.T.; Halkitis, P.N.; et al. Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. Journal of Substance Abuse 13(1–2):185–200, 2001. Rovner, S.; Dramatic overlap of addiction, mental illness. Washington Post Health, 14-15. 1990. Selzer, M., Winokur, A. & Van Rooijen, C.; A self-administered Short Michigan Alcoholism Screening Test. Journal of Studies on Alcohol, 36, 117-126, 1975. Seto, M. C. & Barbaree, H. E.; The role of alcohol in sexual aggression. Clin. Psych. Rew. 15 (6), 545-66, 1995. Stall, R.; McKusick, L.; Wiley, J.; et al. Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: The AIDS Behavioral Research Project. Health Education Quarterly 13(4):359–371, 1986. Volpicelli, J. R.; Alcohol abuse and alcoholism: An overview. J. Clin. Psychiat., 62, 4-10, 2001. penis enlagement exercise free penis elargement video free penis enhancement tip vimax penis enlargement surgery picture compare penis enlagement pills magna rx review penis enargement surgeries homemade penis elargement penis elargement photo

Excerpt from The Steroid Deceit Having abused steroids for three and a half years, I was always afraid of being found out. I took pains to keep my steroid use hidden from my parents. They thought my newfound muscles were the result of all the time I spent at the gym, as well as the various supplements and powders that I always seemed to be taking. Little did they realize that some of those pills I called “vitamins” were actually oral steroids. The façade to my life of deceit began to crack, when I received a panicked phone call from my mother. She had evidently found one of my syringes. I rushed home. Since using steroids, I had become a much better liar than I ever could have imagined, and naturally I was ready to give her an Academy Award winning performance. My mother was waiting for me at the front door, and started in on me as I made my way up the pathway. “Are you using heroin?" “Mom,” I told her, offering her a big smile. “You’ve got it all wrong.” She waved the syringe in her hand as if to say, “How could this be wrong?” I didn’t stop smiling, even though inwardly I was cursing myself for having been careless with my needles. I had slipped up. Until that mistake I had always cleaned up after my usage and secreted everything away. While my mother brandished the syringe, I was doing some waving of my own, showing her a prescription form. By this time we were in the house. “I am not a junkie, Mom,” I told her. “I was given a prescription from a doctor.” “What for?” she asked. “For steroids,” I said, “only steroids.” She still looked doubtful, so I said, “I’ll go show you.” I went up to my room and returned with a vial. “See,” I said, showing her the vial, and then repeated, “It’s only steroids.” It’s only steroids. As a parent I can tell you that if I heard those words from one of my two boys I would be as concerned as if my child had announced, “Don’t worry, it’s only heroin.” I made a big show of throwing out the syringe and vial in front of my mother, My mother appeared pacified. Luckily, she didn’t know anything about steroids, and what I was saying must have sounded reasonable. Besides, my tossing out the vial and syringe clearly demonstrated that I didn’t have a problem. What she didn’t know was that I had a secret stash in my closet with dozens more vials and needles. It was also a good thing she didn’t look closely at the prescription, or she might have wondered why a vet was prescribing a drug to a human. In my hunt for bigger and better steroids I had found a veterinarian willing to write me a scrip for equipoise, a steroid prescribed for horses. As if that wasn’t bad enough, I had made copies of the prescription. I didn’t even have horse sense. I was a drug abuser with an illegal prescription covering up his habit by lying. I wish my mother hadn’t trusted me. I wish she had challenged me. I wish she had taken note of all the warning signs my body and behavior were giving off, and had pulled me up short. According to the U.S. Center of Disease Control, up to 6% of high school students have tried, or are using, steroids. Even if that figure is wildly exaggerated – even if it’s only half of that number – we are still talking about an incredible number of young people using steroids. Teens typically use steroids to get buff, or try and get an athletic edge. What they don’t take into account is the potential hazards that come with the drugs. Some of the side effects include: Psychological addiction; Depression and mood swings; Insomnia; Severe acne; Hair loss; Infertility; Liver disease; Testicular atrophy; Arteriosclerosis; Heart disease; Permanent stunting of growth; Feminization of males including breast swelling (gynecomastia – also known by steroid users as “bitch tits”); Stretch marks; Water retention; High blood pressure; Tendon and ligament damage Specific side effects of females are: Virilization (becoming more masculine) of females, with such symptoms as excessive face and body hair, deepening of the voice which is irreversible; suppression of menses; decreased breast size; and enlargement of the clitoris; It is hard to believe that given all the health risks associated with steroids that they continue to grow in popularity. I am afraid that either the message of their dangers isn’t getting out, or maybe it’s just that the other “message” is so much more prevalent that it’s hard to refute. When people look at the hard, muscled bodies presented by smiling, oversized human beings, they see a tempting portrait. Users and potential users are seduced by this picture of health and vitality. The picture doesn’t show the strain on the arteries, the wear and tear on the heart, or the pinball effect on the psyche. Because society has not yet raised enough red flags over steroid use, the burden for this scrutiny has to fall on parents and loved ones. At the time I abused steroids they were an “under the radar” drug; my parents didn’t even know what they were. Public awareness about steroids has grown, but judging from their increased popularity, teens and adults have not yet come to the realization that using them means playing Russian roulette. To protect their children from the dangers of steroids, parents need to be vigilant. For their own good, no child should be able to get away with what I did. It was wrong of me to pretend indifference about my drug habit and proclaim, “It’s only steroids.” Steroid use is the hidden epidemic. Somehow the war on drugs has missed this target. Parents can’t afford to turn a blind eye, though. Among the warning signs parents should be looking for in a child who might be using steroids is: A rapid increase in the musculature of your child; Your child’s preoccupation or obsession with “getting big”; An outbreak of acne (predominately on chest and back) far and above the usual; Pronounced mood swings;The presence of muscle magazines (look for the usual smiling steroid figures on the cover). There’s an old axiom: if it’s too good to be true, beware. Those bodies are too good to be true; Vials and pills and syringes – it is up to you to read the labels. I told my parents that the oral steroids I was taking were vitamins. Watch out for the following pills: Anadrol; Dianabol; Winstrol; tamoxifen; clenbuterol; clomifen citrate; masterolone Anything in a vial is suspect (if it is in a vial, it is usually vile). The brand names are many and varied, but look for the following substances: stanazalol; nandrolone decanoate; nandrolone phenilpropionate; dromastolone dipropionate; and testosterone. Despite all those misleading advertisements which claim you can lose 10 pounds of fat and put on 10 pounds of muscle in just a few days, it doesn’t happen that way. The human body doesn’t change overnight. When not using steroids, professional athletes are hard-pressed to put on 10 pounds of muscle in a year, even with rigorous workouts. If your child suddenly sprouts muscles, it is your job to be suspicious. Don’t be surprised if your teen credits those muscles to his or her pumping iron, and taking protein shakes and supplements. Speaking from experience, I can tell you that those pills and shakes are all but worthless. Invariably, the spokesperson for those kinds of products is a steroid abuser. The fact is that those supplements will not pack on the pounds and muscles as the manufacturers claim. Steroids will do that. They might also cause you to die or go crazy getting those muscles, but that’s not something you are ever likely to hear coming out of the mouth of Mr. Big Biceps. What should a parent do if they discover that their child is using steroids? One of the first priorities is opening up a dialogue with your child and start discussing this risky behavior. One of my favorite sayings is, “There is nothing uglier than truth when it is not on your side.” Truth is a great antidote to combating steroid usage. From the onset I would impress upon the child that what they are doing is both illegal and harmful. If you take a steroid, in the eyes of the law it’s the same thing as popping an amphetamine or Quaalude. Possession of steroids is a federal offense, and can result in jail time of up to one year in prison along with a fine up to a thousand dollars. If you manufacture or distribute steroids, the penalties are much more severe. It is common for many steroid users to sell or distribute their drugs. Doing a “favor” for another user can now result in a jail sentence. Expect your child to be defensive. When you start explaining about health risks associated with steroids, you are sure to hear, “I don’t know anybody who has had those kinds of problems.” It is entirely possible they’ll be telling the truth. You will have to explain that sometimes the effects are not immediate, and sometimes they can’t be seen. Tell them that steroids are like cigarettes; often they debilitate over time. You also have to try and impress upon them what I think of as “the X Factor.” Every day more evidence comes forward showing the detrimental effects of steroids. It’s only recently that steroids have been linked with depression, just as there have only been preliminary studies on steroids being a possible “gateway” drug. Before the mid-nineties, though, no one was talking about ‘roid rage. And before that no one had any idea about the potential for kidney damage and arteriosclerosis due to steroid usage. Your child will tell you that steroids work, and he’ll be right. They do work, but it’s one of those cases of their working too well. Your child might not want to hear about heart disease or liver tumors or hardening of the arteries. You will hear about the strength gains, and the “incredible” workouts. Your response should be, “At what cost?” The human body is designed for certain maximum levels. Those who abuse steroids can, and do, spend more time at the gym or on the playing field, and are able to push themselves harder and longer. Sooner, usually than later, though, the human body rebels; joints tear and ligaments rip. It isn’t surprising that sports medicine has seen an epidemic of career ending injuries in the past decade. Steroids have given athletes a false platform upon which to perform; when that platform collapses, too often it is game, set, and match. This trend of serious injuries extends from high schools to the professional levels. Sports doctors say they are seeing a huge increase in tendon and muscle ruptures. That isn’t a coincidence. When bodies get pushed too hard, they snap even harder. Student athletes are under enormous pressure to perform and that makes steroids tempting. Non-athletes feel their own pressures; everyone wants to look “buff” and fit. Parents should also tell their children that steroids are cheating. In simple terms of right and wrong, they are wrong, and you don’t want your child to be a cheater. If your son or daughter is looking for an athletic advantage, tell them that you don’t believe in winning at all costs and neither should they. Stress to them that the muscles they think they are getting are artificial and temporary, and if they want the real thing then they are going to have to work for it. Talk to your child and make sure his or her self-esteem is not dependent on body image. This will probably be another case where your child thinks you are old-fashioned and out of it; when your child grows up he will see how wise you were (but don’t expect to get thanked any time soon). It is possible your child has body dysmorphia, with a resulting skewed view on what his/her body really looks like. Harrison Pope established a formula to calculate what he called the “fat-free mass index” (FFMI). Based on those calculations, the upper limits of musculature and build can be defined by their scoring system. The researchers found that a drug-free individual could be muscular, but in a proportional and natural way. Unfortunately, these days we see so many images of bodies accomplished through steroids that we don’t realize them for what they are – fakes. Teens need to have a realistic idea of what is normal body image, and what is abnormal. When confronting a child’s usage of steroids, the natural reaction for any concerned parent is to ban steroids from the household. That prohibition won’t work, though, unless your child realizes it is in his own best interest to quit. Going off steroids is something that can be fraught with problems; consult with a doctor. Going “cold turkey” can have tragic consequences. If you get steroids out of your house, be aware that your child might seek out steroids through friends and find a way to try and hide further usage from you. Don’t be afraid of looking like the “bad guy.” Your child might not understand the serious consequences involved with steroid usage. If you suspect continued use of steroids, take your son or daughter to a physician and have them tested. I would also strongly encourage you to get your child into counseling. Most males will resist this, and will no doubt insist that it’s unnecessary. These are the same males who might suffer severe depression in silence, not doing anything about it. Unfortunately their ultimate solution might be suicide. Without being overly dramatic, parents need to be on a “suicide watch” for a child that is using steroids, or has recently stopped. Coming “down” from steroids can be a perilous time, especially for young people. They need to understand what is happening to them. Because they have tinkered with their body chemistry, stopping steroid usage might result in considerable physical and mental shocks to the system. When young men act rambunctious, people often roll their eyes and say, “Too much testosterone.” Imagine, then, too much testosterone for months and years at a time. Your child needs to know that’s what they wreaked upon their system, and that sometimes body and mind take time to find their way back to normal. Take it from me; it will be one of the most important journeys they ever undertake. pnis enlargement stretcher enlargment manhattan penile surgeon best penis enlargement best pnis enlargement surgery penile enlargment program penis enhancement herb pennis enlargement pic before and after free pennis enlargement video penis elargement photo

Trying to find a hoodia 1000 mg product is not easy. Many companies advertise a 1000 mg product, but reading the fine print on the back or the diet pill bottle does not always support their claims. There are many diet pills containing hoodia gordonii on the market. Sometimes finding a diet pill containing genuine hoodia gordonii is the problem. Compared to a stimulant containing diet pill, hoodia gordonii appears to be much safer. Effectiveness seems to vary among individuals and there is no accepted standard dosage, however many people report that it takes about 3000mg per day to suppress their appetites. In order to avoid taking numerous pills throughout the day and to keep the cost per day at a more reasonable level, we searched for hoodia 1000 mg products. This is what we found. The first problem is finding a diet pill hoodia gordonii product that actually contains 1000 mg of hoodia gordonii. We looked at Hoodia Xtra 1000. The name seems to suggest -- at least to us -- that it is a hoodia 1000 mg product, but each capsule only contains 500 mg. They listed the recommended dosage as two capsules. An advertisement led us to ebay, where many companies sell hoodia products. One would think that that the diet pill hoodia gordonii 5000 contains 5000 mg per capsule, but each capsule actually contains 250 mg of a 20:1 extract. There is no exact equivalency from extract to powder. Some companies claim that twenty pounds of plant are used to create one pound of extract, but it is actually 20 grams or whole plant to create one gram. This does not mean that the extract is twenty times stronger, but that is what they would like for you to believe. The diet pill hoodia gordonii 1000 SRT claims to be a hoodia 1000 mg product, but is sold by a site that sells arts and crafts and has no certifications of authenticity. The price is nice, but really cheap products with no certificates of authenticity are risky in our opinion since you may not be getting genuine hoodia gordonii. The bionutricals diet pill hoodia 1000 is supposed to be 1000 mg, but the recommended dosage is two capsules, three times a day, which would be 6000 mg and no one recommends a dosage that high. They do not show an enlargement of the back of the bottle, so we can not verify the content. The only diet pill hoodia gordonii product that we could find that actually is a hoodia 1000 mg capsule that we could find is Hoodia XR. We have written a lot about Hoodia XR and we wanted to be able to compare it to other products containing the same amount of genuine hoodia gordonii. But, it turned out that we could not find any. If we do, we’ll let you know. For more information about hoodia 1000mg products, visit the Hoodia Info Blog.