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ISD, ALCOHOLISM, AND OTHER DRUG ADDICTION: GWEN AND ARTHURíS CASE HISTORY

Gwen and Arthur are a middle-aged couple who have been married for twenty years, most of them difficult as a result of Arthur's alcoholism. A construction foreman who managed to earn a living in spite of his nightly drinking binges and morning-after hangovers, Arthur has been sober for the past eighteen months and is an active member of Alcoholics Anonymous. Unfortunately, none of the support and advice he has received from other recovering alcoholics has yet been able to help him improve his marriage in general or his sex life in particular.

"I think that if I could start acting like a real husband, things might get better between us," he said, attempting to explain why he was seeking the advice of sex therapists. To Arthur, "acting like a real husband" meant having sex with his wife, which he was unable to do when he came to see us. "You see," he continued, "I hardly ever really, you know, feel the urge. I sort of lost interest while I was still drinking, but I didn't get interested again after I got sober. I really thought I would, and the thing is, I guess I'm one of those guys who can't force it. If I'm not in the mood, I can't do a darn thing in bed."

Actually, most men can't force themselves to perform sexually if they don't feel sexual desire, and prolonged alcohol or drug use will, in fact, lower your sex drive. Like other recreational drugs such as marijuana, alcohol has a direct and toxic effect on male testosterone production, which, along with similar effects created by alcohol-related liver damage and changes in the nervous system, is likely to inhibit sexual desire and functioning long after you stop drinking. What's more, as your addiction to alcohol or drugs progresses, your preoccupation with getting high will detract from your interest in having sex and your ability to perform or respond sexually.

"Oh, I suspect he thought he was a real stud," Arthur's wife, Gwen, said bitterly. "But he was one sorry excuse for a lover. Determined, though. I'll give him that. He'd come stumbling in after midnight hell-bent on having sex. Sometimes I could stall him. I'd go into the bathroom, saying I wanted to put in my diaphragm, and if I waited long enough he'd be passed out on the bed. But mostly, he didn't give me the chance to do that. He just used me, time and time again. To tell you the truth, I was glad when the drinking made him impotent, even if he did get nastier about that time too."

As the years went by, Arthur's behavior left its impact on Gwen. Her dread of her husband's insensitive demands for sex evolved into a complete lack of interest in it. "Sex is not on my list of fun things to do with my husband, or anyone else, for that matter," she said, adding that it would be fine with her if sex therapy failed.

"The man put me through eighteen years of hell," she asserted. "Now he stops drinking, says he's sorry, and expects me to forgive and forget. Well, it isn't that easy. If he thinks he's going to come home and find me waiting at the door all lovey-dovey in a sexy nightie, he's got another think coming. It's his turn now."

Clearly, discontinuing drug or alcohol use will not remedy all the problems that began before you got clean and sober. Physical factors, including medical conditions we will discuss in the next section, also negatively influence your emotional state and your relationship. It is often the combined effectórather than the physical problem aloneóthat causes ISD.

*66\261\8*

Men's Health-Erectile Dysfunction