Sexual Addiction and Sex Addiction Recovery
The idea that addiction is somehow a psychological illness is, I think, totally ridiculous. It's as psychological as malaria. It's a matter of exposure. People, generally speaking, will take any intoxicant or any drug that gives them a pleasant effect if it is available to them. - William S. Burroughs
Addicts turn their pleasures into vengeful Gods. - Mason Cooley
The National Council on Sexual Addiction and Compulsivity has defined sexual addiction as "engaging in persistent and escalating patterns of sexual behavior acted out despite increasing negative consequences to self and others."(2) Sexual addiction is best described as a progressive intimacy disorder characterized by compulsive sexual thoughts and acts. Like all addictions, its negative impact on the addict and family members increases as the disease progresses. Over time, the addict usually has to intensify the addictive behavior to achieve the same results.(5)
The essence of all *addiction is the addicts' experience of powerlessness over a compulsive behavior, resulting in their lives becoming unmanageable. The addict is out of control and experiences tremendous shame, pain and self-loathing. The addict may wish to stop and is unable to do so. The unmanageability of the addicts' life can be seen in the consequences (s)he suffers the loss of close relationships, difficulties with work, arrests, financial troubles, and a loss of interest in things not directly connected to their addiction, low self-esteem, and despair.
Sex addiction can involve a wide variety of practices and may co-occur () with drug and alcohol addiction or other substances and psychological disorders. A large number of sex addicts say their unhealthy use of sex was a progressive process. It may have started with an addiction to masturbation, pornography (either printed or electronic), a relationship, multiple relationships, or a series of one-night-stands, but over the years progressed to increasingly dangerous behaviors.
Sex addiction is characterized by compulsive sexual encounters (physical, emotional, or fantasy) that become self-destructive, are progressively "acted-out," and are not genuinely emotionally fulfilling, feelings of pronounced shame, and that (s)he is unable to stop even though it causes recurring and progressive problems in the areas of marriage, social relationships, health, employment, finances, or the law. Sex addiction becomes the primary mechanism for the addict to temporarily self-medicate to minimize/alleviate stress, emotional or psychological pain, or an attempt to confront, manifest, play-out or replicates an addict's fears. In fact, "it is not uncommon for sexual addicts to have experienced some sexual abuse or trauma, or other forms of abuse, in their childhood."(1)
Numerous studies have focused on genetics to gain insight into addiction and co-occurring mental health disorders, and outcomes consistently point to a poly-genetic predisposition for addiction that can be every bit as significant as environmental and social factors in determining an individual's susceptibility to addiction. When pleasure centers in the human brain are stimulated, chemicals called endorphins are released into the bloodstream. Endorphins are "natural opiates", neurotransmitters responsible for the feelings of well-being and/or pleasure experienced by human beings during pleasurable experiences. In the case of sex addiction, endorphins and related chemical compounds/hormones are believed responsible for the intense euphoria and mood changes that accompany sexual activity.
Any mood-altering experience can be addictive, and chronic/repeated exposure to a mood-altering experience can lead to tolerance, a common warning sign of addiction. Tolerance in drug addicts is characterized by the body and mind requiring ever-increasing amounts of the substance of choice to feel "normal." In the case of sex addiction and other behavioral addictions (e.g., gambling, work, shopping, shoplifting, etc.), this means consistently increasing the frequency and intensity of engagement in the mood-altering experience to achieve the same effect. Viewed from a physiological / biochemical standpoint, the chemical process behind the cravings and compulsion for a behavioral addict to achieve an endorphin "high" through engagement in their mood-altering behavior of choice (i.e., a sex addict craving sex) is no different than a heroin addict craving opiates or an alcoholic craving alcohol, and over time, tolerance develops all the same.
In some severe cases of addiction, the addict's brain can eventually become permanently altered so that the brain's receptors are "tuned-in" only to the chemical(s) or experience(s) to which he or her is addicted.
The sex addict uses sex as a quick fix, or as a form of medication for anxiety, pain, loneliness, stress, or sleep. Sex addicts often refer to sex as their "pain reliever" or "tension reliever." Other indicators that sexual behavior may be out of control include:
- an obsession with sex that dominates one's life, including sexual fantasies that interfere with work performance
- excessive time devoted to planning a sexual activity that it interferes with other activities strong feelings of shame about one's sexual behavior
- feelings of powerlessness or inability to stop despite predictable adverse consequences
- inability to make a commitment to a loving relationship and extreme dependence upon a relationship as a basis for feelings of self-worth
- little or no genuine emotional satisfaction or attachment gained from sexual encounters
Compulsive or addictive sexual behavior may take various forms, including what many regard as "normal" heterosexual behavior. The type of sexual activity and even the frequency or number of partners are not of great significance in diagnosing this problem. Some individuals have a naturally stronger sex drive than others, and the range of human sexual activity is so broad that it is difficult to define "normal" sexual behavior. What is significant is a pattern of self-destructive or high-risk sexual behavior that is unfulfilling, a person is unable to stop, and their life becomes unmanageable as a result.
The first major study of sexual addiction was published by Patrick Carnes in 1991.(4) It was based on questionnaires filled out by 752 males and 180 females diagnosed as sex addicts, most of them admitted for treatment in the in-patient Sexual Dependency Unit of a hospital in Minnesota. The others had at least three years of participation in one of the 12-step programs for recovery from sexual addiction. Of the sex addicts in this survey, 63% were heterosexual, 18% homosexual, 11% bisexual, and 8% were unsure of their sexual preference.
The sexual addicts who responded to Carnes' questionnaire were typically unable to form close friendships. Their feelings of shame and unworthiness made them unable to accept real intimacy. They were certain they would be rejected if others only knew what they were "really" like, so they found myriad obsessive ways to turn away a potential friend or loving partner. Despite a large number of superficial sexual contacts, they suffered from loneliness, and many developed a sense of leading two lives--one sexual, the other centered around their occupation or other "normal" activity.
In Carnes' survey, 97% responded that their sexual activity led to a loss of self-esteem. Other reported emotional costs were strong feelings of guilt or shame, 96%; strong feelings of isolation and loneliness, 94%; feelings of extreme hopelessness or despair, 91%; acting against personal values and beliefs, 90%; feeling like two people, 88%; emotional exhaustion, 83%; strong fears about own future, 82%; and emotional instability, 78%.
Carnes found that 42% of sex addicts in his sample also had a problem with either alcohol or drug dependency and 38% had eating disorders.
In general, as an addict's sex addiction progresses their behavior conforms to a cycle:
- Preoccupation -- the addict becomes completely engrossed with sexual thoughts or fantasies.
- Ritualization —- the addict follows special routines in a search for sexual stimulation, which intensifies the experience and may be more important than reaching orgasm.
- Compulsive sexual behavior -— the addict's specific sexual acting out.
- Despair —- the acting out does not lead to normal sexual satisfaction, but to feelings of hopelessness, powerlessness, depression, and the like.
Compulsive sexual thoughts and behavior lead to increasingly severe consequences, in both the addict's internal and external worlds. The consequences include:
- broken marriages and relationships
- severe depression
- suicidal thoughts
- low self-esteem
- intense anxiety
- fear of abandonment
- moral conflict
- HIV infection
- genital herpes, syphilis, gonorrhea, and other sexually transmitted diseases (STD's).
- Physical damage to sexual organs, surrounding areas, or to the body
- Sexual addiction can also be (but is not always) associated with Obsessive Compulsive Disorder (OCD), Narcissistic Personality Disorder, and manic-depression, among other disorders
Legal consequences of sex addiction result when illegal behaviors such as voyeurism, exhibitionism, or inappropriate touching, result in arrest and incarceration. Child molesting and rape in some cases are addictive behaviors. Sexual harassment in the workplace can be part of a sex addict's repertoire and may result in legal difficulties on the job. Some sex addicts go to jail, lose their job, get sued, or have other financial and legal consequences because of their compulsive sexual behavior.
Financial difficulties from the purchase of pornographic materials, use of prostitutes and telephone and computer lines, travel for sexual contacts, and other sexual activities can tax the addict's financial resources, sometimes to the point of bankruptcy, as can the expenses of legal representation. Sixty percent of addicts have faced financial difficulties, 58% engaged in illegal activities, and 83% of sex addicts also had co-occurring addictions such as alcoholism, drug addiction, eating disorders, or engaged in other compulsive behaviors.
Overcoming sexual compulsivity and addiction starts with recognizing that you are out of control sexually. Getting to that point requires taking a hard look at yourself and the problems - emotional, physical, financial, or legal - caused by your sexual behavior. Is your life un-manageable because of your sexual behavior?
Treatment will focus on two main issues. The first is the logistical concerns of separating you from harmful sexual behavior in the same way drug addicts need to be separated from drugs.
Accomplishing this might require inpatient or residential treatment for several weeks. An inpatient setting protects you from the abundance of sexual images and specific situations or people that trigger compulsive sexual behavior. It's simply harder to relapse in a structured and tightly controlled setting. Sometimes, you can succeed in an outpatient setting with adequate social, family and spiritual support.
The second and most difficult issue involves facing the guilt, shame, and depression associated with this illness. It takes trust and time with a competent therapist to work through these emotions. If you are very depressed, the best treatment might be an inpatient residential setting where professionals can monitor and properly manage your symptoms.
Twelve-step programs, such as Sexaholics Anonymous, apply principles similar to those used in other addiction programs, such as Alcoholics Anonymous and Narcotics Anonymous. However, unlike AA, where the goal is complete abstinence from all alcohol, SA pursues abstinence-only from compulsive, destructive sexual behavior. By admitting powerlessness over their addictions, seeking the help of God or a higher power, following the required steps, seeking a sponsor and regularly attending meetings, many addicts have been able to regain intimacy in their personal relationships.
This approach looks at what triggers and reinforces actions related to sexual addiction and looks for methods of short-circuiting the process. Treatment approaches include teaching addicts to stop sexual thoughts by thinking about something else; substituting sexual behavior with some other behavior, such as exercising or working out; and preventing the relapse of addictive behavior.
People addicted to sex often have significant emotional baggage from their early lives. Traditional "talk therapy" can be helpful in increasing self-control and in treating related mood disorders and effects of past trauma.
Group therapy typically consists of a healthcare professional working with a group of between six and ten patients. Working with other addicts allows you to see that your problem is not unique. It also enables you to learn about what works and what doesn't from others' experiences, and draw on others' strengths and hopes. A group format is ideal for confronting the denial and rationalizations common among addicts. Such confrontation from other addicts is powerful not only for the addict being confronted but also for the person doing the confronting, who learns how personal denial and rationalization sustained addiction.
Recent research suggests that certain psychiatric medications -- namely antidepressants -- may be useful in treating sexual addiction. In addition to treating mood symptoms common among sex addicts, these medications may have some benefit in reducing sexual obsessions.
2 The National Council on Sexual Addiction and Compulsivity - www.ncsac.org and www.sash.net
3 Defense Security Services - www.dss.mil
4 Patrick Carnes (1991). Don't call it love: Recovery from sexual addiction, (New York: Bantam, pp. 22-23, 30-34).
5 Michael Herkov, Ph.D., Mark S. Gold, M.D., and Drew W. Edwards, M.S., Feb 2001
*Remarks: Addiction is a disease and should be characterized as such whether or not it is sex addiction, alcoholism or the broad spectrum of chemical dependency, and should not be construed as an addict's lack of willpower, personal strength, inability to make informed decisions, or personal fault of character. Genuine willpower to overcome an addiction by addicts is manifested in their daily (minute by minute) struggle - battle - to overcome their addiction and recover to lead satisfying and productive lives. For more information: and and .