Sex addiction is a term to describe any pattern of out-of-control sexual behaviour that causes problems in someone's life. Furthermore it is a pattern of behaviour that cannot be stopped, or does not reliably stay stopped.
Psychological dependency has become recognised as a significant contributory factor to addiction, meaning that substances such as cannabis, which is considerably less chemically addictive than alcohol can still be classed as an addictive substance.
"Personally as a society we should be taking much more responsibility for the porn industry as we increasingly are with gambling since 'psychological gambling' entered DSM (Diagnostic and Statistic Manual or the American Psychiatric Association), but the financial ramifications are enormous.
In my clinical experience, sex addiction is not the same as a high sex drive. Many of the addicts I've worked with do not get sexual pleasure from what they're doing and it does not satiate their drive.
Perhaps one of the biggest myths about sex addiction is that it's a condition suffered by men with high sex drives that they can't control. This is simply not the case.
In many ways, sex addiction has more in common with eating disorders than it does with other addictions. In one study 38% of its sample had an eating disorder and in the UK 79% of those with another addiction cited eating disorder. In the same way as bulimia, anorexia and compulsive over-eating are about an unhealthy relationship with food, sex addiction is an unhealthy relationship with sex. In healthy individuals, both sex and food satisfy a natural, innate and primitive drive, but when the relationship becomes corrupt, sex addiction has no more to do with sex drive than eating disorders do with hunger.
Like Pavlov's dogs who salivated every time they heard a bell whether there was food or not, the addict may seek sexual gratification every time they feel a negative emotion whether or not they feel desire.
Neurochemistry of addiction
Pleasure is not purely psychological. It is a physical process triggered by chemicals in the brain - primarily dopamine, endorphines and adrenalin. The chemical addict manages to tinker with these processes by the addition of another substance; the process addict has developed a fast access root to the source of those pleasure chemicals through their behaviour. It is a bit like having a cocaine dispenser in your brain that you can activate at any time you like or need.
But while these pathways (the strengthened and developed pathways to pleasure through the addiction) become more fixed they become less effective at delivering the desired effect and hence the addict finds they need more stimulation in order to get the same affect. This is what's known within the addiction field as 'tolerance and escalation'.
This is the dilemma of the addict. Their sexual acting out has created a fast track to dopamine and in the meantime their other pleasure pathways have begun to fade away. They may still enjoy listening to music or spending time with friends, but compared to the instant hit they can get from acting out it's a poor substitute. But each time they access their reward system through sex, the weaker the other pathways become.
The neurobiology of addiction encompasses more than the neurochemistry of reward. People with addiction experience difficulties with impulse control, deferring gratification and making judgements about harmful consequences - all processes that involve the frontal cortex of the brain and underlying white matter. These areas of the brain are altered by addiction and since they are still maturing in adolescence this is why early exposure is believed to be a significant factor in the development of addiction.
The consequences of sex addiction
Feelings of shame 70.5%
Low self-esteem 65%
Losing a relationship 46.5%
Loss of employment 4%
Wasted time 62.7%
Wasted money 41.9%
Debt 14.7%
Impaired parenting 14.7%
Physical health problems 15.7%
Catching an STI 19.4%
Mental health problems 49.8%
A serious desire to commit suicide 19.4%
Sexual dysfunctions 26.7%
Legal actions against you 6%
Press exposure 0.9%
The dependency on some kind of sexual behaviour and the incessant pursuit of it in spite of all the dame it causes, is what kills self-worth. Unfortunately the lower self worth plummets, the less resources someone has to fight addiction.
Chapter 2. Assessment and diagnosis
Before any kind of assessment can begin, it's essential to understand to what extent someone is ready for an motivated to change.
Sex offending: It's estimated that 55% of sex offenders are also sex addicts and since escalation is a common feature of addiction, crossing a boundary into offending behaviour is a real risk for many addicts. In my survey 43% had viewed either child or animal pornography.
Added to this the shame that addiction creates robs many people of the ability to follow their own moral compass.
Adolescence and addiction:
Identifying sex addiction in adolescence poses a number of difficulties since many of the identifying factors might be described as 'normal' adolescent behaviours.
Clinicians and concerned adults should also be aware of changing cultural norms and not jump to conclusions about behaviours that they find challenging.
Within my survey (of sex addicts) 29% reported that the problem began between the ages of 17 and 25, 31% between 11 and 16 and 8.8% under the age of 10. [68% u18]
LGBTQ sex addiction:
Compared to heterosexuals, it's though there is a greater incidence of sexual addiction among gay men
Classifications of sex addiction
Broadly speaking, addiction is trauma-induced, attachment-induced or opportunity-induced or, in some cases, a combination of two or three.
Trauma-induced:
Significant trauma can also have a direct impact on the structure of the brain and the repetitive nature of the compulsive behaviour can become a way of soothing a hyperactive amygdala and limbic system and reduce symptoms of hyper arousal and hypo arousal.
Attachment-induced addiction:
When a child forms a secure attachment with their primary care giver they are more likely to grow into an adult with positive self esteem who is able to tolerate and manage strong emotions and mild trauma. But if positive parenting has been unreliable or absent a child is more likely to fear negative feelings and turn to an addiction for comfort during times of trouble rather than to a person.
Opportunity-induced addiction:
The internet now floods our senses with visual stimuli and sexual opportunities, and hence pornography and cybersex, like sugar, have become supernormal stimuli and our brains must work harder to control and manage our primal appetite.
The profile of the 'typical' sex addict is changing. Fifty years ago it would only have been those with significantly dysfunctional background who would have been driven enough to pursue their sexual anaesthetic. But now there is an increasing number of clients with only minor historic difficulties who stumble upon the joys of sex and pornography and become hooked. In my survey, 44% of respondents said they had no experience of childhood abuse or trauma and 26.% of respondents had never experienced any of the well-recognised attachment related issues. As clinicians it's important that we recognise this distinct client group and ensure we don't attempt to pathologise their past by trying to find trauma and attachment issues that either do not exist or are not relevant.
There are few of us who won't have used sex and relationships as an aneasthetic when life is hard.
The Assessment process.
Three questionnaires.
Q1: do i have sex addiction?
Q2: Measuring severity.
Q3: Defining the type of addiction.
Chapter 3. How sex addiction starts
Understanding how something came to be is almost always a complex interweaving of many different factors whether that's understanding how you got into the job you do or why a car crash happened. there are always multiple factors to be taken into consideration, many of which are dependent on another.
Diagram: mixture of Social, cultural, relational, biological and emotional
Opportunity-induced addiction
1 in 5 people said not knowing sex could be addictive was the most influential factor in becoming addicted and 1 in 3 cited easy access to sexual opportunities.
Why do only some fall into addiction?
1. Brain development. Addiction seems to run in families which supports a hereditary factor.
2. Dopamine dysregulation. The common denominator in all addiction is dopamine. Dopamine is the neurochemical responsible for the experience of reward and pleasure and is naturally stimulated by eating, drinking, and having sex... the more you do something to increase your dopamine the more you'll want to do it... there is research underway to explore if early exposure to pornography may have similar long term impact on dopamine regulation as happens with addictive drugs... Patrick Carnes' prediction at the annual conference of Addictive Disorders in May 2010 that we have a 'tsunami coming our way' will undoubtedly be right.
3. Personality.
Family environment also plays a part in the following ways:
1. Developing self-control. When we talk about self-control and its role in addiction is't important not to reduce this simply to impulse control... We begin to learn self-control in childhood and there are two ways in which parents can fail to teach this essential skill. The first, which is most common in sex addiction, is to have a strict and rigid home environment where a child is never allowed to make decisions for themselves... The second way that parents may fail to teach self-control is by having a home with too few or no boundaries.
2. Managing difficult feelings.
3. Secrets and shame. Many with addictions learnt o keep secrets from a young age.
4. Sex education. Pornography used to be a masturbatory accessory, an extra treat, whereas now it is often seen as an essential foundation for it.
5. Adolescent loneliness. It's hard to know if some people are born shy or if social difficulties make them shy. Either way shyness can become a heavy burden that particularly impacts forming healthy relationships and developing support systems.
Attachment-induced addiction.
Where there is safe, reliable, supportive parenting it's possible for a child to make mistakes, learn from them and move on. It is also easier for them to consciously recover from trauma. But without that fundamental bedrock of what psychologists call 'healthy attachment' addiction has a greater chance to take root and flourish.
Attachment and the brain.
A child who does not receive its needs for attention, soothing, stimulation, affection and validation may find the consequences structurally written into their developing brain. the altered prefrontal function is associated with high risk of drug and alcohol addiction.
Chapter 4. How addiction is maintained and reinforced.
There are significant relational, emotional, societal and cultural influences that both maintain and reinforce the addictive behaviour.
What's important to recognise is that if the underlying causes of addiction have not been identified and resolved then the proverbial sword of Damocles is still hanging overhead.
Sex addiction has very little to do with sex.
Some people are not consciously aware in the preparation phase and need to be helped to become aware of their S.U.D.s 'seemingly unimportant decisions.'
The psychological strategies engaged during the preparation phase can be described as cognitive distortions. - strategies to help change how we feel about something and consequently change how we behave. -
Common cognitive distortions:
Rationalisation
Justification
Minimisation
Magnifying
Blame
Entitlement
Uniqueness
Mental filter
Victim stance
Normalisation
Denial
Helplessness
Chapter 5. The Partner's Perspective
A helpful chapter that acknowledges the impact on the partners involved and the need to provide adequate care for them. Worth a read but two quick quotes:
What's most important to recognise when considering who to ell is that a partner can share as little or as much as they feel comfortable, with the people they most believe can offer support. Furthermore there is no urgency.And also:
Wherever possible services need to be provided for both so each can recover and rebuild their lives.
PART II - Breaking the chains of addiction
Chapter 6. Treatment objectives and options
It has been understood for many years that successful treatment for any psychological condition is ultimately dependent on the relationship between the client and the therapist and on the motivation of the client.
Overcoming sex addiction is long-term work, especially for those with attachment and/or trauma issues. As discussed previously, addiction affects the brain and synaptic change can take between three and five years. This means that some element of long-term work is essential for many, whether that's alone, in therapy or as part of a recovery or 12-step community.
Treatment objectives:
UR-CURED
Understand sex addiction
Reduce shame
Commit to recovery
Understand and personalise the cycle of addiction
Resolve underlying issues
Establish relapse prevention strategies
Develop a healthy life
Reduce Shame:
It is said that shame is to addiction what oxygen is to fire. It has been shown that whereas shame is likely to increase addictive behaviour, guilt can be a significant motivator to overcome it.
Overcoming sex addiction should never be about changing an individual's taste in sexual behaviours, but about changing their compulsive use of the behaviour whatever it may be.
Many people who've struggled with addiction are reluctant to let go of their shame, as they believe it to be part of their penance or proof that they've accepted responsibility.
Commit to recovery:
It's vital to acknowledge that there will be times when either the desire of the ability to recover is questioned. Addressing these issues early in treatment and agreeing how to manage them can help to ensure that commitment is maintained.
--
Focuse needs to be on not just what someone wants to give up, but also what they want to gain.
Understand and personalise the cycle of addiction:
Everybody is unique and therefore every addiction is unique. In brief it means understanding the unmet needs and unresolved issues of the Dormant phase; identifying Triggers; recognising the cognitive distortions that happen during the Preparation phase; understanding the function of the addiction in the Acting Out phase; and becoming aware of how the Regret and Reconstitution phases are experienced and managed.
Resolve underlying issues:
Unless these are resolved a person will continue to act out. Relapse prevention strategies may help to stop and stay stopped for a while, but without resolving the deeper unmet needs and issues, recovery will be reduced to pure will power and the sufferer has no choice but to 'white knuckle' it.
This stage of therapy may be the longest, the slowest and the most painful as the root of addiction is exposed, examined and pulled out. An overview of treatment strategies is found in chapter 9.
Establish relapse prevention strategies:
Relapse prevention work needs to highlight not only the emotional and environmental triggers that reactivate behaviours, but also the thought patterns that have become automatic, and probably unnoticed over many years.
Develop a healthy lifestyle:
Someone once wisely said that 'recovery is not about learning to manage addiction, but learning to manage life.'
--
There then follows a list of different treatment options. Noteable:
Online:
The Kick Start Recovery programme is a free resource developed by Paula's team that can be downloaded from the web to provide a starting point into recovery. It covers three basic tasks: Face it, Understand it, Fight it.
Good website: https://thenakedtruthproject.com/
Partner therapy:
Ultimately, getting over sex addiction is about realising you're not alone and committing to recovery - howeve rlong it takes.
Chapter 7: Making a Commitment to Recovery
