The Missing Treatment Link – Viewing Addiction as Symptomatic of Disordered Intimacy
Alcoholics and drug addicts don’t drink and use to feel better; they do it to feel less. In other words, addiction is a disease of escape and dissociation from stress and other forms of emotional discomfort. This means that substance abusers don’t get drunk or high because they’re looking to engage with other people, they do it because they’re hoping to avoid the turmoil of other people. Nevertheless, our very human desire for connection that is present from birth onward remains in effect. As such, drug addicted individuals typically do want to connect, even though they are desperately afraid of the trauma that might ensue.
And let’s be frank here: Have you ever met an addict (substance or behavioral) who didn’t struggle with healthy relating and emotional intimacy? The simple truth is most active addicts and addicts in early recovery see themselves as being completely self-contained. Essentially, they’d rather eat dirt than ask for help. This is actually a fairly logical stance when you consider the underlying early-life trauma that most of them have experienced. In short, as I have written many times previously, addicts engage in their addictive behaviors not to have a good time, but to escape from and self-soothe the pain of life in general and psychological disorders in particular – most notably depression, anxiety, low self-esteem, attachment disorders, and unresolved early-life trauma. Interestingly, the initial items on this “things to numb out” list – depression, anxiety, low self-esteem, and attachment disorders – can all be caused by the final item: unresolved early-life trauma. In fact, among the most profoundly intimacy disordered treatment populations – adult female addicts, for instance – a history of profound childhood neglect, emotional abuse, physical abuse, and/or sexual abuse is nearly always present.
A recent (and sadly accurate) cinematic depiction of this intimacy disorders formation process can be seen in Lars von Trier’s latest film, Nymphomaniac: Volume I. The movie focuses on the sexually addicted main character, Joe, played by Charlotte Gainsbourg, whose early-life attachment experiences reflect profound maternal neglect and dysfunctional ways of pleasing her father. Joe does not appear to have a co-occurring addiction, but many women with similar histories and similar intimacy issues do – most often an eating disorder, alcoholism, or drug addiction.
Though the intersection of substance abuse and intimacy disorders is painfully under-researched, it is nonetheless apparent to clinicians in the trenches that many individuals of both genders persistently and consistently, sometimes simultaneously, abuse both substances and non-intimate sexual activity (porn, prostitution, anonymous encounters, serial affairs, and the like). It is also clear that when an addict fuses substance abuse with sexual activity, each behavior reinforces the other, creating over time a surefire “paired trigger” for relapse. Very often, people with this issue primarily abuse stimulant drugs like methamphetamine and cocaine – substances that allow them to be sexual for hours or even days at a time. They can also become hooked on benzodiazepines, cold remedies, and other depressants as a way to “come down” and get some sleep when the party finally (albeit temporarily) ends.
Recognizing this, last spring I developed the Substance Abuse and Intimacy Disorders (SAID) program at Promises, Malibu, treating men for whom substance abuse and sexual issues had become so intertwined that addressing one without also addressing the other was pointless. Unfortunately, this men-only program left similarly addicted females fending for themselves in traditional rehabs geared toward either substance abuse or sex and love addiction, but not both. In the intervening 12 months the need for a sister SAID program has become more and more apparent. In fact, I am finding that women may be more susceptible than men to the dual allure of substances and sexuality. To remedy this inequity, Elements Behavioral Health has opened a much-needed SAID program for women at Right Step, DFW.
Who Does the Women’s SAID Program Treat?
To a certain extent we are dealing with a previously unrecognized category of addict – women who abuse substances and non-intimate sexuality in an integrated way, where use of one inevitably involves or leads to use of the other. Most of the time these women have extensive histories of substance abuse relapse, and nearly always these relapses are directly traceable to their sexual relationships. Often these women are so used to pairing drugs and sex that they can’t seem to enjoy one without the other. In the past many of them have gone into treatment for their drug addiction, but the facility has not addressed the ways in which sex and relationships play into their substance abuse. Then, post-treatment, uneducated about the full nature of their addiction, they go back to the same relationships and sexual life they’re used to, and before they know it they’ve relapsed with drugs.
Common challenges these women face include:
- Maintaining close relationships with people who are still drinking and using (spouses/partners, boyfriends/girlfriends, regular sexual hookups, etc.)
- A history of sexual relationships where drugs and sex have been the primary bond
- A history of having sex or relationships with people primarily because they supply alcohol or drugs
- Using alcohol or drugs to tolerate neglectful and/or abusive relationships
- Inability to enjoy sexual intimacy without the concurrent use of alcohol or drugs
- Making relationships a greater priority than sobriety
- Drinking or using to “please” an addicted partner
- An unresolved history of emotional, physical, and/or sexual abuse
Is the Treatment Process Different?
In most respects, treating women who repeatedly link substance abuse with sexual behavior and/or dysfunctional relationships parallels that of addiction treatment in general (both substance and behavioral). As usual, the process begins with a thorough bio/psycho/social assessment, with the added element here of a deeper than normal examination of the client’s sex and relationship history. After assessment, clients receive a steady diet of cognitive behavioral therapy, group therapy, social learning, and 12-step work, along with various alternative therapies that have proven to be effective in the treatment of addictions, such as EMDR, art therapy, equine therapy, memory therapy, and the like.
The main difference between what the SAID program offers and what you’ll find at other rehab facilities is a conscious recognition of the connection between substance abuse and intimacy problems. Incorporated into this integrated focus are:
- Traditional chemical dependency treatment
- Trauma-informed psychotherapeutic treatment
- Shame resilience treatment
- Healthy vulnerability psycho-education
The overarching goal of the SAID program for women is the creation of a safe environment where women can let down their defenses, own their histories, and lean on other similarly challenged women for support. All of this is achieved using an accountability-based social learning model, which puts a strong focus on intensive group work.
Elsewhere women with this dual issue are likely to have their concurrent sexual behavior minimized (due to client and staff ignorance of and/or discomfort with the subject) or written off as something to be dealt with in their fourth and ninth steps (in a 12-step recovery program). So despite their extensive histories of simultaneously and/or consecutively abusing drugs and non-intimate sexuality, these women typically leave treatment having dealt with only half their problem. Their shame and secrets regarding past and present sexual and relationship-oriented behaviors are left unaddressed, as is education about how they might be able to handle sex and intimate relationships in sobriety without relapsing. In the SAID program, however, the concept of healthy sex and relationships in sobriety is deeply embedded into the curriculum as an integral part of the relapse prevention focus.
This is very good news for a whole lot of previously hopeless, chronically relapsing addicts. Many such women have expended significant financial and other resources trying to get chemically sober, only to relapse because the sex/relationship/intimacy portion of their addictive behavior patterns has gone untreated. Some of these women enter the SAID program having lost hope of ever achieving lasting sobriety. At best, they’re hoping for a brief respite from their addiction so they can (temporarily) get their life back in order, save their marriage, or whatever. However, once treatment in the SAID program begins and they begin to fully understand the nature of their problem, they start to see, often for the first time, a light at the end of the tunnel.
The simple truth is that only by recognizing the full nature of an addict’s impulsive, compulsive, and addictive behaviors – including sex, relationship, and intimacy elements – can clinicians construct and implement treatment regimens that completely rather than partially meet the needs of these particular women. Addressing drug use and sexual acting out simultaneously is the best way to help these clients gain much needed insight into the entire spectrum of their addictive behavior patterns, identifying triggers for relapse and developing the comprehensive range healthy coping mechanisms necessary for lasting sobriety. When treated in this way, these women are finally offered the best available opportunity to both develop and maintain a rewarding, emotionally healthy, drug-free life.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships, along with numerous peer-reviewed articles and chapters.
Weiss LCSW, R. (2015). The Missing Treatment Link – Viewing Addiction as Symptomatic of Disordered Intimacy. Psych Central. Retrieved on December 2, 2016, from http://blogs.psychcentral.com/sex/2014/04/the-missing-treatment-link-viewing-addiction-as-symptomatic-of-disordered-intimacy/