Just Go to a Meeting!

Sex addicts, like many individuals in early recovery, are often highly resistant to the idea of attending 12-step meetings. And, like all addicts, they often have clever and insightful but typically unproductive reasons for not going.

Some examples include: “That’s where the really sick people go, right, not people like me?” or “I can’t talk openly to a bunch of strangers. What will they think of me?” or “What if someone sees me there and tells someone I know?”

And it’s not like the urban or online sex addict is limited in terms of sex and relationship addiction 12-step meetings, as today numerous groups can be found both in-vivo on and the Internet—each with a slightly different focus and population (SA, SLAA, SCA, SRA, SAA, etc.). Yet for a variety of reasons, mainly fear of the unknown, attending therapy often seems a more palatable option than going to a 12-step recovery meeting. So be it.

What is “Hypersexual Disorder”?

The American Psychiatric Association (APA), recognizing the increasing public and clinical acceptance of the concept of sexual addiction, has requested and received extensive Tier 1, peer reviewed research data, along with an exhaustive literature review (Shout out to Dr. Marty Kafka of Harvard!) toward its consideration of a potential DSM-5 Hypsersexuality Disorder diagnosis.

While “Hypersexual Disorder” may not be the ideal term for a problem that more accurately involves the lengthy search and pursuit of sexual and romantic intensity rather than just the sex act itself, the proposed criteria as written do point to problem patterns of excessive fantasy and urges that mirror most aspects of what we have come to know more commonly as “sexual addiction.”

Is Sex Addiction Real?

There will always be controversy – as there should be – when any form of inherently healthy human behavior such as eating, sleeping, or sex is clinically designated as pathological. And while the power to “label” must always be carefully wielded to avoid turning social, religious, or moral judgments into diagnoses (as was homosexuality in the DSM-I and DSM-II), equal care must be taken to not avoid researching and creating diagnostic criteria for healthy behaviors when they go awry due to underlying psychological deficits and trauma.

Pre-Internet sexual addiction research in the 1980s suggested that approximately 3 to 5 percent of the adult population struggled with some form of addictive sexual behavior. Those studied were a self-selected treatment group, mostly male, who complained of being “hooked” on magazine and video porn, multiple affairs, prostitution, old-fashioned phone sex, and similar behaviors.

More recent studies indicate that sexual addiction is both escalating and simultaneously becoming more evenly distributed among men and women. This escalation in problem sexual behavior appears to be directly related to the increasingly high-speed Internet access to both intensely stimulating graphic pornography and anonymous sexual partnering.

Today these connections are furnished not only through the use of home and laptop computers, but also via smart-phones and the related geo-locating mobile devices we now carry in our pockets and briefcases.

In the world of addiction treatment, there are two major areas of concern: addiction to substances, and addiction to patterns of behavior. Substance addictions involve abuse of and dependency upon chemicals such as alcohol, nicotine, prescription drugs, and illegal drugs like heroin and cocaine.

Behavioral addictions, often called “process” addictions, involve problematic repetitive behavior patterns involving potentially pleasurable or compulsive activities such as gambling, sex, working, spending, eating, etc. Some individuals struggle with both types of addiction simultaneously.

Sadly, the general public often mistakenly views process addictions as “moral flaws” or as “less serious” than substance addictions, yet those of us who treat these concerns directly witness firsthand the countless ways in which out-of-control impulsive, compulsive, and addictive behaviors wreak as much havoc on families, careers, and lives as drug addiction and alcoholism.

We also see that process addictions often contribute significantly to substance abuse relapse.

Today’s omnipresent fear that one’s personal identifying data (e.g., social security number or credit card information) may be vulnerable to hackers and identity theft has pushed millions of subscribers into the arms of “identity theft protection” companies like LifeLock.

But is anyone really paying attention to what will happen when the sexually explicit language and photos that are sent via the latest “friend finder” smart-phone app or sex website get hacked or otherwise exploited?

When “joining” sites like Ashley Madison or downloading apps like Blendr, participants are offered some measure of comfort via a click-it guarantee that personal information will be securely maintained. But somehow it seems off the radar to the same professionals and/or married individuals, who would never send their social security number online via an unsecured site, that when you sext and arrange app-based sexual hook-ups, every word and pic sent via these apps also resides in a far-away server. And that information lives there for a whole lot longer than the instant it takes to sext a potential hook-up.

Betty’s Story

Betty has been referred into treatment for a binge eating disorder (BED) by her long-time psychotherapist, who sees out-of-control patterns emerging that need to be addressed outside of the outpatient frame. Betty arrives 75 pounds overweight and has a number of health problems, but with the right combination of therapy and self-care she starts looking and feeling better than ever.

Once home and attending support groups and meetings, Betty finds that men are now taking note of her “improved look.” Betty finds herself both feeling sexy and wanting to be seen. So out she goes, looking for “the one” but settling instead for a lot of romantic attention and casual sex.

Eventually she finds “the one” and settles down into a committed relationship. Sadly, within a few short months of playing house Betty begins to gain weight and within 18 months, Betty has gained back 60 pounds, but also loses her new romantic partner who walks out the door not having gotten the woman he bargained for. This pattern plays out not once or twice, but nearly every time Betty gets into a serious relationship. It has never been identified.

The Therapeutic Use of Abstinence in Relationship and Sexual Addiction Recovery

Try telling a sex addict to stop pursuing and having sex for a month or more and you may quickly find yourself pushed aside for a more enabling (and less directive) therapist, sponsor or friend. Inform a profoundly love addicted (attachment disordered or trauma survivor) woman – the one who lives to seduce – that she can’t wear provocative clothing or makeup for at least 2-3 weeks and you will quickly learn about her level of dedication to recovery and change.

Such is the initial challenge of cognitive-behavioral treatment with sex and love addicts. In truth, a period of abstinence from sexual and romantic behavior, combined with contracted and prescribed boundaries around romance/seduction/dress, can be highly useful clinical tools toward expanding a sex and love addict’s sobriety skill set. This is especially true when working with individuals who’ve spent their whole lives seeing themselves and others as objects.

Why Abstain from Sex and Romance?

Active sex and relationship addicts base their adult self-worth on whether or not they are desirable and typically think, “I have value if I can get x, y or z to desire me sexually.” As such, they objectify themselves and others completely, often viewing their lives and relationships through a lens of conquest, seduction and intensity. This can sadly make the most mundane activities, like finding oneself in an elevator with an attractive stranger or walking past a good-looking person in the grocery aisle, a sexually charged opportunity to pursue people as objects.

Women are catching up to – and even outnumbering – men when it comes to college admissions and earning power. Along with these advancements, women have caught up in less savory ways.

Men don’t want to admit it; women don’t want to admit it; our culture tells us it can’t be so. But research is beginning to address an increasing number of women who are also watching porn, engaging in casual and risky sexual behaviors, and cheating on significant others.

How many women cheat? Accurate estimates are hard to come by, primarily because researchers rely on self-reporting and few women are willing to risk their relationships and reputations in the name of science. Studies from Indiana University and Manchester Metropolitan University have found that roughly 20-25 percent of men have affairs compared to about 15-20 percent of women. These numbers are likely much higher for both genders, with some polls suggesting that as many as 50 percent of married women have cheated.

In some ways the holidays can be a set-up for feeling bad. Our media-reinforced expectations of a warm, loving family-driven holiday season are often challenged by very real feelings of loneliness and disappointment. Those also saddled with a history of addiction or other emotional problems may find themselves longing for tangible ways to escape the emotional tension that this period brings.

This next two weeks, perhaps more than at any other time of year, not only puts more emotional pressure on all of us, but also provides the unstructured time, endless food, candy and drink and intense family interaction, which can challenge the most health conscious and well balanced among us, For those men and women who struggle with love, relationship and sex addictions, this is relapse season.

Courtesy of Fox Searchlight

To some it may feel like our culture has been suddenly barraged with sexual addiction books, film, media and reality TV. Films like Shame, TV shows like Bad Sex, the recent extensive media coverage of sexually troubled politicians and sports figures, combined with a recent Newsweek/Daily Beast cover story on the topic, almost seem to be converging on this issue and pushing it in our faces overnight.

But as a clinician who has been treating sex addiction and training therapists for nearly 20 years, I can reliably report what any experienced marriage counselor or addiction specialist will also tell you – that there has seen a steady escalation of addictive sex and intimacy problems ever since the Internet first came publically available in the early to mid-90’s. With every technological turn of the screw (pardon the pun), those of us who treat compulsive and addictive sex and intimacy disorders have seen an increase in clients troubled by these very issues; to us it makes perfect sense.