Scenario 1: Joan, a 32-year-old working mother of two young children
Joan arrives in therapy complaining that over the past six to eight months she has experienced growing feelings of both sadness and fatigue. She admits to frequent crying jags over what she accurately describes as relatively minor incidents. She also reports difficulty falling asleep, usually because she’s worrying that her children need more from her than time allows. As a result she is fatigued, easily prompted to tears, spaced out, and increasingly forgetful. The final straw for Joan was when she inadvertently locked her toddler son in the family car with the keys inside (requiring a visit from the local AAA truck to free both her son and her SUV). The following day, after a long talk with her husband, who encouraged her to seek help for her general unhappiness, she reached out to a local psychotherapist. After reviewing Joan’s history and stated symptoms over the course of several sessions, Joan’s therapist diagnosed her as being in the middle of a moderate depressive episode. The therapist gave her a referral for medication evaluation, and continued to work with her in therapy – focusing on helping her to better manage stress and to feel more confident as a mother.
In two previous posts I’ve written about clinician prejudice toward sex offenders and ways to effectively treat sex offenders. It was satisfying to see these blogs being well received, and it is my sincere hope that this effort has helped in some small way to pull back the covers on a topic that is often avoided, overlooked, and/or flat out ignored by the therapeutic community. This third and final (at least for a while) blog on sexual offending is intended to briefly address a few remaining offender-related topics.
Eyes Wide Shut
Sex addicts – men and women who obsess about and compulsively abuse sexual and romantic behaviors to the point of self-harm and/or harm to others – frequently appear to be quite functional in other areas of their lives. Unfortunately, as with most active addicts, these individuals are often out of touch with the unforeseen costs of their addictive behavior patterns until a related crisis emerges for which they seek help. Ignoring signs that most others would not miss – STDs, workplace trouble, related chemical dependency relapses, broken relationships, etc. – sex and love addicts place the compulsive search for sex and romance at the top of their priority list without a second thought. In fact, when confronted in the early stages of treatment with something as elemental as an adult sex and relationship history, many sex and love addicts are shocked to “discover” the extent and depth of their acting-out behaviors. This is their denial. It is almost as if they refuse to see, or are unable to integrate into their conscious thought process, the destructive effects of their sexual and romantic activity not only upon themselves, but on those who love them.
Cross and Co-Occurring Addictions
Individuals who are cross-addicted are people who switch from one addiction to another—for instance, Suzanne stops drinking alcohol, then gains 40 pounds in three months, replacing booze with compulsive eating. People with co-occurring addictions struggle with multiple addictions at the same time—for instance, Eric smokes pot morning, noon, and night, and also plays video games for eight to ten hours each day.
Cross and co-occurring disorders are especially common with sex addicts. In one survey of male sex addicts, 87 percent of respondents reported that they regularly abused either addictive substances or other addictive behaviors. Considerable anecdotal evidence suggests that for a majority of sex addicts with a co-occurring addiction the secondary drug of choice is crystal methamphetamine. Sex addicts also use cocaine, crack cocaine, and almost any other stimulant—but crystal meth is usually cheaper and more readily available.
Consider Brad, a married, 38-year-old lawyer:
Stepping It Up in Treatment
Sex addicts, like many in early addiction recovery, are often highly resistant to the idea of attending 12-step recovery meetings. Their reasons are myriad and usually without merit, though they sure can sound convincing on first listen.
Basically, it boils down to this: individuals who hang out in adult bookstores, cruise local red light districts looking for prostitutes, download hard-core pornography on work computers and masturbate in their office during business hours, post hi-definition photographs of their exposed genitalia on dating websites, and openly announce their extramarital availability on Ashley Madison (with a face photo but without a second thought) are the same folks who become very concerned about being “spotted” at one of “those” meetings.
“What if someone sees me there and thinks I’m a pervert?” they fret. Never mind the fact that these meetings usually take place in churches, school classrooms and local businesses after hours with no neon signs announcing what’s going on. Resistance to change is what it is, and even though sex addicts invite risk when acting out, they are risk averse in terms of being seen in 12-step sexual recovery meetings like SAA, SLAA, SCA, SA, and SRA.
It is therefore up to the addiction therapist, when working with a 12-step-averse client, to bring the themes, neurobiological rewiring, and experience of 12-step recovery into the treatment arena—especially in a group therapy setting. Once the sexual behavior problem has been clearly assessed and client/treatment goals and expectations aligned, sex addiction treatment is well served by the therapist initiating discussions on themes like surrender, feeling out-of-control/powerlessness, developing personal integrity, asking for help, accepting responsibility, turning it over, establishing accountability, etc., all within the framework of cognitive behavioral treatment.
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.”
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.
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.