The 3 Levels of Sex Addiction

By Zacharias, LCSW, CSAT, CAADC • 1 min read


Sex addiction is a term that’s becoming more and more prevalent in all aspects of the addiction community.  This is particularly true as we discover more about the addiction interaction disorder of stimulants and sex.  A spirited debate as to whether there’s even such a thing as sexual addiction has been developing for some time now. “People can’t be addicted to sex – it’s just what people do” is often heard, while on the other hand, there are people that apply the same definition of addiction to alcohol and/or drugs to that of sex.  There’s no way to deny that someone who has difficulty controlling their sexual urges, behaviors and/or thoughts will see a progression of their symptoms leading to negative consequences in their lives.  For sex addicts, there are levels to the severity of the addiction and these are a good indication of the type of treatment that is needed. There are three levels of sex addiction.

Level One:  Some of the behaviors listed may exist in someone without a sex addiction, but when acted upon compulsively, is considered level one of sex addiction. There’s no doubt that these can be devastating when done compulsively.

Chronic Masturbation

Affairs, chronic infidelity, love and romance addiction

Sexual relationships with multiple partners

Pornography use and collection (with or without masturbation)

Phone sex, cybersex

Anonymous sex

Going to strip clubs

Level Two:  A common theme among these behaviors listed are that of someone being victimized.  There are also legal consequences to these actions which is a primary difference between Level One and Level Two behaviors.


Public sex – bathrooms, parks, etc.

Voyeurism – online or live



Stalking behaviors

Sexual harassment

Level Three:  These are behaviors in which there are significant boundary violations culturally and legally.


Child molestation

Obtaining/viewing child pornography

Obtaining/viewing rape/snuff pornography

Sexual abuse of older or dependent persons


Professional boundary violations (clergy, therapists, teachers, doctors)

Gay couple image available at Shutterstock.

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Sex Addiction in the LGBT Community

By Zacharias, LCSW, CSAT, CAADC • 2 min read

tvNo longer confined to the shadows, sex addiction is becoming more common in the LGBT community.  One area where there has been a dramatic spike in occurrence is in the gay male population with the prevalence of GPS-enabled hook up apps where people are doing PNP – “party and play.”  Many therapists and counselors are beginning to recognize the impact of sexual addiction on not only the client but their partner as well.  Are you wondering if you or a loved one is addicted to sex?  How can you tell if your partner or loved one is a sex addict?

It is sometimes difficult to tell if someone close to you has an addiction to sex. Addicts often hide their addictive behaviors. Here are some behaviors and warning signs of sex addiction:

  • Stays up late watching TV or using the computer, particularly behind closed doors
  • Looks at pornographic material: magazines, books, videos, suggestive catalogs or online
  • Does not inform loved ones of their whereabouts, has unaccountable time
  • Is demanding about sex, particularly about time and place
  • Is controlling during sexual activity
  • Has frequent mood swings before or after sex
  • Often angry or defensive if someone discusses or shows concern about pornography (always has a good reason for viewing pornography)
  • Does not show intimacy before, during and after sex
  • Avoids socializing with others, especially those who could intimidate them
  • Has a large number of calls to 800- or 900- toll-free numbers
  • Frequently rents or downloads pornographic videos
  • Seems to be preoccupied in public with everything (and everyone) around them, roaming eyes, cannot maintain eye contact
  • Feels depressed
  • Is increasingly dishonest
  • Hides pornography at work or home
  • Unexplained charges or use of money, carrying large amounts of cash
  • Lacks close friends of the same sex (if heterosexual)
  • Frequently uses sexual humor, is overly friendly or flirtatious
  • Cannot tolerate being alone, tries to replace lost relationships with new ones as quickly as possible

Are you concerned you may have an addiction to sex?

Here are 10 questions to ask yourself to gauge if you may have an addiction to sex.

1. Do you feel your sexual behavior is out of control?

2. Are aware of severe consequences if you continue your behaviors?

3. Do you feel unable to stop your behaviors, even knowing the consequences?

4. Do you continue destructive and/or high risk activities?  Have unsafe, dangerous or illegal sex?

5.  Do you use sexual fantasies or sexual activity to help cope with anxiety, difficult feelings or situations?

7. Do you find you need more of the sexual activities in order to experience the same level of enjoyment?

8. Do you suffer from intense mood swings before, during or after sexual activity?  (For example, feel excited then depressed or ashamed?)

9. Do you spend increased amounts of time planning, engaging in, regretting or recovering from sexual activities?

10. Have you missed or otherwise neglected important social, job or family activities because of your sexual behavior?

It is not always easy to determine what are healthy sexual behaviors and what constitutes sexual addiction or obsession.  The examples listed are warning signs that could suggest sexual addiction.  Any one of these is not necessarily indicative of an addiction, however the more that apply show a greater possibility of sex addiction.  There are more and more options for the LGBT community and their partners struggling with any addiction and in this case sexual addiction.

Man watching TV image available from Shutterstock.

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Socializing and Sobriety in the LGBT Community – What does that look like?

By Zacharias, LCSW, CSAT, CAADC • 1 min read

beerA common question that exists for many in the lesbian, gay, bisexual and transgender (LGBT) community facing addiction is “Where and how do I socialize after I get sober?”  For many LGBT individuals, their social lives have often revolved around bars and these experiences can run the gamut from hanging out with friends to fund raising events that occur in the bars.   There is no doubt that the prevalence of addiction – whether to drugs/alcohol or behaviors such as shopping/porn/gambling –  in the LGBT communities is high across all age groups with some estimates saying that up to 40% of the community struggles with addiction.

Gay men, for example, are significantly more likely to have used marijuana, stimulants, sedatives, cocaine, and party drugs (ecstasy, ketamine, and GHB) than men in the general population.  In the past few years, there has been a dramatic spike in the use of crystal methamphetamine in gay and bisexual men as well.  Use of alcohol and drugs among lesbian and bisexual women is higher than the general population.  LGBT events/fundraisers/activities are usually sponsored by an alcohol company which is a clear indicator that the alcohol industry has used this research to their advantage.

As friends settle down into relationships and create families during the late- 30’s to 40’s many LGBT individuals become vulnerable to isolating socially.  This isolation often leads many addicts to avoid or delay treatment which  can also trigger relapses and generally diminish the overall quality of life.

Many LGBT individuals in their late 40’s and 50’s suddenly realize that the crowd they used to run with no longer exists in the way that it once did. This can leave them scrambling for social activities to enjoy.  If they are in recovery for alcohol or drug addiction, the old standby of going to bars and clubs is not a healthy choice.

Fortunately there are now a number of healthy sober social alternatives available… not just in urban areas but all across the world.  There are movie lover screenings, sober dances and gatherings and many learning opportunities.  There are also running groups, softball teams, volleyball leagues, or other fitness groups – the sky is the limit.  These activities are fantastic ways to learn sober socialization skills as well as great additions to recovery meetings and fellowship.

For those LGBT individuals that are in recovery, remember the old saying, “It is all about people, places and things.”  You don’t have to lose the ability to connect with people; there are many activities and social possibilities waiting for you.

Street scene image available from Shutterstock.

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The Lesbian Community and Addiction

By Zacharias, LCSW, CSAT, CAADC • 2 min read


The lesbian community has been vastly underserved in mental health and addiction services so it should come as no surprise that alcohol and drug abuse is a major concern for individuals identifying as lesbian.  A report published by SAMHSA in 2011 found people who identify as LGBT (lesbian, gay, bisexual and transgender) are significantly more likely than the general population to use and abuse drugs or alcohol. This same study found lesbians are significantly more likely than heterosexual women to drink alcohol heavily. Another study published in 2004 from the Journal of Gay & Lesbian Social Services noted the incidence of substance abuse among lesbians is far higher than their heterosexual peers.  Knowing this what  are some of the key barriers to keep lesbians from getting the services that they deserve?  The following five themes highlight some of these key barriers:

(1)   Internalized Shame & Guilt: Addiction is a disease that coincides with tremendous shame and guilt. Many lesbians already struggle with internalized shame and guilt surrounding their sexuality, possibly having experienced rejection from family or friends, or simply as a result of living as a minority in today’s society rampant with hetero-sexist messages. Dealing with both their addiction and sexual orientation can feel like a double whammy, piling shame on top of shame.

(2)   Self-Medication: It is not uncommon for lesbians to use drugs or alcohol to self-medicate or numb themselves from feelings (such as inadequacy, shame, isolation, abandonment, sadness or anger) resulting from their sexual orientation. Unfortunately, this coping mechanism eventually backfires and the “solution” to the problem becomes worse than the problem itself. Drinking or using drugs to numb shame or other feelings may provide some temporary relief, but ultimately this coping strategy creates new problems and does nothing to resolve the feelings one tries to numb away.

(3)   Social Scene: The LGBT social scene is centralized in bars and clubs. Often, lesbians feel there is no way to be sober and remain social in the lesbian community. It is important to understand that the lesbian social scene provided in bars and clubs has specific meaning and importance. These places provide one of the only spaces where lesbians feel a sense of total acceptance, confident to fully be who they are, and allowed to safely and openly to show affection to loved ones.

(4)   “You’re Only as Sick as Your Secrets”: Honesty is one of the key principles of recovery. Lesbians may feel unsafe or uncomfortable outing themselves in treatment centers or 12-step meetings. The inability to express one’s true self can inhibit an individual’s ability to fully recover in mind, body, and spirit. Addiction treatment programs specializing in LGBT-specific concerns can offer lesbians struggling with drug or alcohol addiction a safe and supportive space in which they can fully heal and recover.

(5)   Spirituality vs. Religion: There is a common misconception that the spiritual foundation of 12-step programs is religious. This misconception may create a significant barrier to recovery. The idea of being forced back into religion could instill major resistance in lesbians whose religious upbringings may have been filled with shame, guilt, fear and rejection. It is important that addiction treatment programs educate lesbians about the difference between spirituality and religion, and provide an open setting for lesbians to identify their own conception of spirituality and a loving and accepting higher power.

Lesbians struggling with addiction face unique barriers that are critical to understand and address in treatment.  With this in mind, it is up to us as mental health clinicians to do better for the lesbian community.

Women snorting cocaine image available from Shutterstock.

Families in the LGBT Community

By Zacharias, LCSW, CSAT, CAADC • 1 min read

gayWe are well into 2014 and with the passage into a new year, you may have done the classic tradition of making a New Year’s Resolution.  Resolutions can serve as a guide to making much need changes in your life – that is if you are following through with the commitments that you have set.   However, resolutions can bring about increased stress, and for many, increased anxiety and depression.

Making resolutions is often a tradition that stem from our families of origin and are passed down over time from generation to generation.  It all sounds a bit 1950s Norman Rockwell-ish, but the reality of what constitutes a family in 2014 is much different than that of 50 years ago. Nowhere is this difference more evident than in the LGBT community where families often look much different than that of our heterosexual counterparts.

Due to a myriad of issues—homophobia, rejection of family members due to being gay, religious ideology—many members of the LGBT community have been shunned from their families of origin.

The sting of rejection, while tough any time of the year, can be most profound at the start of the new year.  What’s one to do when such emphasis is placed on being with family during the holidays or at the start of the new year, yet your family may have rejected you for being honest about this integral piece of yourself? Further confounding the difficulties is what to do if you’re struggling with addiction/alcoholism and may or not be in recovery.

How about reinventing your concept of family? Who says things have to be the way they’ve always been?

The idea of a family needn’t be defined by blood alone. Blood signifies relatives—something given with no choice.  Family can signify anything we want it to be—it implies choice. Choice is a beautiful word for anyone, but has special significance especially for those in the recovery community. It’s an opportunity to set the intention for what your life will look like.

If you’re not getting what you want and need in your life, go out and seek it—redefine what your family will look like. Unconditional love, trust, healthy communication, compassion, and loyalty—these are some of the characteristics that define what a family should look like. The opportunity to be transparent without the fear of judgment or critique is the cornerstone of what it means to be in a family.

There are people in the world that will love you and accept you for being LGBT.  There are people in the world that will love and accept for you being in recovery from mental health issues or addictions.  It’s a double bonus if you find both! Set a new tradition for yourself this year and move forward by painting a new picture of what your family will look like.

Gay home image available from Shutterstock.

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Treating Addiction in the Transgender Community – What You Need to Know

By Zacharias, LCSW, CSAT, CAADC • 2 min read

It is estimated that 30 percent of the LGBT population struggles with some form of addiction whether drugs, alcohol, sex or gambling.  Contrast that figure with the estimate that approximately 9 percent of the general population is impacted by addiction and it’s not hard to see that addiction is epidemic in the LGBT community.  Nowhere is this more prevalent that in the transgender community where rates of addiction tend to be even higher.  While most addiction research has focused largely on gay men and lesbians, and less so the bisexual community, it’s important to put equally as much focus on the transgender community.  When working with the transgender community, it is important to remember a few key things:

The educated use of terminology is vitally important so a few key elements are:

    1. Transgender is an umbrella term used to cover the gamut of sexual expressions including transgender individuals, drag queens/kings and those who present in a more androgynous fashion.
    2. Gender Identity is the gender with which one identifies.  An individual may present physically as a male but identify as female (MTF) or an individual may present physically as a female but identify as male (FTM).
    3. Sexual Orientation is the sex or gender that a person is attracted to.  Gender Identity and Sexual Orientation are not the same thing.  It’s important as a provider to ask the client how they wish to identify.
    4. Sex refers to the biological characteristics of a person at birth.
    5. Gender refers to how a person views themselves in the world – i.e. male, female or some combination.

Best treatment practices should involve a variety of trans-specific elements including:

    1. Body image – What it means to be male and what it means to be female should be examined.  Gender dysphoria – the discontent someone may feel due to the sex they were born as or the gender roles associated with that sex – can be quite prevalent.  Messages that are portrayed by the social media related to gender roles can be troubling to the community and cause mixed messages.  Additionally, if someone in the trans community had any surgical procedures, scarring or changes in appearance, this can cause additional stress to an individuals body image.
    2. Grief and Loss – There can be multiple levels to grief/loss that someone in the trans community experiences.  Rejection by friends/family, loss related to the person’s physical attributes, doubt dissatisfaction and/or regret related to surgery may add deeper layers to a persons grief/loss.  These are all conversations that should be had while engaging in counseling.
    3. Sexual concerns – How to have conversations with others around being what it means to be sexually engaged is important.  When engaging in treatment, it’s important to have frank conversations with a trans individual so they can then learn how to have these conversations with others.  Make sure to have these conversations with sensitivity as it is important.
    4. Social Isolation – It’s important to find ways for those in the trans community to be engaged with others.  Social isolation could be a driving factor in someone’s addiction particularly if the person has learned to conceal areas of their life from others such as being a trans individual.  It’s important to connect others in the trans community through support groups, 12-step meetings of through therapists specializing in working within the LGBT community.  Connection helps someone feels as if they aren’t alone in the world.

Substance abuse – It’s not enough for a treatment program to say they are welcoming to the trans community.  Successful treatment means developing a deep understanding of the multiple factors that drive a trans person’s addiction and then working through those multiple treatment issues to deliver the strongest evidence-based treatment.

Gay men at higher risk for meth abuse – What are the warning signs?

By Zacharias, LCSW, CSAT, CAADC • 1 min read

Gay men at higher risk for meth abuse - What are the warning signs?Methamphetamine, also called crystal meth, is highly addictive.  It can be used by snorting, smoking or injecting.  The components of Meth are highly toxic and include: sodium hydroxide (lye), brake fluid, lithium from battery acid, lighter fluid, rubbing alcohol, drain cleaner, paint thinner, anhydrous ammonia, hydrochloric acid, red phosphorus lye, ether, iodine and ephedrine.

What do you look for if you suspect your loved one is abusing Crystal Meth?

Continue reading… »

Welcome to True Colors

By John M. Grohol, Psy.D. • Less than a min read

The LGBT community has a unique set of needs when it comes to mental health. Long stigmatized in society — longer than even those with mental health concerns — LGBT people often suffer from a double-whammy of prejudice and discrimination.

That’s why I’m pleased to introduce True Colors, a blog dedicated to the unique needs and challenges of the LGBT community. Hosted by Jeffrey Zacharias LCSW, CAADC, BRI-I, the blog will focus on the mental health and addiction issues in this community. Jeff is the Clinical Director at New Hope Recovery Center and you can learn more about him here.

Please give Jeff a warm Psych Central welcome!

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  • Jeff Zacharias, LCSW, CAADC, BRI-I: I’ll send you an email and we can look at the issue further but I...
  • Andrea W: Great article. But the question that comes to mind is how do we get Lesbians to access the services that...
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