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Neurochemistry, Escalation, and the Process Addictions

The Neurochemical Quagmire

As is the case with substance addictions, process (behavioral) addictions induce a neurochemical pleasure response comprised of dopamine (pleasure), adrenaline (anxiety, energy), oxytocin (love, jealousy), serotonin (mood stability), and endorphins (mild euphoria). But unlike the substance abuser, those with sexual and other behavioral addictions don’t need to ingest a substance to evoke a neurochemical high. Essentially, individuals who struggle with underlying emotional or psychological issues such as early-life emotional trauma, social anxiety, low self-esteem, and depressive episodes can unconsciously learn to self-medicate by abusing their sympathetic nervous system through intense fantasy, urges, rituals, and ultimately behaviors as means of dissociating from or otherwise coping with internal and external life stressors, emotional pain, and uncomfortable feelings. This “addictive” response is the underlying biological component that drives the dysfunctional behavior patterns of compulsive gamblers, shopaholics, sex addicts, and others who seek intensity as a means of self-soothing distraction.

Over time, sex addicts (and other process addicts) unconsciously learn to control and abuse their own neurochemistry the same way alcoholics and drug addicts learn to abuse the effects of the substances they ingest. Sex addicts become “hooked” on the dissociative emotional arousal and distraction produced by their addiction. Unsurprisingly, sex addicts find as much excitement and escape in thinking about and searching for their next sexual encounter as in the sex act itself. They sometimes refer to this trance-like state as being “in the bubble” or “in the trance.” Much like compulsive gamblers, sex addicts can sacrifice hours, even days of precious time and life-focus while losing themselves to this elevated condition.

Understanding the underlying neurochemistry that drives sexual addiction can help reduce stigma, as it promotes insight into the fact that hypersexuality is not really about the sexual act and orgasm – no more so than compulsive gambling is about winning or losing. Those who abuse their own neurochemistry as a means of self-regulation and affect management spend far more time in the fantasy about, search for, and pursuit of sex and romantic intensity than they ever spend in the actual sexual act.


One issue common to all types of addiction is an increasing tolerance to the mood-altering effects of the addict’s drug or behavior of choice. Over time, addicts nearly always “find themselves” doing more and more of their drug or behavior of choice and/or turning to more intense substances or experiences to attain and maintain a similar level of arousal.

Consider, for instance, drug addiction. The simple fact is relatively few people shoot heroin right out of the gate. More often, drug addicts begin with some sort of relatively innocuous usage such as smoking marijuana or abusing a prescription medication. As time passes, their habits escalate – they start smoking pot around the clock or popping pills by the handful. Eventually, even that level of use doesn’t get (or keep) them high the way it used to. At some point they inevitably discover “harder” drugs like crystal meth, cocaine, and heroin, and they use these substances to make them feel as they did before. Initially they may sprinkle a little bit of cocaine or crystal meth into a joint, or mix a tiny bit of heroin into the pills they’ve learned to crush and snort (for faster effect). Without ever making a conscious decision to do so, they suddenly “find themselves” cooking and injecting their new drug of choice. This is escalation for drug addicts.

Sex addicts escalate their behavior patterns in a very similar fashion. For instance, occasional viewing and masturbating to softcore online pornography is typically regarded as an enjoyable and relatively harmless adult activity – innocuous – akin to drinking a beer or taking a few puffs off a joint. However, for people predisposed to impulsive, compulsive, and/or addictive behaviors, what begins as harmless recreation can over time become an all-consuming activity, pushing the user away from relationships, family, work, exercise, hobbies, and other life-affirming activities. Individuals who become addicted to porn can typically spend multiple hours per day viewing and masturbating to erotic images and videos. Often they find themselves looking at and being turned on by increasingly more intense and/or bizarre imagery – sexual acts that didn’t interest them (and maybe even disgusted them) when they started out. This is escalation for a process addict.

Cross- and Co-Occurring Addictions

For some, escalation involves a cross-addiction (the addict switches from one addiction to another) or a co-occurring addiction (the addict deals with multiple addictions simultaneously). Cross- and co-occurring addictions are especially common in sex addicts. In one survey of male sex addicts, 87 percent of respondents reported that they regularly abused alcohol, drugs, or another addictive behavior in addition to their regular habits of compartmentalized sexual acting out.

Anecdotal evidence suggests that for increasing numbers of sex addicts a secondary drug of choice is crystal methamphetamine. Often called “the sex drug,” meth is the preferred “party favor” for anonymous Internet and smartphone hookups. It is also the most commonly abused drug among prostitutes. Meth causes feelings of euphoria, intensity, and power, along with the drive to obsessively do whatever activity the user wishes to engage in, including having sex. In fact, users say the drug allows them to be sexual for an entire day – even two or three – without sleeping, eating, or coming down, especially when a prescription medication like Viagra or Cialis is along for the ride.

Sadly, while intoxicated and disinhibited by a drug like crystal meth (or cocaine), safe sex is often not a priority, especially for those already inured to multiple anonymous encounters. This propensity for unsafe sex while simultaneously abusing meth, alcohol, and other illicit drugs greatly increases a sex addict’s risk for both pregnancy and contracting or transmitting HIV and other STDs.

How Sexual Addiction Escalates

As with drug addiction, sex addicts generally start out with “tame” behaviors such as flirting with an old boyfriend or girlfriend on Facebook, posting a profile on a “friend finder” app, or briefly looking at porn online. Over time, the behavior is engaged in for longer intervals, and other, more intense behaviors enter the picture. In the digital age, the Internet nearly always plays a part in the development and inevitable progression of sexual addiction. This escalation can take any number of forms, the most common of which are listed below.

  • Extramarital affairs
  • Casual or anonymous sexual encounters
  • Virtual sex (via webcams, using “teledildonic” devices, or in alternate realities such as Second Life and other online sexual gaming environments)
  • Hours, sometimes even days lost to pornography and/or other forms of online sexual behavior
  • Alcohol and/or drug abuse concurrent with the sexual addiction
  • Unsafe sex
  • Sex with strangers, dangerous people, or in dangerous locations
  • Exhibitionism and/or voyeurism (either online or in-person)
  • BDSM and other fetish behaviors that were not previously part of the addict’s arousal template
  • Sensual massage and prostitution (buying or selling)
  • Viewing child pornography or other illegal imagery
  • Sexual offending

Unfortunately, sexual addiction nearly always escalates in terms of time and/or content. Sooner or later these escalated sexual acting out behaviors result in profound and repeated negative life consequences. Over time, sex addicts can neglect important people (children, spouses), interests (recreation, self-care, creativity), and responsibilities (work, finances) to spend hours, sometimes even days, in a fantasy-based, emotionally elevated dissociative state. As their addictive behavior escalates, their sexual activities often start to go against preexisting values and beliefs (relationship fidelity, safe sex, not hurting others, etc.) Not surprisingly, when the acting out is finished, addicts can typically experience an overwhelming sense of guilt, shame, and remorse. At that point they will tell themselves, “This is the last time that I am going to…” Yet ultimately they are compelled to return to the same or an even more intense activity in order to simply feel OK. This downwardly spiraling cycle of shame, escalating behavior, and negative consequences is common to all forms of addiction.

Stopping the Sexual Carousel

Recovery from sexual addiction most often requires extensive counseling with a trained and licensed sexual addiction treatment specialist, coupled with or followed by group therapy and/or a 12-step program. For some people, an inpatient program such as The Ranch in Tennessee or an intensive outpatient program like the Sexual Recovery Institute in Los Angeles may be needed to jump start the process of recovery. It is important to note that sexual addiction is usually a symptom of underlying emotional and relationship concerns that will require longer-term psychotherapy and support to overcome, but this psychotherapy and support typically is successful only after the presenting behavioral issue has been eliminated.

Unfortunately, sex addicts rarely seek treatment on their own. More often than not, they are forced into seeking help by the threat of relationship separation, divorce, job loss, disease, arrest, or some other life trauma. While sex addicts are most often aware of their behavior patterns, the escalation of their addiction is subtle, intensifying (often unnoticed) over a period of time. And, like all addicts, sex addicts employ elaborate forms of denial, minimization, justification, and rationalization that help them to consciously disregard the negative consequences and continue acting out. Sadly, by the time they do seek treatment, most sex addicts end up wishing they had asked for and accepted assistance long before they actually did.

Neurochemistry, Escalation, and the Process Addictions

Robert Weiss PhD, MSW

Robert Weiss PhD, MSW is an expert in the treatment of adult intimacy disorders and related addictions, most notably sex/porn/relationship addictions along with co-occurring drug/sex addiction. A clinical sexologist and practicing psychotherapist, Dr. Rob frequently serves as a subject matter expert for major media outlets including CNN, HLN, MSNBC, OWN, The New York Times, The Los Angeles Times, and NPR, among others. Dr. Rob is the author of Prodependence: Moving Beyond Codependency, Out of the Doghouse, Sex Addiction 101, and Cruise Control, among other books. He blogs regularly for Psychology Today and Psych Central. His podcast, Sex, Love, & Addiction, is rated as a Top 10 Addiction Podcast for 2019. He also hosts a weekly live no cost Webinar with Q&A on A skilled clinical educator, Dr. Rob routinely provides training to therapists, hospitals, psychiatric organizations, and even the US military. Over the years, he has created and overseen nearly a dozen high-end addiction and mental health treatment facilities across the globe. For more information or to reach Dr. Rob, visit You can also follow him on Twitter (@RobWeissMSW), LinkedIn (Robert Weiss LCSW), and Facebook (Rob Weiss MSW).

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APA Reference
Weiss PhD, R. (2012). Neurochemistry, Escalation, and the Process Addictions. Psych Central. Retrieved on August 19, 2019, from


Last updated: 8 Nov 2012
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