Perhaps it’s no surprise that many addicts in early recovery are challenged by the need to invigorate and grow healthy relationship intimacy of all types (sponsors, friends, family, etc.) After all, alcoholism and drug addiction are diseases of isolation, secrecy, and dissociation. In other words, people who consistently abuse substances do so not because they’re looking to connect and engage; rather, they do so to escape from the discomfort of life and relationships. Think of the alcoholic who is miserable socializing at a party until he is drunk enough to put the proverbial lampshade on his head, becoming everyone’s best pal and the life of the party. Of course, by the time he looks and feels like he is finally relating to the other people there, he is completely unavailable to do so.
This is fairly typical of most addicts and the issues they have with healthy relating and intimacy. Simply put, addiction nearly always arises in people with unresolved childhood trauma, psychological disorders, or personality challenges. It’s no secret that issues like childhood sexual abuse, depression, social anxiety, and attachment deficit disorders cause intense feelings of shame and guilt that tend to isolate and separate the afflicted individual. They also often lead to self-medicating with both substances (alcohol, drugs) and behaviors (sex, gambling, eating, spending, and the like). This is, essentially, what we see with the lampshade fellow above.
Exacerbating the situation is the fact that most people dealing with these underlying intimacy issues begin the process of self-medicating relatively early in life, usually during adolescence. And, as soon as they start doing so, the process of emotional growth that is required for healthy adult relationships is stunted. In fact, most addicts (of all types) will tell you that when they enter recovery they feel like they are the emotional age of whatever actual age they were when they started using. So if Mr. Lampshade started his drinking at age 14, he will probably relate to people emotionally and intimately as a 14-year-old until he eventually enters recovery and resumes the process of growing up. So, essentially, he is unable to relate to other adults in a healthy way because his addiction started very early and arrested his emotional growth. Other addicts have deep intimacy disorders to begin with, which may well lead to their substance abuse, which in turn escalates the intimacy issue. Either way, for some addicts substance abuse and intimacy issues can become heavily linked – equal parts of a viciously destructive cycle.
Each Behavior Reinforces the Addiction
Admittedly, the intersection of substance abuse and relationship/intimacy issues is painfully under-researched. That said, it has become increasingly clear to me, as I work to evolve both substance abuse and intimacy disorders treatment, that there are quite a few individuals who consistently, often simultaneously, abuse both substances and non-intimate sexuality (porn, strip clubs, prostitutes, affairs, one-night stands, etc.) It also is clear that when a drug addict fuses drugs with sex that the sexual behavior reinforces the drug use (and vice versa). Over time, this creates a surefire “paired trigger” for relapse. Men with this issue will often also abuse Viagra, Cialis, Levitra, and similar drugs so they can maintain an erection for hours or even days at a time. And both genders can become hooked on benzodiazepines and/or “cold remedies” used as a way to “come down” and get some sleep when the party is finally ended.
It is readily apparent to me that in this type of paired addiction the drug use and current/past/future fears and challenges related to intimacy and adult sexuality must be treated in concert, rather than simply making an assumption that getting the client chemically sober will also clear up the intimacy issues. To achieve lasting behavioral change on either front the client’s complex, interwoven behavior patterns must be dealt with simultaneously in an integrated manner. In other words, without treatment for both issues the client may not heal from either.
Interestingly, as of now there is only one treatment program in the United States focused on treating substance abuse issues that are highly correlated to problems with sex, relationships, and intimacy – the Substance Abuse and Intimacy Disorders Program at Promises Malibu, a fully gender separate (males only) facility opened in January of this year. I am currently working with Elements Behavioral Health (Promises’ parent company) on developing a series of similar treatment centers, but for now there is only the SAID program.
Who Does the SAID Program Treat?
In some ways the SAID program is dealing with a previously unrecognized category of addict. Most of the patients appear to have various forms of early trauma and attachment challenges over which drugs mixed with non-intimate sexuality provide a sense of emotional control. Usually they struggle with isolation and broken relationships, along with the typical health and life-productivity losses naturally related to all forms of addiction. Oftentimes clients report a history of using stimulant drugs such as cocaine or methamphetamine. Party drugs like GHB, Ketamine, and Ecstasy are also common, as are opiates, alcohol, and just about any other drug you can think of. Sometimes drugs and sex are used simultaneously, other times consecutively. For instance, one man might snort cocaine while he engages in marathon sex with prostitutes, and another man might masturbate to online porn for several hours, then feel bad about that and self-medicate with opiates, then feel bad about that and self-soothe with more porn and masturbation. Either way, the men are co-abusing substances and sex as a way to avoid life.
Typically, SAID program clients have extensive histories of substance abuse relapse, and nearly always these relapses are directly related to non-intimate sexuality. Sometimes these men are so used to pairing drugs and sex that they can’t seem to enjoy one without the other. In the past they have gone into treatment for their drug addiction, but the facility has not addressed the ways in which sex plays into their drug use. Then, post-treatment, uneducated about the full nature of their addiction, they look for the same type of sexual encounters they’re used to, and before they know it they’re using drugs again. I want to be very clear here: These are not men who only occasionally have sex when high, or who occasionally use drugs when having sex. Rather, these are men for whom drug use and sexual behaviors are fused. In other words, drugs and sex are not separate issues; they are instead a single, co-occurring addiction.
The SAID program also sees plenty of men dealing with sexual shame related to homosexuality, bisexuality, gender dysphoria, fetishes, and the like who use drugs as a way to disinhibit themselves so they can explore their ego-dystonic sexual arousal patterns, and/or to quell the emotional discomfort they feel after engaging in those shame-inducing sex acts. Again, the SAID program is not set up for men for whom these sorts of behaviors only occasionally occur. Instead, the program is designed for men for whom drug use and sexual behaviors are deeply-related actions – separate but so connected that one nearly always follows the other.
Is the Treatment Process Different?
In most ways, treating men who repeatedly link substance abuse with sexual behavior and/or disturbed relationships and intimacy patterns parallels that of addiction treatment in general (both substance and behavioral). As always, the process begins with a thorough bio/psycho/social evaluation, with the added element here of a deeper than usual examination of the client’s sexual and relationship history. After that, clients receive a steady diet of cognitive behavioral therapy, group therapy, 12-step work, and social learning, along with various “alternative therapies” that have proven effective in the treatment of addictions (somatic experiencing, art therapy, physical exercise, memory training, EMDR, and the like).
The main difference between what the SAID program offers and what you’ll find at most rehab facilities is recognition of the interrelatedness of substance abuse and intimacy problems for these clients. Elsewhere, even in the best drug addiction treatment centers, men with this dual issue typically 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 the addict’s fourth and ninth steps (in a 12-step recovery program). So these men, despite their extensive histories of simultaneously or consecutively abusing drugs and non-intimate sexuality, leave treatment having dealt with only half their problem. Their shame and secrets regarding past and present sexual behaviors are unaddressed, as is education about how they might be able to handle sex in sobriety without relapsing. In the SAID program, however, the concept of healthy sex in sobriety is deeply embedded into the curriculum as an integral part of the relapse prevention focus. So in essence the SAID program provides a much more holistic view of this dually addicted person’s mind and body – particularly in relationship to past and present sexual choices – than currently exists in any other inpatient treatment facility.
This is very good news for a whole lot of previously hopeless, chronically relapsing drug addicts. Many such men 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 men 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 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 fact 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 men. 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 men are finally offered the best available opportunity to both develop and maintain a 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 has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia.