OK, sex addiction and sex addiction treatment are in the news again. This sort of thing typically happens at least a few times a year. The regular news cycle is burbling along, and then some famous person lands in the middle of a big sex scandal (or several). At that point, everybody seems to want answers to these three very specific questions:

  1. What is sexual addiction?
  2. Is this person really a sex addict, or simply making excuses and/or trying to garner sympathy?
  3. What happens in sex addiction rehab?

The first question is easy to answer: Sex addiction is an out-of-control pattern of compulsive sexual fantasies and behaviors that causes problems in the addict’s life.

Answering the second question is also relatively straightforward. Put simply, sex addiction is diagnosed based on the following criteria:

  1. Preoccupation to the point of obsession with sex.
  2. Loss of control over sexual behaviors, typically evidenced by multiple failed attempts to quit or cut back.
  3. Directly related negative consequences (relationship issues, trouble at work or in school, depression, anxiety, loss of interest in previously enjoyable hobbies and activities, social and emotional isolation, legal trouble, etc.)

If the individual in question meets these three criteria, he or she is sexually addicted. Otherwise, that person is not a sex addict.

The answer to question #3 is a bit more involved, but still relatively straightforward.

Sex addiction rehab mirrors, in many ways, substance abuse treatment—generally implementing the same basic structure and cognitive-behavioral approach. The primary differences are the addictive behavior itself—compulsive sexuality rather than compulsive substance abuse—and the way in which sobriety (and therefore success) is defined.

With substance abuse issues, the ultimate goal is (nearly always) long-term abstinence. With sex addiction, however, sobriety is about learning to be sexual in non-compulsive, non-problematic, life-affirming ways. This is similar to the approach we take with eating disorders, another arena in which long-term abstinence is not feasible.

Nevertheless, sex addicts are typically asked to remain completely abstinent (including abstaining from masturbation) during their stay in rehab, which typically lasts anywhere from 30 to 90 days. This brief time-out from sex is mandated because most sex addicts, by the time they finally seek professional help, have completely lost touch with reality when it comes to their sex lives. They just have no idea which of their behaviors are problematic and which are not. Temporarily stepping away from all sexual activity gives them space in which to clear their heads and gain some clarity.

A common misperception about sex addiction rehab (and rehab for other forms of addiction) is that addicts, after completing an inpatient program, will be cured of their addiction. In reality, there is no cure for addiction (of any type). In this respect addiction is like diabetes—treatable, but not curable. So instead of focusing on curing a person who can’t actually be cured, rehab focuses on understanding the addiction and its consequences, establishing early sexual sobriety, and preparing the addict for the lifelong process of post-rehab recovery.

Psychotherapeutic tasks in sex addiction rehab are geared toward the following:

  1. Addressing the addict’s denial—the minimizations, rationalizations, and outright lies the addict uses to justify his or her addictive behaviors. This means we go through the real facts of the situation to help the addict see the truth and the consequences of his or her addiction.
  2. Identifying and eliciting responses to past trauma, abuse, grief, and other issues that typically drive all forms of intimacy and relationship dysfunction, including sexual addiction.
  3. Identifying the addict’s triggers toward sexual acting out, and developing a healthy set of behaviors that the addict can turn to instead the addiction.
  4. Helping to heal family strife, including the provision of support to betrayed spouses and other affected family members.
  5. Starting the process of lifelong recovery from sexual addiction by creating supportive and responsive therapeutic communities the addict can rely upon not only during but after inpatient treatment.

For the most part, sex addiction rehab focuses on the present—the here and now—utilizing highly directive methodologies like Cognitive Behavior Therapy (CBT). With this approach, sex addicts are asked to look at the people, places, experiences, and feelings that trigger and reinforce their sexually addictive thoughts and behaviors. Then they develop and learn to implement methods of short-circuiting the addictive cycle. Essentially, they learn to recognize that they’ve been triggered, and to act in ways that counteract rather than reinforce their desire to act out sexually. That said, treatment proceeds with the past in mind, taking into account the fact that sex addicts tend to be trauma-driven rather than individuals who simply have no capacity for empathy or remorse. In other words, we understand that sex addicts are not bad people; instead, they are good people who’ve engaged in regrettable behaviors as part of their addiction.

It is important to state, once again, that sex addiction rehab does not cure sexual addiction. Instead, it interrupts long-established patterns of sexual acting out, and it provides a safe, structured setting in which sex addicts can build awareness of their addictive problem and coping skills they can turn to instead of their addiction. Usually, with or without the benefit of inpatient sex addiction treatment, addicts must battle their issue on an ongoing basis. Their desire to act out sexually does not ever completely go away. It lessens, certainly, and they learn to respond in non-addictive ways when triggered, but the desire to engage in their addiction does not fully disappear, no matter how good the treatment center or how motivated the addict.