Author: Dr. Linda Hatch

Why Do Addicts Need to Hit Bottom?

“Hitting bottom” is a well known concept among those in the drug and alcohol recovery community which originally gained currency in the Alcoholics Anonymous 12-step program (AA).  It is also commonly referred to among sex addicts and in Sex Addicts Anonymous 12-step groups.  Hitting bottom is a very individual concept and means roughly that point in your life at which you were so broken down and desperate that you were forced to admit that you needed help. 

The original AA concept of hitting bottom was based on the idea that a true addiction is so powerful that by definition it takes something dramatic to make a person seek help.  In other words, for any addict, sex addicts included, the last thing the addict wants to do is stop engaging in the addictive activity.  Against that overwhelming need, a motivation for seeking help will have to be monumentally powerful.  Furthermore, the concept of needing to hit bottom includes the idea that change is impossible without first admitting that you yourself cannot solve the problem, that the addiction is bigger than you are.  The first step to overcoming the addiction, i.e. step 1 in all the 12-step addiction programs, is admitting this powerlessness.

Sex Addicts are Powerless over the Addiction

Those of us who work with sex addicts have no problem with the idea that sex addiction is just as overwhelmingly powerful as any other addiction—we see it every day. Sex addicts no less than drug and alcohol addicts need to reach a point where they are up against the wall and can no longer believe that they can quit on their own.  It makes no difference what the specific sexual addictive behavior is.  Internet pornography is called the “crack cocaine of sex addiction” because it hooks so many people so easily and so quickly, but other sexual addictive behaviors such as anonymous sex, serial seductions, sexual massage parlors, strip clubs, sexual chat rooms and prostitutes are experienced as just as addictive.  All addictive behaviors escalate as the addiction progresses and the addict finds that despite the best intentions, fiercest exertion of will power and the promises to himself or others, he (or she) continues to give in to the urge to sexually “act out.”

What is an “Intervention” for a Sex Addict?

An intervention is an arranged confrontation of the addict aimed at making him/her see the need for help before they hit a more devastating, absolute bottom.  A large number of the sex addicts who come for help do so because of pressure from outside.  This can take the form of a spouse or partner who finds out about the addiction and pressures the addict into getting help, or it can be an arrest for behavior related to the sex addiction or a brush with the law, or it can be losing a job or being at risk for losing a job due to the addictive behavior or its consequences.  This route into treatment does not guarantee that the addict will automatically believe that he/she needs help or that treatment can cure him/her.  But most sex addiction treatment is geared toward overcoming the initial denial of the addict first and it therefore paves the way for the addict to accept the need for help and ultimately to embrace a program recovery.

Some addicts do “hit bottom” without outside pressure.  They suddenly realize that they have no life, that they are incapable of a good intimate relationship, or that they don’t want grow old and die an addict.  But the pressure from a spouse or partner can be an invaluable tool in creating a “bottom” and propelling the addict into treatment.  Instead of hiring an intervention expert, the partner of a sex addict can often get the same results by saying “get help or else,” that is assuming they mean what they say.

“Why didn’t I see that something was wrong?”

Most partners and spouses of sex addicts feel that they had no idea there were sexual addictive behaviors going on behind their back.  They believe, and correctly so, that sex addicts are world class liars and they cannot imagine how they were supposed to have figured out that their spouse was engaging in sexual behaviors like viewing internet pornography at work, having random sexual hook-ups, or spending a small fortune in strip clubs.  Were they wearing blinders?  Definitely not.  Addicts are great liars.  But there are ways in which the sex addict’s behavior is a symptom of a larger problem, and that larger problem was almost certainly one that pervaded the marriage or relationship in many other subtle ways.   If both addict and partner have some of the same unconscious hang ups, then the partner may not be able to clearly see that something is amiss.  The disclosure of the sex addiction will seem to come out of left field.

Both sex addict and partner have intimacy issues

Sexual addictive behaviors are, among other things, a way to avoid intimacy.  Sex addicts tend to pick partners who do not demand that the relationship be based on emotional maturity, honesty, and equality.  The addict is most comfortable with a partner who is so afraid of abandonment that they are either checked out a lot, keeping distance through drama and turmoil, or through behaving in a needy and compliant way.  In other words, one of the ways that the sex addict’s intimacy disorder meshes with the partner’s intimacy issues is that for both of them there is a tendency to choose partnerships with built-in distance. 

Separateness and loneliness: the addict

Sex addiction is a lonely business.  When sex addicts are active in their addiction, they are “intimacy disabled” – they avoid close relating with a partner and substitute the fleeting excitement of sexual acting out.  Most likely they are coming from a place of fear of intimacy that goes way back to childhood experiences.  The upshot is that their way of relating to their partner may be very superficial, intermittent and outright deceptive.  This is not closeness.  Underneath, the addict has feelings of inferiority and loneliness.

Separateness and loneliness:  the spouses of addicts

The person living with a sex addict is fearful of abandonment too and therefore fears intimacy because it carries with it the danger of getting hurt.  In some way there is safety in a partner who is partly unavailable.  Getting too close is not safe.  So the partner of a sex addict (or any kind of addict for that matter) is not the “main squeeze” so to speak.  The addiction is in some ways the addict’s true love.  Often the relationship started out with the addict seeming to be overwhelmingly in love and seductive and the partner may mistake this intensity for intimacy.  In this way the partner is unconsciously settling for a relationship in which there is intense romanticism (at first) but really, in one way or another, an absence of deeper intimacy.  Worse still, the spouse or partner of a sex addict will periodically have a sense of this lack even if they cannot see the cause.  The partner or spouse will be subjected to periodic but constant episodes of abandonment by the person they love.

Learning to be Intimate:  new skills for both addict and partner

The cure for all this loneliness and fear of abandonment is that through recovery both sex addicts and their partners will be receiving appropriate support and professional help in order to overcome their fears and learn to be intimate.  This is a long process; the old fears are deeply ingrained.  But both addicts and their spouses or partners have many of the same fears and the same lack of ability to feel safe in being open with what they feel and who they are.  In the process of recovery the addict and partner can count on having a lot of common areas for growth, and this in itself will be a basis for genuine closeness.

People are Afraid for their Children

A predatory child molester is a parent’s worst nightmare.  The idea that someone who has committed a sexual offense against a child could be loose in the neighborhood is a truly frightening prospect for the folks who live there.  The reflex reaction is to say that if we can prevent one child from being sexually assaulted then any preventive measure is justified.  Likewise, the reasoning goes we should just lock up sex offenders and throw away the key just to be on the safe side.  

Prison sentences for first time offenders guilty only of viewing child pornography have tended to vary widely but to be often extreme.  The average person tends to conclude that any act such as viewing child pornography is surely going to lead to offenses against children.  Such conclusions are often drawn purely on gut level fear rather than any knowledge of the facts. 

The available research does not indicate that the act of viewing child pornography leads to committing sex offenses even though most actual child molesters do view child pornography.  Some have even argued that viewing child pornography can be a less damaging substitute for child sexual abuse and can therefore be somehow useful for those who have those inclinations.

Nevertheless, a conviction on possession of child pornography alone can in itself lead to the offender being placed on the state’s sex offender registry.   Local law enforcement may also notify their communities about the presence of a registered sex offender under certain circumstances.

http://www.nsopw.gov/Core/Portal.aspx?AspxAutoDetectCookieSupport=1

In recent years the internet has allowed child pornography to become a rapidly increasing problem.  In 1995 about 50 people per year were prosecuted on child-pornography charges in the U.S. Currently the number is about 2,500 per year.  The U.S. Department of Justice reports that images of pre-pubescent children are becoming more prevalent and are increasingly violent and sadistic.

Reasons to be Less Afraid

• Residency restrictions may not make communities safer.  An article entitled “Studies Question Effectiveness of Sex Offender Laws,” reviewed two studies which showed that registration does little to increase public safety. http://www.eurekalert.org/pub_releases/2011-08/uocp-sqe083011.phreviewed
• Most convicted sex offenders do not re-offend.  Most estimates of recidivism rates for sex offenders are under 20% which is lower than for other types of crimes. 
• Most sexual offenses against children are not committed by strangers.  The NY State Criminal Justice Department in their “Myths and Facts” about sex offenses reports that for offenses against victims age 16 and under, 93% were assaulted by someone they knew, usually a family member or acquaintance. http://www.criminaljustice.ny.gov/nsor/som_mythsandfacts.htm
• Treatment of sex offenders is thought to be effective.  According to the above link, studies show a reduced rate of repeat sex offenses for offenders who successfully complete their treatment goals.  Treatment with youthful offenders appears to be particularly effective.

There is also growing concern about the possibility that excessive restrictions on registered sex offenders as to where they can live, where they can go, whether they can be on social media sites, GPS monitoring, etc. may lead to their lives becoming so disadvantaged that they are actually at greater risk to reoffend.  In other words, where their life options are so narrowed they may be hindered from leading a normal life even if they start out motivated to do so.

What to Do

On the whole I believe that the lesson is that rather than trying to increase the controls on those offenders who have been convicted, we should channel our anger and fear into efforts to catch and treat young sex offenders, place increased emphasis on treating all sex offenders both incarcerated and in the community, and continue preventive efforts to increase public awareness and awareness on the part of youngsters about the prevalence of and dangers associated with internet pornography.  We need to focus on efforts to prevent children and adults from becoming either sex addicts or sex objects, either predators or prey.

 

 

Sex addiction is hazardous in general

The standard ten criteria for sex addiction listed under the “defining addiction” tab above illustrate the many possible detrimental results when out-of-control sexually addictive behaviors gain a hold on your life.  Some of the criteria suggest that sexual addictive behavior has a negative impact on the addict’s relationships and occupational functioning.  Obviously spending hours a day looking at pornography or hooking up for anonymous sexual encounters costs people their marriages, jobs and connections to people in their lives. 

The more severe varieties of sexual addictive behavior such as exhibitionism, voyeurism, stalking, and molestation carry the additional risk of arrest and incarceration.

Sex addiction is physically and emotionally hazardous to you (and others)

Other defining criteria for sexual addiction point to the direct negative effects on the addict’s mind and body that such behavior can have.  Three of these defining criteria jump out at me:

• Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior
• The need to increase the intensity, frequency, number, or risk level of behaviors in order to achieve the desired effect; or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk
• Distress, anxiety, restlessness, or irritability if unable to engage in the behavior

Mental and Physical Diseases

Physical hazards include first and foremost exposure to sexually transmitted diseases.  The sexual addictive behaviors which involve multiple sexual partners, anonymous sex, or sex with prostitutes etc. involve the possibility of unprotected sex which could lead to the addict contracting HIV, HPV and other sexually transmitted diseases.  The indiscriminate sexual contact with a number of partners could also lead to the exposure to other diseases as well.  These diseases are then potentially transmitted to the partners and spouses of the sex addict as well.  I know of one particularly sad case in which an addict unknowingly exposed his pregnant wife to a pathogen that caused a birth defect in his child.

Mental distress and depression are common among people with sexually addictive behavior patterns.  I have encountered any number of sex addicts who have been suicidal due to their addiction at one time or another.  Recently a man in his 50’s who had been arrested for viewing child pornography died while awaiting sentencing.  He died of a heart attack but my suspicion is that the stress of his situation was the precipitating factor.

Erectile Dysfunction

By definition, an addiction involves a process of gradual desensitization, a numbing of a specific pleasure response in the brain.  As more and younger men who are addicted to internet porn exhibit ED, it is clear that the process of desensitization to sexually addictive behaviors operates in exactly the same way as any drug.

Affects on Women

Women are affected from two directions.  (1) More women are becoming sex addicts (although still fewer than men) and (2) images of women in the media are becoming increasingly sexual across the board.  Sexualized images of women are everywhere in media, film, advertizing etc.  These are images that are:

• Increasingly pornographic
• Increasingly violent
• Increasingly idealized (thin, airbrushed)
• Increasingly intended to look extremely young or even childlike

It is well documented that the dissemination of idealized images of women has many negative impacts on women and girls such as eating disorders, emotional disturbance and lack of sexual self protection.  Body dissatisfaction is common and from 2002 to 2003 the number of girls 18 and younger who got breast implants tripled.

Affects on Children

As adults become accustomed to being bombarded with sexual imagery, they are likely to be more lax about protecting their children from it and are even coming to see it as OK for children.  Sexualized images of children are becoming much more prevalent than ever and sexualized clothing such as thongs and high heels for young children has led to the coining of the terms “prostitot” and “kinderwhore.”  It remains to be seen what the ultimate affect of all this will be on the development of the current generation of children. 

Recovery is not Prudery

If you are inclined to take the issue of sexually addictive behavior seriously and you help others to do so you are helping to push the social agenda in a healthy direction.  There is still pressure in the sexually addictive direction from many people who see recovery as “sexual repression.”  It is important for sex addicts to get help and for those around them to get help and to carry the message.  This is not being against sex.  There is nothing liberated or liberating about being caught up in sexual addiction.

Are there more sex addicts in the US than alcoholics?

The exploding use of internet pornography worldwide has been well documented of late and has prompted people to use the word “epidemic” to describe the phenomenon.  Even the most conservative estimates based on surveys of college students put the figure at six percent or more. But a recent statistical review concluded that “ten percent of adults admit to an internet sexual addiction.” (Internet Pornography Statistics by Jerry Ropelato, Internet Filter Review)

So since there are roughly 232 million adults in the U.S.that means that 23 million of them are internet sex addicts.  If this is even in the ball park, then the number of sex addicts of all kinds in the U.S. is greater than the number of alcoholics (17.6 million) and the number of drug addicts (3.6 million) put together! 

Recreational users

The Internet Filter Review reports that 40 million people in the U.S. per day log onto internet pornography sites (as of 2006.)  This is up from a reported 30 million 3 years prior (Datamonitor.com 2003.)  They are not all addicts but neither are the 22 million Americans who, according to CNN.com, “use” illegal drugs.  But internet pornography is known to be highly addictive.  Powerful stimuli often tailored to people’s specific fantasies, produce high excitement and arousal chemistry in the brain not to mention the reinforcement of easy, anonymous sexual gratification.

Intimacy vs. sexual addiction

The largest consumers of internet pornography are the 12 to 17 year-old age group (safefamilies.org, Statistics on Pornography, Sexual Addiction and Online Perpetrators.)  If as widely reported, the average age of first exposure to internet pornography is 11; this means that tens of millions of young people are forming their ideas and attitudes about sex and sexuality based on alienated, idealized and often exploitive or violent content.  Furthermore they are doing so in many cases long before they will ever have had any kind of intimate physical experience with a real live person.

Sex addiction is a disorder in which the preferred sexual activities take place apart from an intimate relationship with another person.  In other words the sex addict engages compulsively and often in one or more types of sexual situations that have nothing to do with intimacy, such as cybersex, strip clubs, anonymous sex, and sex with prostitutes.  Most people still prefer to have a sex life in the context of a relationship with someone.  But as more and younger people are seduced into spending hours each day in front of internet pornography, they are fast losing their ability to relate sexually in the more complicated, less airbrushed world of real people.  For those kids who started getting hooked on pornography in their early teens, they may never have the chance to begin to learn how to relate intimately.  This very ineptitude will then lead them to flee from sexual relationships into their fantasy world of porn and thus the process feeds on itself.

Not enough addicts getting treatment

The arithmetic is striking.  If there are 10 to 20 million sexually addicted Americans, and there are about 1,500 therapists who specialize in treating them, along with a dozen or so rehab programs (which tend to be costly although very effective) there can be only a tiny percentage of sex addicts actually getting professional help for what is a remarkably intransigent problem.  There are a number of AA type support groups including Sex Addicts Anonymous, Sexual Compulsives Anonymous, Sexaholics Anonymous and Survivors of Incest Anonymous.  The world headquarters of Sex Addicts Anonymous told me that there are currently 1,300 registered SAA groups worldwide.  If each group has an average of 10 people who belong and attend meetings then there are only 13,000 sex addicts getting help through SAA which is the oldest and biggest of the organizations.  Again, a puny percentage of those needing help.

And the good news?

Sex addiction has received a lot more attention in the media around the world of late and by and large the problem has been taken seriously.  A growing number of therapists are being trained and certified by IITAP (International Institute of Trauma and Addiction Therapists) and more residential programs are being created.  Parents are becoming more aware of the issue and there are serious campaigns and organizations combating the sexualization of media and culture and the sexualized depiction of children.  Also there is growing awareness of the violent pornographic nature of imagery present in games as well as media.

And Sex Addicts Anonymous?  Their office told me that worldwide, the number of groups that register with the central organization every year is increasing by twenty percent!  If the growth keeps up at this pace then this alone will go a long way toward spreading the word.

The partner’s experience

If you have ever been around someone who is “in denial” of their sex addiction (or any other addiction) you probably know that it is difficult if not impossible to convince them that they have a problem which requires help.  The sex addict may be exhibiting what looks like a preoccupation or obsession with one or more sexual behaviors which are obviously causing any number of difficulties.  They may be spending a small fortune on strip clubs and lap dances, they may be wasting half their day hooking up for casual sex online, and they are most certainly leading a “double life” with many excuses, secrets and lies.

These behaviors seem blatantly destructive to the addict and undoubtedly cause pain to those around them.  The fact that the addict continues a pattern of secrecy can be crazy making for the partner.  Partners may be deceived about what is going on, but even if they have some clear knowledge about the addict’s behavior, they have little or no effect in changing it.  Partners sometimes blame themselves for the addict’s problems and think that they can help the addict get better without treatment, but this is always a dead end.  Often the partner threatens to leave and then the addict finally goes for help.  Even then, the addict who shows up in my office or in rehab is likely to be still in the grip of a powerful system of denial.  He will state that the reason he is getting help is: “to keep my wife happy.”

The delusional aspect of denial

To understand why denial is so powerful I think it is necessary to understand the factors that underlie the addict’s ability to remain oblivious of the meaning and consequences of his or her behavior.  Even when the behavior is exposed, the addict still finds ways to deny that it is a problem.  This can only be seen as delusion. Denial is a form of delusion and as such it is very persistent and difficult to confront head on.  The mystery for many people is where this delusion comes from and why it persists in the way that it does.  There are three levels of processing on which denial takes place: memory (ignorance), thought (dissonance) and emotion (shame).

Denial is built on three very powerful factors. 

1. Ignorance. For most sex addicts the seeking of a sexual “high” outside of their normal life is all they know.  They literally have no concept of how it would be to be in a marriage or other intimate relationship in which a sex life with that partner was fulfilling.  Usually this is due to their early life experience where for any number of reasons they may never have seen expressions of romantic love, intimacy and commitment in their parents or other adult “models”.   They may see what seem like happy couples leading a normal sex life, but they don’t “get” it on some deeper level.  Even if they crave it, it seems inconceivable for them.
2. Dissonance.  Still you might say “well the addict knows that the behavior is somehow not OK in that he or she hides it from everyone!”  Yes the addict does know that the behavior goes against the value system of those around him and this creates a tension on a deep level.  In order to neutralize this tension or dissonance of ideas, the addict must come to believe that having a compartmentalized secret life is necessary and justified.  An elaborate system of beliefs may come into existence in order to render acceptable that which is clearly not acceptable.  Since the addictive behavior is a compulsive way of dealing with life, it will be impossible by definition for the addict to simply decide to stop engaging in the behaviors.  Instead to the extent that the addict thinks about it at all, any number of rationalizations spring up to keep the dissonance at bay.  Even in the early days of treatment, many addicts will strongly assert that they are basically “good”; they see their sexual behaviors as though they were distinct from who they “are” as a person. 
3. Shame.  A related aspect of the personality of sex addicts is an underlying feeling of lack of self worth and a feeling that no one has or ever will really know them and accept them.  Addicts tend to believe they are unique in their unworthiness and come to feel that their special badness renders them hopeless and beyond help.  Any time they come close to being found out or seeking help, the threat to their sense of who they are is so great that they withdraw.  Shame is the emotional side of the equation. It is a feeling so powerful that addicts cannot expose themselves to others, even others in support groups for other addicts!  The shame not only supports the addict’s belief that he is not worth helping; it keeps him trapped in secrecy.  For many sex addicts (including many addicted clergy) the denial takes the form of a delusional role in life, the pillar of the community, the ideal father, wife, husband and so on.  The knowledge of the shameful hidden behavior feeds the sense of a lack of a real and decent sense of self.

Getting past denial

Dealing with the various forms that the addict’s delusional thinking takes is the first task for the therapist and it is the first step in a 12-step “anonymous” program.  It involves education and information, exploration of the addict’s behavior and feelings in a safe setting, support group participation and a great deal of faith that a better life is possible. 

For the addict, getting to the point of admitting the problem and admitting that he or she needs treatment is often a long process in itself.  Often there is a crisis in which a spouse or partner discovers part of the addict’s pattern of behavior.  The addict may continue to lie, make promises and give explanations which are only partly or not at all comforting to the spouse. These are attempts to maintain the addiction and placate the partner.  They are not reassuring because there is no real recognition of the problem.  The addict is still basically in denial.

What partners can do

Spouses and partners of sex addicts can and should take a stand about what the addict needs to do.  If the addict does not get appropriate treatment then the partnership will be untenable.  After consulting a sex addiction specialist, the partner should make an unequivocal stand regarding the need for whatever treatment is indicated.  Dragging the addict to a marriage counselor will not cause the addict to budge as long as the partner is being wishy-washy about the problem.  Therapists cannot make addicts get treatment.  Very often it is the crisis and the initial leverage of the resulting consequences for marriages, careers etc. that propels the addict into treatment and ultimately into recovery.

For more information for partners of sex addicts and sex addicts see the getting help tab at my home page and also explore the self tests tab and the literature available at Gentle Path Press.  See also my related blog Are you living with a sex addict?

 

During  early recovery abstinence is advised

After the problem of sexual addiction has been acknowledged and some treatment has begun, many partners of sex addicts want to know whether to have sex with the addict or not.  They are not only conflicted and confused about what they feel about it but they are unsure as to what is best for their partner’s recovery.  There are no research studies on this question that I know of and the factors involved vary from one couple to another, not least of which is whether the couple are together, separated or contemplating divorce.

The prevailing wisdom among those who do sex addiction treatment is that a sex addict in the first six months to one year of recovery should abstain from all sex including sex with a partner or spouse.  The reason most often given for this is that the addict probably has a long-standing pattern of using sex as a drug and as an escape.  He or she is seen as needing to have a period of “withdrawal” much like getting free of any other addiction such as alcohol or drugs, in order to allow the body and brain to regain some normal balance and allow the addict to begin to learn new and different coping skills and ways of dealing with life other than escaping into sex or sexual fantasy.

Having sex with their partner may be a bad idea for a sex addict in early recovery because it impedes their recovery:

• It does not allow for the neural “reset” that lets the addict brain to begin to “re-wire” itself.  In other words, it keeps the addiction going by giving the addict a small amount of the “drug.”
• The addict in early recovery will likely revert to his or her addictive fantasies during sex with a spouse or partner.  This means that the addict is not really having sex with the partner but is using the partner to re-live addict behaviors in their mind.  This is sometimes referred to as “euphoric recall.”
• Part of the addict’s recovery is learning how to integrate sex into a normal relationship vs. keeping up a separate and secret sexual life.  Early in recovery the addict will be lacking in the intimacy skills necessary for a healthy relationship.  Only in the context of a healthy relationship can there be a healthy sexual relationship.

Having sex early recovery may be a bad idea for the partner because it is for the wrong reasons:

• They feel the need to have sex with their spouse or partner to “compete” with the object of the addiction or to prove their attractiveness.  Partners of addicts should never take this on themselves.  It’s the addict’s problem and it isn’t ever about the partner!
• They feel they are responsible for “fixing” the addict and think that having sex with them will help.  The addict needs help but not in the form of sex, even with someone they love.
• Sometimes partners feel they should not withdraw sexually because they will be seen as “punishing” the addict.  But even if they are angry, withdrawing sexually can be a normal response to the betrayal.
• They are trying to use sex as a way to repair the relationship.  Partners of sex addicts may be very hurt and traumatized. They need to recover from that trauma first and worry about the relationship later.
• They have a desire for sex themselves and it makes them feel better.  This is often a misguided attempt to make things “the way they were” before the crisis.  It is understandable to feel this way but relationships in recovery need to be very different from what went before.

Bottom line, sex addiction is serious.  It requires not only a recovery from the addictive behavior but the learning of a new way of living in integrity and honesty.  The couple must lay a foundation first before deciding whether to resume a relationship on a new footing or not.  This takes a lot of time and work. Abstaining from sex in the beginning months of recovery is an important part of the process for both addict and partner.

A Hypothetical Case Example

The following is a hypothetical sex addiction case which presents a number of key choice points for the sex therapist or counselor.  A wife finds out that her husband has been “hooking up” with gay men for sexual encounters.  (We’ve seen more than one political scandal about just this situation.)  Needless to say the wife is shell-shocked since she thought they were relatively happily married and believed they had a fairly satisfying sex life.  This seismic jolt not only rocks her world but shakes her sense of her own identity.  The man admits to a problem and is himself confused about what is going on with him.  He feels he loves his wife but is drawn to these peculiar anonymous encounters.  He knows this is seedy at best and dangerous at worst but he has been leading a double life, fooling everyone and convincing himself that he wasn’t really being unfaithful because it wasn’t with another woman.

So this couple show up in my office, or no, they probably seek out a marriage counselor first because nobody has yet thought of the husband as a “sex addict” and my practice is limited to sex addiction.  After doing an initial assessment, many if not most marriage counselors or other therapists would likely suggest that the husband and probably also the wife be seen separately to resolve their individual issues first before trying to work on their relationship.  So first, the therapist who was treating the husband (the wife’s treatment is a whole other story) would be trying to thoroughly evaluate the husband’s psychological issues as well as his sexual orientation. 

Is He Gay, Bisexual, or Just a Sex Addict?

What should really happen first at this point is that the treating professional should evaluate whether the husband has a sexual addiction to acting out with men.  This is pretty straightforward in that there are a variety of well established evaluation tools which can help sort this out you can find a variety of self tests  online.  The newest and simplest of these tests contains only six questions and is called “PATHOS: A Brief Screening Application for Assessing Sexual Addiction” by Carnes et al.

Assume the husband is pretty addictive with his gay behavior, that he does it repeatedly over time, that he has trouble controlling the urge, that he feels bad about it, and that it results in negative life consequences.  So is he gay? bisexual? We still don’t know.  What we know at this point is that he has an “arousal template” so-called, laid down in early life that he re-enacts in brief, furtive sexual encounters that even he finds rather degrading and shameful.  Since sexually addictive behavior is almost universally believed to be related to early traumatic or formative events such as sexual abuse, the first task would be to treat the addiction and resolve the underlying issues so that the husband would no longer be driven to engage in this self-destructive acting out. 

That still leaves unanswered the question as to what his “true” sexual orientation is.  Well, we could ask him!  “Do you think you are really gay or not?”  Very likely he will not have a definitive answer for this until he knows what part of his behavior is coming from trauma re-enactment and what is coming from a sexual orientation preference. One possible scenario here is that the husband was born straight but was molested by an older male at an early age.   He may have married a woman because he “feels” heterosexual, but gets an unaccountable sexual charge from sex with men he will never see again.

Reaching Self Awareness

OK so now suppose the husband is successfully treated and is free of his addiction to back alley sex with strange men.  Now and only now he can begin to have a really healthy sexual relationship with another person that is based on honesty about who he really is and built on love and intimacy.  Since he has only recently become “intimacy literate” he will be engaged in a process of self exploration and self discovery.  But his underlying sexual orientation will now begin to govern his choices rather than his addiction.  If he prefers to be sexual with women, he may decide to try to make a go of it with is wife, or with another woman.  Or he may decide to be openly gay and seek a gay partner.  The point is now he has the option of a healthy relationship.  Somewhere in the dark reaches of his reptilian brain he may still have traces of the old patterns of warped sexual urges, but they will no longer have the power they once had over his life or his lifestyle.

Counseling vs. Treatment

Most of the sex addiction programs and certified sex addiction therapists (CSATs) that treat people for sex addiction make a distinction between “counseling” vs. “treatment.”  The initial approach to helping people with sex addiction  is more often thought of as “treatment.”  The difference is that when we think of counseling or therapy we tend to think of a process whereby people change because they get insights into the cause of their problems and this awareness makes them behave differently.  In treating sex addiction it is the other way around.  It is easiest to think of “treatment” for sex addiction as changing behavior first and thought processes second. 

Treatment for sex addiction can be thought of as a behavior modification program.  It does not require any in depth self analysis to embark on a program of recovery from sex addiction.  It only requires that the addict begins to believe that he or she has a problem and accepts, at least tentatively, that there is a need to get some kind of help in order to fix it.  Treatment is an “action program” requiring that the client agree to follow the directions of the treating professional, make a commitment to see the program through and complete a set of tasks designed to promote abstention from sexually addictive behavior. 

Components of the Treatment Program

Whether it is in a residential rehabilitation program, a clinic or an individual sex addiction counselor’s office, the beginning of a program for treating sex addiction involves some version of the following:

• Acceptance
• Action
• Accountability

Acceptance: Understanding that the compulsive sexual behaviors in question whether they are internet pornography use, serial extra-marital affairs, prostitutes, anonymous sex, or even illegal sexual behaviors represent a hypersexual disorder, an addiction, and that it is out of the addict’s control.  Acceptance means learning enough about sex addiction to realize that it is not going to go away by itself and that no amount of will power can make it stop.  It also involves the dawning realization that the addict has been causing harm to himself and to others.

Action: A commitment to abstaining form the addictive sexual behavior and to regular participation in a program which puts a number of tools in place to help maintain sexual sobriety.  Usually the program or counselor suggests an initial period of abstinence from all sexual activity for three to six months or more. This abstinence applies to sex with anyone including a spouse and even includes masturbation.  During this period the sex addict will usually experience symptoms of withdrawal which can include cravings, strange physical symptoms, sleep disturbances, bizarre fantasies and sexual dreams.  This is because the addictive sexual behavior numbs out feelings in much the same way that drugs and alcohol can.  When that escape is no longer present, the sex addict’s body and brain will be going through a period of re-adjustment.

Accountability:  Treatment promotes sexual sobriety by teaching the recovering sex addict various tools to support the addict’s commitment to abstain from sexual “acting out” addictive behavior.  These include:

• Education and reading about sex addiction in order to gain a better understanding of the function it serves in addicts’ lives and the process of recovery.  This includes raising the addict’s consciousness of the fact that their life has been one built on secrecy and shame and that recovery demands “rigorous honesty” from now o.
• “Reporting in” to an individual therapist and a support group or therapy group in order to increase the recovering addict’s motivation to succeed.  The addict learns to notice signs of dishonesty, isolation, or neglect of self care which could be problematic and opens up about these struggles and the plan to improve in these areas.
•  Attending 12-step meetings such as Sex Addicts Anonymous which allows for more support and encourages the addict to reach out to other people for support and understanding.  In behavioral programs the person is expected to reach out to someone before they act out or when they feel themselves at risk.
• And a series of structured tasks which fill out the addict’s understanding of how they got that way, such as constructing a timeline of one’s addictive acting out behavior, inventories relating to other addictions, family history of addictions, and childhood history of abuse and/or neglect.

During the initial recovery process, the therapist or counselor serves as a combination coach, cheerleader and watchdog.  Establishing sexual sobriety is the beginning step in a much longer process of recovery.  At some time during the initial period of abstaining from sexual acting the addict will be encouraged to “disclose” to a spouse or significant other the nature of the addiction and begin the process of starting to relate on a different and more honest footing.  This disclosure is difficult for everyone and should only be done with the assistance of a sex addiction therapist or counselor.

Long Term Recovery Takes Three to Five Years

Getting honest with one’s self and others, staying honest, and staying sexually sober are the initial phases of treatment.  This is usually the first year or so of recovery.  Later phases involve personal emotional growth and resolving early childhood issues, repair of a primary relationship or starting a new one in a healthy way, dealing with issues involving family or origin, and working on issues involving children extended family, and work, so as to create a balanced, fulfilling lifestyle.