Denial in Sex Addiction: Delusion, Distortion and Dissociation

Denial in sex addiction is a form of distorted thinking. In fact it is a masterpiece of distorted thinking. Breaking through denial marks the beginning of addiction treatment. This is just as true for sexual addiction and behavioral addictions generally as it is for chemical dependency.

Without treatment, the set of ideas, rationalizations and beliefs that constitute a system of denial become more and more entrenched and tend to spread, becoming a world view which supports a deceptive and disordered way of life.

Even for a practicing sex addict, there are moments of clear-headedness when he or she suspects that they are engaging in a problematic or pathological pattern of behavior. But that awareness does not hold up. Why? Because denial is distorted thinking in the context of a semi-dissociated (i.e. “checked out”) state. Continue reading

New Treatment Models for Teen Porn Addiction

The enormous global proliferation of online pornography has made a vast array of sexually explicit material available to a large teen audience on laptops, tablets and smart phones. And if smart accessories catch on, you will soon be able to wear your pornography.

Online pornography accounts for such an overwhelming proportion of internet traffic that a new search engine has been created specifically for adult content. It was designed by two former Google employees and searches only for pre-screened adult content that is free of illicit or malevolent intent. It is also designed to protect the user from cookies and other forms of identity tracking. The site was launched on September 15th and according to the founders has “taken off like a rocket.”

Internet porn has long been seen as more readily accessible than riskier and more costly habits like prostitutes, massage parlors or anonymous hook-ups. This in turn makes it more easily available to youth, with the typical first exposure being in the pre-teen years.

Effects of porn on teens and young adults

A study published this summer in the by the UK’s Institute for Public Policy Research surveyed 500 18-year-olds about the impact of porn on their lives. Most of the respondents reported that accessing pornography was common throughout their school years, began in their early teens and had a damaging effect on their sexual and relationship lives.

Dr. Anthony Jack, a researcher and neuroscience professor at Case Western Reserve University stated that recent studies show “…widespread rates of sexual dysfunction… such that approximately 50% of late adolescents of both sexes report sexual dysfunction of clinical severity”.  (See “Your Brain on Porn” by Gary Wilson)

Another study published this month by researchers in the US found that among a sample of over 900 emerging adults in college more frequent porn viewing was correlated with a greater number of sexual hook-ups and one night stands.

Other recent studies of the brain activity of chronic porn users have begun to show detrimental effects such as:

• Less gray matter and reduced reward center activity while viewing sexually explicit imagery, i.e. desensitization.

• A weakening of nerve connections between the reward centers and the higher brain centers thus increasing impulsiveness and impairing decision making.

• Porn induced erectile dysfunction

As one of the researchers put it, “…regular consumption of pornography more or less wears out your reward system.” And clinicians here and abroad are seeing many more young adults and teens who can achieve erection and ejaculation with porn but not with a real person.

Treating the young porn addict: three models

The current crop of very young addicts have some special characteristics. The pre-teen brain is not fully mature and their emerging sexuality programs them to react powerfully to sexual stimuli. Getting hooked on porn at an early age can be damaging in at least three different ways. These in turn require interventions very different from the years of addiction treatment and relapse prevention that are appropriate for most adult addicts.

I. The drug-driven model

Jeff’s addiction appears to have come about through the habit-forming nature of porn itself in the absence of any other obvious psychopathology.

At first I thought Jeff was just like any other sex addict client, only younger. He had been watching porn on his computer since he was 13, and at age 18 he realized he had begun to fixate on child porn. Fortunately this scared him enough that he came clean to his parents who put him in a 6 week residential program for sex addiction.

After the residential program Jeff saw me for therapy for about a year. He also attended weekly Sex Addicts Anonymous meetings. He was an attractive, sophisticated kid with a sunny disposition, but at 20 he was still a virgin who had never dated a girl. While he was seeing me he began dating a very appropriate same-age young woman and eventually began a robust sexual relationship with her. Although that relationship ended he never returned to porn use that I know of. I am as certain as I can be that he had no residual attraction to children.

What is striking is that although Jeff went along with the usual program of sex addiction recovery, what seems to have worked for him was just getting away from porn! With abstinence, it seems his young brain rebalanced and in a period of months he was able to resume normal sexual development. He became more outgoing and began college with the ambition to become a filmmaker. Jeff needed a structure that would allow him to stay away from porn along with some outside support to get his life back on a normal track.

II. The trauma model

Brad discovered internet porn at 12 and became instantly hooked. He reports that his use escalated very rapidly as did his sexual tastes. He was binging on porn very heavily every day. While still in his teens he says that he quit, primarily out of exhaustion. His sexual interest diminished to zero and as of his mid 20’s he reported that his libido seemed to be permanently gone. He attributes this result to a kind of virtual sexual trauma.

There is some research that would support the idea that very early exposure to sexually explicit material can have effects on the developing psyche similar to actual sexual assault. The young mind is not ready to deal with the shock, adrenaline and stress of the hyper-arousal caused by porn. It thus constitutes a violation which can leave lasting sexual scars. Brad correctly sought out treatment with a specialist in sexual trauma rather than sex addiction.

III. The hybrid model

Ken is a happily married man in his late 20’s. He entered treatment for an addiction to porn and masturbation dating from childhood. He had no other sexually addictive behaviors but he had significant early trauma. His father died of a cocaine overdose when Ken was a toddler. Ken became the “man of the house” at age 3 and soon after had a serious illness requiring months of hospitalization. He had an unhealthy relationship with his narcissistic, demanding mother. Also as a child he witnessed his teenage sisters being molested by an older cousin.

After about 8 months of abstinence from porn and with the support of group therapy Ken has shifted gears. His relationship with his wife whom he adores is going well and he is comfortable with a new-found intimacy with her. In fact Ken no longer presents as an addict; he does however have issues that he knows he needs to work on. In particular he knows he has never fully understood or worked through his early childhood experiences and he is working his way out of his enmeshed relationship with his mother. He is appropriately seeking help for these problems and appears to be at zero risk of relapse into porn addiction.

So the good news is that the youthful porn addict’s brain can recover and resume a more normal developmental trajectory. And given that their only addictive behavior is internet porn and that their total time of usage relatively short, they do not have to overcome addiction as a pervasive and deeply entrenched coping style. They can get cured and stay cured. The bad news is that there is as yet so little awareness of the risks to children and teens on the part of the medical profession, the academic community, schools and the public at large. As with so many public health issues, prevention and education are sorely needed.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Sex Addiction is Real: Just Ask a Sex Addict

The concept of sex addiction came from sex addicts. It was never imposed on them by clinicians– far from it. If you read the first of the personal stories in the Sex Addicts Anonymous “Big Book,” which includes an account of how SAA was founded 36 years ago this is clear. At that time people with compulsive forms of sexual behavior were receiving other forms of psychiatric treatment that were mostly doomed to failure; treatments like aversive conditioning or psychoanalysis. The groundbreaking work of Dr. Patrick Carnes and others created SAA as a way to treat sexual addiction in order to help themselves and ultimately to help others.

Listening to addicts, lots of them

And people have been steadily joining the ranks of self-identified sex addicts. Today SAA has 1,176 groups (regular weekly meetings) in the U.S., that are registered with the International Service Organization (ISO) of SAA. In addition there are 62 in Canada, 51 in the U.K., 31 in Central and South America and 48 in other locations including South Africa. There are 101 different registered telephone meetings and other electronic meetings.

These statistics are as of last October and the ISO informs me that the number of meetings has grown steadily by 10% per year in recent years. That’s a lot of people in SAA alone. And there are currently four additional 12-step self-help programs for sex addicts all modeled on Alcoholics Anonymous:

Sexaholics Anonymous (SA)
Sex and Love Addicts Anonymous (SLAA)
Sexual Compulsives Anonymous (SCA) and
Sexual Recovery Anonymous

Even this does not represent the whole picture. Nowadays many sex addicts can get appropriate treatment with therapists who specialize  in working with sex addiction. And of course there are many people struggling with sex addiction who are not getting any help at all, often because they don’t understand the nature of their problem, or because the psychiatric establishment has yet to educate the mass of clinicians as to the diagnostic issues.

The current wave of sex addiction denial

Today there is a rash of sex addiction denialism or misinformation fueled by some flimsy studies that have been easily discredited and gaining followers among those who feel judged or pushed around by the idea that someone might call them (or anyone) a sex addict. But in fact clinicians don’t go around looking for sex addicts or labeling people just because they exhibit certain behavior. People need to be evaluated on a case by case basis. This is partly because compulsive sexual behaviors can be a symptom of at least half a dozen other psychiatric disorders that don’t have anything to do with addiction.

But the “evidence” that porn and sex addicts are not exactly like drug addicts in this one experimental response in this or that isolated experiment is really largely irrelevant to the experience of thousands of sex addicts over decades. In the attempt to save patients from being mislabeled by clinicians, the deniers have ended up undercutting the recovery efforts of bona fide sex addicts. “Sorry, what you have may not be a “real” addiction; so maybe you don’t really need any help!”

The plural of “anecdote” is “data”

Most people and clinicians generally agree that sex is a good thing. People tend to show up for treatment when they, or someone who knows them, notice that their sexual behavior is way out of control and is causing a lot of problems. Some people have had their lives taken over by pornography, some have lost a job due to sexual behavior, others have been arrested more than once for indecent exposure, and some simply spend hundreds of thousands of dollars they can’t afford on prostitutes.

But whatever brings them into the office or the 12-step meeting, they still need to be helped to figure out if in fact they are a sex addict. This can be done by pointing them in the direction of the literature on the subject, by talking to other people with the same problems, and by well validated tests.

I have listened to numerous patients of mine, read hundreds of emails and blog comments and listening to sex addicts talk at hundreds of SAA meetings over the years. Many addicts are unsure to begin with about whether they really have an addiction. But for many there comes a point when the addict realizes that they simply have no control over this or that behavior. I have heard over and over again: “This is an addiction!” ” I can’t stop even though I desperately want to!” and ” I’m ashamed of what I do because it’s not who I am, yet I do it anyway!”

Other addicts will occasionally waver in their grasp on the addictive nature of the problem. This is not at all unusual. “So am I really an addict?” “So-and-so is so much worse than I am!” But of their own accord or because of many unsuccessful attempts to quit, they come back around to the need to approach the behavior as though it were on a par with alcoholism or drug abuse. Many will tell you that it is more addictive even than these.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Chronic Sex Addiction Relapse: Letting Go Once and For All

Sometimes I feel as bewildered and frustrated as my sex addiction clients when they periodically slip up and engage in their addictive behavior, even as they seem to be making progress in their recovery.  (See also the excellent article by Dr. Patrick Carnes entitled “The Perfect Storm: Assessing for Sex Addiction”)

What is it that makes some recovering sex addicts continue to relapse frequently?  Why are some sex addicts seemingly unable to cut the cord?  I believe that beyond the question of “hitting bottom”, the process of letting go of an addiction is similar to the loss of a relationship and that some addicts get stuck at various stages of the grieving that loss.

Addiction as a relationship

The idea of an addiction as a relationship has been around for a long time.  Sex addiction, like addiction generally, has been defined as a primary relationship with a mood altering experience.  That experience may be a chemical such as a drug or alcohol or it may be an activity such as gambling or sex.  Whatever the chemical or activity, there is some evidence that the brain mechanisms involved in the addiction are all similar.

But beyond brain chemistry, brain alteration and changes in mood (excitement, euphoria, soothing), addictive activity is also something that develops like a relationship.  And the activity as well as everything leading up to it and surrounding it becomes like a friend or even a loved one.

This affection for our addictive activity is not entirely illogical.  For most addicts, their “drug” is something that they have relied on to regulate their emotions, escape stress, and even maintain their ability to function.  A porn addict I know once said “Miss January (his name for his addiction) is always there for me.”  It has served the addict well in some sense.  Yet it also has destructive potential and usually goes against the addict’s own value system.  Hence it is a relationship that needs to end.

In sex addiction treatment a commonly used exercise is that of having the client write a good bye letter, a “Dear John” letter, to his or her addiction.  In this letter the addict “breaks up” with his addiction, often acknowledging that the addiction was important, fun and will be missed.  This exercise underlines for the addict the fact that he or she is letting go of something important.  Whether it is giving up porn, prostitutes, compulsive hook-ups, or fetishes it is going to amount to a real loss.

Grieving the loss

All grief is about the struggle or process involved in coming to acceptance of a loss.  Loss is stressful.  In fact one definition of stress is “a loss or the threat of a loss”.  And so the loss of an addiction is stressful, challenging and potentially even traumatic.

Most sex addicts have a history of childhood relational trauma.  The drug, the “relationship” with a fantasy became a way to endure stress and to substitute something for what was missing in reality.  In dysfunctional families intimacy is fraught with danger and self doubt.  The addictive fantasy involved in much sexual acting out is one of being able to be gratified in a way that feels safe.

Getting stuck in the grief process and relapse

It is possible to get stuck at any point in the process of letting go.  Even once past the denial phase and even after acknowledging the need to let go of the behavior, there may be predictable stages of anger, bargaining, and depression.  A good example is the addict who knows that porn blocking software would hugely improve his chances of getting free of porn addiction but who either rebels against getting it installed, finds excuses, or finds ways around the filters.  I have seen clients use their GPS or their children’s devices when other outlets are blocked.  This addict is stuck in anger and possibly old rebellion against authority.  He or she is saying “you can’t make me.”

Bargaining can go on for a long time too.  The addict makes a deal with their treatment program that says basically “If I get XYZ then I will be able to let go of my addiction”.  This can mean that the addict is going to support group meetings, going to therapy, and reading all the right books but is not willing to experience change.  He is waiting for it to feel right to stop being an addict.  Or he is waiting for a “sign” or for a new relationship to save him etc.  The unpleasant reality is that in giving up the addiction there is nothing that will immediately take its place.  No way to avoid experiencing some sense of loss.

Some addicts go along way down the road to recovery but still can’t give up their addictive behavior completely.  They find that the loss of the addiction brings on depression.  They endlessly analyze why they have relapsed this time.  They feel they cannot tolerate stress or loneliness.  But there is no way to eliminate all of life’s stresses and challenges.  Eventually they begin to realize that they can experience unpleasant feelings without reaching for a drug.    This is the point in a sex addict’s recovery when he or she has turned a corner and is finally done with acting out.  They know it and you can see it.  They will come to acceptance and begin to be solid in their sobriety.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Is Healthy Masturbation Part of Sex Addiction Counseling?

I am returning to this topic because it is one that comes up repeatedly in sex addiction counseling.  Masturbation to pornographic images or fantasies is not necessarily an unhealthy thing on its own. But for sex addicts the uncontrollable acting out of particular sexual fantasies and the act of masturbating while having specific sexual fantasies are very similar processes.

If the addict’s preferred acting out behavior is visiting prostitutes, going to sexual massage parlors, anonymous sexual hook-ups, cyber sex, porn, serial seduction or more likely some combination of behaviors, the fantasies that accompany masturbation will likely mirror those activities.

Sex addicts have what therapists call an “arousal template,” the sexual scenario that they find most exciting. To the addict it is far more thrilling than any other sexual activity; it should really be called the hyper-arousal template.  It may be any one of a myriad of sexual experiences, remembered or imagined, but that scenario is what they return to when they masturbate.

If not an exact repeat of the behavior, the masturbation fantasy will likely contain the essential elements of the arousal template, such as dominance, submission, multiple partners, the feeling of being intensely desired, or any of an array of specific sexual acts or fetishes.

Risks of masturbation during recovery

A great many sex addiction therapists believe that in the initial phase of recovery when the addict is trying to abstain from compulsive sexual behavior, that sexual activity should be avoided entirely, including masturbation.  Even if masturbation is not part of the addict’s acting out scenario per se, it will most likely bring up fantasies of that activity which in turn could trigger the addict to relapse into the full-on behavior.

A sex addict who compulsively seeks sexual encounters with people he or she recruits from online sources such as personal ads may masturbate while thinking of these hook-up experiences.  But this can bring up urges for more, which in turn may lead to the addict “taking a quick look” at the online ads or photos, and then to actual acting out.

When sex addicts use masturbation to “relieve the tension” in order to (theoretically) avoid their preferred sexually compulsive behavior, they may be perpetuating their problem.

In sex addiction counseling we often discourage using masturbation in this way.  If it is a watered down version of the behavior the addict is trying to quit, it has the potential to simply prolong the process of withdrawal.  The addict is trying to “kick” the habit of a compulsive sexual behavior, one that is secret, alienated and often surrounded with shame.  And reliving that behavior in masturbation fantasies is like methadone maintenance for opiate addiction.  It is not the same as getting sober.

Adding masturbation back into the program

When in the recovery of the sex addict, or in the process of sex addiction counseling, is it appropriate to allow for masturbation?  Using masturbation in recovery depends on:

  • The addict’s ability to masturbate without addictive fantasies.  This is difficult for most sex addicts as they often find it hard to get aroused or to climax with different fantasies or no fantasies at all.
  • The addict’s ability to masturbate to orgasm and avoid “edging.”  Edging is the process of repeatedly bringing oneself to the edge of orgasm, pulling back and starting again as a way to prolong arousal.
  • The addict’s ability to plan to masturbate rather than doing it when a sexual urge arises.  The spur of the moment decision to masturbate may be due to urges or triggers that the addict should pay attention to and deal with in other ways than simply reacting sexually.

How masturbation can be useful in sex addiction counseling

Masturbation can be like a sexual laboratory.  Here are some of the ways in which the addict can use masturbation to explore and learn about himself or herself.

  • Psychological factors surrounding the act of masturbation.  Arousal and orgasm may bring up ideas, voices from the past that have played a role in shaping the addict’s sexuality.
  • Emotions or even “body memories” can crop up when masturbation is done without going off into the trance of addictive fantasies.  These emotions and memories may relate to past traumatic experiences that the addict has never worked through.
  • Some people in sex addiction counseling can experiment with changing their fantasies while masturbating.  They can use masturbation to “stretch the envelope” i.e. to go to fantasies and images that are more in the healthy range for them, like thinking about the person they love.  For some this will be a return to a more normal time in their life.

Some people have become free of sex addiction through years hard work in their sex addiction counseling program and have begun a new way of living.   For these recovered addicts, masturbation is often neither compelling or triggering.  It can then take its place as a normal kind of sexual activity.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Signs of a Porn or Sex Addiction Relapse

When a client who is trying to avoid a sex addiction relapse has had a slip I can often tell before they say anything about it.

At first I wasn’t sure what it was that I was seeing; whether it was just intuition or whether they were actually doing something different.  And with some clients I could tell right away and with others I couldn’t.  So what was the difference?

Signs of a relapse

When I see clients who have had a slip since the last time I saw them I can sometimes spot the following signs:

A difference of style.  The addict who is coming in laden with the knowledge that he has had a slip will likely be thinking about the fact that they have to discuss it with me.  This often results in their seeming to be superficially jocular or casual.  They seem to be tap dancing, probably because they feel embarrassed or ashamed about having let themselves and me down.

A difference in cognition.  To a greater or lesser extent, a sex addict who has had a slip or a relapse will be suffering from the aftereffects of their drug.  In order to go into the slip in the first place, the addict will have had to let go of part of their rational thinking, the part that has to do with weighing consequences, and thinking logically about the decision they are about to make.  This suspension of higher order thinking, being in the “bubble” as it is called, may have residual effects on their apparent ability to think clearly and communicate clearly.

Lack of focus.  The addict who has had a slip may seem scattered in the aftermath.  They are not completely able to integrate what they know they have done to endanger their recovery and part of them doesn’t want to think about it or about anything else.  They may deflect or divert the conversation and go off on tangents.  They may even be questioning their interest in recovery, their need to change or the appropriateness of the program.

When are these signs missing?

Why is it sometimes easier for me as a therapist to spot a client who has relapsed than it might be for other people in their life, even their partner?  And when are they able to fool me as well?

I think the answer has to do with the level of commitment to recovery that the addict has achieved.  Most of my clients are trying to be honest with me.  When they have something to say that they would previously have lied through their teeth about, they have an automatic high level of cognitive dissonance about it which causes some visible distress symptoms.

Likewise when the addict is still somewhat on the fence about whether and how much of their sexual acting out they really want to give up, then they will be better able to lie to themselves and therefore their deception will be more impenetrable.

It follows that the more someone has become committed to recovery the more difficult it will be for them to conceal the truth from someone they are close to.  When an addict has not really given up the need for secrecy as a way of life, they will more readily adopt a false persona that may be hard to see through.

An addict who has lied to his wife for years and then gotten into recovery may be better able to slip into old deceitful habits with her than with a new person such as a therapist.  The addict may have been doing well in recovery so far but when it comes to intimate relationships, recovery is more than just avoiding sex  addiction relapse. Relationship recovery and the building of honesty and trust is a long term process that involves revamping the entire basis of the relationship.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Do You Have to Say “I am a Sex Addict” Forever?

Sex addicts, like alcoholics in AA, typically identify themselves as: “I’m so-and-so, and I’m a sex addict.”  Some will say “I’m a recovering sex addict.”  As with the traditional model of alcoholism, they see their problem as chronic: manageable but incurable, like some physical diseases.

I have lately come to believe that sex addicts can recover.  I think there comes a point when they can say “I’m a recovered sex addict.”

Recovering begins with getting sexually abstinent

The 12-step model which originated with Alcoholics Anonymous became the basis for the other fifty-odd 12-step programs that came later.

As with other addictions, sex addiction recovery requires that addicts “kick” the habit first. For SAA members, each person defines their problematic, addictive sexual behaviors.  These are sexual behaviors that are compulsive, go against the person’s values, are dangerous, or cause serious problems.

For one person abstinence may be refraining from exposing himself to women in movie theatres and on buses.  For another it may mean abstaining from extramarital affairs and internet pornography.  Each person decides a set of behaviors they need to avoid and then counts as days of “abstinence” consecutive days of avoiding those behaviors.

These “bottom line” or “inner circle” behaviors as they are called are usually decided on by the addict in collaboration with the therapist or sponsor.  As recovery progresses the addict may add behaviors to the inner circle or take other behaviors out.

Why abstinence is essential in starting addiction recovery

In addition, sex and porn addicts are usually expected to have an initial period of several months of total abstinence from all sex including masturbation and sex with a spouse.  This is because for the sex addict, sex is literally a drug.  It is necessary for the sex addict to go through withdrawal in order to allow his brain chemistry to stabilize and his head to begin to be clear of the delusional preoccupation with the drug or behavior.

As a therapist, I can tell you that I would find it impossible to treat someone’s psychological problems if they were using drugs.  This is equally true with sex addicts.  A person’s drug of choice is bound to be stronger and more effective in the short run than anything I can offer in the way of relief.  Before I can do therapy I must get the client to address this and other “therapy interfering behaviors” as they are called.

What comes after abstinence?

Sex addiction treatment, like the 12-step program model, is designed to go beyond quitting a drug or behavioral addiction.  This is because abstinence alone will not make you stay sober. 

In order for recovery to be lasting, the addict must delve into their life history and arrive at an in depth understanding of the ways they are damaged and how that damage has led to their addiction.  In working through what is usually some kind of early relational trauma, the addict no longer needs to let old fears and insecurities direct his or her behavior.  The addict can then become, as recovering people say, “comfortable in their own skin.”

Without this deeper level of psychological change, most addicts cannot stay away from some form of addictive behavior.  They may manage a period of abstinence for months and even years, but their adjustment to life is fragile and unsatisfactory and they eventually get into trouble again.

The fruits of a fuller recovery

Recovery begins and ends with connection.  In the beginning addicts are in hiding, leading a double life of deception and shame.  The initial commitment to get into recovery involves a decision to connect with a group or person such as a 12-step program group or a therapist.  This is an initial act of faith based on little more than being fed up with the way things are.  This is a big step in itself, since believing in and connecting with anyone is often a stretch for an addict.

But what begins as a connection with a person or an SAA meeting grows into a deeper and wider connection; a connection with one’s own innermost self, with one’s significant other, with community, with meaningful work and with humanity.  The addict “grows up” to become a fully functioning adult who lives in contentment and integrity.

Feeling peaceful and alive, feeling secure and happy, helping others, these are worth the effort.  But I believe that in gaining this, the addict can be confident that he or she has truly changed.  They are not the same person and thus I believe they can say “I used to be a sex addict; now I’m a recovered sex addict.”

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Relapses and Slips in Porn and Sex Addiction

It is accepted among those of us who work with porn and sex addiction that there will be relapses or “slips” at some point in the first year or so of recovery.  Internet pornography in particular is notoriously hard to quit.

Sex addiction is  clever and devious.  It wants to find a way to come out and play.  So even when the addict is totally abstinent from his or her “bottom line” behaviors (behaviors that the addict has identified as the ones that need to be out of bounds) the addict may engage in other watered down kinds of behavior to get a “hit.”  For example, the addict who wants to quit internet pornography may find himself watching movies that have a significant amount of sexual content or looking at YouTube or Facebook videos that are suggestive or outright sexual.

But in early recovery addicts are likely to repeat even their bottom line sexually addictive behavior at some point.  So when is this something to be concerned about? When should it be called a slip and when should it be seen as an out-and-out relapse?

When is it just a slip?

What is counted as a slip is doing the addictive behavior (e.g. going to a strip club, watching porn, engaging in cybersex, having a sexual hook-up with a stranger, or getting together with an old affair partner).  It is not doing the things that lead up to the bottom line behavior but it is actually doing something that is what you have decided not to do any more.  (Slips will usually count as sexual acting out and will mean changing your sobriety date.)  What I believe makes it a “slip” rather than a relapse is:

  • You perform the sexually addictive behavior without planning to.  You did not enter the situation consciously intending to do the behavior.  It “just happened” and you may feel a certain shock at finding yourself in the situation.
  • You do the behavior only once.  You realize immediately what you have done and you get out of the situation before you do it again.  You turn off the computer, you hang up the phone, you get rid of the person’s contact information etc.
  • You talk about it with someone like a sponsor, counselor or recovery partner and you describe it in your regular 12-step meeting right away.  You do not attempt to hide it or minimize it.
  • You figure out what you need to learn from the slip. This means that you use the slip to gain a better understanding of the circumstances that can lead up to you slipping.  Do you have to plan your day or evening more carefully? Should you be more aware of slippery situations like business trips?  You will need to anticipate known stressors or other things that constitute your “relapse scenario” as it is called.
  • You may change your recovery plan in response to the slip.  You might decide to put additional behaviors, people or activities, such as browsing singles ads, into your list of bottom line behaviors so that you see them as relevant to your staying abstinent.   You may also consider whether other addictions such as alcohol or drug use have played a role in your slip and consider addressing them more strenuously.  And you may want to consult with a doctor if appropriate when you believe you may have psychological issues or need medication to stay emotionally stable enough.

Avoiding Relapse

If you respond to the incident of sexual acting out in the way described above you will have gone a long way to avoiding a full on relapse in which you continue the acting out behavior.  Often people have a slip and decide that it is a relapse.  They therefore feel “What the heck! I’ve already blown it; I might as well go all the way.”  This is using the slip as an excuse to keep acting out.  But the fact is a slip does not mean that you have blown your program.  It is an opportunity to make your program better and to learn about yourself.  If you use it.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Being Sexually Triggered vs. Sexually Aroused

Maybe you have heard recovering sex addicts talk about being “triggered” and wondered how it differs from just being aroused or turned on by some stimulus or other. Being triggered is a common term used in sex addiction recovery. It means something different from simply feeling aroused by something or someone.

A triggering experience can be seeing, hearing or doing something that is a precursor to the addict’s sexual acting out behavior. There are sexual images and sexual stimuli to be seen everywhere but certain kinds of perceptions will be more likely to be associated with a particular person’s preferred sexual behavior.

What triggers do

A trigger sets the stage for a sequence of behavior moving toward acting out. An addict whose preferred sexual scenario involves power and exploiting someone weaker, such as that of rescuing a helpless female may be triggered by seeing an attractive woman who is in a difficult situation.

Sex addicts are not always fully aware of why an experience is triggering. It may seem to be unrelated to their sexual acting out behavior and still make them want to go out and do that behavior. An addict who typically finds sexual partners for anonymous sex through the internet may begin to feel an urge to relapse into that behavior when simply looking at Craig’s List ads for someone to play bridge with. The mere fact of online descriptions or photos of people may be enough. In this case the addict is on thin ice, often not realizing it.

The triggering experience need not be sexual and in fact often it is not. For someone who is compulsive with prostitutes or sexual massage parlors, certain parts of town or certain streets may cause the beginning of a chain reaction known as the addict’s “ritual.” An addict who is an exhibitionist or a voyeur will likely become triggered in any situation in which being seen or seeing others undressed is a possibility, such as finding him or herself in a locker room or changing room with little privacy.

In contrast to ordinary arousal, being triggered may involve the beginning of delusional thinking. The addict sees something and either consciously or unconsciously it touches off an association with the addictive behavior on whatever level. At this point, sexual acting out begins to seem more like a viable option even though the addict wants to avoid it like the plague when he has his wits about him.

Identifying “triggery” feelings as useful information

Although addicts may slip into ritual or delusional thinking without realizing it, there are often ways to catch yourself and not move toward a slip or relapse.

  • Feeling triggered can involve a sudden feeling of hyper-arousal, a dopaminergic “burst”, which is different from normal sexual arousal or attraction. It is more sudden and intense and is thus more compelling. To an addict in good recovery it is a warning. Sometimes the triggering involves the blurring of boundaries with other intense feelings like fear or anger which in turn bring on sexually addictive urges.
  • Another way that the addict may identify a trigger is through noticing and examining their own thought processes. Addicts in recovery get progressively better at seeing the ways in which their thinking can go awry. Even though you may not think there was any triggering event, you may still notice that your mind has for some reason begun to distort reality.
  • You may find yourself feeling that there is no harm in doing a particular behavior or you may begin to look for little ways to get a sexual hit.  At this point the addict can get a handle on things by going back and looking at what may have been a triggering experience.
  • Since the sex addict is locked into a pretty set pattern of sexual acting out behavior, it is sometimes the case that the experience of feeling triggered is one of sudden familiarity.  The excitement, the intrigue, whatever it is, feels like where the addict belongs. This is another kind of signal.  In normal arousal there is always some sense of not knowing where it is going.

But remember, they are your triggers and you must manage them. It is never someone else’s fault if you get triggered! Most recovering addicts get very good at identifying what are triggers for them ahead of time and avoiding them. This takes time and experience and is part of what happens in treatment and 12-step work.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Porn Addiction in Film: “Don Jon” Gets Intimacy Disorder Right

The new film “Don Jon” starring and written and directed by Joseph Gordon-Levitt (and hopefully its planned sequel “Sin City: A Dame to Kill For”) have the potential to do more to combat the epidemic of sexist porn and sex addiction than all the “feminist porn” movies, books and women’s studies classes put together.  The film is so well done and so entertaining that you might not notice that it is a feminist film or that it deals with intimacy disorder.

In the title role Gordon-Levitt plays a shallow young man whose life is anchored by strong ties to his family, church and male friends.   He is not a sleaze or a loser, he likes to keep his apartment sparkling clean, and he’s a nice guy with a lot of charm and innocent warmth.  It’s just that he inhabits a social world in which the sexual objectification of women and the search for sexual hook-ups are the norm.  He is also a hope-to-die porn addict, which he confesses to his Catholic priest every Sunday but which he fails to identify as a real problem.  He has no idea what intimacy is let alone intimacy disorder.

The story is one of a man whose consciousness is raised through meeting and connecting with Esther (played by Julianne Moore), a totally present and very spiritual survivor of great personal tragedy.  The theme of the film is stated toward the end: that intimacy is losing yourself in someone else not losing yourself in fantasy.

A lot of the film is taken up with the funny and poignant attempt at a relationship with Barbara, a woman he lusts after but who withholds sex.  Scarlett Johansson gives an amazing performance as Barbara, the sexy, gum-cracking, love addict who wants to mold a relationship to match her fairy tale fantasy of the great love.  As this relationship develops we see that both Jon and Barbara are totally intimacy disordered.  Neither one really knows how to get to know another person or how to move forward in a genuine courtship.

In the Julianne Moore character, Jon finds an ancient goddess archetype,  who approaches him in a night class which he is taking to please Barbara (i.e. to get in her pants).  In case there is any doubt that religion and spirituality are not necessarily the same thing.  Jon goes  to church every Sunday with his family and confesses his “sins” of pornography/masturbation and sex out of wedlock with hilarious honesty (“35 times in the last week”) and while he performs all the resulting Hail Mary’s and Our Father’s diligently, he never evolves one inch until he meets his de facto spiritual guide.

Gordon-Levitt, unlike the character he plays in the film, has feminist consciousness in his DNA.  He is the son of non-observant Jewish progressives.  His father was at one time the news director for KPFK and his mother ran for U.S. congress in the 70’s in the Peace and Freedom Party.  Gordon Levitt is quoted as saying:

“My mom brought me up to be a feminist.  She was active in the movement in the 60s and 70s.  The Hollywood movie industry has come a long way since its past.  It certainly has a bad history of sexism, but it ain’t all the way yet.”