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

4 Spiritual Practices You Don’t Know You’re Doing

Spirituality and spiritual enlightenment are mystified in our culture. By mystified I mean made to seem mysterious and esoteric. I think this is mistaken thinking. In the world of addiction recovery many people balk at joining 12-step groups because the spiritual emphasis is alien or elusive and they cannot relate to the idea of surrender to a higher power.

The 12-step literature is deliberately vague about what is meant by a faith or by a spiritual awakening. But even for people who are very religious there can be something that is not working for them.

A religious client of mine put it well. He said basically that his religion had not been adequate to help him to overcome his sexually problematic behavior. Although he continued in his religious life, he was open to another kind of spirituality as part of his recovery.

I have argued in a previous post that one does not need the concept of a higher power to succeed in recovery and I proposed practicing certain attitudes and behaviors that promote spirituality. These ideas which are now increasingly accessible and a number of excellent writers draw on a variety of spiritual traditions without requiring any kind of religious faith. Their emphasis on mindfulness, meditation and intuition has now become well established in the scientific literature as an evidence-based aspect of treatment.

But in addition to spiritual practices that can be cultivated, I believe there are many things we do in the course of our daily life that draw upon our spirituality. These are things we are not aware of as being spiritual per se, but which serve a necessary purpose in our everyday attempt to regain our equilibrium and cope with inevitable challenges big and small.

I will describe some of these, in no particular order, and give a rationale as to how each is an expression of our spirituality.

Schadenfreude. This refers to the rather base impulse to take some pleasure in someone else’s misfortune. We all do it. Sometimes it’s gloating but very often it’s relief: “At least I haven’t lost my job, or my money or my health, etc.” In other words, “It could be worse.” And hidden in this line of thought is a very important concept; that of gratitude, the idea that life is pretty darn good. Gratitude is a key concept in maintaining contact with reality. In taking our thoughts away from what is lacking and focusing on how lucky we are, we are brought back into the present. We are taken out of the frame of mind of never having enough, of being deprived, or being a victim. We let go of the “if only” mentality and enter into the feeling of the present moment without judgment. It doesn’t get any more spiritual than that. Gratitude is the royal road to acceptance.

“Whatever!” This is what we say when we hit the wall. We are in a situation where we care a lot about the outcome; a test we will pass or not, a meeting that could go well or badly, an operation, even whether or not our partner is telling the truth. At the “whatever” point we are allowing ourselves to let go. Letting go of outcomes is one of the premier spiritual moments and we experience it instinctively when we give up on obsessing about something that is out of our control. Letting go of outcomes does not mean thinking that everything will turn out great, but it implies a kind of faith that we can retain our perspective and our serenity no matter what.

Running away. By this I mean making a conscious choice to hide or isolate one’s self temporarily. This could be getting away from a party or gathering that feels alienating, withdrawing from an unpleasant conversation, carving out quiet time at home, or walking out of a movie. This is a spiritual practice in two ways. It involves listening to an inner voice or intuitive sense that something is not right. In listening to this voice we are practicing getting in touch with or becoming aware of what we are feeling in the moment and being willing to trust that awareness. But isolating, deliberately being alone, also serves to provide the outer stillness that allows us to get centered in inner stillness, to shut out all the noise both inside and outside our heads. This is essential to mindfulness and meditation.

Empathy. Feeling sorry for someone else is powerful spiritual practice. When we pity someone it may or may not do anything for them but it helps us. We are noticing another person not just with our eyes but with our feelings. This involves letting go of any other feelings of resentment or judgment we may have had about the person. It also involves letting go of our separateness; we identify with another being and in so doing we are, at least momentarily, experiencing a oneness with them and letting go of the illusion of our separate ego identity.

There are many resources for spirituality (mindfulness) practices and guided meditations available that do not depend at all on sectarian religion. For more on spiritual practice and guided meditations I recommend the work of Sam Harris  available online at www.samharris.org.

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

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

The Rocky History of Sex Addiction in Public Awareness

It is the height of the AIDS epidemic, around 30 years ago. Dr. Patrick Carnes, the founding father of sex addiction theory, is going to speak to the gay community. He has been invited in by a respected African American sexologist who feels that the gay community really needs to hear his message. On this occasion Dr. Carnes is transported in one of three identical limos so that if he was attacked it would be impossible to know which limo he was in.

The ridicule and harassment began early and didn’t stop. Carnes’ daughter Dr. Stefanie Carnes, now the president of the International Institute for Trauma and Addiction Professionals, remembers that when she was a teenager her father received death threats.

Even some in the AA community were angered when Dr. Carnes started a 12-step recovery program for sex addiction. So what was the idea that evoked such a violent reaction? In his 1983 book Out of the Shadows, [1] Carnes defined sex addiction as “a pathological relationship with a mood-altering experience.” Twenty years later in Facing the Shadow [2] he states:

“Today we understand that addiction is an illness– a very serious disease. Furthermore, problems such as drug, food, gambling and sex addiction are actually related and rely on similar physical processes. Most important, we know that people can get help and that a good prognosis exists. Sex addiction is the last addiction to be understood.”
How sex addiction was thrown under the bus

In an article on the politics of sex addiction Marnia Robinson describes the events inside the American Medical Association in 1992 when they were considering a new specialty: addiction medicine.

“It became clear that the AMA wouldn’t agree to approve the new specialty unless sex was excluded from the list of possible addictions…the reason was strategic. Doctors were bent on snuffing out the tobacco manufacturers’ spin. Big Tobacco was pulling out all the stops to prolong the illusion that “smoking is not addictive.” It claimed that the addiction experts’ evidence should be ignored because, “the experts are saying everything’s addictive. “Excluding sex demonstrated that doctors weren’t saying everything is addictive. Besides, sex addicts were rare, while smokers were everywhere and suffering unnecessarily.”

Some recent progress

The idea of addiction to a behavior has been around for years and gambling has been included in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association as an impulse disorder, but the diagnostic criteria parallel those of most addictions.

In 2011 the American Society of Addiction Medicine announced a new definition of addiction which included behavioral addictions like sex, food and gambling.

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain… such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.”

The research on the brain and behavioral addictions including sex/porn addiction is beginning to show that sex addiction is similar to other behavioral addictions.

So have people gotten over their indignation at the whole idea? Not hardly.

The furor continues

People seeking help for out-of-control sexual behavior are amazed that anyone would claim to have proved that sex addiction doesn’t “exist.” The addict knows it exists.

The overall historical trend will no doubt follow the same progression as that of alcoholism and mental illness. As I have argued elsewhere,  this trend is from demonization to criminalization to medicalization to reintegration as the problem becomes better understood.

On the one hand there are still arguments that sex addiction is not an affliction it’s just bad behavior. On the other hand there are arguments that sex addiction is just a normal variation on the sexual continuum.

The former view is based on the fear that a diagnosis of sex addiction will be too permissive, allowing all manner of sexual behavior with no moral sanctions or personal responsibility. Ironically, the second fear is the opposite: that medicalizing sex addiction will lead to a curtailing of sexual freedom with some sex police deciding what sexual behavior is healthy and what is pathological.

Who are the current sex addiction deniers?

• Pro-pornography people

People who have a vested interest in the pornography industry. Producers and/or viewers of porn are sometimes fearful of any regulation that may grow out of the awareness of internet porn as potentially addictive. One cheating website recently solicited writers from the sexology community to promote affairs as healthy and debunk any unflattering research.

• Anti-feminists

Some who wish to normalize sex addiction, the “boys will be boys” contingent, see medicalization as a feminist plot to control men.

• People with grossly mistaken beliefs

A handful of professionals who are not well acquainted with the field tend to loudly misrepresent it. One such personal communication stated:

“I’ve written extensively on the heavy moral agendas embedded in much sex addiction publications. Further, there is a strong anti-male, and anti-gay/bi male stance implicit in most sex addiction writings, labeling things as unhealthy, due to social stigma, not based on actual research or ill health.”

• Misleading Crusaders 

The occasional zealot in the professional community intent on rescuing patients from the clutches of money grubbing therapists. One of these recently tweeted the suggestion that patients file complaints:

“Remind patients: can file vs. therapist (free, any state) for “false advertising”, including “sex addiction”

What’s next?

Sex addiction treatment does not condemn any specific sexual behavior, does not support any legislation, and has no bias about gender or sexual orientation.

I am happy to report that Dr. Carnes has an article on the diagnosis of sex addiction soon to appear in The Journal of the American Medical Association. Hopefully one more step on the rocky road to understanding.

***********

1. Carnes, P. (1983b). Out of the Shadows: Understanding Sexual Addiction. Minneapolis, MN:
Compcare Publications.

2. Carnes, P.J. (2010) Facing the Shadow. Carefree, AZ: Gentle Path Press.

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

“I’m So Sorry”: Do Sex Addicts Really Mean it?

Celebrity sex addicts from high profile politicians to iconic sports stars whose secret behavior is exposed are quick to apologize.

We see them on television, often with their betrayed spouse beside them, saying how sorry they are and apologizing to their fans, constituents, partners and the world at large for betraying their trust and violating their own values. But can they really be sorry right away?

One’s first and maybe cynical impression is that they are not so much sorry about what they did as they are sorry that their life has been turned upside down. And indeed, in sex addiction treatment, it is not unusual for the addict to initially experience a flood of emotion and remorse just from realizing the full meaning and enormous impact of their behavior. A colleague of mine refers to this outpouring as “narcissistic tears.” They have come face to face with their own human flaw.

Sex Addiction Treatment Stresses Remorse

The accepted protocols for treating sex addiction as well as the 12-step programs stress the need for the addict to come out of the self-centered universe of addiction and begin to see the damage done to others as well as to him/herself. But it is understood that although the initial crisis period results in a flood of shame, the basic change needed for what is known as genuine “victim empathy” to emerge requires years.

As a trainee I observed my supervisor interviewing a new sex addiction client. The client said “But I’m really a good man.” I was surprised when my supervisor responded “No you’re not.” This kind of confrontation is sometimes important in helping to shake loose the addict’s narcissistic false self image.

What is involved in real remorse?

In some instances we can be truly sorry right away. If a bus lurches and you step on someone’s foot you immediately say “I’m sorry”. And in this instance you really are sorry, because you had no ability to control your hurtful behavior. You have immediate empathy and concern for the person even if they are inwardly – or outwardly – cursing you for being such a clod.

The betrayal of other people (and oneself) that accompanies the ongoing sexual acting out of an addict is a different kind of hurt. Losing your balance on a moving bus and stepping on someone’s foot has, as least for most people, no particular connection with their sense of who they are. It is an involuntary act that says nothing about us, hence it is easy to accept that we have (involuntarily) hurt someone.

But if you as an addict have been habitually finding selfish ways to secretly meet your own needs at the expense of other people then “I’m sorry I hurt you” doesn’t seem to cut it.

In the immediate aftermath of the disclosure of a sex addict’s secret life it is clear to everyone, except maybe the addict, that he or she is still the same person. There cannot be an instantaneous transformation. Every bit of fear, conflict, low self worth, and lack of integrity is still there.

Real remorse and victim empathy can only happen when the addict has done enough self exploration and acquired enough self awareness to function in an entirely different way. Major basic change of this kind involves;

• A shift from impression management to honesty and transparency

• A shift from a habit of avoiding, controlling and placating others to a genuine ability to express feelings, needs and vulnerabilities

• A shift from grandiosity and self-centeredness to an ability to really listen to another and to be comfortable being influenced by a partner

• A shift from a compartmentalized life to an ability to share all the parts of oneself with another person

In other words, the addict becomes integrated, stronger, more centered and more available to bond. For those who know the person well, these changes are often very obvious. We feel the addict to be more sincere, more serious and more grounded. And perhaps the most obvious way that this new found integrity is expressed is in the addict’s commitment to recovery for its own sake. The addict is not longer going to meetings and therapy to please someone else or burnish his/her image. Recovery will have become unmistakably important in and of itself.

Implications for partners of sex addicts

The initial feelings accompanying disclosure may be an important motivator in getting the addict to commit to his/her own recovery going forward, including the wish to make it right with the partner.

But although the addict feels some immediate relief in knowing that he has come clean and that help is on the way, the partner who chooses to stick around will often have a much harder time recovering. A large part of the reason for this is that the process of bringing about deeper inner change sometimes seems glacially slow.

The literature on sex addicts and partners reports that on average it takes a year to begin to rebuild trust. Often it seems to take longer than that.  I believe this is not only because the addict needs to “behave” for long enough to establish credibility, and not only because the addict must walk the walk of making amends. It is also because the partner can tell whether and to what extent basic inner changes are taking place. And in the long run this is essential to the credibility of the addict’s expressions of empathy and remorse.

This article originally appeared on Recovery Brands:  http://www.recovery.org/pro/articles/im-so-sorry-when-do-sex-addicts-really-mean-it/

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

What is a Certified Sex Addiction Therapist (CSAT)? Frequently Asked Questions

Mature students studying in libraryWhat is involved in becoming a certified sex addiction therapist or counselor?

First, an important point to remember is that only those therapists who are already licensed or otherwise credentialed in their particular counseling field (e.g. psychologists, clinical social workers, marriage counselors, pastoral counselors) are eligible to enroll in the CSAT training.

Continue reading

Intimacy Disability and the Loneliness of Sex Addicts

Addicts are profoundly lonely. They may be active and sociable; they may have friends. But in terms of the deeper emotional connection to a partner, they tend to keep themselves on a starvation diet. The loneliness of course is self-imposed. Addicts are not addicts because they are making up for the fact that they don’t happen to have a lover. Their addiction and their emotional isolation are both related to a deep fear of intimacy. It has always been striking to me that they should suffer so much in their alienation.

Childhood issues

I find that most often sex addicts are not aware of how fearful they are about intimate relationships.  They have most likely come from families in which they received inadequate or inappropriate forms of connection with adults. Without realizing it, they have adopted a way of behaving based on fear and the avoidance of intimate connection.

I have heard many addicts tell me that as a child they felt ignored discounted, abandoned or invisible. This is their model of close relating; it is one of intense pain and stress. And this can be true despite the fact that their family life and childhood appeared outwardly “normal“.

Intimacy avoidance and sexual acting out

Many sex addicts are using their addictive acting out behavior as a substitute for an intimate connection. Their addictive behavior provides an illusion of some kind of connection, reinforced by sexual gratification in a situation that is safe. Sexual acting out is emotionally safe because it requires nothing from the addict on an emotional level.

For the typical sex addict, this way of finding gratification without intimacy is not a matter of wanting to be selfish and controlling, although that is how it ends up looking. But rather it is a way of finding an escape from negative emotions and achieving some gratification without having to experience intense discomfort and fear. Sometimes it is due to sexual inhibition and shame. Other times it is the fear of letting their guard down and feeling that they will inevitably be hurt. Or it involves feeling so unworthy and unlovable that they cannot feel free to be who they are. Usually it is a combination of the above.

Intimacy avoidance in relationships

The intimacy avoidance that goes along with sex addiction shows up in relationships in a number of ways.

  • Avoiding sex

Sexual connecting in the context of an intimate relationship can be too difficult for an addict to do comfortably. Even if they are very attracted to their partner or would-be partner, they may try to create emotional distance. For example, they may be emotionally absent during sex or lost in fantasy, they may want to drink alcohol as a way to be less present during sex, or they may avoid sex altogether.

  • Avoiding physical intimacy

Sex addicts often come from families in which there was an absence of physical touching and affection. Thus they may feel that hugging, cuddling, etc. are awkward and uncomfortable. Some addicts were smothered by physical touching in an inappropriate way and they too may avoid physical affection due to feeling vulnerable.

  • Not being able to express their needs

Many sex addicts isolate themselves emotionally by avoiding letting the other person in on what they feel, need or want. This is a fear of being unworthy or of being rejected or hurt.

  • Being self conscious around people or in social situations

Often addicts substitute a role or facade for actually showing up emotionally. They may play a role, eg teacher, guru, performer, etc. with people instead of just being able to be who they are and take their chances.

  • Withdrawing into work or another addiction

Some addicts escape the demands of intimacy by becoming swallowed up in work or exercise or other hobbies that take them away from their partner and other potentially intimate contacts.

  • Fleeing intimate connection

Many addicts can enter a relationship but leave before it becomes too intimate. They may think this is a fear of commitment, or not the “right person”, when in reality they feel inadequate to the demands of a relationship and/or fear being abandoned by anyone they are close to.

Intimacy avoidance and loneliness

The same addict who is doing everything to avoid intimacy will often feel desperately needy and lonely. Sometimes the addict is aware of a longing for connection; other times the addict lives without intimate relating but doesn’t quite know what is missing or why they push people away. Isolation and loneliness can then become the excuse and the occasion for sexual acting out such as online sex, sexual massage parlors, prostitutes, etc. It is only in recovery that the addict can recognize his or her own lack of intimacy ability and begin to practice new behaviors to overcome their fears of being known and connected.

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

Attention Deficit Disorder and Sex Addiction: What’s the Connection?

A large number of sex addicts have attention deficit hyperactivity disorder (ADHD)

Dr. Rory Reid of UCLA did research in 2007 and 2011 in which groups of men in treatment for sex addiction were assessed for ADHD and in which 23%-26% were found to meet the criteria for adult ADHD.  Almost all of these (97%) were of the “predominantly inattentive type” rather than being predominantly hyperactive. (The prevalence of ADHD in the general population is 3-5% according to Reid.)

Can impulsivity or low self-concept explain the correlation?

Dr. Reid also gathered evidence about whether ADHD might be “driving” sex addiction due to the impulsivity of people with attention deficit as children.

Continue reading

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

Losing a Partner Complicates Sex Addiction Recovery

A sizable number of couples stay together through the upheaval of sex addiction. According to my educated estimate about half of all sex addicts in sex addiction recovery are working with a partner to try to repair the relationship.

By the same token many sex addicts end up losing their partner following the disclosure of sex addiction and the ensuing crisis. I have found that there are complications for recovery in both situations.

If the sex addict’s partner chooses to stay in the relationship, then the sex addict has certain advantages. The presence of a partner (and possibly children) very often provides a strong motivation for the addict to follow through with treatment and recovery. No matter what the addictive behavior, internet porn, prostitutes, hook-ups, etc. the married sex addict has a lot to lose by failing to get “sober”.  Also the presence of a partner adds a level of accountability. If the addict is truly engaged in recovery, then he or she will be committed to transparency and honesty with a partner and in general. Agreeing to tell all can help to give the addict a reason to be more conscientious about avoiding situations that might lead to relapse.

But what happens when the addict comes clean to a partner, becomes sincerely engaged in recovery and then the partner or spouse leaves? I would like to share my observations as to the impact of divorce on sex addiction recovery; both the negative impact and to whatever extent, the positive impact as well .

Negative impact of break-ups

  • Apart from the loss of motivation and accountability that was connected to the relationship, separation and divorce add serious emotional stresses to the situation. The end of any relationship, even a bad one, is experienced as a loss. This means that even for a person who was not struggling with addiction and recovery, there would be grief and deep feelings of abandonment.
  • As I have discussed elsewhere,  sex addicts tend to be highly co-dependent themselves even though they have lead a secret life outside their relationship. They are insecure and tend to base their self worth on the perceptions of others. The rejection of a break-up only reinforces their feeling of unworthiness which in turn can derail any new found sense of strength in recovery.
  • The turmoil surrounding a separation or divorce can become a serious distraction from the addict’s recovery routine. The mechanics of leaving familiar surroundings, finding a place to live, arranging to see their children if there are any, and dealing with the legal process of impending divorce proceedings can sap the addict’s energy and resources.
  • Addicts in a break-up will be experiencing a great deal of emotional pain and distress. Their typical way of dealing with negative emotions in the past was through escape into their addictive behavior. Thus the added emotional distress of shame and rejection increases the motivation to reach for their “drug”.
  • Most sex addicts have a problem dealing with boredom and loneliness without wanting to act out sexually. Isolation is not helpful to sex addiction recovery and the fact of suddenly being on their own can be a big risk factor, especially if break up has left them feeling less motivated to engage with supportive people.
  • The addict can become obsessed with the partner who has rejected them, thus leading them into destructive fantasies and delusional thinking. They may fantasize that they can win the partner back, or they may ruminate and become angry and resentful. They may also become obsessed with finding a new partner immediately in order to bolster their damaged sense of self and restore parity with the person they have lost. All of this obsessing and emotion pulls the addict away from reality and from the need to address their own recovery and growth.

Is there any upside to break-ups?

Obviously there may be advantages for the spouses and partners who feel that moving on is in their own best interests. But what about the addict? I believe that after the immediate crisis of the break-up and its impact on sex addiction recovery have subsided, the addict will be in a better position to assess the intimacy problems that almost certainly characterized the relationship. I contend that practicing addicts are drawn to partners and styles of relating that do not demand. In that sense, I think the practicing addict promoted a sort of dysfunctional situation both because it was somehow familiar and because it provided a situation that at once allowed and was an excuse for sexual acting out.

In sex addiction recovery, the divorced or separated addict has a chance to recover from the addiction and to learn a new kind of relating built on intimacy and trust.

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