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

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

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

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

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

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

What is involved in becoming a certified sex addiction therapist or counselor?

First, an important point to remember is that only therapists 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.

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