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

“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:

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

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

Not Sure if You’re a Sex Addict?

It is normal to feel uncertain about this question.  Addictions are partly self-defined; especially “process” addictions like gambling, food and sex addiction.  Doctors and therapists don’t go out of their way to look for sex addicts.  If someone comes to me for sex addiction help it is because they suspect that they are having a problem with some sexual behavior that is out of control or is causing serious problems.  A sex addiction therapist may help them decide if that is true and can evaluate other possible causes or co-occurring condition.  The official criteria and categories of sex addiction may help in the beginning.

But even after a person has sought help or support groups for sex addiction, they may continue to wonder if they really are a bona fide sex addict.  This is so common as to be a predictable occurrence at some point in recovery.

Someone who has serial affairs or who has a habit of watching a lot of internet pornography may find him or herself sitting in an SAA (Sex Addicts Anonymous) meeting next to a person who did jail time for viewing child porn or who compulsively visits prostitutes or who exposes himself on buses.  The behaviors of addicts are so varied that it invites comparison.  “Am I really the same as him? Surely my problem is qualitatively different and less serious!”

Doubt is not the same as denial or minimization (although these can be involved as well.)  Other things can cause a person to wonder whether they should define themselves as a sex addict.

Sex addiction may not be the “primary” addiction

Many recovering alcoholics and drug addicts have a tendency to use sex as a substitute drug.  Even if they recognize they are doing this they may discount it as secondary to or a product of their chemical dependency.  See also my post on alcoholics and sex addiction

This tendency to discount sexual issues is especially common when there is an “addiction interaction”.  This is the situation where addicts have more than one addiction (and a great many do) and where the two interact in various possible ways.  A sex addict may use drugs as a part of a ritual prior to sexual acting out or as a way to numb the shame afterward.

Addictions may be fused with other addictions

When two or more addictions are only engaged in at the same time (drinking always goes with seeing prostitutes, drugs are always involved with gambling and sexual acting out) they are said to be “fused”.  This makes it very hard to identify one addiction as the primary one and so the addict may go from one program to another or feel confused as to why they cannot see any change.  When different addictions lead back to one another then the addict must quit all of them at the same time if at all possible.

Sexual acting out may not be continuous

When we think of a compulsive behavior we think of the person as seeking it constantly.  Sometimes this is the case and sometimes not.  There are many sex addicts who have a pattern of intermittent acting out with “down time” between their episodes of sexual acting out.  The period between acting out may be caused by remorse, or it may just be that the cravings for that behavior do not return as powerfully right away.

This episodic pattern can be of any length.  And during the periods between acting out, the addict may think they are in good recovery.  Therapists look for a situation in which the addict can go a week, a month or even several months without acting out and then relapse, almost like clockwork.  This is like the smoker who claims he can quit because he’s done it hundreds of times.   They seem to have some control and can quit for a particular period of time—just not for good.

Also it is not unusual for sex addicts in the first year or two of recovery to get totally turned off to sex.  This is a swing to the opposite extreme of sexual anorexia but does not represent real sexual sobriety.

The person who can sexually “act out” in moderation

There are probably some people who engage in secret, illicit or even risky sexual behaviors but who really are using the behavior as an occasional escape, and one over which they have a lot of control.  It is hard to say how many such people there are but I suspect there are a lot given the current prevalence of porn use, cyber sex, and sexual hook-ups (not to mention infidelity).  These people would probably not show up in a sex addiction clinic.   But the dividing line is such that those behaviors engaged in by someone who really is an addict will eventually lead to more frequent, more destructive or more serious sexual acting out behavior.

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

3 Gateways to Intimacy: Things You Can Practice Doing Now

Intimacy is the ability to be real with a significant other, the ability to be known for who we really are.  And being seen in this way requires that we are secure enough to take a risk and be vulnerable.

Sex addiction has been described as an “intimacy disability.”  Addictive behaviors are ways to deal with stress and negative emotions; ways that do not depend on other people for soothing or emotional support.  Addicts feel mistrustful about being open with their needs and have a deep rooted belief that no one who really knew them could love them.

In recovery, addicts learn to reconnect with themselves and with their inner feelings without running away.  And they learn to reconnect with other people with more trust and less fear of rejection.

But addiction treatment does not automatically resolve all the addict’s fears about being known and about sharing all of themselves with a partner.  Becoming intimacy-“abled” is a much longer process than that of simply kicking an addiction.

Building intimacy skills

It is all very well to tell people to stop judging, to set appropriate boundaries or to “speak your truth in the moment.”  But these can seem pretty abstract and hard to put into practice.

Here are some specific kinds of behavior that the addict can focus on and some ideas about why they may help promote intimacy.


Nurturance involves giving someone what they need.  But in a relationship with a partner it also implies that the nurturer gives something (reassurance, food, listening, back rubs etc.) willingly and without resentment.  You don’t have to be a saint to nurture someone, and you can even do it because you are convinced that it is part of what you should do as a partner.  But real nurturance does mean that you give some attention to what the other person is feeling and that you are sincerely motivated to be kind to them.

Why does being nurturing foster intimacy?  Because it promotes empathy and an understanding of what your partner is like inside.  If done in the right spirit, nurturing makes us more able to be caring.  And taking care of someone is a way for them to feel our love and for our love to become deeper.

Also nurturing another person has the potential to bolster our own self esteem, even if that is not the original motivation.  When we give freely in this way it means that we are “full,” that we are not always worrying about our own need for self enhancement.

Mutual process

How do you relate to a partner when dealing with something specific in your life together?  It could be anything: an analysis of a movie you saw, a decision about buying furniture, or a discussion of one another’s plans and fears.

Addicts are all-or-nothing people: either we do it my way or we do it your way.  Instead of engaging in a constructive back and forth the addict will simply try to convince you of their own point of view.  If you are right they are wrong.

Approaching a question or topic as something to be decided together by a back and forth of ideas is new behavior for many recovering addicts.  But even if it is hard to believe that your partner could be right about anything, you can still practice listening and responding to what the other person says.

This is not the same as arguing your point and trying to convince the other person.  The point is to take a breath and allow the other person’s ideas to stimulate your thinking.

It is obvious how mutual process supports intimacy.  The “we” is greater than each of you alone.  In mutual processing you are building something together.

Shared experiences

It has been said that “love is not gazing into each other’s eyes, but it is gazing together at something else.”  When you can share and experience with someone you are automatically providing fertile ground for intimacy.

People who share intense experiences like being in combat in the armed services know that there is an automatic intimacy of a sort just from having gone through the same thing.  When we share something we re-affirm our common humanity because, to a great extent we have the same reactions to things.  This is especially true for powerful experiences like joy and triumph.

But sharing a joke or a sunset or a silly cat video can help feed intimacy.  This does not require any particular skill; simply that you make sure that you include times when you share experiences in your daily life together.

Fake it ‘til you make it

Fake it ‘til you make it is an idea that is often heard in 12-step meetings.  It means that you engage in healthy behavior even before you have fully embraced it.  And the theory is that in time you will come to feel that it is part of who you are.

In relationships it is also important to engage in specific caring behaviors and ways of relating.  Otherwise couples can end up endlessly talking, reading and “working on the relationship” without really getting anywhere.

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

Is Sex Addiction Treatment Anti Sex?

Those who think that sex addiction treatment is anti-sex are not paying attention.  Some people who say they are “sex positive” claim that sex addiction therapists shame or judge their clients for their sexual behavior.  They go on to conclude that we are “sex negative” and wish to limit people’s sexual choices.

This is a big topic but I want to try to clarify some points about sex addiction treatment and its underlying assumptions.

Sex addiction is largely a self-defined problem

Sex addiction treatment does not label people as having a problem with their sexual behavior.  Rather we try to help people make that determination for themselves.  We do not assume that they are having too much sex or that their unusual sexual activities are unhealthy.

The idea the sex addiction therapists want everybody to have “missionary position” sex with an opposite sex partner in a committed relationship is a complete misrepresentation.  I had a client who got aroused by being choked during sex.  This is unorthodox, maybe even dangerous, and I don’t go out of my way to recommend it, but it wasn’t a problem for her because I thought there was something wrong with it.  Rather she herself decided it was a problem in her life.

How people decide sexual behavior is a problem

The criteria for whether or not someone has a sexual addiction or problem sexual behavior rely on the person’s own report of what is going on in their life.  Among these criteria are the ideas that the behavior has negative consequences in the person’s life.  These include such things as the following.

  • The pattern of sexual behavior is such that it gets in the way of their having or maintaining a kind of relationship that they want.  Often a spouse or partner insists that their behavior is out of control and intolerable.  And often the prospect of losing a loved one makes it clear to the client that they want to change their sexual behavior.  Other times the person’s sexual behavior prevents their being able to establish an intimate relationship with anyone.
  • The behavior causes them significant problems in their life such as getting fired for using pornography at work, getting hurt or arrested due to behaviors like indecent exposure, spending their paycheck on strip clubs and prostitutes or bringing sexually transmitted diseases home to their family.
  • Sometimes the consequences of the behavior have to do with internal discomfort, the feeling “I don’t want to be like this the rest of my life.”  In this case the negative consequence is the fact that the person can no longer ignore the extent to which their sexual compulsiveness or sexual preoccupation goes against their own value system.  I have heard people say “I don’t want to be that old guy sitting home alone watching internet porn for hours” or “I don’t want to keep spending all my time looking into neighbors’ windows hoping to see someone nude.”

In other words, sex addiction therapists don’t go out looking for addicts and trying to convince people that they have a problem.  This just doesn’t happen.  Addicts come to us in pain, often in crisis.

What happens in sex addiction treatment?

An initial period in which the addict abstains from all sex provides a way for the addict’s head to clear; it is not intended as a way of life.  Much as it is impossible to do counseling with someone who is high on drugs or alcohol, it is also hard to deal with a sex addict who is high on his/her drug of choice.  Sex addiction treatment proceeds to:

  • Help the addict define and understand the behavior that is of concern
  • Help the addict understand the origins of the behavior i.e. what drives it and its roots in early life experiences
  • Understand the role of other addictions such as drugs, alcohol, gambling or work as they interact with or support the sexual behavior.
  • Help the addict see that he/she is not alone; connecting with other addicts reduces shame and allows for an honest an open dialogue.

When we do sex addiction treatment in this way we are helping clients develop their own definition of sexual recovery and giving them the tools to get there.

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.

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