Is it Possible to Recover from Sexual Addiction?

The concept of “recovery”

I have seen many sex addicts recover from an unhappy, lonely, self-destructive pattern of behavior in their sexual addiction and go on to not only rebuild their lives but to reach greater heights than they ever imagined.

Yet there is a tradition in the addiction field of viewing addictions as in some ways similar to “chronic” mental illness and chronic medical conditions like diabetes; conditions that require ongoing care and can be managed successfully over time.  This implies that there is no “cure,” that there may be periods of relapse and that there is no end point to recovery.

Current thinking about sexual addiction has moved beyond the earlier more limited concepts.  See a recent review of the history of the concept of recovery in mental health and addiction.

Recovery from sex addiction

Recovery from sex addiction is considered today to involve much more than abstinence from the sexually addictive behavior.  It involves a long term process of years rather than weeks or months in which the addict will make many positive changes in his/her life and functioning and in which abstinence is merely a first step along the way.

Sex addiction is viewed in the larger context of a problem with intimacy in general, usually relating back to a relational trauma of some sort during childhood.  Treatment involves resolving the underlying trauma issues and building up the life competencies that have been compromised.

Sex life in sexual addiction

The sex life of the practicing sex addict looks very different from that of the addict in recovery.  The sex life characteristic of sexual addiction is:

  • Compulsive in that it involves preoccupations, cravings and urges that defy control
  • Compartmentalized in that a chunk of the sexual life of the addict is separate from the addict’s intimate life i.e. the addict leads a double life
  • Secret in that the behavior characteristic of the addicts sexual addiction does not square with the rest of the addict’s life and the face he presents to the world, and
  • Used as a drug in that the hyper-arousal characteristic of the addictive behavior serves to distract, numb or otherwise escape from negative feelings
  • Does not usually involve a real relationship although the addict may fantasize a relationship with a stripper, a masseuse etc.

Sex life in recovery

In recovery the sex addict will be able to integrate his sex life and his “regular” life instead of keeping them separate.  This implies that the recovering addict will be:

  • Less narrow and rigid in sexual preferences and fantasy scenarios
  • Less compulsive about sex, meaning less preoccupied with seeking sex and less obsessed with sexual cravings
  • More relational and less isolated in sexual activity (e.g. sex with a person vs. porn only)
  • Less selfish, in that he will be less focused on himself and his gratification and more able to focus on a partner and
  • Able to give up the “hyper-arousal” of addictive sex in which sexual excitation is used as a drug

Long term benefits in recovery from sex addiction

Not only can the recovering sex addict have a richer, less destructive sex life, but he or she will throughout the time of recovery make many other changes as well.  If recovery continues to be a process of overcoming past fears and insecurities through active participation in treatment, therapy, support groups or a combination of these, the addict can grow in many ways over a period of 3 to 5 years and beyond.

Some of these areas of improved functioning are internal, and some have to do with relationships and general levels of functioning.  The addict in good recovery will show improvement in

  • Empathy for others
  • Less narcissistic attitudes
  • Greater feelings of overall comfort
  • Improved self-care
  • A commitment to honesty
  • Greater ability to be responsible and nurturing as a partner and parent

Addicts in recovery can expect to learn many life skills they never had before, such as the ability to set appropriate limits and boundaries, to stick up for themselves, and to set life goals and achieve them.

So where does it end?

These are pretty hefty promises but I have seen them fulfilled.  You might ask “So why do we keep on talking about ‘recovering’ addicts instead of ‘recovered’ addicts?”  Perhaps addicts feel the need to be vigilant about habits that may still be deeply buried in their “lizard” brains.  Perhaps it is just a leftover tradition from the founders of AA.  For the time being we could just think of it as a way to stay connected to a fellowship and a reminder to us to give back.

Does Sex Addiction Lead to Gay Sexual Experiences?

There is no reason to think that sex addiction is inherently gay vs. straight.  Here are the available estimates to date.  Rob Weiss who writes on sex addiction and gay sex addicts reports that 10% of gay men are sex addicts.  Studies and estimates of the number of straight sex addicts in the U.S. are in the range of 6 to 9%, so a conservative estimate would be about 7%.

Given the available recent data, around 3.5% of the U.S. population are gay. So it seems that of the approximately 250 million adults in the U.S. around 16.9 million are straight sex addicts and around 875,000 are gay sex addicts. (The latter number may be a little off as it assumes lesbians are sex addicts in the same proportion as gay men which may not be the case.)

This set of numbers seems to show that there are an awful lot of straight people in the U.S. who are sex addicts and a relatively smaller number of gay sex addicts.  But proportionally speaking, sex addiction is an equal opportunity affliction.

Although there is no reason to think that sex addiction in and of itself does anything to change a person’s sexual orientation there is occasionally some spill over.  On the basis of my own experience with both straight and gay sex addicts I have concluded that there are some reasons why straight addicts, at some point in their addiction, can have experiences with gay sex and possibly the other way around as well.

Sex addiction is progressive

Untreated sex addicts tend to act out more frequently and to seek out new and more exciting sexual activities.  As with all addictions it takes more of the drug or a stronger drug to keep the high going.  Sex addicts who started out with internet porn and strip clubs may progress to sexual massage parlors and prostitutes.  Sometimes the addict will escalate into risky or illicit behaviors like boundary violations with adults or children or voyeurism.

In the search for a new and different high, I have seen many sex addicts who have had experiences with same sex partners.  This is not to say that they are covertly gay, but in this case it is only that they are looking for the next edgy thing.

Denial can dissolve normal restrains

Sex addiction depends on a sort of delusional state in which boundaries around what is unacceptable behavior become weaker.  Denial allows addicts to let go their inner compass.  And denial too is progressive and spreads to other areas of life.  Secrecy and lack of integrity become the norm.  As the denial and addiction take over the addict more and more ignores the consequences of his behavior regardless of whether he is gay or straight.  He may exploit others or allow himself to be in situations which for him are abnormal.  In other words he may lose the sense of control over his life and be less able to self activate.

Porn as the great accelerator

Internet pornography is so varied and intense it its content that it can present the addict with new and highly charged stimuli which trigger a forgotten experience or trauma from childhood.  If the scenario involves gay sex and if the addict acts on it then it can look like a gay-straight issue when in fact it is unconscious imprinting that does not relate to the addicts underlying sexual orientation.

Recovery and sorting out sexual orientation

In the first year or two of recovery, sex addicts are sorting out who they are.  As they let go of their old way of living and understand the experiences that led to their addiction, they will sort out their sexual orientation, possibly in a new way.

The addict who has been repeating childhood trauma with same sex partners may find that in recovery his more integrated and conscious sexual desires fall in a different direction.  I have seen a gay sex addict come to the realization that he may actually be bisexual and so on.

Sometimes the acting out behavior does represent a true underlying orientation and the person acts it out in secret due to shame.  But first the person needs to be evaluated for and possibly treated for sex addiction and their true orientation can become clear.  See also my prior post Can a Straight Man be Addicted to Gay Sex?

Sexually Addictive Behaviors Connect to Early Memories

In sex addiction treatment we describe the addicts addictive sexual behaviors as “acting out” behaviors.  What does this mean?  In general when we talk about acting out it means doing something that indirectly expresses a fantasy or feeling. Often this acting out is done without awareness of the real fantasy or feeling underneath.  For example, if I lash out when I feel hurt it means that I am acting out my hurt instead of being able to talk about it.

  • The sex addict’s arousal template

You will hear recovery people talk about the sex addict’s “arousal template.”  This refers to a particular addict’s preferred sexual acting out behavior scenario.  These vary widely from person to person.  Many different sexual behaviors can be addictive for different people.  The preferred behavior may involve other people or not.  It may involve voyeurism, paying for sex, anonymous sex, serial affairs, sexual massage parlors, cybersex, exhibitionism, fetishes, and so on.

Even within these categories the behavior may be done in a particular stereotyped way by a particular addict.  And too, the arousal template may be exhibited in the type of pornography scenarios that the addict prefers.  The behavior may be perfectly legal, like viewing pornography or going to strip clubs or it may be illicit, such as child porn or sexual exploitation of the vulnerable.  Whatever it is, it may be done addictively or not.  If it is done addictively it will be done to excess, with escalating intensity, with negative consequences, and with an inability to quit.

  • The arousal template as an X-ray of early trauma

Where does this arousal template come from?  In sex addiction theory it is believed to be based in stressful experiences in childhood.   Any traumatic childhood experiences including an inadequate bond with caregivers can deprive a child of necessary supports and lead to problems in development that lead to any number of addictions as adults.

In childhood any highly charged experience has the potential to become sexualized in the course of development whether it started out as a sexual experience or not.  Take for example a patient who is raised by deaf parents who later becomes an exhibitionistic sex addict.  He grew up never being sure of getting his parents attention because they could not hear him.  He had to be looked at in order for them to know that he needed something, and in order to connect at all.  This produces intense feelings of anxiety and frustration in the child who in adolescence begins compulsively exposing himself to the young girls on the block.  This escalates into various exhibitionistic behaviors in adulthood.

In the above example, it becomes very clear that the sex addict’s addictive sexual behavior is related to early experience.  In the same way we can look at a given addict’s preferred acting out behavior and use it as an X-ray of early experiences that were intense or stressful, or that were violating or frightening.

Of course many other factors come into play in the creation of an addiction in any given person and their life experience.  There are genetic factors, temperamental factors, and family dysfunction which can all increase or decrease the risk of future addiction.

Some experiences are extremely powerful but occur too early to be remembered in words.  These experiences are stored in the brain and body but are not able to be dredged up into conscious memories.  Sometimes we can reconstruct experiences based on what we know of a person’s history and what we can deduce they may have gone through as a young child.

In any case the more strongly the person’s arousal template is connected to a childhood trauma, the more addictive they are likely to become in their sexual behavior.

  • Treatment and the arousal template

Early experiences can shape sexual behavior in ways that are an obvious reenactment of traumatic experiences.   The addict may repeat his or her victimization or may reverse the situation and take the role of the perpetrator.  It is said that repeating trauma in this way “deepens the trauma wound”.

Sex addicts do not know why they are compelled to do a particular thing.  They only know that doing that thing is their most exciting “high”.  In treatment addicts are forced to abstain from their sexually addictive behavior which allows them to begin to see what their emotional landscape looks like without their sexual drug.  This in turn opens the way to connecting with the feelings and experiences that played such a formative role in their early life.  Understanding these feelings and experiencing them instead of acting them out allows the addict to escape from the endless cycle of re-enactment of sexually addictive behavior and to learn healthy coping mechanisms for dealing with emotional stress.

Talking about Sexually Addictive Behavior: Inside a Sex Addicts Anonymous Meeting

Would you like to sit in on a Sex Addicts Anonymous (SAA) meeting?  Would you like to hear what real addicts sound like talking about sexually addictive behavior?

What follows is a fictionalized account of an average SAA meeting.  All the names are fake.

The Intro

The room is small and comfortable.  People are saying hello and chatting casually; there is already a sense of common ground.

The meeting starts with the serenity prayer followed by a reading of the guidelines for the meeting: there will be no “cross talk,” meaning you  listen to what people say but you don’t respond or comment.

Next certain readings are read aloud by members who volunteer.  These are short sections taken from the SAA literature that describe the program and the 12 steps.  “SAA is open to men and women of any religious affiliation or of none….”  The readings promise a new way of living “if you want what we have and are willing to go to any lengths to get it…”  Then it’s time for sharing.

Tom W.

Tom is the leader for tonight, meaning he talks for a somewhat longer time and chooses a topic for that meeting.  He is a tall handsome entrepreneur in his 40’s.  He had been in the program on and off for over 15 years.  Tom recounts his early history of verbal and physical abuse by his mother.  As a child he struggled with learning disabilities.  His father was a sex addict who kept a separate house for women he was seeing.

Tom has used pornography, gone to prostitutes, and had extramarital affairs.  He has been a compulsive seducer.  He says of the women he has dated: “I wanted to take them prisoner.”

Tom has been sexually sober for a few years.  He describes his current stormy relationship.  He knows he is attracted to angry women who remind him of his mother. Tom can flash a dazzling smile but in meetings he is mostly in pain, often tearful when he talks about his struggles.

Tom suggests a topic of relationships.

Joe S.

Joe is a middle-America looking guy in his early 60’s. He has a small mustache, glasses and a paunch.  Joe is married with children and he is active in his church.   Joe is a professional man who lost his job and retired from his career a few years ago after being caught with pornography at work.  His wife has stuck it out even though he has had relapses every so often.

Joe says that when he first got into recovery he felt like: “Quit porn? You gotta be kidding!”  Tonight I see Joe avoiding talking about his marriage.  He talks about seeing his grandchildren that week, about singing in the church choir, and about how life is basically good.  He cannot find anything to complain about in his childhood.

Joe admits, in vague general terms, that he does not have sex with his wife.  He wants to dodge this issue.  He tries to be a glass-half-full kind of guy but it comes off a little forced.  What he does not say out loud is that he is still in love with porn.

Dave T.

Dave is a short and pudgy guy in his 30’s.  He has some kind of job but also gets aid for psychological problems.  He has been acting out continuously by going to strip clubs multiple times per week.   He uses up all his money on strip clubs and he seems to have little if any other life.

Tonight Dave talks about wanting to date one of the strippers he goes to see.  He has tried to strike up an acquaintance with her but nothing came of it.  He doesn’t see that dating a stripper is part of the same fantasy life as his addiction.  He is unable to get abstinent for more than a few days.

Ian A.

Ian is a 30 year-old gay man.  He is fit and pleasant looking in a boyish way.  Ian was physically and emotionally abused by his mother and step-mother and sexually abused by his father.  Ian was a voyeur and an exhibitionist until he got into recovery.  He says that had he kept on acting out he would probably be in prison today.

Ian is very bright and is dedicated to his own recovery.   He quit college and took a low level job until he can get his life on track.

Ian recently decided to break a long-standing habit of showering at the gym.  He did so because he realized he had been using the locker room as a surreptitious way to peek an naked men.  Even as he struggles, Ian is articulate and often very funny.  He wants to be a psychologist.

Bob R.

Bob is a 70-something retired doctor.  He was married to the same woman his whole life and during that time secretly carried on dozens of affairs.  When his wife found out and left him he got into the SAA program.

Bob is funny and philosophical.  He pays lip service to wanting to recover from his addiction but is mostly focused on getting his wife back.  Tonight he announces triumphantly that his wife has agreed to try living together again.  He says he is deeply grateful to the program.

Teri B.

Terri is a serious, pretty woman in her 20’s.  She recently graduated from university with a degree in chemistry.  Her history is one of poor family boundaries, sexualization by her father and molestation by an older girl.  Terri in her young life has a history of compulsive masturbation, indiscriminate sex and exhibitionism.

She talks about her relationships with men.  She has typically picked younger men she could dominate.  She then breaks up with them before they can break up with her.  Teri is in good recovery and is looking to start a healthy relationship.  She recently took up with a guy who is several years older than she.  It feels different, but she is cautious.  She says some day she wants to have children and doesn’t want to pass her problems on to them.

The the meeting goes on for an hour and a half.  There is a new member, Jeremy, barely 20, who was in residential rehab after he admitted watching child pornography.  There is Jerry, who cries when he talks about giving his pregnant wife a sexually transmitted disease resulting in damage to their child.  There is Jeff, who is making no headway in his career in internet technology but instead habitually exposes himself in movie theaters.

After the meeting there is “fellowship” (conversation).  What becomes clear is that these people are struggling and suffering but they are doing so with a purpose.  They read a lot they think a lot and they go to meetings a lot.  Mostly what seems to help is that they are together in their struggle.  They witness the gradual changes in one another.  They are not alone.  Find Dr. Hatch on Facebook at Sex Addictions counseling and on Twitter @SAResource.

Fake Romance: Understanding a Seduction Addict’s Playbook

“What just happened?”

That can be the feeling you get when you’ve encountered a seduction addict. These are the “nice guys” of sex addiction.  But anyone who has ever dated a compulsive seducer can tell you that they are as intimacy disabled as any other sex addict, maybe more so.  They tend to leave a nasty trail of non-relationships behind them and their future looks pretty much like their past.

We’ll look at what to expect in a typical scenario of a person dating a seduction addict, but first let’s look at the essential features of this kind of sex addict.

Characteristics of seduction sex addicts

  • They are addicted to the rush of falling in love, not the sexual act.
  • They are obsessed with being desired sexually and making a romantic connection.
  • They begin to lose sexual desire for a person immediately after the initial conquest.
  • They are not interested in having a real relationship.
  • They cannot sustain interest beyond the initial romance.
  • They are deeply cynical about lasting relationships because they fear them and don’t understand them.
  • They often carry on multiple flirtations to insure a supply for the future.

The stages in a seduction addict’s romantic scenario

(The seduction addict can be male or female.  I am using “he” for convenience only.)

  1. Predatory Flirting.  He  uses any encounter to start a flirtation.  He finds extremely subtle ways to be romantically suggestive.  For example, he might say “Maybe it’s not an accident that we ran into each other.”  Sometimes he will take a strong interest in you, or he may be very protective.  But he keeps it vague and indirect so he always has an “out.”
  2. Romantic Connection.  Assuming you actually connect, there is the initial romance.  Everything is exciting and special.  This beginning stage in an attachment is called “limerence” and it is an altered state.  One seduction addict admitted to me that the high point of a relationship for him was the first kiss.  However, at no point can you expect the addict to take the lead. Instead of making a definite plan for a date he may call or email on some flimsy pretext in order to get you to take the initiative.  Above all he wants to know he is desired.  He will want to feel that you initiated sex.
  3. The Affair of the Century.  The two of you are perfect together.  You are likely to be swept away and to not notice that you don’t know anything about what this guy really wants for the future.  That’s because the future doesn’t exist.  If you ask what his intentions are you will get only vague hints. You never really get past his “story,” that prefab profile of himself that he uses to win people over.  He will resist appearing socially as a couple. Real life would spoil his addictive “high.”
  4. The Exit.  The final phase is one in which the seducer’s “high” wears off. He begins to feel trapped. Often he will hide his waning interest by “doing things” for you; anything from walking your dog to painting your kitchen.  This is partly to avoid a real relationship and partly out of guilt, as he knows he’s getting ready to leave.  He has already begun noticing new targets for seduction.  He will then exit, perhaps explaining that he has neglected his work, or that he’s not ready to make a commitment.

Compulsive seduction is the same as any other sex addiction

In the end, the seduction addict is the same as any other sex addict.  Voyeurs, exhibitionists, pornography addicts; whatever the behavior the addiction is the same.  The addict uses the behavior to avoid intimacy and kill the pain of low self-worth.

Not realizing he needs help, the seduction addict may think he wants a lasting relationship but he will not realize that the problem is him.  He may go on for a very long time without hitting bottom.

The Stigma of Sex Addiction Part 1: The “Non-Anonymous” Movement

Membership in Sex Addicts Anonymous (SAA) is currently growing at a rapid pace in the U.S. and abroad, with about a 20% increase in the number of weekly group meetings every year. SAA and other sex addiction support groups like it follow the AA model of self help support groupswhere the last names of the members are never mentioned and the members protect each other’s confidentiality.  Some people in the addiction recovery community are questioning what they see as a harmful tradition of secrecy. I see very strong arguments on either side of this issue.

http://www.youtube.com/watch?v=-XTom9_3zdA

The “non-anonymous” movement

A new support network called “Addicts NOT Anonymous” was recently founded.  It challenges the idea of anonymity based, says its founder, on the notion that “We may be addicts.  We may have done some terrible things to get our drugs.  But we are NOT nameless, faceless, anonymous nobodies.” 

By shedding their anonymity the non-anonymous people argue that they gain self respect and accountability for their actions.  They seem to see the whole traditional 12-step model as a rigid, ritualistic throwback.

Other opponents of anonymity argue that “We are in the midst of a public health crisis when it comes to understanding and treating addiction.  AA’s principle of anonymity may only be contributing to general confusion and prejudice.”

Reasons in favor of sex addicts coming out of the closet

“Coming out,” whether on the part of alcoholics, drug addicts, homosexuals, rape victims or even undocumented workers, has historically had a number of beneficial effects.

  • It allows people who were formerly shunned or seen as deviant to be seen in a more human light and integrated into society.
  • Making the problems of the closeted group more public improves the prospects for research, understanding and effective treatment for those who need help.
  • For sex addicts in particular, it is certainly true that greater public awareness and acceptance of sex addiction as a disease would greatly reduce the shame of those who struggle with it, and reduced shame would support healing.
  • Being secretive about a large chunk of who we are is always unhealthy and going public would allow the sex addict to have a greater sense of integrity.

Reasons against sex addicts coming out of the closet

“Anonymous support groups like Sex Addicts Anonymous that are modeled after Alcoholics Anonymous protect the identity of their members for some obvious reasons and some less obvious reasons.

  • Sex addicts tend to isolate themselves in one way or another.  It is part of their problem that they feel vulnerable and do not want to be known. They are therefore more willing to participate anonymously.
  • Society is nowhere near ready to accept the sex addict next door in a non-judgmental spirit.  Often sex addiction is seen as being the same as sex offending, child molesting and so on.  This is antithetical to getting help and threatens the very livelihood of sex addicts, particularly if they are teachers.
  • Most doctors and the majority of psychotherapists don’t have adequate training about sex addiction and couldn’t help pave the way for treatment.
  • Part of the basis for addiction treatment is the need for the addict to connect with others and form supportive relationships.  Anonymity provides a basis of equality, a leveling of people that takes out all considerations of differential power, success, and status.  Everyone is equal because everyone’s outward ego identity is concealed.

This last point is the most important.  In 12-step groups like SAA one of the basic tenets is: “Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.”

In creating a support group where people are “just people” not doctors, business executives, or janitors there is a greater possibility for people to see under the surface to the common humanity and common struggle.  This makes for real connection, spiritual connection rather than just membership in an affinity group.  The real connection with another person based on who we are on the inside is ultimately what makes change possible.

 

Are We Responsible For Our Sexuality?

The two recent articles, “Head case puzzle” (7/15/2012) by Robert M.  Sapolsky (a professor of neuroscience at Stanford University) and “Do pedophiles deserve sympathy?” (6/21/2012) by James Cantor ( of the Department of Psychiatry at the University of Toronto) point the way toward what will undoubtedly become an increasingly well understood science of the way in which brain wiring, injuries to the nervous system both before and after birth, childhood factors affecting brain development and genetics are all interwoven in such a way as to produce a human being who is predisposed to particular sexual acts.

But for those who want to see sex addicts and/or sex offenders as responsible for making the right choices no matter how they are wired, Sapolsky’s Op-Ed piece in the L.A. Times is a shot across the bow.

As Sapolsky points out, “Self-discipline, impulse control, gratification postponement and emotional regulation are all just as much products of biology as anything else that emanates from the brain.  The same types of evidence that allowed us to understand the role for biology in such things as abnormal sexual urges have also demonstrated a role for biology in giving in to those urges.”

Where are we with understanding sexual compulsion?

Some sex offenders and sex addicts seem to have wiring that is so messed up that they are incapable of ever gaining any connection with or empathy for another human being.  And yet we used to claim that people with “character disorders” such as borderline personality disorder were incurable too. But we now know that these “disorders of the self” as they are sometimes called are most often related to neurophysiological  issues that may be a result of early trauma and attachment issues and that they can be treated with a great deal of success.

So is sexual compulsion a disability permanently etched in the brain?

At present I believe we operate on the basis of a kind of implicitly understood continuum of biological permanence, which goes something like this:

sexual orientation  –  paraphilia  –  arousal template  – trauma reaction

In this continuum sexual orientation (gay, straight etc.) is accepted by most if not all people as hard wired in the brain if not the genome.   At the most fluid end of the scale, a trauma reaction or behavior that is in reaction to (or a repetition of) specific traumatic experiences which are often quite amenable to change through treatment.

The middle two categories are where the sex offenders and sex addicts are usually located.  Pedophilia, attraction to children, is a paraphilia like other types of sexual fixations.   It is the object of sexual attraction that is the most or only really sexually arousing person or thing.  These are seen as learned rather than innate for the most part but have been viewed as resistant to treatment.

“Arousal template” is the word used in most sex addiction therapy to refer to the sexual preferences such as dominance and submission, voyeurism and so on, which are the result of childhood experiences, early trauma and conditioning.  They are closer to trauma reactions in that with proper treatment they can be worked through and in many cases the person’s sexual behavior can come to be more “normal.”

If there is a neurophysiologically identifiable cause of the problem, we tend to see the person as less responsible for their behavior regardless of how effectively it can be treated.  Actually, the question should be not how much or little people have control over a given behavior, but how far we have come in being able to treat it.  The question of responsibility is one that the legal and philosophical systems rely on but ultimately it has little to do with the scientific reality of the prospects for treatment and recovery.