Category: Uncategorized

The American Society of Addiction Medicine recently came out with the following definition of addiction:

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

Note the key words “chronic,” “brain,” and “substance use and other behaviors” (my italics).  There is now ample evidence that behaviors such as persistent hooking-up for casual sex, excessive internet pornography use, serial seduction and affairs etc. are sexually compulsive behaviors that share the salient aspects of other kinds of addictions.  For example:

-Drugs, cybersex, gambling, and even internet gaming all produce a drastic increase in brain chemicals related to pleasure pathways which can become addictions in the same way.

-Those people with the “disease” develop a tolerance and need an increase in the frequency of the behavior as well as needing more extreme behavior for gratification.

-The behavior follows a progressive course unless it is treated

-The behavior produces dire consequences in the addict’s life.

There is even evidence that the various kinds of addiction can share a common origin in brain development due to a variety of problematic early life experiences. (See also my previous blog post This is Your Brain on Cyber Porn).  Regardless of upbringing, teenagers are particularly vulnerable to addiction due to the fact that their brains are not yet fully developed.  The brain of an 18 year-old is thought to be 80% developed with the last 20% being the frontal lobes (around age 25 or 26).

So why is it important to define the various forms of sexually compulsive behaviors as “addictions?”  My top 5 reasons are:

1. Conservatively, 3-5% of the U.S. population suffers from sexual compulsivity and teens are increasingly engaging in compulsive use of pornography.  This is a significant public health issue just in terms of the numbers.

2. Lives are destroyed by sex addiction: marriages crumble, jobs are lost, people are ostracized and incarcerated and children are exposed to potentially damaging experiences.

3. Sex as an addiction can be treated and people can recovery and lead normal lives with healthy sex lives.  Viewing sexual compulsions simply as “perverted” or as “moral” failings is counterproductive in that it prevents people getting help.

4. Acknowledging that sex addiction is a brain disease resulting in behavioral compulsions allows the people around the addict to be more compassionate and less punitive and judgmental. And by the same token they get to suffer less themselves in the long run.

5. We as a society have one foot in the dark ages when it comes to sexual issues.  We often prefer to retreat into concepts of good and evil.  What we are doing is walling off a human problem and compartmentalizing it.  This is turn leads to the “schizophrenic” cultural trends of increasingly explicit portrayals or sexual imagery in the media on the one hand and branding teens as sex offenders for “sexting” on their cell phones on the other.

So people, could we finally stop asking “is sex addiction an addiction?”

 

 

 

 

 

 

1. “Would I know right away if I was living with a sex addict?”

Doubtful.  Spouses and partners of sex addicts are often unable to readily identify the fact that they are living with a sex addict.  Sex addiction thrives on secrecy and compartmentalization and the addict will go to great lengths to wall off his or her addictive sexual behavior. 

2. “I wonder if my imagination is running away with me.”

Sometimes the addict will make the partner think that he or she is crazy and imagining things (sometimes called “Gaslighting” after the old movie).  Often sex addicts can function well and appear normal to a great extent; working hard, spending time with the kids, volunteering at church, etc.  Don’t expect a straight answer at first!  Trust your instincts.

3. “So what should I look for?”

• The lists of addiction criteria available under the “defining addiction” tab are probably not going to help unless you already have a lot of information.  Some of the “collateral indicators” might be relevant.
• An obvious risk factor would be a life history involving another addiction, such as drugs, alcohol, work, spending, gambling or food.  Addictions are like potato chips, most people have more than one. 
• You can look for whether the person is spending an unusual amount of time on the computer and look into what sites are being visited.  Looking at pornographic websites or videos more than once in a great while is probably cause for concern.
• We all need our privacy, but you can check around and look for indications that the person has a whole separate life.  Are there a lot of sexual magazines, books or other sexual printed material stashed somewhere.
• If you feel that your relationship is not as intimate or feel alienated in some way, get to the bottom of it, don’t allow yourself to be brushed off or placated. 
•  If you have a strong intuition, use technology to monitor the person’s email and other computer use.  Many sex addicts get help only after they are found out by their spouses, partners or parents.
•  Be vigilant to subtler signs of your partner being mentally “out to lunch”, eager to get away from previously enjoyed activities, and being depressed for no reason.  These aren’t necessarily signs of sex addiction; just don’t wear blinders to whatever might be going on. 
•  Last but not least, check on where the money is going, e.g. massage parlors, clubs etc.

4. “What can I do if I find out that I am living with someone who may be an addict?”

Call or email one of the people or programs listed under “getting help” or email me at the “ask Dr. Hatch” tab with your questions.  You can also make an appointment to talk to a sex addiction therapist who can help you get help for the person in question. 

Have a counseling session together.  Problems between people or an episode of infidelity do not mean there is sex addiction.  Many people have affairs who are not addicts, i.e. it’s not necessarily part of a pattern of compulsive behavior.  However, couple counseling does sometimes reveal the presence of addiction.

Don’t blame yourself or think that you can fix it by being more supportive.  If it is a spouse, don’t try to be more sexual — that’s not the problem. 

Living with a recovering sex addict is a big undertaking at best.  Remember, sex addiction can derail a life, wreak havoc with a relationship and have a negative future impact on children.  It’s OK to be vigilant.

Sexual addiction has as one of its antecedents, a failure of normal early attachment due to some disruption in the relationship to a primary caregiver.  Sex addicts are often sexually abused as children but they are more often emotionally neglected and tend to come from families that are rigid, authoritarian or sexually repressed.  This failure leads to an inability to trust and to bond normally with another.  Some attachment problems also arise through accidents of fate such as the illness or absence of a caregiver.  (There is also thought to be both a genetic and environmental predisposition to addictions in general, which may be passed on as a predisposition to addiction in the case of sexual addiction as well.)

Being so-called “intimacy-abled” means being able to form a healthy attachment with a partner in adulthood.  That implies the ability to trust your partner, to trust your own ability to set boundaries, to communicate your feelings in the moment, to be able to commit, and to relate to a partner with all aspects of yourself – mental, emotional, physical and sexual.  The untreated baggage of a disordered attachment history leads to mistrust, fear, distancing, sexual conflicts, feeling unlovable, and lack of experience with healthy communication.  For more see What is Healthy Sex…

 

 Some people in sexual recovery are in a relationship or marriage that existed prior to their being treated and often prior to their addiction being found out.  These people are on a journey that already involves a partner and are motivated enough to work on transforming that relationship and making it succeed in a healthy way.  However, there are those whose marriages did not survive or who have no partner in their lives and find themselves in recovery and wishing to find a romantic relationship.

When recovering from sexual addiction you cannot just assume that you know how to go about the dating process in a normal way.  In fact you may never have approached the possibility of dating in way that was not somehow distorted by your addiction.  When you begin dating in recovery you must be especially conscious of what you are doing.  I knew a woman in sexual recovery who had been addicted to acting out bondage scenarios.  She told me laughingly that in early recovery, she thought she could find a normal relationship and then act out her bondage scenarios within that relationship.  But even if you are very strong in your recovery, you must be aware that your addiction can seep into your relating in ways you are not aware of.  That is why you need to be vigilant as you proceed.

When you were active in your addiction you may have had a relationship that appeared normal and was totally separate from your acting out behavior, but the partner you chose was certain to be different in many ways from the partner you would choose in recovery.  Why?  Because in your addiction the part of you driven to sexual acting out, your “addict”, was in charge of choosing your partner.  You chose a partner who in some way served your need to pursue your addiction, someone who wore blinders, someone who was needy and enabling, or someone who was just “checked-out” in one way or another.

High drama relationships or relationships built around unhealthy sexual or emotional scenarios, unavailable or abusive partners, etc. may have been part of your life before recovery.  These relationships most likely related to a pattern laid down in your earliest experiences with intimacy and sex.  They may reflect fear of abandonment, the need to dominate, the need to degrade or be degraded in order to feel adequate, or any of a number of unhealthy emotional “scripts”.  When you start dating in recovery you need to be vigilant as to the people you choose to date, but you also need to be aware that your own behavior patterns may include seductiveness, predatory flirting or objectification.

Even in recovery, you are still going to be susceptible to that peculiar feeling of “instant connection” with someone, that feeling of “familiarity”. That feeling should be a warning signal to take stock of the situation and be aware that an instant connectedness may indicate that you have come across someone who fits your past pattern of relationships in which healthy love and commitment are not possible.   In other words it may be an illusion.  Can you ever Trust your instincts?  My own feeling is that the healthier you become the more you can rely on your intuitions and your first impressions.

Many people have questions about how and when to share their sexual history with a person they are dating.  Obviously if the person you go out with is also in sexual recovery then it would be appropriate to share your histories with each other right away.  Likewise, it is easier to tell more sooner if the person already knows that you have been receiving treatment for sexual addiction.  In this case, the process of eventually disclosing everything and relating in an open way will be accelerated.  As to people with no knowledge of your sexual recovery issues, it will be necessary to get yourself to begin to share something about your problem right away.  This will not have to be the whole story, but remember, you will be taking the dating process more slowly and carefully than many other people and you will need to let the person know what’s going on with you in general so they can make sense out of the experience.

As you get to know someone you are dating, you will have to share more of the “gory details” of your story so that the other person can know the real you; don’t forget to include the part about how well you’ve done in your recovery!  If and when you want to be really intimate and committed, you will have to be prepared to share everything – no secrets.  Anything less will sooner or later come home to roost as a betrayal.  This is because the other person will feel that regardless of whether things have gone well or badly, they were not able to base their own decisions and behavior on reality.  They will likely feel that their reality has been manipulated and will correctly see this as less than caring on your part.

The sober dating plan outline will ask that you put down in some detail your own individualized plan relative to the key questions about dating including some rules about how and when you will let a relationship become sexual.  It is important to realize that having sexual feelings for someone you are spending time with and even having sexual fantasies about them are most likely normal experiences and as such should not cause any alarm.  The problems arise when you allow yourself to believe that your sexual attraction to someone means they are automatically right for you.  It takes considerable effort and feedback from trusted advisors to hold on to the reality that you still do not really know a person and that you may not be compatible with them and may not even like them.  Until you figure these things out, you may be headed for a casual sexual encounter.  This would not be part of the plan for recovering sex addicts.  Also you should bear in mind that fantasies are one thing, but if you begin to obsess about or sexually target a person, even someone you know well, this is a definite red flag.

The time to construct a sober dating plan is before you start dating, even before you think you are really ready to start dating.  Many addicts in recovery are fearful of dating.  They may think they have something to be ashamed of, they may not know how to go about it, and they may have spent years hiding in their addiction.  Make a plan and try to stick to it (or modify it if you need to – nothing is perfect.)  Remember to check in with others as you go along and listen to their opinions.  It’s a learning process.

 

 

Cyber porn is known as the crack cocaine of sex addiction.

Internet pornography is easy to get hooked on and hard to kick.  Of the more than 20 million people who are sex addicts in this country roughly 71% act out their addiction on the internet.  This takes the form not only of viewing pornographic imagery but increasingly provides a venue for exhibitionism/voyeurism, access to sexual chat rooms, prostitutes, “hook-ups” (finding others who are immediately available for anonymous sex in real life) and selling or trading of pornographic photos and videos. Not only is the internet is a place for cheap, easy access to sexually addictive material and behaviors, it is a significant gateway drug for young people.  The average first time contact with internet porn is age 11.  The largest consumers of internet porn are the 12 to 17 year old group.

Cyber porn is the great accelerator.

Sometimes it goes the other way.  A person prone to sexual acting out behavior discovers new kinds of imagery and behavior that they never thought of consciously before and quickly becomes compulsively fixated on these new scenarios, ultimately seeking to act them out in their life.  It is thought that this takes place because the new imagery acts to trigger something unconscious, something forgotten but not gone, in the psychosexual history of the person.  This is sometimes referred to as “accessing the unresolved”.  People see things they may have once seen fleetingly at an early age and enter a trance-like state in which these images stick.  Whether it comes before or after other kinds of sexually addictive behavior, the internet leads to rapid escalation and acceleration of sex addiction.

The chemistry of internet porn addiction.

Your brain on internet porn is getting a release of dopamine which activates the reward/pleasure centers.  This is addictive in itself (see Sex Addiction is a Drug.)  If accompanied by masturbation there are even more rewarding chemicals released.  People then use this drug as a reward, as an escape or as a relief from boredom or agitation.  Like any drug, the web can then become the person’s best friend causing “relational regression” i.e. the tendency to withdraw and replace the real with the digital.  This not only causes the person to become mentally withdrawn but may interfere with the ability to make any real human connections.  The person’s internet experience becomes their “perfect” reality.  As one patient put it “Miss January is always there for me, she always wants me.”  Intimate contact in reality spoils this fantasy.  There is a correlation between internet porn use and loneliness such that isolation is not only a result but a cause of cyber porn addiction.

Living in the cyber porn bubble.

I would add one other warning label to the whole cyber porn issue (aside from the obvious and growing danger of getting in trouble with the law for various internet related behaviors) and that is that internet pornography users find it extremely easy to sweep their behavior under the rug.  They can deny that it is a problem more easily than other sexual acting out behaviors because it seems to hurt no one.  They can argue that everyone does it, or that everyone wants to.  They can say that it doesn’t cost anything (forget that U.S. internet porn revenue exceeds revenues of ABC, CBS, and NBC combined), and they can say that it is not compulsive, even as it takes over more of their lives.  So your brain on porn is also an increasingly delusional brain, which feeds the vicious circle and makes it the growing epidemic that it is.

 

Sexual behavior in its various forms can be used to cause the release of chemicals in the brain which have the effect of taking the person away from unpleasant emotional states.  Sexual behaviors can become obsessive when they are used in response to these unpleasant internal states to repeatedly block them through brain chemicals relating to pleasure, excitement, or numbing, depending on the type of behavior.

Chemicals released in the brain which relate to specific sexual functions are: dopamine, norepinephrine, serotonin, oxytocin, vasopressin, opioids and epinephrine.  These have the ability to create a desired state of one kind or another, numbing, energy, fantasy/dissociation, or pain (releases opioids) which can be used to “self-medicate” undesirable feelings or traumatic reactivity of one sort or another.

Sexual acting out behavior is usually categorized into one of three types depending on the desired end state.  (1) Arousal created by high-risk behaviors or high drama relationships, for example, act like cocaine and amphetamines (2) numbing created by behaviors such as compulsive masturbation mimics the effects of heroin or alcohol, and (3) fantasy or a trance-like state is achieved by behaviors such as obsession with internet pornography or fantasy charged situations which resembles sedation.  Further, when the sex addict refrains from sex a predictable set of withdrawal symptoms arise.  For more see This is Your Brain on Cyber Porn.