Many of our guests have mentioned Robert Weiss. His books are utilized in treatment by clinicians all over the globe. We thought it was time to go straight to the expert on addiction. Robert graciously accepted our invitation and we’ll enjoy hearing him speak at the National Conference on Addiction Disorders in August 2016.
Today we talk about sex addiction. Of course – we go off topic because that’s what we do on Mental Health News Radio. Each show is a journey and Robert graciously jumped on the train with us!
Written by Robert Weiss, MSW for Mental Health News Radio
How do you define/diagnose sexual addiction?
There are three primary criteria for defining any addiction, including sexual addiction. They are:
- Preoccupation to the point of obsession with the substance or behavior of choice
- Loss of control over use of the substance or behavior, typically evidenced by failed attempts to quit or cut back
- Directly related negative consequences – relationship trouble, issues at work or in school, declining physical health, depression, anxiety, diminished self-esteem, isolation, financial woes, loss of interest in previously enjoyable activities, legal trouble, etc.
With sexual addiction, this pattern of all-consuming and life-destroying sexual fantasy and behavior continues for a period of at least six months. So, in short, sexual addiction is an ongoing, out-of-control pattern of compulsive sexual fantasies and behaviors that causes problems in the addict’s life.
Before a sex addiction diagnosis is made, clinicians must “rule out” the various major mental health disorders that sometimes include hypersexuality and/or impulsive sexual behavior as a primary symptom, such as bipolar disorder, OCD, and ADHD. In short, not every hypersexual person is sexually addicted. For instance, a person in the manic stage of bipolar disorder may become hypersexual, with his or her hypersexual behaviors resolving when the manic episode abates. This person would not be diagnosed as sexually addicted, even though, for periods of time, he or she may look like a sex addict.
Sex addiction is not about the pleasure of sex. Instead, sex addicts use intense sexual fantasies and behaviors as a way to “numb out” and “not feel” emotional discomfort – stress, depression, anxiety, shame, fear, boredom, loneliness, and the like. For sex addicts, sexual fantasy and pre-sexual planning and ritualization are less about the enjoyment of sex and more about emotional regulation, with sexual fantasy and sexual seeking used for distraction and dissociation. In other words, sex addicts don’t engage in sexual fantasy and behaviors to feel good, they do it to feel less – to distract themselves from whatever it is they are feeling. (This is also true with alcoholism, drug addiction, compulsive gambling, and every form of addiction.)
Put simply, the “high” of sex addiction occurs when the addict “gets lost” in the fantasy and pursuit of sex, not when he or she has an orgasm. Sex addicts even have names for this emotionally distracted and disconnected condition, calling it “the bubble” or “the trance.” They typically spend hours, sometimes even days, in this fantasy-induced elevated state – high on the goal/idea of having sex – without ever engaging in any concrete sexual act. In fact, actually having sex and reaching orgasm brings their high to a screeching halt, throwing them back into the real world with all of the stress and emotional discomfort they’d like to escape.
Are there specific risk factors for sex addiction? If so, what are they?
First I’ll talk about addiction in general, and then I’ll move to sexual addiction in particular. The risk factors for all addictions are a combination of genetic and environmental influences. In short, people are at risk when there is a history of addiction (any type) or mental illness (any type) in the family, and/or when they have unresolved trauma (neglect, emotional abuse, physical abuse, sexual abuse, etc.) Early exposure to an addictive substance or behavior also increases the risk of later-life addiction. (Many times early exposure occurs in conjunction with a family history of addiction and/or other childhood issues.) Typically, at-risk individuals turn to alcohol, prescription medications, or illicit substances as a way to self-medicate their stress and emotional discomfort, especially the emotional pain of unresolved early-life trauma, but they may also turn to an intensely pleasurable pattern of behavior, like sex.
As for sex addiction in particular, any form of sexual abuse and/or early exposure to sex or sexualized imagery ups the risk for sexual addiction. This type of sexualized early-life trauma creates a very specific form of shame that we call sexual shame, and many children who feel sexual shame learn to self-medicate this emotional discomfort by eroticizing and reenacting some aspect of the shame-inducing trauma. (Essentially, they attempt to take control of a situation that feels out-of-control.) Sadly, even though these attempts at self-soothing are distracting in the moment, they tend to exacerbate preexisting sexual shame and emotional discomfort, thus creating an even greater need/desire for escape and dissociation. Over time, many sexual trauma survivors find themselves mired in an addictive cycle of self-hatred and sexual shame, ameliorated by sexual fantasy and activity, followed by still more self-hatred and sexual shame. Basically, their escapist addictive sexual fantasies and behaviors automatically and inherently trigger the need for more of the same. This is the self-perpetuating cycle of sexual addiction.
Certainly. There is a tremendous amount of research linking early-life trauma to adult-life issues (like depression, anxiety, and addiction). And this appears to be the case regardless of genetics. In other words, a bad home life can easily usurp good genetics. It is also clear that the more repetitive/ongoing that trauma is, the more significant the later-life effects tend to be. One well-known study found that kids who experience chronic childhood trauma (defined as four or more significant trauma experiences prior to age 18) are:
- 8 times as likely to smoke 2.4 times as likely to have chronic anxiety
- 6 times as likely to be depressed
- 6 times as likely to qualify as promiscuous
- 2 times as likely to become alcoholic
- 1 times as likely to become an IV drug abuser.
So yes, there is a huge link between childhood trauma and adult-life symptoms and disorders – especially addiction.
Most addictions get worse over time. Is that also true with sex addiction?
Definitely. As with other addictions, sex addicts develop a tolerance to the effects of their behavior, which makes it more difficult over time to achieve the high they seek. So their addiction can escalate. For a parallel, consider substance addictions. With alcoholism and drug addiction, over time the addict must take more of a substance or a stronger substance to achieve and maintain the high that he or she seeks. With sexual addiction, the addict must spend increasing amounts of time engaging in the addiction, or the addict must up the intensity level of his or her sexual fantasies and behaviors. Eventually, many sex addicts find themselves engaging in sexual behaviors that hadn’t even occurred to them early in the addictive process. Some act out in ways that violate their personal moral code, their spiritual beliefs, and maybe even the law. For example, a sex addict might start out looking at softcore and/or “vanilla” porn, but over time he or she may escalate to hardcore porn, fetish porn, illegal imagery, webcam sex, real-world affairs, prostitutes, etc.
Is sexual addiction related to sexual orientation or fetishes?
Absolutely not! Sexual addiction is unrelated to who or what it is that turns a person on. Being homosexual does not make someone a sex addict any more than being straight makes someone a sex addict. The same is true with fetishes. Sometimes people with ego-dystonic (unwanted) same-sex or fetish attractions will seek sex addiction treatment, hoping to change their orientation or adult sexual arousal patterns. However, changing one’s adult-life sexual arousal template is not possible. If you’re attracted to men, that’s the way it is; if you’re attracted to women, same story; and if you like both genders, you’d better get used to it, because that’s not going change no matter how much analysis you have or how many 12-step meetings you attend. Again, the same is true with fetishes, including ego-dystonic fetishes. Yes, people can choose to not act on their adult-life sexual arousal patterns, but they can’t profoundly alter those attractions. This is a fact. So, once again, sexual addiction has absolutely nothing to do with who or what it is that turns a person on. Instead, sexual addiction is defined by obsession, loss of control, and directly related negative consequences.
For most people, sexnology is not an issue. They are able to play with and enjoy cybersexual activity in healthy ways – without becoming addicted or experiencing negative consequences – just as most people are able to enjoy things like alcohol, gambling, video gaming, and recreational drugs without becoming addicted. However, for people vulnerable to addiction (thanks to the risk factors discussed above), sexnology can be as much a danger zone as any other potentially addictive substance/behavior. And yes, technology does (indirectly) lead some people into sexual addiction. In fact, as both scientific evidence and anyone who’s been treating sex addicts for more than a decade can tell you, almost every advance in digital technology creates a new batch of sex addicts. Consider that studies conducted in the 1980s (pre-Internet) generally suggested that anywhere from 3 to 5% of the adult male population was sexually addicted. By 1999 – still the very early days of Internet usage – that percentage had approximately doubled, to 8.5%. Seventeen years later we don’t have an updated percentage from researchers, but evidence strongly suggests the number is still climbing.
How do sex addicts define sobriety?
Many people assume that sexual sobriety requires ongoing sexual abstinence (much as sobriety with substance addictions is defined by ongoing abstinence). However, that is not the case. Instead, recovering sex addicts must learn to be sexual in non-compulsive, non-problematic, life-affirming ways. To this end, each sex addict, with the help of his or her therapist or some other informed accountability partner, crafts a personalized definition of sexual sobriety based on his or her unique values and life circumstances. Essentially, sex addicts delineate the sexual behaviors that do and do not compromise and/or destroy their values, life circumstances, and relationships. They then commit, preferably in a written sexual sobriety contract, to only engage in sexual behaviors that are non-problematic (for them). As long as a sex addict’s behavior does not violate these highly individualized boundaries, he or she is sexually sober. (This is also how we handle sobriety with eating disorders, another area of life where complete abstinence is neither desired nor useful.) So, once again, the definition of sexual sobriety, because it takes into account each person’s values and life circumstances, is different for every sex addict. For example, sexual sobriety for 28-year-old single gay man will probably look very different than sexual sobriety for a 48-year-old married father of three. When defining sexual sobriety, the goal is not conformity; the goal is a non-compulsive, non-secretive, non-shaming sexual life.
What type of treatment and recovery works best for sex addicts?
In general, sex addiction treatment strategies mirror the techniques that have proven effective with substance abuse issues – typically a combination of CBT (cognitive behavioral therapy), group therapy, trauma work (when needed), and relapse prevention combined with external social support and social learning (in therapy groups and in the form of 12-step recovery – usually SAA, SCA, SLAA, or SA).
With sexual addiction, CBT looks at the events and emotions that trigger a desire to act out, teaching addicts to recognize these triggers and to deal with them not by acting out but by engaging in an alternative (and healthier) activity – calling a friend, hanging out with family, going to a recovery meeting, etc. Group therapy helps sex addicts understand that they are not alone, which goes a long way toward reducing the shame that typically underlies their behavior. Group therapy is also the ideal place to confront the denial that is integral to all forms of addiction, and to learn which interventions work best in which circumstances.
Of course, every sex addict’s treatment arc is different. Each individual arrives with a unique background and set of problematic sexual behaviors, so each addict needs an approach tailored to his or her particular needs. Some respond best to individual therapy supplemented by group and 12-step work. Others do best in group settings, making little progress one-on-one. Still others struggle utterly until they are physically separated from the people, places, and things that drive their addiction by the protective walls of inpatient treatment.
Where can people learn more about sexual addiction and sex addiction treatment?
For starters, they can read my recently published book, Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction. They can also visit my personal website, RobertWeissMSW.com. The Society for the Advancement of Sexual Health and the International Institute for Trauma and Addiction Professionals also offer a great deal of useful information on their websites. Additionally, Professor Martin Kafka from Harvard has written a brilliant paper outlining the history of sexual addiction, accessible at this link. For treatment information, readers can visit the Elements Behavioral Health website and/or The Recovery Ranch website.
Robert Weiss LCSW, CSAT-S is Senior Vice President of National Clinical Development for Elements Behavioral Health, creating and overseeing addiction and mental health treatment programs for more than a dozen high-end treatment facilities, including Promises Treatment Centers in Malibu, The Ranch in rural Tennessee, and The Right Step in Texas. Rob was instrumental in bringing Dr. Brené Brown’s Daring Way™ curriculum into the Elements system. Previously, he developed intimacy disorder and sexual addiction treatment programming for both men and women at the Sexual Recovery Institute in Los Angeles and The Life Healing Center in New Mexico. An internationally acknowledged clinician, Rob has served as a subject expert on the intersection of human intimacy and digital technology for multiple media outlets including The Oprah Winfrey Network, The New York Times, The Los Angeles Times, The Daily Beast, and CNN, among many others. He is the author of several highly regarded books, including Sex Addiction 101: A Basic Guide to Healing from Sex, Love, and Porn Addiction, and Cruise Control: Understanding Sex Addiction in Gay Men. He is also a co-author, with Dr. Jennifer Schneider, of Closer Together, Further Apart and Always Turned On: Sex Addiction in the Digital Age. He blogs regularly for Psychology Today, Huffington Post, Psych Central, Counselor Magazine, and Addiction.com, among others.