The descriptions and stories in Sex Addiction 101 purposely do not identify specific individuals or their stories. As confidentiality lies at the very center of the psychotherapeutic relationship, we have taken the most exacting measures to preserve the privacy of all real persons. All names are fictitious and all other recognizable features have been changed. Furthermore, the people and circumstances portrayed in these pages are composite in nature; each case represents a great many individuals whose characteristics and experiences have been adapted conceptually, carefully altered in their specifics, and combined to form illustrative viewpoints, characters, and stories. Any resemblance of such composites to actual persons is entirely coincidental.

Library of Congress Cataloging-in-Publication Data

is available through the Library of Congress

© 2015 Robert Weiss

ISBN-13: 978-07573-1843-6 (Paperback)

ISBN-10: 07573-1843-6 (Paperback)

ISBN-13: 978-07573-1844-3 (ePub)

ISBN-10: 07573-1844-4 (ePub)

All rights reserved. Printed in the United States of America. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the written permission of the publisher.

HCI, its logos, and marks are trademarks of Health Communications, Inc.

Publisher: Health Communications, Inc.

3201 S.W. 15th Street

Deerfield Beach, FL 33442–8190

Cover and interior design by Lawna Patterson Oldfield

Contents

Acknowledgments

Author’s Note

Foreword by David Sack, MD

1. Defining Sexual Addiction

2. Am I Addicted to Sex?

3. Sex Addiction—the Basics: Triggers, Escalation, and Denial

4. Why Me? Understanding the Causes of Sexual Addiction

5. Cybersex and Porn Addiction

6. Sex Addiction in Women

7. Love/Relationship Addiction

8. Sexual Orientation and Sex Addiction

9. When Sex Pairs with Other Addictions

10. How to Get Better

11. Finding Therapeutic Help and Healing

12. Loving a Sex Addict

13. Rebuilding Intimate Relationships

14. Long-Term Healing

15. Final Thoughts

16. Recovery Resources, Support, and Education

17. Bonus Chapter for Therapists: The Unofficial Diagnosis of Sexual Addiction

Notes

About the Author

Additional material, worksheets, and writing exercises may be found by visiting www.hcibooks.com.

Acknowledgments

This book is dedicated to those individuals (below) who pioneered and persevered in the early research and treatment of addictive sexual and intimacy disorders. If not for each one of you , this book would never have been written, nor would I still be alive to write it. Sex Addiction 101 is a summation of your commitment to sound ideas and solid research. Thus, this book belongs to all of you, as well as to the reader. You are the pioneering researchers; writers and therapists who risked your professional reputations and careers to help all of us make sense of this shameful, hidden, emotional disorder (compulsive, addictive, non-offending sexual behavior).

Even when surrounded by professional arrogance, dismissal, and derision, you fearlessly beat back the bushes of cultural prejudice and fear, offering hope to people who surely had none. You constantly discussed the issues that no one wanted to discuss and you never stopped talking about them, even when it was uncomfortable or out of fashion. By standing firm in your truth, each of you have helped even the most shamed addict hold out hope that their life might have genuine worth and value—regardless of their prior history. And I am one of those people. Thus, I am personally and professionally forever in all of your debt. As are the tens of thousands of recovering people whose lives are now forever changed for the better because you stood up for them when no one else would.

This book is dedicated to:

Thank you. Each of you has contributed to making our world a better place.

Author’s Note

This is not a book about morality, cultural beliefs, cultural norms, or religion. It is not written as a challenge to those who enjoy recreational sexuality or nontraditional sexuality, either casually or as a lifestyle. As a mental health and addiction professional, it is not my job to judge such behaviors in any way. Instead, I have written this book to help people whose sexual fantasies and activities have run amok to the point where they’ve become a driving life force—overriding their personal goals, beliefs, and lifestyle. In other words, this book is written for those whose abusive and/or addictive involvement with objectified, often non-intimate sexuality, consistently and persistently distracts them from larger personal goals like academic achievement, career development, intimate relationships, recreation, emotional health, and community. Within these pages, I offer understanding, compassion, direction, and hope to those who are too ashamed, fearful, or embarrassed to reach out in other ways.

Although there are many views about whether things like pornography, virtual sex, casual/anonymous sex, and nontraditional sex are right or wrong, good or bad, moral or immoral, it is not the intent of this book to define or address these issues in any meaningful way. I support every adult in his or her right to engage in any solo or mutually consensual (and legal) sexual activity or experience that provides pleasure, satisfaction, and fulfillment. I do not believe that anyone, therapist or not, has the right to judge what turns someone on or how a person pursues sexual activity—as long as that person’s choices do not violate the intrinsic rights and safety of self or others. In short, my work is not focused on what is ethically or politically correct for any individual or the culture at large. With pornography, for instance, I do not promote censorship, nor do I believe that all porn is automatically problematic or exploitative, though some (child porn, for instance) certainly can be.

My primary goal is to assist people who struggle with compulsive and addictive sexual behaviors by helping them to identify their problem as the chronic emotional disorder it is, and to then understand that the problem can be put into remission with proper care and direction—just like alcoholism, compulsive gambling, eating disorders, and/or drug addiction. In a nutshell, I want those who are suffering from sexual addiction to know that their sexual concerns can be addressed without shame or moral/cultural/religious bias. I also seek to offer direction and insight to therapists who may be unfamiliar with the treatment of sexually addicted clients. But most of all, I want to offer sex addicts hope, letting them know that long-term change and healing are possible to anyone willing to invest in the hard work of personal growth and integrity.

—Robert Weiss, LCSW, CSAT-S

Foreword

Mention sex addiction and most people’s response is, Sounds fun. Where do I sign up? In reality, however, sexual addiction is as devastatingly un-fun as a full-blown addiction to alcohol, crystal meth, heroin, and/or any other intensely pleasurable and/or dissociative high. All of these behaviors (sex included) typically start out as a good time, and many people who engage in them feel great . . . for a while. But among those individuals who struggle with underlying emotional or psychological issues such as profound childhood or adult trauma, anxiety, depression, and low self-esteem the tide will eventually turn, and instead of wanting alcohol, drugs, sex, gaming, and/or to binge eat they end up needing alcohol, drugs, sex, gaming and/or binge eating—just to feel okay. Before they even realize it, they’re feeding the beast, drinking, using, or acting out, not to get high with friends, party, and have a great time, but to escape the pain of living life on life’s terms.

People often ask me, How can someone be addicted to sex? They may as well be asking, "How can a person be addicted to any behavior? Don’t you have to put a substance into your body to experience the euphoric rush that drives addiction? My answer to these and similar questions is usually something along the lines of: In the world of addiction treatment there are two major areas of concern—addiction to substances, and addiction to patterns of behavior. Typically, substance addictions involve abuse of and dependency upon chemicals such as alcohol, nicotine, prescription drugs, and illegal drugs like heroin, meth, or cocaine, whereas behavioral addictions, also known as process addictions, are problematic, repetitive behavior patterns involving potentially pleasurable or compulsive activities such as gambling, sex, working, spending, eating, etc." Then I explain the ways in which addictive substances and behaviors affect the human brain.

The Brain on Drugs vs. the Brain on Sex

Much of the confusion around what constitutes a process addiction centers on the fact that many potentially addictive behaviors are healthy, even essential activities with which the majority of the population has little concern or personal struggle. In fact, things like eating and sex contribute to both individual survival and survival of the species, so our brains are programmed to encourage participation in these activities. That encouragement arrives when these behaviors trigger a dopamine response in the rewards center of the brain, resulting in feelings of pleasure. Alcohol and addictive drugs cause a similar neural response. In fact, imaging studies show that the brain on cocaine and the brain when sexually aroused are virtually indistinguishable. In other words, the human brain reacts to sex the same way it reacts to cocaine—one of the most highly addictive substances known to man.

Not surprisingly, this neurochemical pleasure process is a key element in the development and maintenance of addictions, be they substance or behavioral. Individuals struggling with underlying emotional or psychological issues subconsciously learn to abuse the brain’s dopamine response via a substance or pleasurable activity as a means of coping with stress and/or masking emotional pain. Repeatedly using a substance or pleasurable behavior in this way teaches the brain that the way to feel better is to ingest more of that substance or engage in more of that behavior. So whatever the addictive substance or behavior, the drive is the same—addicts want to feel better, which usually means feeling less, and they know their addiction is the easiest way to (temporarily) disconnect, numb out, and not have to experience the difficulties of life.

The Downside of Sex Addiction

Sexual addiction, like all addictions, is not all fun and games. It has a definite downside. To understand this downside we first must understand what, exactly, sexual addiction is. As my esteemed colleague Rob Weiss writes:

SEXUAL ADDICTION, ALSO KNOWN AS hypersexuality or hypersexual disorder, is a dysfunctional preoccupation with sexual fantasy and behavior, often involving the obsessive pursuit of non-intimate sex, pornography, compulsive masturbation, romantic intensity, and objectified partner sex. This adult obsessive pattern of thoughts and behaviors continues for a period of at least six months, despite the following:

1) Attempts made to self-correct the problematic sexual behavior

2) Promises made to self and others to change the sexual behavior

3) Significant, directly related negative life consequences such as relationship instability, emotional turmoil, physical health problems, career trouble, and legal issues

In other words, sex addicts have lost control over their sexual behavior, they are unable to stop their sexual acting out even when they want to, and they experience significant, directly related negative life consequences. (This is a pretty good definition for any addiction.)

For now, I want to focus on the last part—the consequences of sexual addiction. Most sex addicts are deeply ashamed of their behavior and who wouldn’t be? Because of this they most often find themselves leading a double life: keeping their sexual acting out a secret from family and friends, and separating what they do sexually from the rest of their day-to-day life. This compartmentalization leads to the creation of an ever-expanding web of lies told to both self and others. Typically it is the lying, secrecy, and lack of personal integrity that cause the most pain to not only the addict, but also the addict’s spouse or partner (if he or she is in a committed relationship). There are other consequences as well. Hours spent compulsively masturbating to online pornography or pursuing potential sex partners on dating or social media sites and apps are hours not spent developing one’s career, nurturing one’s spouse and/or children, hanging out with friends, enjoying hobbies, and engaging in various other necessary forms of self-care. Furthermore, sex addicts who act out with others (not all sex addicts do) are at a much higher than normal risk of contracting sexually transmitted diseases, including HIV. And the behavior of some sex addicts eventually escalates into illegal activities such as public sex, exhibitionism, voyeurism, illegal forms of pornography, etc., resulting in arrest, public humiliation, and possibly even incarceration.

Addiction Hopping

As any recovering addict can tell you, fighting addiction sometimes feels like playing an endless game of Whack-A-Mole, the carnival game where you pound on plastic moles whenever and wherever they pop up, only to spot various other moles rising from their holes. No matter how many moles you hammer down, another one seems to appear. Addiction is the same way, except the moles that pop up are cross-addictions (meaning the addict uses one addiction to replace another) or co-occurring disorders (meaning two disorders are present at the same time). Whack down booze, and food or nicotine pops up. In fact, it’s quite common to see newly sober alcoholics gaining a quick twenty pounds, and long-ago ex smokers opening up a fresh pack almost immediately after they stop drinking.

Needless to say, addiction’s moles come in an almost endless variety. A few weeks ago I performed a quick online search of the New York Times using the word addiction to see how many options would be listed. In the preceding month, addiction had been used to describe: numerous drugs both legal and illegal, alcohol, smoking, gambling, spending, political spending, fame, horses, preservation of natural resources, smartphones, and Facebook. And those were just the then-topical offerings. Not mentioned during that period were many of the normally newsworthy addictions like work, sugar, binging, purging, shopping, exercising, relationships, and sex.

At the various chemical addiction treatment centers operated by my corporation, Elements Behavioral Health, clients arrive seeking help with alcohol, prescription drugs, and/or illicit drugs. We subsequently find that nearly all of them also suffer from at least one cross- or co-occurring addiction, the three most common of which are: nicotine, eating, and sex. For addicts at our sexual addiction treatment centers—in other words, addicts for whom sex is the primary problem—the story is the same. We see these individuals time and time again turning to nicotine, food, alcohol, or drugs as a replacement for their sexual acting out. These related addictions are so prevalent that at Elements facilities we now actively seek to identify and address cross- and co-occurring issues during the first thirty days of treatment. These disorders are nothing new, of course, but addressing them early in recovery certainly is.

Why This Book?

Much has been written about sexual addiction in the last thirty years. The onslaught began with Patrick Carnes’ groundbreaking work, Out of the Shadows: Understanding Sexual Addiction, published in 1983. Prior to that, clinicians were diagnosing excessive consensual adult sexual behavior patterns using antiquated, pejorative terms like nymphomania and Don Juan-ism. Hardly anyone back then had even the faintest idea of what sexual addiction really was, how to diagnose it, its devastating effects, and how to treat it. Even now there is a great deal of confusion, even within the therapeutic community, with some well meaning sex-positive clinicians actually arguing there is no such thing as sexual addiction. (The majority of those clinicians, if pressed, will nonetheless concede that some people do struggle with impulsive and compulsive sexual acting out. These therapists’ bone of contention seems to center on using the potentially sex-negative word addiction in describing such activity.)

Beyond the controversy over nomenclature (how we name this problem) there remains considerable confusion surrounding the identification, effects of, and treatment of sexual addiction. In truth, very few therapists possess a comprehensive understanding of this incredibly complicated disease, and of those individuals only a handful can present that information in words accessible to the layperson. Among these rare individuals is Rob Weiss, an early protégé of Patrick Carnes. In 1995 Rob founded the Sexual Recovery Institute in Los Angeles, one of the first facilities anywhere offering treatment for sexual addiction and related issues. These days Rob is Senior Vice President of Clinical Development, overseeing the development of addiction and mental health programs at multiple treatment programs around the United States. Additionally, he provides sexual addiction treatment training internationally for psychology professionals, addiction treatment centers, and the US military. He has been featured on CNN, Today, the Daily Beast, the Oprah Network, ESPN and in the Wall Street Journal among many other media outlets internationally. In many ways today, along with his mentor Patrick Carnes, Rob has become the face of and driving force behind understanding and treating profound intimacy disorders like sexual addiction.

Since Out of the Shadows first appeared literally dozens of books on sexual addiction have been published, but hardly any present the comprehensive overview found herein, and none are as up-to-date. This book covers everything from what sexual addiction is and how it can best be treated, to how it affects various subgroups of the population such as women, gays, and teenagers, to how sex addicts can protect themselves from the online sexual onslaught. And Rob presents this material in straightforward, concise language that any reader can understand. Clearly, this work is intended to enlighten not only the clinical population, but actual sex addicts and those who love them. If you are a therapist, my sincere hope is that you will find something here that helps you to help others, and if you are a sex addict or the partner thereof, my hope is that you will come away with a better understanding of this complicated issue, and also with some useful ideas on how to overcome this very serious addiction.

—David Sack, MD

1

Defining Sexual Addiction

BOB IS A THIRTY-SIX-YEAR-OLD DIVORCED financial analyst. His wife left him twelve years ago after she learned that he’d been cheating on her with multiple women the entire eleven months they were married and most of the two years prior to that, when they were dating and engaged. After the divorce, without the constraints of marriage, casual sex with any willing woman became Bob’s top priority—not that it hadn’t been already. In the beginning, most of his work was done in bars and clubs. As time progressed, however, his behaviors moved more into the online realm. He found that video chat sites provided access to a lot more women than a local nightclub, and that most of those women were online for the same reason he was: casual sex. Eventually he discovered hookup apps like Blendr, Tinder, and Ashley Madison. Those were like crack cocaine, he says. With the apps, he was suddenly having sex with multiple women weekly. In time, of course, his work suffered, his friendships suffered, and he grew increasingly anxious, short-tempered, and depressed. Finally, he went to a therapist seeking treatment for his depression, and described his life. A lightbulb went off when the clinician said, You know, I think you might have an issue with sexual addiction. Before that, the idea had never even crossed Bob’s mind. He just thought he was a ladies’ man. But when his therapist said the words sexual addiction, he knew it was true.

What Makes an Addiction an Addiction?

Before discussing the specifics of sex addiction, it may be helpful to briefly define addiction in general terms. Put simply, the criteria for addiction (of all types) are as follows:

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.

Today, most people readily understand the concept of substance addiction. If they have not been addicted themselves (to cigarettes, alcohol, prescription medications, illicit drugs, etc.), then they probably know someone who is. Or, at the very least, they’ve seen relatively accurate portrayals of alcoholism and/or drug addiction on television and in the movies. However, behavioral addictions, also referred to as process addictions, are usually more difficult to fathom. Nevertheless, people can and do become addicted to highly pleasurable, self-soothing, dissociative behaviors just as often and just as easily as they become addicted to highly pleasurable, self-soothing, dissociative substances—and with similarly problematic results.

Can a Behavior Really Be Addictive?

The American Psychiatric Association is not overly accepting