John D. Hawkins Jr., M.S., C.A.P., Registered Mental Health Intern

Sexual addiction is currently one of the most controversial topics and diagnosis in the mental health field. There are those who say the whole concept is a sham for client’s to hide behind when confronted by an angry spouse, partner or family member. Clients frequently inform me they suspect their spouse or partner has a sexual addiction. The psychologist who is credited with identifying this disorder and developing the treatment model for sexual addiction is Patrick Carnes. He was the former Clinical Director for one of the most well known treatment centers in the United States, The Meadows in Arizona. He is now a part of Pine Grove Treatment Center in Mississippi, which is where Tiger Woods entered treatment following the public outing of his numerous infidelities.

While working with countless substance dependent individuals, Carnes began to recognize many of his clients engaged in sexually compulsive behaviors that have the same characteristics as their substance abuse. Furthermore, that if these behaviors were not identified and addressed, it regularly led back to the use of their drug of choice. We now have empirical evidence that what we as therapists refer to as process addictions, such as pornography & gambling, triggers release of neurotransmitters in the brain just as psychoactive substances do. And if these are not treated, an individual has not truly achieved sobriety. One of the primary causes of individuals relapsing into substance use is only ceasing use of a particular substance and not learning how to live non-compulsively. In addition, almost all individuals engaging in sexually compulsive behaviors had a concurrent substance dependence on at least one other substance. For example, cocaine use was typically associated with sexually compulsive behaviors, such as frequent or chronic masturbation. If an individual terminates cocaine use but continues to engage in his sexual compulsivity, he is still trigger the same neurotransmitter release in specific regions in his brain, which will eventually stimulate urges to use cocaine.

In our popular culture, we hear the term addiction associated with everything from the Internet to chocolate to children’s’ trading bracelets. This has caused many to be skeptical of disorders such as sexual addiction. Due to the ever-decreasing reticence towards accepting responsibility in our current society, this cynicism is not without merit. To address this concern, I will first lay out a simple, three item definition to assess whether a particular behavior meets the criteria for what would be termed an addiction.

• Loss of control
• Continued use despite negative consequences
• Preoccupation or Obsession

If these characteristics would describe a certain behavior an individual regularly engages in, we would not be unjustified associating it as an addictive behavior.

When discussing sexual behaviors, I believe clarifying between sexual compulsivity and addiction is a necessity for understanding. An examination of substance abuse as a parallel is helpful. Millions of individuals use alcohol in the United States. The abuse of alcohol takes place along a wide continuum: some abuse alcohol occasionally; others abuse alcohol on a regular basis; and still yet others become alcohol dependent, what we would term an alcoholic. In relation to sexuality, some engage in occasional sexual compulsive behaviors, such as certain uses of pornography or an infrequent ‘one-night stand’. Another segment of individuals would regularly participate in sexual behaviors such as strip clubs, prostitutes, or frequent sexual encounters in an effort to engage in an escape from distressing emotions related to aspects of their daily life. A much smaller percentage of individuals regularly take part in behaviors that place aspects of their life, such as their health, relationships, and employment at risk. Those at the far end of the continuum are perpetrators of sexual crimes, such as voyeurism, rape, and molestation.

Another facet of addiction that is true of sexual addiction is tolerance and withdrawal. Due to the fact that these behaviors induce increased neurotransmitter release, such as dopamine and norepinephrine, which are the same neurotransmitters released when ingesting cocaine, the body will attempt to counteract the effect of this excessive neurotransmitter release; this is what is referred to as tolerance. An individual engaging in sexual compulsive behaviors on a regular basis will no longer achieve the same level of stimulation as they did earlier. They will require an ever-increasing level of intensity to attain their desired effect. An example of this may be an individual who begins viewing Internet pornography, then participating in sexually explicit chat rooms, and finally engaging in real-life sexual encounters. I personally treated a client who came to me for couple’s therapy due to an affair, but when the details were fully disclosed, the event was the culmination of his addiction to pornography that had begun years earlier. The spouse of the client informed me they had not had sex in over five years. This was, in large part, a result of his inability to be stimulated by his spouse due to the tolerance he had acquired from his pornography use.

In my opinion, sexual addiction is a true disorder that can be truly devastating to those suffering from this affliction, as well as their family members who care for them. This by no means justifies their behaviors or abdicates responsibility. The fear of this occurring is why, I believe, so many are reticent to accept sexual addiction as a valid diagnosis. Just as with any addictive disorder, an individual can ultimately seek help, even if they have lost control of their behavior. Another key part in acknowledging sexual addiction is delineating the difference in severity and scope between sexual compulsivity and sexual addiction. Again, similar to alcoholism, not everyone who occasionally abuses alcohol is an alcoholic; the every three month binger and the fifth of vodka a day alcoholic are not in the same category, although the binger could experience life devastating consequences during their binge, such as DUI, sexual abuse, or physical accident. Working with any addictive disorder, whether sexual addiction or substance dependence, requires an individualized approach to assess and treat the specific needs of that unique individual.

I would not diagnosis a client as suffering from sexual addiction without an extensive assessment and detailed history. With that being said, I have diagnosed and treated numerous clients as suffering form sexual addiction. We as therapists know more than ever about sexual compulsive behaviors and sexual addiction than ever before. Sexual addiction is a treatable disorder. There is no need to continue to ‘Hide in the Shadows’, as Carnes would say. If you would identify your sexual behaviors as compulsive and generating negative consequences, I urge you to obtain help today.