Sex Addiction, Sex Addiction and Treatment

The idea that addiction is somehow a psychological illness is, I think, totally ridiculous. It’s as psychological as malaria. It’s a matter of exposure. People, generally speaking, will take any intoxicant or any drug that gives them a pleasant effect if it is available to them. – William S. Burroughs

Addicts turn their pleasures into vengeful Gods. – Mason Cooley

What is Sexual Addiction

The National Council on Sexual Addiction and Compulsivity has defined sexual addiction as “engaging in persistent and escalating patterns of sexual behavior acted out despite increasing negative consequences to self and others.”(2) Sexual addiction is best described as a progressive intimacy disorder characterized by compulsive sexual thoughts and acts. Like all addictions, its negative impact on the addict and on family members increases as the disorder progresses. Over time, the addict usually has to intensify the addictive behavior to achieve the same results.(5)

The essence of all *addiction is the addicts’ experience of powerlessness over a compulsive behavior, resulting in their lives becoming unmanageable. The addict is out of control and experiences tremendous shame, pain and self-loathing. The addict may wish to stop and is unable to do so. The unmanageability of the addicts’ life can be seen in the consequences (s)he suffers by the loss of close relationships, difficulties with work, arrests, financial troubles, and a loss of interest in things not directly connected to their addiction, low self-esteem and despair.

Sex addiction can involve a wide variety of practices, and may co-occur (dual diagnosis) with drug and alcohol addiction or other substances and psychological disorders. A large number of sex addicts say their unhealthy use of sex was a progressive process. It may have started with an addiction to masturbation, pornography (either printed or electronic), a relationship, multiple relationships, or a series of one-night-stands, but over the years progressed to increasingly dangerous behaviors.

Sex addiction is characterized by compulsive sexual encounters (physical, emotional, or fantasy) that become self-destructive, are progressively “acted-out,” and are not genuinely emotionally fulfilling, feelings of pronounced shame, and that (s)he is unable to stop even though it causes recurring and progressive problems in the areas of marriage, social relationships, health, employment, finances, or the law.  Sex addiction becomes the primary mechanism for the addict to temporarily self-medicate in an effort to minimize / alleviate stress, emotional or psychological pain, or an attempt to confront, manifest, play-out or replicate an addict’s fears.  In fact, “it is not uncommon for sexual addicts to have experienced some sort of sexual abuse or trauma, or other form of abuse, in their childhood.”(1)

Countless research studies have focused on genetics and the chemistry of the brain to decipher the disease of addiction theorizing that a poly-genetic pre-disposition (history of addiction in a family) may be 25% to over 50% responsible for an addicts’ physical and, thus, emotional compulsive need. When pleasure centers in the human brain are stimulated, chemicals called endorphins (a natural opiate, this neurotransmitter is similar to morphine. It is produced in the pituitary gland. It protects against excessive pain, and is released with ACTH into the brain) are released into the blood stream. Endorphins and related chemical compounds / hormones released naturally are believed to be associated with the mood changes that follow sexual release. Any chemical that causes mood changes can be addictive, with repeated exposure altering brain chemistry to the point that more of the chemical is “required” in order to feel “normal.” Viewed from a physiological or bio-chemical standpoint, the constant compulsion to achieve an endorphin “high” may be no different than opiates to a heroin addict or alcohol to an alcoholic and, as time goes by, the body requires ever increasing amounts of the chemical to feel “normal.”  The addict’s brain can eventually become permanently damaged so that the brain’s receptors are “tuned-in” only to the chemicals to which (s)he’s addicted.

Indicators of Sexual Addiction

The sex addict uses sex as a quick fix, or as a form of medication for anxiety, pain, loneliness, stress, or sleep. Sex addicts often refer to sex as their “pain reliever” or “tension reliever.” Other indicators that sexual behavior may be out of control include:

  • an obsession with sex that dominates one’s life, including sexual fantasies that interfere with work performance
  • excessive time devoted to planning sexual activity that it interferes with other activities strong feelings of shame about one’s sexual behavior
  • feelings of powerlessness or inability to stop despite predictable adverse consequences
  • inability to make a commitment to a loving relationship and/or extreme dependence upon a relationship as a basis for feelings of self-worth
  • little or no genuine emotional satisfaction or attachment gained from sexual encounters

Compulsive or addictive sexual behavior may take various forms, including what many regard as “normal” heterosexual behavior. The type of sexual activity and even the frequency or number of partners are not of great significance in diagnosing this problem. Some individuals have a naturally stronger sex drive than others, and the range of human sexual activity is so broad that it is difficult to define “normal” sexual behavior. What is significant is a pattern of self-destructive or high risk sexual behavior that is unfulfilling, a person is unable to stop, and their life becomes unmanageable as a result.

The first major study of sexual addiction was published by Patrick Carnes in 1991.(4) It was based on questionnaires filled out by 752 males and 180 females diagnosed as sex addicts, most of them admitted for treatment in the in-patient Sexual Dependency Unit of a hospital in Minnesota. The others had at least three years of participation in one of the 12-step programs for recovery from sexual addition. Of the sex addicts in this survey, 63% were heterosexual, 18% homosexual, 11% bisexual, and 8% were unsure of their sexual preference.

The sexual addicts who responded to Carnes’ questionnaire were typically unable to form close friendships. Their feelings of shame and unworthiness made them unable to accept real intimacy. They were certain they would be rejected if others only knew what they were “really” like, so they found myriad obsessive ways to turn away a potential friend or loving partner. Despite a large number of superficial sexual contacts, they suffered from loneliness, and many developed a sense of leading two lives–one sexual, the other centered around their occupation or other “normal” activity.

In Carnes’ survey, 97% responded that their sexual activity led to loss of self-esteem. Other reported emotional costs were strong feelings of guilt or shame, 96%; strong feelings of isolation and loneliness, 94%; feelings of extreme hopelessness or despair, 91%; acting against personal values and beliefs, 90%; feeling like two people, 88%; emotional exhaustion, 83%; strong fears about own future, 82%; and emotional instability, 78%.

Carnes found that 42% of sex addicts in his sample also had a problem with either alcohol or drug dependency and 38% had eating disorders.

Consequences of Sexual Addiction

In general, as an addict’s sex addiction progresses their behavior conforms to a cycle:

  • Preoccupation — the addict becomes completely engrossed with sexual thoughts or fantasies.
  • Ritualization —- the addict follows special routines in a search for sexual stimulation, which intensify the experience and may be more important than reaching orgasm.
  • Compulsive sexual behavior -— the addict’s specific sexual acting out.
  • Despair —- the acting out does not lead to normal sexual satisfaction, but to feelings of hopelessness, powerlessness, depression, and the like.

Compulsive sexual thoughts and/or behavior leads to increasingly serious consequences, in both the addict’s internal and external worlds. The consequences include:

  • broken marriages and relationships
  • severe depression
  • suicidal thoughts
  • low self-esteem
  • shame
  • self-hatred
  • hopelessness
  • despair
  • intense anxiety
  • loneliness
  • fear of abandonment
  • remorse
  • self-deceit.
  • moral conflict

Health consequences of sex addiction

  • HIV infection
  • genital herpes, syphilis, gonorrhea, and other sexually transmitted diseases (STD’s).
  • Physical damage to sexual organs, surrounding areas, or to the body
  • Sexual addiction can also be (but is not always) associated with Obsessive Compulsive Disorder (OCD), Narcissistic Personality Disorder, and manic-depression, among other disorders

Legal and financial consequences

Legal consequences of sex addiction result when illegal behaviors such as voyeurism, exhibitionism, or inappropriate touching, result in arrest and incarceration. Child molesting and rape in some cases are addictive behaviors. Sexual harassment in the workplace can be part of a sex addict’s repertoire, and may result in legal difficulties on the job. Some sex addicts go to jail, lose their job, get sued, or have other financial and legal consequences because of their compulsive sexual behavior.

Financial difficulties from the purchase of pornographic materials, use of prostitutes and telephone and computer lines, travel for the purpose of sexual contacts, and other sexual activities can tax the addict’s financial resources, sometimes to the point of bankruptcy, as can the expenses of legal representation. Sixty percent of addicts have faced financial difficulties, 58% engaged in illegal activities, and 83% of sex addicts also had co-occuring addictions such as alcoholism, drug addiction, eating disorders, or engaged in other compulsive behaviors.

Treatment of sex addiction

Overcoming sexual compulsivity and addiction starts with recognizing that you are out of control sexually. Getting to that point requires taking a hard look at yourself and the problems – emotional, physical, financial, or legal – caused by your sexual behavior.  Is your life un-manageable because of your sexual behavior?

Treatment focus

Treatment will focus on two main issues. The first is the logistical concerns of separating you from harmful sexual behavior in the same way drug addicts need to be separated from drugs.

Accomplishing this might require inpatient or residential treatment for several weeks. An inpatient setting protects you from the abundance of sexual images and specific situations or people that trigger compulsive sexual behavior. It’s simply harder to relapse in a structured and tightly controlled setting. Sometimes, you can succeed in an outpatient setting with adequate social, family and spiritual support.

The second and most difficult issue involves facing the guilt, shame and depression associated with this illness. It takes trust and time with a competent therapist to work through these emotions. If you are very depressed, the best treatment might be an inpatient residential setting where professionals can monitor and properly manage your symptoms.

12-Step Programs
Twelve-step programs, such as Sexaholics Anonymous, apply principles similar to those used in other addiction programs, such as Alcoholics Anonymous and Narcotics Anonymous. However, unlike AA, where the goal is complete abstinence from all alcohol, SA pursues abstinence only from compulsive, destructive sexual behavior. By admitting powerlessness over their addictions, seeking the help of God or a higher power, following the required steps, seeking a sponsor and regularly attending meetings, many addicts have been able to regain intimacy in their personal relationships.

Cognitive-Behavior Therapy
This approach looks at what triggers and reinforces actions related to sexual addiction and looks for methods of short-circuiting the process. Treatment approaches include teaching addicts to stop sexual thoughts by thinking about something else; substituting sexual behavior with some other behavior, such as exercising or working out; and preventing the relapse of addictive behavior.

Interpersonal Therapy
People addicted to sex often have significant emotional baggage from their early lives. Traditional “talk therapy” can be helpful in increasing self control and in treating related mood disorders and effects of past trauma.

Group Therapy
Group therapy typically consists of a healthcare professional working with a group of between six and 10 patients. Working with other addicts allows you to see that your problem is not unique. It also enables you to learn about what works and what doesn’t from others’ experiences, and draw on others’ strengths and hopes. A group format is ideal for confronting the denial and rationalizations common among addicts. Such confrontation from other addicts is powerful not only for the addict being confronted, but also for the person doing the confronting, who learns how personal denial and rationalization sustained addiction.

Recent research suggests that certain psychiatric medications — namely antidepressants — may be useful in treating sexual addiction. In addition to treating mood symptoms common among sex addicts, these medications may have some benefit in reducing sexual obsessions.


2 The National Council on Sexual Addiction and Compulsivity – and
3 Defense Security Services –
4 Patrick Carnes (1991). Don’t call it love: Recovery from sexual addiction, (New York: Bantam, pp. 22-23, 30-34).
5 Michael Herkov, Ph.D., Mark S. Gold, M.D., and Drew W. Edwards, M.S., Feb 2001

*Remarks: Addiction is a disease and should be characterized as such whether or not it is sex addiction, alcoholism or the broad spectrum of chemical dependency, and should not be construed as an addict’s lack of will power, personal strength, inability to make informed decisions, or personal fault of character. Genuine will power to overcome an addiction by addicts is manifested in their daily (minute by minute) struggle – battle – to overcome their addiction and recover to lead satisfying and productive lives.  For more information: Addiction and Genetics and Drug Addiction and Addiction Intervention and Interventionists.

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