AAMFT Consumer Update
Sexual Addiction

Nearly 12 million people suffer from sexual addiction in the United States. Due to the accessibility of sexual material available on the Internet, cable television and videos, these numbers are increasing. Despite common misunderstandings, this addiction is not simply about "too much sex."

Sexual addiction is a serious problem in which one engages in persistent and escalating patterns of sexual behavior despite increasing negative consequences to one's self or others. Like other addictions, these behaviors continue despite sincere and persistent efforts to stop. Some might not think sex can be addictive because there are no chemicals involved. However, the body produces many hormones and neurotransmitters during sex that produce the same chemical "high" as drugs or alcohol. Sex addicts, like other addicts, often have a background of abuse (sexual, physical, emotional) and/or neglect, and family histories sprinkled with numerous addictions.

Because of the denial and shame associated with sexual behaviors, it is only recently that the reality of sexual addiction has been acknowledged by those caught in its grasp or by treatment professionals.  Since this problem was first addressed in 1983, some have argued that sexual addiction does not exist or is exaggerated. Nevertheless, acknowledgement of compulsive sexuality is growing, and more help is available today than ever before. 

What are the signs?

When sex has become addictive, it is used compulsively to "numb-out," get a "high," or both. An indicator that sexual addiction could be present is if someone expresses concerns about the sexual behavior of a spouse or partner that is not a part of their relationship (like viewing pornography or visiting a strip club). Another sign is if sexual behaviors are kept hidden from a spouse or others. Additional questions to ask to help identify if sexual behaviors are part of a sexual addiction are:

• Have you lost control over your sexual behaviors? Have you crossed lines you didn't think you would cross? Set limits on your sexual behavior that you have failed to meet?  
• Have you experienced negative consequences (such as the loss of a relationship, being less productive at work, or spent less time with family or friends) because of your sexual behavior? Or would you experience negative consequences if others found out about your sexual behaviors?
• Have you tried to stop any sexual behaviors but eventually returned to them?

If a positive response is given to any of these questions, it is a good indication that the person has become sexually addicted, and further assessment by a marriage and family therapist or other professional specializing in sexual addiction treatment is recommended. 

What are some behaviors associated with a sexual addiction? 

• Compulsive masturbation
• Simultaneous or repeated sequential affairs
• Pornography
• Cybersex, phone sex
• Multiple anonymous partners
• Unsafe sexual activity
• Partner objectification/demand for sex
• Strip clubs and adult bookstores
• Use of prostitution/escorts
• Sexual aversion/anorexia
• Frequenting massage parlors
• Sexual paraphilias (a need for unusual sexual stimulation) and/or any sexually offensive behavior

What causes sexual addiction? 

Compulsive behaviors (as listed previously) are often fueled by mismanaged anger or fears of intimacy, and have their roots in the sexual shame of one's family of origin. Incest, avoidance of sex education, double-standards, sexual secrets, or sexual acting out by a parent (such as affairs or pornography use) can all lay the foundation for later sexual compulsivity. Sexual acting out can be used for various reasons, including to medicate emotional pain, manage stress, or as a substitute for true intimacy. As with other addictions, there is usually an escalation of these behaviors due to tolerance, as the addict continues to pursue the needed "high" and/or "anesthetic" regardless of the escalating costs. Unfortunately, many individuals struggling with sexual addiction do not seek help, due in large part to the high degree of shame associated with a problem in this area.

Getting Help

Treatment generally includes a combination of individual, marital, and group therapy. Key tasks for recovery include breaking through denial, learning about the addiction process, and establishing sobriety. These are not necessarily sequential and most addicts will begin working on several of these simultaneously during the initial phase of therapy.

Much of the work in these first tasks is designed to help establish stability for the addict and his or her family. For instance, it is not uncommon for the addict to continue to minimize or deny the extent, frequency and/or damage caused by the sexual acting out. Reading books on the topic, attending self-help groups with others facing the same addiction, or working on a sexual history can help the individual more fully recognize the need for help.*

Establishing sobriety early on in treatment is a critical, yet often difficult task. Defining sobriety can be challenging because complete avoidance of all sexual behaviors is usually not the goal of treatment. Identifying the specific behaviors to be sober from is critical. In addition, addicts must recognize the people, places, emotional states, and relational dynamics that trigger them into the addictive process and which need to be avoided or more effectively managed. If one's primary form of acting out is via the Internet, computer usage can be limited to certain times or places, and filtering or monitoring software can be used. A detailed plan of action for recovery also needs to be created. This plan can be shared with one's partner or family as part of an overall process of restoring relational trust.

Group work is strongly recommended because it affords the recovering addict both support and accountability. Within 12-step groups, it is common to seek out a sponsor with whom one can work through the 12-steps and check-in regarding sobriety. Such groups often provide the added benefit of increased flexibility (more groups per week, different hours, locations, etc.) at no cost. This is particularly helpful when encouraging the addict to have daily contact with somebody regarding recovery, which is important during the initial phase of treatment. 

Couples therapy is also an essential part of recovery. A spouse or partner may fail to see the need for his or her involvement. Initially, the goal of couples therapy is to stabilize the relationship and help the spouse work through the trauma they have experienced. The ultimate goal is to establish a desired level of intimacy, both sexually and non-sexually. An important goal is to help the couple restore trust in the relationship through a process of apology and forgiveness. 

Consumer Resources

Online

The Society for the Advancement of Sexual Health (SASH), www.sash.net
Resources and information about sexual addiction.

Sex Addicts Anonymous (SAA), www.sexaa.org
12-step groups for sex addicts.

Recovering Couples Anonymous, www.recovering-couples.org
Recovering groups for couples where one partner is a sex addict.

Books and Workbooks

*Facing the Shadow: Starting Sexual and Relationship Recovery, by P. Carnes, 2001. Gentle Path Press.
Tools to help the addict break through denial. Includes the "list of excuses," "denial worksheet" and the "consequences inventory." 

Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for Addicts and Co-dependents, by R. Earle and G. Crow, 1998. Tri Star Visual Communications.

Out of the Shadows: Understanding Sexual Addiction, 3^rd ed., by P. Carnes, 2001. Hazelden.

The text of this brochure written by C. Everett Bailey, PhD and Brian Case, PhD.

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