Sexual Compulsivity: The Secret Addiction
by: James Howard, Licensed Professional Counselor
Director, Missouri Lawyers' Assistance Program

With all the attention in the media about the sexual behavior of our president, this seems like a good time to look at sexual behavior in the context of compulsivity, and its attendant consequences.

To provide insight into this area, I recently interviewed Chris Frey, LCSW, a nationally recognized expert on sexual addiction, dual addictions and healing childhood trauma.

Question:

Chris, it seems to me that the last remaining "secret" addiction is sexual compulsivity. Would you agree with this and, if so, elaborate on what contributes to this secrecy?

Answer:

I agree, sex and gambling are the secret addictions we need to be looking at closely as the 90's come to an end. In terms of secrecy, the stigma about sexual addiction is, today, in the place that alcoholism was in the early days of AA; it was okay in our culture to get drunk, but folks who admitted they were alcoholic were judged as morally deficient. In many circles today, it is accepted, or at least ignored, that many people act out sexually with pornography, strip bars, extramarital affairs, but for a person to come forward and say, "I have a problem with sex," is for most a courageous choice accompanied by deep shame and fear of consequences. Our world both exalts (through media) and denounces (through shame-based morality) sex, setting a very confusing and scary picture for a young person beginning to hide in sexually acting out. And remember, more than ever before, sexual contact with a live person can kill in today's world of AIDS and other sexually transmitted diseases. Finally, I believe the video and computer age have made it much more possible for us to hide out in secret, solitary sex. Sex without relationship and intimacy becomes unhealthy, possibly compulsive; and it is available to our youth and ourselves at the touch of a computer keyboard.

Question:

Is sexual compulsivity really an addiction and, if so, how is it similar to other addictions? What is different?

Answer:

Jim, I tired quickly of the current disagreement among professionals about whether something exists in sexual behavior that we can call an addiction. Whatever we label it, this is a greatly under-reported issue. I believe that sexual dysfunction of many forms is one of the most prevalent causes of relapse for alcoholics and chemical dependents. It is clear that there are many people who suffer from an obsessive thought process and pattern of compulsive sexual behavior that seriously damages them and others, a pattern that closely mirrors many of the aspects of our best understood addiction, alcoholism. Sexual addiction is a learned set of behaviors and does not fit into the disease model of alcoholism, but the pattern of preoccupation, the continuing of compulsive behaviors in spite of often disastrous consequences, and withdrawal when removed from the "drug," closely mirror the key aspects of other addictions. I care less about the label of sex addiction and more about the methods of understanding addictive behavior that assist us in helping a person whose sexual behavior has become dangerous and out of control.

One key difference between sex and chemical dependency is that most sex addicts will not choose to go the rest of their lives without sex, whereas the foundation of chemical dependency recovery is lifelong abstinence. Sex addicts often need a period of abstinence to "withdraw," to clear up emotionally and cognitively, and to develop a solid program of recovery. This program includes an essential issue, understanding that a sex addict can remove himself/herself from many triggers for the addiction (strip bars, pornography, etc.), but the primary driving force of this addiction, fantasy about sex, lives within the person and must be confronted.

Question:

Does this condition get progressively worse?

Answer:

Progression is one symptom of chemical addiction that may not be present in the sexual addict in the same way. The roots of sexual addiction are always in childhood. A child or adolescent finds sex, often compulsive masturbation first, as a method to calm some trauma that he/she has experienced; sexual abuse, sexual confusion, abandonment, or maybe a simple way to close out mom and dad's nightly arguments so he/she can go to sleep. This child is not masturbating as a normal and healthy process of self-discovery, he/she is trying to quiet some intense emotional or spiritual pain. This child may eventually move on to other, more risky behaviors ... pornography, phone sex, massage parlors, anonymous sex, serial affairs or may remain focused on the original compulsive behavior with little progression in behavior choice. Second, this addict may progress in frequency of the behavior, or may find a level of compulsive "use" that is continued for years. What are often most progressive are the consequences of the addiction ... detachment from peers and family, slowing of emotional development, diminished sexual desire for your primary partner, fear of discovery, shame; and in some behaviors like anonymous sex, risk of disease, physical attack, and legal problems.

A sidebar for those who deny the existence of this compulsion, or shame those who struggle with it, is the understanding that its roots are in childhood. Many of my clients are multiply addicted and sex addiction usually pre-dates their other addictions. In other words, folks are engaging in compulsive sexual behavior before they have any idea of what sex is really about, let alone grasping the future consequences of their behavior. This does not remove responsibility from the adult sex addict for his or her behavior, it simply provides us with a way of seeing the addictive behavior as unhealthy, perhaps even illegal and immoral, without seeing the addict as hopeless or worthless.

Question:

What are the stages and symptoms of sexual addiction?

Answer:

Jim, the best source for understanding the stages of sexual addiction is still the work of Patrick Carnes, Out of the Shadows and Contrary to Love. Briefly, the early stage of sex addiction is Initiation, the beginnings of the compulsive process. Carnes has stressed the terms Catalytic Environments and Catalytic Events at this stage. Often the future sexual addict grows up in an addictive and sexually dysfunctional environment; this can take many forms. In addition, most sexual addicts experienced a critical event or events which froze them in their sexual development, in some regard. These are events in which the addict is traumatized and, often, finds a sexual outlet that eases the pain. In the case of a child who is sexualized by a parent and later turns to compulsive masturbation, he/she has no way of knowing that the "cure" for the pain will eventually become as painful as the original trauma and will, in fact, prevent him/her from confronting and healing the abuse. Sobriety, then, is not only a vehicle for recovering from the pain and consequences of the addiction, it is an opportunity to unfreeze and heal the Catalytic Events.

The addict them moves to what Carnes has called Establishment, the time in which the addict becomes increasingly preoccupied with, and develops ritualized behaviors for, acting out. Compulsivity and shame increase through the Contingency stage as the addict moves toward Acute acting out and, finally, as in other addictions, the Chronic stage.

Question:

What has been your experience in treating these individuals, particularly in terms of outcomes?

Answer:

I do not keep outcome statistics, but much like other addictions, the relapse rate in sexual addiction is high. The good news ... there are many sober sex addicts moving about our world. I find that a desire to quit, a desire to move beyond the consequences, a willingness to accept responsibility for the damage caused to self and others, and solid information about this addiction are key starting places for recovery. It's amazing to me the number of addicts who commit to sobriety as a result of being provided simple information and empathy about this pain they have wrestled with since childhood, believing no one could understand and having no explanation of their struggle. This commitment may translate into researching the literature for a grasp of the addiction, psychotherapy to change thinking and behaviors, a strong 12-step program of recovery (SA, SCA, SLAA), and, for many, healing work around the childhood trauma that provided the original spark for the addiction. For most addicts, another essential part of healing is how to learn about healthy sex and place healthy sexuality back into their lives.

One other note: As I stated, many individuals are multiply addicted. This may seem unfair or obvious information. One piece of good news for the person who has worked a strong program of recovery for one addiction ... most of what you already know and already works will translate into sexual recovery. You don't have to re-invent the wheel, you do have to do what works.

Question:

What has been your experience in treating professionals with a sexual addiction?

Answer:

I have begun treating more professionals who struggle with sexual addiction in the past several years. Perhaps professionals have some of the most difficult denial; many are used to being in charge, in control, and are quite capable of working their way out of the consequences of many negative situations. Professionally, there may also be much to lose through exposure of an addiction, particularly one with the moral loading our culture places on sex. It is essential to remember, though, that over time, the consequences of secrecy compound and most addicts cannot quit on their own, despite pain and promises. There are treatment professionals, inpatient and outpatient, skilled at this work who can provide anonymity and excellent service. There are programs, such as MOLAP, who have taken on the mission of assisting addicts, of all types, with accessing this treatment. If this article speaks to you or someone you care about, consider what type of help you need, what type of professional you might risk trusting with your secret (male, female, young, older, close to home, some distance away, level of experience, etc). Then, make a call, find that help.

Question:

Finally, what is the connection, if any, between the lack of fathering, initiation and mentoring by so many boys today and sexual problems?

Answer:

A great question to end on, Jim. How many of us, sex addicts or not, were given a significant amount of useful information about sex, intimacy, relationship from men. My father could not give me information he did not have and did not have the skills to communicate. We, as fathers, need to inform ourselves about sex, and develop a comfort with communicating our knowledge, so we can inform our children. I often find this knowledge, personally, in a circle of other men who are experienced fathers and can teach me from their successes and failures.

One exercise I use with clients is this ... Imagine the age you were when you first started acting out sexually in a compulsive manner. Now, imagine that you are the father of that boy. Go to the child, where do you find him? Ask him to sit and answer one question. "If you could have any five things or people you want; an activity, some type of attention from me, something material, anything ... that would be important enough that you would replace acting out with these, what would the five things be?" Jim, every person I've asked has an answer. The answers are many ... time with dad, a hug, an end to the fighting, a sober dad, fishing, golf, a bicycle, a dog, someone who was proud of me ... you get the picture.

Thanks for the opportunity to share my thoughts and feelings on a topic that I believe is essential to anyone interested in recovery.

For confidential, professional help for sexual concerns or any other personal problem, call the Missouri Lawyers' Assistance Program (MOLAP) 1-800-688-7859.