Robert Fortney, LPC-Counseling Services of Lubbock
Article by: Krystyn S. Hucks
Human Development and Family Sciences
Part 1: What
Sex is most often a rewarding stimulus that affects similar areas of the brain as do drugs that are commonly abused or deemed “addictive”. While sex and drugs have similar addiction pathways, the term “sex addiction” and its derivatives still lack support for sex being considered addictive, as evidenced by the exclusion of the term(s) from the DSM-5. The primary suspect for this exclusion is the high comorbidity rates associated with a person self-reporting as a sex addict and also having an Axis I disorder. In one study, 88% of the sample met diagnostic criteria for an Axis I disorder, most commonly mood and anxiety disorders, at the time of the interview (Raymond, Colemanb, & Minerb, 2003).
Moreover, it has been noted that compulsive sexual behavior has been estimated to have a prevalence of between 3% and 6% in the United States (Black, 2000). Sex addiction most likely stems from a past sexual abuse. In a study conducted on persons consulting with a sex therapist, the “prevalence of childhood sexual abuse was high in women (56%) and men (37%)” (Berthelot, Godbout, Hébert, Goulet, & Bergeron, 2014).
Many experts in the field of addiction take the view that sex addiction is defined by a client who reports his/her presenting problem as such. This would most likely include patterned sexual behaviors that continue despite consequence that lead to distress or impairment. This is a view that is intended to be representative of the majority of data based upon self-reports. This article intends to keep with the popularity of the term while not stigmatizing any person or devaluing the work done by others in searching for an alternative term.
Part 2: Treatment
Cognitive Behavioral Therapy
This view of sex addiction is based on the theoretical model, which demonstrates the similarities between drug addiction and sex addiction, cognitive behavioral therapy (CBT) is an appropriate choice for treatment and has been most widely recommended for this reason. In addition, CBT covers the key tasks suggested by the American Association for Marriage and Family Therapy (2016) for the recovery of sex addicts; this includes “breaking through denial, learning about the addiction process, and establishing sobriety.” Overall, CBT seeks to “cease addictive behaviors, change maladaptive core beliefs, and reduce shame” (Assumpção, Garcia F., Malloy-Diniz, Garcia, H., & Thibaut, 2014).
Boundaries. Many experts feel that the key to successful implementation of CBT is the establishing and maintaining of boundaries. This is primarily because sex, in most cases, cannot be completely avoided and it would be unhealthy to do so. According to Sex Addicts Anonymous (2004), a person should define boundaries for things that are abusive, high risk, induce pain, or have the potential to lead the addict astray. These boundaries are not meant to eliminate all sexual behavior. Rather, they allow for the existence of behaviors that the sex addict personally deems to be positive. Overall, boundaries are made by the addict, preferably with help from a professional, and should be both precise and obtainable.
Abusive. Boundaries around abusive behavior should be set to ensure that the person, with whom the addict is engaging sexually, has the ability to freely choose whether or not they want to participate in any sexual activity. For example, using power/relationship ties or not informing a partner of any sexual disease(s) is abusive to that person.
High Risk. Behaviors that are high risk increase the chances that the sex addict will be the recipient of harm. This might include having sex with multiple partners (increasing the risk for sexual disease), masturbating while at work (increasing the risk for being fired), etc.
Pain. Some behaviors, such as masturbating to pornography, may pose little to no risk for the addict or others. However, they may evoke feelings of pain or even shame.
Lead Astray. It is important for a sex addict, like a drug addict driving by an area known to have drugs, to avoid places where one could be triggered into breaking previously established boundaries. For example, the addict might avoid driving by the strip club on their way home from work because they know that this often triggers sexual behavior.