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Defining Sexual Addiction
Bob is a thirty-six-year-old divorced financial analyst. His wife left him twelve years ago after she learned that he'd been cheating on her with multiple women the entire eleven months they were married and most of the two years prior to that, when they were dating and engaged. After the divorce, without the constraints of marriage, casual sex with any willing woman became Bob's top priority—not that it hadn't been already. In the beginning, most of his 'work' was done in bars and clubs. As time progressed, however, his behaviors moved more into the online realm. He found that video chat sites provided access to a lot more women than a local nightclub, and that most of those women were online for the same reason he was: casual sex. Eventually he discovered hookup apps like Blendr, Tinder, and Ashley Madison. 'Those were like crack cocaine,' he says. With the apps, he was suddenly having sex with multiple women weekly. In time, of course, his work suffered, his friendships suffered, and he grew increasingly anxious, short-tempered, and depressed. Finally, he went to a therapist seeking treatment for his depression, and described his life. A lightbulb went off when the clinician said, 'You know, I think you might have an issue with sexual addiction.' Before that, the idea had never even crossed Bob's mind. He just thought he was a 'ladies' man.' But when his therapist said the words sexual addiction, he knew it was true.
What Makes an Addiction an Addiction?
Before discussing the specifics of sex addiction, it may be helpful to briefly define addiction in general terms. Put simply, the criteria for addiction (of all types) are as follows:
- Preoccupation to the point of obsession with the substance or behavior of choice
- Loss of control over use of the substance or behavior, typically evidenced by failed attempts to quit or cut back
- Directly related negative consequences: relationship trouble, issues at work or in school, declining physical health, depression, anxiety, diminished self-esteem, isolation, financial woes, loss of interest in previously enjoyable activities, legal trouble, etc.
Today, most people readily understand the concept of substance addiction. If they have not been addicted themselves (to cigarettes, alcohol, prescription medications, illicit drugs, etc.), then they probably know someone who is. Or, at the very least, they've seen relatively accurate portrayals of alcoholism and/or drug addiction on television and in the movies. However, behavioral addictions, also referred to as process addictions, are usually more difficult to fathom. Nevertheless, people can and do become addicted to highly pleasurable, self-soothing, dissociative behaviors just as often and just as easily as they become addicted to highly pleasurable, self-soothing, dissociative substances—and with similarly problematic results.
Can a Behavior Really Be Addictive?
The American Psychiatric Association is not overly accepting of behavioral addictions, excluding all but gambling addiction, from the latest edition of its Diagnostic and Statistical Manual of Mental Disorders (the DSM-5).1 In fact, the APA has recently shied away from using the word addiction in general, now labeling alcoholism and drug addiction as 'substance use disorders,'2 and gambling addiction as 'gambling disorder.'3 However, most other psychotherapeutic professional organizations are considerably more populist and forward-thinking, in particular the American Society of Addiction Medicine. In fact, ASAM's general definition of addiction, adopted in 2011, addresses behavioral addictions quite clearly, opening with the following language:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors [emphasis added].4
Thanks in large part to the APA's behind-the-times stance, there is often a good deal of confusion among not only the general public but therapists too, when it comes to understanding, identifying, and treating behavioral addictions, including sexual addiction. However, this is largely unnecessary if/when one understands addiction's basic causes and origins.
In truth, addictions of all types form and manifest in the same basic ways. For starters, the risk factors for substance and behavioral addictions are the same—most often a combination of genetic and environmental factors.5 In other words, people are at risk when there is a history of addiction (any type) or mental illness (any type) in the family, and/or they themselves have unresolved early-life or severe adult trauma. A lot of the time, these at-risk individuals turn to alcohol, prescription medications, or illicit substances as a way to self-medicate stress, emotional discomfort, and/or the pain of their underlying psychological conditions, but some will also turn to intensely pleasurable patterns of behavior to feel better.
Put very simply, addictive substances and addictive behaviors trigger the same basic neurochemical pleasure response—primarily the release of dopamine (pleasure), along with adrenaline (excitement), oxytocin (love and connection), serotonin (emotional well-being), and a variety of endorphins (euphoria)—resulting in feelings of pleasure, excitement, control, and, most important, distraction and emotional escape. Over time, some people learn that the easiest way to avoid feelings of stress and emotional discomfort is to ingest an addictive substance and/or to engage in a highly pleasurable (and therefore potentially addictive) behavior. Eventually these individuals begin to use these substances and/or behaviors not to feel better, but to feel less (i.e., to control what they feel). This is a sure sign of addiction. The only significant difference between substance and behavioral addictions is that substance addicts ingest alcohol or drugs to create an emotionally escapist neurochemical high, whereas behavioral addicts rely on an intensely pleasurable fantasy or activity to do the same thing, and some abuse both.
Part of the confusion around behavioral addictions arises because certain potentially addictive behaviors are (for most people, most of the time) healthy and essential to life. For instance, eating and being sexual contribute to survival of both the individual and the species. (This is why our brains are programmed to register/experience pleasure when we engage in these activities.) Unfortunately, for vulnerable people (people at risk for addiction thanks to genetics and/or their environment), this inborn pleasure response can become a go-to coping mechanism used to deal with any and all forms of emotional and/or psychological discomfort, turned to time and time again until the individual loses control over it.
To further understand the link between substance and behavioral addictions, consider a cocaine addict on payday. After receiving his check, he runs to the bank to exchange it for cash, perhaps skipping out of work early to do so. Then he dashes off to his dealer's house to spend money that he really ought to set aside for food, rent, childcare and the like. As he approaches his dealer's house, his heart races, he's sweating, and he is so obsessed and preoccupied with using that he doesn't even notice the police car parked a block away. He is so completely focused on cocaine that the day-to-day world, with all of its problems and obligations, has temporarily receded. In most respects this individual is high already. He has already escaped from his emotional life, his decision-making is distorted, and he has lost touch with healthy reality. It doesn't matter that there are no actual 'drugs' in his system because his brain is pumping out dopamine adrenaline and other pleasure/intensity-related neurochemicals leaving him feeling the same kind of high. Achieving and maintaining this neurobiological state of distraction and emotional escape, no matter how it is induced, is the goal for addicts.
Addiction is all about escaping emotional reality via the manipulation of our own neurochemistry, and this can happen with or without an addictive substance. Sex addicts in particular 'get high' based more on fantasies and ritualistic preparations than anything else. In fact, sex addicts experience more pleasure and escape through anticipating, chasing, and preparing for sex than from the sex act itself. They even have a name for this condition, referring to it as feeling like being in a bubble or a trance. In other words, sex addiction is not so much about the sex act itself, rather it's about losing touch with emotional and sometimes realities for an extended period of time. For sex addicts, engaging in actual sex and reaching orgasm ends the high by throwing them back into the real world, where they must once again face life and all its problems, the very things they were trying to avoid and escape in the first place.
1 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, p 481. Washington, D.C.: American Psychiatric Association.
2 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, pp 481–584. Washington, D.C.: American Psychiatric Association.
3 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, pp 585–589. Washington, D.C.: American Psychiatric Association.
4 'Definition of Addiction,' American Society of Addiction Medicine, accessed Dec 31, 2014, asam.org/for-the-public/definition-of-addiction.
5 National Institute on Drug Abuse. (2007). Drugs, brains, and behavior: The science of addiction. Retrieved September 3, 2014, from drugabuse.gov/publications/topics-in-brief/drugs-brains-behavior-science-addiction; Clay, S. W. (2010). Risk factors for addiction. Osteopathic Family Physician, 2(2), 41–45; and numerous other studies.
©2015 Robert Weiss. All rights reserved. Reprinted from Sex Addiction 10: A Basic Guide to Healing from Sex, Porn, and Love Addiction. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the written permission of the publisher. Publisher: Health Communications, Inc., 3201 SW 15th Street, Deerfield Beach, FL 33442.
