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Recovering From Sex Addiction

With four competing 12-Step programs and numerous new treatments, sexaholics have more options than ever—just in time for the Internet age's explosion in diagnoses.

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By Hunter R. Slaton

05/29/12

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After several years in Alcoholics Anonymous, “Jennifer,” now a 74-year-old Tampa Bay–area resident, realized she had a problem with sex, too. “I’d been doing the same things in the rooms of AA that I’d been doing in bars: picking people up and having a lot of casual sex partners,” she recalls. Coming to the self-diagnosis that this behavior was proof positive of her sex addiction, Jennifer started going to meetings of Sex and Love Addicts Anonymous (SLAA) two years after the pioneering group launched in 1976. There she quickly grabbed some tools—literally—to distract her mind from sexual thoughts. Building things and doing fix-it projects around the house have served her well ever since, allowing her mind to “go into idle.”

Fantasies are a tricky negotiation for recovering sex addicts (or people suffering from “hypersexuality”—the revised DSM, due out next year, reportedly will deny this problem the addiction label). Whereas a drunk can’t quite “think up” an alcoholic slip, euphoric erotic recall is rote for sex-obsessives the world over.

The addiction-or-not argument may remain unresolved, but treatment for sexual obsessions and compulsions has made impressive strides over the past three decades. Standard treatment for sex addiction these days is membership in a 12-Step program plus cognitive behavioral therapy (CBT), a systematic, short-term, goal-setting approach to the talking cure. In the 1980s, frustrated with the failures of the “just-stop-what-you’re-doing” method of fighting hypersexuality, Mississippi-based sex-addiction pioneer Patrick Carnes, PhD, developed a task-oriented CBT (the “Thirty Task Model”) that has inspired numerous treatment programs. Carnes is the eexecutive director of the Gentle Path program at Pine Grove Behavioral Center in Hattiesburg, where golfer Tiger Woods and other celebrity sexaholics have spent time.

As the thinking goes, Jennifer had to challenge her own patterns and routines before starting to figure out how she ended up trolling bars after an uneventful childhood as the daughter of non-alcoholic parents and the sister of three Eagle Scouts.

Not everyone in an “S” fellowship has to follow any particular formula for changing their sexual behavior.

Unlike traditional psychotherapists, who tend to focus on family issues and early development, CBT therapists ask sex addicts to own up to their behavior and their beliefs about themselves; patients even get homework. Alex Katehakis, MFT, clinical director of the Center for Healthy Sex in Los Angeles, gets patients to list everything they do that is “secret, shaming or abusive.”

And then there’s the all-important spring cleaning—the sex equivalent of “getting all the booze out of the house,” says counselor Jeff Schultz, LPC. This is a lot harder in the digital age than it used to be. Chucking flesh magazines and DVDs is one thing, but people need computers and the Internet—where more than 12% of all websites are pornographic—for work and for keeping in touch with family and friends, so cutting the broadband cord is rarely practical.

One option is to set up web-browsing filters or even “accountability software,” which tracks computer activity and shares it with an “accountability partner,” or if sexting is a problem, canceling the text part of your cell-service package.

But that doesn’t touch some of the biggest temptations. “Smartphone apps are crack for sex addicts,” says Robert Weiss, LCSW, founding director of LA’s Sexual Recovery Institute. GPS-based dating services such as Grindr for gays and Blendr for straights make it incredibly easy to find people willing to hook up. And now there’s Siri, the iPhone 4S’s “humble personal assistant.” In the past, if you wanted to find a prostitute, you had to get dressed, get in your car and risk getting arrested. Now all you have to do is ask, “Siri, where are the escorts?” And she will tell you.

It’s very difficult to get sober from sex addiction by yourself, even with the help of a therapist. Since hypersexuality is a problem of isolation and generally comes weighted with an extra dose of shame, 12-Step meetings—with their emphasis on fellowship and acceptance of newcomers regardless of the state in which one “comes in”—seem especially well-suited to the problem.

If a sex addict is unwilling to try a 12-Step program, group therapy can be a good stand-in, so long as the group is specifically focused on sex addiction. Futhermore, group therapy—which is widely viewed as offering more benefits than one-on-one therapy for people struggling with addiction of any kind—holds a potential advantage, in that groups are typically smaller in size, and members are allowed to express their thoughts and feelings about what their fellow members are sharing (whereas 12-Step meetings forbid such “crosstalk”).

But 12-Step programs are still the gold standard when it comes to sex addiction, although there are a number of differences among them. Of the four major “S” fellowships, only Sexaholics Anonymous (SA) defines just what “sexual sobriety” means. And SA is the most conservative from a Judeo-Christian point of view, teaching that “any form of sex with oneself or with partners other than the spouse is progressively addictive and destructive.” Sexual Recovery Anonymous (SRA) is SA’s close cousin, except that “committed relationship” is substituted for “spouse.”

Sexual Compulsives Anonymous (SCA) started as a fellowship for gay and bisexual men and is now much broader. One current SCA member, a 45-year-old LA resident whom we’ll call Scott, remembers about 90% of members being gay men at his first meetings in 1996. It was a welcoming community for him at the time, as a recent refugee from Sex and Love Addicts Anonymous (SLAA): “For me to share [at SLAA meetings] about having gay sex at bathhouses was uncomfortable,” he says. That honesty allowed Scott to begin working the steps—although he ended up having to get chemically sober before his sexual sobriety could kick in.

Not everyone in an “S” fellowship has to stop drinking—or follow any particular formula for changing their sexual behavior, either. The big attraction for many SCA members is that they’re allowed to define their own sexual sobriety. You outline a recovery plan with your sponsor by pinning down your own “bottom-line” behaviors (other fellowships call these “inner circles”)—what you need not to do in order to consider yourself sexually sober. There are “plan meetings” or “plan workshops” for working on your sexual recovery plan in a group setting.

Perhaps the fastest-growing and most broadly based of all is Sex Addicts Anonymous (SAA), which was founded in 1977 by a handful of men who desired greater anonymity from their sex-addiction program. Similar to SCA, members of SAA define their own sexual sobriety with a sponsor or therapist—and right now the program is booming. Katehakis mentions a daily meeting in Los Angeles that has been around for over a decade. A few years ago, the six to 10 individuals showing up each day doubled to 20, with 80 people attending the Saturday-morning meeting.

SLAA is for those with “a compulsive need for sex, extreme dependency on one or many people, or a chronic preoccupation with romance, intrigue or fantasy.” Members of both SLAA and SAA come up with lists of outer-circle, middle-circle and inner-circle behaviors as part of their sexual recovery plan, with “outer” being healthy activities and “middle” ones serving as warning signs on the road to “inner.” A middle-circle action for one person might be looking at pornography, for instance, or checking out photos of an old ex on Facebook, while that could be all the way to relapse (inner) for someone else.

One aspect of sex-addiction recovery that doesn’t get talked about as much is the role of pharmaceuticals—specifically anti-depressants of the selective serotonin reuptake inhibitor, or SSRI, variety. A well-known side effect of SSRIs is that they impair sexual functioning, sometimes curbing desire but most commonly making it difficult to have an orgasm.

About three-quarters of those in treatment for sex addiction are on anti-depressants; some in the program like the libido-reducing side effects. But a lot of professionals think using a drug less for its intended benefit than for its unintended complications is a creepy way to do business. “Medications are overused and prescribed too quickly,” says psychiatrist David Reiss, MD. “Of course I prescribe,” he says, “but not with a shotgun approach, a Rube Goldberg approach.” Katehakis objects on principle to the idea of controlling people’s sexual behavior by prescribing them drugs: “That’s some weird thing that hearkens back to the colony days where they gave prisoners saltpeter.” (Saltpeter, aka potassium nitrate, was long thought to quash male libido.)

Jennifer feels that SSRIs have helped her; she is still able to reach a kind of “pleasure peak," so they don’t entirely kill the joy of healthy sex. “I figured I had more than my share of orgasms in my lifetime anyway,” she says.

Many experts think using anti-depressants for their libido-numbing side effects is a creepy way to treat sex addicts.

But another former sex addict, 45-year-old Sarah, nine years sober in SLAA, says it took a while to see that antidepressants were a bad fit for her. Initially the pills were prescribed in part because of a dramatic suicide attempt (distraught over a man she was dating, she’d walked into the middle of an LA freeway to try to kill herself) and in part due to their inhibiting side effects. But she kept on pursuing reckless sexual encounters and feeling awful about it until the day she joined SLAA.

Sex addicts do sometimes need the extra pharmaceutical help to start the 12 Steps or therapy in the first place. It’s hard-to-impossible to do the psychological work necessary to overcome your addiction if you’re housebound due to crippling depression. “They need to be stable enough to be able to manage the emotional experience they’re going to go into,” says Schultz.

Sometimes issues that are beyond the scope of a 12-Step program—such as childhood sexual abuse, a common experience for many sex addicts—don’t emerge in therapy until after a period of sobriety, which most of the experts who spoke to The Fix agreed was a prerequisite for any deeper trauma work. “Our character defects rise to the surface after getting chemically and sexually sober,” says Scott, who has been meeting with an individual therapist since 1998. “12-Step programs can be therapeutic, but they are not therapy.”

With sex and other so-called process addictions, such as to food, gambling or shopping, it’s tricky to capture what “sober” means. By the same token, it’s more likely that the contours of an individual’s self-defined sobriety will shift over time.

When Jennifer started getting sober, she believed that her problem was with anonymous sex—that if she knew her sex partner’s first and last names, then it was OK. But after she fell into a sexual relationship with a man she’d known for a year only later to discover he was married, she realized that knowing his last name hadn’t helped her out this time. She had to expand the definition of what sexual sobriety meant for her. In that sense, recovery from sex addiction is a continual evolution—for Jennifer, even after decades—one day at a time.

Hunter R. Slaton is the Rehab Review Editor for The Fix. He has written for publications including Men's Journal, Budget Travel, Valet, Blender and Time Out New York.

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