Where Are the Boundaries?

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Where Are the Boundaries?

By Belina Nassi Fruitman 01/19/18

It is critical to uncover and understand what fundamental causes may be driving the client to self-medicate with alcohol, drugs, pornography, hoarding, food or other compulsive behaviors.

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Recently I became intrigued by an article I read by Dr. Chris Donaghue titled Is Sex Addiction Just an Excuse for Bad Behavior? As a therapist working in the mental health and addictions field for about 25 years, this article stopped me in my tracks. Interestingly there was no discussion around healthy boundaries, self-reflection, morality, and the real meaning of addiction.

With all due respect to my colleagues in this interesting and challenging field, it is important for us to share differences in theoretical frameworks and treatment. At times, we all must get back to basics and before being quick to diagnose, look at all root issues and identify whether the behavior is based on a need to fill a sense of emptiness. It is critical to uncover and understand what fundamental causes may be driving the client to self-medicate with alcohol, drugs, pornography, hoarding, food or other compulsive behaviors.


I and most other clinicians agree with Dr. Donagahue that “Mental health diagnoses, in general, are built on white, male, cis, hetero values and are often colonizing and pathologizing of other cultural norms. They are historically bound, and change frequently based on anti-oppression work and changing politics. Diagnoses are social constructs and exist on a continuum; they aren’t concrete truths, but fragile ways of trying to explain behaviors that often stigmatize minorities.” If this is true, we then must ask, “what is addiction?”

The hallmark feature of addiction and/or substance dependence/misuse is first and foremost whether the behavior (or thought, as in Obsessive Compulsive Disorder) is interfering with one’s quality of life. For example, does the behavior interfere with one’s professional work or school and interpersonal relationships? We have all met men and women who have lost their careers, their spouse, their home and even children as a result of their addictions. In terms of sexual addiction, results may include not being able to maintain interpersonal relationships; seeing a computer at work and being triggered to masturbate there despite the risk (and in fact the risk heightens the arousal) of bosses seeing the behavior, attempting or engaging in sex with coworkers, neighbors, babysitters, and friends.

The problematic behavior becomes the priority as the person loses healthy ways to cope with pain (or the root issue). Root issues that I often see in my practice include trauma such as sexual abuse, incest, and abandonment, all of which lead to anxiety and/or depression. In turn, women and men end up in my office after years of self-medicating with drugs, alcohol, food, shopping or sex. Ultimately, when one’s self-medicating interferes with life functioning by leading to consequences including legal problems (DUI, public intoxication, restraining orders), maintaining a career, marriage and/or family, that is when we consider the diagnosis of addiction. Often, instead of creating shame, the label can empower one to understand what is going on and why they are drawn to that behavior; then they can figure out how to cope with discomfort, learn to soothe themselves, and essentially thrive in their lives while remaining authentic.

Creating coping mechanisms for shame is a big part of my work with sexual abuse survivors. For a survivor of sexual abuse, shame tends to be a different issue than for the one who is addicted to watching pornography and is pervasively promiscuous, cheating on a spouse and putting a partner at risk for STD’s. The person addicted to pornography and sex is working on gaining trust and forgiveness from the ones he/she has hurt or betrayed. Shame can be worked through in therapy when one becomes authentic and reclaims themselves, this is a universal theme for all survivors. Furthermore, it is a critical component to recovery.

Dr. Donagahue said “The sex addiction diagnosis has become a waste paper basket for all creative and non-hetero sexuality.” This is just ridiculous; one’s private “sexual creativity” within a healthy consenting relationship is not really what is in question here. That is not what we are referring to when we speak of addiction, but rather the repetition of problematic behavior that leads to negative physical and emotional consequences.

According to a Newsweek article by Chris Lee, “An estimated 40 million people a day in the U.S. log on to some 4.2 million pornographic websites, according to the Internet Filter Software Review…[it’s] a kind of gateway drug…. the potential for abuse of online porn is well documented, with research showing that chronic masturbators who engage with online porn for up to 20 hours a day can suffer a “hangover” because of the dopamine drop-off… most self-identifying addicts—about 90 percent—are male.” If someone drank for 20 hours per day would we question the diagnosis of addiction?


In addictions work we talk about accountability, the importance of being genuine, forthright and transparent. If we teach others that “anything goes,” then they learn that there are no limits, no boundaries, and that despite being human, we do not have to be mindful about our behavior and how it affects our deepest self and others. Now, if you want to be “undiagnosed for free” by Dr. Donaghue, go for it, but you may lose the opportunity to heal and create a fulfilling and meaningful life.

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