About the Author
----------------
Robert Weiss LCSW, CSAT-S is a digital-age intimacy
and relationships expert specializing in infidelity and
addictions--most notably sex, porn, and love addiction. An
internationally acknowledged clinician, he frequently serves as a
subject expert on human sexuality for multiple media outlets
including CNN, HLN, MSNBC, The Oprah Winfrey Network, The NewYork
Times, The Los Angeles Times, and NPR, among others. A skilled
clinical educator, he routinely provides training to therapists,
the US , hospitals, and psychiatric centers in the US and
abroad. Over the years, he has created and overseen more than a
dozen high-end addiction and mental facilities.
Currently, he is CEO ofSeeking Integrity, LLC, being developed as
an online and real-world resource for recovery from infidelity
and sexual addiction. For more information or to reach Mr. Weiss,
please visit his website, robertweissmsw.com, or follow him on
Twitter, @RobWeissMSW.
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Excerpt. © Reprinted by permission. All rights reserved.
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1
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 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 ,
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
s, 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 hom. 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 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 neuro 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
neuro 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) y 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 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 y 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
neuros 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 orm 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:
Communications, Inc., 3201 SW 15th Street, Deerfield
Beach, FL 33442.
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