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Treating Sex Addiction

Table of Contents

We don’t currently have an agreed-upon definition of sex addiction but rather use the term as an umbrella for a broad group of sexual behavioral disorders. Clinicians and researchers continue to work on an accepted definition of sexual addiction, but at the moment, a sexual behavioral disorder can be anything from frequent sexual activity with multiple partners to exhibitionism to fetishism. But the waters become muddied in trying to nail down exactly which behaviors are disordered and which are simply hypersexual, such as the difference between high levels of sexual activity versus illegal activity with nonconsenting individuals, such as children.1

While the experts continue to deliberate over how to officially define sex addiction, they can agree that in many ways, sex addiction manifests like a substance use disorder. One analogous characteristic is engaging in sexual behaviors despite the negative consequences they bring. For example, you might continue seeking out sex despite having already lost your job for related reasons.

woman and man having problems with sexual relationshipSome people describe sexual addiction as having an escalation effect, a concept that is similar to tolerance in substance addictions. In escalation, you may begin needing more and more sexual activities to receive the same high or level of sexual arousal as you did when you first began the behaviors. This is similar to what a heroin or meth addict might experience when using drugs.

When you engage in your desired sexual activity, you may feel euphoric. Essentially, it may deliver a sensation akin to a high. However, when you go without sex, you may feel depressed, which can lead to obsessive thoughts over when you can next engage in sexual activity. This obsession with sex and the compulsive sexual behavior that it eventually leads to can cause you to neglect your responsibilities and social life, in turn, making you feel isolated and alone.

If you recognize these symptoms in your life, you may be ready for sex addiction treatment.

Sex Addiction Treatment Options

When beginning treatment, you will meet with a doctor or therapist who will first ask questions to understand the root of your addiction, such as:1

  • What is the gender and age of the people that you engage with sexually?
  • How long has this behavior been going on?
  • What is the development of this sexual behavior—did it start in childhood or emerge more recently?
  • Do you have a history of sexual violence or abuse?
  • Have you suffered individual trauma?
  • When are your symptoms the worst?
  • What has helped you reduce the severity of these symptoms in the past?

In the assessment, the clinician will try to understand if your sexual acts are illegal (child molestation) or if the activities could potentially cause you to be arrested (exhibitionism). Other forms of sexual behavior disorders may place you at risk for sexually transmitted infections, pregnancy, or physical violence and your treating clinician will want to know to help develop your treatment plan.

Your clinician may also ask questions about:

  • Your employment history.
  • Whether you have a history of substance use or abuse with alcohol or illicit drugs.
  • Legal problems.
  • The quality of your relationships with friends, family, and others.
  • Your mental health status.

All of this information will help the clinician make a proper assessment and devise a solid treatment plan. This information, in part, allows your treatment team to know when to intervene, what the role is of medicine in your treatment plan, and whether or not you should use behavioral support, such as cognitive behavioral therapy. Additionally, your doctor may recommend that you attend support groups, individual therapy, or a combination of these—all of which you can receive through an inpatient or outpatient program.

Outpatient and Inpatient Programs

Couple having problems with sexual relationship
Outpatient treatment is often the better option for people who want to live at home while also taking care of responsibilities such as childcare, work, or school. Outpatient programs require you to visit the treatment facility for a set number of hours per week to work on your treatment plan. The outpatient option is usually preferred by people whose addictions are not severe or who have already completed an inpatient program and are ready to step down their treatment. It is important to keep in mind that outpatient programs do not offer 24-hour care like an inpatient facility.

Along with 24-hour medical supervision and care, inpatient or residential programs require you to live at the center for the duration of your treatment. During your stay, you will attend therapy sessions and learn skills that will help you lead a healthy life without your sexual behavior disorder. Inpatient programs typically last between 30 and 90 days during which you are allowed to focus solely on your treatment without the distractions of your everyday life.

Both inpatient and outpatient programs often incorporate different types of therapy that may include:

  • Cognitive behavioral therapy (CBT).
  • Contingency Management. A form of a token reward system, in Contingency Management you set specific, time-limited goals for yourself and then establish a reward for when you achieve them. This therapeutic model is meant to help you build momentum in your recovery and boost your self-confidence in your ability to achieve and sustain long-term recovery.
  • Motivational interviewing (MI). MI focuses on figuring out which things are personally motivating for you to make positive change, and then developing a plan to strengthen that internal motivation to help you sustain your commitment to sobriety.
  • Couples or family therapy.
  • Group therapy.
  • Experiential therapy, in which the group facilitator creates scenarios for group members to respond to and thus learn better communication and decision making. Or you may actively participate in a project that allows you to dig deeper into issues you were unaware of, which can lead to longer-lasting healing.

Various combination of these therapies can help you more comprehensively address the issues underlying your addiction.

For example, CBT is a popular approach to treating problematic addictive behaviors that helps you learn specific skills and strategies to overcome your addiction and prevent relapse.1 Some of these strategies include urge surfing (tolerating the feeling of the urge until it passes without acting on it), environmental manipulation (banning the internet on home computers), and diffusion techniques (mindfulness and meditation).1 CBT may help you reinforce acceptable sexual behaviors instead of harmful ones.

CBT may also help you learn how to self-monitor situations and identify triggers so that you are less likely to return to participating in destructive sexual behavior.

Examples of triggers may include:

  • Specific people.
  • Places.
  • Objects.
  • Internal experiences or feelings.

You may also participate in support groups during treatment, which are known for being convenient and helpful in practical ways. In 12-step groups, you are held accountable by your sponsor who helps you manage your urges to engage in harmful sexual activities. These groups are also a great place to meet people who are going through similar challenges. It can help you come out of isolation and receive support for your disorder.

These groups were adapted from the Alcoholics Anonymous model to help treat sex addiction:

During treatment, a clinician or therapist may suggest replacing your current addiction with something positive—something known as substitution. Examples could be anything from buying small gifts for yourself to spending more time with friends or loved ones.

Other exercises that may help you stop engaging in disordered sexual behavior may include:2

  • Creating a relapse map: You think through and write down your options when you encounter situations that will likely be triggering.
  • Holding an ice cube: You hold an ice cube in your hand until the craving or urge to engage in unwanted sexual behavior stops.
  • Splashing cold water: Your splash cold water on your face to reset the urge you’re feeling.
  • Doing deep breathing/belly breathing: This can help you calm yourself after experiencing a trigger or during an urge.
  • Distraction: Instead of turning to your addiction, you call someone on the phone or do something productive like cooking, cleaning, watching TV, reading, or exercising until the urge passes.
  • Small rewards: You buy yourself small gifts like chocolate or books to reward yourself for not engaging in addictive behavior. You could also treat yourself to ice cream or go out for dinner with a friend.

In some cases, your clinician may also prescribe medication to help you manage symptoms of your sex addiction if they deem it necessary and appropriate. Medications that may be prescribed include:3

  • Selective serotonin reuptake inhibitors (SSRIs).
  • Naltrexone.
  • Hormone therapies.

For those whose sexual disorder involves children or nonconsenting women, criminal sentencing is the appropriate first step. While in the criminal justice system, those people will also complete a treatment program. In extreme cases, treatment may include antiandrogens, otherwise known as chemical castration. These medications contain testosterone-lowering chemicals, such as:1,3

  • Medroxyprogesterone acetate.
  • Cyproterone acetate.
  • Luteinizing hormone-releasing hormone (LHRH).

Studies find that after 1 year, these medications reduce the likelihood of the person committing additional offenses. However, if that person stops taking the medication, the odds of them engaging in criminal sexual behavior returns to baseline.3

What is Consent?

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In order for a sexual activity to be consensual, consent must always be freely given, meaning that everyone in the situation can feel that they are able to say “yes” or “no” at any point and stop the sexual activity.5

In order for a sexual activity to be consensual, consent must always be freely given, meaning that everyone in the situation can feel that they are able to say “yes” or “no” at any point and stop the sexual activity.5

If you or someone you love is struggling with a sex addiction, call our helpline for more information about rehab options: .

Sources

  1. Ries, R. K., Fiellin, D. A., Miller, S. C. & Saitz, R. (2014). The ASAM Principles of Addiction Medicine. Philadelphia: Lippincott Williams & Wilkins.
  2. Marlatt, G.A. & Donovan, D.M. (Eds.). (2005). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: Guilford Press.
  3. Garcia, F. D., Delavenne, H. G., Assumpção, A. D. F. A. & Thibaut, F. (2013). Pharmacologic Treatment of Sex Offenders with Paraphilic DisorderCurrent Psychiatry Reports15(5), 1–6.
  4. Centers for Disease Control and Prevention. (2016). Sexual Violence: Definitions.
  5. University of Michigan. (n.d.). What Is Consent?