Untangling the Web: Understanding and Treating Sex and Porn Addictions

1. Untangling the Web: Understanding and Treating Sex and Porn Addictions • Robert Weiss LCSW, CSAT • Founding Director • The Sexual Recovery Institute • www.sexualrecovery.com

2. Sex Addiction is Not • A Moral or Religious Stance • A Symptom of Underlying Axis I Illness • Fun • Same Sex Interest or Activity • Sexual Offending • Fetish / Paraphilia • Sociopathy • Crystal Meth Addiction

3. Sex addiction can be… • A Stand Alone Diagnosis

4. The Diagnosis Follows the Characteristics of All Addictions • Criteria for assessing Sex Addiction closely parallels guidelines for assessing Substance Dependency, Alcoholism, and Compulsive Gambling: • Loss of control • Continuation despite adverse consequences • Obsession or preoccupation • The presence of all three criteria operationally defines addiction to any drug or behavior

5. Typical Sex Addict Behaviors • Compulsive Use of Porn (with or without masturbation) • Anonymous Sex (met online or in sex clubs etc.) • Adult Bookstores and Strip Clubs • Sexual Exchange (i.e. Drugs or Favors for Sex) • Prostitutes and Massage Parlors • Fusing Sex and Drugs - Cocaine, Nicotine, Alcohol etc. • Cruising, Intriguing, Objectifying, Seduction • Boundary Violations, Sexual Harassment • Multiple Affairs / Anonymous Infidelity • Abusing Power Relationships for Sex - Predatory

6. Addicted to sex? • Increased Heart Rate • Shallow Breathing • Perspiration- palms, underarms, etc. • “Rush” or “Intensity” Feeling • Reduced Intellectual Functioning

7. ADDICTS CALL IT… • The Bubble • The Trance • Spaced Out • Think ... • Dissociative State • Mood Alteration • Trauma

8. In 12-Step Language ... • POWERLESS!

9. Substances of Mood • Serotonin • Dopamine • Adrenaline • Endorphins • Oxytocin “the cuddle chemical”

10. Sex Addiction is not about sex, it’s about the search for sex and desire for orgasm. It’s aProcess addiction.

11. Challenges Specific to Gay Male Sex Addicts • Differing Cultural Standards of Sexual Behavior - norms • History of HIV / AIDS • In Childhood - History of social isolation and/or hiding self, homophobia • In Childhood - double life/self is learned coping mechanism • Adult Life - Lack of Cultural Boundaries for Problem Sexual Behaviors • Adult Life - Lack of Cultural Validation for Intimacy Building

12. Sexual Addiction Symptoms in Residential or Outpatient Clients • In the Client’s Behavior • Seductive Dress (especially after it is pointed out) • Seeking out “special relationships” with other attractive clients or staff for advice, friendship and direction • Giving “the stare”. • History of CD relapse – especially females • Encouraging Dependency as a form of seduction • Sneaking Porn into treatment - sharing porn in treatment. • Consistent sexual references in jokes and conversation • Consistent sexual objectification. • Lack of empathy about how their sexual behavior affects others. • Having sex while in treatment

13. Sexual Addiction Symptoms in Residential or Outpatient Clients • In the Client’s History • Multiple abortions (females), multiple STDs (both sexes) • Previous arrest or major life consequences related to sex • Drugs/Alcohol used to help tolerate or enhance sex • History of previous sexual acting out in treatment • Drug use fused with sexual behavior • Multiple past failed relationships due to affairs or infidelity • Chronic or Compulsive Masturbation

15. What makes online sex so popular and so exciting? • ACCESSIBILITY • AFFORDABILITY • ANONYMITY Adapted from the “Triple-A Engine” Al Cooper PhD. 1998

16. What’s the big dealIt’s just a guy thing…

17. Consequences of Compulsive Cybersex • Loss of time for work, family, recreation • Family violence / relationship loss • Loss of job because of cybersex at work • Guilt and shame due to keeping secrets • Decreased interest in sex with spouse • Increased preoccupation with sex • Increased overall sexual objectification • Children potentially exposed to porn • Increased interest in deviant sex • Increased Isolation, substance abuse

18. Problems that show up when Meth is Added to this mix ... • 1) Fusion - where I went for sex is where I go for drugs and vice/versa (relapse prevention problem) • 2) The sex I had when high was so intense that sober sex seems boring/vanilla now (relapse prevention problem)

19. Treatment is the Reclaiming of Reality

20. Initial Sexual Addiction Treatment is ... • Cognitive Behavioral and Task Oriented

21. Initial Focus of Sex Addiction Treatment • Stop the acting out ASAP by making contracts and plans • Confronting denial and teach relapse prevention • Carefully reviewing a sex, drug, addiction history • Providing Appropriate Tasks and Interventions • Spouse, job & family crisis resolution • Shame reduction • Holding the client accountable! • 12-step, therapy or faith-based group referral

22. And Sexual Sobriety is… • A clear and well defined written plan • Based on client goals • Mutually agreed upon • Signed • Sobriety plans are behavioral in nature • Sobriety plans flow from the goals of the client • Doesn’t change without prior agreement

23. Simple SexualSobriety Plan • List of Behaviors I Want to Stop • A • B • C • D • E • F • List of Behaviors I Want to Add • A • B • C • D • E • F

24. Treatment Error • Inadequate or poorly detailed history— (Not asking about prior arrests/offending behaviors etc. • Unfamiliarity with resources (porn blockers, 12-step) • Treating Sexual Issues prior to any existing Substance Abuse or Dependency Problems • Normalizing problematic sexual behavior • Initially employing Psycho-dynamic, Analytic, Jungian and other non-cognitive behavioral method • Not identifying triggers, patterns, rituals and behavioral escape methods (relapse prevention) • Focusing too early on trauma

25. Treatment Error • Not addressing the sexual behavior as the primary initial treatment focus • Not properly understanding and/or pathologizing the depth of the betrayal, grief, loss and rage of the partners and spouses • NOT HOLDING CLIENTS ACCOUNTABLE • Not getting supervision / consultation • Not utilizing 12-step programs, faith based support groups, group therapy and psycho-education • Not processing countertransference.

26. 12-step Groups for Sexual Addicts and Partners • Partner Support • S-Anon • Alanon • COSA • CODA • RCA - Couples • Sex Addict Support • SAA • SA • SCA • SLAA-Women • SRA

27. Treatment and Training Information • The Sexual Recovery Institutewww.sexualrecovery.com • IITAP - International Institute for Trauma, and Addiction Professionals • www.iitap.com • SASH - The Society for the Advancement of Sexual Health • www.sash.net

29. Untangling the Web: Understanding and Treating Sex and Porn Addictions • Robert Weiss LCSW, CSAT • Executive Director • The Sexual Recovery Institute • www.sexualrecovery.com