1. Sexual Addiction 101 Robert Weiss LCSW, CSAT-S
Founding Director
The Sexual Recovery Institute (SRI)
The Center for Sexual and Relationship Recovery (The Ranch)
Director of Intimacy & Sexual Disorder Services
Elements Behavioral Health
Author: Cruise Control, Untangling the Web, Closer Together, Further Apart (2013)

2. The Problem

3. What first comes to mind when you think of this group of men?
Fmr. President Bill Clinton
Fmr. Governor Elliot Spitzer
Fmr. Governor Mark Sanford
Actor David Duchovny
Fmr. Senator Larry Craig
Fmr. Sports Hero Tiger Woods
Fmr. Chief Dominique Strauss-Kahn
Fmr. Governor Arnold Schwarzenegger
Fmr. Congressman Anthony Weiner
Fmr. Presidential Candidate Jon Edwards
Fmr. Presidential Candidate Herman Cain
Fmr. General David Petraeus
These are all men whose sexual behavior MORTALLY WOUNDED their ability to lead ... but what if their problem had been drinking or drugs?

4. Sexual Addiction is not
Diagnosed before ruling out ADD/OCD/Mania and Active Drug Abuse
Poorly Researched
Fun
A Moral or Religious Stance
“Sex negative” or a cultural bias
Fetish Behavior
Same Sex Interest or Activity
Crystal Meth Addiction
Sexual Offending - non consensual

5. What Defines Addiction?
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 relief by substance use and other behaviors.
American Society of Addiction Medicine 2011

6. Is Sexual Addiction A Legitimate Mental Health Diagnosis ?
Was in the DSM III - as a descriptor
Was out of the DSM IV
Now being considered for the DSM 5 (Hypersexual Disorder)

7. What Happens Without a Universally Acknowledged Diagnosis?
Moral Judgement
Religious Abuse
Misdiagnosis
Misdirected Treatment- often with meds
Think Alcoholism prior to the 1970’s

8. 2012 DIAGNOSTIC UPDATE
Sexual Addiction Diagnosis written by Marty Kafka MD (Harvard, APA, DSM 5 Committee) from models & research based on:
Historical Review - Nymphomania, Don Juanism etc.
Dr. Patrick Carnes Addiction Model
Dr. Eli Coleman Compulsivity Model
Kinsey “Out of Control Sexual Behavior Model
APA - Sexual Disorder NOS Model

9. Proposed Hypersexual Disorder Diagnosis DSM 5 (2013)
A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following five criteria:
(1) Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior.
(2) Repetitively engaging in these sexual fantasies, urges, and behavior in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).
(3) Repetitively engaging in sexual fantasies, urges, and behavior in response to stressful life events.
(4) Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, and behavior.
(5) Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others.

10. Hypersexuality Disorder Continued
There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, and behavior.
These sexual fantasies, urges, and behavior are not due to direct physiological effects of exogenous substances (e.g., drugs of abuse or medications) or to Manic Episodes.
The person is at least 18 years of age. 

11. Typical Sex Addict Behaviors
Compulsive Use of Porn (with or without masturbation)
Anonymous Hook-ups (met online)
Adult Bookstores and Strip Clubs
Sexual Exchange (i.e. Drugs or Favors for Sex)
Prostitutes and “Sensual” Massage Parlors
Cruising, Intriguing, Objectifying, Seduction
Pushing Boundaries, Viewing “no” as a challenge
Multiple Affairs / Anonymous Infidelity
SmartPhone app Hook-ups
Sexting / Abusing Social Networks / Virtual Sex
Crossing Professional Boundaries
Living a Double Life

12. How Can Sex Be An Addiction?

13. Sexual Addiction is the use of Intense Fantasy to Induce Neurochemical Release
Serotonin - mood stability
Dopamine - pleasure
Adrenaline - energy, jolt
Endorphins - calm
Oxytocin - love/jealousy

14. ADDICTS CALL IT… The Bubble The Trance Spaced Out Think ...
Fight or Flight
Dissociative State
Trauma
Self Soothing

15. In 12-Step Language ...
POWERLESS!

16. Sex Addiction is not about sex or orgasm
Sex Addiction is not about sex or orgasm. It is about the search for sex and desire for orgasm. It’s a Process Addiction much like gambling or eating disorders

17. The Betrayed Spouse
Meditation. Become present. Imagine someone very important who is not here today, maybe your most important adult -husband, wife, parent, friend. Imagine where they might be right now - where they usually are right now -at work, childcare at home. Picture them there. How does that make you feel? What are they doing? Now imagine receiving a call or text to tell you that there is a problem, that this person didn’t show up where they were supposed to be today. No one knows where they are and in fact they have been missing for a while now, but no one wanted to tell you. How would you feel? (Name feelings) What would you do (name actions) Now imagine yourself trying to find out what happened to them. Would you stay here or leave immediately. Imagine your first reactions. Now you have left here to look for them. See yourself first calling and then perhaps visiting those who might know where they are but no one seems to be able to help. No one knows where they are. From some you get conflicting answers, others tell you to stop looking, that it’s natural for this person to take some time to themselves now and then, that you’re making too big a deal out of this. Others who you know MUST have seen your loved one - deny having seen them or make up events that don’t seem to fit What do you do? How do you feel? Perhaps you find a few clues as to where they have gone-imagine yourself finding some clues at their work or at home. Perhaps in a desk drawer you find a credit card receipt, a cell phone bill or on the computer you see something in the online history - how does that feel? What do you do once you find out some information, but not enough? Would you look further? How would you feel?

18. Spouses and Family Over time, profound relationship betrayal produces a trauma response
Over time spouses “go crazy” as their reality and experience is denied them and they adapt to the the addict’s warped agenda
Sex addicts become less responsible, less responsive and more self- obsessed, leaving the spouse increasingly having to manage the life of the family- “it’s like having another child to worry about,” one spouse said.
Children find porn, walk in on “situations”, lose one parent to the addiction and the other to obsession about what the spouse is doing. They end up being handled/managed, not parented.
Sex Addicts don’t understand what BETRAYAL means or does!

19. In a Primary Relationship, Active Addiction by one partner results in both Betrayal and Trauma for a spouse
Meditation. Become present. Imagine someone very important who is not here today, maybe your most important adult -husband, wife, parent, friend. Imagine where they might be right now - where they usually are right now -at work, childcare at home. Picture them there. How does that make you feel? What are they doing? Now imagine receiving a call or text to tell you that there is a problem, that this person didn’t show up where they were supposed to be today. No one knows where they are and in fact they have been missing for a while now, but no one wanted to tell you. How would you feel? (Name feelings) What would you do (name actions) Now imagine yourself trying to find out what happened to them. Would you stay here or leave immediately. Imagine your first reactions. Now you have left here to look for them. See yourself first calling and then perhaps visiting those who might know where they are but no one seems to be able to help. No one knows where they are. From some you get conflicting answers, others tell you to stop looking, that it’s natural for this person to take some time to themselves now and then, that you’re making too big a deal out of this. Others who you know MUST have seen your loved one - deny having seen them or make up events that don’t seem to fit What do you do? How do you feel? Perhaps you find a few clues as to where they have gone-imagine yourself finding some clues at their work or at home. Perhaps in a desk drawer you find a credit card receipt, a cell phone bill or on the computer you see something in the online history - how does that feel? What do you do once you find out some information, but not enough? Would you look further? How would you feel?

20. Betrayal is the greatest source of pain to an addict’s spouse
Betrayal is the greatest source of pain to an addict’s spouse. It’s not so much the addict’s drinking, using, spending, sexing etc. that causes the most hurt to a loving spouse - it’s the lying, broken promises and loss of trust.

21. What is the Emotional State of a Betrayed Spouse?
The betrayed spouses initial emotional state is a form of trauma:
Fearful of further loss and abandonment
Ashamed, remorseful, self doubting and isolated
Anxious and Hypervigilent - easily triggered to previous levels of trauma
Worried about the future -parenting, finances, separation
Having intrusive thoughts and images
Often having problems w/sleeping, eating, self-care

22. How Long Can It Take To Get Off This PDSD-like Ride?
9-18 months: Provided there is an recovery process in place in place for both and both are active in it.

23. What are the clinical needs of this spouse?
Concrete Direction regarding self-care, health issues, talking to family etc.
Education about addiction, disclosure, family dynamics, support.
Holding and Validation of her reality and her feelings
Disclosure and clarity regarding their unknown history
Social support by professionals (peers and family where useful)
Structure toward moving forward
Hope

24. Sexual Addiction Treatment

25. The process of addiction treatment prepares clients for more traditional, experiential and relational forms of psychotherapy. While in active addiction, they are not ready for therapy.

26. Addiction Treatment Method vs. Traditional Psychotherapy
Behavioral problems REQUIRE behavioral forms of intervention and treatment
This includes structured steps and tasks
Problem behaviors have to be contained FIRST before psycho- dynamic therapy and trauma work begins in earnest
Group work is more effective than individual
The treatment is HIGH ACCOUNTABILITY with a strong focus on building ego strength, shame reduction and social skill development
Healing maladaptive attachment is the slow work of long-term therapy, living honestly and 12-step involvement (2-3 years minimum). This is where Psychodynamic, Analytic, Jungian, Somatic and other forms of therapy are most effective
Discuss that the therapeutic relationship is formed by the therapist acknowledging and confronting the defenses and adaptations that no longer work.

27. What is Sexual Sobriety?
A mutually agreed upon clear, written and signed, behavioral contract based on client goals.
Sobriety plans don’t change without prior discussion.
Similar to how we handle eating disorders

28. Sexual Sobriety Contract
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

29. Required Treatment Steps When Working with Sex Addicts
Do a thorough psycho-sexual history/assessment
Confront Denial
Identify the genuine client treatment goals and co-create a sexual sobriety contract or plan aligned with those goals.
Hold clients accountable to all their agreements!
Have client evaluated for psychotropic medication
Educate and teach relapse prevention
Get them into a sex addiction group therapy
Find support for the spouse
Direct healthcare, family and crisis resolution
Refer to long-term 12-step, therapy or faith-based group support

30. 12-step Support Groups for Sexual Addicts and Partners
Sex Addict Support
SAA SA
SCA
SLAA-Women
SRA
Partner Support
S-Anon
Alanon
COSA
CODA
RCA - Couples

31. Sexual Addiction Information
The Sexual Recovery Institute
The Ranch
IITAP - International Institute for Trauma, and Addiction Professionals
SASH - The Society for the Advancement of Sexual Health
E-summits Online and video learning with available CEU’s

32. Sexual Addiction 101 Robert Weiss LCSW, CSAT-S
Founding Director
The Sexual Recovery Institute (SRI)
The Center for Sexual and Relationship Recovery (The Ranch)
Director of Intimacy & Sexual Disorder Services
Elements Behavioral Health
Author: Cruise Control, Untangling the Web, Closer Together, Further Apart (2013)