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Treating Co-occurring Sex & Substance Addictions

Is it really sex addiction?

People in recovery tend to pathologize behavior, and beyond this, we often have a skewed sense of what mainstream human behavior even is. Many with addiction histories are hindered by the shame of past sexual behaviors, but for sexual behavior to constitute an addiction it must meet at least two criteria:

  1. We experience recurrent failure to control the behavior.
  2. We continue the behavior despite negative consequences.

Having a high libido or engaging in behaviors like accessing pornography, masturbation or frequent sex does not necessarily mean you have an addiction. A sex addict engages in behavior that causes unwanted harm to physical, mental and emotional health and which compromises life-manageability.

Paths to recovery from sex addiction are many and prognosis depends on a number of factors. In the case of co-occurring addictions to sex and substances, the importance of slow incremental approaches with lots of support on board cannot be overstated.

Which Is Treated First?

One of the biggest challenges in recovering from co-occurring addictions is that they are almost always intertwined - we use one to offset or enable the other. In most cases, indulging in one addiction triggers the other.

  • Alcoholism and drug addiction open the door to developing behavioral addictions including compulsive use of pornography and sex.
  • Conversely, the shame many of us experience about our behavioral addictions often leads to substance abuse.
  • Some of us indulge simultaneously to enhance the cumulative experience.

When multiple addictions are present, which do we treat first? The one that causes the greatest imminent physical/medical harm. It’s simple triage; the thing that can kill us the quickest has to be the first thing to go.

Therefore, when we struggle with addictions to both substances and behaviors, abstinence from substances needs to take precedence. Making significant changes and addressing the root causes of our behavior is highly problematic when a person remains chemically dependent. Progress made in treatment is likely to be undone each time we drink/use drugs.

Inhibitions & Compensations

Sometimes getting clean and sober leads naturally to reduced behavioral addiction problems.

After attaining abstinence, many of us find that our inhibitions naturally prevent us from engaging in the high risk behavior of our behavioral addictions. For example, the sex addict who depends on alcohol to lower self-consciousness may find it very difficult or even impossible to engage while sober in unhealthy sexual behavior. These cases more easily lend themselves to holistic recovery.

But sometimes getting clean and sober worsens behavioral compulsions.

Those of us who tend to struggle the most experience the exact opposite effect: in the absence of our drug of choice, we simply increase the frequency and/or severity of any other vice (especially those preexisting).

  • If we are unwilling to feed our addiction its drug of choice, it will take whatever we are willing to abuse. In his book 'A Million Little Pieces' James Frey describes his increased awareness and ravenous use of caffeine, nicotine, and food; explaining that the “fury” (his disease) would devour these in an effort to offset what he denied it.


Just as addiction is addiction is addiction, treatment is treatment.

  • Many in recovery are surprised to find that what they learn through alcohol and drug rehabs, counseling, therapy and 12 step programs is not only applicable to all other addictions, but to countless other challenges in life as well.

We learn to move our focus. Just as the drug addict obsesses about attaining and doing their drug of choice, the sex addict stays hyper-focused on sexual thoughts that interfere with other areas of life. In both cases, the most common motivator is to block awareness of negative emotions and how we feel about ourselves.

  • Whenever a person is obsessing, they are simultaneously avoiding. We who have known abuse, trauma, and/or active addiction learned ways to avoid facing ourselves.

We come to accept that we cannot control that which we ignore. We seek greater self regulation and we find that in order to manage ourselves, we must get to know the person we’re dealing with.

Learning Self-Kindness

We know that self esteem and self worth are major contributors to our dysfunction. Through therapy and other forms of self exploration we learn that much of what we believe about ourselves is not true – only what we were taught and made to feel. Moreover, we find that we have two sets of beliefs, two sets of standards, and two ways of judging: one for ourselves and one for everyone else.

This is the best kind of hypocrisy. If we are willing to use the “Golden Rule” in reverse, we become free to judge and treat ourselves exactly as we do others. This gives us the freedom to accept that just for today, this is where I’m at. It allows us to seek help and support. It provides room to breathe by taking a step away from shame and toward recovery.

Clinical Social Worker/Therapist
My story is I'm forever a work in progress and I love connecting with REAL people who are doing great things. I'm blessed to be making a living doing something I love. I'm a proud dad and the luckiest husband ever. I'm an aspiring author - check out my recovery blog at: recoveryrocks.bangordailynews.com Thanks! Jim

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