Never fear shadows. They simply mean there's a light shining somewhere nearby.  - Ruth Renkel.    Controversy Surrounding The Concept of "Sexual Addiction" It’s important to understand that there is no officially recognized diagnosis of sexual addiction listed in The Diagnostic and Statistical Manual of Mental Disorders. The idea of sexual compulsivity is a hotly debated issue among psychotherapists, researchers and academics; some argue that the concept of sexual addiction only advances a “sex negative” political agenda that pathologizes the diverse expression of human sexuality.    On the other side of the argument are those who feel that out of control sexuality is rampant and is as damaging to the individual, his / her family, friends and life as chemical dependency. So what differentiates someone who has a lot of sex from someone who is sexually compulsive? The ability to choose when, where and how one expresses their sexuality.   Human beings have the right to enjoy various consensual sexual experiences. Embracing ones eroticism and sexuality can deepen self-awareness, invite one to be more fully present emotionally, physically and psychologically in relationship with self and others, and offer deeper connection to ones spirituality. However, for people who are sexual compulsive the paradigm of personal and interpersonal interconnectedness is shifted to a model of emotional despair and isolation.    What is being offered in the following pages are ideas and concepts that I have found useful in working with sexually compulsive behavior. I have replaced the word “addiction” with “compulsivity”, except where an author has chosen to use the term – as I have come to believe that this term more fully represents the struggles of the men and women that I have treated in my practice.    Understanding Sexual Compulsivity Sexual compulsive individuals obtain an altered sense of consciousness from engaging in the search for sexual activity. Many of the sexually compulsive individuals that I have treated report histories of family dysfunction and violence, sexual abuse and emotional neglect. Often times these men report a series of shame-based beliefs about oneself, commonly expressed as: I am a bad and unworthy person; No one could ever love me as I am; My needs are never going to be met if I have to depend on others; As my needs will never be met, then sex, which is the only thing that makes me feel good, is my most important need. These beliefs drive the sexually compulsive behavior in several ways; They trap the individual into believing they are alone and cannot reach out to others for help. Secondly, believing they are alone, the individual develops a growing reliance on sexually compulsive behavior as their primary coping mechanism. As the compulsivity progresses, trusting others and allowing them to “know” of ones struggles become associated with emotional discomfort, while the sexual compulsivity, and the rituals surrounding these behaviors become associated with “temporary” comfort. In short, this series of shame-based beliefs and behaviors become the individuals primary world view.   The Cycle of Sexual Compulsivity Patrick Carnes first outlined the cycle of sexual compulsivity in his book, “Out of The Shadows: Understanding Sexual Addiction”.   Triggering events: As previously mentioned, many sexually compulsive individuals have survived traumatic experiences. This often results in the individuals wish to remain in a very limited zone of emotional comfort and expression. When confronted with challenges to this comfort zone, even those many would consider positive, the individual is flooded with emotions he is unable to process. These emotions in turn trigger a need to regain a sense of control and emotional balance. The paradox here is that the more the client tries to regain control and balance, the more out of control he becomes, as he is not addressing emotions, but looking for a way to minimize and avoid them.   Preoccupation: During the preoccupation phase, the individual, looking to regain a sense of emotional equilibrium while avoiding the intensity of their feelings, becomes highly focused on converting their anxiety into sexualized thoughts and feelings. As the individuals becomes more focused on preparing to act out he begins to loose the ability to focus on anything else; essentially preparing to enter “meditative state” - subsequently reinforcing his focus on sexualized thoughts and formulating plans to act out. Again, this is an attempt to minimize overwhelming emotions.   Ritualization: This phase is a highly predictable routine of behaviors used to engage the preferred form of acting out. Each individuals ritual is different and unique to who they are, and has multiple subtle thoughts, feelings and behaviors which drive this behavior forward.   Some simple examples of ritualized behaviors may include; seeking phone sex, cyber sex or internet pornography,  looking for prostitutes, contacting escort services for sexual encounters,  going to “cruising” areas where anonymous public sex occurs. The intense focus involved in ritualization results in a shift in consciousness in which the individual becomes “hyper-focused”, as if in a hypnotic trance: Individuals experiencing this hyper-focus frequently report feeling detached from their experience, describing themselves as being on “autopilot” and feeling “outside” of themselves witnessing their own actions. Some men will report that they have an intense desire to stop their behavior, but feel ”unable” to do so.   Acting-out: In this stage the individual is engaged in the preferred form of sexual behavior. This may or may not include orgasm and ejaculaiton. The term "acting out" implies that the individual is "manifesting" their anger, sadness or other complex emotional experiences outside of themselves onto, and into, the world around them. This process is complimented by the "acting in", or turning ones intense emotional experiences against oneself, as seen in the shame based beliefs which underline sexual compulsivity.   Despair: After acting out, sexually compulsive individuals commonly report a loss of hyper-focus and an immediate shift in mood toward despair and rage with themselves, another form of "acting in". Sexually compulsive individuals may attempt to minimize their feelings of despair and shame, promise themselves “that was the last time” and pledge to “never do it again”. However, regardless of their earnest attempts, they realize that they have again failed to control their behavior furthering their sense of despair and loss of control; preparing the individual for the next triggering event. Individual cycles vary. Some people may engage this cycle of acting out several times a day – while others engage in cycles that are much longer in duration and occur several times a year. The predominant theme at play here, and the corner stone of the compulsivity, is not the frequency or even the intensity with which the cycle occurs, but the inability to stop engaging in behaviors that are identified as unwanted, damaging to ones self, personal and professional relationships and risk consequences that adversely impact the individuals life. Paradoxically, these consequences, if experienced, are then used to validate shameful core beliefs that trigger a new cycle of acting out. Even after the behavior has been discovered, it is often difficult for the individual to acknowledge how out of control these behaviors have become.    Recovery from sexual compulsivity begins with admitting that there is a problem. There are many avenues available for individuals, couples and families to begin healing from the pain of out of control sexual behaviors. Psychotherapy with someone who is experienced in working with sexually compulsive behavior is one path to change. Group therapy can be very helpful in breaking the isolation and shame that accompanies sexual addiction, while building a supportive community with others who have similar struggles.   There are several 12 step self-help programs for sexually compulsive individuals and their loved ones, that offer a free supportive community for regaining control over ones sexual behavior. Whatever method of intervention one chooses, it is important to realize that they are not alone. Recognizing that a problem exists and asking for help are the first steps towards breaking the isolation of sexual compulsivity and regaining ones dignity and self respect.   Addiction Interaction Addiction Interaction refers to the ways in which chemical dependency and / or compulsivity disorders, e.g., sex, eating, gambling, etc., trend towards co-existing, altering and reinforcing the experience and intensity of both activities; making treatment difficult and requiring multi-modal forms of intervention to alter these practices and sustain long term recovery. The theory of addiction interaction compliments the concept that “people, places and things” can, and do, trigger the desire to engage in specific rituals, activities and behaviors. In order to ensure ongoing recovery, one must explore and address all the ways in which these interactions exist, reinforce and manifest in chemical dependency and compulsive behavior. While Patrick Carnes is frequently credited with identifying these processes among sexually compulsive individuals, chemical dependency professionals have long recognized the presence of these activities among substance abusing and chemically dependent populations.   Cross-Tolerance: Cross-tolerance is the process in which one drug increases the body’s resistance to another chemically similar substance. This process results in the body being conditioned to tolerate increasing levels of both substances simultaneously. An example of this process is seen with benzodiazepine and alcohol dependency. Alcohol and benzodiazepines potentiate one another, meaning that when used in conjunction they double the intoxicating effect of both substances on the body, resulting in a cross-tolerance that requires higher doses of either substance to achieve the same “high” - while requiring higher doses of either drug to stave off symptoms of withdrawal. In this way, one develops tolerance for both substances.   Withdrawal mediation: In this process one form of physical or psychological dependency is used to minimize withdrawal from another.  An example may be the chemically dependant individual who remains abstinent from substances, but then begins to gamble compulsively to address the anxiety and vulnerability they feel in the absence of substances, or the individual who begins to regain control of their problematic sexual behavior, only to begin using substances. The idea is that one behavior minimizes the discomfort of the absence of another.   Replacement: Building on withdrawal mediation, replacement is the process by which one behavior replaces another problematic behavior. The individual who regains control over their out of control sexual behavior begins to use alcohol, or others substances or behaviors, e.g., gambling, shopping, working out, etc., in such a way that a new obsession or dependency, either psychological or physiological, begins to manifest and replace the previously identified problematic behavior or dependency in a relatively short period of time.   Alternating Addiction Cycles: Alternating addiction cycles are identifiable patterns of chemical dependency and / or compulsive behavior that go through predictable stages of manifestation. The sexually compulsive individual who develops control over their sexual behavior, who then begins to drink alcoholically, who in turn gets sober only to return to acting out sexually. During this process, other behaviors may become attached to this repetition adding to the complexity of the alternating addictions. The individual involved in this process may or may not notice these occurrences, while friends, family and other important people in the individuals’ life see the pattern clearly.   Masking: Masking is the process by which one behavior is used to minimize the presence of another. An example of this process is someone who uses cocaine as a justification and minimization for engaging in out of control sexual behaviors.   Ritualizing: This process, which builds on the concept of masking, involves the merging of the psychological, cognitive, emotional and behavioral processes associated with one chemical dependency and / or problematic behavior with another. An example is the sexually compulsive individual who goes to his / her favorite bar to drink and then cruises for a sex partner.   Fusion: Fusion, building on ritualizing, is the process by which two separate chemical dependency or problematic behaviors begin to co-exist.  Fusions behaviors can be completely fused, partially fused, or present as occasional binging behaviors. The bottom line is that where one behavior is found, the other will be discovered as well. An example of this process is the sexually compulsive individual who only acts out while using cocaine, and in the absence of cocaine will not act out sexually.   Numbing:  Numbing is the process by which a chemically dependent, behaviorally compulsive, individual utilizes a different set of behaviors that they associate with self soothing from the despair they feel after acting out. An example is the sexually compulsive individual who uses marijuana, alcohol or compulsive eating to calm themselves form the emotional discomfort of after acting out.   Dis-inhibiting: Dis-inhibiting is the process of using a substance or behavior to minimize the anxiety related to engaging in another desired behavior. In non-problematic scenarios, this process may be as simple as having a drink to relax and ask someone out on a date, or using humor and laughter to reduce social anxiety while make connections with a new group of people. However, dis-inhibiting, as it applies to compulsive behaviors and chemical abuse and dependency, is to reduce inhibitions related to chemical dependency and compulsive sexual behaviors. An example is the individual who uses cocaine or alcohol, to approach a prostitute for sex.   Combining: Combining is the process of using various substances in combination with sexually compulsive behaviors to enhance the intensity of both activities. An Eexample of this behavior is the use of crystal methamphetamine in combination with anonymous sexual contacts to increase the intensity of both behaviors.

Traits associated with Sexual Compulsivity and Addiction Escalating the addictive cycle are emotional experiences that include; blame, fear, rigidity, delusion, denial, minimization, rationalization, outbursts of hostility and negativity as well as obsession and shame. Charlotte Kasl Ph.D., in her outstanding book Women, Sex and Addiction: A Search for Love and Power; provides an insightful interpretation of these traits as they apply to sexual compulsivity. While Kasl’s book was written primarily for women struggling with sexually compulsive behaviors, these traits are universal to ALL addictions, genders and sexual orientations.   Blame: Blame signals an increasing sense of powerlessness. When blame messages are decoded within the context of sexual compulsivity one finds underlying issues of over dependency and powerlessness; for example, when someone says; “you make me unhappy because you won’t have sex with me”, what we are actually hearing is “ I feel unable to create feelings of happiness inside myself. My happiness depends on your being sexual with me ”.    Fear: Fear is a natural response against being harmed by outside forces It is primitive and overwhelming - and can indicate that our life is in jeopardy. Fear as it applies to sexual compulsivity is a fear of having the addiction exposed. People protect their addiction, as it feels like the source of their life.   Rigidity: Rigidity is a sign of how fragile the addict has become. People hold onto an external framework, e.g., the cycle of addiction, for a sense of predictability and consistency in their lives, as a defense against the reality that they are crumbling inside.    Delusion: Delusion can manifest as misinterpreting the signals of others, e.g., interpreting a smile, or a casual hello from a stranger, as an invitation to have sex. Delusion is an example of how efficient the addiction has become at warping ones ability to experience reality.   Denial and minimization: Are expressed in statements such as, “there isn’t a problem”, “it’s just a little thing”, “I can stop this behavior if I really wanted to”. To the outside observer this appears “crazy” as the problems generated by the addiction are obvious to everyone but the addict.   Rationalization: Rationalization is a sure sign that someone is lost in an inner struggle. We don’t rationalize when we feel comfortable about something. Using a rationalization such as, “It’s okay to go to the bar just this once, everybody does”, is a way in which the addiction is given permission to be indulged.   Outbursts of hostility: Outbursts of anger occur when someone, e.g., a friend, family member or loved one, challenges the addiction, upsetting the fragile, rigid inner world the addict has created.   Negativity: Negativity permeates all aspects of the individuals’ life. Statements such as “People are jerks”, “Life is stupid” or “No one understands me”, indicate that the individual has become unable to experience kindness, love and compassion, and dwells instead on how bad everything is. This is a projection of how badly the individual is feeling inside.   Obsession and fantasies: These traits tend to focus on addictive ventures, increasingly interfering with concentration, the ability to be present with others, and the completion of the other pressing tasks of life.   Shame: This experience of not feeling “worthy”, of feeling “less than”, permeates the essence of the person struggling with the addiction – as this experience is so painful, it is denied.   Identifying Toxic States Toxic states are intense reactions that leave one feeling “un-centered” and “desperate” for relief. These emotional reactions are negative, involving powerful body centered symptoms and distortions in thinking.   Toxic states often overwhelm ones ability to self soothe, make rational choices and undermine attempts to remain sober. The hallmark of a toxic state is that it is intense, immediate and requires an extreme set of responses which, in the short term, resolves discomfort at the expense of ones personal and relational well being.   Toxic states often manifest as a complex mix of agitation, anxiety, unexplained anger and negative self-talk that can feel impossible to challenge.   Toxic states can also manifest as “cockiness”, and “grandiosity” in which the individual appears to have no humility, or in which the individual appears to see themselves as “the worst person in the world”. Grandiosity, like all toxic states, runs in extremes. While toxic states can feel like a random hodgepodge of symptoms in actuality they align themselves along the experiences of sensing, thinking, feeling, and behaving. A more detailed explanation of these experiences should help to highlight these ideas.   Sensing: Sensing refers to the experiences felt in ones body. Often times our senses are trying to tell us something, the tightening of our stomach, throat or shoulders when we encounter someone we dislike or feel unsafe around, the changes in how we breath when we are upset about a situation. These body-based senses are natural responses to stressful situations, and provide us with information about how to proceed.   People struggling with addictions or histories of abuse have learned to disregard these body-based forms of communication as a way to survive overwhelming physical and emotional stresses, equating these sensations with the need to self medicate or deny what their bodies are trying to tell them about a particular situation. Common sensing experiences include:   • Feeling like one is chocking; • Headaches • Tightening in the throat; • “Butterflies” in ones stomach; • Stomach cramps and aches; • “Knots” in ones stomach; • Nausea; • Light headedness; • Dizziness; • Tremors and shaking.   Thinking: Thinking is a complex activity, which involves organizing information obtained from interacting or observing a situation into some form of meaning. In those struggling with toxic states, these meanings are frequently organized into mistaken beliefs about the future, oneself and others, referred to as cognitive distortions. Often toxic states are accompanied by changes in ones thinking.   Toxic thoughts usually center around;   The self: • “I’m damaged goods” • “No one will ever love me” • “I’m not worthy of having a good life”   Others: • “People will judge me” • “People hate me” • “People can’t be trusted”   The past: • “My life is the way it is because of . . .” • “I’ve made so many mistakes in the I can’t forgive  myself”   The future: • “There’s no hope for me” • “My life will always be this way” • “I’m always going to be lonely”   Feeling: Feelings, like body sensations, are valuable sources of information about the environment we are in and the interactions we are having with others and ourselves. Everyone is entitled to his or her feelings, positive, negative or indifferent.   Feelings, like body sensations, are valuable sources of information about the environment we are in and the interactions we are having with others and ourselves. Toxic feelings tend to be repetitive, fixed and lacking in variability. Some of these toxic feelings include;   • Rage • Depression • Anger • Hate • Paranoia • Envy • Jealousy • Resentment • Regret • Vengeance   Behaving: Behaving is the final series of actions that we engage in based on sensing, thinking and feeling. Toxic behaviors include any activity that is used to minimize, distract or avoid dealing with the discomfort and pain of toxic sensations, thoughts and feelings. Common toxic behaviors include: • Drinking to excess • Eating to excess • Having sex to avoid emotions • Spending money one does not have • Other behaviors which undermine ones well being   In conclusion, toxic states are senses, thoughts, feelings and behaviors that consistently undermine ones sense of well being, while also limiting the quality of ones’ life.

Suggested Reading: Carnes, Patrick, (1991): Don't Call it Love:  In depth research on over 1,000 sex addicts, the process of sexual addiction and paths to recovery. Carnes, Patrick, (1992): Out of the Shadows: Understanding Sexual Addiction. 2nd Edition.  Easy to read outline of the developmental process which drives sexual addiction and compulsivity. Earle, Ralph, and Gregory Crow (1989): Lonely All the Time: Another view of the development of sex addiction offering insight into the family dynamics that feed sexually compulsive behavior.  Kasl, Charlotte, (1989): Women, Sex, and Addiction. Kasl documents the struggles of women who are sexually compulsive, as well as women who are attracted to male sex addicts.  Weiss, Robert, (2005): Cruise Control: Understanding Sex Addiction in Gay Men. A powerful resource for gay men, and therapists, interested in understanding the interaction between homophobia, substance abuse and sexual compulsivity among gay men. This is a great resource, as much of the material in the field of sexual compulsivity and sex addition has been based on the experiences of heterosexual men. 12 Step Recovery Programs: I list these programs as they are free of charge and many people have found them to be helpful in dealing with the shame and isolation of addiction. These programs offer a safe place to meet other people that have struggled with sexual and chemical addictions.  Sexaholics Anonymous (SA) P. O. Box 111910 Nashville, TN 37222-6901 National: 1 (866) 424-8777 Website: http://sa.org Offering groups for both men and women. SA has a reputation of being the least supportive of the 12 step programs to GLBT people. Sex Addicts Anonymous (SAA) P. O. Box 70949 Houston, TX 77270 National Number: 1 (800) 477-8191 Website: http://sexaa.org/ Both straight and gay meetings offered. Women also attend. Sex and Love Addicts Anonymous (SLAA) P. O. Box 119, New Town Branch Boston, MA 02258 (617) 332-1845 (781) 255-8825 Website: http://slaafws.org/ Both straight and gay meetings offered. Women also attend. For Couples Recovering Couples Anonymous P. O. Box 11872 St. Louis, MO 63105 Website: http://www.recovering-couples.org/ (314) 830-2600 The Society for the Advancement of Sexual Health (SASH) PO Box 433 Royston, GA. 30662  Atlanta, GA 30067 Phone: (770) 356-7031 Fax:     (866)  389-3974 e-mail: sash@sash.net website: http://sash.net/ Sexual Recovery Institute 822 S. Robertson Blvd., Suite #303 Los Angeles, CA 90035  Telephone: (310) 360-0130 Fax: (310) 360-0133 E-mail: info@sexualrecovery.com  Website:  http://www.sexualrecovery.com/ The Sexual Recovery Institute is a specialty therapy agency directed toward the elimination of sexual behaviors that cause people unwanted consequences or losses in their lives. SRI can also assist those seeking assistance in addressing sexual addiction and compulsivity by locating therapists, treatment facilities and other services that seek to help those looking to regain control over their sexual behaviors.