Dual Diagnosis - Process Addiction

Sex and Love Addiction

Most of us are quite hesitant to label someone an addict. We are more able to admit that we and others have "bad habits," but we shy away from saying that we are "hooked on" someone or something. I think that part of this fear comes from our stereotype of addicts. Most of us think of alcoholics, for example, as "skid row bums" when, in fact, only about 5% or 10% of alcoholics are that severely debilitated by their disease. Most alcoholics work, and many are not obvious to the public eye.

In the field of chemical dependency, we have come a long way from the moralistic view that people addicted to chemicals simply lack willpower and are morally weak. A major step along this path was the recognition by the American Medical Association in 1954 that alcoholism is a disease. Nowadays, most Americans see alcoholism as an illness, and are aware of treatment options as well as support groups like Alcoholics Anonymous (A.A.). We have even had a president's wife obtain help for drug and alcohol dependence and lend her name to a treatment facility, the Betty Ford Center.

Still, we are afraid to say we think someone might be an addict. In addition to the social stigma and moral judgments involved, another basis for these reservations is the poor success rate associated with addictions. Some 25 years ago, when the only residential treatment program for heroin addicts was in Lexington, Kentucky, their recovery rate was estimated to be an abysmal 4%. Heroin addiction was like a death sentence. The problem was considered to be incurable, much like the current situation with AIDS. Under these conditions, then, it was understandable that diagnosing oneself or someone else as an addict was a heavy burden and, perhaps, a fatal curse.

The following questions are designed to be used as guidelines to identifying possible signposts of sex and love addiction. They are not intended to provide a sure-fire method of diagnosis, nor can negative answers to these questions provide absolute assurance that the illness is not present. Many sex and love addicts have varying patterns which can result in very different ways of approaching and answering these questions. Despite this fact, we have found that short, to-the-point questions have often provided as effective a tool for self-diagnosis as have lengthy explanations of what sex and love addiction is. We appreciate that the diagnosis of sex and love addiction is a matter that needs to be both very serious and very private. We hope that these questions will prove helpful.

Yes [ ] No [ ]

1.) Have you ever tried to control how much sex to have or how often you would see someone?

Yes [ ] No [ ]

2.) Do you find yourself unable to stop seeing a specific person even though you know that seeing this person is destructive to you?

Yes [ ] No [ ]

3.) Do you feel that you don't want anyone to know about your sexual or romantic activities?

Yes [ ] No [ ]

4.) Do you get "high" from sex and/or romance?

Yes [ ] No [ ]

5.) Have you had sex at inappropriate times, in inappropriate places, and/or with inappropriate people?

Yes [ ] No [ ]

6.) Do you make promises to yourself concerning your sexual or romantic behavior that you find you cannot follow?

Yes [ ] No [ ]

7.) Have you had or do you have sex with someone you don't (didn't) want to have sex with?

Yes [ ] No [ ]

8.) Do you believe that sex and/or a relationship will make your life bearable?

Yes [ ] No [ ]

9.) Have you ever felt that you had to have sex?

Yes [ ] No [ ]

10.) Do you believe that someone can "fix" you?

Yes [ ] No [ ]

11.) Do you keep a list, written or otherwise, of the number of partners you've had?

Yes [ ] No [ ]

12.) Do you feel desperation or uneasiness when you are away from your lover or sexual partner?

Yes [ ] No [ ]

13.) Have you lost count of the number of sexual partners you've had?

Yes [ ] No [ ]

14.) Do you feel desperate about your need for a lover, sexual fix, or future mate?

Yes [ ] No [ ]

15.) Have you or do you have sex regardless of the consequences (e.g.. the threat of being caught, the risk of contracting herpes, gonorrhea, AIDS, etc.)?

Yes [ ] No [ ]

16.) Do you find that you have a pattern of repeating bad relationships?

Yes [ ] No [ ]

17.) Do you feel that your only (or major) value in a relationship is your ability to perform sexually, or provide an emotional fix?

Yes [ ] No [ ]

18.) Do you feel that you're not "really alive" unless you are with your sexual / romantic partner?

Yes [ ] No [ ]

19.) Do you feel entitled to sex?

Yes [ ] No [ ]

20.) Do you find yourself in a relationship that you cannot leave?

Yes [ ] No [ ]

21.) Have you ever threatened your financial stability or standing in the community by pursuing a sexual partner?

Yes [ ] No [ ]

22.) Do you believe that the problems in your "love life" result from continuing to remain with the "wrong" person?

Yes [ ] No [ ]

23.) Have you ever had a serious relationship threatened or destroyed because of outside sexual activity?

Yes [ ] No [ ]

24.) Do you feel that life would have no meaning without a love relationship or without sex?

Yes [ ] No [ ]

25.) Do you find yourself flirting or sexualizing with someone even if you do not mean to?

Yes [ ] No [ ]

26.) Does your sexual and/or romantic behavior affect your reputation?

Yes [ ] No [ ]

27.) Do you have sex and/or "relationships" to try to deal with, or escape from life's problems?

Yes [ ] No [ ]

28.) Do you feel uncomfortable about your masturbation because of the frequency with which you masturbate, the fantasies you engage in, the props you use, and/or the places in which you do it?

Yes [ ] No [ ]

29.) Do you engage in the practice of voyeurism, exhibitionism, etc. in ways that bring discomfort and pain?

Yes [ ] No [ ]

30.) Do you find yourself needing greater and greater variety and energy in your sexual or romantic activities just to achieve an "acceptable" level of physical and emotional relief?

Yes [ ] No [ ]

31.) Do you need to have sex, or "fall in love" in order to feel like a "real man" or a "real woman"?

Yes [ ] No [ ]

32.) Do you feel that your sexual and romantic behavior is about as rewarding as hijacking a revolving door?

Yes [ ] No [ ]

33.) Are you unable to concentrate on other areas of your life because of thoughts or feelings you are having about another person or about sex?

Yes [ ] No [ ]

34.) Do you find yourself obsessing about a specific person or sexual act even though these thoughts bring pain, craving or discomfort?

Yes [ ] No [ ]

35.) Have you ever wished you could stop or control your sexual and romantic activities for a given period of time?

Yes [ ] No [ ]

36.) Do you find the pain in your life increasing no matter what you do?

Yes [ ] No [ ]

37.) Do you feel that you lack dignity and wholeness?

Yes [ ] No [ ]

38.) Do you feel that your sexual and/or romantic life affects your spiritual life in a negative way?

Yes [ ] No [ ]

39.) Do you feel that your life is unmanageable because of your excessive dependency needs?

Yes [ ] No [ ]

40.) Have you ever thought that there might be more you could do with your life if you were not so driven by sexual and romantic pursuits?

Yes [ ] No [ ]

Love addicts are characteristically familiar with desperate hopes and seemingly unending fears. Fearing rejection, pain, unfamiliar experiences, and having little faith in their ability or right to inspire love, they wait, wish, and hope for love, perhaps their least familiar experience.

Addictive sexuality is like most other compulsive behaviors: a potentially destructive twist on a normal life-enhancing activity. Defining sex addiction depends less on the behavior itself than on the person's motivation.

Sex addicts display a lack of the ability to control or postpone sexual feelings and actions. The need for arousal often replaces the need for intimacy. Eventually, thrill seeking becomes more important than family, career, even personal health and safety.

As sexual preoccupation increases in terms of energy and time, the sex addict follows a routine or ritual leading to acting out on desires which is then followed by feelings of denial then shame, despair and confusion.

It may be helpful to examine the definition of addiction more closely. Addiction is characterized by the repeated, compulsive seeking or use of a substance or activity despite adverse social, psychologic and/or physical consequences. Addiction is often (but not always) accompanied by physical dependence, a withdrawal syndrome and tolerance. Physical dependence is defined as a physiologic state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal.

Withdrawal syndrome consists of a predictable group of signs and symptoms resulting from abrupt removal of, or a rapid decrease in the regular dosage of, a psychoactive substance or activity; the syndrome is often characterized by overactivity of the physiologic functions that were suppressed by the drug and/or depression of the functions that were stimulated by the object of addiction.

Tolerance is a state in which a drug or activity produces a diminishing biologic or behavioral response; in other words, higher doses or in the case of sex addicts, riskier behavior is needed to produce the same effect that the user experienced initially.

For love addicts, love:

• Is all consuming and obsessive
• Is inhibited
• Avoids risk or change
• Lacks true intimacy
• Is manipulative, strikes deals
• Is dependent and parasitic
• Demands the loved one's devotionv

Sexual addictions usually are revealed in stages:

• Preoccupation: continual fantasies about sexual prospects or situations. This can trigger an episode of sexual "acting-out"
• Ritualization: a preferred sexual activity or situation is often stereotyped and repetitive
• Compulsion: continual engagement in sexual activity despite negative consequences and desire to stop
• Despair: guilt or shame over their inability to control behavior or feel remorse
• Other behavioral problems, particularly chemical dependency and eating disorders

Causes

In the case of love addicts, often their own growth and development were thwarted earlier in life. Similarly, many sex addicts report some form of abuse or neglect as children and frequently see themselves as diminished or damaged in the process. Their parents are often sex addicts themselves.

Stress also plays a part in fueling compulsive sexual behavior by feeding the addict's need for withdrawal and fantasy.

Levels of phenylethylamine (PEA) a chemical in the brain involved in the euphoria that comes with falling in love rise with feelings of infatuation, boosting euphoria and excitement.

Love and sex addicts, may simply be dependent upon the physical and psychological arousal triggered by PEA and stress-related neurotransmitters.

Treatment

If you discover you are in an addictive relationship, you may want to seek professional assistance. Specialized counseling is available for those dealing directly or indirectly with this form of addiction.

Overcoming sexual compulsivity and addiction starts with recognizing that you are out of control sexually. Getting to that point requires taking a hard look at yourself and the problems emotional, physical, or financial caused by your sexual behavior.

Treatment should probably involve at least some of the following:

• A commitment to abstinence
• Rebuilding relationships
• Managing stress
• Self-help

Some treatment for sex addicts follows the format employed by alcoholics. This model views addicts as individuals chronically addicted to a behavior in spite of their attempts to change. They are in a vicious cycle of use, self-judgment, and avoidance that is repeated time and again. The model focuses on three elements of the cycle:

• Use of sex
• Self-judgment
• Avoidance behaviors

The approach to counseling is strongly based on 12-step models.

The three elements of the addictive cycle are impacted by a process created by using:

• A therapeutic environment
• A thorough assessment
• A group process
• Education
• Self/peer assessment

All five items are incorporated into a therapeutic process, which begins with the first contact.

The creation of an environment that supports the therapeutic process is essential to this approach. Clients must be provided with an opportunity to explore their self-judgments without fear of the judgment of others. They must feel they are listened to with empathy and respect. In earlier models of this approach, the counselor was the only one who possessed so-called counselor characteristics. Although this element is still critical, it now applies to the whole multidisciplinary team, a staff of professionals who are naturally therapeutic.

The counselor conducts an initial assessment, identifies the presenting problem, and, if indicated, schedules the client for treatment.

A thorough psychosocial assessment is conducted, and identified blocks to treatment or problems are noted. The counselor begins the bonding with the client during the assessment process. All counseling skills come into play. The counselor then prepares a therapeutic or treatment plan (i.e., the change model) to help the client deal with those identified problems or blocks that will prevent response to the treatment process.

The client follows a simple change model that closely aligns with the 12 steps of NA and AA.Treatment

If you discover you are in an addictive relationship, you may want to seek professional assistance. Specialized counseling is available for those dealing directly or indirectly with this form of addiction.

Overcoming sexual compulsivity and addiction starts with recognizing that you are out of control sexually. Getting to that point requires taking a hard look at yourself and the problems emotional, physical, or financial caused by your sexual behavior.

Treatment should probably involve at least some of the following:

• A commitment to abstinence
• Rebuilding relationships
• Managing stress
• Self-help

Some treatment for sex addicts follows the format employed by alcoholics. This model views addicts as individuals chronically addicted to a behavior in spite of their attempts to change. They are in a vicious cycle of use, self-judgment, and avoidance that is repeated time and again. The model focuses on three elements of the cycle:

• Use of sex
• Self-judgment
• Avoidance behaviors

The approach to counseling is strongly based on 12-step models.

The three elements of the addictive cycle are impacted by a process created by using:

• A therapeutic environment
• A thorough assessment
• A group process
• Education
• Self/peer assessment

All five items are incorporated into a therapeutic process, which begins with the first contact.

The creation of an environment that supports the therapeutic process is essential to this approach. Clients must be provided with an opportunity to explore their self-judgments without fear of the judgment of others. They must feel they are listened to with empathy and respect. In earlier models of this approach, the counselor was the only one who possessed so-called counselor characteristics. Although this element is still critical, it now applies to the whole multidisciplinary team, a staff of professionals who are naturally therapeutic.

The counselor conducts an initial assessment, identifies the presenting problem, and, if indicated, schedules the client for treatment.

A thorough psychosocial assessment is conducted, and identified blocks to treatment or problems are noted. The counselor begins the bonding with the client during the assessment process. All counseling skills come into play. The counselor then prepares a therapeutic or treatment plan (i.e., the change model) to help the client deal with those identified problems or blocks that will prevent response to the treatment process.

The client follows a simple change model that closely aligns with the 12 steps of NA and AA.