Sex addiction is a process or behavioral addiction in which a person engages in a pattern of compulsive sexual behavior that causes them significant distress, functional impairment or problems with daily living. Its exact classification is controversial. Some studies support its similarity to substance addiction, citing its effects on the brain and its behavioral parallels, while others suggest it is an impulse control disorder primarily driven by high libido.
Regardless of these controversies, sex addiction has proven to be a useful term for people seeking a way to overcome detrimental sexual behavior. The addiction model acknowledges and addresses the gap many people experience between their desire to change their behavior and the challenge of making and maintaining that change. It also provides a model for how to overcome sex addiction.
Whether a person has a severe sex addiction that puts their physical health or safety at risk, a compulsion toward illegal sexual behavior or a subtler issue that strains a relationship with an intimate partner, sex addiction treatment can help. The right therapist or program can facilitate insight into the underlying causes of sex addiction while also helping a person learn immediate strategies to address cravings without acting on them.
Therapy for Sex Addiction
The primary intervention for people with addictive or compulsive sexual behavior is sex addiction therapy. While the reasons people can develop a sex addiction vary significantly, ranging from high sexual drive to dependent personality traits, nearly all sexual addictions have cognitive and emotional components that respond well to sex addiction counseling and talk therapy.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is one of the most widely studied forms of therapy and has been found to be an effective, evidence-based intervention for many different mental health conditions. The focus of CBT is examining and bringing to light patterns of thinking that are destructive or irrational and which drive painful emotions and maladaptive behavior.
This intervention is based on the understanding that it is easier to change emotion and behavior by changing thoughts first. Emotions can have deep roots that require years of in-depth therapy to uncover, while thoughts reveal themselves more easily and are usually more malleable.
For example, a person might have developed a fear of separation from a caregiver in their early life. This fear is likely to reveal itself through thoughts and beliefs such as, “It’s not safe to be alone.” Similarly, a person might feel ashamed of their sexuality in ways that emerge in thoughts like, “I can’t let anyone I care about know anything about my sexual life.”
In CBT, a therapist helps a person examine and question such thoughts. In imaginative exercises and thought experiments, a person can explore what would be possible if their beliefs weren’t true. For people whose sexual behavior presents an immediate risk to self or others, CBT may initially focus on surface-level beliefs, such as denial that a particular behavior is a problem.
A CBT therapist will usually also help clients develop behavioral strategies that make it easier to resist cravings. This can include identifying activities, places and relationships that decrease the chances of acting on a sexual impulse and others that increase the chance of acting on it. These strategies are similar to those used in CBT to develop relapse prevention plans for people with substance addictions.
Dialectical Behavior Therapy
Dialectical behavior therapy (DBT) was originally developed in the 1970s by Marsha Linehan for people with borderline personality disorder (BPD). Its purpose was to establish a collaborative and non-judgmental therapeutic model that would not alienate people who were sensitive to invalidation. Since then, people have gained more insight into both DBT and BPD and have found that it is an effective intervention for a wide range of disorders rooted in trauma.
One of the essential features of DBT is its emphasis on having clients first develop and practice a set of skills that will help them improve distress tolerance, regulate emotions and become more effective in interpersonal interactions. These skills are rooted in concepts and practices from meditation and mindfulness.
One of the most significant differences between DBT and CBT is that DBT encourages people to observe thoughts and feelings without judging or acting on them, while CBT emphasizes trying to actively change those thoughts and feelings. For some people, DBT is less invalidating of emotions rooted in trauma and is more immediately effective.
Many people who struggle with sex addiction have experienced trauma. Sexual or psychological abuse can have a long-term effect on how people approach and feel about sexual relationships. One of the primary effects of trauma is that it strips people of a sense of safety. When people have a hard time feeling safe in intimate relationships, they may seek sexual encounters that are more anonymous and dangerous but are less emotionally satisfying.
For people whose sex addiction emerged from trauma, DBT can help them feel safe enough emotionally to explore and address these issues. It can be effective for those without trauma histories as well. By giving people tools to immediately access both thoughts and feelings, DBT can help them find more ways to address the behavior that follows from them.
Psychodynamic therapy is a traditional style of therapy derived from the work of early psychoanalytic thinkers like Sigmund Freud and Carl Jung. It is rooted in the concept of drives and hidden motivations for behavior. The primary focus of psychodynamic therapy is exploring events and relationships from childhood that shaped adult emotional reactions and beliefs. Like DBT, it can be helpful for people whose sex addictions are rooted in childhood trauma.
Unlike CBT and DBT, psychodynamic therapy, which is sometimes also called “depth therapy,” does not focus on immediate strategies for behavioral change. The goal is a deeper and more profound transformation that can take much longer to realize. Traditionally, psychoanalysis was expected to take years, if not decades to complete. This is because it targets emotion and instinct that does not respond as well to rational analysis. Dreamwork is often used to explore these dynamics that lie beneath the surface of thought.
Because psychoanalysis is such a long-term approach, many modern psychodynamic therapists mix dream work and other psychodynamic interventions with techniques from other styles of therapy that can yield more immediate benefits. In practice, many modern psychodynamic therapists follow a course more like that of DBT. First, they help clients establish a set of skills for safer and more effective personal behavior, then proceed into deeper work to help clients explore and resolve trauma.
The impact of sexual addiction is often felt first in close relationships, especially intimate partner relationships. Sex addiction can lead to infidelity in marriage and even to behavior that puts a partner’s mental and physical health at risk. In less severe cases, subtler sexual fixations can lower the quality of intimacy between two partners or alienate them from one another.
These impacts can often cause people to seek couples counseling before individual therapy or other interventions for sex addiction. Like individual therapists, marriage and family therapists and couples’ counselors use a wide variety of approaches. Most forms of relationship or sex counseling for couples focus on identifying and addressing relationship dynamics and require mutual work and investment from both partners.
Some kinds of sex addiction can be addressed primarily by couples counseling focused on shifting intimate dynamics between partners in a relationship. For example, sex addiction driven by an insecure attachment style might respond best to interventions that help both partners work on the way they relate to one another.
Sometimes, people with sex addiction judge themselves for their behavior and see it as a reflection of a moral or personal failing rather than the sign of a deeper disorder or response to trauma. Usually, work in therapy shifts these perceptions and allows people to understand their behavior differently. For many, the revelations they start to experience in couples counseling can lead them to seek individual therapy to complement couples work.
Some people with sex addictions suffer intense shame, anxiety and self-loathing because of the discrepancy between their behavior and their faith. For some, guilt over acts of dishonesty and infidelity are most painful, while for others, the nature of their sexual interests alone causes significant inner conflict.
Many therapists take a secular approach and may not be able to fully address faith-based concerns. For people who want to work on spiritual aspects of their addiction, faith-based counseling may be the best option. Interfaith or faith-specific counseling is available for people of different faiths, and Christian sex addiction recovery groups and individual counseling are especially well-represented in the recovery community.
Medication for Sex Addiction
Prescribing medication for sex addiction is rarely useful on its own but can facilitate recovery when used in combination with therapy. Medications that have shown promise in treating sex addictions include selective serotonin reuptake inhibitors (SSRIs), naltrexone, mood stabilizers and antiandrogens.
Selective serotonin reuptake inhibitors like fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) were initially developed as antidepressants. Since their initial release in the 1980s, research has revealed that other mental health conditions can be successfully treated with SSRIs. Anxiety disorders and obsessive-compulsive disorder (OCD) both respond well to SSRIs. Studies of whether SSRIs can alleviate the obsessive and compulsive elements of sex addiction have yielded conflicting results.
Early studies suggest that naltrexone, an opiate agonist primarily used to treat opioid and alcohol use disorders, can reduce compulsive sexual behavior. Mood stabilizers, which are typically prescribed for bipolar disorder, may also help. However, using these two types of medications to treat sex addiction is still considered experimental and usually only done to complement or promote other therapeutic work.
In extreme situations in which a sex addiction drives behavior that endangers others, such as sexual acts that harm or endanger children, or any kind of sexual assault, antiandrogens can be used to reduce sexual hormones and diminish libido. Using medications to drastically lower or remove the sex drive is not usually recommended in circumstances that do not pose a risk of harm to others or to an individual with a sex addiction.
Sex Addiction Support Groups
Sex addiction can be alienating. Many people take measures to avoid having others find out about their addiction out of fear of judgment and rejection. They may be afraid to discuss it even with the people to whom they are closest. However, talking about sex addiction is an important part of recovery.
Attending a sex addiction support group can be an excellent option for people who are not yet ready to see a counselor or who want additional support beyond the counseling relationship. Sex addiction support groups include:
- Sexaholics Anonymous
- Sex Addicts Anonymous
- Sexual Recovery Anonymous
- Sex and Love Addicts Anonymous
- Self-Management and Recovery Training (SMART) Groups
Participating in any of these support groups can help people release fear and shame and gain wisdom from peers about how to cope with sexual cravings without acting on them.
Sex Addiction Hotlines
For some people, any public venue is too overwhelming in early recovery from sex addiction. Fortunately, calling a sex addiction hotline is an option for people looking for a way to talk to someone anonymously. Some local treatment and crisis centers offer hotlines to people in the surrounding community. National hotlines people can call to talk about sex addiction include the following:
- Sexaholics Anonymous: 1-866-424-8777
- Sex Addicts Anonymous: 1-800-477-8191
- SAMHSA Addiction Hotline: 1-800-662-4357
People can call these hotlines 24 hours a day for everything from simple compassionate listening to advice, counseling or treatment referrals.
Treating Sex Addiction and Co-Occurring Conditions
In the past, the behavioral health community believed it was best to treat addictions first and that co-occurring mental health or behavioral disorders could only be effectively resolved after a person had abstained from an addictive behavior for an extended period of time. Since then, research and practice have revealed that it is more effective to treat co-occurring addictive and mental health disorders together in integrated treatment programs. In these programs, people receive multiple interconnected services from a team of clinicians that communicate with one another and coordinate their interventions.
Treating sex addiction and co-occurring disorders can involve multiple outpatient services or an integrated inpatient program followed by outpatient counseling. Many of the disorders that commonly co-occur with sex addiction, which include depression, anxiety, post-traumatic stress disorder and substance use disorders, can respond to the same interventions. For example, CBT can help a person address depressive thoughts, anxiety-driven behaviors and triggers to resume substance use or detrimental sexual behavior. For many people, combining individual therapy with group treatment and peer support groups can help them maintain their recovery.
Sex Addiction Recovery
The lack of a consistent definition or research consensus makes it difficult to determine a precise sex addiction recovery rate. Many people reference an unverified statistic that the relapse rate for people with sex addictions is 95 percent. However, in a Reuters article reported by Jackie Frank, psychologist Steve Eichel cites an 80 percent short-term sex addiction recovery success rate for people who actively participate in treatment and support groups.
Many sex addiction counselors and recovery groups use a sex addiction recovery timeline to help clients understand their path to recovery. Some 12-step groups use a five-stage model based on the stages of grief. According to this model, after the initial “Crisis/Decision Stage,” a person spends most of their first year of recovery in the “Shock Stage,” then moving to “Grief,” “Repair,” and “Growth” stages. Another model lists four stages:
- Survival Phase: the first six months to one year of recovery
- Stability Phase: starts six months to two years into recovery
- Sustaining Phase: starts one-and-a-half to three years into recovery
- Freedom Phase: starts two-and-a-half or more years into recovery
The idea of both models is that the first phase of recovery is the hardest and when people have the highest relapse rate. Being involved in a treatment program and attending sex addiction recovery groups can help people get through this more difficult phase and achieve a more stable recovery.
Stories of Hope
For people looking for hope and recovery from sex addiction, support groups can be an especially important resource in early phases of recovery for a number of reasons. In addition to providing accountability and social support, they can help people learn recovery strategies and find inspiration by listening to others’ sex addiction treatment success stories. Stories like Steven Jay Schwartz’ story can help people find hope by recognizing how another person overcame similar struggles and setbacks.
One of the best ways to complete the first phase of recovery from sex addiction is to pair support groups with outpatient or inpatient sex addiction treatment. This can be even more important for people with co-occurring conditions like substance use disorders and depression.
The Recovery Village operates treatment centers across the United States that provide integrated treatment for people with dually diagnosed disorders. If you are concerned about compulsive sexual behavior or a sexual addiction and co-occurring substance use or mental health conditions, know that you are not alone and that there is help. Contact The Recovery Village today and a representative can help you learn about treatment options that can meet your needs.
Grant, Jon E., Potenza, Marc N., Weinstein, Aviv, and Gorelick, David A. “Introduction to Behavioral Addictions.” American Journal of Drug and Alcohol Abuse, Volume 36(5): 233-241. Published September 1, 2011. Retrieved January 12, 2019. University of Cambridge Research News. “Brain Activity in Sex Addiction Mirrors That of Drug Addiction.” Published July 11, 2014. Retrieved January 12, 2019. Hofmann, Stefan G., Asnaani, Anu, Vonk, Imke, Sawyer, Alice, and Fang, Angela. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.” Cognitive Therapy and Research, Vol. 36(5): 427-440. Published July 31, 2012. Retrieved January 12, 2019. Fong, Timothy W. “Understanding and Managing Compulsive Sexual Behaviors.” Psychiatry, Volume 3(11): 51-58. Published November 2006. Retrieved January 12, 2019. Zapf, James L., Greiner, Jay, and Carroll, James. “Attachment Styles and Male Sex Addiction.” Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention. Volume 15 (2): 158-175. Published May 9, 2008. Retrieved January 12, 2019. Kelly, Thomas M., and Daley, Dennis C. “Integrated Treatment of Substance Use and Psychiatric Disorders.” Social Work in Public Health, Vol. 28, No. 3-4: 388-406. Published June 3, 2013. Retrieved January 10, 2019. Frank, Jackie. “Woes of Famous, Powerful Shine Light on Sex Addiction.” Reuters Entertainment News. Published June 16, 2011. Retrieved January 16, 2019. Triangle SAA. “Getting Started: Writing a Sobriety Plan.” Published August 7, 2016. Retrieved January 16, 2019. Magness, Milton S. “Stop Sex Addiction.” Central Recovery Press. Published April 2, 2013. Retrieved on Google Books on January 16, 2019. Schwartz, Stephen Jay. “What Does Recovery from Sex Addiction Look Like?” The Fix. Published January 1, 2013. Retrieved January 16, 2019.
Grant, Jon E., Potenza, Marc N., Weinstein, Aviv, and Gorelick, David A. “Introduction to Behavioral Addictions.” American Journal of Drug and Alcohol Abuse, Volume 36(5): 233-241. Published September 1, 2011. Retrieved January 12, 2019.
University of Cambridge Research News. “Brain Activity in Sex Addiction Mirrors That of Drug Addiction.” Published July 11, 2014. Retrieved January 12, 2019.
Hofmann, Stefan G., Asnaani, Anu, Vonk, Imke, Sawyer, Alice, and Fang, Angela. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.” Cognitive Therapy and Research, Vol. 36(5): 427-440. Published July 31, 2012. Retrieved January 12, 2019.
Fong, Timothy W. “Understanding and Managing Compulsive Sexual Behaviors.” Psychiatry, Volume 3(11): 51-58. Published November 2006. Retrieved January 12, 2019.
Zapf, James L., Greiner, Jay, and Carroll, James. “Attachment Styles and Male Sex Addiction.” Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention. Volume 15 (2): 158-175. Published May 9, 2008. Retrieved January 12, 2019.
Kelly, Thomas M., and Daley, Dennis C. “Integrated Treatment of Substance Use and Psychiatric Disorders.” Social Work in Public Health, Vol. 28, No. 3-4: 388-406. Published June 3, 2013. Retrieved January 10, 2019.
Frank, Jackie. “Woes of Famous, Powerful Shine Light on Sex Addiction.” Reuters Entertainment News. Published June 16, 2011. Retrieved January 16, 2019.
Triangle SAA. “Getting Started: Writing a Sobriety Plan.” Published August 7, 2016. Retrieved January 16, 2019.
Magness, Milton S. “Stop Sex Addiction.” Central Recovery Press. Published April 2, 2013. Retrieved on Google Books on January 16, 2019.
Schwartz, Stephen Jay. “What Does Recovery from Sex Addiction Look Like?” The Fix. Published January 1, 2013. Retrieved January 16, 2019.