Effective treatment of sexual addiction typically uses the same basic approach that has proven effective in the treatment of substance use disorders. As such, if you or a loved one decides to work with a therapist or counselor who specializes in sexual addiction, treatment will likely involve a highly directive form of counseling, such cognitive behavioral therapy (CBT), coupled with group therapy, 12-step and other social support groups, and maybe alternative therapies such as art therapy, equine therapy (working with horses), EMDR (eye movement desensitization and reprocessing) and the like.
What Is Sexual Sobriety?
The biggest difference between treatment for substance abuse and treatment for sexual addiction lies in the definition of sobriety. Whereas complete abstinence is typically the goal with alcoholism and drug addiction, long-term behavior change rather than permanent abstinence is the aim with sex addiction. As such, sex addicts are asked by their therapist very early in the treatment process – usually within the first few weeks – to define the behaviors that do and don’t compromise the relationships and values they hold most dear. They then commit, in a written “sexual sobriety contract,” to abstain from problematic sexual activities and to engage in non-problematic sexual activities only moderately and appropriately. It is important to understand that the definition of “sexual sobriety” varies from addict to addict. Some addicts may need to eliminate extramarital sex, casual sex, and anonymous sex, whereas others may need to eliminate webcam sex, digital pornography, and sexting. Sexual activities that are problematic for one addict may be perfectly fine, perhaps even healthy, for another.
Recognizing the difficulty that most sex addicts have when it comes to deciding what’s healthy and what’s not, most treatment programs encourage or require a short period of total sexual abstinence, usually from 30 to 90 days; this includes abstinence from masturbation. This break from all sexual activity gives the addict and his/her treatment team time in which to examine the addict’s full sexual history, including all recent sexual behavior, working together to determine the addict’s definition of sobriety. This period of abstinence is also used to help the addict develop basic coping skills that he/she can rely on when triggered toward his/her addiction.
Early treatment for sex addiction usually focuses on two main issues:
- Separating the sex addict from his/her addiction
- Combatting the denial the addict uses to make his/her behavior acceptable in his/her own mind.
Cognitive Behavioral Therapy is the backbone of most sexual addiction treatment, especially early on. CBT differs significantly from traditional forms of psychotherapy, which usually examine the ways in which the past affects the present. CBT is much more focused on the here and now, attempting to stop the addict’s problematic behaviors before dealing with other, longer-term issues. CBT specifically looks at things that trigger emotional discomfort and the desire to escape through compulsive sexual fantasy and activity; it then identifies ways to short-circuit this pattern. In short, CBT teaches sex addicts to recognize when they’re triggered to act out, and to then stop their sexual fantasies and behaviors by thinking about and/or doing something else – whether that’s calling a supportive friend in recovery, going to a 12-step meeting, cleaning the house, meditating, journaling or going to the gym, for example.
As with other addictions, recovering sex addicts tend to do best with the support of others who are also in the process of healing. To this end, sex addiction-focused group therapy is generally quite useful. In most sex addiction-focused therapy groups, a treatment specialist (sometimes more than one) works with between six and 10 addicts. Addicts learn that their problem is not unique, which helps with the shame, guilt and remorse they almost all feel – and that triggers their desire to act out. Group therapy is also ideal for confronting and overcoming the denial that drives sexual addiction – the rationalizations and justifications that addicts rely on to make their behavior seem OK in their own minds.
Most sex addicts attend 12-step sexual-addiction recovery meetings such as those held by Sex Addicts Anonymous, Sexaholics Anonymous, Sexual Compulsives Anonymous, Sex and Love Addicts Anonymous and Sexual Recovery Anonymous. These support groups serve much the same purpose as group therapy, but on a longer-term and somewhat more social basis. Formal therapy with a trained, certified sex addiction treatment specialist is often a bridge into one or more of these addict-run self-help groups, though many addicts choose to remain in individual and/or group therapy while also attending 12-step meetings. Usually, after the first year or so, formalized therapy focuses on the resolution of longer-term underlying issues such as childhood trauma, with external support groups helping the addict to maintain sexual sobriety.
Some sex addicts struggling to establish or maintain sobriety benefit from either residential (inpatient) or intensive outpatient treatment. These programs may last as little as two weeks or as long as several months, depending on the treatment facility and the sex addict’s needs. Inpatient treatment offers the added benefit of physically separating sex addicts from the sexual images, emotional situations and problematic people that trigger their compulsive sexuality. Both inpatient and intensive outpatient programs typically offer not only individual therapy, but the group work that can be essential to the healing process.
It’s important to recognize that every sex addict’s path to recovery and a healthier, happier, more fulfilling life will be different. Each addict arrives with a unique background and a distinctive set of problematic sexual behaviors. As such, every person needs to find or create a program of recovery tailored to his or her particular needs. To learn more about treatment, visit the Get Help section.
Sources: American Society of Addiction Medicine; Archives of Sexual Behavior; Behavioral addictions: Criteria, evidence, and treatment, European Archives of Psychiatry and Clinical Neuroscience; National Institute on Drug Abuse; Out of the shadows: Understanding sexual addiction (3rd Ed.); PLOS One; Sex addiction 101: A basic guide to healing from sex, porn, and love addiction; Understanding and treating sex addiction: A comprehensive guide for people who struggle with sex addiction and those who want to help them.