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Sex, Love and Poly-Behavioral Addiction |
by:
James Slobodzien |
ProposingNew Diagnosis and Theory for Patients with Multiple Addictions
By James Slobodzien, Psy.D., CSAC
Experts infield of addictions are presently purporting that between three and six percent ofworld’s population (oneninethree to threeeightsix million people) are presently affected bysexual dependency or compulsivity (Carnes, twozerozerofive). Sexual dependency isdiagnosable and treatable disease, which today is generally, regarded in aboutsame way that alcoholism and drug addiction (chemical dependency) was regarded fourzero years ago. Even so, there still existswide range of understandable misunderstandings about compulsive sexual acting out, created out of ignorance aboutnature of sexual addiction, and supported and perpetuated bymultibillion dollar pornography industry.
Sexual Dependency - isglobal term that coverswide range of maladaptive and self-defeating behavior patterns and relationships such as:
one. Love Addiction –disorder in which individuals repeatedly become involved in enmeshed, intense, codependent relationships, even when those relationships or partners are destructive;
two. Romance Addiction -disorder in which individuals become obsessed withintrigue andpursuit of romance and thrive onthrill ofchase, but find it impossible to sustaincommitted, intimate relationship with another person;
three. Sexual Anorexia –disorder in which individuals become dominated and obsessed withemotional, physical, and mental task of avoiding sex; and
four. Sex Addiction –disorder in which individuals become obsessed with sexually-related, compulsive self-defeating maladaptive behavior.
But can one really be addicted to love aspopular eightzero’s song proclaims? Inrecent research study, (Aron, A. twozerozerofive) published inJune issue ofJournal of Neurophysiology, researchers used functional MRI to watchreal-time brain activity of oneseven college students (onezero women, seven men), all of whom were inearly weeks or months of new love. These researchers concluded that, love may vie forsame real estate inbrain as drug addiction. “Early love, rooted as it is incaudate nucleus, is all about addiction.” "It isdrug addiction." "It's certainly got some ofmain characteristics of drug addiction -- as with drugs, once you fall in love you need that person more and more, so much so that, afterwhile, you have to marry them. There are other things, too -- real dependence, personality changes, withdrawal symptoms." “And just likeneed for cocaine or heroin, love can make people do crazy, sometimes dangerous things.” According to Aron (twozerozerofive),findings help explain instances where people fall in love with people they aren’t even sexually attracted to; or why others can feel equally strong, sudden emotion fornewborn child or even God.
So does this mean that all people who are newly in love haveaddiction? Are all men who look at pornography addicted? Are all women who read romance novels addicted? Are all people who avoid sex considered sexual anorexics? No, no, no, and no. Then how can we differentiate between addiction and healthy relationships? Like other forms of addictive diseases and lifestyle disorders such as chemical dependency, pathological gambling, eating disorders, and religious addiction -
Sexual dependency is characterized byaddictive cycle of:
one. Obsession or preoccupation;
two. Ritualization;
three. Compulsive behaviors;
four. Loss of control and despair; and
five. Shame and guilt that perpetuatesmaladaptive belief system of impaired thinking and unmanageability.
Typically, sexual addictive patterns are considered pathological problems when issues concerning sexual behaviors becomefocus of life, causing feelings of shame, guilt, and embarrassment with related symptoms of depression and anxiety that cause significant maladaptive social and/ or occupational impairment in functioning. Addicts don’t use sex for affection or recreation, but formanagement of anxiety and/ or emotional pain.
We must consider that some people develop dependencies on certain life-functioning activities such as sex that can be just as life threatening as drug addiction and just as socially and psychologically damaging as alcoholism.
Sexual addiction takes many forms with various levels of severity to include:
one. Controversial behaviors (obsessions with pornography, and sex with strangers to engaging in cyber-sex);
two. Unacceptable behaviors (exhibitionism, voyeurism, indecent phone calls); and
three. Profound Sex offender behaviors (rape, incest, and child molestation).
Though solitary forms of this addiction may not be overtly risky, they can be part ofpattern of distorted thinking and identity conflict that can escalate to involve harmingself and others. An example ofSexual Disorder (NOS) or Not Otherwise Specified inDSM-IV-TR, (twozerozerozero) includes: distress aboutpattern of repeated sexual relationships involvingsuccession of lovers who are experienced byindividual only as things to be used. (It should be noted thatDiagnostic and Statistical Manual of Mental Disorders has never usedword “addiction” to describe any of its disorders).
The defining elements of this kind of addiction are its secrecy and escalating nature, often resulting in diminished judgment and self-control (Carnes, onenineninefour).
Brief History of Sex Addiction
In oneninesevensix,suburban hospital administrator asked Dr. Patrick Carnes to startexperimental program for chemically dependent families. The theoretical constructs ofprogram originated in general systems theory, especially as it applied to families andonetwo-steps of Alcoholics Anonymous. One ofmany factors which stood out fromfamily perspective was thataddictive compulsivity had many forms other than alcohol and drug abuse including overeating, gambling, shoplifting, and sexuality. Members of groups like Overeaters Anonymous and Gamblers Anonymous had already pioneered in applyingonetwo-steps to other addictions soFamily Renewal Center extended its programming based ononetwo-steps, to sexual addiction.
In onenineeightthree, Dr. Patrick Carnes formally introducedconcept of sexual addiction toworld intext entitled “Out ofShadows.” Since thenfield of sexual addiction and compulsive sexual behavior has developed dramatically. Terms such as addiction, compulsivity, hyper-sexuality, and “Don Juanism,” all have been used to describe what generically could be called "out of control sexual behavior." Regardless of its name, clinicians from all fields agree thatsyndrome exists in which individuals havesense that they have lost control over their sexual behavior.
According toSociety forAdvancement of Sexual Health (SASH), sexual addiction ispersistent and escalating pattern or patterns of sexual behaviors acted out despite increasingly negative consequences to self or others. The fundamental nature of all addiction isaddicts' experience of helplessness and powerlessness overobsessive-compulsive behavior, resulting in their lives becoming unmanageable. The addict may be out of control. They may experience extreme emotional pain and shame. They may repeatedly fail to control their behavior. They may suffer one or more offollowing consequences ofunmanageable lifestyle:deterioration of some or all supportive relationships; difficulties with work, financial troubles; and physical, mental, and/ or emotional exhaustion which sometimes leads to psychiatric problems and hospitalization. Addictions tend to arise fromsame backgrounds: families with co-dependency including multiple addictions; lack of effective parenting; and other forms of physical, emotional and sexual trauma in childhood.
The Society forAdvancement of Sexual Health (SASH, twozerozerofive) report thatsymptoms of sexual compulsivity often accompany other addictive behaviors:
Alcohol and Drug Addiction – Alcohol and drugs alter libido, enhancing it early in drug addiction and inhibiting it later. There ispattern in cocaine addiction of selling sexual favors for cocaine. Ascost of drug addiction increases,drug addict usually can't afforddrug from ordinary job income, and must resort to (either/or) stealing, drug dealing or prostitution to support their habit. Alcohol and many drugs cause blackouts or amnesia duringdrug using experience, and if sex is coupled with that drug using experience thendetails ofsexual experience may not be remembered.
Food Addiction - Sexual anorexia or pathological self-denial of healthy sex isfrequent accompaniment of overeating and anorexia nervosa.
Pathological Gambling - The lifestyle ofgambler often includes hyper-sexuality, where both compulsions feedfalse sense of self-esteem ofaddict.
Religious Addiction - Compulsive religiosity sometimes accompanies sexual addiction assex addict is seeking religion to lessen guilt and shame. The beginnings of compulsive religiosity may signalonset ofperiod of sexual anorexia.
Multiple Addictions
Since it is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist,initial therapeutic intervention for any addiction needs to includeassessment for other addictions. National surveys revealed thatvery high correlation exists between sexual addiction and other substance abuse and behavioral addictions. Sexual addicts who have reported experiencing multiple addictions include sexual addiction and:
§ Chemical dependency (fourtwo%)
§ Eating disorder (threeeight%)
§ Compulsive working (twoeight%)
§ Compulsive spending (twosix%)
§ Compulsive gambling (five%)
Poor Prognosis
We have come to realize today more than any other time in history thattreatment of lifestyle diseases and addictions are oftendifficult and frustrating task for all concerned. Repeated failures abound with all ofaddictions, even with utilizingmost effective treatment strategies. But why do fourseven% of patients treated in private addiction treatment programs (for example) relapse withinfirst year following treatment (Gorski, T., twozerozeroone)? Have addiction specialists become conditioned to accept failure asnorm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained insemi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply tolack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (withsingle dependence) simply due tolack of diagnostic tools and resources that are incapable of resolvingcomplexity of assessing and treatingpatient with multiple addictions?
Diagnostic Delineation
Thus far,DSM-IV-TR has not delineateddiagnosis forcomplexity of multiple behavioral and substance addictions. It has reservedPoly-substance Dependence diagnosis forperson who is repeatedly using at least three groups of substances duringsame onetwo-month period, butcriteria for this diagnosis do not involve any behavioral addiction symptoms. InPsychological Factors Affecting Medical Condition’s section (DSM-IV-TR, twozerozerozero); maladaptive health behaviors (e.g., unsafe sexual practices, excessive alcohol, drug use, and over eating, etc.) may be listed on Axis I, only if they are significantly affectingcourse of treatment ofmedical or mental condition.
Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates arenorm instead ofexception inaddictions field, whenlatest DSM-IV-TR does not even includediagnosis for multiple addictive behavioral disorders. Treatment clinics need to havetreatment planning system and referral network that is equipped to thoroughly assess multiple addictive and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension ofindividuals’ life, anddesired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.
New Proposed Diagnosis
To assist in resolvinglimited DSM-IV-TRs’ diagnostic capability,multidimensional diagnosis of “Poly-behavioral Addiction,” is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompassesbroadest category of addictive disorders that would includeindividual manifestingcombination of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized bypreoccupation withcontinuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.
Poly-behavioral addiction would be described asstate of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual hasoverpowering desire, need or compulsion withpresence oftendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence oneffects of this pathological relationship. In addition, there isonetwo - month period in whichindividual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, butcriteria are not met for dependence for any one addiction in particular (Slobodzien, J., twozerozerofive). In essence, Poly-behavioral addiction issynergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.
Conclusion
Consideringwide range of sexual behaviors in our world today, one should always take into accountindividual’s ethnic, cultural, religious, and social background prior to making any clinical judgments, and it would be wise to not over-pathologize in this area of Sexual Dependency. However, since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning - poly-behavioral addiction needs to be identified to effectively treatcomplexity of multiple behavioral and substance addictions.
Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively manage poly-behavioral addiction?
The Addiction Recovery Measurement System (ARMS) is proposed utilizingmultidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation ofindividual’s comprehensive life-functioning progress dimensions. The ARMS hypothesis purports that there ismultidimensional synergistically negative resistance that individual’s develop to any one form of treatment tosingle dimension of their lives, becauseeffects ofindividual’s addiction have dynamically interacted multi-dimensionally. Havingprimary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate formultidimensional synergistically negative effects ofindividual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourageuse of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may playrole inindividual’s primary addiction. The ARMS’ theory proclaims thatmultidimensional treatment plan must be devised addressingpossible multiple addictions identified for each one ofindividual’s life dimensions in addition to developing specific goals and objectives for each dimension.
Partnerships and coordination among service providers, government departments, and community organizations in providing addiction treatment programs arenecessity in addressingmulti-task solution to poly-behavioral addiction. I encourage you to supportaddiction programs in America, and hope that(ARMS) resources can assist you to personally fightWar on poly-behavioral addiction.
For more info see:
Poly-Behavioral Addiction andAddictions Recovery Measurement System (ARMS)
By James Slobodzien, Psy.D. CSAC at:
http://www.geocities.com/drslbdzn/Behavioral_Addictions.html
National Council on Sexual Addiction & Compulsivity
P.O. Box seventwofivefivefourfour
Atlanta, GA threeoneonethreenine
(sevensevenzero) fivefourone-ninenineonetwo
http://www.ncsac.org
Sexual Addiction Resources
http://www.sexhelp.com
James Slobodzien, Psy.D. CSAC, isHawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over twozero-years of mental health experience primarily working infields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings. He isadjunct professor of Psychology and also maintainsprivate practice asmental health consultant.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision. Washington, DC, American Psychiatric Association, twozerozerozero, p. seveneightseven & p. seventhreeone.
American Society of Addiction Medicine’s (twozerozerothree), “Patient Placement Criteria for
Treatment of Substance-Related Disorders, threerd Edition, Retrieved, June oneeight, twozerozerofive, from:
http://www.asam.org/
Arthur Aron, Ph.D., professor, psychology, State University of New York, Stony Brook; Helen
Fisher, research professor, department of anthropology, Rutgers University, New Brunswick, N.J.;
Paul Sanberg, Ph.D.,professor, neuroscience, and director, Center of Excellence for Aging and
Brain Repair,University of South Florida College of Medicine, Tampa; June twozerozerofive,Journal of
Neurophysiology
Carnes, P.J. (onenineeightthree). Out ofShadows: Understanding Sexual Addiction. Minneapolis, MN: Compcare.
Carnes, P.J. (onenineeightnine). Contrary to Love: HelpingSexual Addict. Minneapolis, MN: Compcare.
Carnes, P.J. (oneninenineone). Don't Call it Love. Minneapolis, MN: Gentle Press Publishing.
Carnes, P.J. (oneninenineseven). Sexual Anorexia: Overcoming Sexual Self-hatred. Center City, MN: Hazelden.
Carnes, P.J., & Delmonico, D.L. (onenineninefour). Sexual Dependency Inventory. Wickenburg, AZ: The Meadows Institute.
Carnes, P.J., Delmonico, D.L., & Griffin, E. J. (twozerozeroone). InShadows ofNet: Breaking Free of
Compulsive Online Sexual Behavior. Center City, MN: Hazelden.
Delmonico, D.L. (oneninenineseven). Internet Sex Screening Test. [Online]. Available at: http://www.sexhelp.com
Delmonico, D.L., Griffin, E.J., & Moriarity, J. (twozerozeroone). Cybersex Unhooked: A Workbook for Breaking Free From Online Compulsive Sexual Behavior. Wickenburg, AZ: Gentle Path Press.
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Marlatt & J. R. Gordon (Eds.), Relapse prevention (pp. twofivezero-twoeightzero). New York: Guilford Press.
Schneider, J.P. (onenineninefour). Sex addiction: Controversy within mainstream addiction medicine, diagnosis based onDSV-III-R and physician case histories. Sexual Addiction & Compulsivity: Journal of Treatment and Prevention, one(one), onenine-fourfour.
Slobodzien, J. (twozerozerofive). Poly-behavioral Addiction andAddictions Recovery Measurement System (ARMS), Booklocker.com, Inc., p. five.
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| James Slobodzien, Psy.D., CSAC, isHawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over twozero-years of mental health experience primarily working infields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings. He isadjunct professor of Psychology and also maintainsprivate practice asmental health consultant. |
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