Robert Weiss LCSW, CSAT-S Founding Director The Sexual Recovery Institute (SRI)

1. Sexual Addiction 101 Robert Weiss LCSW, CSAT-S Founding Director The Sexual Recovery Institute (SRI) The Center for Sexual and Relationship Recovery (The Ranch) Rob@SexualRecovery.com Director of Intimacy & Sexual Disorder Services Elements Behavioral Health Author: Cruise Control, Untangling the Web, Closer Together, Further Apart (2013)

2. The Problem

3. What first comes to mind when you think of this group of men? • Fmr. President Bill Clinton • Fmr. Governor Elliot Spitzer • Fmr. Governor Mark Sanford • Actor David Duchovny • Fmr. Senator Larry Craig • Fmr. Sports Hero Tiger Woods • Fmr. Chief Dominique Strauss-Kahn • Fmr. Governor Arnold Schwarzenegger • Fmr. Congressman Anthony Weiner • Fmr. Presidential Candidate Jon Edwards • Fmr. Presidential Candidate Herman Cain • Fmr. General David Petraeus These are all men whose sexual behavior MORTALLY WOUNDED their ability to lead ... but what if their problem had been drinking or drugs?

4. Sexual Addiction is not • Diagnosed before ruling out ADD/OCD/Mania and Active Drug Abuse • Poorly Researched • Fun • A Moral or Religious Stance • “Sex negative” or a cultural bias • Fetish Behavior • Same Sex Interest or Activity • Crystal Meth Addiction • Sexual Offending - non consensual

5. What Defines Addiction? • Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. American Society of Addiction Medicine 2011

6. Is Sexual Addiction A Legitimate Mental Health Diagnosis ? • Was in the DSM III - as a descriptor • Was out of the DSM IV • Now being considered for the DSM 5 (Hypersexual Disorder)

7. What Happens Without a Universally Acknowledged Diagnosis? • Moral Judgement • Religious Abuse • Misdiagnosis • Misdirected Treatment- often with meds • Think Alcoholism prior to the 1970’s

8. 2012 DIAGNOSTIC UPDATE • Sexual Addiction Diagnosis written by Marty Kafka MD (Harvard, APA, DSM 5 Committee) from models & research based on: • Historical Review - Nymphomania, Don Juanism etc. • Dr. Patrick Carnes Addiction Model • Dr. Eli Coleman Compulsivity Model • Kinsey “Out of Control Sexual Behavior Model • APA - Sexual Disorder NOS Model

9. Proposed Hypersexual Disorder DiagnosisDSM 5 (2013) • A.Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following five criteria: • (1) Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior. • (2) Repetitively engaging in these sexual fantasies, urges, and behavior in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability). • (3) Repetitively engaging in sexual fantasies, urges, and behavior in response to stressful life events. • (4) Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, and behavior. • (5) Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others.

10. Hypersexuality Disorder Continued • There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, and behavior. • These sexual fantasies, urges, and behavior are not due to direct physiological effects of exogenous substances (e.g., drugs of abuse or medications) or to Manic Episodes. • The person is at least 18 years of age. 

11. Typical Sex Addict Behaviors • Compulsive Use of Porn (with or without masturbation) • Anonymous Hook-ups (met online) • Adult Bookstores and Strip Clubs • Sexual Exchange (i.e. Drugs or Favors for Sex) • Prostitutes and “Sensual” Massage Parlors • Cruising, Intriguing, Objectifying, Seduction • Pushing Boundaries, Viewing “no” as a challenge • Multiple Affairs / Anonymous Infidelity • SmartPhone app Hook-ups • Sexting / Abusing Social Networks / Virtual Sex • Crossing Professional Boundaries • Living a Double Life

12. How Can Sex Be An Addiction?

13. Sexual Addiction is the use of Intense Fantasy to Induce Neurochemical Release • Serotonin - mood stability • Dopamine - pleasure • Adrenaline - energy, jolt • Endorphins - calm • Oxytocin - love/jealousy

14. ADDICTS CALL IT… • The Bubble • The Trance • Spaced Out • Think ... • Fight or Flight • Dissociative State • Trauma • Self Soothing

15. In 12-Step Language ... • POWERLESS!

16. Sex Addiction is not about sex or orgasm. It is about the search for sex and desire for orgasm.It’s a Process Addiction much like gambling or eating disorders

17. The Betrayed Spouse

18. Spouses and FamilyOver time, profound relationship betrayal produces a trauma response • Over time spouses “go crazy” as their reality and experience is denied them and they adapt to the the addict’s warped agenda • Sex addicts become less responsible, less responsive and more self- obsessed, leaving the spouse increasingly having to manage the life of the family- “it’s like having another child to worry about,” one spouse said. • Children find porn, walk in on “situations”, lose one parent to the addiction and the other to obsession about what the spouse is doing. They end up being handled/managed, not parented. • Sex Addicts don’t understand what BETRAYAL means or does!

19. In a Primary Relationship, Active Addiction by one partner results in both Betrayal and Trauma for a spouse

20. Betrayal is the greatest source of pain to an addict’s spouse. It’s not so much the addict’s drinking, using, spending, sexing etc. that causes the most hurt to a loving spouse - it’s the lying, broken promises and loss of trust.

21. What is the Emotional State of a Betrayed Spouse? • The betrayed spouses initial emotional state is a form of trauma: • Fearful of further loss and abandonment • Ashamed, remorseful, self doubting and isolated • Anxious and Hypervigilent - easily triggered to previous levels of trauma • Worried about the future -parenting, finances, separation • Having intrusive thoughts and images • Often having problems w/sleeping, eating, self-care

22. How Long Can It Take To Get Off This PDSD-like Ride? 9-18 months: Provided there is an recovery process in place in place for both and both are active in it.

23. What are the clinical needs of this spouse? • Concrete Direction regarding self-care, health issues, talking to family etc. • Education about addiction, disclosure, family dynamics, support. • Holding and Validation of her reality and her feelings • Disclosure and clarity regarding their unknown history • Social support by professionals (peers and family where useful) • Structure toward moving forward • Hope

24. Sexual Addiction Treatment

25. The process of addiction treatment prepares clients for more traditional, experiential and relational forms of psychotherapy. While in active addiction, they are not ready for therapy.

26. Addiction Treatment Method vs. Traditional Psychotherapy • Behavioral problems REQUIRE behavioral forms of intervention and treatment • This includes structured steps and tasks • Problem behaviors have to be contained FIRST before psycho-dynamic therapy and trauma work begins in earnest • Group work is more effective than individual • The treatment is HIGH ACCOUNTABILITY with a strong focus on building ego strength, shame reduction and social skill development • Healing maladaptive attachment is the slow work of long-term therapy, living honestly and 12-step involvement (2-3 years minimum). This is where Psychodynamic, Analytic, Jungian, Somatic and other forms of therapy are most effective

27. What is Sexual Sobriety? • A mutually agreed upon clear, written and signed, behavioral contract based on client goals. • Sobriety plans don’t change without prior discussion. • Similar to how we handle eating disorders

28. SexualSobriety Contract • List of Behaviors I Want to Stop • A • B • C • D • E • F • List of Behaviors I Want to Add • A • B • C • D • E • F

29. Required Treatment Steps When Working with Sex Addicts • Do a thorough psycho-sexual history/assessment • Confront Denial • Identify the genuine client treatment goals and co-create a sexual sobriety contract or plan aligned with those goals. • Hold clients accountableto all their agreements! • Have client evaluated for psychotropic medication • Educate and teach relapse prevention • Get them into a sex addiction group therapy • Find supportfor the spouse • Direct healthcare, family and crisis resolution • Refer to long-term 12-step, therapy or faith-based group support

30. 12-step Support Groups for Sexual Addicts and Partners • Partner Support • S-Anon • Alanon • COSA • CODA • RCA - Couples • Sex Addict Support • SAA • SA • SCA • SLAA-Women • SRA

31. Sexual Addiction Information • The Sexual Recovery Institutewww.sexualrecovery.com • The Ranchwww.recoveryranch.com • IITAP - International Institute for Trauma, and Addiction Professionals www.iitap.com • SASH - The Society for the Advancement of Sexual Health www.sash.net • E-summits www.e-summits.comOnline and video learning with available CEU’s

32. Sexual Addiction 101 Robert Weiss LCSW, CSAT-S Founding Director The Sexual Recovery Institute (SRI) The Center for Sexual and Relationship Recovery (The Ranch) Rob@SexualRecovery.com Director of Intimacy & Sexual Disorder Services Elements Behavioral Health Author: Cruise Control, Untangling the Web, Closer Together, Further Apart (2013)