Treatment of Child Pornography Offenders for Internet Sex Addiction

1. Treatment of Child Pornography Offenders for Internet Sex Addiction Michael L. Nover, Ph.D. February 17, 2012 NJ-ATSA

3. Internet Addiction:A Real Disorder? Jerold J. Block, M.D., Oregon Health & Science University: • A compulsive-impulsive spectrum disorder • Called for inclusion in DSM-V • Three subtypes • Excessive gaming • Sexual preoccupation • Email/text messaging • Four components: • Excessive use • Withdrawal • Tolerance • Negative repercussions

4. Internet Addiction:A Real Disorder? Maressa Hecht Orzack, Ph.D., McLean Hospital Names this phenomenon: Computer Addiction, Internet Addiction, or Cyberaddiction • Lists the following psychological symptoms • Sense of well-being or euphoria • Inability to stop activity

5. Internet Addiction:A Real Disorder? • Craving more and more time at the computer • Neglect of family and friends • Feeling empty, depressed, irritable when not at the computer • Lying to employers and family about activities • Problems with school or work

6. Internet Addiction:A Real Disorder? Kimberly S. Young, Ph.D., Center for Internet Addiction Recovery, defines internet addiction as: “any online-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. She lists the following types: • Cybersex and cyberporn • Online affairs

7. Internet Addiction:A Real Disorder? Dr. Young (continued) • Online gambling • Online gaming • Compulsive surfing • eBay addiction

8. Internet Addiction:A Real Disorder? Dr. Young (continued) • Eight key symptoms: • Preoccupation • Increased use • Inability to stop • Withdrawal symptoms • Lost sense of time • Risky behaviors • Lies • Escape to the internet

9. Why is the Internet Addictive?(Cooper, 1998) The “Triple A Engine” • Accessible • Affordable • Anonymous

10. Why is the Internet Addictive?Mary Anne Layden, Ph.D., Center for Cognitive Therapy, University of Pennsylvania “The internet is a perfect drug delivery system:” • Available 24/7, anywhere there is a computer with internet; • Anonymous – assumed, privacy of one’s own space; • Affordable – free or relatively low cost;

11. Why is the Internet Addictive?Mary Anne Layden, Ph.D., Center for Cognitive Therapy, University of Pennsylvania • Role model – visual modeling of sexual acts performed by eroticized sexual actors; • Memory – visual images, sensate and affect that the brain does not forget; • Arousal - sexual stimulation resulting in arousal, leading to masturbation and reinforced by orgasm; and • Somatic effects – arousal and orgasm results in release of oxytocin from the pituitary gland, under the control of the endorphin system.

12. Internet Sex Addiction Signs of Sexual Addiction Carnes (1991) • A pattern of out-of-control sexual behavior • Severe consequences due to sexual behavior • Inability to stop despite adverse consequences

13. Internet Sex Addiction • Persistent pursuit of self-destructive or high-risk behavior • Sexual obsession and fantasy as a primary copy strategy • Increasing amounts of sexual experience because the current level of activity is no longer sufficient • Severe mood changes around sexual activity • Inordinate amounts of time spent obtaining sex, being sexual, or recovering from sexual experience • Neglect of important social, occupational, or recreational activities because of sexual behavior

14. Internet Sex Addiction Treatment Issues: (Delmonico, Griffin, Carnes, 2002) Multi-faceted approach First Order Change: • Reduce access to internet • Raise awareness (cognitive distortions, denial, minimization, rationalization, etc.)

15. Internet Sex Addiction Treatment issues (continued) Second Order Change: • Attack the appeal • Treat co-morbid conditions • Include the family • Couple therapy • Address social isolation • Collateral issues • Promote healthy sexuality

16. Internet Sex Addiction Treatment Modalities • CBT (Relapse Prevention) • 12-step self-help groups (SA, SAA, SLAA) • Pharmacotherapy (SSRI’s, anti-androgens)

17. Marlatt’s Relapse Prevention Model High-Risk Situation No Coping Coping Response Response Decreased Self-Efficacy & Increased Pos. Outcome Expectancies Self-efficacy Lapse Abstinence Violation Effect Decreased Probability Increased Probability Of Of Relapse Relapse

18. Marlatt’s Relapse Prevention Model • Recognize chain of events leading to addictive behavior. • Learn how to interrupt the chain of events leading to addictive behavior. • Learn coping skills. • Develop problem-solving & Self-control skills. • Learn decision making & coping with urges. • Develop early antecedent interventions. • Minimize the extent of relapse • Practice

19. Marlatt’s Relapse Prevention Model Steps • Avoiding lapse • Awareness of precedents of high risk situations and warning oneself. • Develop specific avoidance strategies • Develop coping skills • Assertiveness • Communication • Problem-solving • Anger management • Relaxation techniques

20. Marlatt’s Relapse Prevention Model • Develop urge-coping techniques • Aversion methods • Support system • Substitute behaviors • Minimizing Lapse • Awareness when in danger • Contract for performing or abstaining from specific behavior • Protecting activities • Awareness of relapse possibility

21. Relapse Prevention Treatment Strategies High Risk Situations • Describe past relapses • Describe relapse fantasies • Identify internal (thoughts, feelings, sensations) and external (situational, interpersonal) cues that “trigger” relapse • Develop self-monitoring techniques • Develop behavior assessment skills

22. Relapse PreventionTreatment Strategies No Coping Response • Skill training • Relaxation training • Stress management • Conflict resolution • Problem-solving • Relapse rehearsal • Efficacy enhancing imagery

23. Relapse PreventionTreatment Strategies Lapse • Contract to limit addictive behavior • Reminder cards • What to do when you have a slip • Programmed Relapse

24. Relapse PreventionTreatment Strategies Abstinence Violation Effect • Identify cognitive distortions • Cognitive restructuring

25. 12-Step Programs Sex Addiction Recovery Groups • SA Sexaholics Anonymous (www.sa.org) • SAA Sex Addicts Anonymous (www.saa-recovery.org) • SCA Sexual Compulsive Anonymous (www.sca-recovery.org) • SLAA Sex and Love Addicts Anonymous (www.slaafws.org) • SRA Sexual Recovery Anonymous (www.sexualrecovery.org)

26. 12-Step Programs - Essential Features (Parker & Guest, 2002) • Addiction is a disease. • Individuals with an addiction require support from other recovering, addicted members. • Reliance on a “power greater than self” is necessary for recovery. • Abstinence from the addicted behavior is the foundation of recovery.

27. 12-Step Programs - Essential Features (Parker & Guest, 2002) • Recovery is a life-long process • Helping other addicted people is essential to long-term stable abstinence from addicted behavior. • Acceptance of the realistic limits of being human is imperative.

28. The 12-Steps – The Program’s Core(Parker & Guest, 2002) Step one: We admitted we were powerless over addicted behavior – that our lives had become unmanageable. Step two: Came to believe that a Power greater that ourselves could restore us to sanity. Step three: Made a decision to turn our will and our lives over to the care of God, as we understood God.

29. Step four: Made a searching and fearless moral inventory of ourselves. Step five: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. Step six: Were entirely ready to have God remove all these defects of character.

30. Step seven: Humbly asked God to remove our shortcomings. Step eight: Made a list of all persons we had harmed and became willing to make amends to them all. Step nine: Made direct amends to such people wherever possible, except when to do so would injure them or others.

31. Step ten: Continued to take personal inventory, and when we were wrong promptly admitted it. Step eleven: Sought through prayer and meditation to improve our conscious contact with God’s will for us and the power to carry that out. Step twelve: Having had a spiritual awakening as the result of these steps, we tried to carry this message to addicts and to practice these principles in all our affairs.