How can sexual addiction be a real addiction?

Sharon O’Hara is the former Clinical Director of the Sexual Recovery Institute and sees private clients for individual, group, and couple therapy both in Beverly Hills and San Pedro.

To answer this question, we have to look at the problem of addiction in general. What makes any behavior an addiction? When do you cross the line from behavior that could be considered a bad habit into addiction territory? For example, how many beers a night make you an alcoholic? How much chocolate do you have to consume to be labeled a chocoholic? How many affairs does one have to have in order to say that this person is a sex addict?

Sorry, folks, but there is no magic number when it comes to addiction. Addictionologists have generally agreed that for a behavior to be labeled an addiction, the following elements must be present:

  1. Can’t stop despite negative consequences.
  2. Presence of a mood-altered state
  3. Strong element of denial.
  4. Behavior is chronic and escalating because of tolerance.
  5. Occurrence of withdrawal symptoms.

Let’s look at each of these elements in turn and see how compulsive sexual behavior fits these 5 descriptors:

1. Can’t stop despite negative consequences.

Let’s say that a guy drinks a six-pack of beer one night. Is he an alcoholic? Maybe. Let’s say that he drinks these six-packs every night for a week. Is he an alcoholic? Maybe. Let’s say that he then gets arrested for driving under the influence, goes to court and has his license suspended, after which he is so upset that he goes out drinking to feel better and has a wreck driving home. This guy is definitely moving into addiction territory at this point. He had to go out and do the very same behavior to feel better that brought him some negative consequences in the first place.

Sexual addiction works the same way. It’s not the number of affairs or prostitutes that defines the sexual addict. It’s what happens after there are consequences. Let’s take the case of a man who is married, loves his wife, and wants to stay married. But he starts going to strip bars and eventually ends up spending most of his paycheck for lap dances, leaving him with no money to buy his kid a birthday present. The next week he’s feeling so guilty that the only thing that takes his mind off his problems is to go back to the strip bar. Or to go to a massage parlor. More guilt leads to more secret sexual behavior until there is the development of an ongoing secret life.

I know of a case where a young man was arrested five times for exposing himself in mall parking lots. He got off with probation until the sixth time, when the judge was fed up and said that if he got arrested again for exhibitionism, he would have to go to jail. This guy was so nervous and fearful walking out of the courthouse that he actually exposed himself on the way to his car in the courthouse parking lot. There you have addiction in action.

2. Presence of a mood-altered state.

Cocaine makes the user feel powerful and alert. Alcohol relaxes many people. Why do people engage in addictive behaviors? It’s simple. They want to change their mood. They want to feel better, at least in the short run. So they drink. Or shoot up. Or go to massage parlors. In the old days, it was thought that you had to take a substance in order to be an addict, e.g., a cocaine addict is addicted to cocaine. But a cocaine addict isn’t really addicted to cocaine, but rather to the feeling that comes with cocaine, in other words, the power surge, mind in overdrive, feeling like you can take on the world, willing to take risks in the name of adventure, with perhaps a heightened sexual drive. (Which, by the way, often dissipates as the user does more and more cocaine.)

Many sex addicts don’t need drugs in order to go into a profound sexual trance, often using specific rituals to deepen the effect. Fantasy and pornography usually play a large role in the development of the trance state. Addicts report feeling like their brains have been taken over, as if they are in the control of someone else, like a Jekyll & Hyde situation. I know a gay man who felt the need to cruise around the park for hours looking for just the right person to have anonymous sex with, sometimes not even having sex but going home exhausted. Sex addicts who also use alcohol, marijuana or other drugs to deepen their sexual trance state report that they often relapse in chemical dependency treatment if their sexual trance urges are ignored.

There is a psychiatric problem known as obsessive-compulsive disorder. It involves doing rituals over and over in a driven way. Think of Jack Nicholson in As Good As It Gets. This is not addiction because there is no high. In the movie Jack washed his hands over and over but was still a grouch. Some therapists try to treat sexual addiction as belonging in this category. But the sex addict is after a high; he wants that trance state.

3. A strong element of denial.

Look at the letters in DENIAL. They could be said to stand for Don’t Even kNow I Am Lying. It is said that in this country alcoholism is the most untreated treatable disease. And the reason that most alcoholics don’t get better is that they refuse to admit that they have this disease. So they don’t go for help. You aren’t going to recover from cancer if you don’t first admit that you have it. Then you have to take chemo or whatever else the doctor says is most effective.

Sex addicts, also, have a million excuses for their compulsive behavior: We Italians have a high sex drive; what my husband doesn’t know won’t hurt him; all gays have anonymous sex, no big deal; it’s only a hand job at the massage parlor, so what can it hurt? The only way to come out of denial is to have consequences that actually mean something, such as the loss of a job or important relationship. Family members can find ways to set up interventions, as has been done historically with other addicts.

4. The behavior is chronic and escalating.

Sex addicts, like other addicts, are not just going through a phase. Rarely does addictive behavior just go away on its own. Instead, the addict has to find new ways to get high because of the phenomenon of tolerance. The lap dance at the strip bar isn’t enough because you don’t get to touch the woman, so then it’s off to the massage parlor. Perhaps that person only does hand massage, so then there may be an escalation to intercourse with call girls. Then regular intercourse becomes boring and S&M painful scenarios may emerge.

Or, say a person starts off exposing himself once a month from the bedroom window as a teenager, for a lark. A pornography collection is built, fantasy life increases, and the next thing you know the exposing behavior is escalating out of the house, so that the person is risking car accidents by driving while masturbating, several times a week or even daily. Sexual addiction often starts in childhood, which is why it often includes strongly ingrained ritualistic patterns of behavior that are very hard to break, especially without professional help.

5. Occurrence of withdrawal symptoms.

Everybody knows that alcoholics can go into withdrawal and have, for example, delirium tremors (DT’s), if they are in advanced stages of alcoholism and stop drinking suddenly. But do sex addicts have withdrawal symptoms? Dr. Patrick Carnes, author of Don’t Call It Love and other books on sexual addiction, conducted research on hundreds of sex addicts and found that when they enter treatment they often have many of the same withdrawal symptoms that alcohol and drug addicts have. I used to work in a hospital setting, and when we had sex addicts stop their rituals in a “cold turkey” fashion through the use of celibacy contracts, they often reported sleepless nights, intrusive dreams, a high level of waking anxiety, irritability, and emotional liability (roller coaster feelings). They often had sexual “using dreams,” much the same way that drug users do when they first enter treatment.

In summary then, it is clear that compulsive sexual behavior does have all these elements that make up an addictive disorder. The good news is that recovery from sexual addiction can be successful, especially if the addict follows some of the tried and true methods of addiction recovery, such as going to appropriate 12-Step meetings, seeing a therapist, entering a treatment program or considering a halfway house.

(If you copy this article for others, please copy the following author bio as well):

Sharon O’Hara, MFT, CSAT, has offices in the Beverly Hills and Torrance/San Pedro area, specializing in treating sex addicts and their partners. She can be reached via email at

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