1. Untangling the Web: Understanding and Treating Sex and Porn Addictions Robert Weiss LCSW, CSAT Founding Director The Sexual Recovery Institute www.sexualrecovery.com Robert Weiss LCSW, CSAT Founding Director The Sexual Recovery Institute www.sexualrecovery.com

2. Sex Addiction is Not ‣ A Moral or Religious Stance ‣ A Symptom of Underlying Axis I Illness ‣ Fun ‣ Same Sex Interest or Activity ‣ Sexual Offending ‣ Fetish / Paraphilia ‣ Sociopathy ‣ Crystal Meth Addiction ‣ A Moral or Religious Stance ‣ A Symptom of Underlying Axis I Illness ‣ Fun ‣ Same Sex Interest or Activity ‣ Sexual Offending ‣ Fetish / Paraphilia ‣ Sociopathy ‣ Crystal Meth Addiction

3. Sex addiction can be… A Stand Alone Diagnosis A Stand Alone Diagnosis

4. The Diagnosis Follows the Characteristics of All Addictions Criteria for assessing Sex Addiction closely parallels guidelines for assessing Substance Dependency, Alcoholism, and Compulsive Gambling: ‣ Loss of control ‣ Continuation despite adverse consequences ‣ Obsession or preoccupation The presence of all three criteria operationally defines addiction to any drug or behavior Criteria for assessing Sex Addiction closely parallels guidelines for assessing Substance Dependency, Alcoholism, and Compulsive Gambling: ‣ Loss of control ‣ Continuation despite adverse consequences ‣ Obsession or preoccupation The presence of all three criteria operationally defines addiction to any drug or behavior

5. Typical Sex Addict Behaviors Compulsive Use of Porn (with or without masturbation) Anonymous Sex (met online or in sex clubs etc.) Adult Bookstores and Strip Clubs Sexual Exchange (i.e. Drugs or Favors for Sex) Prostitutes and Massage Parlors Fusing Sex and Drugs - Cocaine, Nicotine, Alcohol etc. Cruising, Intriguing, Objectifying, Seduction Boundary Violations, Sexual Harassment Multiple Affairs / Anonymous Infidelity Abusing Power Relationships for Sex - Predatory Compulsive Use of Porn (with or without masturbation) Anonymous Sex (met online or in sex clubs etc.) Adult Bookstores and Strip Clubs Sexual Exchange (i.e. Drugs or Favors for Sex) Prostitutes and Massage Parlors Fusing Sex and Drugs - Cocaine, Nicotine, Alcohol etc. Cruising, Intriguing, Objectifying, Seduction Boundary Violations, Sexual Harassment Multiple Affairs / Anonymous Infidelity Abusing Power Relationships for Sex - Predatory

6. Addicted to sex? ‣ Increased Heart Rate ‣ Shallow Breathing ‣ Perspiration- palms, underarms, etc. ‣ “Rush” or “Intensity” Feeling ‣ Reduced Intellectual Functioning ‣ Increased Heart Rate ‣ Shallow Breathing ‣ Perspiration- palms, underarms, etc. ‣ “Rush” or “Intensity” Feeling ‣ Reduced Intellectual Functioning

7. ADDICTS CALL IT… ‣ The Bubble ‣ The Trance ‣ Spaced Out ‣ Think... ‣ Dissociative State ‣ Mood Alteration ‣ Trauma ‣ The Bubble ‣ The Trance ‣ Spaced Out ‣ Think... ‣ Dissociative State ‣ Mood Alteration ‣ Trauma

8. In 12-Step Language... In 12-Step Language... POWERLESS!

9. Substances of Mood ‣ Serotonin ‣ Dopamine ‣ Adrenaline ‣ Endorphins ‣ Oxytocin “the cuddle chemical” ‣ Serotonin ‣ Dopamine ‣ Adrenaline ‣ Endorphins ‣ Oxytocin “the cuddle chemical”

10. Sex Addiction is not about sex, it’s about the search for sex and desire for orgasm. It’s a Process addiction.

11. Challenges Specific to Gay Male Sex Addicts Differing Cultural Standards of Sexual Behavior - norms History of HIV / AIDS In Childhood - History of social isolation and/or hiding self, homophobia In Childhood - double life/self is learned coping mechanism Adult Life - Lack of Cultural Boundaries for Problem Sexual Behaviors Adult Life - Lack of Cultural Validation for Intimacy Building Differing Cultural Standards of Sexual Behavior - norms History of HIV / AIDS In Childhood - History of social isolation and/or hiding self, homophobia In Childhood - double life/self is learned coping mechanism Adult Life - Lack of Cultural Boundaries for Problem Sexual Behaviors Adult Life - Lack of Cultural Validation for Intimacy Building

12. Sexual Addiction Symptoms in Residential or Outpatient Clients In the Client’s Behavior Seductive Dress (especially after it is pointed out) Seeking out “special relationships” with other attractive clients or staff for advice, friendship and direction Giving “the stare”. History of CD relapse – especially females Encouraging Dependency as a form of seduction Sneaking Porn into treatment - sharing porn in treatment. Consistent sexual references in jokes and conversation Consistent sexual objectification. Lack of empathy about how their sexual behavior affects others. Having sex while in treatment In the Client’s Behavior Seductive Dress (especially after it is pointed out) Seeking out “special relationships” with other attractive clients or staff for advice, friendship and direction Giving “the stare”. History of CD relapse – especially females Encouraging Dependency as a form of seduction Sneaking Porn into treatment - sharing porn in treatment. Consistent sexual references in jokes and conversation Consistent sexual objectification. Lack of empathy about how their sexual behavior affects others. Having sex while in treatment

13. Sexual Addiction Symptoms in Residential or Outpatient Clients In the Client’s History Multiple abortions (females), multiple STDs (both sexes) Previous arrest or major life consequences related to sex Drugs/Alcohol used to help tolerate or enhance sex History of previous sexual acting out in treatment Drug use fused with sexual behavior Multiple past failed relationships due to affairs or infidelity Chronic or Compulsive Masturbation In the Client’s History Multiple abortions (females), multiple STDs (both sexes) Previous arrest or major life consequences related to sex Drugs/Alcohol used to help tolerate or enhance sex History of previous sexual acting out in treatment Drug use fused with sexual behavior Multiple past failed relationships due to affairs or infidelity Chronic or Compulsive Masturbation

15. What makes online sex so popular and so exciting? ‣ ACCESSIBILITY ‣ AFFORDABILITY ‣ ANONYMITY ‣ ACCESSIBILITY ‣ AFFORDABILITY ‣ ANONYMITY Adapted from the “Triple-A Engine” Al Cooper PhD. 1998

16. What’s the big deal It’s just a guy thing… What’s the big deal It’s just a guy thing…

17. Consequences of Compulsive Cybersex ‣ Loss of time for work, family, recreation ‣ Family violence / relationship loss ‣ Loss of job because of cybersex at work ‣ Guilt and shame due to keeping secrets ‣ Decreased interest in sex with spouse ‣ Increased preoccupation with sex ‣ Increased overall sexual objectification ‣ Children potentially exposed to porn ‣ Increased interest in deviant sex ‣ Increased Isolation, substance abuse ‣ Loss of time for work, family, recreation ‣ Family violence / relationship loss ‣ Loss of job because of cybersex at work ‣ Guilt and shame due to keeping secrets ‣ Decreased interest in sex with spouse ‣ Increased preoccupation with sex ‣ Increased overall sexual objectification ‣ Children potentially exposed to porn ‣ Increased interest in deviant sex ‣ Increased Isolation, substance abuse

18. Problems that show up when Meth is Added to this mix... 1) Fusion - where I went for sex is where I go for drugs and vice/versa (relapse prevention problem) 2) The sex I had when high was so intense that sober sex seems boring/vanilla now (relapse prevention problem) 1) Fusion - where I went for sex is where I go for drugs and vice/versa (relapse prevention problem) 2) The sex I had when high was so intense that sober sex seems boring/vanilla now (relapse prevention problem)

19. Treatment is the Reclaiming of Reality

20. Initial Sexual Addiction Treatment is... Cognitive Behavioral and Task Oriented

21. Initial Focus of Sex Addiction Treatment ‣ Stop the acting out ASAP by making contracts and plans ‣ Confronting denial and teach relapse prevention ‣ Carefully reviewing a sex, drug, addiction history ‣ Providing Appropriate Tasks and Interventions ‣ Spouse, job & family crisis resolution ‣ Shame reduction ‣ Holding the client accountable! ‣ 12-step, therapy or faith-based group referral ‣ Stop the acting out ASAP by making contracts and plans ‣ Confronting denial and teach relapse prevention ‣ Carefully reviewing a sex, drug, addiction history ‣ Providing Appropriate Tasks and Interventions ‣ Spouse, job & family crisis resolution ‣ Shame reduction ‣ Holding the client accountable! ‣ 12-step, therapy or faith-based group referral

22. And Sexual Sobriety is… A clear and well defined written plan A clear and well defined written plan Based on client goals Based on client goals Mutually agreed upon Mutually agreed upon Signed Signed Sobriety plans are behavioral in nature Sobriety plans are behavioral in nature Sobriety plans flow from the goals of the client Sobriety plans flow from the goals of the client Doesn’t change without prior agreement Doesn’t change without prior agreement A clear and well defined written plan A clear and well defined written plan Based on client goals Based on client goals Mutually agreed upon Mutually agreed upon Signed Signed Sobriety plans are behavioral in nature Sobriety plans are behavioral in nature Sobriety plans flow from the goals of the client Sobriety plans flow from the goals of the client Doesn’t change without prior agreement Doesn’t change without prior agreement

23. Simple Sexual Sobriety Plan List of Behaviors I Want to Stop ‣ A ‣ B ‣ C ‣ D ‣ E ‣ F 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 List of Behaviors I Want to Add ‣ A ‣ B ‣ C ‣ D ‣ E ‣ F

24. Treatment Error Treatment Error Inadequate or poorly detailed history— (Not asking about prior arrests/offending behaviors etc. Unfamiliarity with resources (porn blockers, 12-step) Treating Sexual Issues prior to any existing Substance Abuse or Dependency Problems Normalizing problematic sexual behavior Initially employing Psycho-dynamic, Analytic, Jungian and other non-cognitive behavioral method Not identifying triggers, patterns, rituals and behavioral escape methods (relapse prevention) Focusing too early on trauma Inadequate or poorly detailed history— (Not asking about prior arrests/offending behaviors etc. Unfamiliarity with resources (porn blockers, 12-step) Treating Sexual Issues prior to any existing Substance Abuse or Dependency Problems Normalizing problematic sexual behavior Initially employing Psycho-dynamic, Analytic, Jungian and other non-cognitive behavioral method Not identifying triggers, patterns, rituals and behavioral escape methods (relapse prevention) Focusing too early on trauma

25. Treatment Error Treatment Error Not addressing the sexual behavior as the primary initial treatment focus Not properly understanding and/or pathologizing the depth of the betrayal, grief, loss and rage of the partners and spouses NOT HOLDING CLIENTS ACCOUNTABLE Not getting supervision / consultation Not utilizing 12-step programs, faith based support groups, group therapy and psycho-education Not processing countertransference. Not addressing the sexual behavior as the primary initial treatment focus Not properly understanding and/or pathologizing the depth of the betrayal, grief, loss and rage of the partners and spouses NOT HOLDING CLIENTS ACCOUNTABLE Not getting supervision / consultation Not utilizing 12-step programs, faith based support groups, group therapy and psycho-education Not processing countertransference.

26. 12-step Groups for Sexual Addicts and Partners 12-step Groups for Sexual Addicts and Partners Partner Support ‣ S-Anon ‣ Alanon ‣ COSA ‣ CODA ‣ RCA - Couples Partner Support ‣ S-Anon ‣ Alanon ‣ COSA ‣ CODA ‣ RCA - Couples Sex Addict Support ‣ SAA ‣ SA ‣ SCA ‣ SLAA-Women ‣ SRA Sex Addict Support ‣ SAA ‣ SA ‣ SCA ‣ SLAA-Women ‣ SRA

27. Treatment and Training Information ‣ The Sexual Recovery Institute www.sexualrecovery.com www.sexualrecovery.com ‣ IITAP - International Institute for Trauma, and Addiction Professionals www.iitap.com ‣ SASH - The Society for the Advancement of Sexual Health www.sash.net ‣T‣T he Sexual Recovery Institute www.sexualrecovery.com ‣I‣I ITAP - International Institute for Trauma, and Addiction Professionals www.iitap.com ‣S‣S ASH - The Society for the Advancement of Sexual Health www.sash.net

29. Untangling the Web: Understanding and Treating Sex and Porn Addictions Robert Weiss LCSW, CSAT Executive Director The Sexual Recovery Institute www.sexualrecovery.com Robert Weiss LCSW, CSAT Executive Director The Sexual Recovery Institute www.sexualrecovery.com