1. Female Sex and Love Addiction in the Recovery Community Presented by Caroline Frost, MFT September 23, 2011

2. www.TheCenterForHealthySex.com Female Sex Addiction Women’s track – Female sex addiction not new, but still not well understood. Charlotte Kasl, Marnie Feree, Kelly McDaniel Part of the problem is knowing how to identify problem sex in women Covert sexual behaviors (men often more extroverted, less careful, get caught)

3. www.TheCenterForHealthySex.com What does she look like? One face of Female Sex Addiction Reality Bites You’re outta there before the condom comes off!” "I'm just beating them to the punch."

4. www.TheCenterForHealthySex.com Women’s Issues and Sex Addiction Sex addiction can be confused for sexual empowerment Addicts may be perceived as sassy, confident, maneaters Women get confusing messages about sex and sexuality

5. www.TheCenterForHealthySex.com Four Cultural Beliefs “I must be good to be worthy of love” “If I am sexual, I am bad” “I am not really a woman unless someone desires me sexually or romantically” “I must be sexual to be lovable.” From Ready to Heal: Women Facing Love, Sex, and Relationship Addiction, by Kelly McDaniel

6. www.TheCenterForHealthySex.com Where are female SAs? Sex addiction may be comorbid with BPD, eating disorders, alcohol and drug abuse, OCD, compulsive shopping, gambling, PTSD These presenting problems may be more overt or noticeable, and women may seek help for these issues first. Thus… Many female sex addicts are already in inpatient treatment.

7. www.TheCenterForHealthySex.com When Addictive Love Meets Heroin… Sid and Nancy …the results can be fatal. Folie a deux Toxic enabling Affective dysregulation Entitlement Suicide/murder

8. www.TheCenterForHealthySex.com Outreach A dozen visits to rehabs and sober livings Started dialogue about sexuality in recovery In FOO, High levels of relational trauma, physical and sexual abuse, and addiction widespread

9. www.TheCenterForHealthySex.com The Elephant in the Room I learned many of the women hadn’t discussed their sexuality or sexual behavior in CD treatment In every group there was at least one (usually more than half) who appeared to be sexually compulsive, love addicted, or sexually anorexic. Reactions: fear, relief, anxiety, bafflement

10. www.TheCenterForHealthySex.com Sex in Recovery I asked about 100 women in rehab and sober living about sex while using and sex in sobriety. These are some of the common answers: Dissociative sex “I do it to numb out” Codependent sex “My boyfriend stuck with me, it’s the least I can do” Sexual anorexia “Ew. I don’t even want to think about sex” Compulsive sex “At least I’m not drinking, right?” “Boring” sex “At least when I was high I could get off” Awkward sex “Now that I’m sober I don’t know what to do with him…or IT!”

11. www.TheCenterForHealthySex.com What’s going on in rehab? According to my clients and many of the women I’ve spoken to in rehab/sober living: –Sexting between patients –Use of pornography –Mutual masturbation –Orgies –Sex behind buildings –Sexual behavior followed by relapse or vice versa

12. www.TheCenterForHealthySex.com What’s going on in rehab? (cont’d) –Obsessions with other patients –Difficulty maintaining friendships because of “rehab-cest” –Dismissal due to sex with a patient –Peeping –Sadomasochistic sex play, humiliation

13. www.TheCenterForHealthySex.com Lauren: “If I could stop screwing, I’d stop using.” Early 20s, in and out of rehab Sober from addiction to downers for 1 mo. Gruesome traumas, abuse of all kinds Borderline features Scored 14 on SAST and 18 on LAST Treated for multiple addictions and BPD

14. www.TheCenterForHealthySex.com Lauren (cont’d) Reported rehab was helpful in many ways, but sex was barely addressed in all three Acted out sexually at all rehabs, disciplined by being dismissed Described a sexually charged environment, with men and women Now sober from CD, struggling with sexual sobriety, working through trauma

15. www.TheCenterForHealthySex.com A Call for Research How do we know if sex addiction is present? We don’t!—But research is needed. How prevalent is sexual acting out in rehab? Sober living? How do rehabs respond to instances of sexual misconduct? How many women in treatment for CD have a comorbid sex addiction? What have you heard?

16. www.TheCenterForHealthySex.com What’s to be done? We have much to learn about the relationship between sex and drugs and how it plays out in our treatment centers Sex must be spoken about explicitly and routinely as part of a thorough recovery model Female sex addiction risks being overlooked for other “louder” symptoms—so we must look closely Screening should involve a detailed sexual history, close attention to nonverbal cues, attire

17. www.TheCenterForHealthySex.com What’s to be done? (cont’d) Clinicians should investigate treatment centers when referring clients for CD and ask how they manage sexual acting out CD treatment facilities should incorporate a screening protocol Intake should include a detailed sexual history, the Hypersexual Behavioral Inventory (HBI), and the Sex Addiction Screening Test (SAST)

18. www.TheCenterForHealthySex.com What’s to be done? (cont’d) CD therapists and professionals: consider referring your acting out clients to a sex addiction specialist for an assessment. Center for Healthy Sex Women’s 11-day Intensive Outpatient Program. –Individualized program –Sensitive to female-specific circumstances