Sex, Love, and Poly-Behavioral Addiction

Experts in the field of addictions are presently purporting that between 3 and 6 percent of the world’s population (193 to 386 million people) are presently affected by a sexual dependency or compulsivity (Carnes, 2005). Sexual dependency is a diagnosable and treatable disease, which today is generally, regarded in about the same way that alcoholism and drug addiction (chemical dependency) was regarded 40 years ago. Even so, there still exists a wide range of understandable misunderstandings about compulsive sexual acting out, created out of ignorance about the nature of sexual addiction, and supported and perpetuated by the multibillion dollar pornography industry.

Sexual Dependency - is a global term that covers a wide range of maladaptive and self-defeating behavior patterns and relationships such as:

1. Love Addiction – a disorder in which individuals repeatedly become involved in enmeshed, intense, codependent relationships, even when those relationships or partners are destructive;

2. Romance Addiction - a disorder in which individuals become obsessed with the intrigue and the pursuit of romance and thrive on the thrill of the chase, but find it impossible to sustain a committed, intimate relationship with another person;

3. Sexual Anorexia – a disorder in which individuals become dominated and obsessed with the emotional, physical, and mental task of avoiding sex; and

4. Sex Addiction – a disorder in which individuals become obsessed with sexually-related, compulsive self-defeating maladaptive behavior.

But can one really be addicted to love as the popular 80’s song proclaims? In a recent research study, (Aron, A. 2005) published in the June issue of the Journal of Neurophysiology, researchers used functional MRI to watch the real-time brain activity of 17 college students (10 women, seven men), all of whom were in the early weeks or months of new love. These researchers concluded that, love may vie for the same real estate in the brain as drug addiction. “Early love, rooted as it is in the caudate nucleus, is all about addiction.” "It is a drug addiction." "It's certainly got some of the main characteristics of drug addiction -- as with drugs, once you fall in love you need that person more and more, so much so that, after a while, you have to marry them. There are other things, too -- real dependence, personality changes, withdrawal symptoms." “And just like the need for cocaine or heroin, love can make people do crazy, sometimes dangerous things.” According to Aron (2005), the findings help explain instances where people fall in love with people they aren’t even sexually attracted to; or why others can feel equally strong, sudden emotion for a newborn child or even God.

So does this mean that all people who are newly in love have an addiction? Are all men who look at pornography addicted? Are all women who read romance novels addicted? Are all people who avoid sex considered sexual anorexics? No, no, no, and no. Then how can we differentiate between addiction and healthy relationships? Like other forms of addictive diseases and lifestyle disorders such as chemical dependency, pathological gambling, eating disorders, and religious addiction -

Sexual dependency is characterized by an addictive cycle of:

1. Obsession or preoccupation;

2. Ritualization;

3. Compulsive behaviors;

4. Loss of control and despair; and

5. Shame and guilt that perpetuates a maladaptive belief system of impaired thinking and unmanageability.

Typically, sexual addictive patterns are considered pathological problems when issues concerning sexual behaviors become the focus of life, causing feelings of shame, guilt, and embarrassment with related symptoms of depression and anxiety that cause significant maladaptive social and/ or occupational impairment in functioning. Addicts don’t use sex for affection or recreation, but for the management of anxiety and/ or emotional pain.

We must consider that some people develop dependencies on certain life-functioning activities such as sex that can be just as life threatening as drug addiction and just as socially and psychologically damaging as alcoholism.

Sexual addiction takes many forms with various levels of severity to include:

1. Controversial behaviors (obsessions with pornography, and sex with strangers to engaging in cyber-sex);

2. Unacceptable behaviors (exhibitionism, voyeurism, indecent phone calls); and

3. Profound Sex offender behaviors (rape, incest, and child molestation).

Though solitary forms of this addiction may not be overtly risky, they can be part of a pattern of distorted thinking and identity conflict that can escalate to involve harming the self and others. An example of a Sexual Disorder (NOS) or Not Otherwise Specified in the DSM-IV-TR, (2000) includes: distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by an individual only as things to be used. (It should be noted that the Diagnostic and Statistical Manual of Mental Disorders has never used the word “addiction” to describe any of its disorders).
The defining elements of this kind of addiction are its secrecy and escalating nature, often resulting in diminished judgment and self-control (Carnes, 1994).

Brief History of Sex Addiction

In 1976, a suburban hospital administrator asked Dr. Patrick Carnes to start an experimental program for chemically dependent families. The theoretical constructs of the program originated in general systems theory, especially as it applied to families and the 12-steps of Alcoholics Anonymous. One of the many factors which stood out from a family perspective was that the addictive compulsivity had many forms other than alcohol and drug abuse including overeating, gambling, shoplifting, and sexuality. Members of groups like Overeaters Anonymous and Gamblers Anonymous had already pioneered in applying the 12-steps to other addictions so the Family Renewal Center extended its programming based on the 12-steps, to sexual addiction.

In 1983, Dr. Patrick Carnes formally introduced the concept of sexual addiction to the world in a text entitled “Out of the Shadows.” Since then the field of sexual addiction and compulsive sexual behavior has developed dramatically. Terms such as addiction, compulsivity, hyper-sexuality, and “Don Juanism,” all have been used to describe what generically could be called "out of control sexual behavior." Regardless of its name, clinicians from all fields agree that a syndrome exists in which individuals have a sense that they have lost control over their sexual behavior.

According to the Society for the Advancement of Sexual Health (SASH), sexual addiction is a persistent and escalating pattern or patterns of sexual behaviors acted out despite increasingly negative consequences to self or others. The fundamental nature of all addiction is the addicts' experience of helplessness and powerlessness over an obsessive-compulsive behavior, resulting in their lives becoming unmanageable. The addict may be out of control. They may experience extreme emotional pain and shame. They may repeatedly fail to control their behavior. They may suffer one or more of the following consequences of an unmanageable lifestyle: a deterioration of some or all supportive relationships; difficulties with work, financial troubles; and physical, mental, and/ or emotional exhaustion which sometimes leads to psychiatric problems and hospitalization. Addictions tend to arise from the same backgrounds: families with co-dependency including multiple addictions; lack of effective parenting; and other forms of physical, emotional and sexual trauma in childhood.

The Society for the Advancement of Sexual Health (SASH, 2005) report that the symptoms of sexual compulsivity often accompany other addictive behaviors:

Alcohol and Drug Addiction – Alcohol and drugs alter libido, enhancing it early in drug addiction and inhibiting it later. There is a pattern in cocaine addiction of selling sexual favors for cocaine. As the cost of drug addiction increases, the drug addict usually can't afford the drug from ordinary job income, and must resort to (either/or) stealing, drug dealing or prostitution to support their habit. Alcohol and many drugs cause blackouts or amnesia during the drug using experience, and if sex is coupled with that drug using experience then the details of the sexual experience may not be remembered.

Food Addiction - Sexual anorexia or pathological self-denial of healthy sex is a frequent accompaniment of overeating and anorexia nervosa.

Pathological Gambling - The lifestyle of the gambler often includes hyper-sexuality, where both compulsions feed the false sense of self-esteem of the addict.

Religious Addiction - Compulsive religiosity sometimes accompanies sexual addiction as the sex addict is seeking religion to lessen guilt and shame. The beginnings of compulsive religiosity may signal the onset of a period of sexual anorexia.

Multiple Addictions

Since it is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist, the initial therapeutic intervention for any addiction needs to include an assessment for other addictions. National surveys revealed that a very high correlation exists between sexual addiction and other substance abuse and behavioral addictions. Sexual addicts who have reported experiencing multiple addictions include sexual addiction and:

* Chemical dependency (42%)

* Eating disorder (38%)

* Compulsive working (28%)

* Compulsive spending (26%)

* Compulsive gambling (5%)

* Poor Prognosis

We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private addiction treatment programs (for example) relapse within the first year following treatment (Gorski, T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?

Diagnostic Delineation

Thus far, the DSM-IV-TR has not delineated a diagnosis for the complexity of multiple behavioral and substance addictions. It has reserved the Poly-substance Dependence diagnosis for a person who is repeatedly using at least three groups of substances during the same 12-month period, but the criteria for this diagnosis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting Medical Condition’s section (DSM-IV-TR, 2000); maladaptive health behaviors (e.g., unsafe sexual practices, excessive alcohol, drug use, and over eating, etc.) may be listed on Axis I, only if they are significantly affecting the course of treatment of a medical or mental condition.

Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field, when the latest DSM-IV-TR does not even include a diagnosis for multiple addictive behavioral disorders. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictive and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals’ life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.

New Proposed Diagnosis

To assist in resolving the limited DSM-IV-TRs’ diagnostic capability, a multidimensional diagnosis of “Poly-behavioral Addiction,” is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.

Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 - month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.

Conclusion

Considering the wide range of sexual behaviors in our world today, one should always take into account an individual’s ethnic, cultural, religious, and social background prior to making any clinical judgments, and it would be wise to not over-pathologize in this area of Sexual Dependency. However, since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning - poly-behavioral addiction needs to be identified to effectively treat the complexity of multiple behavioral and substance addictions.

Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively manage poly-behavioral addiction?

The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual’s comprehensive life-functioning progress dimensions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual’s primary addiction. The ARMS’ theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension.

Partnerships and coordination among service providers, government departments, and community organizations in providing addiction treatment programs are a necessity in addressing the multi-task solution to poly-behavioral addiction. I encourage you to support the addiction programs in America, and hope that the (ARMS) resources can assist you to personally fight the War on poly-behavioral addiction.

For more info see:
Poly-Behavioral Addiction and the Addictions Recovery Measurement System (ARMS)
By James Slobodzien, Psy.D. CSAC at:
http://www.geocities.com/drslbdzn/Behavioral_Addictions.html

National Council on Sexual Addiction & Compulsivity

P.O. Box 725544

Atlanta, GA 31139

(770) 541-9912

http://www.ncsac.org

Sexual Addiction Resources

http://www.sexhelp.com

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision. Washington, DC, American Psychiatric Association, 2000, p. 787 & p. 731.
American Society of Addiction Medicine’s (2003), “Patient Placement Criteria for the
Treatment of Substance-Related Disorders, 3rd Edition, Retrieved, June 18, 2005, from:

http://www.asam.org/
Arthur Aron, Ph.D., professor, psychology, State University of New York, Stony Brook; Helen
Fisher, research professor, department of anthropology, Rutgers University, New Brunswick, N.J.;
Paul Sanberg, Ph.D.,professor, neuroscience, and director, Center of Excellence for Aging and
Brain Repair,University of South Florida College of Medicine, Tampa; June 2005, the Journal of
Neurophysiology
Carnes, P.J. (1983). Out of the Shadows: Understanding Sexual Addiction. Minneapolis, MN: Compcare.
Carnes, P.J. (1989). Contrary to Love: Helping the Sexual Addict. Minneapolis, MN: Compcare.
Carnes, P.J. (1991). Don't Call it Love. Minneapolis, MN: Gentle Press Publishing.
Carnes, P.J. (1997). Sexual Anorexia: Overcoming Sexual Self-hatred. Center City, MN: Hazelden.
Carnes, P.J., & Delmonico, D.L. (1994). Sexual Dependency Inventory. Wickenburg, AZ: The Meadows Institute.
Carnes, P.J., Delmonico, D.L., & Griffin, E. J. (2001). In the Shadows of the Net: Breaking Free of
Compulsive Online Sexual Behavior. Center City, MN: Hazelden.
Delmonico, D.L. (1997). Internet Sex Screening Test. [Online]. Available at: http://www.sexhelp.com
Delmonico, D.L., Griffin, E.J., & Moriarity, J. (2001). Cybersex Unhooked: A Workbook for Breaking Free From Online Compulsive Sexual Behavior. Wickenburg, AZ: Gentle Path Press.
Gorski, T. (2001), Relapse Prevention In The Managed Care Environment. GORSKI-CENAPS Web
Publications. Retrieved June 20, 2005, from: www.tgorski.com
Lienard, J. & Vamecq, J. (2004), Presse Med, Oct 23;33(18 Suppl):33-40.
Marlatt, G. A. (1985). Relapse prevention: Theoretical rationale and overview of the model. In G. A.
Marlatt & J. R. Gordon (Eds.), Relapse prevention (pp. 250-280). New York: Guilford Press.
Schneider, J.P. (1994). Sex addiction: Controversy within mainstream addiction medicine, diagnosis based on the DSV-III-R and physician case histories. Sexual Addiction & Compulsivity: Journal of Treatment and Prevention, 1(1), 19-44.
Slobodzien, J. (2005). Poly-behavioral Addiction and the Addictions Recovery Measurement System (ARMS), Booklocker.com, Inc., p. 5.


James Slobodzien, Psy.D. CSAC, is a Hawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings. He is an adjunct professor of Psychology and also maintains a private practice as a mental health consultant.

What Does Unconditional Love Really Mean?

Unconditional love means unconditional freedom. Love and freedom are two of those words that are interchangeable. Freedom of choice is unconditional love, unconditional freedom. Choice is another of those words that are interchangeable with Love and freedom.

For the most part humanity understands little of what the word ‘unconditional,’ means. Unconditional means… "NO CONDITIONS." This lack of understanding is what has divided man from man and religion from religion throughout his sojourn in the physical reality. It is again man’s ego trying to grasp the idea, and not being able to surrender to its meaning. Let me demonstrate. The one common thread that I have found weaving through man’s many belief systems is; God is Unconditional Love. I have yet to have anyone tell me, that this is not so. It seems to be accepted by all belief systems that are centered around a creator. If you are in disagreement with this statement then there would probably be no sense in you reading further.

Now it must be made clear in this example, that "unconditional," means, that there are no "conditions," to God’s Love. Do you understand and agree, that "unconditional" means no "conditions apply?" Be sure, because it gets more difficult to differentiate as we move along.

Do you understand that if there was a condition to God’s love, then God would be giving "conditional" love? Conditional love is not the same as unconditional love as described in the preceding paragraph. I have never heard or read anywhere that God gives conditional love, have you?

Love and freedom are the same, if there is a condition to freedom then it is not unconditional. Freedom is given from unconditional love. Freedom of choice is the same thing as unconditional love; they are all the same thing. If you can follow this understanding and accept it, then there is something further you need to understand.

This is extremely difficult for most all humans to do. Because love, freedom and choice are unconditional, there can be no "PUNISHMENT," for practicing them, once again "No Punishments." Here is where the so called enlightened fall by the wayside. They cannot accept any of these things without the recourse of punishment. You can practice unconditional love, unconditional freedom and unconditional choice with no punishments! God will never punish you! Retribution is a lie, it was all made up. Only "Man," will punish you. Anyone who tells you different, is not coming from unconditional love. They live in fear of you practicing these things. They do not understand what “unconditional,” means.

Most all who have read the first half of this article will not have problems with it until they get to the “No Punishment,” part. At this point man’s ego takes over and will try to reason his way out of agreeing with the principle. He will begin to say, yes I understand what unconditional means, but! Then he will start, you cannot have people running around doing whatever they want. There is a price (condition) for freedom. You can not freely love anyone you want, that is immoral (conditional). Our choices are limited by are colour, sexual orientation, creed, age, sex, geographic region (conditional).

If you buy into these conditions, then you are in direct contradiction with what you agreed with when you started reading this article. If you didn’t agree to the first part, then you have read farther then you were supposed to. You were warned! For those that did agree that God is unconditional love, and don’t understand the contradiction, let me explain. There seems to be a paradox here. Can unconditional love and conditional love exist at the same time? The answer is yes, because we have forgotten our heritage we have moved away from unconditional. God gives unconditional love, man does not!

This is where the contradiction comes from. We understand the love of God, and feel inferior. We can not except that unconditional love is who “we” really are, and therefore apply conditions to our love and freedom. We project our human emotions and feelings onto God effectively insulating ourselves from the reality of unconditional love. We attach certain conditions to his love. If we do not follow his will, we will be punished by him as we would punish those that would not do our will. Man’s love, freedom and choice are conditional because we have always had freedom of choice, to choose and accept those conditions that are conditional. It is paradoxal and appropriate that humanity should set conditions for itself and God has set NO conditions for him!

Who is it that is teaching us about conditional love? Who is actually separating us from the love of God? It is in the Newspapers and has been for weeks. I’m in Canada; it is August 08, 2003. For weeks now there has been a major controversy about legalized gay marriages. Who do you think is at the forefront of all the objections? Who is it that is using fear tactics to persuade politicians and supporters to change their policies? Who has come out and said that they fear for the souls of those supporters? It is the same institute that has for centuries, taught us of Gods "conditional," love. They have taught us that God’s love is unconditional, but we will be punished for practicing it, therefore have made it conditional. They have used fear, punishment and death to implant this lie into our belief systems. They have been as the false profit. The institute does not correctly reflect God’s love, nor come close to interpreting it. Their interpretations reflect only their fear the share with the rest of humanity.

As you reason these contradictions, listen to yourself. Are you coming from unconditional love, or are you reacting from fear? What ever you now believe, you will have chosen it from unconditional love. It will be your reality. You have unconditional freedom to live conditionally, in conditional love and freedom of choice.

At this moment try to imagine choosing to live unconditionally, try to choose between the two, conditional or unconditional. And if you chose the later, how would you condition yourself.

Feel the unconditional love as you make a free choice. As you make the choice you should notice that you are not being punished for it. That may come later, not from God but from those that would appose your choice. If nothing else understand the contradiction. But also understand that who you really are is "free." Do not fear for your soul, your soul can take care of itself and of course that is exactly what it is doing. It is the "BLIND FAITH," (which is not surrender) that leads you into darkness, when you do not question it.

Not taking responsibility for your own salvation has given power to those that would use your vulnerability to keep you on the straight and narrow. Not yours, but theirs.

The human ability to see "black" and call it "white," is a real blessing in a world of contradictions that require us to make a choice and believe nothing else. There is no one more blind than he who will not see. This has lead us into the notion of right and wrong, you are wrong, I am right. We both cannot be right, right?

If we could live with the choices of others not being as our own, we would free ourselves from the necessity of making any kind of choice and double the possibilities that lay before us. It would be another major step into expanding our enlightenment. To truly free humanity, mankind must see all aspects of itself as being free.


Roy E. Klienwachter is an ordained minister,light worker, writer and author of Spiritual New Age Wisdom books written in simple language with the eloguence of Zen wisdom.

http://www.klienwachter.com