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Treating Multiple Addictions: Why We Treat Sexual Addiction and Substance Abuse Concurrently

Sexual addiction can be accompanied by other addictions and/or substance abuse. While on the surface, different addictions seem to be associated with their own unique set of behaviours, they are often fueled by the same underlying feelings of guilt, shame, avoidance and trauma. Addictions interact within the individual making it difficult to tease them apart.

When examining patterns of problematic substance use in individuals seeking help for a sexual addiction, it becomes clear that the two are inextricably linked. It is estimated that between 40-60% of individuals with a sexual addiction also meet the criteria for alcohol or drug addiction (Vesga-Lopez et al., 2007). Many individuals with sexual addiction admit to using substances in order to deal with, or escape from, the pain that is caused by their sexual behaviour. People may also use substances to get over their inhibitions in order to engage in sexual behaviours that might be uncharacteristic for them if they were not drunk or high.

It is important to investigate how multiple addictions can feed into one another. Sometimes people use one of their addictions to mask or dismiss the other, perhaps more shameful addiction. For example, an individual may deny having a problem with sexual addiction and insist that their problematic sexual behaviour is only caused by intoxication. However, it may be the case that drugs or alcohol are merely masking the pain and shame associated with the sexual addiction and help the person withdraw from the emotional consequences of his or her actions. By the same token, both addictions may work on intensifying one another in such a way that the person only engages in their sexual addiction under the influence of alcohol or drugs. These rituals then serve to protect the addiction and ensure that patterns of use are stable and predictable (Schneider et al., 2005).

A major concern with treatment of substance use disorder alone is that untreated sexual addiction often precipitates a relapse of substance use. Dealing with one addiction while ignoring the other may end up intensifying the problem that has not been addressed. A good example used by Schneider and colleagues (2005), is when a person in early recovery from a substance addiction turns to sexual performance enhancers in order to continue the ritualized sexual behaviour that was previously enhanced by the substance use. This sexual behaviour can continue to be problematic for the individual. The individual may continue to feel a sense of shame and pain. Therefore recovery is about addressing the entire addictive process, not just those associated with a particular substance or behaviour. The addictive process, whether it be related to sexual behaviour or substances is often characterized by a pattern of secrecy, cognitive distortions and rituals. Therefore recovery from addiction regardless of type, would involve embracing and attempting to live a life of honesty, authenticity and emotional growth.

Fortunately, many underlying similarities between multiple addictions mean that the underlying framework for concurrent treatment is quite effective. A recent study conducted at Bellwood Health Services confirms that individuals with a comorbid sexual addiction and substance use disorder attending the same treatment centre as those with only sexual addiction, have comparable treatment outcomes at six-months follow-up. Both groups demonstrated substantial improvement not only on measures of substance use and sexual impulse control but also on self-reported measures of well-being and quality of life (Hartman et al., 2012).

Past psychological trauma, sexual abuse, abandonment and neglect are important issues that need to be addressed in treatment. The recovering addict must learn to recognize the signs of being actively involved in the addictive process and work hard at replacing maladaptive coping strategies with positive and affirming ones. The individual needs to be given the tools to be able to function effectively in their environment and successfully meet life’s challenges without turning to substance use or problematic sexual behaviour.

By Iryna Gavrysh and Simone Arbour

A Self-Assessment for Sex Addiction
Are you worried about your sexual behaviour? Worried if it’s a sex addiction? Test yourself here:


Hartman, L. I., Ho, V., Arbour, S., Hambley, J. M., & Lawson, P. (2012). Sexual addiction and substance addiction: Comparing sexual addiction treatment outcomes among clients with and without comorbid substance use disorders. Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 19, 284-309.

Schneider, J., Sealy, J., Montgomery, J. & Irons, R. (2005). Ritualization and
reinforcement: Keys to understanding mixed addictions involving sex and drugs.
Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 12, 121–148.

Vesga-Lopez, O., Schmidt, A., & Blanco, C. (2007). Update on sexual addictions
Directions in Psychiatry, 27(2), 143–158.


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