Sex in comparison with other addictions
I needed to distract myself, so I went off to gamble; gambling is sometimes an excellent sedative for love.
(Casanova, 1798/1958, p. 77)
Different addictions show similarities in terms of observable events in the body, behaviour and subjective experience (Orford, 2001). People addicted to sex, alcohol, gambling or eating all reveal several or all of the following:
A feeling of being ‘out-of-control’ and driven. The behaviour is excessive by conventional standards.
Mental preoccupation with the addictive activity.
An experience of conflict and guilt.
Failed attempts at restraint.
The addictive behaviour might sometimes take certain features of a habit, a kind of automatic reaction to a particular stimulus. It is well established that drug addiction shows this property (Tiffany, 1990). For sex, St Augustine described this: ‘Habit was too strong for me when it asked “Do you think you can live without these things?”’ (Confessions, VIII.11). An escape from boredom and the achievement of euphoria are common features underlying chemically based and non-chemically based addictions (Chaney and Chang, 2005; Orford, 2001). Various addictions, including sex and gambling, are also associated with the attainment of so-called ‘dissociated states’ of mind. Thereby, the normal flow of conscious mental life is disrupted and distraction occurs so that the focus moves from anxious thoughts, such as rumination about personal inadequacies (Kuley and Jacobs, 1988; Orford, 2001).
Unlike some other addictions, the sexually addicted person is almost inescapably bombarded day and night with visual trigger cues to their addiction. The streets throng with sexual cues and, even at home, TV and Internet advertisements tell of the association between sex and success as measured by such things as the value of one’s car. Going to a self-help group might unavoidably put the addicted person in close proximity to precisely the trigger to their addiction, rather as if meetings of Alcoholics Anonymous were to be held in a bar.
In comparison with gambling
In gambling addiction, the person can gain relief from painful thoughts and act out fantasies of boosted esteem. The majority of heavy gamblers gave positive answers to each of the following questions concerning their gambling experiences:
Did you feel as if you were in a trance?
Did you feel outside yourself watching yourself from another vantage point?
Did you feel as if you had acquired another identity?
Have you ever had a memory blackout whilst gambling?
People addicted to gambling also tend to be sensation-seekers, putting a value on variety and novelty. They offer accounts of the experience in such terms as ‘relief of boredom’, ‘oblivious to surroundings’, ‘adrenalin rush’ and being on a ‘high’; occasionally the experience is compared to sexual excitement (Orford, 2001). Similarly, people prone to impulsive buying occasionally report being ‘overwhelmed’, ‘out of control’ and ‘hypnotized’ as they interact with prospective purchases (Rook, 1987). Subsequently, goods bought impulsively can lead to long-term distress.
Sexually addicted people report a similar altered state of consciousness to gambling addicts (Chaney and Chang, 2005; Schwartz and Southern, 2000). Engaging in the addictive activity triggers a boost of self-esteem, combined with dissociation, loss of the sensations of time, boredom and self-identity. From addicted patients, Bancroft and Vukadinovic (2004) recorded ‘nothing else under consideration’, ‘kills time and pain’ and ‘feel detached from what is happening’. This suggests a shift to a lower level of control of consciousness and behaviour, in which present external stimulation is ‘in the driving seat’.
The altered state of consciousness that can be gained by engaging in sexually addictive behaviour was illustrated by Ryan (1996, p. 3):
It’s as if an electronic magnet in my solar plexus were switched on. At its most intense, I’d go into a kind of trance, dissociated, beamed in from Mars, my mouth dry and my heart pounding, my usual waking consciousness hovering somewhere outside my body while I was taken by the pull.
A primary factor in gambling addiction appears to be the generation of excitement, with large heart rate increases as a gambler starts to get near to the gambling location and throughout the gambling activity (Brown, 1997). It seems that increases in arousal are an ingredient in increasing hedonic tone and in turning the gambling situation into a trigger to addiction. This factor could equally apply to sexual addiction. Gambling also suggests another factor that might generalize to sexual addiction: the disparity between current hedonic tone and a memory of the highest hedonic tone ever experienced. Presumably, a big and unexpected win is comparable to an early mind-blowing sexual encounter or porn image. Over weeks and months, the individual is motivated to try to close this gap.
A profoundly important feature of both gambling and sexual addictions is the uncertainty of reward. To those of a behaviourist orientation, reinforcement is said to be ‘partial’ rather than ‘continuous’. The gambler does not know when luck will change and high winnings will arise. Similarly, neither does the sex addict know who might appear in the nightclub next time or when reward in the form of the perfect image will follow the click of a mouse. When high reward follows the click, it does so without delay, another contribution to the strength of reinforcement. As discovered by B. F. Skinner, such a so-called ‘schedule of reinforcement’ is one that is particularly effective in strengthening behaviour and causing its persistence in people, rather as with rats and pigeons pressing a lever for food.
In comparison with drugs
In the case of drugs, the prime trigger for the move to addiction is a substance taken into the body that has effects (‘incentive sensitization’) on the brain. Subsequently, as a result of classical conditioning (see Chapter 2), particular features of the environment (e.g. places where the drug is taken) then get locked into a new mode of interaction with the chemically changed brain. That is to say, these features of the environment acquire conditional incentive properties such that they can trigger changes in the brain that underlie drug-wanting.
As noted earlier, if we generalize from studies on rats (Pitchers et al., 2010), sexual experience sensitizes dopaminergic systems underlying wanting. One could speculate that such sensitization is excessive in the case of sexual addiction. In sex and drugs, a similar set of chemical effects within the brain seems to be triggered (Pitchers et al., 2010), but in the case of sex, both initially and subsequently, the trigger is from outside the body (e.g. by repeated contact with pornography). By conditioning, this then sets up links with other features of the environment (e.g. the red light signalling brothels comes to trigger wanting/desire). Thus, expressed in physical terms, in each case a crucial link in the addictive sequence is the effect on the brain (Gold and Heffner, 1998).
Of the people interviewed by Giugliano (2008), some did not stop their sexually addictive activity for long enough to experience withdrawal symptoms. Others did report withdrawal effects and they consisted of such features as:
depression
anger and irritability
insomnia
anxiety
fatigue
guilt and shame
inability to focus
physical ailments
That symptoms of withdrawal from sexual addiction have features in common with those of withdrawal from drugs points to the broad validity of the term addiction (Maltz and Maltz, 2010).
Ambivalence and conflict
For each addiction, the addicted person can be in conflict, often torn between carrying on and trying to quit (Orford, 2001). Maltz and Maltz (2010) suggest that sexually addicted people are (p. 2): ‘unable to stop using pornography even when they are aware of the negative consequences it is having on their lives’. Ambivalence is best conveyed in the words of people who have experienced out-of-control sexual behaviour. Consider this example (Giugliano, 2008, p. 148):
I remember throwing away porn
and my heart went (hand gesture – indicating breaking) and then I went back to the trash and took it all out again.
There is also the insight of the English comedian Russell Brand (2007, p. 10): ‘It felt strange to be chatting up the airhostesses on the American Airlines flight, knowing that I was on my way to a residential treatment centre for sexual addiction.’ Occasionally, ambivalence is felt already in the immediate after-effects of engaging in the activity. This is illustrated by the American writer Michael Ryan, who was ‘basically heterosexual’ but engaged also in homosexual activity (Ryan, 1996, p. 330):
[T]o have sex with men, was my deepest degradation. It enacted my calcified childhood shame. Of all my shame-based sexual behaviours, this was the most shameful to me.
In some cases, the conflict arises more from the pressure of others, for example courts and the probation service, than from regrets or a wish to acknowledge the problem and try to quit. Salter (1988, p. 87) writes: ‘For many clients child molestation is an addiction. They are more frightened by being without the addiction than of continuing it.’
The danger of relapse is common to addictions as are some of the conditions likely to trigger it, for example being in a mood associated earlier with addiction, reviving a memory of the addictive experience or being in an environment earlier associated with the activity. Chapter 12 described the so-called ‘cold-to-hot empathy gap’: that is, a person in a cold emotional state has difficulty empathizing with how they would feel and their ability to resist temptation when in a hot state. This can be a problem in sexual addiction, where a person in a cold state is tempted to do a test of their reaction and, say, take just a quick look at porn (Maltz and Maltz, 2010).
Tolerance and escalation
Another criterion leading to the description ‘addiction’ is that the behaviour shows tolerance over time, for example increasingly larger doses of drug are required to obtain the same high. Something analogous to this is found in sexual addiction (Chaney and Chang, 2005). Tolerance in this case is closely linked to the phenomenon of habituation or satiation to a constant incentive and the revival of desire that is triggered by novelty. Consider the case of Tom (Maltz and Maltz, 2010, p. 135):
I never found the perfect picture, but I would find one that suited me in the moment, that helped me reach climax. I never returned to the same one. Every night was a different picture. Each one I looked at quickly got old and lost its power. I became really desensitized.
Note that the consequence of engaging with porn shows habituation, while wanting porn is as strong as ever or even stronger, exemplifying the wanting–liking distinction. One could speculate that the feedback consequence of engaging in sexual behaviour is something like a rush of endorphins. Presumably, over repeated experience the size of the rush diminishes, yet the memory of the earlier rushes is still present.
A 30-year-old American male reported how his criteria of acceptance have changed:
In the last couple of years, the more porn I’ve viewed, the less sensitive I am to certain porn that I used to find offensive.
(Schneider, 2000, p. 257)
The following cases lead to a similar conclusion (Giugliano, 2008, p. 147):
Yes in the initial experience of going to a bathhouse if I ended up with two people that was like, ‘Wow my God, I’m a slut.’ But over the years two is like nothing. I know it may sound very crude but to be with 3 or 4 people at different times doesn’t seem to be a big deal anymore.
One of the things I did not engage in before, which became commonplace, is engaging in sex with more than one person at a time. I’ve had sex with four people in my room. You need to experience more and more intensity or it becomes boring after a while.
I took bigger risks. Over time I would go towards prostitutes that would not require condoms. It started monthly then weekly.
It increased in time and frequency. It started out weekly and ended up daily. And I would spend more time having phone sex.
In other words, the only way is up. Rather as the heroin addict might well scoff at cannabis, so the sex addict will not find satisfaction in what earlier was attractive. Previously satisfying sexual activities, for example marital sex, can seem boringly tame by comparison.
The notion of tolerance in the face of danger (Apter, 2007) could well apply to some situations of sexual addiction. As a given ‘dose’ of danger is repeatedly experienced, a perception of safety increases. Hence, the danger level needs to be increased to obtain the same thrill, rather as a mountaineer who acquires skill will require ever more challenging climbs.
This might provide insight into a strange phenomenon, so-called ‘bug-chasing’ (Moskowitz and Roloff, 2007). This consists of gay men who are not HIV-positive seeking out HIV-positive sex partners for unprotected sex. The researchers suggest that, through stages of escalating risk, bug-chasers are led to seek the ultimate risk: that of death. As the authors express it (p. 26): ‘They have an increased tolerance for their sexual behaviours, and as a corollary, need to escalate the risk and significance of the sexual act to get “high”.’
Is out-of-control sexual activity an addiction, a form of compulsion or an impulse control problem?
Would the phenomenon termed ‘sexual addiction’ be better described under the heading of ‘sexual obsession and compulsion’, an example of an obsessive-compulsive disorder (OCD)? Is it like compulsive checking or hand-washing? Alternatively, is it an ‘impulse control disorder’?
Similarity to OCD
There are some common features with OCD, expressed as a shift of weight of control to a lower level. A low serotonin level appears to be implicated in OCD, hypersexuality (Kafka, 1997) and love addiction, possibly associated with elevated dopamine activity (Fisher, 2004). Also, the same medication, boosting serotonin levels, is employed to treat both OCD and sexual addiction. In each case, the person can feel out of control and driven, sometimes engaging in futile self-destructive behaviour and wishing they could quit. Conflict is the hallmark of each condition, where things can get more severe over time. Stress, anxiety and depression can exacerbate both conditions and experiencing unstructured time can be dangerous. In each case, temporary relief is sought in an activity that only serves to make matters worse in the longer term. However, the criteria just described apply equally to drug addiction as to sex addiction.
Difference from OCD
There is a fundamental difference between OCD and addiction. At their roots, addictions appear to tap into a basic biological incentive (‘go’) system that normally moves the individual towards contact with something positive. This process might well have got corrupted, has become counterproductive in any biological sense and no longer serves the interests of the individual. It might no longer bring as much pleasure as in the beginning, but the activity normally has the capacity to give intense pleasure, in the case of addictive activity particularly in the early stages (Giugliano, 2008).
In the sample of fourteen men studied by Giugliano, only one reported that he engaged in the activity ‘to neutralize anxiety rather than for sexual pleasure’. So, an addictive activity is multi-purpose according to context – to give pleasure and avoid pain. Sexually addicted people spend enormous amounts of time thinking about sex, but do not generally describe their erotic thoughts as ‘intrusive’, unlike people with OCD (Giugliano, 2008). An exception is certain paraphiliacs, such as paedophiles trying to quit, who often experience their sexual imagery as intrusive and demanding (Schwartz and Masters, 1983).
In OCD, by contrast the individual is invariably trying to escape from something aversive, such as apparently contaminated hands, the insecurity of an unlocked door or the pain of an unacceptable mental image (Toates and Coschug-Toates, 2002). The obsessive imagery is usually intrinsically aversive, unlike that of most sexual addictions. Pleasure is never the expected goal in OCD; rather the goal is invariably the alleviation of suffering (Giugliano, 2008). At its basis, the engagement of an ‘avoid’ or ‘escape’ system places it in disti
nction to addiction. Certain forms of therapy also point to the logic of a distinction between OCD and addiction. In OCD, the individual is gradually coaxed into contact with the feared object whereas in addiction he or she is coaxed away from contact with it. However, as a similarity with OCD, some forms of therapy try to induce satiation with the content of the addiction, rather like trying to associate relaxation with the obsession.
In comparison with impulse control disorders
When sexual behaviour is out of control, it can also exhibit features in common with impulse control disorders, which are defined as a failure to resist a harmful impulse, drive or temptation. On these disorders, Giugliano (2008) notes that: ‘The individual feels an increasing sense of tension or arousal before committing the act and then experiences pleasure, gratification, or relief at the time of committing the act’ (p. 144). In such terms, one sexually addicted person gave the following account (Giugliano, p. 146):
It’s like the pleasure one gets from scratching an itch…it’s the pleasure of letting a sneeze go.
How Sexual Desire Works- The Enigmatic Urge Page 38
