Treating Sex Addiction with Harm Reduction Psychotherapy
This week, I received the exciting news that I'll be participating in a panel discussion about sex addiction, approaches to treatment, and how best to help clients needing support with these issues. I'll be talking about treating sex addiction with harm reduction psychotherapy. The conversation will take place at the conference for the International Institute for Trauma and Addiction Professionals in Phoenix in May. It's going to be a great chance for mental health professionals on the front lines of out-of-control sexual behavior treatment to compare treatment options and philosophies.
Normally I don't post too much about developments in the field of addiction, though I did give an update about sex addiction receiving a diagnosis last summer. But this panel is so important and exciting because it's evidence of a growing number of voices in the addiction field who think a bit differently about how to help those struggling with addictive behaviors, including sexual behaviors.
I thought I'd briefly compare the traditional approach and the harm reduction approach as I consider my remarks for the panel. I'm very much thinking out loud here as I continue to evolve and grow, so I invite you to be a part of the dialogue in the comments below.
Treating Sex Addiction: A Traditional Understanding and Treatment Approach
Sex addiction has been discussed for more than 30 years now and has entered into the national discourse. It's become widely accepted as a "thing," a real addiction characterized by loss of choice, preoccupation, and continuation of problematic addictive behaviors despite negative consequences. These are and continue to be the hallmarks of any addiction. Addiction has, based on much research, been traditionally conceived as a "primary, chronic disease of brain reward, motivation, memory, and related circuitry" (ASAM, 2013), as evidenced by the American Society of Addiction Medicine's definition. Addiction
affects neurotransmission and interactions with reward structures of the brain . . . such that motivational hierarchies are altered and addictive behaviors . . . supplant healthy, self-care related behaviors . . . [and] the memory of previous exposures to rewards . . . leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors (ibid.).
The Disease Model
This definition focuses almost exclusively on how behavior alters biology, which in turn shapes behavior. The power of addictive behavior to rewire our brains can be very helpful to some in explaining why they feel so powerless over their problematic sexual behaviors. Understanding addiction this way can also take away much of the shame that they've felt about their secret lives for so long. For others, especially their partners, it can feel like a cop-out that means that their partners aren't responsible for their deeply hurtful actions.
Treatment and Recovery
Any way that we understand addiction will have implications for treatment. Sex addiction is traditionally treated with individual therapy, groups, and adjunctive 12-step program like SA, SLAA, or SAA with the goal of stopping the problematic behaviors completely and experiencing personal and spiritual transformation in recovery. As there is no "cure" for addiction in this purview, recovery is seen as a lifelong process. Addiction and its symptoms can only be managed, often with the help of continued participation in a 12-step community.
Treating Sex Addiction: A Harm Reduction Approach
Many clients who are struggling with sex addiction and problematic sexual behaviors are ready to change their behaviors, but at any given time, most aren't. Researchers Prochaska, DiClemente, and Norcross found that about 80% of people across a range of 15 high-risk behaviors were not ready to take steps toward change. Yet 90% of treatment programs are geared toward people who are ready. This creates a mismatch between where most people struggling with addictive behaviors are and the treatment provided.
Starting Treatment Where the Client Is
Harm reduction seeks to start wherever the individual is in seeking change and reducing the harm associated with their behaviors. It accepts that people may not be ready to change, and that requiring individuals to stop behavior before they are ready may mean that they discontinue treatment altogether. That being said, most of the couples I hear from dealing with this issue are in the throes of a crisis, with the partner just finding out about the secret sexual behavior. Sometimes this crisis and the very real possibility of losing one's partner unless changes occur is enough to make one ready for positive change. But often it's not, which can result in what the traditional approach would call relapses or slips.
Treatment and Recovery
Harm reduction does not dismiss the neurobiological changes that occur as a result of addictive behaviors. However, harm reduction tends to view these changes not as the onset of a disease but in terms of changes that naturally occur in the brain as the habit is "overlearned." Our brains change no matter what we do, so that addiction is not primarily a medical issue but a behavioral one. (Read more about this here.)
The good news is that the addictive behavior can, with practice and support, be unlearned. Often this perspective is empowering for clients as they feel they can regain control over behaviors that have wreaked havoc in their lives. So instead of seeing these occurrences as a "failure" (as many clients do), a harm reduction approach sees a return to sexually acting out as an opportunity to create positive change.
Often I explore with clients why they wanted to engage in the addictive behavior and think with them about alternative ways they can meet that need without acting out. The great benefit of an approach like this is that the client begins thinking self-reflectively about the behavior, which is crucial to creating and maintaining change. Communicating implicitly or otherwise that the relapse was a failure or the result of a disease allows them to put all of their "badness" in the disease, so that it remains split off from the self. That's a sure way to ensure that the addictive behavior will continue to be a problem.
Harm Reduction for Treating Sex Addiction
Harm reduction takes very seriously the damage caused by the addictive behaviors in a person's life and seeks to partner with them collaboratively and with respect to help them reach their goals for treatment. If you or someone you love needs help, change isn't easy but it is possible. It would be my great privilege to journey with you, helping you get to where you want to go.
About the Author
Jeremy Mast is a licensed marriage and family therapist, a Certified Sex Addiction Therapist, and the founder and director of the Center for Integrative Change. He is passionate about helping those struggling with substance use and problematic sexual behaviors and their loved ones find lasting healing. In his spare time, he enjoys reading, rock climbing, health and fitness, and trying out new recipes while cooking at home.