Substance Abuse and Sex Addiction Connection
Substance use disorders are diagnosed when the recurrent use of alcohol and or drugs causes clinically and functionally significant impairment, including health problems, disability and a failure to meet major responsibilities at work, school or home. According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use and pharmacological criteria. A substance use disorder can involve alcohol, tobacco, cannabis (marijuana), stimulants, hallucinogens, opioids and other prescription and illicit drugs.1
Sex addiction can involve pornography, sexting, compulsively engaging in sex acts with multiple partners, excessive masturbation, exhibitionism/voyeurism and sometimes pedophilia. Sexual addiction (also called hypersexual disorder) is not included in DSM-5, which was published in 2013. Despite this omission, diagnostic codes for this disorder were incorporated into the International Classification of Diseases (ICD-10), the primary diagnostic codes used in the U.S., on Oct. 1, 2015. Although ICD-11 is not scheduled to be published until 2018, a diagnosis of Compulsive Sexual Behavior Disorder (CDBD) is being considered, with the following suggested definition, remarkably similar to the clinical definition of substance abuse.2
Compulsive sexual behavior disorder is characterized by persistent and repetitive sexual impulses or urges that are experienced as irresistible or uncontrollable, leading to repetitive sexual behaviors, along with additional indicators such as sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other activities, unsuccessful efforts to control or reduce sexual behaviors, or continuing to engage in repetitive sexual behavior despite adverse consequences (e.g. relationship disruption, occupational consequences or negative impact on health). The individual experiences increased tension or affective arousal immediately before the sexual activity, and relief or dissipation of tension afterward. The pattern of sexual impulses and behavior causes marked distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.2
Sex and Drug Addiction
One of the hallmarks of compulsive sexual behavior is continued engagement in the activity despite the direct negative consequences, the same path as substance use disorders. Strong links exist between substance use disorders and other addictive behaviors such as alcohol and sex addiction. Two small studies consisting primarily of men with sexual addiction found an estimated 96% had an anxiety disorder, 71% had a mood disorder (e.g. depression), 71% had a substance use disorder, 46% had personality disorder, 38% had an impulse control disorder and 14% had obsessive compulsive disorder.3 More than 83% of self-identifying sex addicts are dependent on alcohol or drugs, are workaholics or compulsive gamblers.4,5
Like other disorders, compulsive sexual behaviors vary in type and degree of severity. Due to the high rate of co-occurring disorders, a person may not seek professional help for these compulsions, but they are revealed during the course of treatment for depression or other conditions. Psychologically, sexual behaviors serve as an escape from emotional or physical pain, or as a method for coping with life stressors. Unfortunately, like drugs and alcohol, using these behaviors as a coping mechanism creates an ever-growing cycle of additional problems, increased desperation, shame and preoccupation.5
Compulsive or hypersexual behaviors may be linked to manic episodes in people with bipolar disorder, illicit drug abuse, prescription medications (e.g., dopamine agonists) and medical conditions (e.g. frontal-lobe tumors). The defining difference is once these primary problems are treated, the compulsive sexual behaviors resolve.5 Although many people do not experience this, the drugs most notably linked to compulsive sexual behaviors are stimulants such as cocaine and methamphetamine. The latter is purported to enhance sex drive, lower inhibitions, delay orgasm and improve sexual performance. In a cocaine-related sexual behavior study, 50% of males versus less than 20% of females reported cocaine use was associated with increased sex drive, fantasies and sexual acting-out behaviors. In a different study, 60% to 70% of meth users experienced drug-induced increases in sex drive, fantasies, pleasure, performance, obsession and unusual or risky sexual behaviors compared to 40% to 50% of cocaine users.6
Sex Addiction Treatment
Considering the high rates of co-occurring psychiatric and substance use disorders, it is imperative all individuals with compulsive sexual behavior disorder are properly assessed for the presence of these disorders. All co-occurring disorders should be incorporated into treatment, although substance abuse typically takes precedence due to the potentially serious consequences of withdrawal. A considerable challenge in recovery from co-occurring addictions is that they are nearly always intertwined, in that one is used to offset or enable the other. Alcoholism and drug addiction can open the door to compulsive use of pornography and sex, or conversely, the shame related to behavioral addictions leads to substance abuse. Making significant changes and addressing the underlying causes of sexual addiction is difficult when a person is chemically dependent. Drinking or using drugs counteracts any progress made in therapy. In the case of stimulants, breaking the connection between drug use and compulsive sexual behaviors requires stopping drug use and or temporary abstinence from sex.7
- Substance Use Disorders. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/disorders/substance-use Updated October 27, 2015. Accessed June 5, 2017.
- Krueger RB. Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD-10 and DSM-5 despite rejection of this diagnosis by the American Psychiatric Association. Addiction. 2016 Dec;111(12):2110-2111. doi: 10.1111/add.13366.
- Starcevic V, Khazaal Y. Relationships between Behavioural Addictions and Psychiatric Disorders: What Is Known and What Is Yet to Be Learned? Front Psychiatry. 2017;8:53. doi:10.3389/fpsyt.2017.00053.
- Risky Business: Sex. Mental Health America website. http://www.mentalhealthamerica.net/conditions/risky-business-sex Accessed June 5, 2017.
- Fong TW. Understanding and Managing Compulsive Sexual Behaviors. Psychiatry (Edgmont). 2006;3(11):51-58.
- A Vicious Cycle: Stimulant Drugs and Compulsive Sex. Rehabs website. http://www.rehabs.com/pro-talk-articles/stimulant-drugs-and-compulsive-sex-how-to-break-the-cycle/ Published September 9, 2014. Accessed June 5, 2017.
- Treating Co-occurring Sex & Substance Addictions. Choose Help website. http://www.choosehelp.com/topics/sex-addiction/treatment-for-co-occurring-sex-substance-addictions Accessed June 5, 2017.