It is important to examine how addiction or disease may be using fear of sexual intimacy as an excuse to avoid continuing recovery.

Attitudes and experiences with sex need to be evaluated. If there are serious problems such as a history of sexual abuse, these certainly need to be treated. An overall negative attitude toward bodily pleasures and sensual feelings may exist. Professionalhelp in such cases is recommended.

Bulimia and Anorexia

Studies of young women with anorexia and bulimia reveal that restricting anorexics tend to have lost any interest in sex. Bulimics are not much different from their normal counterparts in terms of sexual experience and interest. It has been theorized that the problems bulimics suffer with impulse control could be related to bingeing, which is safer than promiscuity, but this is clinical observation rather than a scientific finding at this point. Other theories could just as well explain the bingeing behavior.

Alcohol and Other Drugs

Many drugs, like alcohol and cocaine, seem to have a positive effect on sexuality at first. Alcohol dissolves inhibitions, so people with reservations about sexual behavior (some healthy and some unhealthy) find themselves doing things they had only dreamed about. Cocaine, because of its stimulant effect, produces an initial perception of great sexual performance. All drugs commonly abused eventually lead to impotence, however. For some it is more emotional than physical, but the expectation of drug-enhanced sex is a great myth.

Overall, addicts are likely to suffer from a variety of problems that interfere with healthy sexuality. Trust issues, negative sexual experiences, body image distortions, inability to have fun, and family of origin messages are all factors that could present problems in the ability to have satisfying sensual and sexual experiences.

Human beings have somehow devised taboos and ideas about sex that are anything but natural. Research on primates has shown that monkeys have great difficulty copulating if they have not grown up with sexually active monkeys and seen it done many times. They also become very neurotic if they are not in physical contact with other monkeys most of the time during their early lives. Mark Schwartz, ScD, a noted researcher into sexual dysfunction and sex addiction, says that he would have trouble designing a way of relating to sex that would guarantee more dysfuriction than the one humanity has.


The most common problems with sex are not medical in nature, or premature ejaculation, or anything like that. The greatest problem is fatigue. For two people who both work and have other responsibilities, to come home after a hard day, fix dinner, give “quality time" to the kids, and then, after 10 or 11pm, to achieve great sex including simultaneous orgasms, is expecting a bit much.

The second most common problem is overemphasis on performance. When two people accept the responsibility to satisfy the other sexually, they take on an incredible task — one that is unparalleled in nature. Most sexual therapy consists of teaching people to be responsible for their own sexuality, to slow down, take the focus off orgasm, and enjoy the experience of sex.

Gay & Lesbian Experience

Gay people encounter most of the sexual problems of other groups, with added stress from many sources. Many in society still discourage the LGBT community with all sorts of subtle, obvious, and sometimes even violent discrimination. Many gays experience exile from their family of origin.

Studies report up to 25 percent of male bulimics and anorexics are gay. Other addictions are also common among the gay community. Outside larger metropolitan areas, there are few Twelve-Step groups that specifically encourage gays, and most of those are in AA. Many gays would feel uncomfortable discussing their problems in an ordinary meeting. Finding a meeting listed as “Gays Welcome” might help.

See the module on LGBT issues.

Starting to Talk

Whatever your problems regarding sex or sexuality, whether directly involving your addiction or not, the first step is to talk about it. Talk honestly with your partner, talk with others, inside the Twelve-Step programs and out. If the problem does not resolve itself through talking and your own common sense, seek competent professional help.

Many people in early recovery are especially vulnerable to others in relationships and sexuality. If you have a poor body image or poor self-esteem, you may feel starved for attention and feel trapped in a sexual or abusive relationship with the fear that you might never attract another person.


Having an affair outside a marriage or other committed relationship (including religious vows) usually creates a dangerous weakness in your integrity, and it will become more difficult to maintain rigorous honesty in your recovery and the rest of your life. It will also produce a serious barrier in that committed relationship.

Sexual affairs Not all affairs include actual sexual activity, but most do get around to sexual behavior eventually, even if there was no intention to “go that far.” When sex is involved, the guilt, the risk of pregnancy, the threat of AIDS, herpes, or other venereal disease, and other factors add to the excitement, increase the possibility of addictive behavior, and make good, solid honesty and recovery more difficult.

Prostitution Paid sex has often been thought to be less damaging to a marriage than affairs in which there is romance or love. For most people, however, the illusion that it is harmless adds its own handicap to the recovering addict. The danger of AIDS, of arrest by legal authorities, or underworld involvement may add to the excitement and make recovery much harder.

Romantic affairs Some affairs never reach the point of sexual activity. While this eliminates the risk of pregnancy, of AIDS, and of the guilt of inflicting these problems on the other party in the affair and the partner in the committed relationship, it also creates a few problems of its own.

People who have nonsexual romantic affairs usually live in a fantasy delusion that since sex is not involved, the relationship is “platonic,” and therefore good, wholesome, and wonderful. Delusion increases as they self-righteously cast aside any hints that others suspect an affair, because “we haven’t done anything wrong.” This type of affair often goes on for a long time, causes severe damage to the primary committed relationship, and tends to generate lots of addictive behavior.

Sex Addiction

Obsession, shame and guilt, isolation, and unhealthy sexual activity are hallmarks of sexual addiction. All the usual characteristics of addiction apply to sex addiction also. Patrick Carnes (1983), a noted authority on sex addiction, has identified a four-stage cycle:

  • Preoccupation — the addict is obsessed with the idea of sex and searching for sexual stimulation.
  • Ritualization — this involves special routines and rituals that intensify excitement and arousal.
  • Compulsive sexual behavior — acting out sexually, which the addict is powerless to stop.
  • Despair — hopelessness because of the inability to stop what they don’t want to do.

Carnes also identified three levels of compulsive sexual activity. Level 1 includes activities that are generally tolerated by society if they are isolated incidents. Examples are masturbation, extramarital sex, sex without considering the partner’s feelings, pornography, strip shows, using prostitutes, and homosexual activities.

Level 2 acts are intrusive and may incur legal action. Voyeurism, obscene phone calls, and exhibitionism are examples.

Level 3 behavior significantly violates another’s boundaries, and may involve criminal prosecution. Child molestation, rape, and in- cest are examples.

Biochemistry No one can deny that the biochemistry associated with sex is extremely powerful. It satisfies survival instincts without which our species would never have lasted. Sex releases many neurotransmitters and hormones that form a physical part of the addiction.

Romance Falling in love, romance, and relationship addiction are often intertwined with sex addiction. There is a neurochemistry here as well. Phenylethylamine (PEA) is an excitatory amine that is chemically similar to amphetamines. Its concentration increases when people are falling in love, and when it falls back to normal, the honeymoon is over. Some people get addicted to this chemistry with or without sex addiction.

Treatment The Twelve-Step model has been very successful in treating sex addicts. Schwartz has found that a Twelve-Step approach helps sex offencers with guilt so they can get on with treatment in a positive way. Carnes also uses this approach at the Institute for Behavioral Medicine in Golden Valley, Minnesota.


Note that sex addiction is one of those addictions that superficially seems to have no relation to a drug. However, there are certainly endogenous drugs that are produced in the body with sexual activity, such as oxytocin. It is involved not only with orgasm, but with romance, social interaction, and even bonding. In certain individuals, it can also relate to maladaptive social traits like aggressive behavior.

Sex addiction often coexists with alcoholism, drug addiction, eating addiction, or others. Recovery requires abstinence and/or moderation for both addictions. Alcoholics or eating addicts who continue to act out sexually suffer shame and guilt to a degree that relapse with alcohol or food is almost inevitable. See the module Sex Addiction Groups.

Sex, see also: Addiction, Adolescents, Arousal, Assertiveness, Behavior, Binge history, Bingeing, Biochemistry, Body image, Control, Craving, Defenses, Drugs, Excitement, Exercise & activity, Guilt & shame, Incest, Intimacy, Loving & caring, Moodifiers, Neurotransmitters, Obesity, Pregnancy, Relationships, Self-image, Sex addiction groups, Sleep, Stress & strain, Therapy & treatment, Trust.

Updated 2 Oct 2015

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Addictionary 2 by Jan & Judy Wilson

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