Over the last few years in my practice, I have increasingly experienced male clients presenting with what I have named and perhaps identified as substance abuse induced sexual addiction (SAIS).
A clear pattern of behaviour is emerging. The typical client is high functioning earning middle to high income. In many cases initially, the client is seeking assistance for drug and alcohol (AOD) issues. In some instances, the client has been caught out by his partner, or the partner is concerned about the AOD usage with no knowledge of the sexual component.
On a regular basis the client binge drinks and becomes intoxicated. Upon reaching this point, the client will score cocaine or methamphetamine. These two psychotropic substances are known for enhancing and prolonging the sexual experience. Once absorbed along with the alcohol the client will engage in a range of sexual activities not limited to but including, an hour to days of viewing pornography, seeking and participating in on-line sex chat rooms, visiting massage shops, brothels, strip venues, or using the services of escorts.
Generally, when rapport is built during the initial session, and with the appropriate use of questions, and or normalising, the sexual addiction component is disclosed. This is a critical point in the therapy, as I have noticed the client is carefully evaluating my response and non-verbal body language to gauge my reaction. At this point the client may disclose feelings of shame and not uncommon, feelings of self-disgust and low self-efficacy. There will be a strong presence of Leon Festinger’s cognitive dissonance, meaning when a person’s beliefs do not match up with their behaviours.
A salient conundrum in working with SAIS clients is to determine what comes first, the chicken or the egg? Are they addicted to drugs, alcohol, sex or all?
In other words, in terms of their SAIS, what is the trigger? Does craving for, and drinking alcohol allow them to let down their guard tempting them into using drugs? Are they using the alcohol as a deliberate gateway to using drugs? Does being substance affected make them lose their locus of control? Does this lead to them impulsively acting upon their sexual desires at that moment? Is it planned? Conversely, do they have underlying sexual inhibitions and anxieties surrounding their sexual experiences? If so, do they make a choice to drink and take drugs as to be able to fulfil their desires? Often when intoxicated some clients find their attractions and fantasies completely opposite to when they are non- substance affected and thus under the influence, allowing them to feel comfortable enough at the time to enjoy the experience albeit many report loathing and questioning themselves at the end of the sexual experience. And finally, is there evidence of a sexual addiction when they are non-substance affected?
So, does SAIS exist? In my practise I am seeing a growing cohort presenting with comorbid alcohol, methamphetamine and or cocaine abuse combined with extreme sexual behaviours. The large number of presentations I see may be skewed as one of the area’s I advertise and specialise in is AOD as well as sexual addictions. Nevertheless, clients are presenting with a SAIS like issue. My evidence is purely empirical, and much more research is needed to be undertaken.
By John Arber