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i I Understanding Sexual Addiction Second Edition Patrick Carnes, Ph.D. CompCane Publishers

M M M M MM M MM r ~ ~ ~ ~ ~ ~ ~ MIlis I 1 The Addiction Cycle I i I Although Hefner was approaching forty-five, and had been involved with hundreds of photogenic women since starting his magazine, he enjoyed female companionship now more than ever; and perhaps more significant, considering all that Hefner had seen and done in recent years, was the fact that each occasion with a new woman was for him a novel experience. It was as if he was always watching for the first time a woman undress, rediscovering with delight the beauty of the female body, breathlessly expectant as panties were removed and smooth buttocks were exposed - and he never tired of the consummate act. He was a sex junkie with an insatiable habit. Gay Talese Thy Neighbor's Wife Del was a lawyer. Brilliant, charming, and witty. He had a special breakthrough in his career when he was appointed as one of the governor's special aides. His wife and three children were proud of his accomplishments. However, Del's public visibility was creating a problem because he was also a sexual addict. His double life included prostitution, porno bookstores, and affairs. Del would initiate relationships with women, feeling that he was "in love." After the initial sexual contact, he would des- perately wish to be free. These relationships became char- acterized by his ambivalence. He wanted to be sexual, but he did not want the relationship. Yet he couldn't say no clearly without fear of hurting the women's feelings, so he never quite 9Z-166991VQ9-,.

.. .r. .. r.. .. i.r r .. .. a r.r ... .. .r~ .. .. ... .. ~ I Out of the Shadows: Understanding Sexual Addiction broke off the relationships. Instead he hoped their frustration would force them to give up. The result was that he had a series of relationships at the same time in various stages of initiation and frustration. There was not only the juggling act of keeping his relation- ships straight. Some of these women were vital to him profes- sionally. He exploited relationships to receive cooperation. His problem was that the women would believe that he cared for them. The professional complications were extreme. One time, he was involved with a colleague and her secretary at the same time. The secretary went in to talk to her boss about this "prob- lem" she had. Del had to face two very angry women. His other behaviors were also problems. In porno shops, he was sexual with a number of men in the movie booths. Worse, the shops he frequented were near the capitol where he was liable to be recognized. He vowed to stop when, sitting in a meeting in the attorney general's office, a plan was described for a raid on a local porno shop-the one he had patronized two days before. But he did not stop. Neither were his visits to massage parlors without peril. One night his masseuse was a young girl quite high on some form of drug. Del decided to have his massage anyway, including a "hand job." When she masturbated him, she hurt his penis. Del was too shameful to complain or even to tell anybody. When he got home, he was so upset, he masturbated-despite his penis being sore. Late one evening, Del pulled up next to a young woman at a stoplight. He had always had the fantasy of picking up a woman on a street. He looked at her and she smiled at him. Del became very excited. They drove side by side for several blocks. She returned his stares at each stop sign. Soon she pulled ahead of him, turned off the road, and pulled to a stop. He followed and pulled up behind her. She waved towards him and pulled out again. Del thought she wanted him to follow. , , ` The Addiction Cycle Del's mind raced ahead to where she could be leading him. She drove in the direction of a well-known local restaurant with a popular late night bar. Convinced that was where they headed, he speculated that after a drink, they might end up at her apart- ment. His mind filled with fantasies, he pulled up behind her when she stopped. As he was opening his door, she leaped out of her car and dashed into the building. Surprised, he looked up to see that he was not in front of the restaurant. Rather, she had stopped at the police station three blocks away. Horrified, Del got back in his car and raced home. While driving, he was in shock at how out of touch with reality he was. She had not been encouraging him to follow her, but was in fact frightened. He, on the other hand, was so caught up in his fantasy, he failed to notice that she was parking at a police station. He felt a flood of remorse for subjecting the woman to a frightening ordeal. Also, he was terrified that she would accuse him of attempted rape and that he would be arrested. When Del arrived home at 1:30 a.m., he was so scared that he sat and prayed. At 2:00, there was a sound of a siren in the distance. He promised God that he would change. He fantasized about what it would do to his wife and kids. Truly, it was the most desperate moment of his life. Finally, he went to bed. When he awoke in the morning, he felt tremendous relief. He knew he was not to be picked up. He went to work and put enormous energy into his job that day. At the end of the day, he felt the need of a reward. He stopped at a massage parlor. Del was a man who valued the law. He also prided himself on his honesty with people-a fact he often parlayed into seduc- tion. His children and wife were central to his life. He had worked hard in his career. His addiction, however, violated his own values and the law, as well as jeopardized his career and family. His story - of which just a few pieces are related here - is one of constant predicaments. Del's addictive behavior put 2~,~T66E9~~~ 3

MMMMMMM~i r IM , , Out of the Shadows: Understanding Se.run! Addiction i him in situations in which he was vulnerable to tremendous consequences. His degradation was only exceeded by the vio- lation of his own principles. Because of Del's sexual addiction, his fantasy became more real than the nightmare he created. I What Is Sexual Addiction? A way to understand sexual addicts like Del is to compare them with other types of addicts. A common definition of alcoholism or drug dependency is that a person has a pathological relation- ship with a mood-altering chemical.' The alcoholic's relation- ship with alcohol becomes more important than family, friends, and work. The relationship progresses to the point where alcohol is necessary to feel normal. To feel "normal" for the alcoholic is also to feel isolated and lonely since the primary relationship he depends upon to feel adequate is a chemical, not other people. The sexual addiction is parallel. The addict substitutes a sick relationship to an event or process for a healthy relationship with others. The addict's relationship with a mood-altering "experience" becomes central to his life. Del, for example, routinely jeopardized all that he loved. His vows to quit were lost against the power of his addiction. The only thing which exceeded his pain was his loneliness. Addicts progressively go through stages in which they retreat further from the reality of friends, family, and work. Their secret lives become more real than their public lives. What people know is a false identity. Only the individual addict knows the shame of living a double life-the real world and the addict's world. Leading a fantasy double life is a distortion of reality. Del was so caught up in his fantasy a police station became a restaurant and a cooperative prospect was, in fact, a desperate 4 The Addiction Cycle and frightened woman. An essential part of sanity is being grounded in reality, so in the sense that addicts distort reality, the sexual addiction becomes a form of insanity. The Addict's Belief System How does addiction begin? How does the progressive insanity occur? It begins with the delusional thought processes which are rooted in the addict's belief system. That is, addicts begin with core beliefs about themselves which affect how they per- ceive reality. So important is this factor-the belief system-in the addiction equation, it is a theme throughout this entire book. For now, we need only to point out its role in the impaired thinking of the addict. Each person has a belief system which is the sum of the assumptions, judgments, and myths that one holds to be true. It contains potent family messages about a person's value or worth, relationships, needs and sexuality. Within it is a reper- toire of what "options"-answers, solutions, methods, possib- lities, ways of behaving-are open to each of us. In short, it is a model of the world. On the basis of that model we: plan and make decisions. interpret other people's actions. make meaning out of life experiences. solve problems. pattern our relationships. develop our careers. establish priorities. For each of us, our belief system is the filter through which we conduct the main task of our lives: making choices. 5 59166MQZ

M M M i M M M = Out of the Shadows: Understanding Sexual Addiction i , I 0 The addict's belief system contains certain core beliefs which are faulty or inaccurate and, consequently, which provide a fundamental momentum for the addiction. Generally, addicts do not perceive themselves as worthwhile persons. Nor do they believe other people would care for them or meet their needs if everything was known about them, including the addiction. Finally, they believe that sex is their most important peed. Sex is what makes isolation bearable. Their core beliefs are the anchor points of the sexual addiction. Impaired Thinking Out of the belief system-the set of interacting faulty beliefs- come distorted views of reality. Denial leads the list of ways addicts distort reality. Addicts use many devices to deny-to themselves and others-that there is a problem. Ignoring the problem, blaming others, and minimizing the behaviors are part of the addict's defensive repertoire. Consequences such as venereal disease, unwanted pregnancy, lost jobs, arrests, and broken relationships are either overlooked or attributed to factors other than the addiction: Venereal disease "A lot of people get it now." Pregnancy -"She tricked me into it." Arrests -"Cops had it in for me. They had no real proof." Jobs "The boss needs to be liberated." Relationships "Her family always had prob- lems. She simply couldn't han- dle it." When addicts believe in the defensive rationalizations, the result is denial that a specific incident or behavior is a part of a total behavioral pattern. i.. rrr .r +.. .. .r. ... r .r. rir ~ The Addiction Cycle Arguments, excuses, justifications, and circular reasoning abound in the addict's impaired mental processes: If I don't have it every few days, the pressure builds up. I am oversexed and have to meet my needs. What she doesn't know won't hurt. She really enjoyed, asked for, deserved it. Every guy will get what "nookie" he can. If only my wife would be more responsive. Men are like animals-males are more sexual than females. With the stress I am under, I deserve it. It doesn't hurt anybody because ... I couldn't help it, given how she acted. No one really cares. It's my way of relaxing. Women always pretend they don't want it when they do. Whatever the rationalization, it further cuts the addicts off from the reality of their behavior. Sincere delusion is believing your own lies. The addicts who make a commitment to change or follow through on something are sincere in their intentions. They are as sincere as when they vow to themselves to quit. They may even experience a great deal of emotion-tears of pain, expressions of tenderness, or anger when someone doesn't believe in their good intentions. However, their commitment to others is no more valid than their vows to themselves. It appears to be paradoxical to be sincere about telling a lie. It is not. But it is evidence of seriously impaired thinking. An example of the thinking process will help. The addict who has been confronted by his wife because he was not at work when he was suppose to be spins out a tale as to his whereabouts. She doubts he is telling the truth. He is incensed at her distrust. He assumes she would be this way even if he 6Z166Eot 0Z 7 6

.. .. ..E .. ... M .. M .. ... r. .. .. .. .. .. .. r M i ( Out of the Shadows: Understanding Sexual Addiction were truthful. So he takes it a step further. He assures her that he had even told her earlier that this would happen. This makes her feel even crazier, because she cannot remember. His emo- tions about her distrust are real. He is now even more incensed that she cannot remember. His lies and his sincerity become fused. Making declarations of love in order to seduce, becoming incensed at the behavior of the arresting officer in order to obscure your own behavior, and protesting that something "hap- pened only once" in order to cover up-all are types of sincere delusion. Ironically, the addict knows that he really is not trustworthy. In his isolation, he is also convinced that most people cannot be trusted. Further, he is certain that if anyone found out about his secret life of addictive experiences, there would be no for- giveness. Only judgment. To complicate matters, he has placed himself in so many precarious situations, he lives in constant fear of discovery of his being so untrustworthy. The suspicion and paranoia heighten the sense of alienation. The addict's blame of others for all problems is another way to protect his secret life. Fault lies with spouse, children, par- ents, work associates, or boss. The addict is critical, self- righteous, and judgmental. There is no acceptance of personal responsibility for mistakes, failures, or actions. This appearance of integrity further insulates the addict's world from reality. The blame dynamic provides further justification for the addict's behavior. Ungrateful children, demanding spouses, hard-nosed bosses create an unfair world in which the addict deserves a reward. To be honest about one's limitations would bring the wall crumbling down-and, in turn, jeopardize the one source of nurturing and care that can be counted on: the sexual addic- tion. Each of these delusional thought processes--lenial, rationali- zation, sincere delusion, paranoia, and blame-closes off an g -ACissE9M The Addirticin CYrle important avenue of self-knowledge and touch with reality for the addict. Gone are the feedback loops which serve as vital correctives to a faulty belief system. In this way the addict's world becomes closed off from the real world. Within that world the addictive cycle is now free to work. The Addiction Cycle For sexual addicts an addictive experience progresses through a four-step cycle which intensifies with each repetition: I. Preoccupation-the trance or mood wherein the ad- dicts' minds are completely engrossed with thoughts of sex. This mental state creates an obsessive search for sexual stimulation. 2. Ritualization-the addicts' own special routines which lead up to the sexual behavior. The ritual intensifies the preoccupation, adding arousal and excitement. 3. Compulsive .cexual behavior-the actual sexual act, which is the end goal of the preoccupation and ritualization. Sexual addicts are unable to control or stop this behavior. 4. Despair-the feeling of utter hopelessness addicts have about their behavior and their powerlessness. The pain the addicts feel at the end of the cycle can be numbed or obscured by sexual preoccupation which re-engages the ad- diction cycle. Sexual addicts are hostages of their own preoccupation. Every passerby, every relationship, and every introduction to someone passes through the sexually obsessive filter. More than merely noticing sexually attractive people, there is a quality of desperation which interferes with work, relaxation, and even sleep. People become objects to be scrutinized. A walk through 9

M M M +.. M ~ M .r. M ..r r. .. Out of the Shadows: Understanding Sexual Addiction I I a crowded downtown area is translated into a veritable shopping list of "possibilities." To understand the trance-like state of preoccupation imagine the intense passion of courtship. We laugh at two lovers who are so absorbed in one another that they forget about their surroundings. The intoxication of young love is what the addict attempts to capture. It is the pursuit, the hunt, the search, the suspense heightened by the unusual, the stolen, the forbidden, the illicit which are intoxicating to the sexual addict. The new conquest of the hustler, the score of the exposer, voyeur, or rapist, or the temptation of breaking the taboo of sex with one's child-in essence, they are variations of a theme: courtship gone awry. The addict uses-or abuses, rather-one of the most exciting moments in human experience: sex. Sexual arousal becomes intensified. The addict's mood is altered as he or she enters the obsessive trance. The metabolic responses are like a rush through the body as adrenaline speeds up the body's functioning. The heart pounds as the addict focuses on his search object. Risk, danger, and even violence are the ultimate escalators. One can always increase the dosage of intoxication. Preoccupa- tion effectively buries the personal pain of remorse or regret. The addict does not always have to act. Often just thinking about it brings relief. The sexual addict's excitement-seeking parallels some other types of compulsive/obsessive addicts. In that sense, there is little difference between the voyeur waiting for hours by a window for ninety seconds of nudity and the compulsive gam- bler hunching on a long shot. What makes the sexual addict different is that he draws upon the human emotions generated by courtship and passion. The trance is enhanced by the sexual addict's ritualization. Professionals have often wondered why sex offenders use the same "MO" (modus operandi or method) each time, when it .. M +.. ... .a ~~ The Addiction Cycle only makes apprehension easier. The answer is simple. A ritual helps the trance. Like a yogi in meditation, the addict does not have to stop and think or disrupt his focus. The ritual itself, like preoccupation, can start the rush of excitement. Addicts often talk about their rituals. The compulsive mastur- bator and his surroundings, the incestuous father and his elabo- rate preparations, the exposer's regular routes, the hustler's approach and cruising area-all involve complex rituals. The rituals contain a set of well-rehearsed cues which trigger arousal. The preoccupation trance supported by extensive rituals is as important as-or sometimes more important than-sexual contact or orgasm. The intoxication of the whole experience is what the addict seeks in order to move through the cycle from despair to exhilaration. One cannot be orgasmic all the time. So the search and the suspense absorb the addict's concentration and energy. Cruising, watching, waiting, preparing are part of the mood alteration. The first two phases of the addictive cycle (preoccupation and ritualization) are not always visible. The addict struggles to present an image of normalcy to the outside world. The public self is a false ego, since the addict knows the incongruity of his double life. Compulsive sexual behavior, the third phase of the cycle, however, leaves a trail, despite the protective public image. In the story of Del, described earlier in this chapter, Del repeatedly made commitments to himself and to God that he would stop. These resolves were short-lived. Del could not control his behavior even though he wanted to. Like Del, addicts are powerless over their behavior. They have lost control over their sexual expression-which is exactly why they are defined as addicts. The failure of their efforts to control their behavior is a sign of their addiction. Sexual addicts often describe the process of picking a day-a child's birthday, a change of jobs, a holiday-as "the last day." Usually, this marks a time when 10 IEMMQZ Il

~ ... .~ .. ~.. .. .. r .r~ .. .. i.. r.. .. ... .. .. ~r ~ 0 Out of the Shadows: Understanding Sexual Addiction "it" will never happen again. Sometimes addicts will set goals- a year, a month, or a week. Whether forever or a shorter time, the addicts betray themselves, buying into the delusion that they are in control of their behavior. When they fail, yet another indictment of self-control and morality is added to ever-increas- ing shame. For the recovering addicts who have acknowledged powerlessness, there is hope. They know that they might get through one day free from their addiction-with a lot of help. The despair which the addict experiences after being compul- sively sexual is the "low" phase of the four-step cycle. The let-down combines the sense of failure at not having lived up to resolutions to stop with hopelessness about ever being able to stop. If the behavior was particularly degrading, humiliating, or risky, the addict's self-pity grows. If the behavior violated basic personal values or exploited them, the addict experiences self-hatred as well. Addicts often report suicidal feelings along with their despair and shame. Standing in the wings, however, is the ever-ready preoccupa- tion which can pull the addict out of the doldrums. The cycle then becomes self-perpetuating. Each repetition builds upon the previous experiences and solidifies the reiterative pattern of the addiction. As the cycle fastens its grip on the addict, the addict's life starts to disintegrate and become unmanageable. Unmanageability The addict is caught up in the task of keeping his secret life from affecting his "public" life. Even so, the consequences come: arrests, unmasked lies, disruption, unmet commitments, attempts to explain the unexplainable. The addiction surfaces in the addict's inability to manage his or her life. For a moment, the addict recognizes he or she cannot continue. But the impaired mental process blurs reality with euphoric recall of sexual suc- cesses. The addict faces yet again the ultimate seduction: a unique opportunity which, of course, will be "the last time." '? ZET66EHOZ The Addiction Cycle This unending struggle to manage two lives "normal" and addictive-continues. The unmanageability takes its toll. Fam- ily and friendships are abbreviated and sacrificed. Hobbies are neglected. Finances are affected. Physical needs of other kinds are unattended. The addict's lifestyle becomes a consistent vio- lation of his or her own values, compounding the shame. The impaired mental processes result in faulty problem-solving in all areas of the addict's life. These decisions add to further unmanageability. Nowhere is this more clear than in the workplace. Faulty problem-solving and diversion of energy require extra time and effort to hold down the job. Extra long hours at work further the unmanageability at home. Worse, if the addiction is con- nected with the work environment, the addict's position is even more precarious. Addicts often point to the connection between their addiction and the stress of high performance demands where there is important personal investment. Graduate school, for example, is often when addicts first encounter compulsiveness. The stress of proving one's self in an arena where every inadequacy is evaluated is a potent flashpoint for the ignition of sexual addic- tion. So are new jobs, promotions, and solo business ventures. Unstructured time, a heavy responsibility for self-direction, and high demands for excellence seem to be the common elements in these situations which are easy triggers for addictive be- haviors. Procrastination becomes a daily nemesis for these ad- dicts. For once ignited, the addiction makes work easy to put off. One of the worst consequences of the addiction is the addicts' isolation. The intensity of the double life relates directly to the distance of the addicts from their friends and family. That is, the more intensely involved in compulsive sexual life the addicts become, the more alienated they become from their parents, spouses, and children. Without those human connections, the addicts paradoxically lose touch with their own selves. The 13

, i = M = i i M M M M e = M = M Our of the Shadows: Understanding Sexual Addiction unmanageability from the addiction has run its course when there is no longer a double life. When there are no longer friends or family to protect or job to hold or pretenses to be made-even though some things are valued enough to want to stop-the addiction is at its most destructive and violent point. The addict's world has become totally insulated from real life. The Addictive System As addicts move from healthy relationships to sexual compul- sion, their internal processes combine to form an addictive system. The addictive system-as with all systems--contains subsystems which support one another. Often this support oc- curs in repetitive, predictable cycles. To picture the addictive system with its subsystems consider the human body. It is a complex system with many subsys- tems-the nervous system, digestive system, etc. Clearly, when one subsystem, such as the nervous system, is upset, all the other bodily systems are affected and must adjust in some way. The addictive system starts with a belief system containing faulty assumptions, myths, and values which support impaired thinking. The resulting delusional thought processes insulate the addiction cycle from reality. The four-phase addiction cycle (preoccupation, ritualization, sexual compulsiveness, and de- spair) can repeat itself unhindered and take over the addict's life. All the other support systems including relationships, work, finances, and health become unmanageable. The negative con- sequences from the unmanageability confirm the faulty beliefs which hold that the addict is a bad person who in unlovable. In turn, revalidated beliefs allow further distortion of reality. Diagrammed, the addictive systems looks like this: 14 CE166E9P0Z The Addiction Cycle Unmanageability Impaired Thinking Addiction Cycle T Preoccupation Despair ftitualization %~ Sexual Compulsivity THE ADDICTIVE SYSTEM Belief System /00* C 15

i , I I M ~M M MM am M ~M'bm ~ M Out of the Shadows: Understanding Sexual Addiction Within the addictive system, sexual experience becomes the reason for being-the primary relationship for the addict. For the addict, the sexual experience is the source of nurturing, focus of energy, and origin of excitement. It is the remedy for i pain and anxiety, the reward for success, and the means for maintaining emotional balance. Outsiders, especially those who ( care about the addict, witness the unmanageability and maybe even the behavior. They see the addict's personal loss, the self-degradation, and the abandoned hope and values. It would seem so simple to just stop-even for a while. For the exhibitionist, for example, who may spend up to seven hours a day cruising and another four thinking about it, the task is not so easy. The addiction is truly an altered state of conscious- ness in which "normal" sexual behavior pales by comparison in terms of excitement and relief from troubles. In the addict's world, there is an on-going tension between a person's normal self and the addicted self. A Jekyll/Hyde struggle emerges. The addictive system is so compelling that to stop would be like death. Yet, as the system continues, the person's values, priorities, and loved ones are attacked. Some- times, only a major crisis can restore perspective. Such was the case of Carrie. Carrie was a music teacher. She was known for boundless energy and creativity in music. She served four elementary schools, carrying heavy equipment from school to school in her old red Volkswagen bus. The kids loved her and she loved them. Colleagues admired her skills. Parents were grateful and attended her concerts in masses. Carrie had another life as well. Her singing was true and compelling. She received regular engagements at local night spots. She dreamed of being a star. Her singing career, however, never got beyond the local piano bar circuit. No matter how hard she tried, her professional singing career was stymied. As she approached the age of thirty, her disappointment grew into 16 VET66EM9 The Addiction Cycle panic that her dream might not happen. Carrie's sexual addiction started to flourish at the point when she began panicking about her career. In the beginning there were occasional one night stands with hotel customers in bars in which she sang. Then it became every night she worked. The ritual started with her looking over the patrons, selecting the most interesting. Animated conversations during the breaks followed. After finishing, she would go to his room and have sex. Leaving at three or four in the morning, she would return home for a few hours of sleep before school started. She did not like what she was doing. In the morning, looking at the trusting faces of the children, she would feel the profound incongruity of where she had been but a few hours before. Also, her teaching was slipping as the addiction progressed, though no one really noticed but her. The children were still excited and everyone she worked with was convinced she was great. Still, she knew. She even discovered that being at four different schools made it easier for her to cover when she overslept. She had simply "stopped at one of the other schools." Carrie also had ceased dating and started singing on week- ends. Since she lived alone, her only human contacts were the children and her piano bar customers. What she really wanted was a husband and a family. As her addiction progressed, she began to believe no man would want to be with her if he knew about her life. The consequence which brought Carrie help was an unex- pected heart attack at the age of thirty-three. The short nights had taken their toll. Finally, sitting in a hospital bed, Carrie told her story to a woman chaplain. Amidst deep sobs, she talked of her loneliness and her love of the children. Through her conversations with the chaplain, Carrie acknowledged that the number of men she had slept with in the three-year period was in the hundreds. It was a miracle she had not contracted venereal disease or been injured. The damage to her self-image 17