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Sex
Addic)on
Treatment
&
Assessment
Elana
Clark‐Fowler,
LCSW,
CSAT‐S
www.recoveryhelpnow.com
What
is
Sex
Addic)on?
• 
Sexual
behavior
clearly
works
as
a
mood
enhancer
and
mood
alterator.
• 
Closely
resembles
the
paEerns
of
alcoholics
and
drug‐addicted
clients.
• 
PaEerns
are:
1)
a
loss
of
control;
2)
a
con)nua)on
of
the
behavior
despite
adverse
consequences
such
as
arrests,
broken
marriages,
&
financial
problems;
3)an
obsession
or
preoccupa)on
with
obtaining,
using,
or
recovering
from
the
behaviors
(Carnes
&
Schneider,
2000).
10
Criteria
 Loss
of
Control
:
Clear
behavior
in
which
you
do
more
than
you
intend
or
want.
 Compulsive
Behavior:
A
paEern
of
out
of
control
behavior
over
)me.
 Efforts
to
Stop:
Repeated
specific
aEempts
to
stop
the
behavior
which
fail.
 Loss
of
Time:
Significant
amounts
of
)me
lost
doing
and/or
recovering
from
the
behavior.
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Cont.
Criteria
 Preoccupa)on:
Obsessing
about
or
because
of
the
behavior.
 Inability
to
Fulfill
Obliga)ons:
The
behavior
interferes
with
work,
school,
family
and
friends.
 Con)nua)on
Despite
Consequences:
Failure
to
stop
the
behavior
even
though
you
have
problems
because
of
it
(social,
legal,
financial,
physical
&
etc.)
Cont.
Criteria
 Escala)on:
Need
to
make
behavior
more
intense,
more
frequent,
or
more
risky.
 Losses:
Losing,
limi)ng,
or
sacrificing
valued
parts
of
life
such
as
hobbies,
family,
rela)onships
and
work.
 Withdrawal:
Stopping
behavior
causes
considerable
distress,
anxiety,
restlessness,
irritability,
or
physical
discomfort.
Examples
of
Sex
Addic)on
 
 
 
Excessive
viewing
of
porn
and
internet
sex
sites
(webcam,
virtual
worlds,
chat
rooms,
and
etc.)
Chronic
masturba)on
(can
include
self
injury)
Bathhouses,
pros)tu)on,
massage
parlors,
sex
clubs,
sex
in
public,
anonymous,
and
causal
sex
 
Excessive
objec)fica)on
and
fantasy
 
Having
sex
outside
commiEed
rela)onships
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Signs
of
Sex
Addic)on
Lying
Spending
excessive
amounts
of
money
and
)me
 Cruising
for
hours
 Injuring
or
pu]ng
one
self
at
risk
 Aliena)ng
and
isola)ng
 Rituals
and
rou)nes
 Unable
to
complete
tasks
or
preoccupied
 Shame
&
guilt
a_er
par)cipa)ng
in
act
 
 
Levels
of
Sex
Addic)on
(1983,
Carnes)
 
 
 
Level
1:
Society
has
a
higher
tolerance,
culturally
accepted
or
is
a
public
nuisance
(masturba)on,
porn,
strip
clubs,
pros)tu)on,
and
anonymous
sex).
Level
2:
Behaviors
are
intrusive
to
others
and
have
s)ff
legal
sanc)ons
(exhibi)onism,
voyeurism,
and
indecent
calls)
Level
3:
More
significant
boundary
viola)ons/
sexual
abuse
(molesta)on,
incest,
and
rape).
10
Types
of
Sexual
Behavior
Emerged
from
a
Sex
Addic)on
Survey
by
Carnes
 Fantasy
Sex
 Seduc)ve
Role
Sex
 Voyeuris)c
Sex
 Exhibi)onis)c
Sex
 Paying
for
Sex
 Trading
Sex
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10
Types
Con)nue
 Intrusive
Sex
 Anonymous
Sex
 Pain
Exchange
 Exploi)ve
Sex
Origins
of
10
Types
 A
total
of
10
“types”
of
sexually
compulsive
behavior
emerged
in
the
sex
addicts
surveyed
by
Patrick
Carnes,
Ph.D.
Addic)on
Cycle
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1/26/11
Sex
Addic)on
Assessment
Tools
 
 
A Useful Tool for Self-Assessment: http://saa-recovery.org/
IsSAAForYou/SelfAssessment/
The Sexual Addiction Screening Test (SAST), HBI: Hypersexual
Behavior Inventory, Internet Sex Screening Test, & Women’s
Sexual Addiction Screening Test (WSAST):
http://www.thecenterforhealthysex.com/tests/
Sexual Dependency Inventory (SDI)
 Sexual Addiction Screening Test – Revised (SAST-R) available on
www.SexHelp.com.
 
What
is
Love
Addic)on?
Overwhelming
desire
for
another
person,
to
the
detriment
of
other
aspects
of
one’s
life
(work,
money,
family
&
etc)
 Excessively
cap)vated
with
feelings
of
romance,
intensity
and
sexual
desire
 AEach
their
reality
to
lover’s
iden)ty
and
base
their
self‐worth
by
lover’s
reac)ons
 Difficulty
iden)fying
individuality
and
act
without
boundaries
(extreme
neediness
or
needless/wantless
behaviors)
 
Examples
of
Love
Addic)on
Affairs
Destruc)ve
or
numerous
failed
rela)onships
 Having
excessive
brief
rela)onships
that
end
a_er
the
“honeymoon
stage”
has
worn
off
 Stalking
 Obsession
 Fantasy
 Intoxica)ng
rela)onships
 
 
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Signs
of
Love
Addic)on
Excessive
fantasy
and
roman)c
intensity
to
distract
from
emo)ons
and
daily
ac)vi)es
 Consumed
with
thoughts
and
ac)ons
related
to
partner
 Difficulty
being
alone
 Using
sex,
seduc)on,
and
manipula)on
to
hold
onto
partner
 Lying
or
chea)ng
 Sexualizing
conversa)ons
and
flir)ng
 Excessive
)me
spent
on
the
internet
or
emailing
qualifier
 Defining
sexual
experiences
and
roman)c
intensity
as
love
 
Assessment
Tools
for
Love
Addic)on
 
 
Love Addiction Self-Test:
www.centerforhealthysex.com/tests/
http://www.slaafws.org/node/10
Sexual
Anorexia
(Sexual
Aversion
Disorder)
An
aversion
and
disgust
of
being
sexual
with
another
person
or
a
loss
of
“appe)te”
for
sexual
interac)on
 Extreme
discomfort
when
talking
about
sex
or
being
touched
 Finds
themselves
having
difficulty
focusing
during
sex
o_en
distracted
by
thoughts
and
emo)ons
 Difficulty
trus)ng
or
having
others
close
 Preoccupa)on
of
others
being
sexual
 Lacks
pleasure
and
may
have
problems
with
performance
 
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Assessment
 
The
four
W’s
(Where,
When,
What,
&
Who)
&
How
 
What
is
the
client’s
boEom
line
behavior?
 
What
images
are
exci)ng?
Who
is
the
qualifier?
What
is
the
arousal
template?
 
Where
does
he
act
out?
 
Triggers?
Determine
“slippery”
behavior
 
How
severe?
Has
there
been
injuries
or
high
risk
behavior?
 
Obtaining
a
sex
history
 
Assign
the
Sexual
Dependency
Inventory
(SDI)
 
Determine
proper
level
of
treatment
(i.e.,
inpa)ent,
outpa)ent,
increased
sessions
or
addi)onal
referrals)
Interven)ons
Assigning
reading
and
use
of
educa)onal
material
for
both
the
individual
and
partner
 Cogni)ve‐Behavioral
Treatment
 Mo)va)onal
Interviewing
 Partner/Family
Support
 Group
Treatment
 12‐step
mee)ngs
 Later,
trauma
treatment
techniques
(EMDR,
Soma)c
Experiencing,
and
Post‐Induc)on
Treatment)
 
Things
to
Remember
Accountability
Support
 Boundaries
 Confidence
 Educa)on
 Curiosity
 Assessment
 Structure/Plan
 Level
of
Care
 Keep
in
mind
culture,
sexual
orienta)on,
gender,
ethnicity,
age,
and
history
 
 
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Suggested
Reading
List
•  Carnes, Patrick & Moriarity, Joseph Sexual Anorexia:
Overcoming Sexual Self-Hatred. HCI Publishing, 199
•  Carnes, Patrick & Adams, Kenneth Clinical Management of
Sex Addiction. New York, NY: Brunner-Routledge, 2002. •  Carnes, Patrick Don’t Call It Love: Recovery from Sexual
Addiction. New York, NY: Bantam Books, 1991.
•  Carnes, Patrick Out of the Shadows: Understanding Sexual
Addiction, 3rd Edition. Center City, MN: Hazelden, 1994.
•  Kasl, Charlotte D. Women, Sex, and Addiction: The Search
for Love and Power. San Francisco, CA: Harper San
Francisco, 1990.
•  Mellody, Pia Facing Love Addiction: Giving Yourself the
Power to Change the Way You Love. New York, NY: Harper
Collins, NY, 1992.
Suggested
Reading
List
•  Mellody, Pia The Intimacy Factor: The Ground Rules for
Overcoming the Obstacles to Truth, Respect, and Lasting
Love. San Francisco, CA: Harper San Francisco, 2004. •  Schaeffer, Brenda. Is It Love or Is It Addiction? San Francisco,
CA: Harper San Francisco, 1987.
•  Weinhold, Barry. Breaking Free of Addictive Family
Relationships. Dallas, TX: Stillpoint, 1991.
•  Weiss, Robert & Schneider, Jennifer. Untangling the Web: Sex,
Porn, & Fantasy Obsession in the Internet Age. Alyson
Publications, 2005.
•  Weiss, Robert. Cruise Control: Understanding Sex Addiction
in Gay Men. Alyson Publications, 2005. Websites
Survivors of Incest Anonymous
www.siawso.org
•  Love Addicts Anonymous (LAA)
  www.loveaddicts.org
•  Sexaholics Anonymous (SA)
  www.sa.org
•  Sex Addicts Anonymous (SAA)
  www.sexaa.org
•  Sexual Compulsives Anonymous (SCA)
  www.sca-recovery.org
 
 
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Websites
Sex and Love Addicts Anonymous (SLAA)
www.slaafws.org
•  Sexual Recovery Anonymous (SRA)
  www.sca-recovery.org
•  S-Anon
  www.s-anon.org
•  COSA
  www.cosa-recovery.org
•  Recovery Couples Anonymous
  www.recovery-couples.org
•  Incest Survivors Anonymous
  www.lafn.org/medical/isa
 
 
Treatment
Centers
Sexual Recovery Institute
www.sexualrecovery.com
The Meadows
  www.themeadows.org
  Del Amo Hospital
  www.delamohospital.com
  Life Healing Center
  www.life-healing.com
  Sierra Tucson Treatment Center
  www.sierratucson.com
  Center for Healthy Sex
  www.centerforhealthysex.com
  ElanaClark-Faler, LCSW, CSAT-S
  www.recoveryhelpnow.com
 
 
 
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