Chapter-9

Sexual addiction is often not a stand-alone issue. In fact, a significant percentage of sex addicts also deal with cross and/or co-occurring addictions.1 Individuals who are cross-addicted switch from one addiction to another, whereas people with co-occurring addictions deal with multiple addictions simultaneously. Typically, cross and co-addicted people move seamlessly from one substance to another, from one behavior to another, and even from substances to behaviors and behaviors to substances.

Examples of cross-addiction include the following:

Dan, a married father of two, alternates between periods of sexting and having webcam sex with women he’s met on one or more hookup apps and binge drinking. He acts out sexually until he feels so ashamed that he decides to stop, and then he starts drinking. He continues with the drinking until he feels so ashamed that he decides to stop, and then he starts to act out sexually. He continually switches from one addiction to the other.

After leaving treatment for sex and love addiction, Alice, who had never struggled with her weight while active in her sex and love addiction, gained 40 pounds in less than a year, replacing her intensely focused sexual and romantic acting out with another addiction: binge eating.

Examples of co-occurring addictions include the following:

Jane began drinking in her early teens, after she was sexually abused by a family member. Shortly thereafter, she began dating. On dates, she struggled with her adolescent desire to explore her sexuality, so she drank to numb those feelings. Over time, drinking and sexual activity became one and the same. When she drank, she wanted sex. When she didn’t drink, she avoided sex altogether. Now in her late thirties, she can’t stop drinking, nor can she stop being sexual.

Evan, a young gay man, loves the feeling of sex when he’s high on crystal meth. Every night after work, he activates his Grindr profile and does a few “bumps.” After a hit or two of meth, all he cares about is sex—and the more the merrier. Sometimes he hooks up with five or six guys in a single night. Most of the time he takes Viagra with the meth because he can’t maintain an erection without assistance. Then, when the evening finally winds down, he drinks an entire bottle of cough syrup to put himself to sleep.

As mentioned above, cross and co-occurring addictions are relatively common with sex addicts. One survey of 1,603 self-identified sex addicts found that 69 percent of heterosexual men, 79 percent of heterosexual women, and 80 percent of homosexual men admitted to a cross or co-occurring addiction, or some other similarly problematic behavior.2 Another survey of self-identified sex addicts found that 58 percent reported either current or past issues with drug addiction, and 31 percent reported either current or past issues with alcoholism. Compulsive gambling (29 percent), compulsive video gaming (37 percent), eating disorders (47 percent), and compulsive spending (49 percent) were also common.3

Below are some of the many ways that addicts can shift their obsession from one substance or experience to another:4

1) Alternating Cycles: switching back and forth from one addiction to another, often for years on end (i.e., flipping between binge-drinking and sexual acting out)

2) Combining: when various addictive substances/behaviors are combined to create the perfect high (i.e., mixing meth with porn and then cybersex)

3) Cross-Tolerance: using one addiction as a way to tolerate another (i.e., getting drunk to self-soothe shame about sexual behaviors)

4) Disinhibiting: using one addiction to reduce inhibitions related to a second addiction (i.e., getting high before having sex with a stranger)

5) Fusing: using one addiction to amplify another (i.e., using cocaine to heighten the pleasure of orgasm)

6) Inhibiting: viewing one addiction as the lesser of two evils (i.e., smoking cigarettes instead of looking at porn all night)

7) Masking: using one addiction to hide another (i.e., going to AA for alcoholism but never looking at compulsive sexual activity)

8) Numbing: using one addiction to numb the shame of another (i.e., getting drunk after cheating on your spouse)

9) Replacement: replacing one addiction with another (i.e., cutting down on the use of hookup apps by gambling for hours on end)

10) Rituals: incorporating one addiction into the ritual phase of another (i.e., buying meth before beginning the search for a prostitute)

11) Withdrawal Mediation: using one addiction to stop another (i.e., shopping compulsively as a way to stay out of sex clubs)

Stimulants and Sex Addiction

With sex addicts, stimulant drugs like cocaine and methamphetamine (aka, “meth” or “crystal meth”) are often the co-occurring drug of choice. Alcohol, GHB, MDMA, and various other “party drugs” are also used in conjunction with sexual addiction, but cocaine and meth are most prevalent. This is because cocaine and meth allow users to be sexual for several hours (or even days) at a time, especially when erection enhancers like Viagra, Levitra, and/or Cialis are along for the ride. On hookup websites and apps, cocaine and meth are often used as an inducement for sex, with profiles saying things like, “Come over and party with me and my BFF Crystal.” A more simple tactic is simply stating that one is looking to PNP, with “PNP” standing for “party and play.” It is well understood in the digital hookup community that the “party” portion of the adventure will involve a stimulant like cocaine or meth, perhaps commingled with porn, multiple sex partners, and days-on-end sexual encounters.

Unfortunately, stimulant drugs are highly disinhibiting, which means the user’s beliefs about the need for safer sex will often disappear when high, greatly increasing the risk for HIV and other STDs, unwanted pregnancies, etc. Furthermore, stimulant abuse is highly destructive in its own right, both physically and mentally. Exacerbating matters is the fact that many men and women with a co-occurring sex and stimulant addiction also abuse alcohol, benzodiazepines (Valium, Ativan, Xanax, etc.), and/or over-the-counter cold medicines as a way to “come down” and get some sleep when the party is finally over.

When stimulant drug abuse is consistently fused with the hunt for and experience of intensely arousing sex, these paired behavioral patterns can become mutually reinforcing. Over time, even simple sexual fantasies and/or memories of past sexual acts can become a psychological trigger to abuse drugs, and vice versa. Eventually, without help, stimulant drug use and sexual activity can become so tightly paired that engaging in one behavior inevitably leads to the other. For this type of dually addicted individual, getting high and seeking/finding/having sex becomes a single coexisting and complementary addiction.

A study focusing on gay men who struggle with meth abuse strongly supports the idea that stimulant abuse and sexual activity can become so intertwined that drugs and sex are no longer separate addictions.5 In fact, the study found that for some gay men the leading reason for meth use was “sexual enhancement,” with test subjects stating that meth use both lowered their sexual inhibitions and prolonged the duration of their sexual acting out. Other research has provided similar findings, with one study of heterosexual male and female meth users finding that males typically cited a “desire to boost sexual pleasure” as a primary reason for using.6 Yet another study found that meth use increases the likelihood of numerous high-risk sexual behaviors, and that binge drug use in particular is strongly associated with binge sexual activity, an increased number of sexual partners, and unprotected sex.7

Among clinicians who routinely treat sex addicts (and also stimulant drug abusers), the studies cited above are probably not surprising. The most important thing to note here is that when drug and sex addictions intertwine and fuse in this way, treatment and recovery become much more difficult. In short, the dual addiction to stimulants and sex is double trouble in terms of both potential consequences and risk for relapse. Usually, these dual addicts must be treated for both of their addictions simultaneously. Otherwise, they are unlikely to heal from either.

Co-Occurring Addictions:
Where to Start?

If you struggle with both substance and behavioral addictions—for example alcohol and sex or drugs and spending, etc.—there is a general treatment rule of thumb, which applies here. Unless there is a profound safety or relationship component that applies to your sexual behavior (i.e., a spouse about to leave you, you are having unsafe sex, you are going to get arrested where you go see prostitutes, etc.), then get sober FIRST from drugs and alcohol. As mentioned previously in this book, alcohol and other substances are by nature disinhibiting, meaning that there are things you would not do or say sober that you may well do or say when loaded. This may be true of your problem sexual and romantic patterns. It may well be that when you stop using, the problem sex stops, too. If that is the case you likely do not have concurrent addictions (substances and sex), but rather your drinking and using leads you to sexual behavior you don’t feel good about or want to do sober. Better to take care of your using first and then see what sexual issues remain.

Many addicts who are truly dually addicted (substances and behaviors) will not able to address a behavioral issue (sex, gaming, gambling, etc.) while still getting high. And the reality is that it is very hard to stay focused on sexual and romantic behaviors when trudging through the challenges of early drug and alcohol sobriety. For this person, it may also be best to first get sober on drugs/alcohol and then start reigning in and working on sex/relationship issues.

Some addicts don’t have the luxury of choosing which addiction to work on first (substances or behaviors), due to the immediacy of their life situation and/or addiction-related consequences. For such people (double-dippers as they are known in the recovery community), there is a need to get sober simultaneously from both substances and behaviors. In these cases, it takes a tremendous amount of work and support—daily meetings, multiple support groups, therapies and even sponsors, etc.—to get there. Trying to get sober on more than one addiction at a time is a big task. Therefore, it is not unusual for such people to enter residential treatment in order to have a safe place to deal with both issues simultaneously, or at least get sober on substances first, with life’s stressors left behind while doing so. If you are among these folks, and you go away to get help, you will find yourself welcomes and well-supported in treatment, a process can often provide life-changing experiences over as few as twenty-eight to thirty-five days. Getting sober while in working in a holistic rehab/trauma program can be much like a year of therapy in a month as well-designed and well-run treatment centers can and do change lives for the good, every day.

Why Do So Many (Sex) Addicts Have Cross
and/or Co-Occurring Addictions?

Sex addicts aren’t the only addicts prone to cross and co-occurring addictions. The simple fact is that whatever the addiction—sex, drugs, alcohol, gambling, eating, or anything else—the motivation is the same. The addict wants to feel better, which actually means the addict wants to feel less (i.e., to control what he or she is feeling). As discussed throughout this book, addictive substances and behaviors all happily oblige by altering brain chemistry in ways that temporarily distract the individual from stress, emotional discomfort, and the pain of underlying psychological conditions like depression, anxiety, attachment deficit disorders, unresolved early-life or severe adult trauma, etc.

Certainly some addicts are purists, sticking with their drug or behavior of choice no matter what. For others, however, their primary addiction is just one part of a larger pattern. These individuals are sometimes referred to as “garbage can users,” ingesting whatever addictive substance or engaging in whatever addictive behavior is available, as long as it creates the escapist neurochemical rush they seek.

Ultimately, whatever the addiction, the result is always the same:

√ A compelling craving for the substance/behavior

√ A negative impact on health, self-esteem, family, relationships, finances, career, etc.

√ An inability to stop using the substance/behavior despite adverse consequences

Sadly, as mentioned above, for some sex addicts co-occurring addictions can become inextricably linked. This means that if the addict is engaging in one activity, he or she is almost certainly engaging in the other. In such cases, the addict must address both of his or her addictions simultaneously. Otherwise, he or she may not recover from either.