With the recent media surges surrounding certain celebrities' personal lives, such as Tiger Woods, Jesse James and Charlie Sheen, and their short time in “rehab” one may beg to ask the question if sexual addiction actually exists and if it does, do these rich and powerful people suffer from this affliction or is this a way for them to make an excuse for their promiscuous behavior? This paper will not answer questions regarding if certain celebrities are telling the truth regarding having this sexual addiction. That truth is between that person only. The purpose of this paper is to hopefully answer questions regarding the how sexual addiction works, the possible causes of sexual addiction, the possible treatment for sexual addiction and the validity/controversy of sexual addiction. Hopefully, with this information being presented, this will lead to an understanding of this affliction. Just like everything else, more needs to be known about sexual addiction. More data needs to be gathered and compiled about this issue. This paper will shed some light on this topic, but if anything, this paper will also bring forth a true need for more knowledge of this topic so that more people can be helped.
How does sexual addiction work? To answer this question the model of addiction must be fully understood first. There are three known stages of addiction. These known stages are as follows: 1. drug intoxication, 2. drug craving, and 3. compulsive drug administration. If and when someone who is addicted tries to stop there is a fourth stage called withdrawal. The first stage of addiction is a short and quick stage. It is characterized by an overwhelming need to obtain the drug of choice. This stage is associated with higher levels of dopamine concentrations in the limbic brain regions, especially the nucleus accumbens, along with frontal brain regions (Goldstein and Volkow 2002). This stage also starts to change cell signaling in the brain from dopamine to glutamate. This “prototype” is witnessed especially in regard to the D1 dopamine receptor. At this point in early dependence this receptor stimulation causes the activation of cAMP-dependent protein kinase (PKA). The activation of PKA in turn activates cAMP which will also activate a response element binding protein named CREB and the introduction of early gene products like cFos. The introduction of cFos and other early gene products can last for several hours to a few days. During this time small neuroplastic changes occur in response to initial drug administration. These events do not spell disaster for the drug user for at this point since these changes as so minuscule that they do not mediate the enduring behavioral consequences of addiction (Kalivas and Volkow 2005).
The second stage known as drug craving or the transition into addiction period is readily witnessed with full changes in cell activity. This is especially documented with D1 protein receptors such as ∆FosB. ∆FosB is a transcriptional regulator that modulates the making of specific AMPA glutamate receptors. (Kalivas and Volkow 2005). As stated before, the turn from dopamine to glutamate will lead to addiction in the subject.
At this point in the addiction, a pathological motivation comes about via a Pavlovian conditioned motivated process (Robinson and Berridge 2008). This learned response links the drug and its environment with a pleasurable experience. This learned experience usually is solidified with the amygdala, hippocampus and activation of the thalamo-orbitofrontal and anterior cingulate circuit (Goldstien and Volkow 2002). At this point dopamine does still play a role in the addiction. Repeated drug use sensitizes only the neural systems that determine motivation, not the neural systems that regulate the pleasurable effects of said drug (Robinson and Berridge 2008). To be said a different way, a pleasure reward circuit both alerts the subject when a salient stimulus appears and recalls learned associations when a no longer novel but still motivationally relevant stimulus comes back (Bostwick and Bucci 2008).
The third stage is known as compulsive drug administration or the end stage of addiction. This point is categorized by loss of control. It is associated with further changes in dopaminergic, serotonergic and glutamatergic circuits (Goldstien and Volkow 2002).
The last and final stage of addiction ends with withdrawal. Withdrawal results in a disruption of the behavioral circuits. This will result in dysphoria, anhedonia, and irritability (Goldstien and Volkow 2002).
Now that the basic idea of addictions has been explained further detail of how this addiction works can be explored. To get the dopamine “fix” sex addicts report about their sex outlet. Some of these outlets are usually seen with self gratification: masturbating 5-15 times a day, masturbating until self injury, exhaustion and/or social pressure. Some other key identifiers of the typical sex addict are as follows: Constant searching/fixation on the “perfect partner”, loneliness after orgasm, obsessive drive for sexual stimulation, hiding and/or hording or erotic materials, spending of excessive amounts of funds on erotic materials, highly skilled romance artists, demanding sexual expression through manipulation, coercion and/or violence, and the absence of sexual expression results in anxiety, depression and/or anger (Mick and Hollander 2006). Once these characteristics are applied to the model of addiction, one begins to see the idea of a sex addict.
While there is no direct single cause for the sexual addiction, one can theorize that many different factors come into play to describe how this addiction originates in a specific individual. If anything this addiction may take root as early as pre-teen years (Bostwick and Bucci 2008). It is also important to note that this addiction does seem to have a age barrier. This type of addiction is typically seen as an adult addiction due to age restrictions on erotic material and the traditional age for legal sexual relations. The Internet plays a crucial role in the addiction forming and staying present. The Internet is so successful in helping fuel the fire for the addiction all because of the coined term “Triple A engine”. The basis of this term are access, affordability, and anonymity (Meerkerk et al 2006). This “Triple A engine” is essential for this addiction because it makes it easy for the abuser to hide said addiction. Another possible, slight/rare, cause for this addiction can be a result of a brain disorder known as Kluver-Bucy Syndrome. Although this is rare disorder in humans, the research states that to damage to the amygdala, and frontal lobes can result in a hypersexuality (Mick and Hollander 2006). Androgens and serotonin modifying drugs are also seen to play a role in human sexual behaviors. (Mick and Hollander 2006). Thus, toying with both of these can cause a spike in sexual activity.
As presented above, just about anything can cause a sexual addiction. Just note that, with present knowledge on the addiction, there is no known set cause/causes. What this addiction all boils down to is what unconditioned stimulus will eventually turn into a learned/conditioned stimulus. Once this connection is learned, just about any of these causes will fulfill the addict's requirements to not feel the affects of a withdrawal. Since withdrawals are very unpleasant to a sex addict, just like any other addict, will go about large lengths to prevent such a thing from occurring.
There are two typical forms of treatment for sex addiction. The treatments come in the form of therapy and drug administration. There are two forms of traditional therapy that seem to present the most useful results. Couples therapy(if a significant other is involved) and group therapy seem to yield the best results when dealing with the small amount of research that can be gathered on this topic. Since so many different variables can be put into play when it comes to couples therapy, group therapy will be discussed in a greater detail. Typically, sex addicts have the following personality traits: loneliness, social anxiety, low self esteem and shyness (Orzack et al 2006); it can be determined that group therapy is the most beneficial for this type of addiction. A study that was completed by Orzack et al, showed the positive results of this type of group therapy. An approach which had self described addicts meet on a weekly basis allowed the members/patients of this study to identify the undesired sexual activities and thoughts and then modify maladaptive cognitions from the feedback that was provided by two different therapists and by the other members of the group (Orzack et al 2006). The only draw back to this procedure is the time that it makes for this therapy to take it's full effect. In the long run a therapy in this nature keeps the patients from relapsing back into addiction.
The other possible form of treatment could be the use of drugs. This approach should only be used when it is found to be the only way to extinguish the addiction. This approach
should be taken with caution also due to the fact that little clinical research has been done for compulsive sexual behavior (Grant et al 2005).
Problems also arise when certain drugs are used to treat this disorder. With the use of the drug naltrexone, for example, will completely erase all of a person's sexual drive. In the research that was conducted with naltrexone, it stated that yes, the addict was revealed of his addiction, but with the use of the drug it absolutely wiped out his sex drive still leaving his marriage in near ruins (Bostwick and Bucci 2008). The choice of medication depends if the sex addiction has qualities of a more readily researched addiction or if it fall under a obsessive-compulsive disorder. In the case of addiction, it should be treated with opiate antagonists; in the case of OCD, it should be treated with an SSRI (Mick and Hollander 2006).
The current edition of the DSM (DSM-IV-TR) does not include a section on sexual addiction. There is a good reason for this, this reason being the controversy surrounding calling this disorder an addiction. Darrel Regier, the vice-chair of the DSM-5 task force, said that “[A]lthough 'hypersexuality' is a proposed new addition...[sex addiction is] not at the point where we were ready to call it an addiction.” Many claim that one cannot call sex addiction an actual addiction because many of the symptoms are more on the lines with OCD based. Others propose that this unwanted behavior is usually part of a larger disorder. This OCD idea is countered with how the behavior comes about. To remind the readers, an addiction is characterized by failure to control a behavior and continuation of the behavior even though the behavior is known by the adult to be harmful to their health and wellbeing. An addiction, like this sexual behavior, is a learned behavior.
To conclude, it is still unknown wether to call this sexual behavior an addiction or a obsessive-compulsive disorder. More research needs to be done and documented to truly tell which is which. There are many proposed treatments theorized by many professionals. Some of the more popular treatments that are being used are group therapies and drug treatments. For the most part group therapies seem to be the most effective. Even though group therapies take longer to take effect than drug therapies, they yield better results in the long run. The causes of this disorder are many and it is not “set in stone” as to what officially causes it.
References
Bostwick, MD, J. M., and Jeffrey A. Bucci, MD. (2008). Internet Sex Addiction Treated with Naltrexone. Mayo Clin Proc, 83(2), 226-230. Retrieved from http://mayoclinicproceedings.com/ content/83/2/226.full
Goldstein, Ph.D., Rita Z., and Nora D. Volkow, M.D. (2002). Drug Addiction and Its Underlying Neurobiological Basis: Neuroimaging Evidence for the Involvement of the Frontal Cortex. Am J Psychiatry, 159, 1642-1652. Retrieved from http://ajp.psychiatryonline.org/cgi/content/ abstract/159/10/1642
Grant, J. E. (November 2005). Impulse Control Disorders in Adult Psychiatric Inpatients.Am J Psychiatry, 162(11), 2184-2188. Retrieved from Http://ajp.psychiatryonline.org/cgi/ content/abstract/162/11/2184
Hecht Orazck, Ph.D., Maressa, Andrew C. Voluse, B.S., David Wolf, PSY.D., and John Hennen, Ph.D. (2006). An Ongoing Study of Group Treatment for Men Involved in Problematic Internet-Enabled Sexual Behavior. CyberPsychology & Behavior 9(3), 348-360. Retrieved from http://www.liebertonline.com/doi/abs/10.1089/cpb.2006.9.348
Meerkerk,M.A., Gert-Jan, Regina J.J.M. Van Den Eijnden, Ph.D., and Henk F.L. Garretsen, Prof. Dr. (2006). Predicting Compulsive Internet Use: It's All about Sex! CyberPsychology & Behavior 9(1), 95-103. Retrieved from http://www.liebertonline.com/doi/pdf/10.1089/ cpb.2006.9.95
Mick, MD, T., and Hollander, MD., E. (2006). Impulsive-Complusive Sexual Behavior. CNS Spectr 11(12), 944-955. Retrieved from mbdownloads.com/1206cns_Mick.pdf
Kalivas Ph. D., P, Volkow M.D., N. (Aug. 2005). The Neural Basis of Addiction: A Pathology of Motivation and Choice. Am J Psychiatry 162(8), 1403-1413. Retrieved from http://ajp.psychiatryonline.org/cgi/content/abstract/162/8/1403>.
Robinson, Terry E., and Kent C. Berridge. (18 July 2008). The Incentive Sensitization Theory of Addiction: Some Current Issues. The Royal Society 363, 3137-3146. Retrieved from http://rstb.royalsocietypublishing.org/content/363/1507/3137.abstract
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