Is There an Overlap Between Sex Addiction and Substance Abuse?
Sex addiction is a common term for hypersexuality, a compulsive pattern of sex-centered thought and behavior that can potentially interfere with a person’s ability to participate fully in everyday life. This addiction is not officially recognized by U.S. mental health professionals, although rough guidelines exist for diagnosing its presence. In a study published in August 2013 in the journal Sexual Addiction & Compulsivity, a Canadian research team examined the degree of overlap between sex addiction and substance use disorder. These researchers found that unusually large numbers of substance use disorder patients have symptoms of hypersexuality.
Sex Addiction Basics
Sex addiction gets its name because affected individuals have a relationship to sexual thoughts and activities that strongly resembles the relationship that substance addicts have to alcohol or drugs. Unofficially, it belongs to a group of conditions called behavioral addictions or process addictions, all of which feature dysfunctional, addictive behavior that does not revolve around drug or alcohol use. Specific aspects of addiction associated with both substance addiction and process addiction include ongoing cravings for a substance or behavior, lack of the ability to avoid participating in substance use or a behavior, a failure to fully recognize the damaging effects of substance use or a behavior, and a damaging emotional reaction to ongoing involvement in substance use or a behavior.
In 2009, a researcher from a prominent mental health facility called the McLean Hospital proposed an official mental health definition for sex addiction under the term hypersexual disorder. Specific symptoms listed in this definition included an involvement in sex-oriented behaviors, urges or fantasies that substantially disrupt everyday life; a reliance on sex-oriented behaviors, urges or fantasies to relieve highly negative states of mind; a recurring involvement in sex without any regard for seriously negative emotional/physical outcomes; high levels of sex-related personal distress; and the absence of any substance use that might possibly explain one’s sex-related behaviors, urges or fantasies. Ultimately, the American Psychiatric Association, which approves the definitions used to identify mental health disorders in the U.S., did not accept hypersexual disorder as a diagnosable illness.
The Mayo Clinic lists a number of behaviors that may indicate a compulsive, addictive relationship to sex. Examples of these behaviors include acts of sexual exhibitionism, a desire to divorce sex from emotional involvement, recurring use of sex-oriented websites, recurring involvement in anonymous sex, recurring participation in extramarital sex, participation in sex with multiple partners, excessive involvement in masturbation and involvement in sex that has a predominantly sadistic or masochistic component. Since many or most of these behaviors frequently occur in people not adversely harmed by their participation, some experts doubt the usefulness of sex addiction as a potential mental health diagnosis.
Substance Use Disorder
Substance use disorder (SUD) is the common term for a range of diagnosable illnesses that revolve around the abuse of, or addiction to, some sort of mind/body-altering substance. The American Psychiatric Association specifically names eight types of substances—tobacco, inhalants, opioid narcotics, stimulants, hallucinogens, cannabis, alcohol and sedative-hypnotic or anti-anxiety medications—as potential sources of SUD. It also gives mental health professionals the freedom to identify any other substance as a source of damaging abuse or addiction in any given individual.
Degree of Overlap
Depending on the source used for reference, sex addiction affects roughly 3 percent to 6 percent of the adult U.S. population. In the study published in Sexual Addiction & Compulsivity, researchers from two Canadian institutions looked for symptoms of hypersexual disorder in a group of 211 individuals receiving treatment for some form of substance use disorder. These researchers concluded that about 25 percent of the study participants had symptoms that could potentially qualify them for a sex addiction diagnosis.
Significance and Considerations
The extremely high degree of overlap between substance use disorder and symptoms of sex addiction strongly suggests that people affected by SUD are also exposed to certain factors that make them abnormally susceptible to involvement in hypersexual thoughts, urges or behaviors. However, the authors of the study published in Sexual Addiction & Compulsion did not specifically investigate the underlying reasons for this apparent connection, and therefore could not make any detailed conclusions regarding the true significance of their findings. Despite the limitations of their work, they recommend that mental health professionals who treat people with substance use disorder rigorously screen their patients for signs of sex addiction.