Kadie McCourt - Sexual Addiction and Traumatic Incident Reduction (TIR): An Introduction

Doctoral Candidate, University of Toronto

The following report is a transcription of Kadie McCourts presentation at the 2011 TIRA Technical Symposium in Ann Arbor, Michigan

According to Niko Tinbergen (1951), a Nobel prize winning ethologist, we can understand four aspects of behavior: mechanism, development, evolution and adaptation.

• Mechanism refers to the region of the brain that controls the particular behavior. Scientists have pinpointed many regions of brain such as the nucleus accumbens and the prefrontal cortex. Each of these influences thoughts, and the creation of individual goals.
• Development is connected with age, thus if a person is young we may explain inappropriate behavior, such as excessive drinking or strong interest in sex, as being due the individuals age, and believe it is because their brain has not developed completely, especially since the brain is not fully formed till age 21. This is often the case when explaining behaviors of teenagers as their frontal lobe is undergoing the formation stage.
• Evolution, in this context, is the expected behaviors in our society; for example to be sexually active prior to marriage is acceptable in our society, but fifty years ago it was not.
• Adaptation happens when we modify our behavior to fit our environment. For example, it may be acceptable to check out the girls at the bar, but that behavior will bring serious consequences at work.

These four factors influence our perceptions of addiction in society. For example, males who choose to have multiple sexual partners tend to be viewed with the same negative stigma that females have had for decades. Yet, in the gay/lesbian/bi-sexual/ transgender/queer (GLBTQ) society, having many sexual partners can be acceptable. Thus defining an addiction, especially a behavioral addiction, can be very difficult as the behavior needs to be assessed based on Tinbergens four criteria. In different settings and different cultures, particular behaviors may be more acceptable than others and some may be shunned. This, in determining if a behavior is an addiction, it is very helpful to consider if it has a negative impact on oneself, can harm others, or has a negative impact on ones relationships. Defining a behavioral addiction, such as a sexual addiction, needs to meet the same criteria as a substance addiction, with the behavior substituting for a substance.

According to Erikson & Wilcox (2001), our brain mechanisms influence whether we will have an addiction. It seems a dysregulation of brain chemistry results in a dependence on the drug of choice for the individual (Erikson & Wilcox, 2001). For example, cocaine affects the dopamine receptors and tells the body to flush more into the system; the body stops using its own signals for the amounts to flush into the system and the individual becomes dependent on cocaine. Heroin does the same with endorphins, which act like morphine; thus individuals in a lot of pain are susceptible to heroin addiction. Alcohol affects serotonin, GABA, acetylcholine, endorphins, glutamate and dopamine. All of these are neurotransmitters in the brain, which tell our brain and body how to behave and function. Many of them, such as serotonin, endorphins and dopamine, influence happiness. With addicts, their brains stop releasing these neurotransmitters without the substance of choice and thus it becomes a vicious cycle for the individual. Erickson and Wilcox (2001) coin the term of emotional learning, which means that repeated use of the substance often leads to a permanent change in the persons brain. It is believed this is also true for individuals with a behavioral addiction.

According to the DSM IV, an addiction is defined as having the following characteristics: loss of control, continuation despite adverse effects, and obsessive preoccupation. For sexual addiction, the definition is not as clear. According to Schneider (2004), is any sexual behavior may become a sexual addiction. This is not based on the frequency of the behavior but on the consequences or possible consequences to the individuals health, relationships, career or legal status. Also, this sexual behavior needs to be unmanageable by the individual for it to be considered addictive (Schneider, 2004). Schneider cites three levels of sexual addiction. Level 1 = normal acceptable and tolerable, including masturbation, viewing pornography or multiple affairs. Level 2 involves behaviors that are victimizing to others or viewed as nuisance crimes, such as exhibitionism, voyeurism and obscene phone calls. Level 3 is illegal behaviors that have serious consequences for the victim and the offender, including rape, incest, child molestation. Schneider (2004) indicates that individuals who are compulsive at level 3 are also compulsive at levels 1 & 2. He also suggests that addictive sexual disorders can progress from the first two levels, because the addict needs to do more and take a greater risk to experience the same level of stimulation. As well, both males and females can have a sexual addiction (Schneider, 2004).

Sexual addiction is believed to have the following process of progression. The initial phase is a result of sexual observances/or experiences during adolescence or early adulthood that are very intense. The outcome is that sex or sexualized behavior becomes a method of coping (Schneider, 2004). Next is the establishment phase. This is when the addictive cycle begins and the individual experiences preoccupation, ritualization, sexual acting out, despair, shame and guilt (Schneider, 2004). Then there is the de-escalation phase, where for some the behavior will decrease or is substituted by another addictive behavior such as drinking or drugs, or may decrease due to strictly to personal will power (Schneider, 2004). Last is the acute phase, when the addict is preoccupied with the addiction and becomes isolated or alienated from family and friends. Unfortunately some addicts only stop when they are incarcerated or there is an absolute loss of opportunity to engage in the sexual behavior (Weiss, 2004).

To assist clients in overcoming an addiction there are minimal options. Unlike gambling where absolute abstinence from the behavior is the desired effect, this type of a decision regarding sex will hinder a healthy relationship. One strategy is to use a sexual boundary plan (see appendix), in which the first column lists all of the behaviors that are harmful, shameful, problematic or hurtful to the individual or others (Weiss, 2004). In short, these are the sexual behaviors that must stop immediately. The second column involves listing the people, places and experiences that can result in unwanted sexual behavior; these are the warning signs that the behavior will occur. The last column lists the rewards when the individual is not engaged in the behavior: what the sex addict can do with the time and energy that is not being spent on the addiction. Fortunately, with Traumatic Incident Reduction1 (TIR) and related techniques, this is not the only strategy to assist clients with a sexual addiction.