What Happens in Sex, Porn, and Chemsex Treatment?

It is not unusual for sex addicts, porn addicts, and individuals with paired substance/sex issues to expect, when they enter treatment, that their therapist will want to focus on the identification and resolution of childhood issues. But that is generally not what happens. Trained addiction therapists do, of course, try to identify and acknowledge unresolved childhood and adult-life trauma, abuse, and neglect because these things do play into the ‘why’ of addiction. But resolving those issues is not an initial therapeutic focus.

Other concerns, mostly involving client safety and current addictive behaviors, are nearly always paramount early in the process. After all, helping sex, porn, and chemsex addicts understand their early-life issues doesn’t exactly provide them with the concrete tools they need to stay sober in the moment. Before addressing underlying issues like trauma, addicts must first learn to cope with day-to-day life without returning to active addiction as a way to self-sooth and self-medicate.

So, if we’re not focused on resolution of early-life trauma, what are we focused on in the initial stages of the treatment process?

The progression of sex, porn, and chemsex addiction treatment is actually quite logical. The first step is a thorough bio-psycho-social assessment. This careful evaluation explores and evaluates nearly every aspect of the addict’s life, including his or her sexual history, relationship history, and drug use. Individuals are assessed not just for sex, porn, and chemsex addiction, but for other psychological issues (anxiety, depression, other addictive/compulsive behaviors), along with relationship, family, legal, work, social, recreational, and financial concerns that may need to be dealt with.

Typically, the preferred methodology in addiction treatment is behavioral in nature, most often cognitive behavioral therapy (CBT) and/or dialectical behavior therapy (DBT). These approaches differ significantly from traditional talk therapy, which focuses on the ways in which the past affects the present, relying instead on a more directive, accountability-based approach. Stated simply, addiction is, first and foremost, a behavioral problem, and it responds best to behavioral treatment.

With CBT and DBT, the clinician and the addict look at the people, places, emotions, experiences, and events that trigger and reinforce the addict’s addictive thoughts, desires, and behaviors, and then they identify ways to short-circuit the addict’s addictive thinking and behavior. Essentially, CBT and DBT teach addicts to recognize that they’ve been triggered and to act in ways that counteract rather than reinforce their desire to engage in the addiction. So rather than engaging in the addiction, addicts learn to engage in healthier behaviors like calling a supportive friend, going to a 12-step meeting, going for a walk, cleaning the house, reading a book, meditating, helping others, enjoying a hobby, etc.

With addiction recovery, the initial work of therapy is reality based, focusing on the addict’s behaviors and well-being in the here and now instead of looking at and seeking to resolve past traumas. Later in the recovery and healing process, after the addict has established solid sobriety and support, if the addict so desires it, early-life trauma can be looked at and resolved. But this should not occur until the addict is able to tolerate this incredibly difficult, emotionally painful work without relapsing.