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When Sex Is No Longer Fun

By Jeremy Hainsworth


It’s a word that can light up part of some peoples’ brains the same way mentioning cocaine or heroin might.

Indeed, a compulsive sexual behavior can be just as alluring for the addict trying to numb feelings as any other form off using – be that alcohol, chemical, shopping, gambling or any other form.

“Knowing you are a sex addict doesn’t mean you are bad or perverted or hopeless. It means you may have a disease, an obsession from which many have healed,” Dr. Patrick Carnes, a pioneer in the field, once said.

While the form of using may be different from other addictive behaviors, the symptoms are essentially the same.

“It’s a compulsive behavior expressed in sexual activity although activity can be considered obsession, fantasy of course, other things people might do that may not be a behavior you can see outwardly,” said Nelson Sacristan, an Edgewood Healthcare Network (EHN) counselor and clinical manager of EHN Vancouver.

“At its root would be trauma, an inability to have intimacy, expressing emotions, sexual behavior,” Sacristan said. “The root of it is similar to chemical addiction.”

More recently, he said, people coming into treatment may have grown up with the Internet and haven’t socially matured or learned how to court or date and acquire a partner.

And now, readily available online pornography may fill that void.

“They’re not truly addicted to sex or compulsively with sex outside of pornography,” Sacristan says.

Porn could also be traumatizing to young people, according to the vice president of U.S.-based International Institute for Trauma and Addiction Professionals (IITAP). Tami VerHelst says that trauma could add to the roots of a person’s addictive behaviors.

Sacristan added that a person with compulsive sexual behavior might also use chemicals to enhance the stimulation of porn or to disinhibit them for other behavior.

“It allows them to go forward and do something sexually they might not otherwise do,” he said.

“They maybe might say it was because I was drinking or using cocaine that I picked up an escort.”

For others, the alcohol or chemical usage might enhance stimulation, including that from porn.

And, some might use substances or food afterwards to deal with the guilt or shame of what they have done.

“One of the emphases in IITAP was addiction interaction disorder,” he said.

Sacristan said there are four ways that addiction neuropaths in the brain are activated through sexually compulsive behavior.

First, there is activation through stimulation or numbing.

Then, there are those who might fantasy, obsession or intrigue with a person.

It’s not so much about sex, Sacristan explained. He said such people don’t have a good check on reality and need to be shown how to test that.

“It’s more around having the thoughts or wishing for the relationship,” he said.


Then, there’s deprivation, people who are “sexual anorexic.’ They don’t seek relationships or may be turned off by sex. Such people might have other deprivations and treatment can look at what other needs aren’t being met.

As such, say Sacristan and other experts, sex addiction should be treated in such a way for the person as a whole to move into recovery, which means ensuring whoever is providing treatment is educated and qualified in the field, and  has standing as a Certified Sex Addiction Therapist, or CSAT.

Across the EHN realm, the goal is to have CSAT-certified staff at all facilities, so the network can provide treatment where a need is identified.

Sacristan said IITAP provides that certification.

He said the counseling is 12-step friendly but not necessarily part of a program.

“It’s looking at the root of the behavior,” he said. “You kind of think of where the addict is coming from, what is the effect they are looking for.

“Some folks use obsessive compulsive sexual behavior basically like to numb out from life, having a lot of depression or anxiety.”

Terms such as “sex addiction” and “sex addict” do trouble Sacristan, however. He prefers the term “compulsive sexual behavior.” He believes the other terms are loaded and could lead to stigmatization.

“I’d rather talk about the behavior than just say, ‘Okay, you’re a sex addict.’”

But that’s a personal choice.

Though not a clinician herself, for her part, VerHelst says many people are just as happy to have a name associated with the condition, to know they’re not alone, that they can receive help.

“The people with this issue don’t have a problem with the label,” she said, noting some 40,000 per month visit the Sex Addicts Anonymous website.

Whatever the terminology, the concept first began to crystalize in the early Eighties with the publication of Dr. Patrick Carnes’ book Out of the Shadows.

Sacristan said Carnes, an alcoholic and sex addict started a fellowship in Minnesota and “put the idea of sex addiction on the map.”

“He created a task-centered approach for recovery that is based on the 12 steps,” VerHelst said.

Through his work, Carnes identified four phases and 10 symptoms of sex addiction.

Much like other forms of addictive behavior, the phases are: preoccupation, ritualization, compulsive sexual behavior and despair.

The symptoms, Carnes found, are:

  • a pattern of out of control behavior;
  • severe consequences due to sexual behavior;
  • inability to stop despite adverse consequences;
  • persistent pursuit of self-destructive or high-risk behavior;
  • ongoing desire or effort to limit sexual behavior;
  • sexual obsession and fantasy as a primary coping strategy;
  • increasing amounts of sexual experience (because the current level of activity is no longer sufficient);
  • severe mood changes around sexual activity;
  • inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experience, and;
  • neglect of important social, occupational, or recreational activities due to sexual behavior

Out of the Shadows cemented Carnes’ reputation as a thought leader in the field and others in the addiction field began to follow his lead.

That, however, led to the acknowledgment that there was a need for a training standard and that certification to treat those with compulsive sexual behavior was necessary.

That led to the creation of the Certified Sex Addiction Therapist, or CSAT program.

Through the creation of the IITAP, a certification program built around academic study, experiential training, supervision and assessment competence was born.

VerHelst said the goal of sex addiction therapy is to help people move past damaging behaviors and onto happy, productive lives. But, first she said, it’s important to discover if indeed a person is in need of help fro the condition.

And that’s where the six-point PATHOS questionnaire screening tool for sexual addiction comes in. The questions it asks are:

  • Do you often find yourself preoccupied with sexual thoughts?
  • Do you hide some of your sexual behavior from others?
  • Have you ever-sought help for sexual behavior you did not like?
  • Has anyone been hurt emotionally because of your sexual behavior?
  • Do you feel controlled by your sexual desire?
  • When you have sex, do you feel depressed afterwards?

VerHelst suggested if you answer ‘yes’ to one or more of the questions, seeking help might be a wise idea.

Another tool, she said, is the Sexual Addiction Screening Test designed to assess sexually compulsive behavior that indicates the presence of sex addiction.

And, VerHelst said, the www.sexhelp.com website is also an invaluable tool for those making their first foray into concerns for themselves or others.

So, once a person has some concerns or a sexually obsessive behavior is identified through other treatment or counseling, specific work on the issue can begin, Sacristan said.

VerHelst said CSAT treatment involves a 30-task “recipe for recovery.”

It’s work a counselor does with a client that can help uncover deeper wounds that have resulted in the negative behaviors.

Tools CSAT therapists have to assist clients include a sexual dependency inventory, post-traumatic stress inventory, a money and work program and assessments for partners.

VerHelst said there are currently 1,700 such therapists worldwide.

“If we had five times that, we would still be underserving,” she said.

But, VerHelst stressed, the concept to sexual addiction is not without its detractors.

Indeed, debate over its existence had led it to be included in the third edition American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III) only to see it removed in the DSM-V.

She said the women’s liberation movement in the Seventies opposed the idea and that the pornography industry adamantly opposes the concept of sexual addiction.

“They have a multi-billion dollar reason for it not to be ‘a thing,’” she said.

“There was a lot of politicking,” she said.

Despite that, educating of counselors continues to move forward to address the need for treatment, VerHelst said.

Moreover, Sacristan stressed, treatment does not ask people to stop having sex.

“Abstinence is not the goal,” he said. “We want to get people to the point where they can function.”

Certified Sexual Addiction Therapists across the Edgewood Health Network

Getting more Canadian counselors trained to meet the demand for people with sexually compulsive or addictive behavior is the goal behind sessions being held at the Edgewood Health Network’s Nanaimo treatment centre April 5-9 and Aug. 23-27.

The Certified Sex Addiction Therapy (CSAT) training allows counselors to identify and help those with compulsive sexual behaviours that are impeding their ability to live happy, normal lives.

While Edgewood is hosting the training on the first two of the four CSAT modules,the education itself is being provided by U.S.-based International Institute for Trauma and Addiction (IITAP).

Edgewood clinical director Elizabeth Loudon said the sessions attract between 30 and 50 people from across North America.

Loudon has just completed part of her CSAT training through IITAP.

She said it was clear there was a need for more Canadian therapists to have access to the training.

“I’m really stoked to be part of a learning movement,” Loudon said. “I’m really proud to have Edgewood behind it.”

IITAP vice president Tami VerHelst is excited about Edgewood being more involved with training greater numbers of CSAT–trained therapists in Canada.

“The need is there,” she said. “We’re really hoping we can engage a lot of Canadians.”

Right now, she said, many Canadians who might need sex addiction therapy have to travel many hours to find help.

Greater training in Canada, and through education such as that in Nanaimo, will help more Canadians deal with compulsive sexual behavior, VerHelst said.

“She (Tami) knows how dedicated we are here,” Loudon said.

Loudon said some participants could stay in rooms at Edgewood and enjoy the campus experience while others would be accommodated offsite.

Click here to learn more about this IITAP (CSAT) module series in April hosted at the Edgewood Treatment Centre in Nanaimo, BC .


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