Sexual Addiction and Treatment

Case Study Assessment
Chemical Use Assessment/History and Treatment Recommendations
Name: Alan
DOB/Age: 42
Dates of Interviews: July 10-15, 2019
Evaluator: X
Reason for Assessment
Alan is addicted to pornography and masturbation and wants to stop looking at pornography while alone. He has been “hooked” since the age of 14 but has never come close to expiring the same feeling he had when he looked at porn for the first time. He wants to stop his addiction because he feels it is hurting his marriage and he does not want to lose his wife, who knows about his one infidelity as well as his addiction and worries that he might stray again. He has already been divorced once and has a son who does not live with him. Clearly he wants to break free of his addiction but does not know how to do it.
Sources of Information
Alan is the sole source of information for this case. He has presented himself for treatment with the understanding that the chemical dependency from which he is suffering can be treated. His current wife Becky could become a secondary source of information, as could his former wife, if more information is considered to be needed, but this is unlikely as Alan is very upfront about his history and his problem and sincerely wants help.
Background Information
Alan is a 42 year old divorced and now re-married adult male suffering from a pornography and masturbation addiction, which he has had since the age of 14. It is quite likely that this addiction played into the dissolution of his first marriage, and though he and his current wife look at pornography together he feels he is not helping his situation by looking at it alone while at work in his office and masturbating by himself. It was this type of fantasy addiction that compelled him to place a Craigslist ad earlier on, which led him to cheating on his current wife. It was a one-time affair and his current wife knows that but she is fearful he may do it again. Alan is fearful his habit is something he cannot control and that it will end up hurting his marriage. He wants to stop looking at pornography and masturbating alone, but his work in IT is such that he always has convenient access to it and thus he does not see any way to help himself.
Current Status
Alan’s current status is that he is addicted to pornography and masturbation and cannot control himself: if he is alone at work, he will use his computer to view pornography and masturbate.
Indicators of Use/Abuse/Dependency
Alan appears to have both a psychological and physical dependence on pornography and masturbation—though it is unclear what happens to him when he attempts to stop or whether he has ever attempted to stop. He has not indicated any withdrawal symptoms or what experiences he had in previous attempts to stop. He is a compulsive masturbator and even though he believes it is not good for his marriage and wants his marriage to last, he cannot stop himself from looking at pornography and masturbating. He believes it may ruin his marriage and seems to be basing this belief on the fact that he has already seen on marriage fail. His parents are divorced, and though the reason for this divorce is not given, it could possibly be related to sexual addiction or infidelity on his father’s part. He does state that his first exposure to pornography was by way of his step-father’s pornographic magazine.
Attitude and Behavior
Alan is very friendly, likable and has a good nature about him. He is in love with his current wife Becky and believes she is his soul mate. The fact that he has not experimented with other women since the one affair suggests that he is a bit more realistic about what love is and what it entails and that the fantasy he concocts while alone, looking at pornography and masturbating is not the same as actually engaging in sexual intercourse with another person. However, he feels his addiction is a weakness that threatens his happiness and he wants to be able to ease his wife’s fears regarding the possibility of future infidelities. He sometimes views pornography with his wife, but does not indicate whether or not he believes this might be a problem, too.
Social Functioning
Alan’s social functioning ability appears to be normal. He is friendly and personable and does not seem to have any sociopathic tendencies. He is able to maintain a job, though it does not require much social interaction. He has one failed marriage behind him, but is currently happily married and enjoys a happy relationship with his parents.
Occupational Functioning
As Alan works in IT and has his own office it could be deduced that he is doing well, occupationally speaking. However, the terms of the occupation itself could be linked to his problem, at least behaviorally speaking, as his office and alone time is what gives him opportunity to masturbate compulsively. It is unclear whether there is an option to work in a more social setting or whether that is even something he would be willing to do.
Financial Factors
There are no financial factors that appear to be an issue in this case.
Familial Relationships
Alan’s relationship with his parents is healthy. Like his mother, who is divorced by re-married, Alan too has been divorced once and is now re-married to Becky. He has a step-daughter and a son, but the son does not live with him. He is happy with Becky and wants to make sure their marriage stays strong.
Legal History
Alan does not have any legal history pertaining to this case.
Health History
It is unknown what the affect of Alan’s addiction has had on his health, though it is likely that he is suffering from a physiological addiction similar to what drug addicts suffer from: “cocaine addicts had nearly identical brain activation patterns when viewing pornography and cues related to their addiction” (Park et al., 2016, p. 23). In other words, the same physiological addiction that a cocaine addict has is likely to be the same chemical dependency that Alan feels. Aside from this, his health history appears to be fine.
Spiritual History
Though Alan did grow up going to Sunday school and to church with his grandparents, he does not consider himself a spiritual person.
Diagnostic Impression
Alan has a pornography and masturbation addiction. His sexual addiction has developed over the course of his adolescence and adult life. His work in IT may have come about because he prefers to be connected to the Internet so that he can indulge his addiction. As Brand, Snagowski, Laier and Maderwald (2016) indicate, there is a strong neural basis for pornography addiction to be made that is comparable to other addictions. It is evident that since Alan feels his addiction is a threat to his happiness and marital success, and that he cannot stop it (i.e., is a compulsive masturbator), the diagnosis for him is addiction. As Laaser (2004) points out, sexual addiction is typically developed as a result of “building-block behaviors” that can start at a young age and lead to addiction over time (p. 28). There are no criteria in the DSM-V for sex addiction, though researchers have been calling for its inclusion since 2001: “clinicians worldwide are reporting varying patterns of over- and underacting within the spectrum of sexual behaviors, causing distress, dyscontrol, and other disadvantages to individuals, families, and communities” (Manley & Koehler, 2001, p. 253). Thus, in spite of its absence in the DSM-V, it is evident that sexual addiction is a legitimate addiction, and thus it should be treated as an addiction (Doweiko, 2015).
Treatment Recommendations
The problem with recommending a treatment for Internet-based pornography addiction and masturbation addiction is that there are no clearly accepted practices when it comes to treating sexual addiction. Young et al. (2009) note that “anecdotal evidence has suggested that mental health practitioners’ report increased caseloads of clients whose primary complaint involves the Internet” (p. 475)—and they add, unfortunately, that “little is known about the incidence, associated behaviors, attitudes of practitioners, and interventions involved related to this relatively new phenomenon”—i.e., the phenomenon of Internet pornography addiction (p. 475). However, sexual addiction itself is not a new phenomenon and there is literature available that suggests it may be treated via a number of different methods, including a spiritual approach (Gilbert, 2014). Gilbert (2014) shows that practicing Catholics have found the Novena to Boniface of Tarsus to be quite powerful in helping the addict to overcome sexual addiction.
In Alan’s case, it does not appear that a spiritual approach to treatment, such as what Gilbert (2014) recommends, would be necessarily helpful—as Alan does not consider himself to be a spiritual person. However, it could be discussed with him, since he does have some background—at least in his youth—in going to church. It might even be argued that since his addiction began in his adolescence, likely around the same time that he stopped going to church, he may find it a meaningful practice to take up once again. Supplanting the physical lure of the sensual fantasy with a realistic desire for spiritual peace could be an effective step in the right direction for Alan and part of a broader cognitive behavioral therapy approach that would assist him in conquering his addiction.
However, as McKeague (2014) states, “shame is the core affect of sex addiction” (p. 203) and what Alan may be missing in his life is the feeling of shame associated with compulsive masturbation. It would be recommended to Alan that he sincerely think about whether pornography is inherently good or bad—and if he believes that it may be leading to problems in his marriage, he should consider eliminating it altogether—not just when alone but also when with his wife. Having a way to be accountable or to hold himself accountable to someone may also help: he could hold himself accountable to someone he trusts. Accountability and shame are typically linked, so the shame that he would feel about using pornography at work might serve as a negative motivator to be more resilient to the triggering impulses. Porn blockers on his computer and phone may be helpful, but these should be installed by someone he trusts.
Since being alone at work gives Alan the opportunity to look at porn, it should be suggested that Alan also explore the possibilities of working in a more public space or transitioning to a job wherein he is working with others and is not given the opportunity to be alone. If he is open to this idea, it may mean that the psychological hold over his will is not as strong as he thinks and it too could be a good first step in conquering his addiction. Still, as Gilbert (2014) points out, attempting to overcome this type of addiction without using prayer or acknowledging a higher power and the need for external assistance (i.e., grace) may be like fighting a losing battle. Even in Alcoholics Anonymous and the 12-step approach to battling addiction, there is recognition of the need for a spiritual component or approach.
Addiction is not something one overcomes easily and it is typically a lifelong issue that the person must face. That means the person is going to have to take significant steps to change his life and this is true with Alan. To battle his addiction, he needs to remove himself from those places wherein he is most likely to feel tempted—and that is his office at work and, on occasion, when with his wife. The first step to treatment will be to identify ways for Alan to reduce the instances in which he has access to porn and then to begin engaging in positive habits—like prayer or church-going—that can further assist him in dealing with his addiction triggers.
References
Brand, M., Snagowski, J., Laier, C., & Maderwald, S. (2016). Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction. Neuroimage, 129, 224-232.
Doweiko, H. E. (2015). Concepts of chemical dependency (9th ed.). Stamford, CT: Cengage Learning.
Gilbert, D. (2014). The Novena to St. Boniface of Tarsus: A Pastoral Program for Addressing Sexual Addiction in Colonial Mexico. Catholic Social Science Review, 19: 87-109.
Laaser, M. (2004). Healing the wounds of sexual addiction. Grand Rapids, MI: Zondervan.
Manley, G., & Koehler, J. (2001). Sexual behavior disorders: Proposed new classification in the DSM-V. Sexual Addiction &Compulsivity: The Journal of Treatment and Prevention, 8(3-4), 253-265.
McKeague, E. L. (2014). Differentiating the female sex addict: A literature review focused on themes of gender difference used to inform recommendations for treating women with sex addiction. Sexual Addiction & Compulsivity, 21(3), 203-224.
Park, B., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., ... & Doan, A. (2016). Is Internet pornography causing sexual dysfunctions? A review with clinical reports. Behavioral Sciences, 6(3), 17.
Young, K., Pistner, M.,O’Mara, J., & Buchanan, J. (2009). Cyber disorders: the mental health concern for the new millennium. CyberPsychology & Behavior, 2(5), 475-479.