Treating Alcoholism, Sex Addiction, and Other Process Addictions Together

Alcoholism, sex addiction, and other process addictions are often tightly intertwined, driven by a dysfunctional reward circuitry and sharing common psychological roots. The interrelated nature of these disorders means that dual diagnosis treatment offers the best outcomes, allowing you to participate in both pharmacological and psychotherapeutic interventions while experiencing the power of peer support.

Alcohol addiction has historically been among the most vilified of illnesses, but thanks to breakthroughs in scientific research, that is slowly changing. With the emergence of sophisticated medical imaging, we are now able to observe the structural and functional changes that occur in the brains of addicts, confirming that addictive behaviors are not simply a matter of personal choice but a chronic disease of the brain itself. As this knowledge trickles down into public consciousness, we are seeing increased support for comprehensive alcohol addiction treatment and empathy for those who struggle with this painful illness.

Now, scientists are using neuroimaging technologies to investigate the nature of an addiction that remains deeply stigmatized and whose very existence is often disputed: sex addiction. In 2014, researchers at the University of Cambridge used functional magnetic resonance imaging to examine the brain activity of 19 men who struggle with compulsive sexual behavior and 19 healthy men. They found that when exposed to pornography, the brains of those affected by compulsive sexual behavior behaved differently than those who don’t. “There are clear differences in brain activity between patients who have compulsive sexual behavior and healthy volunteers,” says Dr. Valerie Voon, lead author of the study. “These difference mirror those of drug addicts.”

Dr. Voon’s research is part of a growing body of evidence showing significant similarities between drug and alcohol addiction, sex addiction, and other process addictions, evidence that is both breaking down stigmas and paving the way for better treatment. But it’s also providing vital clues about why alcoholism and process addiction like sex addiction so often co-occur and why they must be treated together.

The Dysfunctional Reward Circuitry


Process addictions, including sex, gambling, video game, exercise, and shopping addictions, are estimated to affect anywhere from 15 to 61% of the population in a 12-month period, depending on study methodology. These addictions rarely occur in isolation; according to one study, 89% of people with one type of addiction experience report experiencing co-occurring addiction and amongst people with sex addiction, a full 87% report having at least one other addiction. Often, that co-occurring addiction is alcoholism.

So why do alcoholism and process addictions like sex addiction so often co-occur? Partially, the answers lie in the behavior of the brain itself. As neuroimaging studies reveal, addictive substances and behaviors produce the same neurological effects. “Like alcoholics, sex addicts suffer from disrupted activity in their nucleaus accumbens and the rest of the brain’s reward circuitry,” writes Dr. Ralph Ryback. In other words, addicts learn that certain behaviors and substances produce pleasurable effects by flooding the brain with dopamine. The addicted brain will then seek out this dopamine release again and again without regard for potential consequences. As the brain becomes accustomed to this wave of pleasure, it needs ever more intense “doses” to maintain equilibrium and stave off withdrawal.

However, dopamine release isn’t substance-specific; people can experience the same pleasure from sex as they do from alcohol. Indeed, some theorize that the substance or behavior of addiction may be largely irrelevant; the true addiction is not to sex or alcohol, but to the disordered activation of the brain’s reward circuitry. As such, someone who uses alcohol to produce such effects are more likely to seek out the same effects through other means, such as compulsive sexual behaviors, shopping, or gambling.

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The Roots of Alcoholism, Sex Addiction, and Other Process Addictions


The connections between alcoholism, sex addiction, and other process addictions are often not simply about neurological behavior, however. Rather, these addictions can stem from deep psychological turmoil and act as disordered methods of coping with overwhelming distress. “Like an alcohol, the sex addict relentlessly seeks out satisfaction from an external source to palliate an internal pain,” says Dr. Frances Cohen Praver. “[Addicts use sex] to dispel feelings of inadequacy, depression, anxiety, rage or other feelings that the addict experiences as unbearable.”

The internal pain that predates the addictive behaviors is then typically further augmented by the addiction itself, spurring you further into the original addiction and increasing your propensity for developing a co-occurring addiction. For example, more than two-thirds of alcoholics with a co-occurring sex addiction “consider their sexual addictive behavior to be their primary and earliest dependence.” In many such cases, alcohol addiction often developed at least in part as a response to the pain of compulsive sexual behavior, helping people temporarily cope with psychic damage. At the same time, alcohol further lowers your inhibitions and damages your ability to make healthy choices, compromising your ability to gain control over your process addiction. This cycle of co-occurring addictions and psychiatric pain is, of course, not exclusive to sex addiction; the same phenomenon occurs with virtually all process addictions as you seek to quell both the original feelings of distress and that which originates from your addictions themselves.

The Need for Dual Diagnosis Treatment


The interconnected nature of alcoholism and process addictions mandates that the full spectrum of disorders must be treated simultaneously to achieve the best possible outcomes. As such, dual diagnosis treatment is now considered the gold standard for helping people with these co-occurring illnesses to make full and lasting recoveries.

Part of the value of using brain-imaging technology to observe how alcoholism and process addictions affect the brain lies in the way it can inform treatment. More specifically, if a medication is proven to suppress cravings for one disorder, it is possible that it can make similar interventions in another disorder that involves the same neurological processes. For example, naltrexone, an opioid antagonist that “limits the release of dopamine within the nucleus acccumbens,” reduces cravings and addictive behaviors for people with both alcohol addiction and process addictions, including sex, shopping, gambling addictions. The success of such treatment sharply demonstrates the shared neurology of seemingly disparate forms of addiction and supports the theory that dopamine is the true addiction. These findings are driving physicians to increasingly harness the potential of pharmacological therapies to target multiple addictions simultaneously.

But while medication can be an invaluable part of the recovery process, it cannot stand alone. Rather, the roots of your addictions must be fully addressed; without removing the internal pain that drives your addictive behaviors, the impetus to use will persist and your distress will remain. Comprehensive addiction treatment using a broad spectrum of psychotherapeutic modalities will help you understand and resolve your psychological struggles. By fully investigating the sources of your pain and developing the skills to cope with that pain in new and productive ways, you can disrupt maladaptive behaviors and reorient your brain toward healthy patterns. In doing so, you can break free from your alcohol and process addictions once.

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The Power of Peer Support


One of the most powerful aspects of comprehensive dual diagnosis treatment programs is the opportunity it provides for peer support. While peer support has been shown to be vital for all types of addiction, it can be particularly beneficial for people with co-occurring process addictions. Because these addictions remain largely misunderstood by the public, many people living with such addictions experience extreme shame, secrecy, and silence. Having to bear the burden of process addictions on your own only serves to isolate you further within your disordered state and perpetuates your inner pain.

At dual diagnosis treatment centers, however, you are not alone. Rather, you are surrounded by expert clinicians and compassionate peers who understand and validate your struggle. Here, you don’t have to suffer in silence or carry your pain on your own anymore; you are able to share and express that pain to people who will listen to and respect your story while guiding you toward recovery with warmth and empathy. This can be an extraordinarily powerful experience, one that is instrumental as you learn how to live without alcohol and destructive behaviors and begin to create a new, more fulfilling life.

Alta Mira offers comprehensive treatment for people struggling with drug and alcohol addiction as well as co-occurring mental health disorders and process addictions. Contact us to learn more about our innovative suite of programs and how we can help you or your loved one start on the journey to healing.