Addiction Is the Same But Different
Addiction is an equal opportunity disease, affecting men and women alike, regardless of age, ethnicity, religion, wealth, marital status, social standing, or pretty much anything else. And for the most part the underlying issues that drive addiction are the same for both genders—addictive substances and/or behaviors are used as a way to feel a sense of control over life stressors, emotional discomfort, and the ongoing emotional pain of unresolved depression, anxiety disorders, trauma, abuse, and the like. In other words, a person may not be able to control what he or she will feel at the end of a frustrating work day—ineffectual, sad, angry, afraid, or whatever—but if that person has a drink or two, then he or she knows exactly which feelings will ensue. As such, for both men and women, addiction is not about partying and having a great time, it’s about control.
There are, however, some differences between male and female addicts, including the fact that alcoholic and drug addicted women are more likely than men to link substance abuse with their sexual and romantic life. Consider Amy, a 47-year-old alcoholic and methamphetamine addict currently in treatment. During her assessment she stated:
This is my third round in rehab for booze and meth. And I wanted to go all three times. Every time when I got to the treatment center, I immediately felt better, like being in treatment was safe, you know. At the first place, I got kicked out after about 10 days because they caught me fooling around with one of the guys I met in group. I didn’t mind because we decided to stay together and stay sober after we got the boot. Well, that lasted about two days. He decided that he wanted to get high before we had sex - you know, just to make the sex better. I said OK, and that was that. The second time I made it through treatment because I stayed away from the men, and I even stayed sober afterward for about six weeks, until I met this guy in one of my CMA meetings. I didn’t even like him that much, but he wanted to have sex with me and I’d been lonely and celibate since starting treatment, and that was like 10 weeks, so despite my sponsor’s insistence that I not see him again, we started dating. I mean, if you could call what we did together most of the time dating. After a while he relapsed, so I left. I stayed clean for another month or so, but feeling lonely and sorry for him (and for myself) I gave in, went looking for him, and we got high. The third time I went to rehab was about six months ago. That time I went to a women-only treatment center so I wouldn’t have to deal with any men. That was actually really cool. But of course when I got out there were tons of men at my AA and CMA meetings. I decided to stay away from the guys in CMA because so many of them relapse and I didn’t want to get dragged down again, but AA seemed safe, so I started going out with this guy who’d been sober for three years. We dated until about a month ago, when he broke up with me. It wasn’t three days before I got drunk over him, and then I got high, and here I am again, back at ground zero.
Sadly, Amy’s story is not atypical. In fact, a large percentage of the women who struggle to remain sober and eventually return to treatment do so after relapsing in relation to their sexual and/or romantic endeavors. Many of them, like Amy, endured very difficult childhoods. During her assessment Amy revealed that both of her parents were alcoholic and neglectful. At times, her father was physically abusive. Making matters worse, her uncle sexually abused her in her early teens, only stopping when she threatened to tell. Amy further revealed that she’d been in therapy previously, several years in total, and that the abuse she suffered in childhood had been “talked to death.” She said that what she really wanted this time was help with getting clean and staying clean.
So one must ask: If Amy has truly talked extensively and worked toward resolution of her early-life trauma, why can’t she stay sober? The answer lies more in her present than in her past.
Addressing the Link between Substance Abuse and Intimacy Disorders
Not infrequently women like Amy complete substance abuse treatment, sometimes enthusiastically, and re-enter the world filled with shaky confidence and hope. However, because their problematic adult history of intimate relationships, sexuality, and dating was either not dealt with or written off as something to be handled later, these women were ill-prepared for the challenges of ongoing real-world sobriety. In short, their shame and secrets regarding past and present sexual and relationship oriented behaviors were left unaddressed, as was education about how they might be able to handle/tolerate/manage sex and intimate relationships in sobriety without relapsing. Even in the rare cases where their sex and relationship history was discussed, that work was most often directed toward early trauma and abuse rather than the adult-life choices that can so consistently lead to relapse. In short, these women went through substance abuse treatment and returned to the world uneducated about the full nature of their addiction, and because of that they went right back to the same problematic yet familiar relationship patterns. And eventually those relationships (or the ending of them) left them vulnerable to relapse.
Common challenges faced by female addicts include:
- Maintaining close relationships with people who are still drinking and using (spouses/partners, boyfriends/girlfriends, regular sexual hookups, etc.)
- Avoiding close relationships with women, especially when men are around.
- A history of sexual relationships where alcohol/drugs and sex have been the primary bond
- Using alcohol or drugs to tolerate neglectful and/or abusive relationships
- Inability to enjoy sexual intimacy without the concurrent use of alcohol or drugs
- Making relationships a greater priority than sobriety (including meaningful and supportive friendships with sober women)
- Drinking or using to please an addicted partner
- A history of having sex or relationships with people primarily because they supply alcohol or drugs
- A lack of direction and insight related to the adult manifestations of early emotional, physical, and/or sexual abuse
In recent years it has become increasingly clear, as I work to evolve both substance abuse and intimacy disorders treatment, that many addicts of both genders consistently abuse substances (or engage in other addictions) in conjunction with and/or in reaction to problems with adult intimacy and sexuality. Furthermore, when these individuals fuse substance abuse with sexual/romantic activity, each behavior can reinforce the other, creating over time a paired trigger toward the formation of addiction and/or addiction relapse. Either way, I have found that treating the addict’s substance abuse issues without also addressing his or her adult sexual and romantic behaviors often leaves the addict vulnerable to relapse. In other words, if treatment doesn’t address both substance abuse and the client’s adult intimacy issues, then the client may not fully heal.
As of now, there are very few treatment facilities for women that address this linking of substance abuse and sex/relationships. One is The Ranch, located in Nunnelly, TN, where treatment typically focuses on trauma and relationship disorders (and the ways in which they relate to addiction). The other facility, addressing the link more directly, is the Substance Abuse and Intimacy Disorders Program at Right Step, DFW. What these two programs provide that most other rehab facilities don’t is a conscious recognition of the connection between substance abuse and sex/relationship/intimacy issues. Beyond that, treatment parallels that of effective addiction treatment in general (both substance and behavioral).
Most of the clients at the Substance Abuse and Intimacy Disorders Program, like Amy in the example above, have spent a great deal of time and money trying to get chemically sober, only to relapse thanks to their unaddressed intimacy issues. Many have lost hope of ever achieving any sort of lasting sobriety or happiness. The good news is that once they enter the SAID program and become fully educated about the dual nature of their problem, hope is typically renewed. These women seem to understand intuitively that by recognizing and treating the full nature of their addiction - including sex, relationship, and intimacy elements - they finally have a chance at real recovery. Simply put, addressing substance abuse and sexual/romantic behaviors simultaneously is the best (perhaps the only) way to help these women gain much needed insight into the entire spectrum of their addictive behavior patterns, identifying triggers for relapse and developing the comprehensive range of healthy coping mechanisms needed for lasting sobriety. When treated in this way, these women are finally offered the best available opportunity to both develop and maintain a rewarding, emotionally healthy, drug-free life.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction,and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships, along with numerous peer-reviewed articles and chapters.