Table 1: Twelve-Step Program for Sex Addiction
For the Addict
Sexaholics Anonymous (SA). P.O. Box 111910,Nashville, TN 37222-6910, (615) 331-6230

Sex Addicts Anonymous (SAA), P.O. Box 70949, Houston, TX 77270, (713) 869-4902

Sex and Love Addicts Anonymous (SLAA)
P.O. Box 119, New Town Branch, Boston, MA 02258, (617) 332-1845
For the Partner
S-Anon, P.O. Box 111242, Nashville, TN 37222-1242, (615) 833-3152

Codependents of Sex Addicts (CoSA)
9337 B Katy Fwy #142, Houston, TX 77204, (612) 537-6904
For Couples
Recovering Couples Anonymous, P.O. Box 11872, St. Louis, MO 63105, (314) 830-2600

Professionals and interested patients can also write for information to:
National Council on Sexual Addiction and Compulsivity (NCSAC)
1090 S. Northchase Parkway, Suite 200 South, Atlanta, GA 30067, e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
website: http://www.ncsac.org

Source: Irons RR, Schneider JP. Addictive sexual disorders. In: Miller NS, ed. Principles and Practice of Addictions in Psychiatry. Philadelphia, Pa: Saunders; 1997:441-457.
Schneider JP, Irons RR. Primary Psychiatry. Vol. 5. No. 4. 1998.

Treatment
Unlike the goal in treatment of substance use disorders, which is abstinence from use of all psychoactive substances, the therapeutic goal for sex addicts is abstinence only from compulsive sexual behavior. The counselor can help the client identify which sexual behaviors are best avoided. For many sex addicts, masturbation is analogous to the "first drink" which can lead to relapse. Some recovering sex addicts can eventually resume this practice if they restrict their sexual fantasies to "healthy" themes, whereas others must continue to avoid it.

Because sex addicts were often sexually abused as children (83% according to Carnes2), and because they have distorted ideas about sex, they frequently lack information about healthy sexuality. Education about this subject is highly desirable. In the early recovery period, sex addicts and their partners frequently have sexual difficulties, often to a greater degree than during the active addiction phase. Therapists can provide reassurance during this phase. If the compulsive sexual behavior was same-sex, as is surprisingly common even among men who identify themselves as heterosexual,9 therapists can help patients work through issues of sexual identity.

Group therapy is the cornerstone of sex addiction treatment. Shame, a major issue for sex addicts, is often addressed best in group therapy, where other recovering addicts can provide both support and confrontation. Education about sex addiction is a major component of all treatment programs.7,12,13,14

For patients who are suicidal or have other comorbid psychiatric or addictive disorders, or who are unable to recover in an outpatient setting, several inpatient treatment programs are available in the United States. Most are located in hospitals that also treat substance use disorders. Increasingly, treatment programs for substance use disorders are now assessing for the presence of sex addiction and other addictive disorders, and are either treating the problem themselves or referring out for such treatment.

Because a large percentage of people with addictive sexual disorders are also chemically dependent, the initial decision often facing a treatment professional is which addiction to treat first. By the time sex addicts seek help for this disorder, many are already in recovery from their substance dependence. If not regardless of which addiction is primary the drug dependence must be treated first if sex addiction treatment is to succeed.

The 12 steps of Alcoholics Anonymous have been adapted for use in programs for eating disorders, compulsive gambling, sexual addiction, and other addictions. For those with addictive sexual disorders, attendance at a program dealing with sexual addiction is highly recommended. Several fellowships have evolved, which differ primarily in their definitions of "sexual sobriety." Programs modeled after Al-Anon (the mutual-help program for families and friends of alcoholics) are also available, and attendance by spouses of sex addicts can be very helpful both for the spouse and for the relationship. The two major fellowships have no significant differences. Group support can be a powerful tool for overcoming the shame that most sex addicts and their partners feel. For information about the nearest meetings available in the United States and Canada, contact the fellowships listed in Table 1.

In cases of professional sexual exploitation, it is important to have a thorough assessment to determine the cause. Some exploitative professionals have a better prognosis than others for return to professional practice. In contrast to those who exploit primarily as an expression of an Axis II characterological disorder, sexually addicted professionals who have successfully completed comprehensive assessment and primary treatment can often return to work without compromising public health and safety. Irons11 devised a set of proposed contractual provisions for reentry. Such a contract can be part of a binding legal stipulation between the professional and a state professional licensing board and can define a standard of care for potentially impaired health care professionals.