Views from an addiction therapist Q & A

Tullos

A certified sex addiction therapist, Thomas Tullos has worked and trained for the past seven years with Dr. Patrick Carnes, considered one of the nation's leading experts on sexual addiction. Tullos serves as Clinical Director at Gentle Path, a Mississippi-based clinic that treats sexual disorders.

QUESTION: Around the turn of the century, some mental health professionals were saying that not enough evidence existed to definitively say there was such a thing as Internet porn addiction. Has that changed?

ANSWER: Yes, mental health professionals as well as the general public are now much more aware of Internet porn addiction as being a part of the disease of addiction. There is a growing network of mental health professionals who are Certified Sexual Addiction Therapists, who are trained specifically with Dr. Patrick Carnes' 30 Task model to address the issues related to sexual compulsivity.

The way I see it, there is one disease of addiction, it's a brain disease that can manifest in many different ways. About 83 percent of those individuals diagnosed with the disease of addiction have more than one manifestation of the disease, which can include chemicals such as alcohol, drugs, nicotine, and processes such as overeating or restricting food, overspending, overworking or gambling; and, of course, sexually compulsive behaviors that include multiple affairs, use of prostitutes, frequenting strip clubs and excessive use of Internet sexual materials.

There is so much more to learn about this disease and certainly more research is necessary to provide data for future intervention and relapse prevention.

QUESTION: The idea of sexual addiction is startling for some people. What behaviors might indicate to somebody that they are struggling with an addiction and not just making poor choices?

ANSWER: As with any addiction, a person must meet clinical criteria in order to be diagnosed with a sexual addiction. A person must meet at least three of the 10 criteria to be diagnosed with a sexual addiction. Some of the criteria includes: the person exhibits a pattern of out-of-control sexual behavior; repeated attempts to stop or control the behavior without long- term success; continuing the behaviors despite the negative consequences to self or others; or feeling distress, restless, irritable or stressed when unable to engage in the behaviors. Certainly, the sexual behaviors are important to know, yet it is more about how a person is using sexual behavior to regulate their emotional life.

QUESTION: The recovery process for drug addicts and alcoholics has been well documented. What steps must a sex addict take to regain his/her life?

ANSWER: The steps are too numerous to answer in one interview, yet for the person struggling with sexually compulsive behavior, I think the first step is to admit that something is out of balance in their life and to seek a supportive person, a counselor or clergy person or friend and share what's going on with them. There are many treatment options available, and it is unnecessary to suffer needlessly.

QUESTION: It is now common for children to regularly view pornography on the Internet. Can you describe the impact of graphic images on a developing brain and speak to possible long-term effects?

ANSWER: With our patients at Gentle Path, we are seeing a generational divide with individuals who were children before Internet pornography was available and those born after the availability of online pornography. It is common in our patients to have some type of exposure to pornography as a child in their history. Of course, other factors may be involved as well in the formulation of addictive behaviors.

What we are seeing now is the rapid escalation of the disease process with those individuals who have more access to Internet pornography at younger ages. The sheer quantity, relatively easy access, the "real time" streaming video capability, the perceived anonymity and, most importantly, the extreme levels of stimulation occurring in the developing brain of children offers up a recipe for future disaster.

In real terms, the stimulation occurring in that individual's brain initially is like the stimulation occurring in a first time crack user.

Of course, over time, just like the crack user, an individual will develop tolerance and then need more of the "drug" to get the same level of stimulation as before, hence the need to look at more and more extreme forms of pornography and/or move into other forms of sexual behaviors.

QUESTION: Not everybody who sees a Playboy centerfold at the age of 7 becomes a sex addict. As with drugs and alcohol, are there some people who are more at risk to develop a sexual addiction?

ANSWER: Certainly, family history of addiction as well as underlying trauma issues are risk factors for an individual. Early exposure to sexual behaviors or materials, profound boundary violations and the lack of a consistent environment of healthy affirmation, nurturing behaviors and reasonable limit setting may play a part in the development of this disease.

QUESTION: In the preface of Dr. Patrick Carnes' 2001 edition, "Out of the Shadows, Understanding Sexual Addiction," he writes that "sexual activity on the Internet has fundamentally altered our sexuality." How and to what end?

ANSWER: I interpret this statement in that with the onset of the Internet, that even in the most remote parts of the world, a person can access sexual material that never in our history was available before. And people can engage in sexual activity with great access, with almost anyone with or without their permission in some cases (video voyeurism), and work in the shadow of perceived anonymity and have prolonged extreme levels of stimulation in the brain, the impact of which we are still trying to understand.

QUESTION: A common statement is that an alcoholic can purge his system of booze. A drug addict can clean up. But a porn addict cannot remove graphic images from his/her head. Is there a way for a porn addict to "deprogram?"

ANSWER: As with any addiction, there are struggles with urges or cravings and with sexual addiction there is the issue of fantasy, which is a strong component of the addiction. A person can fantasize any time they want about past images or experiences. So strategies have been developed in which a person can manage these aspects of the addiction and in a sense reprogram his/her brain.

The first task in Dr. Carnes' approach is to break through the denial. A simple tool used with most mental health clinicians is the use of affirmations, where an individual says affirming things to themselves to create new brain pathways and they strengthen the pathway with use. Of course, abstaining from the compulsive sexual behaviors for at least 90 days allows for the brain to begin its healing process from the high levels of past stimulation that occurs with the behavior.

QUESTION: It's estimated that 4 in 10 Internet porn users are women. What is it about the Internet that is appealing to women in such huge numbers?

ANSWER: I believe that it's the same reasons for women as for men: We are all sexual beings, we can all have family histories of addiction, experience trauma, be exposed to sexual behavior or material at young ages, and there is a profound need for all of us to connect to other people. Sometimes we choose to do it in unhealthy ways.

Certainly, we have learned that men are more visually oriented than women, but the Internet provides a menu for all those who wish to partake. Fantasy, romance, unlimited sex and extreme stimulation possibly to the point of overwhelming numbness are all there at your fingertips for both men and women.

QUESTION: Some in the porn industry argue that their product can have positive societal effects: in helping bored couples spice up their sex life; in allowing a disabled or physically dysfunctional person an outlet; in helping sexual abuse victims heal. Is any of this true?

ANSWER: There are always many sides to a debate. Not everyone who uses Internet porn is an addict, just as everyone who drinks alcohol is not an alcoholic. The current prevalence rates for sexual addiction are anywhere from 3 percent to 6 percent of the population. That percentage may be growing. Moderation is the key in living a healthy life.

I treat many loving, kind, generous individuals and their families who suffer from this joyless disease. I don't know what else I can add to the debate other than I see the pain daily caused by the dysfunctional sexual behaviors of those individuals we treat at Gentle Path. Repair is possible.