David Fawcett, PhD, LCSW; Understanding Sex Addiction

Montare Media presents Season 2, episode 14 of the Discover U Podcast with JD Kalmenson: Understanding Sex Addiction with David Fawcett, PhD, LCSW.

Learn More about Montare Behavioral Health: https://montarebehavioralhealth.com/about/digital-library/

JD Kalmenson interviews David Fawcett, PhD, LCSW, to learn about the somewhat still taboo topic of  sex addiction. Questions explored include; what makes it different from other addictive disorders? What are some of the underlying causes? Is it possible to be fully recovered? What is chemsex, and why is it so addictive? What are the best treatment modalities? 

David Fawcett, PhD, LCSW, is a clinical sexologist working in addictions and mental health for three decades. He wrote Lust Men and Meth, A Gay Man's Guide to Sex and Recovery, and is VP for clinical programming at Seeking Integrity, which provides treatment programs for sex porn and chem sex addiction. David produces the podcast, Sex Love and Addiction- healing conversations for men who have sex with men. And he produced the award-winning documentary Crystal City. He's on the ITAPs faculty for the rainbow advocate and educator certification program. And he is a highly regarded trainer, both in the US and internationally. 

Host Kalmenson is the CEO/Founder of Renewal Health Group, a family of addiction treatment centers, and Montare Behavioral Health, a comprehensive brand of mental health treatment facilities in Southern California. Kalmenson is a Yale Chabad Scholar, a skilled facilitator, teacher, counselor, and speaker, who has provided chaplain services to prisons, local groups and remote villages throughout the world. His diverse experience as a rabbi, chaplain, and CEO has inspired his passion and deep understanding of the necessity for effective mental health treatment and long-term sobriety.

Follow JD at JDKalmenson.com

Transcript

JD Kalmenson: 

Welcome to another episode of Discover U, our podcast exploring innovative and effective solutions to issues in mental and behavioral health. I'm JD Kalmenson, CEO of Montare Behavioral Health, a family of dynamic and comprehensive mental health treatment centers in Southern California. I am so honored and excited to introduce you to our wonderful guest today, Dr. David Fawcett. David Fawcett, PhD, LCSW, is a clinical sexologist working in addictions and mental health for three decades. He wrote Lust Men and Meth, A Gay Man's Guide to Sex and Recovery, and is VP for clinical programming at Seeking Integrity, which provides treatment programs for sex porn and chem sex addiction. David produces the podcast, Sex Love and Addiction- healing conversations for men who have sex with men. And he produced the award-winning documentary Crystal City. He's on the ITAPs faculty for the rainbow advocate and educator certification program. And he is a highly regarded trainer, both in the US and internationally. Welcome David! So happy to have you with us today.

David Fawcett: 

Thank you so much. It's delightful to be here. Thank you. 

JD Kalmenson:

Awesome. So to begin with, let's talk about sex edition in the broader sense. Other than let's just say gambling, most of the addictions of people familiar with are substance based, are chemical dependency. And here clinically I know that they're sometimes referred to as processing disorders. Can you give our audience an understanding of what sex addiction is all about? Maybe, you know, what's the history of how it sort of became a formal diagnosis, and you know, what are the parameters of it? 

David Fawcett:

Sure. You bet. You know, I think for many years it was assumed that to be an addiction, it had to have a substance involved like alcohol or cocaine or heroin. And the idea of sex or gambling or porn, or even food was considered pretty controversial in terms of calling it an addiction. And as we got better imaging techniques with F MRIs and pet scans and other kinds of imaging tools, we were able to really see that if I take cocaine or if I look at porn, my brain lights up in exactly the same ways, it's just two different methods to manipulate the same brain chemistry. And so it became quite clear that these were very definitely addictive disorders, so, behavioral addictions. And so when we use sex in a compulsive way, when we look at porn, when we gamble, when we engage in kleptomania, when we overwork, when we do high risk exercise, there's a bunch of different things that basically replicate the fight or flight syndrome, which sets off a lot of adrenaline and dopamine. And it's that chemical rush that is the intensity to which people get addicted with these addictions. Here in the US and Canada, gambling has made it to the DSM. The rest are under study, but I assume in a few years, we'll get there. But basically what we're understanding now is that those behaviors basically induce the same kind of chemical flow, particularly dopamine, which is kind of the star of the show that really induces this euphoria intensity that people crave. 

JD Kalmenson: 

So my understanding is actually that the dopamine release from sex is analogous to some of the stronger drugs and has an even more powerful release than some of the, the lighter drugs. Is that something that you've seen? 

David Fawcett:

You know, it's, it's true. Not as high as same methamphetamine, but just to put into perspective an orgasm, which is the most dopamine we can get from any human experience short of a substance, is twice the normal level. Cocaine is about three or four times that. Methamphetamine is about 1300 times that, so it's a huge amount of dopamine release. What we see and it's kind of apples and oranges based on the brain scans we have to do to get these measurements, but basically porn and sex addiction has the same kind of dopamine release potential as cocaine or cocaine use. So very, very strong. And so really of the, of all the potentially addictive behaviors, the most potent of the most alluring, if you will, are sex porn, cocaine, and methamphetamine, 

JD Kalmenson: 

So you're saying it's definitely stronger than gambling addiction from the dopamine release perspective. 

David Fawcett:

Again, I haven't seen those numbers compared gambling is extremely potent also. They work in the very same way because they, they create this like endless just very much like a Facebook feed that bottomless feed of dopamine or a gambling slot machine thing in Vegas, where you keep looking for the win, right. And our brain kind of starts to expect that and want that. And so they, they all set that phenomenon up in different or, or greater degrees of severity. Gambling is quite potent though for, and what we find is that certain individuals seem to be more susceptible to certain kinds of behaviors than others, right. So somebody might be more, and we don't know if this is biological, I'm sure it's a combination of genetic versus environmental as well. But some people that tend to be more drawn toward gambling them porn, but, but they have that addictive influence. Nonetheless

JD Kalmenson:

That is a very interesting point that you just brought up. If we're all sort of chasing this dopamine, it's just fascinating that some find it in this manifestation and others are more vulnerable and prone to finding it in another one. You reference the DSM  in the United States and Canada still doesn't recognize it as being on par with even gambling, let's just say, and given the neuroscience and the clear cat scans that are able to detect the, you know, what occurs in the brain, it's just, it's mind boggling that it still hasn't reached that level of recognition. Is there do, is there a reason that they're hesitating or vacillating on that?

David Fawcett:

Well, just remind you back in 1973, homosexuality was taken out as a mental illness, one vote so I mean, things move slowly and it's a very conservative group. And I think there's just I think it'll just take time and frankly, a younger panel coming on and making those decisions. They're very traditional, right? It is under review. And I don't know what the votes are secret. I don't know how close it got to be, be included or not, but I think so

JD Kalmenson:

Who, who votes on this?

David Fawcett:

There's a panel of, of members from the American psychiatric association. Okay. That are part of this special panel that, and they take it very seriously. I don't mean to demean them at all. They're you know, they're distinguished, and they take this very seriously and they wanna do, they have every good intention. But I think sometimes they're overly conservative to the point where it's kind of hurting people where there's clearly a disorder that we're not able to address really directly in this country.

JD Kalmenson:

Right. And, it is affecting people, because at the moment to receive treatment for sex addiction, my understanding is that you either have to be diagnosed with a secondary mental health diagnosis that would warrant medical necessity for treatment, or you can privately pay. But if, as far as insurance goes, they will not cover sex addiction in a primary diagnosis. Is that right?

David Fawcett:

That's absolutely true.

JD Kalmenson:

Yeah. So it does have very practical ramifications and implications for millions of Americans. When people talk about sex addiction, I think there's a big myth out there. And like with eating disorder, everybody who likes to eat jokes around and they say that they have an eating disorder. Right. And the same is true with sex addiction because, you know, there are plenty of people, I think almost all people enjoy it. And that's why there is some gray sort of murky area about what makes it an addiction versus just something that we enjoy that we like to do very often. So what are the parameters from a clinical perspective when somebody knows that they're not just, let's just say doing something that they enjoy very often, but that there are ancillary implications that this might be compulsive in an actual addiction.

David Fawcett:

 So we, we use the same 11 criteria in the DSM that we use for any other addictive disorder for drugs. So there's different 11, but the primary ones that we look at are an inability to control the behavior, a preoccupation to the extent of making choices to engage in that behavior, to the exclusion of other important events, whether those are work or family, and the inability to stop and inability to control the behavior. So basically as these behaviors becoming more and more out of control, and, and I've heard the same talk where people joke about gee, maybe I'm a sex addict, but to meet a real sex addict, there's such pain involved because there's betrayal and cheating on the part of the spouse. And people really do try to make an effort to stop. And they can't, they're acting out they're, it's just a really horrible kind of situation for people to be in. So I think, but it, but it's the same criteria for any addiction of just losing control and, and not being able to control it or, or manage it in any way whatsoever.

JD Kalmenson:

And there's probably, you know, as far as stereotypes, and as far as the lack of understanding sex addiction sounds to me like the way alcoholism was a hundred years ago, where it was just, you know, people viewed it as a disciplinary issue as a values issue. And then here today, we obviously know with the millions of Americans who attend AA meetings and the awareness and the type of widespread understanding that society has, that this is not a, a willpower issue, but that this is a disorder and there's something as powerful as an addiction that can make you do really destructive things. I think that, you know, that there, we still a bit of ways to go for that level of societal understanding in this domain, in sex addiction.

David Fawcett:

High, highly stigmatized. Yes. And, and do people still view it as a moral issue. And certainly there's an aspect of moral incongruity, right. If I'm a sex addict, I do things that aren't in line with my values and that's my addiction kind of pulling me to act out in those ways. So that's one of the healing processes of recovery is kind of getting myself back into integrity with myself and my behavior. But it's not a, it's not my moral incongruity didn't cause that behavior right, right. As a result of it, and it's not a moral issue to start with it, it wasn't a moral lapse, it's an addiction. And so I think that's the clarity that we need to have for people.

JD Kalmenson:

Yeah. Yeah. Most definitely talking about what leads to someone to sex addiction, the causations, the pathways I know with regards to, let's just say chemical dependency at, Montare, at Renewal, our organizations, we have an assessment where we've created three general categories that we've seen based on our experiences that have led people to chemical dependency. And the first one is you know, unresolved trauma and mental health that have not been dealt with therapeutically and psychiatrically that leave an individual with such acute pain that the mind-altering substance becomes a way to numb and silence that pain. The second category is circumstantial, and we define circumstantial by circumstances, really leading to a lot of the, the acting out a lot of the, the dependency and had life dealt them with a completely different set of circumstances, they may not never have ended up becoming an addict as it were. So the circumstances could be anything ranging from surgery, painkillers, painkillers, finishing. They were already susceptible. They have an addictive personality, but had that not happened, they may never have ended up becoming a full-blown addict. And then lastly, we referred to the third category as the intrinsic addict, which what we mean by that is that there is some sort of a deeper, highly, spiritually sensitive personality that they have, which requires a lot of meaning and purpose for them to feel good for them to feel like the status quo in their life is, is their equilibrium is there. And when they don't have that, there's a vacuum and there's a void that leaves no rest and it festers, and it pesters. And that's, I think that the most misunderstood category, and I feel like the, the 12 steps is the most amazing platform for that category because it's a real spiritual program that injects a lot of meaning and purpose and gives them the opportunity to live in such a sensitized manner. So many people could lie, but come home and eat dinner and look at their family in their face. And they don't, and they could live with that, but to this category because of the sort of highly sensitized nature of their, their, their, their psyche, they can't, that doesn't work for them. And I'm just wondering whether you see any parallel with these three categories, the circumstantial addict, unresolved mental health, or the intrinsic. Do you see any parallel between these three and sex addiction as having similar paths and cause pathways and causations to sex addiction? 

David Fawcett:

You know, I think there are certainly, I see all three of those in there. I think there's some overlap. I'm just now in the literature starting to see aspect, and I love your intrinsic category to what they're calling highly sensitized individuals, right? People that are kind of highly attuned, highly sensitive and, and have that kind of exquisite emotional reactivity, right. That, needs fine tuning if you will, and then they, they become more, I think, vulnerable to addicted disorders as a way of self-soothing. I think for sex addiction, because of the sexual component, what we see an awful lot of, of trauma, and if not outright trauma, certainly adverse childhood experiences. And usually not just one or two, but I'd say probably in excess of four or five typically, and very often, very, very often those include some kind of sexual abuse. And so I think, and if not sexual abuse, or very often in, in conjunction with sexual abuse, there's a family structure that's often very rigid or hierarchical or, or disconnected, right? So the child really has, has kind of no safe haven within that family of origin. And I think so people become very independent. People learn very soon that they have to take care of their own needs. They often are sexualized very young. So they learn that sex is, but not only a currency for validation for themselves, a way to get respect and attention from adults, it's a way of getting validation. It's a way of, of soothing, all kinds of feelings. They often learn how to compartmentalize and drop into fantasy easily is a way to just disconnect. So there's a lot of these patterns that are set in that kind of family of origin early on that, that kind of feed and grow into this addictive behavior, or at least set the stage for it as an adult. I think unlike substances, because of the potential role of sexual abuse, to kind of what we would say, kind of skew the arousal, temp, the sexual arousal template, it can really impact someone's sexual taste, someone's sexual fantasies as they get older, that can be a real issue for people, and so I think that's slightly different maybe than some of the substance issues. Although I think it's that kind of trauma base is really typical. The opportunistic piece perhaps is less common because I'm thinking of, you know, the athlete who's injured who gets hooked on opioid medications or something like that. We don't see that as much with sex addiction. Although we do see an awful lot of opportunistic entryways into addiction, you know, finding your father's porn stash, for example, or, or that, that could just kind of accidental stuff like that. That can just trigger something that, and I have guys, I have adults who are, you know, 60 years old who vividly remember that those first images they saw, you know, 50 years ago. So those things burn into, and that was just kind of a chance encounter. And that kind of set a stage for this development, this whole fantasy of life for the rest of their adult lives. And so I think those kinds of opportunistic moments kind of, sort of fit those circumstantial categories you were speaking of before. 

JD Kalmenson:

Right? Except I'm, I'm wondering, you know, whether it comes to the circumstantial addict, you sometimes find folks in their forties and fifties, who've never struggled with any type of chemical dependency with any type of substance abuse somehow because of the circumstances and define their way there at such a later advanced stage in life. Do you find any parallel to that in the sex addiction space?

David Fawcett:

Totally, and it comes in specifically and in a lot of the guys I treat who combine amphetamines and sex, right? And so I do a lot of work with men who have sex with men who are now in their fifties or sixties, and they're feeling less attractive, less energetic. They talk about when they walk down the street, nobody really sees them anymore, they feel invisible. They feel kind of unworthy. And so certain drugs like amphetamines make them feel, they fill them with self-confidence. They make them feel sexual. They give them all kinds of energy. And so I'm seeing these guys who were never in any way, addictive, who are now hooked on cocaine and methamphetamine and sexually acting out in a way, because it's, it's their way of kind of dealing with their fading, you know, youth, I guess, in a very counterproductive way, obviously. 

JD Kalmenson:

That leads me to my next question. I, my understanding of sex addiction is the dependency is not necessarily about the sex, but around the feelings that surround it, the lead, the lead up the, the, the rush of emotions, the chase, and that really makes so much sense based on what you're saying. The, the validation piece is so powerful because we all crave validation. Even if we're not needy about it, it's an existential sort of need because it justifies our existence. And so if somebody's feeling insecure and they're not feeling affirmed, then being lusted after, as it were, or being desired, becomes a very sort of tangible way for them to feel validated in the here in the moment. 

David Fawcett: 

Absolutely. Absolutely. And, and we see that all the time, especially when you add computers into it and the kind of pseudo intimacy that you know, relationships with air quotes can occur. Right. If you're talking to someone online or you're paying someone online, to kind of act out with you, there's this intimacy that occurs and you get validation from them, but it's all transactional. And, and even if you're paying someone in person to do that for you, whether it's an escort or, and whatever they're you're doing with them in every case, people come away feeling just so much emptier. It backfires, there's a, there's a brief, it's like to sugar high, you get a brief hit of dopamine, and they just end up that much lonelier… same thing with guys. Clients said that hook up with, they've had, you know, 400 sex partners. They're the loneliest people in the world because they're just, they're looking for that connection, but they're looking in the wrong way. They're not getting an authentic connection. They're hooking up, but it's not going anywhere. 

JD Kalmenson: 

Right. And that's clearly one area or one genre, but let's just say somebody who is addicted to pornography, it would be hard to imagine how that could be a validating experience. It's so  you know, what, you know, what type of affirmation of validation could occur at that front? Is there sort of another category where it's just the dopamine released that drives the dependency?

David Fawcett:

I, I think, yeah, maybe slightly different. I think what, what happens with pornography, there's a certain kind of personality that's drawn to that because when you're looking at pornography, you're in total control, mm-hmm, <a, there's no vulnerability, there's no exposure, there's no emotional risk. You don't have to go and meet somebody or, or share anything about yourself. You know, you're controlling the scene, you're controlling the fantasy, you're controlling everything. And I think that appeals to certain people, because there's no emotional risk, they, they can be in their own world and control the fantasy. And that makes, and the more they immerse themselves in that, the harder it is to engage back in real life. Right. It gets almost detached from real life, but it, and that's one of the, the STR the skills of recovery, one of the strategies of recovery is to teach people how to really break back into the real world and connect in authentic ways emotionally.

JD Kalmenson:

Right. That makes sense. A follow up question to that would be is cultivating healthy intimacy, a really powerful antidote to the addiction, to the disorder?

David Fawcett:

You know, I think earlier we talked about some of the I guess co-occurring or underlying disorders. I didn't mention, I probably should have one thing I think probably every sex addict has is an intimacy disorder. I think every addict I've ever worked with just doesn't know how to be intimate. And that may be from their own abuse or just growing up in a dysfunctional family or whatever reason, but they just don't know how to connect in healthy ways. And a lot of their connection is sexual or transactional, and they don't know how to be emotional and compare that with just how we socialize men in this society. Right. Which is not great in terms of emotions. So I think that how to be intimate is just almost nonexistent. And so I think, yeah, that to cultivate compassion, empathy, intimacy, you know, trust, vulnerability, all those aspects that are kind of alien to guys, at least when they first come into treatment those are the, those are the skills that I think are the key. 

JD Kalmenson:

As far as the unresolved mental health or other co-occurring mental health diagnoses, what in your experience have you seen linked most with sex addiction that might be you know, a precipitating sort of diagnosis to the sex addiction, or that makes one more susceptible or vulnerable to sex addiction? Is there any specific mental diagnosis, whether it's bipolar or attachment disorders, what have you seen in your experience that really more often than not end up being linked to a co-occurring sex addiction? 

David Fawcett:

Right. That's a great question. So I think what we try to do is kind of a differential diagnosis, because you can have sexual acting out that looks like sex addiction, but if it's driven by a bipolar manic event that really isn't an addictive disorder per se, it it's driven now. It could be, but we we've had many people with sex addiction who are also bipolar. But we have to really kind of do some fine tuning on that and see what's driving it because you can have people acting out due to their bipolar mania that are not sex addicts. So we have to kind of separate that out. Same thing with, with obsess compulsive disorder, people aren't getting the dopamine high from sexualizing out. They're kind of resolving their anxiety with it. So we kind of look, those are a little bit on the side, but trauma, as I mentioned, for sure, the two main ones I would say are anxiety and depression are the ones that we see most often playing out throughout. And, and I would say you mentioned detachment disorders as a category. I think that's profound. We see an awful lot of people who are in that that quadrant of fearful avoidant. And I think that also goes back to that, that kind of disrupted family of origin stuff, where people are desperate for connection. Like, come here, come here, kind of borderline come here. But once they, but people get too close, whoa, go back. I'm feeling overwhelmed, and engulfed. So there's this push pull thing all the time, but I think those attachment issues, but I would say just good old anxiety and depression are the ones that we…

JD Kalmenson:

That's very, very eye opening because so many people struggle with anxiety and depression, yet they don't end up becoming addicted to sex. So is there a rhyme and a reason why some are more susceptible to that particular way of medicating themselves and getting rid of those feelings or looking for a temporary distraction, whereas others would never think of doing that as a way to self-medicate?

David Fawcett:

You know, I think this is kind of where we're on the edge of what we know. Right. I, I think there's a, a genetic component to addictive disorders. We know that's true for chemical addiction. I suspect it's probably true for different kind of behavioral addictions as well, different tendencies, even patterns that are passed on from one, a lot of the guys that we work with when we do a family history, they'll often try to identify and, and see that usually their father, sometimes their mother were both were in some ways acting out sexually. So I think sometimes these patterns do persist and it's, it's learned to some extent. In other cases, people learn from their peers for that, going back to that validation thing, their peers acted out. Sometimes, you know, boys will be boys kind of stuff and their fraternities or whatever. And, and some of some guys just kind of never grow up after that. They continue that acting out behavior. So I think there's kind of many pathways. You’re absolutely right. A lot of people have anxiety and depression, but not everybody becomes an addict, but I think there are other kind of X factors around the edges there that, that create that outcome.

JD Kalmenson:

Yes. And that is so interesting because people don't necessarily associate depression, anxiety as you know, co-occurring disorders that are often coupled as sex addiction. So I think that is very interesting. You know, when people read in the news about sexual predators in any area in domain, a lot of them assume that they're sex addicts. Is that a legitimate assumption, or are the two completely unrelated and a predator is a predator, and it doesn't have to be an addict that doesn't have to be an addictive inclination that's fueling and driving that predatory behavior. What are your thoughts on the correlation between the two?

David Fawcett:

No, it's a great question. I really appreciate it too, cuz it's in my experience, those two are very, very different things. At Seeking Integrity, we treat sex addiction. We work very hard to rule out and keep offenders from coming in, but the offender behavior, the offender is not getting their dopamine from the acting out, the preoccupation in the way, the traditional way, at least the sex addict would do that. The offender is getting their dopamine and their other neurochemicals from more power and control, from manipulation. It's more about taking advantage of people and actually and worse. And so I think it's a very, very different mindset and much more and you know, every population of a certain degree of antisocial personality, but there's a much more the way I kind of distinguish the two in very crude categories:

The offending behavior is largely antisocial. The sex addiction population is largely narcissistic. And, and they're very narcissistic, but in my experience, they're narcissistic, I guess, tendencies because they're narcissists who can be taught compassion and empathy, which I guess isn't a true narcissist. But they have those self-centered entitled, you know, it's all about me kind of thing, but, but they're teachable for the most part. And I think that's the difference. In my opinion, offender is a pretty hardcore and a whole different mindset. That's that doesn't really respond to any of the things we do in terms of treatment for sex addiction.

JD Kalmenson:

Very different. That's very powerful to know yeah. That, that recovery for sex addiction does not necessarily spell recovery for offenders.

David Fawcett:

No,

JD Kalmenson:

Yeah.

David Fawcett:

There are people that have both, right. But I right in my experience there's primary one or the other

JD Kalmenson:

And even if you do have both, they're two separate issues and diagnosis that have to be dealt with, and that's the point that they're not one in the same. All right. So we've talked about a lot of components of the addiction. Let's jump into the recovery. What does the recovery look like? I mean, when you look at sex addiction, it seems to be more similar to the eating disorder recovery model, which is to regulate the behavior as opposed to the total abstinence model that you'll find with substance abuse. And that leads me to the age-old debate that you find that a lot of these disorders eating disorder and in substance abuse, does one recover or is one perpetually in a state of recovery? Does one have the option or the ability, is it possible to truly put it behind you and to now sort of not identify with that at all? Or is it something that will be lurking in the back of one's mind and you gotta constantly be vigilant and really make sure that you never lose sight of that potentiality lurking latent right underneath?

David Fawcett:

Right. It's a complicated answer. So, so you're right with things like with sex, obviously the goal is not to just be abstinent. You know, like now I'm a recovering alcoholic. I could, I just never have to drink again. Easy, done. But as a sex addict, the goal is not to give up on sex. The goal is to integrate sex in a healthy way. And so that the methodology there is, it's what what's called a circle plan, which is a, basically three concentric circles. The innermost one defines the behaviors that represent relapse. And the beauty of this by the way, is that the behaviors that represent relapse are different for every sex addict. Right. I might be able to masturbate as part of my recovery, but somebody else might not wanna masturbate for 90 days. And these things can change too, by the way, prefer, say for the first 90 days, because that leads me into other things. And so that's, that's not gonna be one of my recovery behaviors. Initially, at least somebody else might be able to look at porn. Somebody else might not. So there's Who determines that is that you and your therapist, who's gonna analyze where the compulsive nature of the behavior begins and where it ends?

David Fawcett:

Exactly. So it's a, it's a collaborative effort. So before somebody goes home from our program, we sit down as a therapist, the client, and oftentimes the, the therapist at home. And then once that person goes home, they'll bring in a sponsor. And these things are like contracts, right? They, they can't be just changed willy-nilly cuz I feel like it one day, but they have to be kind of negotiated. They can be changed, but, but we encourage people to really not changing 'em often, but it has to be done with some accountability. So if I say if I've not been masturbating, but I said, gee, I think I can do that safely now. I can't just say I'm gonna do it, I gotta run that by my sponsor, my therapist, and it's, it's a way of, of identifying different behaviors that may or may not be problematic. 

David Fawcett:

So the, the innermost one is relapse. There's a middle circle. That's I get, I call them like the red, like traffic lights stop. The middle circle is not the innermost, but the middle ring is yellow, like caution, right? Slippery slope. That might be going on an app like Tinder or going to dangerous places or going to a bar or meeting somebody or calling in a fair partner or, you know, whatever it is for somebody. And then the, the outermost circle represents behaviors that are other, other ways of getting dopamine, basically healthier behaviors. You know, spending time with my family, spending time, working out, listening to great music, cooking, doing things with friends, you know, whatever those might be playing music, those are kind of healthier behaviors. So that's how we kind of distinguish and it's, it allows us, it gives us a model to differentiate certain kinds of behaviors so we can tailor it to different situations for people. 

JD Kalmenson: 

Right, right. It would, it would seem to me that the pathway and the causation that led somebody to sex addiction, just like the pathway and causation that leads somebody to any type of substance abuse would be heavily instrumental in determining whether the recovery can be sort of final at absolute or it's an ongoing journey. Do you feel, or do you see any evidence of that, that based on the different sort of profiles within sex addiction that really determines what the recovery looks like?

David Fawcett: 

Yeah, I think so. We're talking about these behaviors, right? Whether it's masturbation or watching porn or whatever I'm a sex therapist and sex addiction therapists, both. And, and I do a lot of work with what we call the arousal template, which is that map in our heads of what's erotic, right? And we know from addiction that especially these high intensity dopamine, rich addictive fantasies, they lay down these really potent fantasies that are directly connected to our addiction and they don't go away. They stay in our brains, and at any moment, well into recovery, we could reignite those things and they're very powerful. They can lead us off the path very quickly. And so some of the strategies we talk about with our clients is kind of how to avoid those hotspots in our brains and redirect our erotic energy into different areas. And that maybe, and that's one of the challenges of recovery by the way, because for a long time in early recovery, people lose sexual interest because there's nothing that matches that intensity or that dopamine rush that they used to get from porn or acting out or any of that, just their wives or their partners, or just normal life doesn't do it. And now that comes back, but it's an adjustment, and they have to kind of really retrain themselves and re redirect their erotic energy, if you will. 

JD Kalmenson:

That’s so interesting. You talked about the arousal template and I'm sure that's something, you know, so nuanced and detailed that it might be out of the scope of, of our discussion, but in a nutshell, does that have a lot to do with an individual's experiences? Does that help shape inform that? Or is there a lot of subliminal, subconscious Freud and sort of influences in that arena of what makes somebody get aroused by this? And somebody else get aroused by that? 

David Fawcett:

You know, again, it's, it's really complicated. It can be, some of is genetic, like sexual orientation, for example, and other kinds of aspects. Some of it is cultural, you know with fashion trends and what the church says morally and laws and things like that. TV shows, things like that, culturally. And so there's, there's many different factors, but, and a lot of it is, is experiential. And so and, and including negative experiences. So if I'm sexually assaulted, that's gonna affect my arousal template and for better or for worse. Right. We see that as an impact of children that are sexually assaulted, they are permanently, their arousal templates permanently damaged, and that will affect their sexual tastes and, and sexual self-image if nothing else for the rest of their lives.

JD Kalmenson:

And even if they, if, if they treat them, if they get treatment for trauma and they successfully undergo trauma treatment, you said the word permanent and that's very definitive. So that, that that's something that might never change.

David Fawcett:

I, I think what the treatment can do and I, I do trauma treatment myself. I think what it can do is help people learn to live with that in some way, do workarounds in some way, do some resolution so they're not triggered every time certain things happen. And so they're, you know, happier people, are kind of at peace of themselves. But from an arousal template point of view, from a sexual point of view, those aspects are pretty much there. And I think we have to kind of learn to work around them, for example, somebody who's been assaulted early on might have that kind of what I guess, Freud would call it repetition compulsion, right? To keep doing that over the, over the course of their lives. And I think with trauma therapy, we can interrupt that cycle and help people understand that and not do that, but the impulse may still be there. And some of that damage may always be there, but they may not have to react to it in a harmful way or a self-harmful way.

JD Kalmenson:

So interesting. So even with decades of, let's say alternative patterns being created in the brain, the arousal template is sort of really etched in and it's, it's fixed, it's here to stay?

David Fawcett:

That's pretty much what our research shows that it, it just, those things are there and they can't really be taken out. 

JD Kalmenson:

That makes sense. And you mentioned that it would be impossible to remove something from the arousal template, but can new healthier alternatives be added? 

David Fawcett:

That's the beauty here. The way our arousal template gets kind of, and I, this is not my word… some of the literature talks about being perverted is, is through neuroplasticity, right? The brain is constantly changing wherever we turn our attention. The brain kind of goes with us and tries to help us out. And so these experiences, these life experiences, the kind of porn we look at the kind of things that happen to us, all that goes into our arousal template and starts to inform our erotic fantasies for better, or for worse in much the same way in recovery. We can start to retrain our erotic focus toward healthier things. So part of the recovery strategy for the folks I work with is really looking at intimacy skills and what is healthy sexuality. And most of us don't know what that is, right? And so we're starting to look at that and understand things. Sex therapy techniques like sensate focus, which is a touch exercise, an intimate touch exercise. There are ways of kind of rewiring that part of the brain in a healthier way, right? So we're not stuck with that. We can use that concept of neuroplasticity. The brain is always changing to teach it new things, right? Leave the old stuff behind

JD Kalmenson:

That makes so much sense. 

JD Kalmenson: 

You know, being that this is not DSM recognized as if yet in the United States in Canada. So the interventions and the treatments are probably not as standardized, but what would you say in your experience are the gold standards of treatment? Obviously, every individual is a unique composite, with myriads of really unique details that go into what led them here and what their treatment should look like. But as a whole, if you had to generalize, what are the most powerful and effective interventions that you have found in your experience? 

David Fawcett: 

I think there's a couple, I think just in terms of modalities group is an incredibly powerful force, just that group modality of other guys. And I, by the way, gender-based groups of men, groups of women are the most effective that group process. We do timelines, like life stories where people pull it all together, or it's a big project doing times of their life history, their sexual events, their substance use their major, you know, acting out, and kind of put all the patterns together. We do impact letters from spouses, and they’re read in group about what, how this for example, how my husband's sex addiction impacted me. These are incredibly painful letters of betrayal and they're read in group. And all the guys say these are things I've heard before, but suddenly in the context or group, where they're kind of a little more vulnerable and open, they can, it's the pathway toward compassion and empathy. It starts to open it up a bit. So those letters, and I think ultimately ongoing care, this is not a quick fix, I would also say really, because I really believe trauma or at least traumatic adverse experiences underlie a lot of this, that really has to be addressed at some point. And I think to do that too soon, because I, I view addiction as someone's primary coping mechanism, right. And if we take that away, and then start doing trauma work too soon, we can really upset them. I've seen people relapse from some well-meaning therapists, starting trauma work way too early before the person had the ability to regulate themselves. So, but trauma work at some point. And then in sex addiction, very important, important if you wanna heal your relationship, there's something called a formal disclosure process. When this, this involves the addict’s therapist, the spouse's therapist, it's a formal basically clearing that this is what happened, the whole thing out on the table once and for all. And it's, it's a very formal process that involves a lot of back and forth and trust. And it's the whole point of that is to clear the air and start over. And it's a, it's like a baseline for healing. And if a couple intends to go forward and heal, that's a really critical benchmark for them to do. 

JD Kalmenson:

That's interesting because you don't find that formal disclosure being as vital in other areas of recovery, like chemical dependency and gambling,

David Fawcett:

I think because of the nature of sex addiction, it's just so personal.

JD Kalmenson:

Right, and secretive. And such a betrayal of trust.

David Fawcett:

I mean, we get guys who have had affair partners in their, in their bed at home, you know, their wife's bed and things like that that are just such are sleeping with the wife's sister. There's these ultimate just horrible betrayals that have to be talked about and cleared. And the thing is, and the addict always thinks, well, maybe she'll leave me. Well, maybe she will, but at least she has the right to know. And then make her, you know, you can't really decide whether to go forward or down unless everything's out on the table. So, right. But you're right. I think because of the nature of sex addiction is so personal in that regard, it's different.

JD Kalmenson:

Right. And then you mentioned the word earlier sponsor, and that's a word that has to do with the 12 step program. 12 steps, everybody knows the 12 steps, it's worldwide millions of followers. And I know that there is this fellowship also for, in the world of sex addiction. Is it as powerful as the 12 steps for drugs and alcohol? Is it different? Is it unique or, you know, is it just, you know, the same basic model being applied and integrated in another disorder?

David Fawcett:

I would say it's pretty much the same basic model. Like, like other areas, there are different fellowships that have sprung up. They, and they have slight variations there. The original one was Sexaholics anonymous, SA and they actually defined recovery for you as heterosexual monogamy, which was fine for some people, but not for everybody, obviously people that particularly those of us who aren’t heterosexual. So, but there's others SA, a SCIA, SCLA and so on. So there's other kind of fellowships that some of, sometimes they're just more popular in one part of the country than another, sometimes there's slight variations, some are more amenable to people that use drugs in addition to sexualizing out. So I always recommend to my clients to kind of go around, see what, see what feels the most comfortable in terms of fit. But I, but the 12 step programs are certainly an, an essential aspect of recovery from my point of view for this disorder.

JD Kalmenson:

Sure. So in general, treatment for sex addiction would typically be gender specific, right?

David Fawcett:

Totally. Yes. In my opinion, yes.

JD Kalmenson:

Right. And that, and that makes a lot of sense. So I mean, an interesting question that comes to mind is when you're, you know, when you're dealing with a gay population, does that create any type of a different dynamic with the group, or it's just, everybody's here for the same reason to get better. And nobody sort of allows the sexual tension in the room to distract them.

David Fawcett:

You know when Dr. Weiss and I were creating, Seeking Integrity, I've worked mostly with gay men over my career. He's worked one through straight men. And, and when we decided to work together, I said, well, of course we'll have to have separate groups. And he goes, why? And, and we went with one combined group, and it's been amazing. And I found it very healing in that, in my experience, the gay guys who are kind of afraid of these straight guys, they can, they they're both are demystified for the other. Right. They're both, both become vulnerable. And they, they relate they, after the first group, basically, they're just guys. And they can really learn from each other. I found it be tremendously healing and, and basically a non-issue. And, and that, you know, once in a while, like in any therapy group, if there's an attraction or something that comes up, right, we deal with it in group, or we address it. But, but it was so much of a non-issue. I was kind of astonished.

JD Kalmenson:

That's amazing. Cause you thought it would be yeah. But then turned out not to be. 

David Fawcett:

Right. 

JD Kalmenson: 

Right. Right. So now you've done a lot of work with co-occurring drug use and sexual disorders. How does the addition of the drug addiction, the drug component impact somebody with a proclivity towards sex addiction? Does it get treated as two separate sort of disorders, but obviously they're interconnected, they're intertwined. 

David Fawcett: 

So we in my approach over the years, that actually has been to really look at them as a single disorder with two different expressions. Right? So because the dynamic is the same, it's two different ways of getting dopamine. It's all about that manipulating brain chemistry with just two different avenues to do it. Now the recovery strategies are different, right? One is abstinence. One is, is that circle plan I mentioned it's more tailored, but overall it's the same stuff. And it's the same stuff. I, I do recommend for clients that have both that they engage in two different 12 step fellowships, which sounds a bit tricky. And I, the danger there is kind of splitting and stuff, but generally the 12 step programs for drugs and alcohol don't wanna hear about sex and the sex programs don't wanna hear about drugs. And so people that use both have nowhere, no safe space to talk about how those things intersect. And that's been a real problem sometimes. And so like I've created a work group on Tuesday nights that I moderate where people can talk about that. So right. Just, we're trying to create more safe spaces where people can talk about how those things intersect. Cause they'll get shut down in most traditional 12 step meetings. 

JD Kalmenson: 

And what you're saying is because they're two expressions of the same addiction. So it's, it's, it's difficult for somebody who's suffering from both to go to a 12 step meeting, strictly dealing with drugs and to talk about their drug addiction, which is so intimately associated and intertwined with another addiction that they're not allowed to talk about. And the same is at the, at the sexual you know, at, at the sex addiction, 12 step support group. So that would basically mean that it's very difficult for somebody who struggles with chemsex to end up being recovered from just one without the other. That's probably very rare.

David Fawcett:

Yeah. I don't even recommend people to try that because it's extremely rare. And, and usually if one relapses on one, the other will follow soon behind, right. It's this the two. And, and I, I use the term fused in the brain when, when you do those things repetitively and there are, they're neurological reasons for this, but those two things get fused where they're, they're almost inseparable. One, one will trigger the other in terms of cues and triggers. And so it's, it's almost inescapable really. And, and even to, to the point where I've had meth clients who never had a problem with alcohol saying, why can't I have a beer with my friends, never had a problem with alcohol, but alcohol will, disinhibit their desire to stay away from meth, and sex. And so even the meth user, I recommend saying we have an all abstinence, abstinence from all substances, including alcohol. But so it gets tricky in terms of how we start to define this.

JD Kalmenson:

Yeah. It makes so much, I mean, it's tricky and it makes sense that you have to really treat them as one and the same. What are the biggest obstacles that you find to sustainable recovery from sex addiction? 

David Fawcett: 

 I think people had that initial period we spoke of where you, I dunno if you wanna call it a sexual anorexic period, but they have very low sexual desire. They get frustrated. And after usually several months, their sexual desire starts to return or else they push it and, and they don't know how to control it. And when it comes back, it's this urge that they feel they want to go act out on. And it's, it's very difficult to kind of reinitiate any kind of sexual behavior or control the urge when it starts to come alive again. 

JD Kalmenson: 

Here they thought they thought they've recovered because they had, they weren't experiencing any desire.

David Fawcett:

It was just kind of dormant,

JD Kalmenson:

Dormant. Right. They thought, and then all of a sudden it hits them outta nowhere and they don't know what to do with that.

David Fawcett:

Right. And the other thing, this is true for sex addiction too, but also true for chemsex, the, in the memory of it. And then in that arousal template, the dopamine lays down such high intensity fantasies that they're very powerful and they can be very triggered very easily. And so seeing I've had clients see their somebody they used with on the street six months later, or get a text from a dealer a year later, or just, just some single random event can trigger this whole, like, like sweating kind of craving shaking urge for the drug and, and acting out. So the potential for really strong triggers lie everywhere. And I think that's the danger that people have to be really vigilant for a long time. And that's what is tricky, I think, to, to do. And the other thing, if I could just say one more thing with methamphetamine, particularly meth, unlike any other drug damages, the, the dopamine transport system, which means when, when it sits on that dopamine receptor it's neurotoxic, it actually destroys it. 

And so with chronic meth use, you're destroying your, your dopamine system for distributing it. The good news is it comes back, but it takes up to 24 months to come back. And when you don't have good dopamine transport in your brain, you're, you're depressed, like seriously depressed. Meth users call it suicide Tuesdays after a weekend of partying you're, you're impulsive, you're hopeless. And so there's this period of what we call anhedonia for, for three or four months where people are just miserable. And it's really hard to get through that because, you know, a day without meth is like nails on the wall kind of thing. And if you're not feeling any improvement whatsoever… I've had my clients in that state say, well, nobody really ever gets sober from that, you know? And I, one guy said, and if they do, they obviously didn't know how to use meth in the first place. It's like just that, that this disbelief that anybody can really do this. So there's that, that head space that makes it very hard to sustain the recovery. 

JD Kalmenson:

That's so challenging.

David Fawcett:

Yeah.

JD Kalmenson:

So David, I know that when it comes to chemical dependency, it's vital for the recovery process, that folks leave the comfort of their house wherever they are, and enter into a 24 hour inpatient program to be able to recalibrate and really be receptive to the message of recovery when it comes to sex addiction. Is it the same sort of vital benefit for folks to leave where they are andenter into a program or can a lot of the lessons and insight and intervention occur online through zoom meetings and through other outpatient levels of intervention? 

David Fawcett:

In my experience, I think if people could do it at home on a zoom meeting or by reading a book, they would do it and they can't. Right. I think we have found with sex addiction; people really benefit from that safe container of a safe place where they can get away from their electronics, get out of their home where there's a lot of stormy dynamics with their partners or wives or husbands and kind of just get away and out of the environment for a while and into a group setting where they can really focus. Also sex addicts really jump at their work a lot as a distraction. So just really pulling them outta their lives and focusing on the issue. That's really, I believe essential plus sex addiction has a little bit of withdrawal also in terms of mood, people get very anxious, very irritable. So that's also kind of useful to help monitor 

JD Kalmenson:

David, thank you so much for shedding. So much light on this topic that is still like you just referenced so taboo and stigmatized, but so necessary for so many. And the information that you shared was really enlightening. So thank you very much for joining us today on the discover you podcast. How can people find out more about you and the work that you do?

David Fawcett: 

Yeah, you can look at our website, which is seekingintegrity.com. And I also wanna point out, we have a sister site that has a ton of free resources, free weekly webinars, including the chemsex support group mentioned. Dr. Rob Weiss does a free sex addiction support group every week. These are weekly groups, that's sexandrelationshiphealing.com. There are groups for professionals, for partners, for sex addicts, all kinds of stuff, podcasts, a ton of resources, all free sexandrelationshiphealing.com and seekingintegrity.com. 

JD Kalmenson: 

Awesome. 

And thank you audience for joining us too. I hope you enjoyed today's episode of Discover U.  At Montare, we want you to know that you're not alone on your journey, and to find out more about innovative treatment programs, you can find us @montarebehavioralhealth.com and you can listen to our Discover U podcast on iTunes, Spotify, or wherever you get your podcasts. Wishing all of you wonderful health in a safe and productive day. See you next time.