Addiction or Choice? Understanding Sexual Compulsivity, Responsibility, and Recovery (Episode #139)

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Welcome to the Human Intimacy Podcast. Dr. Kevin Skinner with Marianne Michaelis, licensed clinical social worker. I often am asked, uh, so who's the social worker? Marianne's a social worker. I am a licensed marriage and family therapist to our listeners, if you're asking. So yes, I'm trained as a marriage and family therapist. So I do a lot of couples work. Anyway, so that being said, now that I've got that out there, I've answered that question. So Marianne, today's topic, talking before the podcast, something that's really been in your mind a lot and something that's coming up is, is this an addiction or is it choice or somewhere in the middle? And today's topic is really answering that question. Where would you like to start, Marianne?

So Dr. Skinner, as you mentioned, this is something that I've been seeing quite a bit in my clinic. And what I'm seeing is clients, especially betrayed clients who are trying to understand that question. I don't understand sexual compulsivity. What does that mean? Like the addiction, what does that mean? Versus is my spouse or partner, are they choosing these behaviors? And I think why this is such an important conversation is that I think that as a betrayed partner, we're trying to make sense of what just happened. We're, because of the impact on the reality, my whole world as I knew it, everything that I thought that I knew and understood. has just blown up and I'm trying to regain my footing. And so this question of, how did my partner do this? How can I even make sense of this? This is a really logical place that most betrayed partners go to. What does this mean to me? What does this mean about me? And so there's all these questions in this space that are trying to be answered. And how did this happen is the biggest one. Let me make sense of it. I often see my clients who are grappling with this question. What they're really grappling with is, if I can intellectualize this, if I can make sense of it, then maybe I won't have the same pain, the grief, because if my partner made a choice and every time they acted out, they were intentionally not choosing me, that must mean that I'm not good enough, that there's something wrong with me, that I'm unlovable, that I'm defective. And so I'm trying to grapple and kind of pull this apart to really make sense of it. So it's such a valid question that I think every individual who's been betrayed goes through trying to make sense of their experience.

You know, and Marianne, my first response to what you've just said is something that we often say, and many betrayed partners just like They don't get it. It doesn't make sense. And it's, here's what I say, like, your spouse's behavior is their responsibility. And then the harder part is it's not about you. And that's where I often hear people say, I wish I could believe that.

Yes.

I wish I could believe that, but I can't believe that. I mean, obviously there was something that I did wrong. There was something that was wrong with me. I wasn't to whatever enough. And when I see people truly healing, they really do draw the conclusion, this wasn't about me. Even if their spouse blamed them, the healthy response is, I'm still not responsible for your choices.

I agree with that. And I often see what you said. My clients will say, I get it here. I get it in my head. Makes sense here. But in my heart and my body, what I've internalized about that, my internalized belief, Doesn't match what I can intellectually. And so there's this discrepancy between the two, but that point of that, that point that we get to that you're talking about of, oh, this isn't about me. I usually see that coming down the road. Most of my clients aren't there at the beginning. It usually takes time as they're doing their therapy, as they're working through.

Mm-hmm.

all of their emotions. It's usually something that I see happen later on down the road, that there's something that shifts and they go, oh, okay, now that shift, now that's aligned for me.

And for some people it is understanding it through the lens of an addiction model. For other people, the addiction model feels like a cop-out. And so I've seen it go both directions. Oh, okay. I can understand the addiction model. We've seen escalation. We've seen withdrawals. We've seen You know, an increased tolerance. We see the typical addictive behaviors that, that makes more sense for some people. And for other people, like, no, that's just a stupid excuse.

Let me dive into that a little bit more. I know in grad school when I was learning about the addiction model, I also heard it termed as the disease model. And it was the way that it was taught to me was this is something, it was almost like, this is something that happens kind of like cancer that you can't You have no control over. You can't do anything about. And my mind was like, well, wait a second. There are behaviors that are here. Like, I don't know that I can control whether or not I get cancer. Maybe there's some lifestyle choices I can do, but that may or may not determine whether or not I get cancer. But an addiction, whether or not I'm drinking alcohol or bringing a substance in, Mm-hmm. or accessing substances that become addictive, that does feel like that's more of a choice and not just something happening with my genetics or my body. And so as, as you're talking about that, the addiction model or the disease model, as it gets tied in there, it gets very confusing. It's very, very confusing.

Well, let me just go through a story then. So in my career, I've heard many stories. So I'm going to put many of these stories together. I'm 4 years old. And my first exposure to pornography is my mom's boy— live-in boyfriend who has pornography all over the place. They're in a fight, they're in an argument. And my mom comes to me and says, hey son, just look at this, as a way to distract him away from the conflict, the fight that was going on in the other room. It was a pornographic magazine. Now I look at that story and how often does a 4-year-old have a choice of what that— what those images mean? The average age today of looking at pornography, about 11-year-olds, 50% of our young adults, our children are being exposed by age 11. Would we give an 11-year-old alcohol? Would we give an 11-year-old cocaine? No, we wouldn't. And so the research on drugs and addiction suggests that the earlier you're exposed to alcohol, the earlier you're exposed to cocaine, the more likely you are to be addicted to it. As an adult. So then where does choice come in? And that's my question. So, so yes, it can be an addiction model and it can be addictive and I can have early exposure and all of those life events, but there's also a choice and that's where the reality of all of it comes into play. So when people say, is it either or? Is it, which one is it? I think it's actually both. It can be addiction and I can develop choice. Notice the word develop choice. And I think it's a both/and there, Marianne.

Right. I think it's also important to understand we've got a lot of neurochemistry that we're talking about here as well. We're dealing with these seeking behaviors. I mean, I think we've got these drivers of, I have this emotion that feels uncomfortable for me. And so I want to find something to make it feel better. And so oftentimes our seeking behaviors are driven by Anticipatory dopamine. And we're seeking that dopamine, which is a reward that makes things feel better. And so that may be a driver that's happening, but also when we're looking at addiction, we're also dealing with huge dopamine spikes. We're also dealing with floods of glutamine, glutamate floods, which just blow through. It's like a dam.

Mm-hmm.

bursting forth. And so we've got these huge neurochemicals that we're trying to deal with and we're trying to make sense of. There's a point where our choice, instead of being this huge wide open choice, our choice—

It's narrowed.

Our choices are very narrowed. Our brain options in that moment are really limited. And I have a really good example of this. In a situation when we're talking about triggers, I might be, I might hit a trigger where I might have some really big reactions that feel like, even though in the back of my head, I might be thinking, this isn't a good idea. And you might say, well, wait, don't you have a choice there? Why didn't you make that choice?

Yep.

Yeah. Yeah. It just came out. I don't know. I shouldn't have. I wish I hadn't, but it's a very similar If we can look through that same lens, we often do things that don't make sense. So we know maybe we shouldn't have, but because of what we're experiencing, oftentimes because our body is just trying to find a homeostasis of where am I okay, if I've been relying on certain behaviors for a really long time, or I'm just trying to get to that place where I feel okay, I may do things That I don't feel proud about and that I'm, that I have a lot of guilt and shame about afterwards.

Which is common for most individuals when they're acting in addictive tendencies, right? It's after the math, not before, right? So the concept you just described there is narrowed perception, right? My realities are getting narrower and narrower until the point that I can only see acting out. I can only see that. Again, that fits within addiction model. So where does choice come in? And the choice is actually learning how to respond in productive ways in those times where you would have had narrowed perception or that limited options. So we're trying to increase options, make sure that they have choice, because if you don't realize you have choice, then yeah, it's going to feel like you're out of control. You don't have, you don't have options. At the end of the day, both of them have to work. It can be addictive. When I see people walk down that pathway, let's say that earlier example of somebody who very early exposed to pornography or anything sexual, sure, they're going to have challenges. They're going to have adversity because what they've learned is it's sexual activity that is what they're using for coping with stress and difficult emotions. And that's universally, that's been my experience in the work that we do. But everyone still has a choice to be different, act different, feel different, and they have that option. And that's where I think the greatest change is. Like, one of my favorite stories is actually a treatment center back east where they treat people who deal with alcohol dependency. And I was talking with this person and they said, you know, one of the first things we realized with substance use is the body's now malnourished. And so they actually give them vitamins, Minerals to replenish the body that's actually being— it's literally so deficient in so many chemicals because of the alcohol that is suppressing. So they're not getting the nutrients that they need. And so they actually give them an infusion of those minerals, which is very helpful nutrients. And then they actually prepare them to run a marathon. The training, the mindset. And so they build up this— part of the treatment program is is ultimately running a marathon. And as we talked, it is a fascinating conversation because they're trying to focus on both elements, the health of this human being, and then having a purpose, something that they're working on, which fits with Charles Duhigg's book, The Habit of Change.

That's fascinating. I'm just thinking about the— this gives a coping skill. This gives a new tool. I go out for a run, I practice, I'm doing these things, and it's also giving A lot of bilateral stimulation, a lot of time. Yeah, a lot of time on your feet to have your body moving while you're processing through. That's fascinating.

My point is, is what point does choice come into it? There's always going to be an awareness that we have to come out of. So we come off of autopilot and we come into intentional awareness. And that's usually a more painful place because initially I'm, when I'm in an addictive tendency, We're going to call it unconscious incompetence. I don't know what I don't know. Then something happens. I get into trouble. I get into some situation and now I have conscious incompetence. I know I've got a problem and I don't know what to do about it. That's a really painful place.

And I want to underscore what you just said, because as you're talking about this unconscious incompetence, how many times do we hear a client say, Or their spouse says, why did you do this? They're like, I have no idea. I do not know. I have no idea why I did— like, right now I can consciously recognize all of the damage that I've done, but in that moment, I have no idea. I have no words to explain to you why I did that. And I think, I think that's what we're talking about. I don't understand it myself. I—

Well, we hear that all the time, Marianne. Like, I don't know. Right? Well, what do you mean you don't know? Well, I don't know. Well, okay. What was going on? What were you thinking? Well, okay. Conscious incompetence is now I'm slowing down. What was I thinking? You're processing. You're trying to understand what allowed me to go down that rabbit hole. What allowed those behaviors to occur? Once you get to that place of conscious incompetence, you know, you know what you're doing. That is so painful because You still don't have the answers. Like, how do I respond to this? And that's the skill development where you go from this conscious incompetence to conscious competence, where you learn new skills. You learn to practice how to regulate emotions, how to be attuned when you're vulnerable, how to reach out to people. I mean, all the steps of recovery shift us from this conscious incompetence into conscious competence. That's, that is a skill and it takes practice. So that's how we get choice, in my opinion. It's practiced over time.

Yes. And what I would add to that, at least what I explain to my clients, is every day we have brand new baby neurons in our brain. When we're younger, we have a lot more. As we get older, we don't have as many, but we still have brand new baby neurons. And the reasons why, as clinicians, we say, hey, here are the things that I want you to start doing. I want you to start going to group. I want you to start making contacts. I want you to find a sponsor. I want you to start utilizing better self-care. Here's very specific things I want you to start doing. The reason why is we're trying to help our clients create brand new neural pathways so that we're building in new behaviors so that if my clients are reaching out to a contact 3 times a day, That's a new behavior that they haven't been doing in the past. And as they're doing that, if they're doing that consistently every day, when they hit a trigger or an urge or a challenge or something comes up, it's not weird for them to make a phone call because they've already been doing it 3 times a day. So for them to say, hey, I'm struggling a little bit. I'm starting to realize, oh, things aren't really working well. We're putting in new behaviors. Because usually we look at healing through a relational lens. We heal relationally. We need other people. And so I've gotta learn how to turn and connect in vulnerable ways, not just superficial.

Right.

But I've gotta learn how to say, I'm struggling. This hard thing's going on. And the places where previously with my pain or my discomfort, I've turned to acting out behaviors, I've already been building new, what we call structures or new places to turn instead. These are new behaviors. And this is once again where I also think the choice really comes in, in maybe I can't change exactly. I can't change my past. I can't change what I've been exposed to or what I've done in the past, but I can start to create these new patterns. Moving forward.

And that then is opening up to the perception. So we talk about narrowing perception. Now I've got an opening up and I can start to see multiple options and ways to respond. And so when I'm dealing with stress, I can reach out to a support person. I can go for a walk. I can ride my bike. I can go swimming. I can open up many different options. I could reach out to my spouse. I look at multiple options like, wait, why was this so narrow before? And really in life, when you realize that there are options, That feels a freedom that maybe you haven't felt in sometimes decades and years and decades. So I think that that's part of the concept. We're shifting from this place that felt like it was an addiction into multiple choices. And that's when I start to choose into this relationship because awakening has occurred within me. And to me, that's really the process that we're talking about. So when someone says it was an addiction or choice, the choices were narrowed because of the addictive behaviors. We're opening up multiple options and we're learning that You know what? I can do different things. It reminds me going back to The Power of Habit with Charles Duhigg. He shares an incredible story in there about this this person whose husband left her for for another person, and she was just in an emotional place that was so painful. At one point, she had gone to the affair partner's apartment complex and threatened to burn it down, and so it was going very well for her. She decided that she had a little bit of money, and she. flew herself to Cairo, to Egypt, to go see the pyramids. And horrible experience in the beginning, right? She woke up hearing the chanting in the mosque below. She sat up in bed to light a cigarette. She lit the pen and the pen was smoking. And she's like, well, I can't even, I can't even smoke right. She's thinking. And then she gets up to go to the bathroom and there's a glass of water there, drinking water, a glass one. It spilled and hit the ground and shattered everywhere. And she said, I can't do anything right. She still had her tour planned. So she gets in the taxi on the way to the pyramids. She's like, something has got to change in my life. And she decided that she was going to trek across this desert. And she said, I don't even know what the desert is, but in a year from now, I'm going to come trek across that desert. In order for me to do that, I got to give up smoking. And so she, you know, gave up smoking. Went over that next year, and it wasn't even a year. It was like 9 to 10 months. She'd given up smoking. She'd started a new job. She started running. She eventually ran marathon, half marathons. She got out of debt. She, over time, and they were watching her brain. And this is the interesting thing. The old habits, eating habits, smoking. Every time she saw those things, it still lit up in her brain because they were doing brain scans and watching her brain change over time. But it was, in their words, it was actually crowding out those, those old habits. And the brain was truly, it was changing and they were watching. And that's why they were so fascinated. As they watched her brain, this is the National Institute of Health. They're watching her brain change. And it's just a beautiful story of narrowed perception. Now I'm doing one thing and they called it a keystone habit. And you change one habit, you can change multiple habits because they start to have an outward expression. So what they found is her running changed her eating habits, which changed how she slept, which changed how she dealt with money. Her food intake, everything began to change in her life. Within a few years, she had remarried, was happy, healthy, living a life that was free from the prior experience. And to me, that keystone habit is really what we're looking for in this process of anyone overcoming addictive tendencies. And I might even add someone who's been in trauma.

I think one of the underlying concepts of that is our neural pathways That together, they wire together. What that means is we have these neurons that are reaching out and making connections. And the more that we use them, the stronger they become. And these are like the highways of where our thoughts and our actions are coming. And so over time with repetitive actions, we're creating stronger and stronger patterns for behaviors and actions. I wonder, Dr. Skinner, before we wrap this up, I wanna circle back to where we started in the beginning and just also comment for that betrayed partner who's in this space of saying, how do I make sense of this? I want to really emphasize that because there is this oftentimes this discrepancy between what my logical brain hears and understands and makes sense of, because I can imagine right now, if a betrayed partner's listening to this, they might say, Okay. Yeah. Yeah. That makes sense for me logically, but it still doesn't make sense for me in my heart or internally. What I want to really speak to in this space is that this is the relational healing that has to come. And we heal relationally. Oftentimes once our brain starts to see, oh, I'm seeing new habits, I'm seeing new patterns, I'm seeing my partner show up in new and different ways. That's when that shift, I think, often starts to come after time of like, oh, now I can make sense of this because I'm seeing and feeling relational differences. And I, and yes, that can settle into me where I'm not so much in a frantic, I've got to understand this. Our brain is just really panicking, trying to understand, am I safe? What does this mean for the future? But I wonder what your thoughts are on that.

Yeah. That question of, am I safe? Or how do I know that I'm safe? If I'm the betraying spouse, the only way is you've got to understand yourself at a deeper level to understand how to express and explain, here's what I was thinking. Here's a kind of transparency that maybe you've never had before of those thought processes and what you're going to do in the future to make sure that they don't repeat. Like, that's one of the challenges with that addiction mindset is like, Well, it's out of my control. That feels hopeless for the entire system, right? So if I'm the person acting out, it's how I'm going to do this, what I've learned about myself and how I maintain options and choices so I don't go back into that space. That's an important lesson for the betrayed partner to hear is how are you going to do that? And that's how you rebuild trust relationally is you have to understand yourself at that level. Like, here's the things that I can't do anymore. Here's my, what we call them, thought errors. I've— here's what I was thinking. And I've gotta be very aware that when those start to come in, I've got to respond in a more productive way. And then for the betrayed spouse, there's only one other thing I would say there. And please understand that their actions, while they hurt you, they have to be their responsibility to correct, to understand how to get through those in a healthy way so they can choose you in the right way.

I love that. I, what the wording I was gonna just add to that, you called it responsibility. I would call it also accountability. And the more a betraying partner can be accountable, this is mine. I, these were my choices. This is what my actions have caused. And that validating, I can understand how you're feeling this way. It makes sense that you're feeling this way because I didn't create that safety for you. I didn't show that for you. It makes sense. The more there's that accountability that is taken, that, that also allows that betrayed partner to have a little bit more space to, oh, okay. Yeah. They're saying it's not my, like, I can see and feel and hear. And that once again lets me let go of that a little bit more and lets me have that healing that I need.

Yeah.

And then the thought errors, you know, I, in my mind, I was blaming you. In my mind, I was shifting the responsibility. I did deceive you. Again, that's the reparative part of owning how I deceived, how I blamed, how I minimized. That is essential for the betrayed partner to hear. Right.

So, you know, Dr. Skinner, as we're getting ready to wrap up for today, I also just wanna mention Just about a year ago, we launched a couple of podcasts and courses that go along with this topic. We launched the RISE: Hope and Healing After Sexual Betrayal podcast. And along with that, on the Human Intimacy website, we also have a companion course that walks betrayed partners, especially newly betrayed partners, through understanding their experience through essential principles and steps of beginning to heal from betrayal trauma. So if you weren't aware of that, or if you hadn't heard of it, or if you haven't taken it, we invite you to visit humanintimacy.com and check that out. It can be really helpful for betrayed partners trying to make their way through their healing and recovery journey. And do you wanna talk about the Reclaim?

Yeah, the Reclaim. If you've been struggling with pornography, it's really just a focus on helping you reclaim the parts of your life that have been lost to your pornography use. And it is designed to help you have greater awareness and understanding of what to do in difficult moments, but also how it's influencing parts of your relationship and how you're approaching your relationship. So the Rise and the Reclaim podcasts, and also the courses that support them.

We spend our time in these podcasts and creating these courses because as clinicians, this is what we see in our offices every day. And our goal is to create resources for individuals who are in pain and couples who are in pain, who are trying to heal and looking for research-based helpful content. Yeah.

You know, and let me just close with this then, you know, if you are in a situation where you like need some more support, we have info@humanintimacy.com where you can ask your questions. Well, if you would also send a message, we've had a lot of people reaching out. Wanting group support. If you're interested in group support, please send us a message, info@humanintimacy.com, and we can provide educational information to help you in your healing journey. So thank you so much for listening to the Human Intimacy Podcast. Marianne, thank you for your time, and we look forward to hearing from you. And in the meantime, have a great week.

Thanks.

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