As clinicians working in the field of addiction, we become familiar with patterns of relapse. Identifying those circumstances or behaviors that lead to relapse is critical in the recovery process.

An important part of therapy is to help the addict identify the circumstances that may trigger a relapse, and ultimately to assist him or her in developing a plan to deal with this. Sexual behavior, love, relationships and codependency are common triggers for relapse, but are often overlooked and unexplored in the treatment process. It is important to explore each of these — sex, love and relationships — as they are an essential part of the treatment assessment and consequent treatment process in addressing addiction. Sex, love or relationships that have become problematic or addictive have the potential to be one of the greatest triggers for relapse. If these issues are not addressed, chance of relapse is greatly increased (Tays, Garrett & Earle, 2002).

The purpose of this article is to explore and understand the impact that love, relationships and sex have in the treatment process and in early recovery. The understanding of how behaviors and core beliefs, influenced by early childhood experiences, as well as the interpretation of messages received from family and society are integral parts of gathering information to be used during the treatment process.

Explorations of bonding and attachment, as well as fear of intimacy, are important issues in the addicts’ search for sobriety. Addressing the challenges of love, sex and relationships in early sobriety is all part of the redefining and return to self that is required in the recovery from all addictions. The exploration of these issues in treatment and recovery are crucial to the recovering process.

As addicts stop using substances that alter thinking, feeling and behaviors, they may be left with little, if any coping skills. The addict may turn to other addictive behaviors that can manipulate the brain chemistry for escape. These addictive behaviors may include sex, love and relationship (SLR). The chemicals produced during the euphoria of courting and sex provides the rush of the high. These changes in brain chemistry provide the escape the drugs and alcohol had produced. Addicts learn to manipulate brain chemistry without ever ingesting a drug. This process, often referred to as switching addictions, is common in treatment and early recovery (Miller, Gorski & Miller, 1992). SLR behaviors prove to be most challenging to treatment facilities when male and female populations are combined. The same behavior is often seen in support groups, such as Alcoholic Anonymous (AA) and Narcotics Anonymous (NA), or other self-help groups that focus on addiction.

In Western culture, the experience of falling in love, sexuality and the process by which human beings court and attract, produce chemical responses that can mimic addiction. Human bodies are designed to attract, connect and bond to another. While the interaction of chemicals in the brain stimulate the desire for mating, these chemicals are also mood altering. This intense chemical reaction is often associated with the feeling of love (Fisher, 2000). As the chemical intensity settles, the heightened sense of euphoria also subsides. Often relationships end as the intense feelings die down, with the belief that the love has gone. It is common in our society to go from one relationship to the next, believing that true love is that intense emotion. Courting and dating practices become serial in nature if the quest for euphoria is the goal.

Features of codependency are also saturated in our culture in regard to sex, love and relationships. On any given day, music can be heard echoing the belief that one is incomplete without a partner; that life is not worth living without someone to love. The phrase, “you complete me”, often thought of as a romantic statement of love, adds to the belief that one can not be whole alone. Marriage ceremonies include the practice of lighting candles that signify each partner and the relationship. The individuals marrying then blow out their candles, signifying their unity. What does this mean to their individualism? The belief that “soul mates” know what the other is thinking and can anticipate their needs, leads to the belief that true love makes partners mind readers. The lack of this “skill” means that something is wrong in the relationship. Healthy individuals understand that these beliefs only undermine the building of skills needed for a healthy, fulfilling union. These skills include an understanding of both self and partner as well as communication and commitment.

Because addiction strips individuals of skills needed to nourish a relationship, the euphoria becomes the goal of interpersonal interaction. This euphoria can be experienced in the heady experience of believing one can fall in love at first sight, or in a short term love relationship, as well as relationships where dependency becomes the glue that holds the relationship together. Sexual interaction triggers chemical releases in the body that are as powerful as the ingestion of many drugs. Chemicals, which are intended for bonding purposes, are released during sexual encounters (Fisher, 2004). What then does the body experience when bonding chemicals are released in relationships in which bonding or commitment have no part? How do these relationships affect the recovery process?

When an addict descends into the world of addiction, choice ends and cognitive structuring suffers (Carnes, 2001). An addict’s life consists of obtaining the drug, using the drug and recovering from the drug. His primary relationship has become a substance, not a person. The interpersonal skills required to develop and maintain a meaningful relationship are lost. The addict feels intense pain and loneliness but it is the feelings of hopelessness and shame that envelops him. There is a desire for connection, but the addict has lost or quite possibly, has never even known intimacy with self and, therefore, does not know how to develop intimacy with another. The feelings of aloneness, shame and guilt fuel the addiction (Laaser, 1996). Early recovery can bring the first glimpse of hope and an awakened desire to connect with others. As the reality of addiction is first explored, the addict is with others who understand and can relate to the experience. Group members and therapists provide the validation of the addict’s reality and pain. The intimate connection that the addict desires is being fulfilled with those who are supporting recovery, and the process of trust begins to build for the first time.

Often the beginnings of trust and intimacy can be confused with love and/or sexuality, as this may have been the only way the addict experienced feelings of connection while in the addiction. Early recovery brings with it a sense of confusion with regard to all feelings, including love, bonding and sexuality. Early recovering addicts fall in love with others who show care and concern and who can relate to or are walking the same path. It is common for a patient to believe that he or she has fallen in love with a fellow patient in treatment, a member of his or her support group, or even with the therapist. Part of the treatment and recovery process is helping addicts understand and explore those feelings, as well as patterns and themes that have been present in the past.

Sex, love and relationship addiction all stem from the feelings of abandonment (Laaser, 1996). Feelings of abandonment are central to trust, security and feelings of safety and well-being. Those who have either experienced or perceived abandonment have learned to not trust themselves or others (Schwartz & Southern, 2002).  These individuals believe that their needs will not be met and that becoming vulnerable will only lead to pain and repeated abandonment. However, the desire for connection and intimacy remains. Addicts learn that they can duplicate the feelings without becoming vulnerable or intimate. Sex addicts use pornography, fantasy, masturbation, exhibitionism and voyeurism, S & M, and exploitation of the vulnerable, among other behaviors, to fulfill the rush without the intimacy of a relationship. Love and relationship addicts will use others to try to fulfill the need for intimacy, but their fear and pain of abandonment keep them disconnected. They are unable to truly give themselves to relationships, thus resulting in multiple short-lived, shallow and often destructive relationships. When the chemistry wears off they move on to the next, blaming their partners for not being enough. They may find themselves involved in abusive relationships in which they cannot leave. All of these are a reenactment of previous abandonment (Ferree, 2001).

Such is the case with Mike, who was raised in a home by a father who was both an alcoholic and a womanizer. His mother suffered from a chronic illness. Mike learned early on not to have needs, as no one would meet them. He learned to escape in the “girlie” magazines that his father kept around the house. As he reached puberty, he lacked the social skills to interact with girls. Drugs and alcohol took away the pain. He found that his good looks could attract others, and he soon learned that one night stands fulfilled his needs. He had a desire to connect with another, but fear and pain kept him from connecting with self and others. He continued to use drugs, alcohol and women to escape. He managed to have short-term relationships, but found that his partners were needy and smothering. He would then move on to the next, and as he grew tired of the relationships, he would turn to pornography or strip clubs for relief, and then back to women. The cycle continued as he spun out of control. By the time he reached treatment, Mike was not only lost in a world of chemical dependency but he also was caught up in sex, love and relationship addiction.

Mike is a typical addict in any treatment setting or recovery meeting. As addicts become clean from drugs and alcohol, they begin to experience the pain and feelings that the drugs masked. The craving to escape the pain continues, and many have learned that sex, love and relationships provide the escape for which they are searching. These addicts begin to feel a connection with others who are experiencing the pain with them, and that connection is often romanticized or sexualized. Since the relationship is forbidden, it becomes a reenactment of pain from the original abandonment of childhood. The addict attempts to meet his or her needs by using others, who cannot fulfill those needs. This can happen with other patients, members of the addict’s self-help group or even with the therapist. They have become accustomed to reenacting pain from the feelings of abandonment, wanting a connection (Ferrer, 2001). In cases where addicts have experienced sexual abuse, the trauma can become part of the reenactment. Often abusive sex becomes equated with love.

This reenactment is human nature, as we are all products of our environment. We learn about intimacy from experiences around us. Parents provide us with a vast knowledge of information through overt or covert teachings. Our opposite sex parent often provides us with information we use for choosing a mate, whereas our same sex parent often serves as a role model for ourselves. We use this information because it is what is familiar; what we know (Fisher, 2004). We do not choose partners that will not reenact set patterns. It feels unfamiliar and, therefore, uncomfortable. Often we mold partners into someone who will recreate our template.

Our minds are superhighways that sort information to make sense. As information is received, the mind searches to find information that was previously received for meaning (Kastleman M., 2001). This is how lovemaps (Money, 1986) and templates (Carnes, 2001) are formed. This is also how transference takes place. The exchange of feelings and information is processed through the brain to make meaning. Feelings associated with past people and situations, familiar to us, are transferred to the present situation. It is often difficult to understand or know what is real during transference (Tays, Garrett & Earle, 2002). Addicts experience this phenomenon while in treatment and therapy. Feelings of love, hate and anger that originated from the past, can be transferred. Clinicians need to be aware and address issues of transference throughout the treatment process.

Brain chemistry adds fascinating enlightenment to the understanding of how love becomes a drug. The brain produces norepinephrine, dopamine, adrenalin, testosterone and various hormones, all of which are love-related chemicals. These chemicals produce feelings of attraction and desire, perpetuating the mating process (Fisher, 2000). They provide intense feelings of euphoria and satisfaction. Addiction to chemicals elicits the same response. The primary function of chemical use is to intensify the interaction of dopamine and other neurotransmitters, like norepinephrine. This produces feelings of exhilaration. The addict becomes accustomed to living under the influence of these chemicals, whether the high is chemically enhanced or achieved by manipulating the brain’s natural chemicals.

Tasks of treatment

One of the tasks of treatment is to provide therapeutic interventions that will arm addicts with the skills and tool to make changes in thoughts, feelings and behaviors (Tays, Garrett & Earle, 2002). One of the most important concepts to be learned is developing boundaries. Addicts have crossed boundaries while in their addiction, and thus are out of touch with their behaviors. SLR issues compound the impairment. Addicts have to explore their own boundaries, their motivations and manipulations. Addicts must learn to become honest with themselves before they can practice honesty with others. As they begin to become honest with themselves, explore their motives, wants and needs, they can begin to explore their relationships with others. Boundaries provide the safety and security to learn to trust and be present in healthy, sustaining relationships.

Problems in relationships where addiction is present are intensified because of the addiction. An addict’s primary relationship is with a drug rather than a person. Partners of addicts usually have expectations that the problems in the relationship need to be addressed immediately. They are suffering and have waited for reparation. This is an impossible expectation.  Addicts do not have the tools to address the relationship problems until later into the recovery process. Addicts have to learn to live a life of sobriety, honesty and begin to build coping skills before issues in the relationship can be addressed. This is where the importance of individual recovery for each partner is necessary. Support groups, such as Alanon, Naranon and Codependents of Sex Addicts (COSA), are extremely helpful. Partners need the support of others to work through the process and to understand and address their own feelings. (Schneider & Corley, 2002)
As addicts become focused on a drug and eventually lose themselves to that drug, a codependent suffers a loss of self as they become focused on the addict.  Since addiction is a family disease, healing needs to be addressed as a family. Partners become so focused on the addict and the problems that arise with the addict that they can get lost in the codependency. Codepen-dency often mirrors addiction, and the codependent is equally powerless over the addiction (Hart, 1990).

A period of abstinence from relationships may be helpful, as challenges of sobriety are explored (Carnes, 2001). Individuals in their first year of recovery are asked to not enter into new love or sexual relationships for a period of time, so they may do the work necessary to enable a foundation of healthy relationships and establish new patterns and behaviors conducive to a life in recovery. If a relationship is already established, it is often recommended that a period of sexual abstinence be agreed upon, so that the addict may focus on his or her individual work and re-establish healthier patterns. Part of the work that needs to be addressed is that of exploring abandonment and bonding. This work should be continued after treatment with a therapist who understands addiction and addictive relationships.

As clinicians working with patients who are going through the recovery of addiction, a thorough understanding of the patient’s history with drugs and alcohol, as well as sex, love and relationships is essential. Knowledge of brain interaction and disease concept are crucial. Addressing issues of trauma, shame, guilt, boundaries, bonding, intimacy and establishment of relationships are all part of the recovery process. However, timing is key. In the first 30 to 90 days of treatment and sobriety, recovering addicts have difficulty comprehending the complex changes they are experiencing. Their bodies are in pain, their emotions are out of control, and usually, life situations are getting worse. This is a difficult time for addicts. Clinicians need to be aware of the individual needs of the addict, and work from that level. Often, the patient is not ready to address deeper issues until well into recovery. The addict may be too delicate or too defended. Others are living in situations where triggers are present, therefore inviting relapse. As issues surface, the question arises: does this patient have enough resources and tools to deal with the pain without relapsing (Ferree, 2002)?

To put the patient on a path of healing from abandonment issues, the counselor needs to explore those issues, as well as the role of parental attachment (Adam & Robinson, 2002). Fear of intimacy, lack of trust, and inability to commit, often result when abandonment issues are unresolved. It may be necessary for this work to be held off until sobriety is well established (Carnes, 1991). However, working through the abandonment, which is imperative to long-term sobriety, is at the heart of SLR work.  Addressing pain from the past, and healing the trauma that preceded the pain and subsequent addiction, is key to long-term sobriety. It is through this work that hope, restoration and renewal of relationships occur. An important part of the healing process is to understand the patterns, and how pain and trauma are recreated. This understanding enables the addict to form new behaviors and eventually, to break free of the compulsion to use substances or sex and relationships as a means for escape (Carnes, 1997).

As addicts break free from these compulsions, options and choices come into view. Sobriety brings new opportunities to practice living life on life’s terms. Decision-making skills are honed and used. The common practice of finding other escapes and/or substituting one addiction for another is minimized. However, the most important work is done when intimacy is created with self. Addicts work to establish an environment to become comfortable with a new sense of self. As the return to self occurs, there is room for forgiveness, honesty, restoration and redefining of identity. It is through this redefining that a foundation for healthy sex, love and relationships can be established. This ultimately is the goal of SLR recovery.

References

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