Pairing Substances with Sex and How This Affects the Brain

This entry was posted in Blogs and tagged , , , on
Dr. David Fawcett

All addictive processes, whether with substances or behaviors, affect the brain in the same basic way: They impact the flow of various neurochemicals in order to manipulate the user’s mood. Some drugs or actions may be directed more toward activating or arousing sensations while others may have the effect of disconnecting or dissociating the user from uncomfortable thoughts or feelings. But they all manipulate the user’s mood.

It is common for an addict to focus on the problematic use of one particular drug or behavior while having a significant degree of denial about the impact of other addictive processes. A significant number of sex addicts, for example, are also addicted to substances. If only one of these issues, such as sex addiction, is treated, while others, such as drug addiction, are allowed to flourish, then the odds of relapsing on everything are greatly increased. This is because addictions, each of which is essentially a maladaptive coping strategy, are basically interchangeable when a shift of mood is desired by the addict.

Sex combines easily with many other addictions, including different kinds of drugs. While these substances may generate a variety of different sensations, they can all be paired with sex. Alcohol, for example, physiologically impairs sexual functioning, yet it is appealing because of its disinhibiting properties. Marijuana creates a type of body high that many people find appealing for sex and sexual fantasy. Amphetamines, of course, are well known for their ability to accelerate sexual desire and intensify sexual experiences and fantasies.

Once the user begins to combine substance use and sexual behaviors into the same addictive ritual, substance use and sex essentially become one behavior. The brain’s ability to constantly adapt, a process known as neuroplasticity, fuses these behaviors into a single set of triggers, cues, and actions.

This has many consequences. The most significant is linked to the brain’s remarkable ability to adapt to the high levels of increased stimulation that result from addictive activities. This adaptation is known as tolerance, and it is a universal feature of addictive behavior. Tolerance simply means that the level of input no longer generates the desired dopamine rush, so the addiction must be escalated to achieve the desired high.

The brain quickly adapts to the fantasies, activities, and other aspects of the addictive ritual, which greatly impairs the addict’s ability to generate the desired dopamine kick. Novelty is required to sustain those high levels of dopamine, and repeated use of the same fantasies or sex partners eventually doesn’t generate the desired level of stimulation. The answer is to escalate.

This escalation may take shape as an interest in more taboo behavior or something that is rougher, higher risk, or kinkier. Once this occurs, behaviors, people, or fantasies that used to be very erotic no longer hold much interest. This loss of intensity also occurs with other things in our lives that give us dopamine, such as eating good food, listening to great music, or doing something that we really love to do. Moreover, escalations in sexual behavior can permanently modify the addict’s arousal template.

The good news is that recovery can lead to a restoration of prior levels of enjoyment, but it takes time. The brain needs to adapt from the very high levels of stimulation that addicts have taught it to expect and reset to levels that are both realistic and sustainable.

Most addicts want to know how long this reset will take. While adequate research remains to be done in this area, we know a great deal based on anecdotal observations. Many self-help groups for porn addicts have found that a period of 90 days is useful for this readjustment. I have had porn-addicted clients who experienced this return to normal very quickly and others for whom it took longer. It has also been observed that the younger someone is in recovery, the more quickly this brain reset will occur.

The longest period of readjustment is typically experienced by methamphetamine addicts, especially when they’ve paired meth with sex. This is because they have experienced not only the escalation described above but the physical destruction of neural pathways resulting from the neurotoxicity of methamphetamine itself.

Generally speaking, I have observed that it is essential for recovering addicts to permanently avoid thoughts, fantasies, and other triggers that reactivate the “hot zones” in their arousal template. In neurological terms, it can be said that these neural “superhighways” are deeply grooved; that is, addicts can drop into them and suddenly find themselves within an addictive fantasy without any conscious process. Therefore, in recovery, addicts must be extremely careful with their thoughts, feelings, and fantasies.

Changes have also been observed in how quickly humans experience a release of dopamine following a trigger. The first time we experience any “reward,” such as an orgasm, we have a great burst of dopamine. The same is true for the first time we get drunk or the first time we experience any addictive behavior. We get an intense and exciting feeling. Our brain records these sensations, along with the circumstances, emotions, and any other details that will help it find its way back this heightened sensation. As humans, we are wired to want to experience this reward again, and soon. Therefore, the brain naturally learns how to recreate the circumstances and lead us back to this reward (intoxication).

One of the ways this is accomplished is by luring us with little bursts of dopamine when we think about the behavior. After we first experience a reward and get that burst of dopamine for the first time, we can remember that event and we will get a small mood-altering anticipatory hit of dopamine. We get a little bit high simply by remembering the past pleasurable event. Over time, the brain learns to release dopamine in anticipation of the activity. This is the cause of preoccupation, which is a common feature of addictions – especially sex, porn, and amphetamine addiction, where anticipation can hold as much appeal as the reward itself.

Recovery means patiently retraining the brain to avoid the automatic thought processes that lead to hot spots in the arousal template. Living a sober life will at first seem unnatural, as the brain tries to pull the addict back toward the addictive rewards it has learned to expect. Happily, because of neuroplasticity, addicts’ brains can adjust back toward a sober baseline, where cues and triggers don’t automatically pull them over a cliff. The more conscious control addicts have over their thoughts and feelings, the better their ability to manage triggers in ways that reinforce recovery as opposed to leading them back toward relapse.

Addiction is really the process where our brains do what they are designed to do, which is adapt. Addictive drugs and behaviors hijack the part of our brain that helped us survive as a species for thousands of years. The good news is that commitment, patience, and being as pristine as possible with our thoughts and feelings can harness the same neuroplastic ability to adapt, helping addicts bring their brains along with them on their journey into recovery.

*****

If you or someone you care about is struggling with compulsive or addictive use of pornography, plenty of help is available. Residential treatment and online workgroups can be found at Seeking Integrity: Los Angeles. Free online podcasts, articles, webinars, drop-in discussion groups, and daily inspirations are available through SexandRelationshipHealing.com.