ABSTRACT
Despite the prominence of 12-step recovery as an approach to addressing compulsive sexual behavior (CSB) worldwide, little is known about the phenomenological experiences of recovery from CSB among individuals who participate in 12-step groups for CSB (known as ‘S’ groups). The present qualitative study used in-depth interviews to explore lived experiences of recovery from CSB among 14 members (13 males and one female) of an ‘S’ group. Inductive thematic analysis of the interview data yielded five themes: (i) unmanageability of life as impetus for change, (ii) addiction as a symptom of a deeper problem, (iii) recovery is more than just abstinence, (iv) maintaining a new lifestyle and ongoing work on the self, and (v) the gifts of recovery. Participants typically described their initiation into recovery as being precipitated by the escalating negative consequences of their sexual behavior. Over time in recovery, they came to see their sexual acting out as a manifestation of unresolved underlying issues that would need to be addressed in recovery. They also came to believe that to achieve lasting abstinence from their problematic sexual behaviors, their overarching recovery goal would need to expand beyond just abstinence to the long-term maintenance of the quality of their recovery as a whole. This was achieved primarily through the creation and maintenance of a new lifestyle and engagement in ongoing work on the self. This new way of living was described as resulting in positive changes beyond just the alleviation of CSB symptoms, including personal transformation and improvements in overall quality of life. This qualitative study is the first to analyze recovery experiences of ‘S’ group members using a bottom-up approach and provides insights into how these members describe and make sense of their recovery journeys.
Introduction
Although the clinical phenomenon of compulsive sexual behavior (CSB; also conceptualized as ‘sex addiction’, ‘hypersexuality’, ‘sexual impulsivity’ or ‘out-of-control-sexual-behavior’) has been described and theorized about in the literature for decades (e.g., Barth & Kinder, Citation1987; Carnes, Citation1983; Coleman, Citation1991; Goodman, Citation1992; Grubbs et al., Citation2020; Kafka, Citation2010), it has only recently received formal recognition as a clinical disorder. In 2019, the World Health Organization (WHO) included the diagnosis of compulsive sexual behavior disorder (CSBD) as an impulse control disorder in the eleventh revision of the International Classification of Diseases (ICD-11; World Health Organization [WHO], 2019). A conservative approach was taken for the ICD-11 in categorizing it as an impulse control disorder instead of an addictive disorder because there is (to date) insufficient clinical evidence to determine whether the processes involved in the development and maintenance of the disorder are equivalent to other recognized forms of addiction (Kraus et al., Citation2018).
The prevalence of CSB in the adult population has been estimated to be between 3% and 8.6% (Bőthe et al., Citation2020; Dickenson, Gleason, Coleman, & Miner, Citation2018; Klein, Rettenberger, & Briken, Citation2014; Sussman, Lisha, & Griffiths, Citation2011). According to the ICD-11, CSBD is characterized by “a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behavior… over an extended period (e.g., six months or more) and causes marked distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning” (World Health Organization, Citation2019, p. 1). CSB encompasses various types of compulsive solo or relational sexual behaviors such as masturbation, pornography use, cybersex, casual sex with multiple partners, use of escort services and sex workers, or frequenting of strip clubs (Karila et al., Citation2014; Reid, Carpenter, & Lloyd, Citation2009). Moreover, individuals with CSB may engage in more than one sexual behavior that is compulsive (Derbyshire & Grant, Citation2015). These compulsive behaviors lead to significant negative consequences for the individual, including (but not limited to) emotional distress, relationship difficulties (e.g., betrayal of trust in romantic relationships), diminished self-esteem and self-respect, unintended pregnancies, and risk of HIV and sexually transmitted infections (McBride, Reece, & Sanders, Citation2008; Muench et al., Citation2007; Reid, Garos, & Fong, Citation2012). While rigorous outcome studies on CSB treatments using gold-standard approaches such as randomized controlled trials are scarce, likely due to CSB only recently receiving formal recognition as a clinical disorder (Grubbs et al., Citation2020), various treatments have nonetheless been delivered to treatment-seekers over the years. Treatment approaches (for reviews, see Briken, Citation2020; Dhuffar & Griffiths, Citation2015a; Efrati & Gola, Citation2018b; Garcia et al., Citation2016; Malandain, Blanc, Ferreri, & Thibaut, Citation2020; Miles, Cooper, Nugent, & Ellis, Citation2016) include individual and/or group psychotherapies, pharmacotherapies, and mutual-help support groups such as 12-step groups, which is the focus of the present study.