SEXUALITY ISSUES IN ADDICTION, TREATMENT AND RECOVERY A Dissertation Presented to ...

113 Pages·2016·1.92 MB·English

SEXUALITY ISSUES IN ADDICTION, TREATMENT AND RECOVERY

A Dissertation
Presented to the Faculty of the American Academy of Clinical Sexologists

In Partial Fulfillment
of the Requirements for the Degree of Doctor of Philosophy

by
Richard M. Siegel
April 2016
Submitted in partial fulfillment of the requirements for the
Degree of Doctor of Philosophy.

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Acknowledgments & Dedication

I have to extend my most sincere and heart-felt appreciation to the faculty at the
American Academy of Clinical Sexologists, its founder and director, Dr. William
Granzig, and especially to my dissertation committee, comprised of Dr. Jacob
Pastoetter and Dr. David Fawcett, under the leadership of Dr. Anagloria Mora.
Their support, patience and encouragement throughout this long process was
above and beyond the call of duty, whether waiting unduly long for edits or being
pressured to review them. They will have my undying gratitude.

I would also like to acknowledge my life-long debt of gratitude to my family for
their unwavering emotional and financial support. I express my thanks to my
dad, Bob Siegel, my oldest brother, Dr. Steve Siegel, my exceptional and
beautiful daughter, Layne Siegel, and especially, my brother, Larry Siegel, who
has single-handedly served as my mentor, therapist, vocational counselor,
advocate and promoter, co-author, co-researcher, co-presenter and co-
conspirator for the past 25 years. Larry pioneered much of the earliest work in
South Florida – bringing sexuality education into drug and alcohol treatment
centers in the 1980s – that inspired this research…and this researcher.

I’d like to thank Dr. Rebecca Shelby, for her invaluable assistance, delivering a
crash-course in statistical analysis, and George Nichols, Andrew Theriot and
Joshua “Bugsy” Bird, for their assistance developing survey questions, recruiting
survey participants, identifying treatment centers and their clinical directors, and
gathering data.

Sadly, the past four years spent doing this research were marked by tragic
losses of three remarkable and particularly inspirational women in my life, to
whom I dedicate this paper: my former dissertation committee chair, Dr. Peg
McKeal, who helped this project take shape; Dr. Susan Lee, my sex therapy

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mentor and supervisor for fifteen years, and business partner in the Florida
Postgraduate Sex Therapy Training Institute and Sex Therapy Training Institute
of New York; and my original encourager, supporter and cheerleader, my
beloved mom, Ruth Siegel. I like to imagine the three of them, sharing a laugh at
my foibles, beaming proudly at this accomplishment, and toasting my career,
which all three of these remarkable women played a role in allowing me the
pleasure to have.

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Curriculum Vitae

Richard Siegel is Co-Director of Modern Sex Therapy Institutes, a postgraduate
continuing education institute training sex therapists and sexual medicine
specialists at multiple sites throughout the country. Mr. Siegel is a Florida-
licensed mental health counselor and Board-certified sex therapist, and is
certified by the American Association of Sexuality Educators, Counselors &
Therapists (AASECT) as a sex therapist and supervisor. He has a rich
experiential background, including over 20 years working in sexuality education
and addiction treatment, teaching on college campuses, and a private sex
therapy practice, as well as being a seasoned and in-demand workshop and
conference presenter, in addition to his work in training and supervising sex
therapists, sexuality counselors and educators.

Richard has served AASECT as conference co-chair for three consecutive years,
followed by two elected terms as Board Secretary, and has been appointed as
the incoming chair of the Supervisor Certification Committee. He is also a
Clinical Member of the Society of Sex Therapy & Research (SSTAR), and has
been serving as the Membership Committee chair since 2015. He has worked
enthusiastically to integrate traditional sex therapy into the emergent specialty of
sexual medicine, as well as the addiction treatment field.

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Abstract

Evidence-based literature has clearly identified a strong connection between
personal issues that are sexuality based, and drug and alcohol use and abuse.
However, licensed and certified drug and alcohol clinicians receive little or no
sexuality training focused on those sexuality issues known to be connected to
drug and alcohol use. Sexuality based issues connected to substance abuse,
such as sexual trauma, sexual health, sexual dysfunction, sexual orientation or
sexual scripting, are rarely, if ever, included in typical drug and alcohol treatment
programs, despite the growing body of evidence supporting the effectiveness of
incorporating them in improving treatment outcomes and relapse prevention.
In this study, people who have attended drug and alcohol treatment were
surveyed to determine if and how drug and alcohol treatment centers are
addressing sexuality concerns of their patients/clients. It was hoped that an
investigation of the respondents’ (n=78) answers would provide a “snap-shot” of
the current state of in-patient and out-patient alcohol and other drug (AOD)
treatment centers’ programming in various parts of the United States. Further, it
sought to provide empirical evidence to verify what has long been anecdotally
known about the sex-avoidant culture of traditional recovery communities, such
as Alcoholics Anonymous, Narcotics Anonymous, and scores of others, and by
extension, the majority of addiction treatment centers. It is intended to contrast
this largely sex-negative culture with a both firmly established and actively

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growing body of both thought and research evidence that a positive view of
sexuality and sexual health are, in fact, perfectly congruent with the goals of
addiction treatment. And lastly, this research is an attempt to provide insight into
the notion that improved integration of sexual health programming into existing
treatment planning can improve treatment outcomes, strengthen recovery and
decrease relapse rates among patients leaving treatment and entering into
recovery.
An analysis was also made of sixty seven (67) treatment centers’ marketing
materials, either hard-copy brochures or internet websites, to determine the
percentage of treatment centers that advertise either sexual health education or
sex therapy as part of their treatment offerings, especially in comparison to other
common therapies and modalities typically offered in the industry.
Overwhelmingly, patients reported that sexual health education or information
were not a part of their treatment experience, and that the predominance of the
messages they did receive during treatment was that sex was something
dangerous to recovery, and something to be avoided to ensure treatment
success or lasting recovery.
This paper underscores the importance of the groundwork laid by clinicians and
researchers over the past thirty years, and will hopefully join the current
movement germinating across the United States in its ongoing efforts to move
the treatment industry to recognize the importance of fully implementing sexual
health programming into treatment planning.

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TABLE OF CONTENTS

Dissertation Approval..................................................................................................................ii
Dedication and Acknowledgments ………………………………….………………………………..iii
Curriculum Vitae..........................................................................................................................v
Abstract.......................................................................................................................................vi
Table of Contents......................................................................................................................viii
Chapter 1: Introduction................................................................................................................1
Chapter 2: Definitions and Terminology……………………………………………………………..5
Chapter 3: Study Aims and Methodology..................................................................................11
Chapter 4: Statistical Analysis...................................................................................................14
Chapter 5: Results………………...............................................................................................15
Chapter 6: Discussion...............................................................................................................39
Study Findings……………………………………………………………………………………………………..40
Literature Review of Improved Understanding of Sex- and Drug-Linked Behaviors.…………...………….48
Challenges with 12-Step Approaches to Problematic Sexual Behavior.…………………………………….51
Sexuality Education for Drug and Alcohol Treatment Professionals.............……………………………….54
Sexually Marginalized Populations………………………………………………………………………...........57
Select Literature Review to Compare Effectiveness of Some of the More Common Treatment
Modalities Offered…………………………………………………………………………………………............60
Effective Integration of Sexual Health Programming in Drug & Alcohol Treatment………………………...71
Chapter 7: Implications for Clinical Interventions......................................................................80
Chapter 8: Study Limitations and Suggestions for Further Research.......................................82
Appendices
Appendix A: Request to Participate in Survey................................................................85
Appendix B: Indication of Informed Consent..................................................................86
Appendix C: Survey Questionnaire................................................................................88
Appendix D: Analysis of Marketing Materials.................................................................93
Selected Bibliography................................................................................................................95

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Chapter 1 – Introduction

“The failure to deal with social-sexual issues may impair the progress of recovery
in a chemically dependent individual and his or her family.” (Coleman 1988)
These words, written by Dr. David Smith in the forward of the seminal work,
Chemical Dependency and Intimacy Dysfunction, by Eli Coleman (1988) are the
beginning focus for this research that will validate the need for extensive
intervention in social-sexual dysfunction for substance abuse and addiction
treatment and recovery to be stable and complete. Sexuality issues must be
addressed for those in recovery, at the beginning of and throughout treatment, in
order for the person to be more successful and less vulnerable to relapse.
Therefore, treatment centers must incorporate ongoing discussions about
sexuality into their treatment protocols to give best quality of care. There is a
growing awareness among many practitioners, of the overlap and potential
complementary interaction between the fields of substance abuse and clinical
sexology regarding the need for healthy sexual development in those who have
addiction diagnoses (Smith 2005; Braun-Harvey, 2009; James, 2011; Fawcett,
2015; Pappas, 2015). The need for this therapy may be recognized, but it is not
being implemented at the medical and therapeutic levels. Medical doctors,
mental health practitioners, addiction specialist, nurses, and group leaders in
addiction treatment centers do not have training in clinical sexology, and are
seldom qualified to address sexual dysfunction at the social level in treatment
settings (Abraham 2008, McKeal 2004). Sex therapists and sexual medicine
practitioners have become more aware that often there is a biological basis for

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many sexual dysfunctions, with alcohol and other drug abuse often playing major
roles in the development of such problems. Clinicians in the substance abuse
field have an increasing awareness that sexual dysfunction and relationship
concerns often contribute both to the initiation of a substance abuse problem and
in the relapse of clients in treatment; however, few addiction professionals ever
have a background, or receive any training, in sexuality. Addiction treatment
staff, both primary therapists and group facilitators, are certainly qualified to
begin discussions individually and in groups to access the sexual-social
experiences, and possible problems, of those in recovery and access the need
for further therapeutic interventions. Another factor is the lack of cross-training
between the mental health and SUDs [substance use disorders] fields, and
between the prevention and recovery fields, which is necessary to promote
understanding, collaboration, and a recovery agenda (SAMHSA, 2012).
Intimacy problems, sexual dysfunction, and abstinence from mood-altering
chemicals often co-occur. Many individuals find their sobriety jeopardized
because of an inability to comfortably integrate sexuality and recovery, and they
therefore continually relapse. Others who do attain recovery can be mired in
insecurity and continue to fail in their attempt to develop intimate relationships
(Coleman,1987). While some reviews of this literature exist (Coleman,1982 and
O’Farrell, Weyland, and Logan,1983), many issues of sexuality and recovery
from chemical dependency continues to be often overlooked (Fawcett, 2004;
James, 2008; Braun-Harvey, 2009 & 2012).

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