Tolerance: Tolerance occurs when the body needs increasingly larger or more potent doses to get the same effect from an addictive substance or a behavior.
Escalation: Escalation occurs when a person indulges his or her tolerance to an addictive substance or behavior with larger or more potent doses.
Addicts of all types almost universally experience tolerance to their substance/behavior of choice and a corresponding escalation in their usage of that substance/behavior. This is relatively easy to picture and comprehend with substance abuse; less so with behavioral addictions. After all, pretty much anyone who’s ever had a cocktail knows that the first time you drink, you only need a beer or two to feel high. Meanwhile, a few years later, after drinking has become a common practice, the same reaction typically occurs only after three or four beers. And that’s for drinkers who are not alcoholic!
For whatever reason, this is more difficult to comprehend with potentially addictive behaviors (such as sex). In fact, most people who are not addicted to a behavior seem to think that pleasurable behaviors should always provide the same rush no matter how often you engage in them. However, sex addicts know that this is absolutely not the case. In the same way that substance addicts must take more of a drug or a stronger drug to achieve and maintain the high they seek, sex addicts (and other behavioral addicts) must either spend increasing amounts of time in their addiction or raise the intensity level of their addictive activity.
When one understands the basic neurochemistry of addiction, this is actually not surprising. Essentially, in a non-addicted brain the nucleus accumbens (often referred to as the brain’s “pleasure center” or “rewards center”) responds to naturally occurring, life-affirming stimuli – eating, relaxing, helping others, achieving success, being sexual, etc. – with feelings of pleasure. This pleasure results from the release and reception of various neurochemicals in the brain – most notably dopamine, but also adrenaline, oxytocin, serotonin, and a few others. For instance, a good meal causes the release of dopamine into the rewards center, where said dopamine attaches to dopamine receptors, creating the sensation of pleasure. (Pleasure doesn’t happen until dopamine “plugs in” to a receptor.) This and similar life-affirming activities are rewarded because they ensure survival of both the individual and the species. This is intelligent design at its finest.
Unfortunately, the best laid plans of mice, men, and human evolution sometimes go awry. With addictions, this occurs when the rewards center is either manipulated or fooled. The easiest way to do this is to artificially stimulate the system by ingesting an addictive substance – nicotine, alcohol, cocaine, heroin, etc. These substances create the same basic pleasure reaction, but bigger. In fact, they typically flood the brain with anywhere from two to ten times the level of dopamine provided by normal pleasure-inducing stimuli. Is it any wonder we go back to these substances again and again and again?
Of note: Over time, addicts become less interested in the experience of pleasure and more interested in the secondary gains of their addiction – numbing out and escaping from the vicissitudes of life.
Now I can begin my discussion of tolerance and the need for escalation. Essentially, the human brain is surprisingly malleable, adapting over time to whatever inputs it receives. So, as addictive inputs are repeatedly received, the brain adjusts to the flood of dopamine that’s roiling around the rewards center by producing less dopamine and/or reducing the number or dopamine receptors. (Again, dopamine is experienced as pleasure only after it plugs in to a receptor.) In other words, as addiction sets in, the brain is conditioned to expect artificially inflated levels of dopamine, and it “heals itself” in ways that reduce the impact thereof. As such, the amount of stimulation that got a person high when he or she first started using (simultaneously providing the secondary gain of emotional escape) might have very little impact by the time addiction sets in. And this is true regardless of whether the addictive stimulation is caused by a substance or a behavior because the neurochemical reaction – the dopamine rush – is the same either way.
It’s common knowledge that almost nobody shoots up with meth or heroin right out of the gate. Instead, drug addicts start with marijuana and alcohol. As their tolerance builds, they smoke and drink more of those substances, and they experiment with harder drugs, perhaps crushing and snorting prescription painkillers or ADHD meds for a more powerful high. In time, they find themselves with a needle in their arm and little to no idea how they got there – all because their brains have gradually adjusted to excessive levels of dopamine (and the other pleasure inducing neurotransmitters).
Well, sex addiction works in exactly the same way. For instance, occasionally viewing and masturbating to generic (i.e., vanilla) online porn is typically regarded as an enjoyable and relatively innocuous activity, akin to drinking a beer or inhaling a few puffs of marijuana. However, for some people what begins as harmless recreation can become an all-consuming activity, pushing the user away from relationships, family, work, hobbies, and other life-affirming activities. Hours and sometimes even days are lost to sexual intensity. Over time, the user may find that he or she is looking at and being turned on by increasingly more graphic sexual imagery and/or engaging in other sexual activities (webcam sex, casual sex, anonymous sex, and the like) – with little to no idea how they got there.
Some relatively common forms of sex addiction escalation include (but are not even remotely limited to) the following:
- Hours, sometimes even days, lost to pornography, webcam sex, virtual sex games, and other forms of online sexual activity
- Lost weekends in seedy hotel rooms with prostitutes and drugs
- Serial affairs
- Continuous casual and/or anonymous sexual encounters
- Unprotected sex
- Sex in dangerous locations and/or with dangerous people
- Exhibitionism – online or real world
- Voyeurism – online or real world
- Substance abuse concurrent with sexual fantasy and activity
- Illegal sexual activity (prostitution, sensual massage, illegal porn, etc.)
So, as occurs with all addictions, sexual addiction nearly always escalates in terms of time and/or intensity level. And sooner or later, without intervention, these escalated behaviors result in profound life consequences. Over time, sex addicts neglect the people who are important to them (children, spouses, friends), interests (recreation, self-care, creativity), and responsibilities (work, finances, family) – all so they can spend hours, sometimes even days, in a fantasy-based, neurochemically elevated state. As their addiction escalates, their sexual activities may even violate their inherent values and beliefs (relationship fidelity, safer sex, not lying to or hurting others, etc.) For many, this is the cruelest and most painful consequence of all.
Robert Weiss LCSW, CSAT-S is Senior Vice President of National Clinical Development for Elements Behavioral Health. In this capacity, he has established and overseen addiction and mental health treatment programs for more than a dozen high-end treatment facilities including Promises Treatment Centers in Malibu and Los Angeles, The Ranch in rural Tennessee, and The Right Step in Texas. An internationally acknowledged clinician and author, he has served as a subject expert on the intersection of human intimacy and digital technology for multiple media outlets including The Oprah Winfrey Network, The New York Times, The Los Angeles Times, The Daily Beast, and CNN, among many others. He is the author of several highly regarded books, including Sex Addiction 101: A Basic Guide to Healing from Sex, Love, and Porn Addiction. For more information please visit website at robertweissmsw.com.
Robert Weiss PhD, MSW, CEO of Seeking Integrity LLC, is a digital-age sex, intimacy, and relationship specialist. Dr. Weiss has spent more than 25 years developing treatment programs, educating clinicians, writing, and providing direct care to those challenged by digital-age infidelity, sexual addiction/compulsivity, and other addictive disorders. He is the author of several highly regarded books on sex and intimacy disorders including Prodependence, Out of the Doghouse, Sex Addiction 101, and Cruise Control, among others. He also podcasts (Sex, Love, & Addiction 101) and hosts a free, weekly interactive sex and intimacy webinar via SexandRelationshipHealing.com. His current projects are: SexandRelationshipHealing.com, an extensive online resource for recovery from sex and intimacy disorders; and Seeking Integrity Los Angeles, an Integrated Intensive Program for Sex and Intimacy Disorders (Opening in Feb, 2019). For more information or to reach Dr. Weiss, please visit his websites, RobertWeissMSW.com and SexandRelationshipHealing.com, or follow him on Twitter (@RobWeissMSW), LinkedIn (Robert Weiss LCSW), and Facebook (Rob Weiss MSW).