Sexual Addiction Risk Across Levels of Substance Use Disorder Care

Why Substance Use Treatment Programs Need to Screen for Sexual Addiction Too

Addiction rarely shows up alone. Clinicians who work in substance use treatment have long observed that clients struggling with drugs or alcohol often carry other compulsive patterns alongside their primary diagnosis, including compulsive sexual behavior. Yet many treatment programs are not structured to catch this overlap. A study published in Sexual Addiction and Compulsivity examines exactly this gap, looking closely at how risk for sexual addiction shows up across different levels of care within a substance use treatment setting.

The study, titled Comparative Study of Three Levels of Care in a Substance Use Disorder Inpatient Facility on Risk for Sexual Addiction, was conducted by Erin Deneke, Cheryl Knepper, Bradley A. Green, and Patrick J. Carnes.

A Well-Documented but Underaddressed Overlap

The connection between substance use disorders and compulsive sexual behavior is not a new observation. Later research building on this study would go on to note that nearly one-third of individuals in treatment for substance use disorders endorse at-risk levels of compulsive sexual behavior, and that untreated sexual compulsivity may contribute to relapse for individuals working to recover from substance use. Despite how common this overlap appears to be, dedicated screening for sexual addiction has historically not been a standard part of most substance use treatment protocols.

This study set out to bring more structure and data to that overlap by examining an actual inpatient population and comparing sexual addiction risk across different intensities of substance use care.

Comparing Risk Across Three Levels of Care

The research team examined clients within a substance use disorder inpatient facility, comparing three distinct levels of care to see how risk for sexual addiction varied across them. Rather than treating the inpatient population as a single uniform group, this approach allowed the researchers to see whether clients receiving more intensive levels of substance use treatment also tended to show higher, lower, or comparable levels of sexual addiction risk.

This kind of comparative design has practical value for treatment programs. If risk for sexual addiction is meaningfully different across levels of care, that has direct implications for where and how screening resources should be concentrated within a treatment facility.

Why This Research Has Lasting Relevance

Since its publication, this study has become a frequently cited reference in the growing body of research examining the relationship between substance use disorders and compulsive sexual behavior. It appears in later research on topics ranging from dispositional mindfulness among women in residential treatment for substance use disorders, to the role of trauma symptoms in compulsive sexual behavior among adults in residential treatment, to broader reviews of how compulsive sexual behavior disorder co-occurs with other addictive disorders.

Its continued citation reflects something important: this study helped establish an evidence base for a clinical reality that many substance use treatment providers had observed anecdotally but had not yet had rigorously documented, particularly across different intensities of care.

What This Means for Treatment Programs

For clinicians and program administrators, findings like these underscore the importance of building sexual addiction screening directly into substance use treatment protocols, rather than treating it as a separate or secondary concern. If certain levels of care carry elevated risk for co-occurring sexual addiction, treatment programs have an opportunity to intervene earlier, potentially reducing relapse risk and providing more comprehensive care for clients whose struggles extend beyond substances alone.

This kind of integrated understanding reflects a broader shift happening across the addiction treatment field: recognizing that behavioral addictions and substance use disorders often share underlying vulnerabilities, and that treating one without attention to the other may leave clients without the full support they need.

Supporting Research That Connects the Dots Between Addictions

AFAR is committed to supporting research that examines how sexual addiction intersects with other forms of addiction, helping treatment providers build more integrated, effective care models. Studies like this one provide the evidence base that shapes better screening and treatment protocols across the addiction field.

If you would like to support AFAR's continued investment in this kind of research, consider making a donation today.

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Source: Deneke, E., Knepper, C., Green, B. A., & Carnes, P. J. (2015). Comparative Study of Three Levels of Care in a Substance Use Disorder Inpatient Facility on Risk for Sexual Addiction. Sexual Addiction & Compulsivity, 22(2), 109-125.