Ritualization and Reinforcement: Keys to Understanding Mixed Addiction Involving Sex and Drugs

Treatment of patients with multiple addictions begins with assessment in various areas, including the patient's particular addiction interaction pattern, and the effect of the addictions on his or her life and relationships. Some questions to consider in the first category include: Are the addictions alternating or are they parallel? Do they interact in an escalating fashion? Two common ways in which multiple addictions interact are ritualization and reinforcement. This paper describes the nature of ritualization and how rituals reinforce maintenance of an addictive cycle that include both sex and drugs. We describe the ways this process is played out in three scenarios: (1) Addicts who isolate as the paramount feature of a particular ritualized pattern of sex and drugs; (2) women who try to manage childhood trauma and domestic violence through addictive rituals; and (3) gay addicts who use ongoing multiple partners as a ritual to maintain intensity. We also present suggestions for clinicians working with these three populations.