Recovery Unscripted Podcast - Episode 12

Featured Guest: Dr. Jes Montgomery, Psychiatric Consultant, Pine Grove

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My guest today is Dr. Jes Montgomery, an expert in treating addictive sexual behavior with nearly 30 years of experience focusing on the family and long-term aspects of recovery. He sat down with me at the Recovery Results conference in Dallas to demystify some common misconceptions about sex and pornography addictions and to share how he has applied the core beliefs of his mentor Dr. Patrick Carnes to help bring these conditions out of the shadows.

One of the challenges of treating sex addiction is the abundance of misinformation that often leads to the shame and stigma that prevents individuals from seeking help. “There are a lot of ideas that are misconstrued about what sexual addiction is and there’s a bit of mistreatment around that too,” Jes says “Because the goal of sexual addiction [treatment] is not to stop being sexual but to do it in a healthy way…I think one of the things we offer as sex addiction therapists is that I have a comfort level with all sorts of behaviors and very little surprises me anymore.”

Jes got his start in this field by training under sex addiction treatment pioneer Dr. Patrick Carnes who wrote the groundbreaking book Out of the Shadows. And Jes sees a lot of similarity between substance addictions and the concepts of sex addiction that are described in Dr. Carnes’ core beliefs related to self-image, relationships and needs. “I think what they all share in common is the core beliefs that Patrick Carnes first wrote about,” Jes explains. “When the addiction has taken over, what we begin to see is that it becomes in essence the ‘perfect best friend.’”

But still there is a lot of grey area and even disagreement among the medical community related to sex addiction, which isn’t currently recognized by the DSM-V. “A lot of [treatment professionals] have the attitude that if you’re not putting something into your body, it can’t be an addiction,” Jes says. “There are those people who can view pornography and they walk away from it. And what we’re not clear about is what’s the line between that behavior and what we see in the addiction treatment world.”

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Podcast Transcript: David Condos with Dr. Jes Montgomery

David Condos: Hey guys, welcome to this episode of Recovery Unscripted. A podcast powered by Foundations Recovery Network. I’m your host David Condos, and I’m excited to bring you another great conversation recorded at the Recovery Results conference in Dallas. Our guest today is Jes Montgomery, a sex addiction therapist with nearly 30 years of experience focusing on the family and long-term aspects of recovery. He also helped establish the sexual addiction treatment program at the Pine Grove center in Mississippi. Now one quick note before we get going. Because of the sexual subject matter, some parts of this interview may not be appropriate for children. So if you have kids around, use your discretion. All right here’s Jes. Welcome Jes Montgomery.

Jes Montgomery: Thank you. Good to be here.

David: I thought we’d start off by having you tell a little bit about your own personal story and what led to you getting started in this field.

Jes: Okay. I grew up in rural, relatively rural south Louisiana. Grew up to be a family doctor, was in practice there and I began to be interested in addictions mostly because my family entered in addiction treatment process and we all learned about the impact of the disease. I gradually backed into working in addictions and late 1980s. I got certified by what is now a ASAM. After a period of time I finally went back to get a psychiatry residency and doing psychiatry training between 37 and 40 years old is a lot different from doing family medicine training a 25 to 28. I was able to listen differently, had always planned on working in some variety of addictions but over the time in working with psychiatrists I uncovered sexual trauma in a lot of our patients and sexual compulsion. Met Patrick Carnes, right about the time he published The Sexual Addiction. His second edition came out as Out of the Shadows and have tagged along with him and a lot of training’s and so forth as he’s put them together over the last 25, 30 years. That’s been my area of focus looking at the non-chemical addictions and the struggle with when there’s a process it goes on in your head and it has an addictive overtone. What does that mean to that person? That’s what I’ve mainly been doing with Pine Grove. Five years ago, they invited me to be the psychiatrist for the program, they treat sexual addiction and we’re now the Gratitude program. That’s what I do, I’ve step back, I usually say I taught Gratitude everything I know so I only go once a month to make sure they remember. I’m still their primary consultant, they contact me on a regular basis. It’s amazing when we teach people well they do the job well. I’ve been able to step back, work on some other projects, act my age, I enjoy being a grandfather.

David: Nice. Well yes, nothing wrong with that.

Jes: I’ve enjoyed every minute of it.

David: Yes right, I want to talk a little bit about your presentation here at the conference it was titled, “How to Do Recovery with Problematic Sexual Behavior.” Could you tell us a little bit more about addictive sexual behavior. How it is diagnosed? How it is treated? How that factors in?

Jes: One of the reasons I like to do this presentation is that there are a lot of ideas that are misconstrued about what sexual addiction is. There’s a bit of mistreatment around that too because the goal of sexual addiction is not stop sexual but to do it in a healthy way. When we look at the different models and the different professionals that have been in conflict over it. There’s a fight over whether this behavior is a problem or not in the nice comfortable Diagnostic and Statistical Manual that the APA puts out. We don’t have a checklist for sex addiction. There was a lot of debate about how to begin that and it reflects difficulty within our field, we’re just talking about sexuality because it’s such a broad thing. Likewise somebody who’s exploring their sexuality may come across things, that maybe compulsive for a while adolescents and young adults. It’s not particularly addictive it may take over for a while but looking at it and helping them to understand there’s a healthy component of this and let’s find it. One of the things I talk about this morning, college age students get drunk and it’s pretty much the norm. It’s expected if we look at their specific behavior, it reaches the level of binge drinking and for some people who would be a mild moderate substance use disorder that’s intermittent.

The majority of them leave college, they grow up hearing socially, they never have a problem and some may never drink again. It’s the people who continue to escalate and continue to move forward. The same thing can be said about sexuality, we also see a similar pattern in men and women in the lesbian and gay, bisexual community who when they come out have difficulty figuring out their sexuality and bench or do some dysfunctional behaviors. It’s not an addictive process however, many of these folks can find it useful to be involved in an in an LGBT friendly 12-Step group that talks about sexuality. Just to be able to talk about it, to have other people who can give them feedback without the shame and guilt and the discomfort that we culturally have not talking about sex.

David: I assume that’s one of the challenges is that culturally, people don’t really want to talk about sex in this type of way anyway. It seems that would be a challenge to get them to open up about it.

Jes: Tremendously, one of the things we offer as sex addiction therapist is, I have a comfort level with all behaviors and very little surprises me anymore. Sometimes being able to say what about and add something that they really want to talk about or they hadn’t thought about but it’s something they’re curious about. A lot of times the first couple of sessions I get the drama. I may not get the painful part that I’m looking at this pornography and I’m putting myself down. I’m not satisfied with my sexual partners because I can’t do what the gymnastics and the marathons that I see on the pornography. I’m internalizing that is something wrong with me and to be able to hear that other people struggle with that. To see somebody say this is how destructive I used to be with that behavior and now this is what recovery looks like for me, can be really helpful in that process of integrating. This is what it means for me.

David: Yes, it’s interesting it seems there are some similarities and differences between sex addiction and other types of addiction. What would you say are some of those?

Jes: Well, the similarities lie in that sense of being out of control, being a gas that their own behaviors and then trying to stop and failing. I think what they all share in common is the core beliefs that Patrick Carnes first wrote about. There are four core believes that I’m a– first of all, I’m a bad unworthy person there’s something inherently defective of me, the shame core. The second is if you really knew me you wouldn’t like me. The third is my needs are never going to get met if I have to depend on others so that I wall myself in, I latch on to this behavior or this fantasy or this magical glass needle whatever and that becomes my only source of love and affection and that’s the fourth core belief. When the addiction has taken over, what we begin to see is that it becomes in essence the perfect best friend. When we start talking about relationship difficulties, intimacy avoidance and those things, it complicates that factor.

The magic of whatever it is who if it’s paying for sex, if it’s compulsive masturbation, if it’s anonymous sex, all of those things begin to take on a magical tone that is a best friend. Part of what we do in treatment, in recovery is we rip that best friend out of their hands. One of the things have been much more attuned to in the last several years is the grieving process, it goes along with giving up an addiction. When somebody we love dies, there’s a marker. When we give up an addiction, it’s still around. There’s liquor store–

David: It could come back at any time.

Jes: Right and all of these things are still haunting until the addiction is thoroughly grieved and the whole sense of loss is acknowledged.

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David: Another thing I wanted to talk about I read that you’re an expert in Internet pornography addiction, that you’ve even provided expert testimony in some cases a deal with that subject. It seems for someone like me who is on the outside looking in that that would be a challenging condition to treat both because of the ubiquitous nature of its availability and then also because by its nature it’s secretive condition to be with. How do you go about treating that?

Jes: In getting ready to treat it, we had to come to the realization of what a problem it is. I’m old enough to remember it was a big thing on a Boy Scout camp out for somebody to distinct one of their fathers playboys away. We are talking about something that’s accessible on my smart phone, on my computer, on my iPad. Plus we are talking about an industry that is extremely creative. One of the things that I see, is that there seems to be a path through pornography where people get into trouble is, on one or two ends of the spectrum. One is when kids start looking in pornography, a lot of times they establish their erotic template around what they see. They’re looking for models and things that look like that age. Well, if you’re doing that when you are 20, you are going to be pulled in by the process to images that are more and more intense and illegal.

David: It can escalate just like any other addiction.

Jes: We are also within that, we have the popularity of Snapchat and immediate transfer of images. When you are a 17-year-old dating a 15-year-old, your parents don’t predictably worry about it but when that 17-year-old takes a picture of the first time they have sex and sends it to that little girl or little boy that’s a celebration of their relationship. However, if that’s caught that’s also producing and transmitting under age pornography. We have a whole volatile population that is very much at risk. Where we are seeing it now is they get caught on a back truck where they are looking for images that remind them of that image and they end up on some of these illegal sites. If there’s emotional in congruence if they are struggling with I shouldn’t be doing this or whatever, that fills that addictive process. We have to sort all of that out from the offending behavior, when somebody comes in and they are clearly they are spending six to eight hours online a day, they are getting caught at work multiple times, they’ve lost a job because they’re looking for pornography, that has more of the addictive quality. That’s when we begin to look at what’s true in the rest of their live, what are they attracted to in pornography and try to understand what that template is. To see what is at its core a healthy drive and then peel the layers back to find that.

David: It seems like another challenge to treating this particular area is that our culture doesn’t really view this whether it’s sexuality or pornography. Doesn’t really view it as being a disease in the same way as you think of all illegal drugs. Well, that’s if you are using illegal drugs you have an addiction disease or but if you are using pornography it’s not really viewed in the same way. How do you address that?

Jes: What we do two things. One is that that’s the quandary even in the addiction medicine societies that a lot of people have the attitude that if you are not putting something into your body it can’t be an addiction. That gets a little bit grey when you talk about binge eating and compulsive eating. You’re intaking normal things, your nutrition but to a degree that’s pathological. We’ve also run into where science shoots itself in the foot because we have brain science it tells us where addiction resides, what gets activated in the brain. There have been some studies done particularly on that lessons, viewing pornography and the time that they are viewing it, it doesn’t show the immediate dopamine increase. That bunch of literature argues against pornography having an addictive component. However, there are also studies that show that after a certain point ones that’s triggered it looks just like it does in the brain that’s triggered from cocaine or whatever even though they haven’t used it. We have both extremes and in there, there is a normal response to arousal and they’re again are those people who can view pornography and they walk away from it. What we are not clear about is what’s the line between that behavior and what we see in the addiction treatment world.

David: It seems like that’s there is a lot of complicated fine lines.

Jes: Yes, a lot of definite maybes.

David: What are some other projects that you’re working on currently?

Jes: Right now, I’m working on a concept of how can we use the technology that everybody wears around to foster recovery. I think that there are a lot of indicators out there that tell us the people are in jeopardy. Individual indicators but if we take enough of them, if they are not sleeping, if they are not eating in balance and so forth and look at those on a regular basis. Whether it’s having somebody upload from their electronic arm piece but they slept last night, how they’ve eaten. Watching those trends and learning from that person we can begin to put things together. They can be red flags and it has in part come from a bit of analytic training where I look for what people are not saying and try to figure out what their motivation is. Also watching people in group therapy and seeing how people change over several days in a row, it originally began about ten years ago noticing that people who were struggling on Thursday were more likely to be in trouble on the weekend either not getting up for groups or not going to activities. Beginning to look at those passive things and see if we can integrate that into both treatment and recovery. They were looking at more objective things and it eventually becomes outcome data. If we can engage people during treatment and have them realize that when I don’t sleep for two nights in a row, I want to act out the next day then on their second night of lost sleep they can put something in place. They can do something and all of a sudden that indicator that little thing that they are noticing becomes a reminder that they need to take care of themselves.

David: Is your vision for that that individuals would be able to download this and use it on their own or that it would be as they are going through some kind of group?

Jes: The biggest value has to do with attachment and that being connected makes a difference. I would like it to be connected to electronics but also to a human. It targets somebody who will send me a text message and if I don’t answer the text message they will call me. There is a human contact. I’ve done some of this with a couple of people in my outpatient practice and when they come in we sit down and we look at the last week. The weekly summary and we look at the rough spots and they know that this electronic piece is connected to a human being who has their best interest at heart.

David: To offer that human connection and that accountability they can be part of the whole process.

Jes: Making the accountability just an acknowledgement of hey this is what’s real right now and here is the data, is much better than saying hey you don’t look right.

David: Gives you something objective to talk about?

Jes: Right. The recovering person can begin to see their body, their being and all of the things that are reflected in the data as a part of themselves that’s reaching out for help. That is sending up warning flairs these don’t always know what they mean when we feel them.

David: All right well I wanted to wrap up with this final question. You’ve devoted a lot of your time and effort to both psychology and then the field of sexual health as well, over the past couple of decades. Could you tell us a little bit about why helping people find recovery is important to you?

Jes: My role both in my family as a kid and the rest of my life has been to point out that the emperor has on no clothes when people don’t want to look. It was a fitting thing as I learned about how addiction was present in my family. I could identify that a lot of those things that made me a great candidate for medical school were very compulsive, that between the skeletons in the closet of the family history and in my own development that I was on that road. I relate very much to that struggle and have used the 12 Step programs and the 12 Step family programs for my own healing and my own growth. It’s one of those things that I have ended up doing work that I love doing because I learn every day. I begin a group by asking the group what they going to teach me today because that’s when we do healing, that’s the best part of it. It has become both a joy and a challenge and a collection of people that I can feel connected to and understand in a what way that I think would be different if I hadn’t looked internal first.

David: Well, thank you for your time. It was very insightful and interesting stuff.

Jes: Well, thank you and for the opportunity.

David: Thanks again to Jes for joining us. Now I get to close the show by highlighting another powerful story of recovery for our ongoing series called Hero of the Week. This week’s story comes from Melissa T. who shared it on the Heroes in Recovery website along with over 1400 other encouraging entries. Starting in her early teens, Melissa began circling from LSD abuse to alcohol abuse, to eating disorders, to sex addiction as she puts it. I was replacing one addiction with another but she says everything changed for her when she returned home after a residential treatment and made a commitment to take her recovery seriously. Now with 18 years of recovery, Melissa works for an extended care facility in Arizona that helps young men with substance abuse disorders and sexual additions, start their own journeys of healing. As Melissa writes in her story, I have learned to have appropriate boundaries and to really enjoy loving other human beings. I had to learn what was going on with me internally and identify how to have a relationship with myself first before I could have any relationship with others. I couldn’t relate to others for the longest time because I couldn’t relate to me.

Thank you Melissa for sharing that and helping to break this stigma around addition and metal health issues. If you’d like to read Melissa’s full story or share your own visit heroesinrecovery.com.

This has been the Recovery Unscripted podcast. Today we’ve heard from Jes Montgomery, psychiatrist consultant for the sexual addiction treatment program at Pine Grove. For more, visit pinegrovetreatment.com. Thanks to you for listening. Please share this podcast, subscribe and leave us a review on iTunes to let us know what you think. See you next time.