Shame is the feeling of being inherently flawed, defective, and unworthy of love. Sexual shame occurs when this belief is fostered by traumatic sexual experience, usually in either childhood or adolescence (but also in adulthood). This trauma can be overt, covert, or even societal in nature. In other words, people who are sexually abused nearly always carry around a great deal of sexual shame, as do people who feel icky about too much trust and affection (even when that doesn\u2019t turn overtly sexual), as do kids who are societally denigrated because they are gay, bisexual, gender dysphoric, etc. Needless to say, shame\u2014especially sexual shame\u2014is a powerful form of emotional discomfort, potentially resulting in depression, anxiety, and lifelong challenges with trust, intimacy, and relationships. Any and all of these issues may create a powerful desire to escape and dissociate\u2014to numb out\u2014via addictive substances and\/or behaviors. Over time, many individuals learn to self-medicate their sexual shame in this fashion, resulting in various forms of addiction and all of the usual negative life consequences that accompany that disorder. Sometimes sexually shamed individuals learn to addictively self-soothe their pain, often relatively early in life. Body image issues, shame about being looked at and\/or touched inappropriately, and serving as a surrogate spouse for one or both parents\u2014fulfilling the emotional role of a spouse\u2014can all begin very earlyin childhood. For kids in these unfortunate family-attachment situations, numbing out typically involves alcohol and\/or drugs, but many also \u201cescape\u201d through sexual behaviors, including sexual fantasy, pornography, and masturbation. Sadly, much of the time these kids are simply eroticizing and reenacting the incidents that created their sexual shame in the first place, creating an even deeper sense of emotional discomfort and a more powerful need\/desire to escape and dissociate. Sexual Shame Often Unaddressed For the most part, addiction specialists and treatment facilities are in tune with the general connection between shame and addiction. However, the role played by sexual shame often goes unrecognized and\/or unaddressed. The reasons for this are twofold: \tSexual shame is usually the deepest and most powerful form of shame, meaning it is the most difficult form of shame to talk about and therefore the least likely to be revealed in therapy. \tTreatment specialists are often not trained to ask about and address sexual shame. And even when they are, they sometimes don\u2019t feel comfortable doing so. As such, many addicts go through multiple rehabs and\/or years of outpatient treatment and 12-step work without ever addressing their deepest issue\u2014sexual shame. As such, their depression, anxiety, and attachment deficit issues never fully heal and their desire to self-medicate continues, which makes lasting sobriety difficult at best. Fusing Sex and Substance Abuse Sometimes substance abuse and adult sexual activity can fuse into a single, co-occurring addiction, with substance use and sex continually reinforcing one another. This means the addict has two sets of triggers to deal with\u2014triggers for substances, and triggers for sex\u2014which is double-trouble when it comes to sobriety. In such cases, both long-standing and newer sexual shame must be treated in concert with addiction, rather than assuming that sobriety will clear up a client\u2019s shame-related devastation. So to achieve lasting sobriety when sexual shame is driving and\/or triggering the addiction, adult sexual behavior patterns (addictive or not) must be dealt with in an integrated manner. In other words, without concurrent treatment for both sexual shame and addiction, many addicts may not heal from either issue. Whenever sexual shame is an issue, it is best dealt with in the presence of an empathetic and supportive therapist and\/or a similarly traumatized therapy group. By sharing about sexual shame, even long after the sexually shaming event(s) occurred, sexually shamed addicts greatly increase their odds for lasting sobriety, no matter their primary addiction. Beyond that, effective treatment of sexually shamed addicts parallels effective addiction treatment in general, incorporating cognitive behavioral therapy, group therapy, social learning, and 12-step work. The only real difference is the added element of a deeper-than-usual exploration of the addict\u2019s sexual shame, sexual history, and current sex and relationship patterns, followed by education about ways in which the addict might be able to be sexual in healthy ways in the future.