Sex Addiction: The Never-Ending Debate
A few weeks ago, after writing and publishing a blog titled “Treating Sexual Addiction” on the Counselor Magazine website, links to this fairly brief article made its way into various LinkedIn forums, including the Professional Sexology group (1,700 members), a forum that leans heavily toward the “sex addiction is a myth” school of thought. Generally, in virtual professional forums I am willing to answer questions, but I try to avoid ruffling feathers. As such, I typically don’t post about sex addiction in the groups that don’t want to hear about it (such as Professional Sexology). That said, I do believe an occasional debate is good for everyone involved—and we certainly have had (and are still having) a good one in the Professional Sexology forum. So far, the link to my little Counselor Magazine blog has received well over 100 comments, with more appearing every day. When I printed this material out, I was shocked to see that it had generated more than 30 single-spaced pages of commentary.
Given this deluge, I thought it might be insightful (and a little bit fun) to share an abbreviated version of this rather lively debate. Please keep in mind that, out of necessity, I am cherry-picking the main points of this discussion while working hard to be fair to all participants. If you want to read the entire commentary in its unexpurgated form, you can access it via LinkedIn in the Professional Sexology forum (though you have to first be approved for membership). I have chosen to fix grammar and spelling (everyone’s, not just my own), recognizing that LinkedIn commentary is often typed quickly and sent without proofreading. I have also redacted the names attached to these comments, in case any of the posters would prefer to remain anonymous away from their LinkedIn group.
So, on with the posts…
- Dr. A: There is a huge, unresolved debate going on in psychotherapy listserves regarding the use of the term “sexual addiction.” Many claim that sexually compulsive behavior cannot be classified as addiction.
- Me: [Dr. A], so good to see you weigh in here. … Yes, there is a lot of debate, but little substance to that debate. This is much more a political hot potato among the APA and research professionals than…a reality that there is no problem. … Ask any clinician who has been practicing for a decade or more and they will tell you what they are seeing. The challenge is more about…the APA’s recent aversion to all language involving “addiction,” along with the fact that few want to pathologize any form of consensual sexual behavior. It’s a bit of a mess, in fact. But that doesn’t mean that the problem doesn’t exist. For more detail, I suggest you read Marty Kafka’s well-researched APA proposal [hyperlink added] about the Hypersexual Disorder diagnosis. There you will see A LOT of peer-reviewed, tier one research pointing to the problem.
- Dr. A: Glad to hear there are some peer-reviewed research papers addressing this issue.
- MSW Candidate: I think it’s important to mention that part of the reason there is such controversy around the subjects of sexual addiction and compulsion is the automatic stigmatization and pathologization that goes along with any sort of sexual expression that is outside of the mainstream.
- Professor: So often the debate loses sight of the most fundamental issue—what are the criteria for classification of addiction and can sex meet these criteria by ticking a number (most) of the boxes? … Surely, for some, sex can tick most if not all of these boxes….
- Psychologist/Author: I will note a powerful place where Rob, me, and the research agree. Some individuals who are using high levels of porn and sex also have high levels of depression. … It’s not the sex that causes the depression, but negative life events, and sex/porn is the coping mechanism. … The difference in my view from Rob’s is that I, and the research, indicate that the focus on sex is a simplistic distraction from the real issues involved. I think these people deserve help dealing with the social, moral, and relational conflicts they encounter due to their sexual behaviors. I just think that labeling their problems as a disease is foolish and unproductive.
- Dr. B: Sex addiction is a made-up term…used in treatment centers to bring patients in for inpatient, costly, long-term therapy…. Sex therapists treating these patients are better equipped [than addiction specialists] to handle the emotional distress, relationship problems, sexual dysfunction, underlying depression, and anxiety. As mental health professionals, we are duped by the huge addiction industry, which [is focused] on making money rather than helping patients with their intra-psychic or interpersonal problems.
- Director of Training, Psychotherapy Institute: I do not doubt your observations of the “sex addiction industry.” However, that in itself is not an argument to deny the phenomena that we are observing in responding to our clients’ self-description of their experience…and the very real distress that it is causing. Nor that clinicians are seeing a rise in these presentations by clients. … I believe it is absolutely right for us to challenge the conflict that arises through moralistic bias and the injunctions of religiosity conspiring to condemn sexual enjoyment that is outside of what is regarded to be…mainstream or “normal appetite.” That’s been a big part of the picture, especially for people from identified sexual minorities. But that is not the whole picture.
- Me: To clarify my bias here, I am a sex addict. … I had well over 1,000 sexual partners between the ages of 14 and 25, before my first “S” meeting in 1985. Today, after many years of 12-step involvement and psychotherapy (a great combination, by the way), I have a loving husband of 14 years, a meaningful career, and live transparently, without shame, secrecy, or a double-life. … I wish this outcome—or whatever version they wish to have for themselves—on every client I treat. For the record, sex addiction clinicians have nothing against casual sex, prostitutes, fetishes, sexual orientation, or gender identity. Those issues are not sex addiction. Sure, there are unethical clinicians who will label someone as a sex addict due to some moral or ethical bias on the therapist’s (or the client’s) part, but that is not what my field is about.
- UK Clinician: Whilst happy for you to have found this, [a 14 year committed relationship] is not the goal or desirable life for many others. The implication is that if I don’t find something similar to your normative model of living I am shamed into a dysfunctional object that needs to be controlled back into your version of “sanity” and “normality.” … Sorry, this is enforced societal normativity—I would say white middle-class respectability which sucks and is unhealthy (creating depression and anxiety in an intolerable consumerist value system) for a lot of people. Using therapy to get people back into these norms and societal values turns therapy into a psychological police regime.
- Me: I never stated that a 14-year relationship was any kind of norm or desirable to all, [only that] it was desirable to me. Others have differing sexual/relationship goals and experiences that make them equally happy, and I am glad for them. … Sadly, few sexologists seem to…acknowledge the relationship between early trauma, abuse, and neglect, and the mirror process of adult acting out—in a variety of ways, the pursuit of sex among them.
- UK Clinician: I would hope you could reach the points I am making which are about the policing of social norms as correction, the language of punishment, the language of race supremacy, as well as the politics of “evidence.”
- LCSW, Psychotherapist: I am in Cambridge for a three-day conference at Harvard Medical School entitled “Treating the Addictions.” … This morning I heard a terrific presentation by Staci Gruber, PhD, Director of the Cognitive and Clinical Neuroimaging Core at McLean Hospital, and Associate Professor of Psychiatry at Harvard. … Dr. Gruber presented a ton of current research indicating that the neurobiologic transmittal cycle for behavioral addictions like sex is precisely the same as what occurs with a host of chemical substances. [Given this and other research, the] use of the concept of “sexual addiction” has far more validity than many, many other terms and diagnoses that we use in mental health. … I really object to the idea that there is an “industry” out there that is just about making money and uncaring about the plight of the people. Those are not the thousands of caring clinicians I have met during the course of a 25-year career. … I know that sexual addiction is a very valid concept. I know it is as scientifically sound as most of mental health. Beyond that, if it is helpful to people, as it clearly is, then why would we not use it?
- Psychologist/Author: It was once accepted as common clinical sense that masturbation was unhealthy, homosexuality was a disorder, and women were less intelligent than men. Debates such as this force us to question our clinical assumptions, and ground them in data, in order to keep us, and our field, moving forward. If we allow the field of clinical diagnosis and psychotherapy to be based upon what “feels” true, then we doom the field to cultural relativity and subjective bias. Lastly, Rob, as always I appreciate your disclosure as a self-identified sex addict…but I’m sorry to say that it makes you rely too heavily on your subjective experiences. The strength of your belief in sex addiction is not evidence that sex addiction is real. … If the sex addiction field…was led by people who are clinicians/scientists first, and self-identified sex addicts second, the field would be stronger, more credible, and less subjective.
- LCSW, Psychotherapist: [Psychologist/Author], you would have enjoyed (or perhaps struggled with) the conference I just returned from at Harvard…. I think the “science” would have appealed to you. Tons of research presented by very senior clinicians. … By my estimation all of it confirmed the utility (as well as the science) behind the term “sex addict.” At the end…they had a “layperson” speak. He identified as a sex addict. At times shaking, he stood and told a long story of trauma and abuse that had led him into profound isolation, multiple personality disorder, divorce, and some very dangerous behavior including a near attempt at murder. He spoke of how the term “sex addict” had given him a place to begin and ultimately…turned his life around. Though the conference had a host of PhDs, MDs, and LCSWs present, this individual received, by far, the biggest and longest applause. I feel differently than you. I feel that it is not only indicated but essential for us “experts”…with our fancy degrees to listen to the hearts of the people. … True understanding does come from persons—clinicians or patients—who have in fact struggled with the addiction. … While I know the research and science fully support the term “sex addict,” I think the time has come for us all to put down the papers and actually listen to the people whose lives have been literally saved.
- Psychologist/Author: It’s clear that you both seem to think that the criticisms of sex addiction come from people who are not clinically experienced, and come from an “ivory tower” perspective. I’m happy to say that’s not true. I am a practicing clinical psychologist who has been working with sexual issues, including sexual offenders, since roughly ’95-97. … I am one of the new breed, though, of clinicians who argue for the need for evidence-based treatment. That evidence base doesn’t exist for sex addiction.
- Me: Please remember that if it wasn’t for people like Betty Ford coming out [as alcoholic]…the NIH and private organizations [would not have] established the meaningful research funding it took for chemical dependency to be understood as something other than a moral problem. It was her face and personal experience, expressed so articulately, that changed that diagnosis forever—something no university, psychiatrist, or institution had been able to do until then. This is why I talk about my past.
- Psychologist/Author: I’ve seen: clients who were shamed and bullied into accepting a label of sex addict; clients who entered sex addiction treatment facilities [and] spent large amounts of money they didn’t really have for treatments not shown to be effective; …men who embraced the sex addiction label and then used that label to bully their partner and excuse their behaviors; criminals around the world who’ve used the sex addiction label to excuse their behaviors; a media which uses the sex addiction concept to feed fear and create lack of understanding; therapists around the world who’ve told me that they refrain from challenging the validity of sex addiction because of the angry, defensive, attacking, shaming responses they receive from sex addiction therapists. … Rob, frankly it’s this last that’s has kept me going at this. The outright angry defensiveness and attacks from the sex addiction industry, merely at me raising questions and challenging the validity of this concept….
- Dr. A: I agree that we need more research to validate what therapists have seen and “know,” but their case study knowledge is not, in my opinion, less valid than a double-blind research study.
- LCSW, Psychotherapist: I actually have a little concern that within our field there has been a rush to “scien-tize.” If one is not using the term “neurology” or “data” or “synapse” or “amygdala” in the “presentation,” shame on them. Turn the channel. I object to that. While I love science and am very clear that the “science” and “data” and “research” is there to fully support the use of the term “sex addict,” I am first and foremost a relational therapist. All else I do comes second. I do believe wholeheartedly in some old-fashioned (and not-so-scientific) concepts like faith and trust and instinct. Despite all our wonderful and usable “advances,” I actually think trust and honesty, as unmeasurable as they are, still count.
I think this profoundly simple statement by LCSW, Psychotherapist sums things up rather succinctly and gracefully. I assure you, however, that the sex addiction debate rages onward, on LinkedIn and elsewhere. I can also tell you that as tiring and repetitive and downright crazy as the conversation can sometimes be, I embrace it, and, more importantly, I constantly learn from it. The person I’ve labeled Psychologist/Author, in particular, has made many thought-provoking statements over the past few years. In fact, I have come around to his way of thinking on a few points—in particular I agree that we need more research on sex addiction, though I disagree about there not currently being enough to justify a formalized diagnosis. I also agree, rather strongly, that our clinical community as a whole needs to become less judgmental, more neutral, and less shaming in our assessment and treatment of sexual issues. In turn, the beliefs held many of my anti-sex addiction colleagues also appear to have softened somewhat, though what I view as obvious—that early childhood neglect, abuse, parental enmeshment, and poor social skills can manifest in adult life through addictive sexual behavior—they often choose to either ignore or not comprehend. Perhaps someday the therapeutic community as a whole will reach consensus on the topic of sexual addiction as a real and treatable disorder, as we’ve done in recent years with alcoholism and drug addiction. That would certainly be nice (and incredibly validating to the tens of thousands of self-identified sex addicts currently seeking recovery). Until then, enjoy the show. It’s never dull.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships. He has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and the aforementioned Sexual Recovery Institute in Los Angeles. He has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia.
Weiss LCSW, R. (2014). Sex Addiction: The Never-Ending Debate. Psych Central. Retrieved on November 25, 2015, from http://blogs.psychcentral.com/sex/2014/03/sex-addiction-the-never-ending-debate/