sex addiction

In November of 2016 the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) issued a politically motivated, painfully biased, and clinically unsound policy statement saying their organization “does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder,” and that sex addiction treatment is not “adequately informed by accurate human sexuality knowledge.” Certain segments of the media then misinterpreted this as AASECT saying sex addiction does not exist, when all they were actually saying is that, as of now, they don’t think there is enough research to verify it. Importantly, nearly every other addiction and/or sexuality professional organization disagrees with AASECT’s opinion, including, among others, the American Society for Addiction Medicine, the Society for the Advancement of Sexual Health, and the International Institute for Trauma and Addiction Professionals.

As a clinical professional, I would generally think (and hope) that before the leadership of a respected professional organization like AASECT voiced such a strong opinion (to both its membership and the general public), it would conduct a careful and impartial organizational review of the facts, focusing first on the empirical evidence and next on the clinical experience of the identified treatment population. However, according to AASECT member Michael Aaron, a self-proclaimed “central character” in this odd little drama, that is precisely what did not take place.

In a recent Psychology Today blog, Aaron actually brags about how easy it was to push AASECT in a predetermined direction that aligned with his personal opinion. In his post, he writes about “taking matters into my own hands,” using “renegade, guerilla tactics” intended to be “polarizing,” using “controversy as an opportunity,” viewing “collaborative language as unproductive,” and creating “provocative language” and a “circus atmosphere.” At one point he gives props to his “fellow agitators.” He also says that when he finally got the ear of AASECT’s leadership, he talked them into assembling a small corps of like-minded individuals to craft an opinion on sexual addiction. Then, rather than having that opinion reviewed by AASECT’s membership as a whole or even a representative segment of AASECT’s membership, he “advised our group to send the statement to only a small group of handpicked individuals…and to carefully define the parameters of involvement.”

Now, I’m not a researcher or policy maker, but it seems to me that if you have a certain belief and you only seek information, input, advice, and feedback from those whose beliefs mirror your own, that does not exactly qualify as an impartial and fully informed intellectual review process. And if you and your colleagues then foist your shared but not empirically supported or adequately reviewed opinion onto the general public as a “factual statement,” well, that’s just not helpful to anyone except maybe yourself.

Anyway, that’s the basic backstory of how AASECT came to issue the aforementioned statement: a small group of seemingly close-minded professionals deliberately created controversy and a circus atmosphere, and then crafted an opinion that was reviewed and signed off on only by those few who agreed with it. AASECT’s dissenting members were deliberately excluded from the process. And there are definitely AASECT members who dissent, as Aaron admits in his blog. At one point he says that so many members were speaking positively (or at least neutrally) about the sex addiction treatment model on the group’s list-serve that he felt he needed to either leave the organization or “take matters into my own hands and stir things up to create the changes I was seeking.”

The fact that AASECT’s leadership allowed Aaron and his cohort to do exactly that, without an impartial organizational review process, concerns me greatly. It is one thing when a politician presents his or her opinions as fact. As Americans, we (sadly) have come to expect this, and we know that it’s our job, as voters, to decipher which words are truth and which are simply a ploy to get elected. But when licensed clinical treatment professionals choose to ignore empirical evidence and the insights of their colleagues in favor of their personal opinions, that’s another story entirely. Because it is very difficult for laypeople—who generally choose to trust whatever it is that doctors and mental health professionals tell them—to know what is true and what isn’t.

Please understand that I am not in any way saying that AASECT as an organization does not do good and sometimes groundbreaking work. They do. And lots of it. Over the years they have been instrumental in removing both stigma and pathological designations from perfectly normal and healthy sexual behaviors such as homosexuality, bisexuality, polyamory, kinks, fetishes, etc. As a gay man, I owe a great debt to AASECT and the many other clinicians who helped open the metaphorical closet door in ways that let me live my life openly, both personally and professionally. So hooray for AASECT and everyone else who fought that battle. However, the organization’s belief that no consensual sexual behavior should ever be pathologized is pushed a step too far with its recent statement on sexual addiction.

At the end of the day, what is most important here is that neither of AASECT’s claims about sex addiction are based in fact. First, AASECT’s statement says there is not “sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder.” Second, AASECT claims that sex addiction therapists are not “adequately informed by accurate human sexuality knowledge,” basically implying that sex addiction therapists choose to pathologize unconventional but perfectly healthy behaviors like homosexuality, bisexuality, fetishes, and the like.

As to the first claim, I cite Harvard’s Dr. Martin Kafka. In 2010, Dr. Kafka reviewed existing research on hypersexuality (the term he uses to describe sexual addiction) and concluded there was more than enough evidence to support an official diagnosis—more evidence, in fact, than there is to support many of the existing and commonly accepted psychological disorders. Moreover, since the publication of Dr. Kafka’s research several new studies have appeared, further establishing sexual addiction from a variety of angles, in particular by linking specific neurobiological reactions of sex addicts to neurobiological reactions of substance abusers and other addicts. (Using FMRI imaging it is possible to track, in real time, addictive reactions within the brain. And these responses are always very similar, regardless of the nature of the addiction.) Other relevant recent research can be found here, here, here, here, here, here, and here, to cite but a few examples.

As to the second claim, AASECT seems to think that theirs is the only group that refuses to pathologize “unconventional” sexuality. In reality, certified sex addiction therapists (CSATs) are every bit as accepting and sex positive as members of AASECT. Still, sex addiction deniers mistakenly argue that sex addiction treatment forces a therapist’s preconceived and narrow vision of sexual health onto vulnerable clients. Aaron says as much in his blog, calling sex addiction treatment “extremely destructive to clients as it often addresse[s] sexuality concerns from a moralistic and judgmental perspective.”

In reality, that is absolutely not what properly trained sex addiction therapists do. We do not define sexual addiction based on who or what it is that turns a person on, nor do we pathologize any type of consensual and legal sexual activity. Instead, we diagnose a client’s loss of control that results in severe life consequences (i.e., the client’s addiction), and we treat that issue without judging the specific nature of the client’s sexual actions. We are not the sex police. In fact, we are wonderfully sex positive, encouraging all legal and consensual sexual activity as long as those behaviors are not out of control, a repetition of severe trauma, or creating serious consequences. To this end, IITAP, the professional organization that educates and certifies CSATs, has both trainings and a stringent ethics code ensuring the sex positive nature of sex addiction treatment.

It is a sad event when those who shout the loudest and from the highest rooftop narcissistically assume their opinions are automatically right, regardless of what the actual evidence shows. This behavior is especially concerning in the fields of physical and mental health, where vulnerable people with debilitating issues seek needed assistance from knowledgeable professionals and assume the advice they’re given is based on the empirical truth, rather than mere opinion. Put another way, the general public does not expect to be lead astray by the clinical community. Yet here we are with AASECT’s opinion masquerading as fact.

It is unfortunate on many levels that AASECT’s leadership has been manipulated and misled by a small but vocal portion of its membership, resulting in the creation of an inaccurate public statement that could potentially drive people away from a treatment they desperately need. It is also unfortunate that AASECT has chosen to distance itself from other sexual health professional organizations. It seems to me that rather than throwing intellectual rocks at each other and polarizing the profession, we should all be working together for the good of our clients. So perhaps it is time for the various sexual health professional organizations to band together, seeking affiliation through cooperation rather than division through subversion. After all, if we as trained professionals can’t be empathetic and helpful to each other, and accepting of our different viewpoints, what chance do our clients have?