Why “Sexual Addiction” Is Not A Useful Diagnosis — And Why It Matters
If convicted mass murderer Ted Bundy had said that watching Bill Cosby reruns motivated his awful crimes, he would have been dismissed as a deranged sociopath. Instead, Bundy has said his pornography addiction made him do it–which many people treated as the conclusion of a thoughtful social scientist.Why?
There’s a phenomenon emerging in America today that affects everyone, particularly those in the helping professions. Not caring about it, or having no opinion about it, is no longer an option.
I am not interested in trashing 12-step programs. AA performs a great service every year in helping people handle their addiction to alcohol and other drugs. The question that has been put to us is, is the addiction model a good one for diagnosing sexual problems, and is the 12-step model a good one for treating sexual problems?
And if it is, is it as appropriate for treating rapists as it is for people who masturbate more than they think they should?
HOW THE SEXUAL ADDICTION MOVEMENT AFFECTS PROFESSIONALS
People are now self-diagnosing as “sex addicts.”
They’re also diagnosing their partners. Non-sexologist professionals such as ministers and doctors are diagnosing some of their clientele as sex addicts, too. As a result of these trends, many people who should be seeing therapists or sexologists are not. And many who don’t need “treatment” are getting it.
The sexual addiction movement is aggressively training non-sexologists, such as marriage counselors, in the treatment of sexual problems.
Many professionals are now taking these programs instead of those offered by sexologists. Also, some professionals now feel incompetent to treat certain systemic problems without this sexual addiction “training.” It is important to note that the content of this sexual addiction training is sexologically inadequate: there is little or no discussion of systems, physiology, diagnoses, cultural aspects, etc.
The concept of sexual addiction affects the sexual climate of the society in which we work–negatively.
This negativity is reflected in anti-sex education legislation, anti-pornography ordinances, homophobic industry regulations, etc.
Sex addicts now have cachet as sex experts.
Mass murderer Ted Bundy, widely quoted as an expert on the effects of pornography, is only one example. Right-wing crusaders now routinely quote “sex addicts” to justify repressive beliefs and public policy suggestions.
DEFINING SEXUAL ADDICTION
In the literature, the sex addict is typically described as:
Someone who frequently does or fantasizes sexual things s/he doesn’t like; Someone whose sexual behavior has become unstoppable despite serious consequences (including, according to Dr. Patrick Carnes, unwanted pregnancy) Someone whose sexual behavior and thoughts have become vastly more important than their relationships, family, work, finances, and health; Someone whose sexual behavior doesn’t reflect her/his highest self, the grandest part of her/his humanness;
According to the National Association of Sexual Addiction Problems, “6% or 1 out of 17 Americans are sexual addicts.” That’s about 14 million people.
From this literature and from meetings of groups like Sexaholics Anonymous (SA), the beliefs of people committed to the sexual addiction model appear to include:
Sex is most healthy in committed, monogamous, loving, heterosexual relationships The “goal” of sex should always be intimacy and the expression of our highest self; There are limits to healthy sexual expression, which are obvious (e.g., masturbation more than once a day) Choosing to use sex to feel better about yourself or to escape from problems is unhealthy.
CLINICAL IMPLICATIONS OF THE CONCEPT
It sees powerlessness as a virtue.
Step 1 of the traditional “12 steps” of all AA-type groups is “we admitted we were powerless over X (alcohol, our sexual impulses, etc.)…”
Controlling our sexuality can be painful, not because we lack self-control or will power, but because sexual energy is powerful and demands expression. The primitive, infantile forces behind those demands often make sexuality feel like a matter of life and death–which, in the unconscious, it is.
“Sex addicts” say they are “out of control,” but this is just a metaphor–i.e., they feel out of control; controlling their impulses is very painful. We’ve all had that experience, with sex and with other things. Virtually everyone has the ability to choose how to control and express their sexual impulses (we’ll discuss the small group who can’t later). The concept of sexual addiction colludes with peoples’ desire to shirk responsibility for their sexuality. But powerlessness is far too high a price to pay.
It prevents helpful analysis by patients and therapists.
The concept of sexual addiction prevents any examination of the personality dynamics underlying sexual behavior. It prevents the assessment and treatment of sexual or personality problems, because identifying and dealing with the “addiction” is the goal.
By encouraging people to “admit” that they are powerless, the concept of sexual addiction prevents people from examine how they come to feel powerless–and what they can do about that feeling. This careful examination, ultimately, is the source of personality growth and behavior change. The expression “That’s my addiction talking” is creeping into the popular vocabulary. This translates into “don’t confront or puncture my defenses.”
It trivializes sexuality.
The concept of sexual addiction ignores the childhood passions at the source of sexual guilt. Aggression, lust for power, and greedy demands to be pleasured are all part of normal sexuality, which every adult needs to broker in some complex fashion.
People learn to feel guilty about their sexual impulses as infants. “Sex addicts” are told they have nothing to feel guilty about, that they can learn to feel better one day at a time. But people know all the “good” reasons they have for feeling sexual guilt. By denying the dark side of normal, healthy sexuality that most people know they have, the concept of sexual addiction increases guilt.
Self-identified “sex addicts” want us to remove the darkness from their sexuality, leaving only the wholesome, non-threatening part–which would, of course, also leave them as non-adults. Rather than collude with this understandable desire, competent therapists are willing to confront this darkness. Instead of snatching it away from patients, we can help them approach, understand, and ultimately feel less afraid of it.
Another way to describe this is that:
It lets people split–i.e., externalize their “bad” sexuality.
Once a person describes her/himself as a “sex addict,” s/he can say, “I don’t want that sexual feeling or behavior over there; the disease wants it.” Good therapists know how to recognize splitting, how it blocks adult functioning, and how to move patients away from it.
It makes a disease out of what is often within reasonable limits of sexual behavior.
High levels of masturbating and any patronage of prostitutes, for example, are typically condemned as “abnormal” and reflecting a “disease,” according to SA-type groups. Which experts get to make judgments about acceptable sexual behavior? Exactly where do their criteria come from?
It doesn’t teach sexual decision-making skills or how to evaluate sexual situations.
Rather, the concept uses a “just say no” approach. As experience with family planning shows, “just say no” helps people abstain from self-destructive sex about as well as “have a nice day” helps people deal with depression.
SA-type groups say that ultimately, sexual abstinence is more like abstinence from compulsive eating–that is moderation–than it is like abstinence from compulsive drinking–that is, zero participation. On what theoretical basis has this critical judgment been made? Simple expediency.
Where is the healthy model of sexuality?
The sexual addiction model of human sexuality is moralistic, arbitrary, misinformed, and narrow. Excluded from this model are using sex to feel good; having “bad” fantasies; and enjoying sex without being in love. Where is the theoretical justification for this moralistic position?
We’ve seen this before: the concept of sin as sickness. It has led to sincere attempts to “cure” homosexuality, nymphomania, and masturbation–by the world’s leading social scientists, within our own lifetime. It is outrageous to treat sexual problems without a model of healthy sexuality that relates to most people’s experience. The sexual addiction concept shows a dramatic ignorance of the range of typical human sexuality.
At the end of competent sex therapy or psychotherapy treatment, the patient is a grown-up, able to make conscious sexual choices. Sex addiction treatment offers a patient the chance to be a recovering sex addict. Which would you rather be?
PROFESSIONAL IMPLICATIONS OF THE CONCEPT
It reduces the credibility of sexologists.
Prospective patients are now asking therapists a new set of questions: “Are you in recovery yourself?” “Have you treated sex addicts before?” What if a therapist is emotionally/sexually healthy and therefore not “in recovery?” Is s/he then disqualified as a professional?
The public, I’m afraid, is now getting a picture of us as being ivory tower types out of the touch with the real–i.e., destructive– sexuality out on the street. They’re feeling, “You want to waste time discussing systems, regression, defenses, and meanwhile there are kids buying Playboy out there!”
It replaces professional sexologists as relevant sex experts.
There are two groups of people behind this:
a) Addictionologists, often in recovery themselves (i.e., they have unresolved sexual and impulse control issues). They typically have little or not training in sexuality; and
b) 12-steppers themselves, lay people who love being in recovery. Their missionary zeal has nothing to do with science or clinical expertise. They freely generalize their own experience with sexual problems and “recovery” to all people and to human sexuality.
Both groups of people are now being quoted–and are actively portraying themselves–as sex experts.
By offering training from people with little or no sexological background, the concept suggests that all sex therapists offer is just another “theory” about sexual functioning. Just as creationists now want (and frequently get) “equal time” when scientists teach or discuss evolution, addictionologists now want–and are beginning to get–“equal time” regarding sexual functioning.
Graduates of such training programs believe that they have learned something about sexuality, when they haven’t. They have learned something about addiction. And they are taught that they are competent to treat addiction in any form, whether its vehicle is alcohol, food, gambling, love, or sex.
Most addictionologists admit they lack skills in differential diagnosis. They and their 12-step programs let anyone define him/herself as a “sex addict”. How many personality disorders, how much depression, how many adjustment reactions are being treated as “sex addiction?”
POLITICAL IMPLICATIONS OF THE CONCEPT
It strengthens society’s anti-sex forces.
“Sexual addiction” is the Right’s newest justification for eliminating sex education, adult bookstores, and birth control clinics. They are using the same arguments to eliminate books like The Color Purple from school libraries, even in supposedly liberal California. Businessman Richard Enrico, whose group Citizens Against Pornography takes credit for eliminating the sale of Playboy magazine from all 1,800 7-11 stores, did so, he says, “because smut causes sex addiction.” And he was able to convince one of America’s largest corporations of this complete fiction. We should not be colluding with this destructive force.
It emphasizes negative aspects of sex.
Sex addiction treatment is essentially creating a special interest group of people who feel victimized by their own sexuality. Not others’ sexuality, like rape victims–their own sexuality. This lobby/interest group is growing as increasing numbers of people are recruited into identifying themselves as sex addicts. With the agenda of protecting people from their own sexuality, they are a dangerous group, easily exploited by the Right and other sex-negative points of view.
It frightens people about the role of sexuality in social problems.
Increasingly, “sex addicts” and trainers are talking in public about how sexual impulses took over their lives and made them do things like steal money, take drugs, and see prostitutes. This frightens people about their ability to control their own sexuality–as if they’re vulnerable to being taken over. * It supports public ignorance about sexuality.
“Sex addicts” and trainers spread stories about how childhood masturbating to Playboy leads to porn addiction, and about how prostitutes become so alluring that people destroy their marriages. The public, of course, takes the additional step that this could happen to anyone–even though there is no data to support this idea.
The movement continues to spread dangerous lies about sex, even though, for example, the ultraconservative Meese Commission was unable to find any evidence that pornography leads to child molestation, and even though no medical society in the world has ever proven that masturbate of any kind is harmful.
It focusses on the “dignified” “purpose” of sex.
These words always seem to mean a rigid sex role system, with sex needing love to give it meaning. Sweating and moaning never seem dignified to people concerned with the dignity of sex. Ultimately, the “purpose of sex” can only be a political, rather than a scientific, concept.
It obscures the role of society in distorting our sexuality.
Sexologists understand that our moralistic American society constricts healthy sexual expression. We all know the sexual and intimacy problems this creates; in fact, we are now beginning to understand how such distortion even helps create sex offenders. But the sexual addiction movement only sees society as encouraging “promiscuity,” instead of discouraging pleasure and healthy sexuality. This simplistic analysis cannot see how the media and other institutions make gilt-free sex almost impossible.
The sexual addiction concept attempts to heal society’s sexual pain while keeping its economic, political, and social foundations intact. This is not only naive and ineffective, it is dangerous.
WHY IS THE SEXUAL ADDICTION CONCEPT SO POPULAR?
It distances personal responsibility for sexual choices.
As Loyola University’s Dr. Domeena Renshaw says, “my illness makes me have affairs” is a very popular concept. The concept seems to allow sexual expression without the punishment our infantile side fears. This is a great childhood fantasy. But the price is too high.
It provides fellowship.
SA-type meetings provide structure and relaxed human contact for people who have trouble finding these in other ways. The program also allows alcoholics in AA to work the steps again. This is one of the single biggest sources of self-described “sex addicts.” In fact, Patrick Carnes claims that 83% of all sex addicts have some other kind of addiction.
It provides pseudoscientific support for the intuitive belief that sex is dangerous.
In doing so it legitimizes sex-negative attitudes and supports sexual guilt.
It lets people self-diagnose.
This is very American, very democratic. People like to feel they are taking charge of their lives, and self-diagnosing gives them the illusion that they are.
It encourage people to split.
When people are troubled by their sexuality, it is comforting to imagine the problem “out there” rather than “in here.” A striking example is Jimmy Swaggart, who railed against immorality out in the world, while behaving in the very ways he was condemning.
It also encourages a kind of splitting among non-“sex addicts.” In answering the defensive question “how can people be sexual like that?” It makes people who behave in certain ways essentially different from us “normal” folk. Basically, people use the concept of sexual addiction as a projection of their fear about their own sexuality. Its very existence is sort of an exorcism of sexuality on a societal level.
It helps people get distance from their sexual shame.
Most of us have deep shame about our sexuality–either our overt behavior, or the more primitive urges and images left over from childhood that we’ve never accepted. This profound sense of shame is what people would really like to get rid of; the behavioral symptoms they’re supposedly addicted to are just a symbol of that shame.
SA-type groups reframe this same into a positive thing. It is a badge for membership; it lets “addicts” know they’re heading toward a solution; it affirms that a sex-crazed society is victimizing them; and it suggests they’re being too hard on themselves. Good therapy does the opposite: it helps people feel their shame, relate it to an even deeper pain, and temporarily feel worse–before helping them resolve it.
WHY DO SO MANY PEOPLE CLAIM TO GET RELIEF FROM SEXUAL ADDICTION PROGRAMS?
First, we should keep in mind that simply because people claim that something gives them emotional relief doesn’t mean it works in the way they claim. Astrology apparently helped reduce Nancy Reagan’s anxiety about husband Ron’s career, but that doesn’t mean it actually helped either of them make better decisions.
The recovery process can be emotionally reassuring for many people.
It offers structure, goals, fellowship, and an accepting social environment. In fact, since most of the talk at SA-type groups is about sex and relationships, it’s a relatively easy place to meet people for dating. And that does go on.
Conversation at SA-type meetings is exclusively about material that each individual is already focussing on. Thus, all conversation feels like it’s about the individual “addict,” and so participants can feel connected with others without having to abandon their own narcissistic focus. This feels intimate, and gives the illusion that an individual is making progress. And, of course, virtually everyone gets to hear stories of people who are worse off than they are, and so they feel better.
People enjoy feeling like they’re heading somewhere.
While “addicts” learn to enjoy the process of recovery, they also learn they’re never going to fully get there. So they set their sights lower–and do accomplish never being cured.
Because the sexual addiction movement is not interested in personality change, it can offer symptom relief without any ethical conflicts. In many cases people do get that relief–although it’s at the expense of the rest of their character structure. Finally, as “addicts” continue learning how to distance themselves from their “bad” sexuality, they feel an increasing sense of direction and relief.
Addicts transfer some of their compulsivity to the SA-type group meeting itself.
For many “sex addicts,” meetings (sometimes many times per week) are the most important part of the week. In a predictable setting and way, with comforting regularity, they get to listen to and talk about sexual feelings and behavior they dislike.
This feeling is perfectly conveyed by a “sex addict” quoted in a recent Contemporary Sexuality. He notes that, “Every Thursday night for the past year and a half I have repeated that statement [about his so-called addiction] to my 12-step support group.” By itself this is a trivial point; in the context of a program supposed to heal compulsive behavior, it is troubling.
WHAT ABOUT SEXUAL COMPULSIVITY?
Most self-described sex addicts aren’t out of control; they are relatively “normal” neurotics for whom being in control is painful. In fact, as the National Association of Sexual Addiction Problems says, “most addicts do not break the law, nor do they satisfy their need by forcing themselves upon others.”
Those who are really sexually compulsive are typically psychotic, sociopathic, character-disordered, etc. Some of these people have impaired reality testing. Others have absolutely no concern about the consequences of their behavior. Dr. Renshaw states that “undifferentiated sexual urgency is a symptom of manic-depression.” These people don’t need help laying off one day at a time. They need deep therapy, medication, structured behavioral interventions, or other intensive modalities. The University of Minnesota’s Dr. Eli Coleman, for example, reports treatment success with lithium, comparable to the clinical results lithium produces with other compulsives. It is absolutely indefensible to suggest that the same mechanism is operating in the rapist and in the guy who masturbates “too often.” The concept of sexual addiction does nothing to diagnose serious problems, assess danger, discuss beliefs about sex, take a history, or change personality. There are no treatment statistics on true obsessive- compulsives using the sexual addiction model. We must also, and this is much harder, continue to resist and interpret society’s demand for simple answers and easy solutions about true sex offenders.
Sexual energy scares people; distorted expressions of that energy terrify people. We need to continually educate policy-makers and the public as to why the treatment of sex offenders is so complex and difficult, and why quick-fix solutions are worse than partial solutions. We must find a way to say “I don’t know” or “We’re still working on it” without apologizing. Cancer researchers, for example, have done a good job of making partial answers–like early detection and quitting smoking–acceptable.
The concept of “sex addiction” really rests on the assumption that sex is dangerous. There’s the sense that we frail humans are vulnerable to the Devil’s temptations of pornography, masturbation, and extramarital affairs, and that if we yield, we become “addicted.” Without question, being a sexual person is complex, and we are vulnerable–to our sex-negative heritage, shame about our bodies, and conflict about the exciting sexual feelings we can’t express without risking rejection. Sexuality per se, however, is not dangerous–no matter how angry or frightened people are.
Professional sexologists should reject any model suggesting that people must spend their lives 1) in fear of sexuality’s destructive power; 2) being powerless about sexuality; 3) lacking the tools to relax and let sex take over when it’s appropriate.
Addictionologists have cynically misled the public into thinking that “sexual addiction” is a concept respected and used by sex therapists and educators. Even a brief look at our literature, conferences, and popular writing shows how rarely this is true. But addictionologists don’t care about sexual truth or expertise–only about addiction. The sexual addiction movement is not harmless. These people are missionaries who want to put everyone in the missionary position.
In these terrible anti-sex times, one of our most important jobs is to reaffirm that sexuality–though complicated–is precious, not dangerous. Now more than ever, our job is to help people just say yes.
Both the professional training and public seminars were relevant, interesting, and engaging. Your ideas on negotiating sexual reality made sex and relationships seem feasible. And you handled the equipment glitches with professional aplomb.
- The Prostate Centre, British Columbia, Canada
Your workshop was one of the highest rated presentations. Participants found your humor, clinical experience, and ease with questions particularly valuable.
- American Association of Sex Educators, Counselors, & Therapists
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