Whether or not sex addiction is real and should be diagnosed and treated as an official disorder (currently, sex addiction is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5) is definitely not a new debate. In fact, sex addiction is a highly controversial area among both the general public and professionals in the field of addiction and mental health.
Proponents for legitimizing sex addiction in the next edition of the DSM and other important diagnostic references believe it’s a very real, underreported and undertreated disease that’s common among those with early-life trauma, including childhood sexual abuse. In addition, these mental health professionals argue that the brains of sex addicts react to sexual stimuli in the same way the brains of drug addicts respond to substances.
Those opposed to making sex addiction an official diagnosis, recognized by the American Psychiatric Association (APA) — which publishes the DSM-5 — and by other leading authorities in the realm of mental health, say that there is little to no scientific proof that there is any amount of sex that’s unhealthy (or healthy) and that the terms “sex addict” and “sex addiction” themselves are based on social and moral values toward sex. Naysayers also argue that labeling problematic sexual behavior as “addiction” undermines the individual’s personal responsibility for that behavior. Some have gone on to say that sex addiction is just a media-inflated term abused by high-profile celebrities (Tiger Woods, John Edwards, Anthony Weiner, David Duchovny, to name a few) looking to justify serial infidelity.
Addiction.com asked Robert Weiss, LCSW, CSAT-S, senior vice president of clinical development at Elements Behavioral Health, and the author of Always Turned On: Sex Addiction in the Digital Age, and David J. Ley, PhD, a clinical psychologist in Albuquerque, New Mexico, and author of The Myth of Sex Addiction, to share their expertise on this complex, controversial issue.
Weiss: “In many ways I find this question amusing because I don’t think I’ve ever met an alcoholic, drug addict, sex addict (or any kind of addict) who didn’t race to treatment at least in part hoping that by going people would feel more sorry for them than angry. And I’m amused because, here’s the thing, if a treatment program itself is well-managed, insightful and incisive, then the addict’s initial motivation for attending is really moot. What matters is that they got there! What matters is what happens while they are there! In residential addiction treatment settings (rehab), we are nearly always working with people who enter our care to get out of trouble, only to find themselves working harder and longer than they thought possible once in our care to face down their own demons. Getting the client to simply enter treatment, regardless of their self-identified reason, is the goal. because once they are there, the treatment process itself has it’s own way of pushing them beyond any initially shallow and/or self-serving motivations toward change.
Where I do worry is when serious sex offenders try to deflect blame and minimize punishment for their more violating sexual behaviors by self-identifying as being ‘sex addicts,’ thus misusing the sex addiction diagnosis to make their serious sexual misconduct seem less so. I also worry that people who are uncomfortable with their sexual orientation or their other sexual turn-ons may mislabel these desires and behaviors as sexual addiction, or worse, that some unethical clinician will support them in this quest, mislabeling their orientation or fetishistic arousals as being ‘addiction.’ And, sadly, this does sometimes happen, even though the problem of active sexual addiction is actually unrelated to who and/or what it is that turns you on.
As for sex addiction as a label being used to excuse people caught red-handed engaging in inappropriate, problematic or possibly even illegal sexual activity, that’s just a flat-out misuse of the sex addiction diagnosis. This is as true for the man who wants to excuse his first affair by calling it ‘sex addiction’ (when found out by his wife), as it is for the violent sex offender who wants to excuse his truly heinous sexual behavior as ‘just an addiction.’ Further, an addiction diagnosis of any kind can never be used to justify anything, including bad behavior.
Instead, an addiction diagnosis brings with it a responsibility and obligation for the person to truly own and take responsibility for any past harm caused. And clients are strongly encouraged to be vigilant in staying away from any future triggers or roads back into the disorder. This is done to discourage and prevent future addictive behavior from reoccurring and to help them gain a sense of personal integrity. All addicts learn in treatment to be fully accountable for their past and present actions; not to hide them under a rug. Under no circumstances are sex addicts absolved of responsibility for the pain and problems their choices have caused. So no matter how shameful it may be to face the reality of a past sexual misdeed, doing so is integral to emotional healing and recovery.”
Dr. Ley: “[According to] 2013 research for the DSM-5 trials of the proposed but rejected construct hypersexual disorder, the majority of people in residential treatment for sex addiction were white men who made over $80,000 per year. The concept of sex addiction sprang into being just as society began to apply the same sexual expectations toward men that had been imposed upon women. As powerful men could no longer expect sexual privilege, the idea that their sexual misbehaviors reflected a disease offered a way to diminish their personal responsibility and accountability. Sadly, the concept of sex addiction is often invoked by such men in legal proceedings in the U.S. as a means to avoid legal accountability.
But the idea of sex addiction is a powerful one in our society because it serves many different purposes. In that same research for DSM-5, gay and bisexual men were at three times the risk of being labeled a sex addict compared to heterosexuals. The sex addiction model has become a vehicle for moral and religious forces to mask their moral judgments behind pseudo-scientific and quasi-healthcare-related facades. Religiously motivated groups have adopted the concept of sex addiction as a means to attack homosexuality, alternative sexualities and pornography. Various forms of addiction are commonly blamed for ‘causing’ homosexuality and used as justification for treatments that mirror gay conversion treatment. I’ve spoken with countless individuals who were told that their sexual attractions were a disease and evidence of an addiction, when in fact these were men struggling with being gay or bisexual, in conflict with their family’s religious values.
The idea that pornography and alternative sexual behaviors are addictive is also used by secular and political groups as a tactic to justify a widening range of sexual restrictions. Cries that people must be protected from the dangerous, addictive effects of sex are used to justify censorship of Internet access in Great Britain, as well as claims that pornography should be restricted because it causes erectile dysfunction or sex crimes. These claims are universally based upon hyperbolic and nonscientific concerns, and ignore a wealth of research regarding the positive effects of sexuality and even pornography.
So, yes, the idea of sex addiction is sometimes used as an excuse for men who choose not to exert control over their sexual behaviors. But it is also used just as frequently to shame and suppress the sexual behaviors of others, reflecting moral and religious values towards sex. Ultimately, these dynamics reveal that the concept of sex addiction is based upon the idea that there is a ‘right’ form or amount of sex. This is a moral concept, not one based on scientific or medical research.”