Sex Addiction: A B.S. Excuse for Not Thinking

Tiger Woods has reportedly sought treatment for sex addiction. Given the tsunami of false reports about him, this rumor is highly suspect. Nevertheless, no one would be surprised if he joined the list of high-profile figures, usually men, who have been labeled sex addicts or actively sought treatment as such, e.g. David Duchovny, Charlie Sheen, Michael Douglas, Eliot Spitzer, Mark Foley and Ted Haggard, to name a few.

Whether applied earnestly or as a PR gloss for bad behavior, sex addiction is an increasingly common diagnosis. In my view, it’s a problematic one. It’s ambiguous, hard to define, blurry around the edges, and an excuse for not thinking. If a married man has a lot of extramarital sex, is he necessarily a sex addict? If a seemingly straight man frequents restrooms for casual sex, is he an addict? How much pornography does someone have to look at, how many hours spent in chat rooms, hookers hired, to go from "hound dog" to "sex addict?"

Current attempts at diagnosis focus on the extent to which sexual compulsions interfere with a person’s good judgment or are pursued despite obvious risks to health, job and family. Anyone who has experienced such compulsions or has treated them knows what I mean -- the husband who spends untold hours cheating on his wife online or with hookers, spends money he doesn’t have pursuing his sexual interests, engages in unsafe sex, etc. But how much risk does there have to be? If my lifestyle easily allows me to spend five hours a day surfing Internet porn or cruising for hookers, I may experience little risk but a high level of compulsion. If I feel too guilty to leave a terrible marriage and instead have a series of affairs, am I being compulsive or simply escaping a lonely existence? What about a priest who feels compelled to have sex, thereby risking his entire identity and belief-system; is he a sex addict or did he choose a ridiculously unhealthy lifestyle? Subjective experiences are clearly unreliable: Some people with very strict consciences and conservative backgrounds experience almost any sexual impulse as "out of control," while for others, living in a Fellini film would barely make the forbidden list.

Traditional addictions like those to alcohol or heroin always involve the presence of tolerance and withdrawal; that is, increasing amounts of the substance are required to achieve the same effect, and in its absence the addict suffers an increasingly painful psychophysiological state as the body and brain rebound. But when it comes to sex addiction, physiological tolerance and withdrawal are usually not present, and if they are, they don’t govern the addict’s life in the same way that, say, opiates do. Sex addicts get anxious when they can’t get their "fix" -- they don’t go into DTs.

Sexual compulsions are real and they harm the person in their grip as well as others. But they shouldn’t be called addictions.

But why should we care, especially when labeling sexual compulsions as addictions can sometimes have clear benefits. By accepting their helplessness to control their behavior, people can take it out of the harsh "good versus bad" arena and into one deserving of treatment. Such treatment is always based on a 12-step model focused exclusively on stopping addictive behavior. It is usually supportive and accepting in its focus on maintaining sexual sobriety "one day at a time." I have several patients who have found such support to be very healing.

The problem is that in our culture once something becomes viewed as an addiction, any real inquiry about its meaning goes out the window. No one cares any more why a man spends so much time on the Internet or spends a ton of money seeking out dominatrices. His focus -- our focus -- naturally shifts to simply stopping his behavior, one day at a time. No one cares why I can’t be faithful in a relationship. My problem is my compulsive behavior; my recovery is measured only by the cessation of that behavior. Everything else, like the meaning of my behavior, is either discounted as intellectualized psychobabble or viewed as an elaborate rationalization. When addiction is the problem, its whys and wherefores, its psychological origins and meanings, are superfluous.

Unfortunately, it is precisely because of this bias that the success rates of the 12-step treatment approach to sexual compulsions are so poor. Unlike alcohol, sex is a natural and normal part of human life. So is sexual fantasy. Unlike heroin, sex naturally engages issues of intimacy, power, autonomy, and love. Sexual arousal always has meaning. In fact, sexual excitement of any kind is impossible unless its mental and social context is specifically conducive to it. While the desire for sexual pleasure is natural, the how, where and why are not. Sexual desire actually begins in the mind and travels down. The "problem" of sexual addiction always involves the mind and the social world, never the desire itself.