Sex Addiction: Is It Really an Addiction?

This week's segment of CBS Doc Dot Com examines sexual addiction, a subject about which I learned absolutely nothing in medical school and have not learned much more since. In researching the topic over the past week, I began to understand that it is extremely controversial, with experts not even agreeing about whether sexual addiction is a true addiction.

When most people hear the term, they usually think they know what's meant by sexual addiction. They may think of someone (usually a man) who has an incessant need to make sexual conquests, sometimes despite his own best intentions. But even back in the days when Sam Malone got this diagnosis on the old TV show "Cheers," it was clear that a real definition was lacking. In 1998, two researchers published an article entitled "Sexual addiction: many conceptions, minimal data." As Erick Janssen, Ph.D., Director of Education & Research Training at The Kinsey Institute, explained to me in an email: "We do not have a generally accepted definition of 'sex addiction.' It was originally approached as involving some kind of 'inability to adequately control sexual behavior,' but this is, as you can tell, not a very objective definition. According to some, sexual addiction seems in the eye of the beholder, or in the eyes of his or her therapist."

For one side of the definitional argument, I spoke to addictions treatment specialist Mavis Humes Baird, who is convinced that sexual addiction is a true disorder because people are in the throes of an impulse they can't control, that there are underlying changes in the brain that cannot be addressed by psychotherapy alone. She told me, "for example, if one of the partners in a couple is having affairs and they're not a sex addict, marriage counseling or family therapy is very effective. But if they're a sex addict, all the therapy in the world getting at problems in the relationship won't touch the addiction. One of the primary referral sources for sex addiction is couples counselors who have been doing attachment work with couples for years with the addiction going on unaffected and sometimes kept secret for all those years. You can't treat the sex problems between the partners until the addiction is treated. And that's done by a combination of specific treatment protocols, and 12-step program involvement, and sometimes medication."

But Ms. Baird also told me it's not listed in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and that there's a struggle about whether it will be included in the next edition. One crucial repercussion of not being listed in the DSM-IV is that the exclusion makes it more difficult for patients to receive reimbursement for treatment. Some researchers hypothesize that sexual addiction, substance abuse, and gambling share neurochemical changes in the brain--underlying problems with brain wiring and nerve transmitters such as dopamine. For many of those researchers, it would seem to follow that treatment should be covered as other addictions are.

On the other side of the definitional aisle is Dr. Herbert Kleber, Professor of Psychiatry at Columbia University Medical Center, where he is the Director of the Division on Substance Abuse. When I asked him about sexual addiction, he said: "Is it an addiction? I'm convinced gambling is an addiction but am agnostic about sexual addiction. Once you let one of them in the door do you let in shopaholics, kleptomaniacs, etcetera? Where do you draw the line?"

Dr. Janssen echoed Dr. Kleber's skepticism, telling me: "There are no reliable prevalence statistics on sexual addiction. That is, it has not been measured in representative samples of men and women. A few studies in non-representative samples have concluded that it could involve 5-10 percent of the adult population. Most sex researchers prefer to not use that term, instead relying on terms like 'sexual compulsivity' or 'sexual impulsivity' to reflect people's experiences and actual behaviors." Dr. Kleber and his colleagues wrote a classic article in which they argued that drug dependence was a "chronic medical illness" and not just a "social problem." The implication was that you could no more "snap out of" drug dependence than diabetes, asthma, or high blood pressure.

But Dr. Kleber is not convinced that what he calls "controversial addictions" to sex, the Internet, food, and shopping are true addictions. "We don't know enough about what goes on in the brain with these disorders. Do we include all of them, some of them? At this point, the jury is out."

Whatever the jury ends up saying about disease classification and underlying brain biology, one thing seems clear to me: for people suffering from this problem - and for their loved ones - the pain and the need for help are quite real. This is a disorder that desperately needs more research.

For an overview interview with Mavis Humes Baird on the subject of sexual addiction, click here.

For an interview with Ms, Baird about the relationship between Internet pornography and sexual addiction, click here.

For an interview with a self-described recovering sex addict, click here.

For an interesting WebMD article on the subject, click here.

For a good review of the concepts of sexual addiction, sexual compulsivity, and sexual impulsivity, click here:

Comments

[SALifeline]

We have just completed creating a foundation that focuses on finding help for those that suffer from Pornography / Sexual Addiction. We have teamed up with a leading Neurologist who has written on wonderful book that presents the case on why Pornography is so addicting. Even more addicting then Alcohol or Drugs. You can learn more by going to http://salifeline.org

[Anastasia]

A former friend of mine has a sex addiction. It's all about being compelled to go out and have sex now. While it seems difficult to have too much sex, after a while it's not about pleasure, so much as it is fulfilling a chronic need.

It's like an obsessive compulsive disorder. Not getting the need met causes extreme anxiety but at the same time, there's a great deal of shame and self-loathing attached to this kind of behavior.

[coastalcarla]

From the sound of many of the posts here, it sounds like we have a full crew of therapy jun kies in attendance. Sex addiction - what will it be next? Does every person that lacks common sense and self control get to brand themselves with a disorder now? And we're supposed to pity them?

Lack of self control is not a disorder - it's a character flaw. Work on improving it, instead of making excuses for it.

[DrunkenTromboneMaster]

ADHD gets a pass because it truly is a chemical imbalance and is treated effectively with medication. But ADD is definitely bullshit.

[Acleacius]

We can be addicted to or compulsive about anything, they are defense mechanisms or symptoms of some physiological issue. We try to subconsciously hide/fight some mental or physical pain, whether it's painful memory or allergic reaction putting your body into a hyper-histamine state. Without the skills or technology to recognize how to deal with them in a necessarily healthy or effective way, especially if it happens while we are young, our brain's look for ways to protect. Ninety nine percent of the time this seems to be done by flooding our brains with endorphins, from addiction or compulsive activity. We develop our methods based on our individual sociocultural experiences and why there are so many different methods, yet confined to high endorphin release.

[MrMike513]

I am constantly amazed at how little most people, even doctors and therapists, know about addiction.
The best definition of addiction is this:

"Addiction is engaging in behaviors that cause problems in your life, yet you continue to engage in said behaviors despite the problems."

Note that this definition does not mention any type of substance such as drugs, nor does it include anything about frequency. You don't have to be engaging in the behavior daily to be addicted. The key to identifying addiction is the effects the behavior has on your life.

By this definition, any person with 2 DUIs is an alcoholic. Why? Because only an addict would risk the criminal and financial hardships of a DUI conviction a second time. If a person has one infidelity in their marriage, that does not make them a sex addict. But if they have more than one affair they probably are a sex addict. Is a person who has a drink or smokes a joint everyday an addict? No, not if it doesn't cause problems with their work or personal relationships or finances. But the person who only gets drunk once a year, and gets in fights and ends up in jail each year, is an addict. The non-addictive personality does not think the consequences are worth it.

The bottom line is that a person can be addicted to ANYTHING, and people who don't understand that don't understand addiction.

[DrunkenTromboneMaster]

You should be concerned about how little YOU know about addiction.­......Webs­ter's defines it as "the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming to such an extent that its cessation causes severe trauma.

[MrMike513]

You've done an excellent job of proving my point. Webster's culls it's definition from usage in print media, and the fact that their definition is so wrong shows how little people who are writing about addiction actually know about addiction. Thank you.

[theotherbed]

Oh, nice that you looked it up in the dictionary....now you know...NOTHING!

This obfuscation provoked a rant over at theotherbed.com, where we go beyond the dictionary. Now look up Cliff Clavin, since the "Cheers" references are flying around, apropo of NOTHING!

[Leper]

My understanding of addiction was that there was a physiological component, that the body (not just the brain) would react when the addiction was not sated. Sex addiction appears to be more of an obsession/­compulsion disorder and many obssession­/compulsio­n disorders cannot be treated by therapy alone.

This is not to say that the condition is not serious because it is. I just think that we have a tendancy to slap on the label of addiction to give it more emphasis and more urgency which is sad because of what it says about our priorities in mental health.

[gevan]

What matters in any addiction is whether or not it interferes with our ability to cope with life on our own terms. Does it make life unmanageable? If so, it should be dealt with. If not, enjoy.

[witz]

Always funny to read these articles for the masses with absolutely no soul or understanding of the addiction. It's like they're orbiting in some satellite around earth.

Yes, it's an addiction. I've been sober for 16 + years. Yes I go to meetings and they help immensely because they rewire my brain. Sex addicts can no more control their self destructive behavior than an alcoholic can control their drinking. At the core level there is a chemical problem in the body that sex equals out. It's not about conquests, most of the guys in program are there for internet porn, phone sex, or acting out with prostitute­s/stripper­s/massage girls or guys.

A lot of people seeking help experience changed lives for the better.

[squarebird]

Witz .. wake up .. you have cured yourself of being a human being. Internet port and phone sex is sign of an 'addiction'? Puh-lease. They, like all sex play, are simply a way to enhance the joy of masturbation. The term 'addiction' is reserved for repetition of harmful behaviors .. otherwise working 8 hours a day would be termed an 'addiction'. Or sleep. Or eating. Or driving cross-country in the RV.

[mckinley]

Watched the interview - sorry, don't buy it.

He calls calls himself a "sex addict" because his behavior once included - while a single man - seducing a married woman?!

Sorry, this guy is just full of himself - "woe is me!", And Then He Found God - and he wants the world to feel sorry for him for how hard his life is.

[phlashba]

you have the brain of a child.

[coastalcarla]

It's a new "disorder" - called Perpetual Victim Syndrome. People that make stu pid decisions and then make excuses for their stu pidity by blaming everyone but themselves. It's never their fault - they have a "disorder", you see.

How very convenient. Anything to escape responsibility for their life turning out badly, due to their own id i otic behavior.

[DamaskinosLives]

Sex is a basic biological function , like eating and excreting.

Life cannot exist without these basic biological functions.

To suggest that there is an addiction because it offends your cultural viewpoint is wrong.

The only time it is wrong is when there is coercion or violence.

The rest of the time, as a worst case, it is merely extremely ill advised
.

[PresidentRobertBooth]

If we legalised prostitution and offered discounts, sex addicts could get their fix without the need to get into destructive relationships.

[JohnSawyer]

If discounts for having sex with a prostitute were offered, don't you think everyone who uses prostitutes would try to get a note from their doctor?

[TomFox]

The problem is that with sexual addiction is that the emotions are running the show. And that circumvents the part of the brain that says..."Hey, this is not a good thing for you". I'm sure you could probably decide very easily what works for you. But for someone caught in the throes of this addiction it isn't that way. There is never enough, even when married.

The way out of the addiction is to deal with it.

[StellaWafers]

Sad to see these posters are not getting the point of the argument. People with this sort of behavior damage themselves and all the ones around them too. You could argue against a person being an alcoholic too- but we are much more aware of the impending decline of an alcoholic's life than someone with this affliction. If you don't know anyone with it, be thankful.

[ilikemusic]

Can you be addicted to sex even if your never get any?

[Isis N]

I was going to ask the exact same thing!

[RevSpaminator]

As long as you have something to stimulate.

[Roxie74]

Yes, it's called sexual anorexia. Sex addiction is very real and can be very destructive; there is even a twelve step program for it.

[PresidentRobertBooth]

We are all addicted to sex.

At a primal level, it's our only reason for existing.

[NoSillyName]

Not.

[MarkBoston]

yes , in essence ... I agree with you ... on a pure organism level. Reproduction IS the only real goal. Perfect example is the May fly.

[JohnSawyer]

But we're not May flys.

[yellowdoggie]

Maybe, for men. For women, it's the urge to procreate. And believe me, that urge goes away with time. Thank god.

[Edgew]

Compulsions can be worse than addictions! I once worked with an eighteen-year-old who had permanently damaged his kidneys because of his OCD compulsion to urinate only at home. He’d sometimes have to go up to fourteen hours without urinating, horribly distending his bladder.

But I digress. The most interesting thing I’ve read in these comments is the thought that sex cannot be an addiction because it does not have the withdrawal feature of addiction.

In classical addiction (drug addiction as the example), constant repetition of the addictive behavior leads to tolerance (lessened pleasure/positive feedback), which triggers an increase in the behavior’s intensity or frequency in order to at least maintain the previous pleasure level, and if the behavior is interrupted or ended, “withdrawal” (intense physical or psychic pain that may subside).

Not so with a so-called sex addict. There are instances one can imagine where an interruption to chronic sexual activity does NOT lead to withdrawal: Suddenly becoming engrossed in a diverting work project, becoming worried about some new physical malady, starting a new semester at a new school, etc.

Maybe these semantics are not important. It seems like they should be, but am I wrong?