Hello. My name is Brian and I am a sex addict.
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It never occurred to me that I might be addicted to love. But then Marty Klein, a sex therapist in Palo Alto, Calif., and author of the book "America’s War on Sex," asked me to take a Web screening test created by Patrick Carnes, the best-known popularizer of the "sex addict" idea.
I answered all the questions as honestly as I could, but some seemed awfully vague — "Do you often find yourself preoccupied with sexual thoughts?" — or rather commonplace — "Have you subscribed to or regularly purchased or rented sexually explicit materials (magazines, videos, books or online pornography)?" But then Carnes’ definition of sex addiction itself can be vague: "Sexual addiction is defined as any sexually-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one's work environment."
That may seem specific but it all depends on how one defines "compulsive" and the effects on others who may or may not be disturbed by another’s sexual proclivities.
Anyway, here is what I was told: "We have compared your answers with people who have been diagnosed with sex addiction. Your answers HAVE MET a score on [the] basis of six [of] the criteria that indicate sex addiction is present."
Don’t feel bad, Klein told me. He often asks professional audiences to take the same test and a lot of them come up sex addicts, too, which may say something about therapists, but more, perhaps, about the test.
In fact, though the terms "sexual addiction" and "porn addiction" are often bandied about, and though the famous (including a certain former President and many of Hollywood's leading men) are often labeled sex addicts, neither term is a recognized diagnosis in the DSM, the bible of psychiatric medicine.
Experts just can't agree on whether sexual addiction is a real problem. This week, for instance, the Society for the Scientific Study of Sexuality is meeting in Indianapolis to discuss, among other things, the topic of sexual addiction. Some argue that there is no such thing, and that terms like "sexual addiction" and "porn addiction" are unhelpful at best, dangerous at worst. The argument is not just about word choice.
“Sexual addiction was invented by Patrick Carnes,” Klein argues. In his book, he labels porn and sex addiction “ridiculous,” and says that the terms have been used as part of an overall strategy to demonize sexual expression by what he calls the “sexual disaster industry.” The goal, he believes, is to build an aura of fear around any activities, such as porn consumption, homosexual sex and premarital sex, that do not conform to the beliefs of those who oppose those activities.
Treatment for football addiction, too?
Daniel Linz, a psychologist at the University of California at Santa Barbara who studies communication, law and society with an emphasis on sexuality, largely agrees with Klein. "We tend to call things addictions that have unfavorable connotations or behaviors that some in society regard as being unacceptable. We do not talk about Sunday afternoon football addiction, money addiction, or a workaholic as people who need treatment like a cocaine addict. We tolerate a certain level of obsessiveness. But this is not the case with more deviant activities. We do not approve of constant viewing of sex. So we pathologize it."
Carnes, who has a Ph.D. in counselor education, does pathologize deviancy. He believes sexually addictive behaviors fall into 10 distinct types: fantasy sex, seductive role sex, voyeuristic sex, exhibitionistic sex, paying for sex, trading sex, intrusive sex, anonymous sex, pain exchange sex and exploitive sex.
Ken McGill, director of the Gentle Path program, a treatment center created by Carnes (who has been on vacation and whose office declined to make him available for an interview, saying that McGill can speak for him), argues that sexual addiction is not only real, but often creates the very same behaviors displayed by crack, heroin or meth addicts. These behaviors lead to habits destructive to jobs and family life or to the creation of shame and guilt. About 350 patients have come through the Hattiesburg, Miss., program, he says, and between 70 percent and 80 percent of them "are maintaining their sobriety."
The fact that sex addiction and porn addiction are not in the DSM is not terribly relevant, he argues, because "addiction is not in the DSM either."
Carnes argued the same thing in a 2003 article as part of a special report by the Sexuality Information and Education Council of the United States. "The DSM’s system is … best viewed as a ‘work in progress’ rather than the ‘bible' … It condenses the criteria for addictive disorders — such as substance abuse and pathologic gambling — into three elements: Loss of control (compulsivity), continuation despite adverse consequences, and obsession or preoccupation." For many people, upwards of 6 percent of the U.S. population and growing, he insists, all three elements are present in sex addiction.
But despite being the leading advocate of the sexual-addiction model, Carnes has a very brief record of research publication and McGill admits that Gentle Path’s results have not been peer-reviewed. "We have not published the research, but I do interact with our alumni … We are moving to scientifically gather data."
This lack of hard research has fueled the controversy and left the field open to sometimes fantastical statements, especially, Klein argues, among those advocating a conservative moral or religious view of sexuality.
McGill says that Gentle Path has no particular religious outlook, but Carnes’ views have been enthusiastically embraced by social conservatives and anti-porn, anti-premarital sex advocates. For example, an organization called Aware, an abstinence-only sex education group based in Washington state, linked to from the Web site for Gentle Path Press, the publishing arm of Carnes’ sexual addiction treatment business, declares that, "Porn can be very addictive. Images viewed for only a few seconds can produce a structural change in the brain and body that may last a lifetime."
There is no scientific evidence for this claim, Linz says. Any strong image will leave memory traces, he explains, but such images could be of love, war, a favored pet, great art or Linda Blair spinning her head in "The Exorcist."
But anti-porn crusaders have sometimes insisted that they have proof of what Judith Reisman calls "erototoxins" as powerful as the most addictive drugs. In 2004 she testified before a Senate subcommittee on the "science behind pornography addiction," saying that advances in neuroscience had revealed the effects of erototoxins.
Now, though, her Lighted Candle Society is asking for donations to fund scientific studies to produce the evidence she told Congress already existed, evidence McGill says he’d like to generate, too.
McGill’s own Ph.D. in psychology (he is not currently licensed as a psychologist, needing, he says, to complete one more test) comes from Azusa Pacific University, a self-described "evangelical community of disciples and scholars who embrace the historic Christian understanding of Scripture." (His thesis project was the creation of a Bible-based sex-addiction program to serve the homeless in Los Angeles.)
The university believes that "sexuality is to take place within the context of a marriage covenant between a man and a woman and that individuals remain celibate outside of the bond of marriage. Therefore, we seek to cultivate a community in which sexuality is embraced as God-given and good and where biblical standards of sexual behavior are upheld."
Cost of breaking a sex addiction
McGill is a board member of the Society for the Advancement of Sexual Health, a group created by Carnes, and is certified by the International Institute for Trauma and Addiction Professionals, another Carnes creation. Therapists can achieve certification as sexual-addiction specialists by completing IITAP courses. A five-day intensive training course, for example, costs $1,250.
The standard in-patient 45-day treatment at the Gentle Path facility in Mississippi costs $37,100. If all 350 patients McGill says Gentle Path has treated since 2005 paid the regular amount, the organization has taken in almost $13 million in two years.
"The sexual disaster industry makes so much money out of scaring the hell out of people," Klein argues.
None of which is to say that the work going on at Gentle Path does not help some people or that pathological sexual behavior does not exist. Inappropriate and destructive sexual expression certainly does exist and people do suffer from what renowned sexologist Eli Coleman, director of the human sexuality program at the University of Minnesota, prefers to call "compulsive sexual behavior." Sexual compulsives may have some other underlying problem, like obsessive-compulsive disorder, depression or bipolar disorder, he says.
"Or they are psychotic," Klein says, "and the vehicle they use to express that happens to be sexual behavior. If we lived in a culture that was more comfortable with sexuality and not hysterical about it, we would not get hung up on the sexual content of their behavior but rather would focus on the problematic decision-making … when people wash their hands 20 times a day we do not send them to a hand-washing clinic, we treat their OCD." It could also be, Klein says, that some "sex addicts" are just selfish and prefer not to exert control over their sexual lives.
McGill agrees that other psychological problems may underlie pathological sexual expression, but says it can work the other way around: that the sexual addiction itself can create depression or anxiety, for example.
Dr. Thomas Mick, a psychiatrist at Mount Sinai School of Medicine in New York, agrees with certain points of both sides.
While there is no physiological dependence in "sex addiction" like there is with alcoholism or narcotic addictions, and while there are no physical withdrawal symptoms, people who are kleptomaniacs, pyromaniacs or "sex addicts" can exhibit some of the same behaviors as those who are chemically addicted, he says. No matter what you call it, some people are in distress.
Klein, McGill and the others do agree on one thing. If the form of sexual expression is not creating problems in one’s life, there is no need for treatment. In fact, the definition for "male hypersexuality," another term thrown into the mix, includes having more than seven orgasms per week, only because most men do not have more than seven orgasms per week. It could be that a man who does has a problem, or just has a very fulfilling marriage.
The debate over sexual addiction highlights concerns over whether society can literally impose a diagnosis by declaring certain activities unacceptable. This was the case with homosexuality, which was once a diagnosable disease mainly because society frowned on it.
This cultural influence is why sexologist Coleman, who has tried to seek a middle ground in the debate, has a word of caution. "In order to avoid overpathologizing," he has written, "it is important for professionals to be comfortable with a wide range of normal sexual behavior — both types of behavior and frequency of behavior. And it is important to look at all sexual behaviors in context."
MSNBC.com columnist and Glamour magazine contributing editor Brian Alexander’s book, “America Unzipped: In Search of Sex and Satisfaction,” will be published Jan. 15 by Crown/Harmony Books.
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