What is Sex Addiction? (Part 2)
What is Sex Addiction?
Many times, in attempts to recover from sex addiction on their own, sex addicts end up developing another addiction. 83% of sex addicts also have concurrent addictions such as alcoholism, marijuana or other drug abuses, eating disorders and compulsive gambling (Hayden, 2013). When multiple addiction coexist, untreated sex addiction complicates recovery from chemical dependency and makes relapse to drug addiction more likely. When alcohol or drug abuse is up, inhibitions go down, creating a slippery slope for sex addicts to maintain sexual addiction recovery.
Involvement with the law or fear of exposure by the law perpetuates a fear that feeds the cycle of addiction and shame. 58% of sex addicts report having engaged in some form of illegal activity (Hayden, 2013). Sometimes out of fear of legal consequences, treatment is not sought, and recovery is impossible. Fear of public humiliation is also a problem that may cause the sex addict to retreat and shy away from recovery.
Another reason sex addiction recovery is difficult is the lack of acknowledgment of its existence by the DSM-5. In the 19th century, individuals who lost control over sexual behaviors were diagnosed with moral insanity, satyriasis, or nymphomania (Levine, 2010). For the first time since diagnostic manuals existed, the diagnosis of addiction is no longer limited to substance use (Potenza & Childress, 2010). For instance, pathological gambling, now termed gambling disorder, has been described as a behavioral addiction under the chapter named “Substance-related and addictive disorders,” reflecting evidence that gambling behaviors activate reward systems, similarly to drugs of abuse (Holden, 2010). There has been growing evidence that “hypersexual disorder” (sex addiction) has been linked with positive reinforcing effects and may become addictive. Some have argued that, like addiction, hypersexual disorder patients may develop tolerance to increasing levels of sexual stimulation, and even withdrawal-like syndromes in the absence of sexual activities (Piquet-Pessôa et al., 2014). However, there is still debate on whether less recognized forms of impulsive behaviors such as compulsive sex can be conceptualized as addictions (Piquet-Pessôa et al., 2014). Some therapists have interpreted the APA’s decision to omit this diagnosis from the DSM-5 as a victory against a ‘sex-negative’ diagnosis (Katehakis, 2012). However, given the scarcity of studies in the field, the DSM-5 has decided to exclude sexual addiction as a behavioral addiction.
Sex addiction treatment can be expensive. Since sex addiction is not recognized by the DSM 5, insurance companies do not reimburse for treatment. This leaves many underserved communities without adequate treatment. The average cost for therapist specializing in the treatment of sex addiction is $225 dollars an hour. The average cost of in-patient sex addiction treatment is $65,000. Many times, the population that receives quality care is limited to the elite and those who have financial means.
Sex addiction is one of the most controversial problems to have entered the public arena in the past 50 years and one that has generated a vast amount of media attention (Hall, 2013). Many times, people suffering from this problem are often classified as perpetrators based on cultural misunderstanding (Burke, 2003). There are not enough clinical experts who work with sex addicts therefore we give no voice to the advocates of this population. Conceptually, there is a fractured nature between cultural stigma, therapist’s awareness, and reality which leads to insufficient treatment (Carnes, 1989).
Carnes (1989) addressed the cultural issues faced by clinicians then when he wrote, “Sexually compulsive people challenge, and often confound, professional understanding because of their incredible diversity preferences” (p. 37). Also, because of insufficient training in the mental health field, many addicts go undiagnosed or receive ineffective treatment.
There are still some medical and psychological professionals who doubt sex addiction exists or view focus on it as sex negative, and many more have not yet grasped the complexity of the condition (Hall, 2013). This conflict among professionals makes it difficult for sex addicts seeking recovery to know where to turn for help. With mixed information, it can be confusing on what proper steps to take and who to trust when seeking treatment. Because of this divide, sex addiction behavior can be treated improperly which may lead to relapse.
There are two distinct interdisciplinary professional organizations that are devoted to the promotion of sexual health counseling; the American Association of Sexuality Educators, Counselors and Therapists (ASSECT) and Certified Sex Addiction Therapists (CSAT). AASECT’s does not support the classification of sex addiction or porn addiction as a mental health disorder due to insufficient empirical evidence, and AASECT does not believe sexual addiction training programs and educational pedagogies to be adequately informed by accurate human sexuality knowledge. (AASECT Position on Sex Addiction, n.d.). In contrast, the CSAT community posture that sex addiction is real, and treatment is possible. Their certification program provides innovative training built around academic study, experiential training, supervision and assessment competence (About IITAP, n.d.). Because of the different worldviews on how to approach problematic and consequential sexual behaviors, the profession has a divide. There is a necessity of cooperation from a range of disciplines to effectively treat this problem. To narrow this further, an alliance needs to be created between sex therapists and sex-addiction therapists to talk about what healthy sexuality looks like in sex addiction recovery.
It is important to give voice to those who are in recovery for sexual addiction and how they experience healthy sexuality while in recovery. Between three and six percent of Americans suffer from some form of sex addiction. We do not hear enough about those who have been able to recover from this addiction and how they were able to do it. Those addicted to sex are likely to find help and information more difficult to come by which is why we need to hear about the experiences of those who have found recovery (Herkov, 2019). The current trend of inconsistency in the way sex addiction is viewed makes it difficult to argue its prevalence to those who do not agree with this disorder (Herkov, 2019). The epistemology around sex addiction diagnoses, treatment, and recovery continue to be poorly understood by the public and new narratives need to be explained so the general population can better understand this problem and how treatment works.