It’s true. Or so says the completely unscientific but -- according to the New York Times -- expert opinion of SexHelp.com. I’m outing myself by displaying my test results on this very page. It’s small so you might not see that I’m a “10” on the sex addict scale. I was pleased to see that I beat out fellow sex addict Dr. Petra Boynton (she’s only a 9, but she’s British).

As you’ve probably read of late Petra and I are in good company. Yesterday actor David Duchovny left his sex addiction rehab program, presumably bolstered after an intense few weeks of being told to masturbate less, stop fantasizing about sex, only have sex when he feels an emotional connection with his partner, and for goodness sake, don’t use sex to make yourself feel good or express something about your identity (also no sex toys, sex outdoors, BDSM, etc… etc…).

So why am I sharing such a personal fact with so many people I barely know? Well it’s not an elaborate ploy to get more dates and feed my addiction. It’s more of a response to the sex addiction literature I’ve been reading and the absolutely shameful news coverage of the two most recent sex addiction media events (first Duchovny, then the anal-bead-heralded movie premiere of Choke).

Blogs aren’t always conducive to elaborate arguments, so if you’re interested in a reading why everything you know about sex addiction is wrong, there’s lots to sink your teeth into. Here let’s just take two examples.

First up this quote from a CNN.com story published following Duchovny’s disclosure that he was seeking counseling for his “sex addiction”:

'We're seeing it with epidemic proportions now, particularly with regards to cybersex,' said Mark Schwartz, psychologist and former director of the Masters and Johnson Institute in St. Louis, Missouri. 'There isn't a week that goes by where I don't get two calls' about sex addiction.

A St. Louis psychologist who was affiliated with a sex therapy institute receiving two calls a week is hardly an epidemic (and even according to some of the sex addiction people the numbers haven’t changed from what they claim are the 6-10% of Americans who are sex addicts). And any clinician who makes broad social statements based not even on their clinical experience but the anecdotal evidence of their phone records really needs to brush up on their ethical obligations as a mental health professional.

Next up is this gem from a peer reviewed journal article written for nurses about women and sex addiction:

Addiction in women is a growing problem in the United States and is recognized as a very serious disease. Today researchers are able to document the neurochemistry of addiction in the brain. It has been found that sexual activity can create a “high” equal to that of crack cocaine.

Sounds pretty scary. The problem is that it is an inaccurate description of the actual research and it takes that mistake and further confuses it with a leap in logic. It’s true that some studies show that brain activity (although not neurochemistry as suggested in the quote) is present in similar areas during cocaine craving and orgasm. But this in no way means that the experiences are equal.

So what have most of the major news organizations done when called to report on a concept that still hasn't been accepted into either of the bibles of world mental health professionals? Well they go right to the people who invented the term; the sex addiction and recovery industry. Turning to “sex addiction counselors” as experts on human sexuality is like turning to the Ministry of Truth for an expert opinion on where we came from. Without agreement from mental health professionals, without a solid basis of evidence-based research, and in many cases without a grasp of sexological research the sex addiction industry has established itself as a necessary body to treat an illness that only they agree exists.

This is not to say that there aren’t people who struggle with out of control sexual behaviors. People lose relationships, families, jobs, and more because they feel like they can’t control a particular behavior. The problem is not that the sex addiction industry is making up the pain, the problem is that by mixing morality and ambiguity into their theory they actually reduce their chances of helping people in pain deal with their problematic behaviors. Quick fixes are great for selling books and winning elections. But they leave most of us regular folks high and dry in the end.

And so I’ve decided to come out as a sex addict. I seem to be coping fine. I work three jobs, I volunteer my time with several organizations, and if I weren’t Jewish I’m sure I’d go to church with some regularity. I even occasionally see my family (never as much as they like, but I blame that on the addiction). Sure I need help, and I never hesitate to avail myself of mental health services when in need. But I hope I can set an example that it is possible to be labeled a sex addict by a website and still be doing okay. Maybe I should make t-shirts.

**I hesitated before giving this post the title I gave it. I think there’s a tendency among those who don’t agree with the sex addiction model to make fun of the people who get labeled or label themselves as sex addicts. These people may be in genuine crisis and instead of getting the support they need they're being led up the garden path (either by people who know better or should know better). I didn’t want to increase their pain by seeming to make fun of them. But in the end, after reviewing the “research” the terminology is so ludicrous that I felt I had no choice. Plus I bet there isn’t a group that Petra Boynton belongs to that I wouldn’t be proud to join.

Despite a wide acceptance by the media, there is no agreement among bio-medical and social science researchers regarding sex addiction. Some debate the proper definition and others believe that the very idea of an addiction to sex is misguided and not helpful to those who need help. There is general agreement that some people have problems controlling their own sexual behaviors despite many efforts and obvious negative consequences of the behaviors. These problems may be mild or seriously debilitating. While there is no debate that some people engage in out-of-control sexual behavior, there is enormous disagreement about whether or not such behavior should be called sex addiction.

The 'Popular Definition' of Sex Addiction

You may have read about sex addiction in the media, either in the context of one celebrity having a sex addiction, or in an article about how the Internet is turning us all into sex addicts. The definition of sex addiction most often used in this context developed out of a vocal movement of therapists, community organizations, and religious groups led by Patrick Carnes who first articulated his vision of “sex addiction” in his book Out of the Shadows: Understanding Sexual Addiction.

On Carnes’ website he describes sex addiction this way:

"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.

Sexual addiction has been called sexual dependency and sexual compulsivity. By any name, it is a compulsive behavior that completely dominates the addict's life. Sexual addicts make sex a priority more important than family, friends and work. Sex becomes the organizing principle of the addict's lives. They are willing to sacrifice what they cherish most in order to preserve and continue their unhealthy behavior."

The main feature of Carne’s definition of sex addiction is inability to control one’s sexual behavior, which also includes thinking and fantasizing about sex too much. In this formulation sexual activity and even the desire for it creates a “high” which Carnes and his colleagues equate with a drug high. The addiction is evidenced by the fact that people will engage in risky, hurtful behaviors despite understanding the negative consequences that will result.

There are many problems with the concept of sex addiction. Most importantly, there is not enough empirical research to back up this definition and the majority of “evidence” given by those who subscribe to this definition consist of stories from therapists who, we’re told, have worked with clients and successfully treated them.

How Common Is Sex Addiction?

If you’re someone who is worried about their ability to control sexual thoughts, desires, and activities, this may be something you want to know, but unfortunately there isn’t a good answer. First, it’s impossible to know how many people share an experience (like sex addiction) if we don’t agree on what that experience is. Secondly, the unscientific estimates vary wildly from therapist to therapist and from one newspaper article to the next. Estimates from the sex addiction camp range from 6–10% to 45% of the American population having a sex addiction.

Causes of Sex Addiction

Theories as to what causes sex addiction or out-of-control sexual behaviors depend to some extent on the definition one subscribes to. Causes that have been cited (but never proven) include psychological causes (e.g. inability to control impulses, sex as a way of dealing with depression or anxiety, sex as a coping mechanism), bio-medical (faulty neurotransmitter regulation, in rare cases some neurological or psychiatric disorders) and social/relational (problems with intimacy, communication problems, discrepancies of sexual desire, increased access to sexually explicit material). Many sex addiction writers often suggest a relationship between sex addiction and childhood sexual abuse, and between sex addiction and current drug abuse.

Other Definitions of Sex Addiction

Researchers who reject the idea of an addiction model have used other terms over the years, including:

• compulsive sexual behavior
• impulse control disorder
• hypersexaulity
• nymphomania
• styriasis
• out-of-control sexual behaviors

From the perspective of an individual struggling with a behavior they feel like they can’t control, what you call it may seem less important than how to stop it. But definitions are important as they often influence treatment. For example if you define sex addiction by the amount of sex you have, treatment will be designed to reduce your frequency of sexual behavior. If you define sex addiction as an inability to experience intimacy, treatment will try to build one’s capacity for sexual intimacy.

I Don’t Care About Definitions, I Think I’m a Sex Addict

Broadly speaking, if you are struggling with out-of-control sexual behaviors and think you may be a sex addict, it is always a good idea to consult with a licensed therapist. A lucrative industry has developed around the sex addiction model and you can easily find a therapist who is "certified" to treat sex addictions. The problem is that these therapists may not have training in sex therapy and may, in fact, have no education in human sexuality. While many therapists deal with sexual issues with clients, if you're looking for someone who has specialized in sexuality you should seek out a certified sex therapist. At a minimum make sure you understand the training and credentials of whoever you work with before engaging in treatment.

Despite a lack of empirical evidence and scientific agreement on whether sex addiction is real, a vocal and lucrative sex addiction industry has developed in the last 15 or so years. There are websites, books, support groups, educational videos, touring speakers and countless religious organizations all claiming an epidemic of sex addiction is on the rise -- and that anyone with a computer and an interest in sex is in danger.

To make matters more confusing, the mainstream media has been easily wooed by the simple and provocative message of those who believe in something called sex addiction. As a result, reporters by and large print their claims as fact, without doing a lot of checking.

Yet there are many professionals, both sex therapists and sex researchers, who argue that sex addiction as it is presented in the media and to the public through self-help books and talk show appearances doesn’t really exist. They do believe that there are people who have problems with out-of-control sexual behavior, but believe that the sex addiction model makes matters worse for those people by not recognizing the complicated nature of the problem. Here are some of the main arguments made against the idea of sex addiction.

Sex Addiction Takes Sexuality Out of Context
In the sex addiction model, the individual is powerless against their addiction. All that exists is their internal needs and their external actions. The sex addiction model ignores important social and relational factors in the meaning of sex for an individual. Instead of understanding that sexuality and sexual behavior are tied to many of our core values and beliefs, the sex addiction model isolates sexuality from the rest of our lives and in so doing will likely result in incomplete or ineffectual treatment.

Lack of Empirical Evidence and Testable Definitions
Most of what is written about sex addiction comes from therapists working one-on-one with clients, and not from the clients themselves. The movement has failed to produce enough well-designed empirical evidence, and their use of moralistic and vague terminology results in statements that are difficult to test by others hoping to better understand whether the addiction model is applicable.

Sex Addiction Pathologizes Healthy Sexuality
Sex addiction proponents suggest that some sexual behaviors (like viewing pornography or paying for sex) are inherently dangerous. Similarly, most sex addiction material refers to masturbation more than once a day as a sign of problem and to other sexual activities (e.g. sex outdoors, BDSM, sex outside a relationship) as signs of addiction. There is no research to suggest that masturbating more than once a day is unhealthy, and some current research on BDSM suggests that it may actually be associated with greater sexual health and satisfaction.

Misleading or Misunderstanding the Science of the Brain
Consider this sentence taken from an article published in an addictions journal:

Addiction in women is a growing problem in the United States and is recognized as a very serious disease. Today researchers are able to document the neurochemistry of addiction in the brain. It has been found that sexual activity can create a “high” equal to that of crack cocaine.

Sounds pretty scary. The problem is that it is an inaccurate description of the actual research and it takes that mistake and further confuses it with a leap in logic. It’s true that some studies show that brain activity (although not neurochemistry as suggested in the quote) is present in similar areas during cocaine craving and orgasm. But this in no way means that the experiences are equal. Here’s another quote that is typical of what is written by both addiction proponents and media reports:

"The amygdala is the center for sexual arousal and desire and is also the part of the brain that processes drugs such as crack cocaine."

What are some problems with this claim? First, there isn’t agreement on what region of the brain is most important for sexual arousal. Second, the fact that two completely different experiences (sexual response and drug use) are both processed in the same region doesn’t mean that there are any similarities between these two experiences. What this author fails to mention is that the amygdala is also responsible for processing fear. Should we infer then that there is an inherent relationship between fear and sex and drug use?

Addiction Is a Bad Analogy
There remains a debate about whether or not it’s reasonable to call out-of-control sexual behavior an addiction. Sex -- even if it is engaged in excessively -- isn’t in and of itself harmful (and who gets to determine what excessive is?). Some argue that the comparison of a biological drug dependency to something as multi-faceted as sexual experience doesn’t make sense and results in missing the point when people are having real problems controlling their sexual activity.

Sex Addiction Is a Moral Term not a Scientific One
Sex therapist and author Marty Klein is one of the most vocal critics of sex addiction and refers to it as “a set of moral beliefs disguised as science.” Klein points to the three fundamental concepts of sex addiction:

• Sex is most healthy in committed, monogamous, heterosexual relationships
• There are "obvious" limits to healthy sexual expression (for example, masturbation more than once a day)
• Choosing to use sex to feel better about yourself or to escape from problems is unhealthy.

Klein points out that these concepts are inaccurate and not supported by sexual science. They are, however, strong moral positions and ones shared by many on the religious right who often use the concept of sex addiction as a political tool.

Sex Addiction Is Culturally Bound
This critique is more about the advocates of sex addiction than the term itself. In descriptions of sex addiction, the problem is described as being biological and never is the cultural context referred to. The premise of sex addiction is that too much sex is bad for you and certain kinds of sex are bad for you. These beliefs are deeply tied to religion and culture, and yet that qualification is absent in the most prominent writing about sex addiction.

Sex Addiction is Too Blunt a Measure
The sex addiction literature describes a wide array of behaviors and patterns (everything from masturbation to child molestation) as being a sign of sex addiction. A significant problem with this approach is that it misses the complicated and sometimes subtle overlap in expressions of mental health issues. Behaviors or thoughts that could be called sex addiction may actually be a manifestation of depression, OCD, or another mental health issue that’s gone undiagnosed and untreated. Some clinicians argue that the sex addiction model is simply too blunt a tool to be useful.

Sex Addiction Leads to Improper Treatment
This is perhaps the greatest problem with the concept of sex addiction. In trying to fit what are likely a myriad of sexual problems people have into one simple model, and by proposing a cookie cutter approach to treatment, the sex addiction model may be making the situation worse for people who are already dealing with a very serious problem. People who experience feeling out-of-control about sexual behavior may not be helped by forcing themselves to not think about or engage in sex. In fact, stifling your sex drive may cause more harm than good.