Scarlett is a 23-year-old psychology major with an active sex life and a drive exceeding her boyfriend’s.
“I’m down to fuck!” she says with a smile that reveals experience beyond her years.
As well as enjoying sex, she is fascinated by the science behind it. In addition to understanding the cycle of sexual response, she knows hormones play a significant role in one’s sexuality and realizes her genetics and environment may have influenced her attitudes and taste in it, too.
“I was taught there were no taboos unless it harmed someone else,” Scarlett remarks. “My parents were probably closet libertines.”
But after seeing the movie Shame with her boyfriend, she was introduced to a new concept: Sex addiction.
Shame is an erotic drama surrounding a successful, single New Yorker who struggles to hide his sex addiction after his sister moves in with him. After watching the film, Scarlett started to wonder if she was a sex addict, based on the similarities of her sexual thoughts and fantasies to those of the protagonist. She also questioned whether sex addiction is real or junk science, something made up to make money off wealthy people looking to excuse bad behavior.
Sex addiction was first referenced in the early 1980s by Dr. Patrick Carnes, founder of the International Institute for Trauma and Addiction Professionals, as “any sexually-related behavior that interferes with normal living and causes stress on family, friends, loved ones, and one’s job.” With his first book, The Sexual Addiction, Carnes defined the term and made it mainstream to propose treatments used for drug addiction. Today, there are 2500 registered sex addiction therapists in the US, and sex addiction has become a large part of the addiction treatment industry, worth an estimated 42 billion dollars per year. But can sex be an actual addiction?
First, we need to understand what addiction is. According to the American Society of Addiction Medicine, “addiction” is defined as:
“A primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors….it is characterized by the inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” (American Society of Addiction Medicine Public Policy Statement, 2011)
Many studies have been conducted in an attempt to prove the legitimacy of sex addiction. Most recently, a study published by the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism suggested men who were identified as sex addicts have higher levels of oxytocin in their bloodstream, which they argued leads to compulsive sexual behavior. Despite the studies, sex addiction is still not seen as a form of addiction among many in the medical community. So, the question remains, is sex addiction real? Are we giving unfair treatment to people with behavioral disorders who clearly need help? Or, is it a made-up excuse for people to justify inappropriate sexual behavior?
One of the most vocal skeptics of sex addiction as a legitimate medical diagnosis is clinical psychologist, Sexual Health Alliance board member, and author of The Myth of Sex Addiction, Dr. David Ley, Ph.D. Ley’s book discusses the history and questionable science surrounding the “disorder,” exposing the moral and cultural judgments embedded in the concept and the significant economic factors that drive the label of sex addiction in clinical practice and popular culture.
After researching the subject, Dr. Ley felt it was essential to bring this to light because he thought people going through sex addiction treatment were not getting the appropriate help they needed.
“I found that this was a concept that was very, intentionally using pseudo-science to mask morality—particularly conservative/religious morality around heterosexuality, monogamy, and against masturbation,” he said. “Issues of morality, homophobia, and particularly concerns around alternative sexuality were largely behind the claims of sex addiction.”
Scarlett concurs. “I’m into kink; I’ve hooked up with strangers. In the age of Tinder, is that unusual?”
Not really. The number of Tinder users around the world is 57 million. 38% are female users with an average age of 23. According to one survey, 28.6% of all hookup app users answered that they’d had two or more one-night-stands – 10% of those were women. Given Tinder’s and other hook-up apps’ reputation, one must assume ‘hooking up’ is a primary motivation.
Soon after The Myth of Sex Addiction was published in 2012, Dr. Ley was invited to The Dr. Phil Show to discuss the book. He said the reaction from the general public was so strong that it launched national interest in discovering if sex addiction was a real medical problem.
“I didn’t realize how seriously people viewed sex addiction as an acceptable excuse for unacceptable actions. When writing the book , sex addiction was blindly accepted, and now, it’s not,” he said.
CAN WOMEN BE LABELED AS SEX ADDICTS?
Because the protagonist in Shame is male and men are typically seen as having higher sex drives than women, Scarlett wonders if sex addiction is only diagnosed in men.
In Dr. Carnes’ second book, Out of The Shadows: Understanding Sexual Addiction, Carnes says that anyone can be affected by sex addiction. Still, specific categories of people are at a higher risk.
“Most [sex addicts] were abused as children – sexually, physically, and/or emotionally. Most grew up in families where addiction flourished, including alcoholism, compulsive eating, and compulsive gambling. Most grapple with other addictions, but they find sex addiction the most difficult to stop.” (Carnes, CSAT MEDIA KIT – cdn.ymaws.com, 2008.)
By contrast, Dr. Ley believes that there are much more complex reasons someone may be labeled a sex addict.
“There are individuals who use the label of sex addiction to avoid responsibility for their actions, but others are given the label because they want more sex than their partner or because they want a different kind of sex than their community allows. Some people apply that label to themselves because they are confused about their sexuality.”
Both of these stances imply that sex addiction knows no gender.
Stereotypically, however, most individuals labeled as sex addicts are men with narcissistic qualities. In an interview with CBC Radio, Dr. Ley stated that 90 to 95 percent of those labeled sex addicts are men–with almost half being straight, white men who make over $100,000 per year.
Additionally, the majority of Carnes’ book does not address women directly. Dr. Ley, however, credits this to the nature of the topic and the sexism behind it.
According to Dr. Ley, when a woman gets diagnosed, she is usually referred to as a ‘love addict’ rather than a sex addict. This plays off the conservative ideology that there’s no way a woman can enjoy sex as much as men, let alone more so.
“When women get labeled as sex addicts, it is overwhelmingly with women who are, frankly, being slut-shamed for liking sex as much as men…They [people or therapists] have unbelievably antiquated sexual ideas right now around women. So, when they see women, they label them as love addicts, and this comes from the idea that men want more sex than women and that women fall in love too easily,” he said.
Dr. Ley is not alone in this opinion. Rehabilitation centers, such as The Right Step in Houston and Hill County, Texas, acknowledge women are more likely to be labeled a love addict over a sex addict. However, they say that love addiction is different from sex addiction.
“Some people believe that women typically develop a form of non-sexually manifested behavioral addiction called love addiction, not sex addiction. However, women can develop active cases of sex addiction just like men. Additional biases that may potentially prevent the general public, researchers, or doctors from considering compulsive sexual behavior in women as sex addiction include a cultural belief that highly sexually active women are merely needy.”, (rightstep.com, Women Have Unique Risk Factors for Sex Addiction, 2015)
The Right Step backs up their sex addiction claims further by citing a 2015 study from Portugal’s University of Porto and University of Aveiro, which was later published in the Journal of Sex and Marital Therapy. In the study, 235 college-aged women were given self-questionnaires about trait affect, impulsiveness, psychological symptoms, ability to recognize their own emotions, sexual response in states of anxiety versus depressive mood, and coping skills. The study concluded:
“Two factors help predict the onset of compulsive sexual behavior or sex addiction in women. These factors are a tendency to think or act impulsively and involvement in a pattern of behavior characterized by hostile relationships and aggression toward others. Overall, the study’s authors concluded that the manifestations of impending sex addiction in women can differ substantially from the indicators associated with this condition when it appears in men.”
According to therightstep.com, the study also claims that early signs of sex addiction in women are much more subtle when compared to men. However, no specific examples of subtle symptoms are given. It also should be noted that the authors of the study acknowledge this omission:
“…there is missing evidence on the relation between psychological factors and sexual compulsivity in the absence of significant psychiatric disturbance. Such disturbance may mask the psychological dimensions underpinning sexual compulsivity.”
In the article Unseen and Unnoticed: Women and Sexual Compulsivity, author Samantha Smithstein, Psy.D claims that women have both similarities and differences in sex addiction symptoms compared to men. Similarities include: the inability to control sexual behavior, continued behavior despite negative consequences, and obsessive thoughts in planning or obtaining sex. The main difference, Smithstein says, is that symptoms of sex addiction in women accumulate over time. However, like the 2015 study, her claims are not specific and could be applied to any woman with a high sex drive.
“The woman may first think that she’s enjoying a varied sex life with a range of men or that it’s positively feeding her self-esteem; the behavior may start as a teen. Over time it becomes extremely difficult to stop the patterns of sexual behaviors established… If a woman continually engages in sex with strangers, has dangerous affairs, can only feel pleasure through sadomasochistic acts, and usually feels depressed or melancholic ‘the morning after’, these are signs that she may have sexual compulsivity,” Smithstein said.
However, if viewed objectively, the behaviors presented, especially in the 2015 study, project high sex drives in young women who are newly fertile [ages 14 to18] or, at the peak of fertility [ages 20 to 25], are not uncommon. Female college students, in particular, tend to give in to their sexual impulses due to peer pressure, a higher risk of being exposed to alcohol, and experiencing the world on their own for the first time without supervision.
Given this, it would be unfair to assume that these are symptoms of sex addiction but rather, a reaction to elevated hormones and the individual’s environment. It could be argued that if these studies prove anything, women who are labeled sex addicts have symptoms or behaviors that are no different from men.
WHAT DO OTHER EXPERTS SAY?
Dr. Ley is not the only professional who believes that sex addiction is not real. Groups such as The Association for Treatment of Sexual Abusers, and The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) have come out against the concept.
However, many who support the belief of sex addiction cite The World Health Organization in their argument after adding compulsive sexual behavior disorder to the ICD-11ICD-11, in 2018.
If you look at the actual verbiage, addiction is not mentioned. However, if we look at the diagnostic requirements of compulsive sexual behavior disorder and sex addiction, as presented by Dr. Carnes in his 1992 book, Don’t Call it Love: Recovery from Sex Addiction, we will see that they are remarkably similar.
|Diagnostic requirements for compulsive sexual behavior disorder- WHO||Diagnostic requirements for Sex Addiction- Don’t call it love: Recovery from Sex Addiction (Carnes, 1992)|
|A persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior.||A pattern of out-of-control behavior (Note: it is not specified if it is related to sexual or general behavior)|
|Engaging in repetitive sexual behaviors have resulted in it becoming the central part of one’s life to the point of neglecting one’s health, personal care, interests or responsibilities||Severe consequences due to sexual behavior and inability to stop despite adverse consequences.|
|The individual has made numerous unsuccessful attempts to control or significantly reduce their sexual behavior||Persistent pursuit of self-destructive or high-risk behavior.|
|The individual continues to engage in repetitive sexual behavior despite legal consequences.||Ongoing desire or effort to limit sexual behavior|
|The individual continues to engage in repetitive sexual behavior even if they do not get enjoyment out of it.||Sexual obsession and fantasy as a primary coping strategy|
|The pattern or failure to control intense or repetitive sexual urges or behavior occurs over six months or more||Increasing amounts of sexual experience because the current level of activity is no longer sufficient.|
|The pattern of failure to control intense or repetitive sexual urges or behavior is not better accounted for by another mental health disorder, medical condition, or severe medication side effects||Severe mood changes around sexual activity|
|The pattern or failure to control intense or repetitive sexual urges or behavior results in marked distress that is entirely related to moral judgments and disapproval of sexual impulses, urges, or behaviors.||Inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experience|
|One’s sexual behavior has a significant impact on their family, social, educational, occupational, or other important areas of functioning||Neglect of important social, occupational, or recreational activities due to sexual behavior|
|Expresses repetitive sexual behavior in a variety of ways including sexual behaviors with others, cybersex, phone sex, or other forms.||Qualifies for a sex addiction screening test (Note: many professionals argue that the assessment is not grounded in reliable research and pathologizes many sexual behaviors based on judgments, morals/values, and beliefs of the SAST designers.|
Because of the findings above, those who believe sex addiction is an actual condition tend to present both sides as the same. However, Dr. Ley says this is not true.
“Sex therapists heard this and ran with it….the pseudoscience behind sex addiction has been rejected by WHO and the American Psychiatric Association and is seen as poor clinical practice,” he said.
Further supporting Dr. Ley’s point, in a 2017 interview with CBS News, Dr. Nicole Prause, neuroscientist and founder of Liberos LLC, shared that her company conducted a study in 2015 that stimulated the P-300 brainwave, the brainwave that is enhanced when most addicts are tempted by their specific addictive stimuli. In the study, cocaine addicts were shown photos of cocaine and people doing cocaine. The results were then compared to identified sex addicts, who were shown pornography. According to Dr. Prause, the results from the sex addicts showed the opposite response.
“Sex addicts had a lower brain response in that area, so it was very inconsistent with an addiction model. Sometimes it’s been called a bio-marker of addiction…sex looks very different from other proposed addictions,” she said.
Dr. Prause later added that the study proves there is no similarity to other forms of addiction. She believes that sex addiction is actually a combination of high sex drive and social shame.
On the other side of the aisle, there are many credible doctors and researchers who believe in sex addiction and attempt to make viable points. In most cases, they point to the release of dopamine and oxytocin during orgasm as the reason why sex can be addictive.
Curiously, Dr. Alexandrea Katehakis, Ph.D. M.F.T., who is the Clinical Director of The Center for Healthy Sex, and certified sex and sex addiction therapist, believes that sex addiction is real, even though she is certified by AASECT.
“While some experts say sex doesn’t lead to comparable neurological effects, many sex addiction therapists disagree. With drugs and alcohol, an external substance alters the body’s neurochemistry. With things like compulsive sex, internal mechanisms are creating neurobiological and neurochemical [changes],” Katehakis said. (self.com, 2017)
She added that this is seen during the sexual response, making her claim legitimate.
“When you’re excited, physiological changes, like the release of the neurotransmitter dopamine, abound, she said.”
The 2021 study by the Journal of Clinical Endocrinology and Metabolism also says that dopamine and oxytocin can play a large part in sex addiction.
“We discovered that men with compulsive sexual behavior disorder (CSBD) had higher oxytocin levels than healthy men,” said Andreas Chatzittofis, M.D., Ph.D., of the University of Cyprus Medical School in Nicosia, Cyprus and Umeå University in Umeå, in Sweden.
Despite the studies and research that has gone into this, Dr. Ley says that the argument is a distraction from the real problem, a person’s choices.
“This idea in recent research that oxytocin is causing high levels of sexual behavior is very, very poor research. It’s an incredibly simplistic way of thinking. I’ve talked with colleagues about the study, and they say its stats and design are actually a mess… Oxytocin is released during orgasm, but so are other neurochemicals such as testosterone, progesterone, and serotonin,” he said. “At a deeper level, they are mistaking effect for cause. People with higher sexual behaviors are likely to have higher oxytocin levels, but the oxytocin is coming out of their behaviors, not what is causing the behavior.”
Dr. Ley added that those who believe dopamine can be addictive have a kindergarten understanding of how neurochemicals work.
“Dopamine is associated with reward but is not a rewarding neurochemical,” he said. “We can imagine that if a person continuously engages in a particular behavior before achieving orgasm, they teach themselves that those behaviors are difficult to change. In this case, we are not talking about the desire to have sex–we’re talking about behavior and choices.”
Who is labeled a sex addict, who believes in it, and how is it treated.
Generally speaking, most doctors and researchers of sex addiction agree that cognitive behavioral therapy and commitment and acceptance therapy can be beneficial in treating characteristics of ‘sex addicts.’ And as a whole, most scientists and researchers who are for and against the argument can agree that one’s environment plays a part in developing what some call sex addiction. However, Dr. Ley says that those who believe in sex addiction also have ulterior motives for why they believe sex addiction exists. These factors include
1. People who self-identify as sex addicts
2. Those who are a part of a conservative/religious group
3. People who rely on the concept as an income.
But if it is clear that “sex addiction” knows no gender and neurochemicals are not a factor. Sex addiction must be based on behavioral choices and one’s environment, right? Dr. Ley says it usually comes down to 5 types of people.
1. People who struggle with moral conflicts over the sexual desires they were taught they shouldn’t have
2. Those in a monogamous relationship struggle because their partner doesn’t want sex as much as they do.
3. People who have a higher physiological drive for sex
4. People who feel guilty about their sexual desires.
5. People who use sex addiction as an excuse for their actions.
In Out of The Shadows: Understanding Sexual Addiction, Carnes claims that using the 12-step model can “fundamentally interrupt and alter the addictive system….[and] can restore the capacity for meaningful relationships by developing in addicts and co-addicts new beliefs to replace dysfunctional or faulty beliefs” (ch. 7, Transforming BelievesThrough the Twelve Steps, para. 1).
Certified sex therapist and relationship counselor, Scott Church, MA, LPC, backs up Carnes’ model.
“The Sex Addiction model provides relief in knowing their experience has been named, a language to describe and communicate their experience, discover that others share their experience, and resources for education, support, and treatment.” (The Sex Addiction Model: Why an Adjunct/Alternative is Needed, 2015)
However, Church went on to say that he understands both sides of the argument.
“There are those who are critical of this model (including myself)….the Sex Addiction model is based on assumptions that many in the field do not share, including sex and sexual desire is dangerous, there is only one best way to express sexuality, sex that enhances intimacy is the best sex, people need to be told what kinds of sex are wrong/bad, and laws and social norms define sexual health.”
Because many of the characteristics of a labeled sex addict have to do with one’s environment and behaviors, many doctors and researchers who reject the concept of sex addiction, including Dr. Ley, agree that the 12-step treatment model most sex addiction rehabilitation centers use is not helpful. He says that the model relies on suppressing, denying, and refusing sexual thoughts, desires, and behaviors.
“These people deserve help but labeling the problem as sexual or solely a sexual behavior problem that could be fixed by stopping sex—that’s a disservice to those people,” Dr. Ley said.
“The model makes people feel ashamed of their sexual desires, thereby negatively affecting their mental health….These are people having more sex and seeking out sexual experiences because that’s who they are. It’s not the case that people have more sex, and it changes their brain, and then they want more sex—their brain was already a highly sexual organism to start with.”
The legitimacy of withdrawal symptoms is also up for debate in the medical community.
A few symptoms of “sex addiction” withdrawal line up with drug addiction withdrawal, such as depression, anxiety, and irritability. However, if you compare the two, other symptoms of sex withdrawal, including shame, low-self esteem, guilt, and anger, can be treated with CBT or other types of therapy outside of the 12 step program. Hallmark signs of drug addiction include fatigue, sweating, vomiting, depression, seizures, hallucinations, and even death. (Mayoclinic.com, 2017)
Dr. Ley says that this is also something to consider when thinking about the legitimacy of sex addiction.
“In the research field, addiction has been defined as when the brain moves away from wanting something to needing it,” Dr. Ley said. Sex addiction doesn’t cause the same results we see from severe alcohol withdrawal or other addictive substances like seizures or death…. People may become irritated or angry, but no one has ever died of blue balls.”
Sex addictions’ impact on culture
In thinking of all of this, Scarlett also considered the relevance of sex addiction in today’s culture and how it plays a role in the “MeToo” movement. Prominent cultural figures such as film producer Harvey Weinstein, professional golfer Tiger Woods, and former general manager and ESPN baseball analyst Steve Philips have all gone through a sex addiction program since the MeToo movement burst onto the scene in 2017.
While some may see MeToo as another excuse to prove the legitimacy of sex addiction, Dr. Ley says the movement has been a catalyst towards disbelief in sex addiction.
“I think the MeToo movement has been a wonderful opportunity to invite, or greater encourage, or demand greater personal responsibility for sexual misbehaviors.”
One can also argue sex addiction can be seen as a culturally bound label, deeply rooted in socio-cultural norms, particularly in America. For example, while sex addiction is studied worldwide, America has the largest number of sexual addiction rehabilitation clinics compared to other countries, most in religious-conservative communities such as Utah, Alabama, and Texas. On a global level, Dr. Ley realized the effects of cultural differences in views of sex addiction firsthand during an interview with a Brazilian reporter about The Myth of Sex Addiction. During the interview, the reporter asked him, “isn’t this [sex addiction] just an expression of Americans’ fear of sex?” After all the information presented and conducted during my interview with Dr. Ley, I believe that the answer is yes.
“People often find what they want to find but don’t consider alternative exceptions. This idea was founded in America 40 years ago, and there’s still no proof that addiction therapy helps. When you look at other societies that don’t have the same sexual conflict that we do–sex addiction as a label is seen as confusing,” he said.
So what should Scarlett think? Is sex an addiction? Unfortunately, we still don’t know for sure. Experts can’t seem to nail down a true definition of it, and therefore, they tend to disagree on whether it is a diagnosable disorder. While the chances are slim, Dr. Ley said he could change his mind if viable findings were presented to him.
“The sex addiction label is a fascinating way for people to blame their sexual behaviors, not on themselves, but on sex,” he said. “If you can show me research that demonstrates there is a group of people who are struggling to control their sexual behaviors who are not struggling with moral incongruence, who are not pedophilians, who are not struggling with anxiety, or depression or bipolar disorder, who are not coming out of one of these underlying conflicts–they have no other problems other than this struggle with sex, then I will say, maybe this is real, but at this point, we can’t find those people.”
Note: the interview from Dr. David Ley was taken from an over-the-phone interview. All other quotes and information were taken from secondary sources. Scandalous! reached out to Sex Addicts Anonymous and The Society for the Advancement of Sexual Health. Both organizations declined to comment for this article.
Smith, S. (n.d.). Interview with Dr. David Ley, Ph.D. Scandalous! Magazine. Web. Retrieved February 4, 2022.