sex addiction, ctd.

[topaz]

I started to reply to a comment in my earlier post about this, but decided it's worth expanding into a general post.

My skepticism about sex addiction is not so much about whether it exists, or is even possible, but more about whether it's a useful way to address unhealthy sexual activity.  Certainly it's possible to become psychologically dependent to an unhealthy degree on just about anything: cocaine, cards, cocks, chamomile or cardamom.  In principle, a person could become obsessively focused on any one of these things to the extent of obstructing their ability to lead a normal life.

But that doesn't mean that it's helpful to frame the issue as an "addiction."  Let's remember here that sex, unlike narcotics or gambling, is not just an ordinary part of every day life, but for many people is a crucial part of their lives.  When an entire recovery industry -- complete with twelve-step programs, self-help books, licensed counsellors and three-day seminars -- springs up to treat an "addiction" to one of the most natural and fundamental things a person can do, it starts to smell suspicious.  It is even harder to take seriously when you consider that sex is the one thing that an average American is most likely to feel guilt and shame about anyway.  It cannot be hard to persuade someone with a high sex drive who feels periodic guilt and shame about it that they have a psychological addiction that requires professional treatment.

It's clear that the traditional trappings of addiction treatment -- the twelve-step programs, psychological reconditioning, and the like -- have been instrumental in helping people cope with chemical addictions to alcohol, nicotine or narcotics.  But there is a critical component to those programs that is not present in treating, say, sex addiction or overeating: the addict learns that they can never again indulge their addiction without risking a relapse.  As far as I can tell, sex addicts are not taught that they must remain celibate for the rest of their lives; nor have I been able to learn why the sex addiction industry omits this step.  Maybe because they know it wouldn't work.  But if so, that brings me back to my original question: does it make sense to talk about unhealthy sexual focus as an "addiction" at all?

What I understand about sex addiction as people describe it -- that it is characterized by compulsive sexual activity and an inability to form intimate emotional relationships -- makes it sound like the underlying problem faced by sex addicts is not so much an unhealthy dependency on sexual activity as some kind of emotional disconnection that leads them to substitute sexual intimacy for an emotional one.  In other words, it is not that they are addicted to sex so much as confused about what it is and how to use it.  That above all suggests that "sex addiction" is an entirely wrong and counterproductive way to frame a real problem.

Comments

[moontoad.livejournal.com]

What about food addiction? It's also crucial to life. Do you feel it exists like other more typical addictions do?

[qnetter]

I don't, really -- it's a bad framing. I think there are unhealthy eating behaviors, sure. But the whole notion of "addiction" -- physical and psychological dependence on a substance or behavior one otherwise uses optionally and voluntarily -- goes out the window when the substance in question is one for which everyone has a genuine physical need.

[jacflash.livejournal.com]

I think you don't understand addiction.

I also think you're going to get flamed bigtime on this one, so I'll just sit back with some popcorn and watch instead of saying any more.

[isotopeblue.livejournal.com]

Lots of good points above.

My understanding is that there's a good deal of skepticism in the psychiatric community about whether sex addiction is an addiction in a technical sense. We've learned a little about the neurochemistry of classical addictions like alcohol and heroin, and it's not clear that questionable behaviors related to sex work anything like that. What is clear is that there's great financial incentives for certain therapists to push the notion that sex addiction exists.

I read a couple of books on sex addiction (Out of the Shadows by Patrick Carnes was one) a few years back and was deeply unimpressed. The tone is one of voyeuristic horror, trotting out anecdotes of lives gone astray. There's usually a more or less explicit agenda of pushing pair-bonded monogamy as the only healthy way to express sexuality.

[dbang.livejournal.com]

In SLAA (sex and love addicts anonymous -- a 12 step program that does apply the addiction model to sexual and romantic compulsions) members are encouraged to identify a "bottom line" -- certain behaviors that are, in fact, to be abstained from 100%.

So, for instance, there might be a guy who is addicted not to sex in general but to t-room sex. That's the behavior that he identifies as his "bottom line". his equivalent to AA sobriety is total abstention from t-rooms. Other common "addictions" in SLAA would be: prostitutes, pornography, one night stands, extra-marital sex, etc. These are all things that one can in fact abstain from successfully.

I've done a lot of reading and, um, personal research :-\ on issues of addiction and compulsion. I don't think the addiction-disease model is a perfect one (even for classic addictions like alcoholism) but it can be useful and effective.

[dbang.livejournal.com]

Everyone needs food, but not everyone needs every type of food. Most addiction-model approaches to recovery from compulsive eating identify trigger foods that are in fact optional -- very often, sugar and refined carbs.

Also, while everyone needs food, it can be certain behaviors around the food, not the food itself, that is identified as the addiction. so unless you reject entirely the concept of addiction to a *behavior*, there are lots of ways that the addiction model can be successfully applied to eating.

[dbang.livejournal.com]

What is "addiction in a technical sense"? DSM criteria? The presence of withdrawal symptoms? I don't think there's a universally agreed upon definition of the word such that you can say something is or isn't "technically" an addiction.

Anyway, I think the most useful terminology is one that leads to the most effective treatment. If something responds to "addiction" treatment, then it's an addiction. IMO and all that. (Sex and eating respond only moderately well to treatment as an addiction :-\)

[browngirl.livejournal.com]

This makes sense to me. (But then, having been told I'm a food addict because I'm fat and a foodie, and a sex addict because I'm poly, I have my skepticisms as well, and I agreed with your previous post.)

[awfief.livejournal.com]

And not everyone needs certain amounts of food. Hunger is hunger, which is different from appetite -- you might have an appetite or craving for something whether or not you are hungry.

There are people who eat when they do not have an appetite, nor are they hungry. Meaning they don't want food, they don't need food, and yet, still eat.

[qnetter]

Right. I think "addiction" is a bad label for this, because it took both of you two paragraphs each to explain that "food addiction" is not as simple as "addiction to food."

[qnetter]

I think you don't understand addiction.

And I think there are lots of things labeled as addiction that are not.

If it takes four sentences to explain that "sex addiction" is not addiction to sex per se, or that food addiction is not addiction to food per se, then it's not sex addiction or food addiction -- it's just a shorthand way to lump a whole set of different but somewhat related behaviors together that you claim addiction treatment approaches are effective for under a label.

But they're also different from addiction -- or, more specifically, the obvious literal definitions of the labels are so different from addiction -- that the model breaks as much as it benefits.

[wolfkitn.livejournal.com]

*thinks: do i really want to step into this...?*

not DSM criteria, but here is a working definition of addiction that i've come up with, based on observations of others, mostly lovers, friends, and family members. it has two parts:

1. the person can not give up the thing for a reasonable, yet noticeable period of time (i usually name 2 weeks for this, but sometimes less, depending on the thing) in response to the request from a person who they say they love, and who they believes loves them; and

2. the person can not have a conversation about the thing without getting defensive/angry to the point of someone needing to call quits to the conversation.

obviously, i don't use this for treatment of anyone, professionally.

but i do keep it in my mind: can i talk about X with the person? how do they respond? have they tried to give it up? what happens? have they tried to give it up for a set period of time, even a few days; and if so, what has happened?

[slinkr.livejournal.com]

I would leave the psychologizing to the psychologists.

[dbang.livejournal.com]

That sounds to me like a set of criteria for addiction, not a definition of addiction.

Or, rather, that's a way to distinguish an addiction from something-slightly-less-than-addiction?

But as a definition it's missing any reference to the thing one is addicted to, or impact on one's life. By that definition, "breathing" qualifies. :-) I absolutely could not give it up for two weeks, even at the request of a loved one, and I would definitely find the suggestion that I should to be angering.

[dbang.livejournal.com]

whereas what she wrote is not what I wrote and you didn't respond to what I wrote. In my professional and personal experience, the behavior of eating when full is less likely to respond to an addiction-model approach than the eating of specific types of foods from which one can abstain entirely.

[qnetter]

Fair enough.

I still think there's something circular about defining addiction as "something that can be treated with some level of effectiveness with addiction treatment."

[malefica-v.livejournal.com]

It's only a matter of time until we see the term "para-addiction" here, I'm afraid.

[ratatosk.livejournal.com]

I think this is well-written and I agree with it. I am looking forward to your regular column on related issues. :P

[dbang.livejournal.com]

Not if you have some "canonical" addiction against which to base it...most people would agree that, say, alcoholism or opiate addiction would represent such a canonical addiction. Then, we can devise approaches to treat those addictions, and call other things addictions according to the extent to which they follow similar patterns and respond to similar treatment modalities.

[keyne.livejournal.com]

Some of the folks in this thread have degrees or professional training in psychology.

[mrf-arch.livejournal.com]

makes it sound like the underlying problem faced by sex addicts is not so much an unhealthy dependency on sexual activity as some kind of emotional disconnection that leads them to substitute sexual intimacy for an emotional one. In other words, it is not that they are addicted to sex so much as confused about what it is and how to use it. That above all suggests that "sex addiction" is an entirely wrong and counterproductive way to frame a real problem.

Interestingly, this suggests the possibility that the addition / recovery model is useful precisely because the model does not accurately describe the behaviors to be treated, or the treatment method. Given that there's a lot of existing cultural baggage around addiction, (and that a lot of it is about the addict as a victim of their addiction, rather than the addiction being a moral choice the addict makes and re-makes) it may well be more comfortable to consider oneself a sex addict, and therefore in need of a recovery program, than to address the underlying damage head on.

[surrealestate.livejournal.com]

I can't speak to sex addiction specifically, but just wanted to say that not only do I believe it is possible to have an addiction to someone that one cannot simply cut out of one's life, but it's also a lot harder to deal with than something you can just eliminate and still be healthy.

I would much rather have a substance issue to overcome precisely because it's a lot easier to stop doing something entirely than it is to figure out how to keep doing it, but just not do too much of it.