Don Draper is “TV’s most successful sex addict”, according to Elements Behavioral Health – the organization that owns Promises Treatment Centers, the Sexual Recovery Institute, and the Ranch – in a recent Web site article. Now in its sixth season, the AMC award-winning series “Mad Men” depicts the main character, Don Draper – brilliantly portrayed by actor Jon Hamm – as a rising executive in the boozey, smoke-filled advertising world of the 1960s, where he has one sexual affair after another and is currently cheating on his second wife. As a strikingly handsome guy with money, charisma, and power, women are irresistibly drawn to him. Plagued by memories of a troubled childhood, his brooding character also seems to harbor deep angst.
Is there such a thing as “sex addiction”?
If living in today’s world, Draper may well wind up in rehab for “sex addiction” – probably at a place calling itself “an integrated treatment program” that would also deal with his excessive drinking. Indeed, “sex addiction” treatment has become a growing sideline business for a number of today’s drug and alcohol rehabs, with more and more counselors becoming “Certified Sex Addiction Therapists” (CSATs.)
In fact, there is no agreed-upon definition for any such disorder as “sex addiction.” The preferred term by many experts, “hypersexual disorder”, was under consideration for the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for release in May of 2013. While initially expected for placement in a section about conditions requiring further research, hypersexual disorder was completely nixed from the new DSM. So how can a rehab facility diagnose and treat someone with a disorder that is not recognized and has no accepted set of defining criteria?
Individuals can certainly experience and suffer from problematic sexual behavior that might include feelings of loss of control, preoccupation with sexual fantasies that gets in the way of life, or urges and behaviors that lead to negative consequences and/or impaired functioning. But there’s a great deal of controversy over viewing this behavior in the same way as alcohol and drug addiction. The causes are unknown and addiction is only one possible model for understanding problematic sexual behavior – some experts see similarities with obsessive compulsive disorder, while others feel it could be tied to abnormal levels of dopamine or serotonin or say it might have to do with problems related to emotional regulation.
Sex addiction “treatment”
In rehab, Draper would probably spend his days in “group”, learning about the 12 steps of Alcoholics Anonymous (both for his excessive drinking, but also adapted for his supposed “sex addiction”), reading AA’s Big Book, attending psycho educational lectures, and maybe taking part in equine therapy, a ropes course, and doing a “timeline” to document the history of his sexual escapades. And he’d more than likely be encouraged to attend 12-step meetings for sex addicts. If you take a look at my book, Inside Rehab, you’ll see that this sounds much like traditional drug and alcohol treatment, just tweaked here and there for “sex addiction.”
Several experts told me there is no research support for this overall approach. One of them, Rory Reid, PhD, LCSW, of UCLA’s Department of Psychiatry and Biobehavioral Sciences and an expert on hypersexual behavior, said, “Sadly, many of these residential and inpatient programs for ‘sex addiction’ charge exorbitant amounts of money for their ‘treatments,’ and, to my knowledge, not one of them has invested in or published outcome research to show efficacy of their interventions.” Psychologist David Ley, PhD, author of The Myth of Sex Addiction, added, “They’ll argue that they’ve done their own studies, but these haven’t been peer-reviewed and have only been described in pop psychology journals and books.”
With only about a dozen outcome studies on hypersexual behavior, most of them not rigorously designed, there really isn’t much research at all on treatments that work best. Moreover, in his book, Dr. Ley adds, “No research has ever been published in peer-reviewed scientific or medical journals that supports the assertion that CSAT-certified treatment providers are effective, or that the training and therapeutic program they complete has any demonstrated therapeutic effectiveness.”
So is Don Draper a “sex addict”?
While one might assume that his indulgences with women and alcohol may in part be Draper’s attempts to medicate his troubled soul and that his trysts have led to some negative consequences, whether or not his behavior is “pathological” is in the eye of the beholder. For a long time (for Draper anyway), he was quite happy and faithful in a second marriage, and he doesn’t seem to exhibit feelings of loss of control or pathological sex-related behavior that impairs his ability to function. Having serial monogamous love affairs is the not same as “Looking-for-Mr.-Goodbar” one-night hookups stereotypical of compulsive sexual behavior. That’s not to say that Draper might not benefit from outpatient one-on-one therapy (not a one-size-fits-all approach) with a licensed mental health professional, who could help him address his underlying unhappiness.
It concerns me when TV docs diagnose people they've never seen with this or that psych problem. And diagnosing fictional characters with unrecognized maladies who don't even fit the bill to further a cause troubles me, too.
When I asked Dr. Ley if he thinks Draper could be seen as a “sex addict”, he said, "Draper is a great portrayal of a high-testosterone male. He is driven, seeking success, and is charismatic. He’s a natural leader and just happens to love sex. Throughout history, men like Draper have changed the world, from John F. Kennedy to King David. Draper certainly has his flaws, but to suggest that they are rooted in sexuality is incredibly insulting to the talented writers who've created such a rich and captivating character."
What do you think about these so-called "process" addictions, as many rehabs call them – for instance compulsive shopping, video game playing, and working? (The only one recognized in the DSM is gambling disorder.) But what about the others – are they "addictions" and should they be treated like drug and alcohol addictions?
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Copyright Anne M. Fletcher