The Problem With "Sex Addiction" Therapy

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When there is physical pain, for example, a recurring gut problem, people tend to google what the symptoms are and they’re likely to read about bowel cancer on the first click. The same goes for people who are worried about their sexual behaviours being out of control. They are likely to read all about “sex addiction” and “porn addiction” on the first click. There are multiple articles on this subject, most of which are anecdotes, yet positioned as “truth”.

In the case of gut problems, the medical doctor will do all the relevant tests before arriving at a diagnosis. However, the “sex addiction” literature and trainings encourage therapists to collude with their client’s sense of defectiveness. Since the 80’s, the term “sex addiction” has become popular and largely unquestioned and unchallenged, becoming firmly embedded in our psyche and enhanced by sensational stories of celebrities adopting that label to excuse themselves from their offensive sexual behaviours: “I’m not a sex offender, I’m a sex addict, I can’t help myself, it is my disease.”

Since then, the field of clinical sexology grew exponentially. Although the clinicians writing about “sex addiction” tried very hard to make their theories fit with addiction theories, it was not endorsed from a scientific perspective. David Ley was one of the first clinicians to make compelling arguments against the myths of “sex addiction”, and many more clinicians who are informed by contemporary sexology concur with Ley’s arguments.

It was only in 2018 that the World Health Organisation (WHO) agreed on the diagnostic criteria for compulsive sexual behaviours, stating that it is not an addiction but an impulse control disorder. On social media, the “sex addiction” clinicians, who previously claimed to be scientific by inventing tests to confirm an addiction to sex or porn, started to promote a disregard for the nomenclature: “It doesn’t matter what we call it. If clients are distressed about their sexual behaviours, we will help them.” Some even believed that “sex addiction” and compulsive sexual behaviours are the same things, though, according to the ICD-11 classification, they are clearly not.

As diligent clinicians, we do have to work with what is evidence-based and understand what we are actually treating (addiction or compulsivity?) before offering therapy to clients. If therapists use “sex addiction” and compulsive sexual behaviours interchangeably, they may not be clear on what they’re treating and which interventions they ought to use. Most importantly, if therapists are not clear, it brings up the important ethical issue that clients are unable to make an informed decision about the treatment they have. If a client believes that they’re getting treatment for sexual compulsivity but end up getting an addiction treatment without their informed consent, it is a serious ethical problem.

One of the main problems with the “sex addiction” theory is that it encourages therapists, even the ones claiming that they do not offer an abstinence-based treatment, to recommend abstinence-based programmes, such as 12-step programmes. Abstinence-based programmes, also called “Reboot”, have been found to be harmful to clients. It is the duty of all therapists not to recommend resources that have a high likelihood of harm, but, unfortunately, “sex addiction” therapists are trained to do so routinely, according to the “sex addiction” literature.

While the ICD-11 and DSM-5 have not endorsed “sex addiction” and “porn addiction”, and while there is no robust evidence of the effectiveness of addiction interventions applied to sexual compulsivity, and while there is evidence of harm from abstinence-based programmes, a crucial question arises: why do so many “sex addiction” therapists refuse to accept that “sex addiction” and “porn addiction” are not clinically endorsed and, instead, persist with addiction theories and treatments that are not evidence-based?

There are two possible answers proposed: financial gains and promoting a moral campaign.

The “sex/porn addiction” narratives are often fear-mongering (“porn destroys brains”). Those narratives are also embedded in heteronormative and mononormative shame (“I’m a bad husband because I fantasize about having sex with others”). Fear and shame are powerful emotions that drive people to find help. The clinicians whose income solely rely on treating “sex addiction” have good incentive to keep the fear-mongering and shame-soaked stories alive so that they can keep filling up their clinics.

The “sex addiction” therapy literature claims to be clinical and scientific, yet it promotes monogamy, it pathologises some normative sexual behaviours that are practiced by queer people, it pathologises kink (believes it to be an addiction due to childhood trauma), and also pathologises sex workers (assumed to be either victims or mentally ill for choosing sex work). The literature is also sprinkled with religious messages, validating prayers as an intervention, or, worse, some aversion interventions that are close to conversion practices. This indicates that “sex addiction” therapy is used as a moral campaign to control the narrative of the right way to be sexual, according to the beliefs of the therapist. Some “sex addiction” therapists say that their goal is to help clients achieve “healthy sexuality”, but it is easy for the therapist who has a position of power to impose their moral definition of “healthy sexuality” onto their vulnerable clients.

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With the growing literature and understanding of gender, sex, sexuality and relationship diversities (GSRD), it is becoming more apparent that many therapeutic spaces are not safe for marginalised people, such as queer people, polyamorous people, and sex workers. The industry of “sex addiction” is one of them. Luckily, it is changing, thanks to the great work of sex-positive clinicians who are informed by contemporary clinical sexology and GSRD.