Sex Addiction: Fact or Fiction?

Part 1 of this series shows that “sex addiction” does not meet standard criteria for real addictions. Proponents of sex addiction understand this, but don’t want to drop the term “addiction.” It’s frightening, which helps market their treatment programs. So they’ve redefined “addiction” using the acronym SAFE to identify four signs of "addictive” sexuality:

• Secret.

• Abusive, i.e. causing harm.

• Feelings, i.e. used to avoid painful emotions.

• Empty, i.e., outside of committed relationships.

Like the addiction concept, the SAFE formula is also riddled with misconceptions.

• Secret. There’s a big difference secret and private. People have a right to privacy. It’s socially unacceptable—and illegal—to masturbate in public. So people scratch that itch it in private. Unless it substantially interferes with life responsibilities, what’s wrong with solo sex in private? People use the bathroom in private. Is that “addictive”?

Meanwhile, some people do, indeed, keep their sexuality secret. Many lesbian/gay folks are out with friends but not with families or coworkers for fear of ostracism. Their secrecy is not pathological. It’s a reasonable way to cope with bigotry and discrimination.

• Abusive.

Many argue that BDSM is abusive. Actually, no one gets abused. Submissives (subs) declare their personal limits in advance, and dominants (doms) respect them, just as athletes respect the rules of their sports. Subs also have “safe” words, signals that immediately stop play if they feel uncomfortable. The irony of BDSM is that subs control the play, and can invoke their safe words at any time.

BDSM aficionados insist that no other human interactions are as trusting or intimate. The estimated 5 million American BDSM players and tens of millions of BDSM fantasizers are not “addicts.” They’re as mentally healthy as the general population. See my previous post, A Loving Introduction to BDSM.

• Feelings. Life involves suffering. Both solo and partner sex are soothing. What’s wrong with using sex to assuage physical or emotional pain? It’s much healthier than taking drugs, many of which are costly and indisputably medically addictive.

• Empty. Lovemaking in committed relationships can be great, but not always. For some committed partners, sex feels unsatisfying. Meanwhile, most adult Americans have enjoyed casual sex. For the substantial majority, it’s fun and life-affirming, not empty or “addictive.”

“Excessive”?

An old joke asks: “Who’s a pervert?” Someone who does it more often and in more ways than you. Substitute “sex addict” for “pervert,” and the punch line still applies.

The sex-addiction industry claims the affliction involves “excessive” sexual thoughts and/or actions that distress victims or their loved ones, including: erotic fantasies, masturbation, watching porn, sexting, phone sex, and visits to strip clubs, sex workers, and/or sex clubs.

But what’s “excessive”? Who knows? The only accurate generalization about sex is that everyone is unique. For there to be “excessive” sexuality, there must be a “normal” frequency that “addicts” grossly exceed. But there is no normal sexual frequency, either solo or partnered. The best evidence shows an enormous range of making whoopie, from asexuality to more than once a day. If there’s no consensus about what’s normal, how can Carnes et al. call any anything excessive?

The sex-addiction industry postulates that “excessive” sex involves seven or more orgasms a week. They arrived at this figure by surveying Americans’ sexual frequency and arbitrarily labeling the most active 5 percent as “addicted.”

Really? Consider popcorn. People eat varying amounts, from none to buckets a day. Do the most popcorn-loving 5 percent have a mental health disorder?

Consider couples newly fallen in love. They often burn up the sheets for months on end, sometimes years. Are they “sex addicts?”

Consider dancing. Pretty much everyone enjoys it. Many take dance classes for fun and fitness. And some become professionals and dance for hours a day for years. Professional dancers think about dancing a great deal, may suffer debilitating injuries, and while performing often endure extended absences from loved ones. Do they have “compulsive hyper-dancing disorder"?

Now consider porn. The sex-addiction industry contends that porn grabs men by the nuts and won’t let go. But statistics from PornHub, the world’s largest porn site, show that 86 percent of visits last less than 20 minutes. Some men (and women) visit PornHub several times a day, but the vast majority use porn for quick little breaks. They don’t get trapped in some spider web of “addiction.”

Canadian researchers surveyed the personalities, libidos, and sexual compulsivity of 7,938 women and 6,458 men, age 18 to 94. One-third (44 percent of the men, 22 percent of the women) scored in the range the addiction industry calls “hypersexual.” But the researchers found only one real difference between the “addicted” third and the other two-thirds—libido. The “hypersexuals” simply enjoyed sex more and had sex more often.

Divorce?

The sex-addiction industry claims that compulsive use of porn has caused an epidemic of divorces. Divorce is complicated and has many causes. It’s myopic to blame a large proportion of the nation’s divorces on porn.

According to the Centers for Disease Control and Prevention, the U.S. divorce rate peaked in 1980. Since then, it has steadily fallen. The Internet porn explosion since the late 1990s has neither slowed nor reversed the nation’s steadily moderating divorce rate.

Porn undoubtedly contributes to some divorces, but with the divorce rate decreasing while access to porn has vastly increased with the Web, we clearly have no porn-fueled divorce crisis.

Close relationships?

Some research shows that frequent porn use interferes with close personal ties. But most studies find no evidence of this. If porn causes significant social isolation, men would have to spend hours a day viewing it. Very few do (above).

English investigators surveyed the social ties and porn habits of 164 men. “There were no differences in social connections based on self-reported porn use.” In fact, the men who viewed the most porn reported the closest social ties to friends, family, and spouses. The researchers concluded that regular porn viewing suggests “craving for intimacy,” not any escape from it.

Everyday responsibilities?

The sex-addiction industry contends that problematic sex interferes with important commitments. I’ll grant that getting fired for watching porn at work is problematic. It’s also rare. Many people’s work schedules and commutes interfere with family responsibilities. Are they mentally ill? We applaud top athletes for their constant training, but their regimens typically require sacrificing some family time, social life, and other recreation. Are they “addicts?”

Sexual irresponsibility?

Proponents of sex addiction contend that porn spurs risky sex. Some research supports this. An Australian review of 17 studies shows that as porn viewing increased, the men expressed less inclination toward safe sex.

But what men say is much less important than what they do. Since the Internet porn explosion, the teen pregnancy rate has declined 60 percent, and the abortion rate has fallen 48 percent to its lowest level since 1973. Men may say porn frays their commitment to safe sex, but they’ve actually become more sexually responsible—in part because women have become more assertive: Want nookie? Here’s a condom. No compelling evidence shows that porn torpedoes safe sex.

Some research shows that as porn consumption increases, men admit more affairs and visits to sex workers. However, this is an association, not proof of cause and effect. It’s possible that porn viewing causes affairs and visits to prostitutes. But it’s equally possible that the finding reflects individual libido differences. As men’s sexual desire increases, so does their porn use and their willingness to step out. The association might also be explained by differences in sexual frankness. Men who feel more comfortable admitting porn viewing may also feel more willing to admit non-monogamy. No persuasive evidence shows that porn causes risky sex.

Libido and arousal?

The sex-addiction industry argues that men who watch porn have “difficulty becoming sexually aroused with partners.” Another myth. UCLA researchers surveyed the porn habits of 280 men. As their viewing increased, so did their desire for real sex—both solo and partnered. Far from destroying libido, in this report, porn spurred it.

Next, these researchers showed the men porn and asked how turned on they felt. The more porn they reported viewing outside the study, the more arousing they found the experimental videos. Far from short-circuiting men’s arousal, porn appears to enhance it.

Anxiety? Depression? Substance Abuse?

Several studies show that sex labeled “addictive” is associated with mood disorders and substance abuse. Again, this association may not signal cause and effect.

Consider homosexuality. Dozens of 20th-century studies showed a consistent link between being lesbian/gay/bi/trans and drug abuse and psychiatric disorders. Gay bashers insisted that homosexuality caused these problems, that being gay was inherently unhealthy. They developed treatment programs to return the LGBT population to the one true path, monogamous heterosexuality.

But other studies showed that most LGBT mental disorders were caused not by their sexuality, per se, but rather by the guilt and shame they experienced from being socially stigmatized. Relentless discrimination can drive people crazy.

Now that most Americans view being LGBT as a variation on normal, the LBGT population’s mental health looks increasingly like that of heterosexual Americans.

In 2001, U.S. Surgeon General David Satcher declared, “There is no valid scientific evidence that sexual orientation can be changed.” Since then, most states have outlawed so-called “conversion therapy” as nonsense.

The situation with purported “sex addiction” is similar. The real issue is rarely sex, but usually the guilt and shame people feel about their sexuality.

Brain Changes Identical to Drug Addicts?

Proponents of “sex addiction” insist that "addicts" experience brain changes identical to those of drug addicts, notably, spikes in levels of the neurotransmitter dopamine. Drug addicts experience dopamine surges. So do “sex addicts.”

So what? During sexual arousal, everyone experiences dopamine surges. Dopamine is the neurotransmitter of pleasure. For the large majority of people, sex is pleasurable. When erotically engaged, of course their dopamine levels rise. Every pleasure temporarily boosts dopamine.

UCLA researchers performed brain scans on 122 people, some of whom had been diagnosed as “sex addicted.” Their brain physiology looked nothing like that of substance abusers.

Proponents of sex addiction claim that as men descend into it, addiction-related brain changes cause erectile dysfunction. German investigators performed PET scans on men with normal erection function and on a dozen ED sufferers who viewed lots of porn. Their brains showed no differences.

University of New Mexico scientists explored the brain function of 52 adults self-identified as “sex addicts.” Their brain function was normal, nothing like that of drug addicts. The only real difference between them and the general population was greater libido.

Finally, University of Minnesota investigators explored the brain function of 16 men, eight diagnosed as “sex addicts.” There were no differences, not even in areas involved in compulsivity. The only distinction? The “sex addicts” scored much higher in anxiety. This corroborates the observation that “sex addiction” is not about sex, but about the anxiety some people feel about it.

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Part 1 of this series explores whether sexual habits including frequent porn watching constitute actual addictions. Part 3 discusses the true prevalence of out-of-control sex, and how to change it without mislabeling anyone as “addicted.”