How useful is the sex addict concept?

Question:

I run a sex offender treatment program in Northern California and am wondering what you think about Carnes' notion of "sexual addiction." I've always been uncomfortable with the term, because I think of "addiction" as a physical dependency to a particular substance at a cellular level.

But, the truth is I've treated many men who describe their relationship with sex in terms similar to the way drug addicts decribe their relationship with specific chemicals. (Mostly, these men are compulsive masturbators, exposer and voeuyers who occasionally step over the bounds of these "non-contact" crimes and sexually molest a child or children). So, in spite of my discomfort with the term, I often use it, because it gives these men a model on which to base the necessary behavioral changes and eventual development of new, less self and socially destructive habits..

I believe they CAN change their sexual practices and have been pretty successful with what is basically a cognitive-behavioral approach, often supported by temporary medication (SRI category) and enhanced with psycho-educational material and, when appropriate, family therapy.

Obviously, I can't recommend a total abstinence approach for this "addiction," but I do recommend a one year abstinance contract a la Carnes to help them break their "addictive" pattern.

R.K

Any comments?

Stanton's Answer:

Dear R.

Well, I wrote Love and Addiction, which is included at this site. (I might add I did so well before Carnes wrote his book on sexual addiction.) Addiction is not something which takes place at a cellular level -- that's a myth you have heard. Most people take narcotics without being addicted, people become addicted (as you note) to a range of powerful experiences.

My problem with Carnes is not calling sex an addiction, but in labeling it a disease, which has so many stupid and useless connotations (that it is inbred and thus impossible to change; he also applies it to a host of sexual behaviors, including many which entail value judgments -- we don't want to call every cheater or every spouse who strays an addict). I discuss sexual addiction in relation to Love and Addiction in my new preface.

But if the term describes something useful for you, obviously maintain it. Your applying a cognitive-behavioral approach (which I would say is not Carnes' approach) implies you are modifying his concept and techniques in a useful way. Why not write a pamphlet -- "treating sexual offenders for sexual addiction, modified and updated concepts and approaches."

Thanks for letting me know of your success with the term, and spread it around.

Best,
Stanton

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