You're addicted to what?

New patients tell me all the time how they can’t keep from doing self-destructive sexual things; still, I see no sex addiction. Instead, I see people regretting the sexual choices they make, often denying that these are decisions. I see people wanting to change, but not wanting to give up what makes them feel alive or young or loved or adequate; wanting the advantages of changing, but not wanting to give up what makes them feel they’re better or sexier or naughtier than other people.

I don't have much of an opinion on the matter, but I have heard people use the same arguments about alcohol/cigarettes/other substances. I follow his argument; it has a logic. But the nature of addiction sees users abandon altruistic thoughts for their own needs while knowing it's wrong and hating themselves for it. Isn't that sort of the definition of addiction--to be compelled to use regardless of short- or long-term consequences?

Interesting article.
posted by smirkette at 10:30 PM on July 10, 2012 [3 favorites]

Okay, got farther. His beef with the clinical diagnosis criteria is compelling. Teach me not to read the entire damn thing. /slaps wrist.
posted by smirkette at 10:34 PM on July 10, 2012

I think it would be cool if there were a word that described a stereotyped pattern of behavior used to escape emotional pain.

Defence mechanism?
posted by nebulawindphone at 10:40 PM on July 10, 2012 [2 favorites]

Here's the point:

Perhaps the most interesting thing about the sex addiction movement—and certainly the most telling—is that it did not arise from the field of sex therapy or any other sexuality-related field. Rather, it was started in 1983 by Patrick Carnes, whose background is in counselor education and organizational development. He claims no training in human sexuality.

“Sex addiction” has been adopted enthusiastically by the addiction community, and to a lesser extent by the marriage and family profession—the latter historically undertrained and uncomfortable with sexuality. You can, for example, become a licensed marriage counselor without ever hearing the words vibrator, clitoris, spanking, tongue-kissing, or panties during your education.

Almost thirty years after its invention by Carnes, “sex addiction” is still not a popular concept in the fields of sex therapy, sex education, or sex research. Of course, the media loves it, decency groups love it, and those who identify as some other kind of addict (alcohol, food, drugs) love it, especially if they’re fans of the Twelve Steps.
posted by Brian B. at 10:44 PM on July 10, 2012 [3 favorites]

Isn't that sort of the definition of addiction--to be compelled to use regardless of short- or long-term consequences?

In the vernacular it is -- I personally have a cookie addiction, for example -- but as a diagnosis addiction is a lot more complicated. He mentions that the difficulty of settling on a definition for sex addiction is why it has been left out of the DSM so far.

I was surprised that he followed that note up with this, though:

But sure enough, various clinicians and researchers are trying to establish the scientific basis for sex addiction—by referring to neurology and hormones, as measured by brain scans.

This seems unreasonably dismissive of scientific research and really made me question the author's objectivity on this. It's one thing to demonstrate that the research is not even close to compelling yet; It's quite another to dismiss a whole line of inquiry because the findings may contradict your argument.

Doing a little more research into the author I find that he is an MLSW and a self-propelled media machine. As such I would take anything he says about science and research with a grain of salt.

Still, his commentary about the social and clinical aspects are very interesting. I don't agree with him on all points but this was a very worthwhile read.
posted by Tell Me No Lies at 10:57 PM on July 10, 2012 [4 favorites]

I participate on a few sites about sexuality and have been looking for good, easy to digest citations on why 18 year old guys who think about sex are not sex adicts. Because there are many, many people out there who believe charlatans like Dr.Drew and think their perfectly wonderful sexuality is a dirty thing.
posted by munchingzombie at 11:19 PM on July 10, 2012 [5 favorites]

Heroin addiction treatment programs never suggest that the addict cut down to 3 or 4 injections per week. “You’re an addict, so you can never use heroin—or alcohol—ever again” is far closer to what we’d expect.

And that would be an unfounded assumption too.
posted by benzenedream at 12:11 AM on July 11, 2012 [1 favorite]

Decani Calling bad behaviour an addiction has always been a great way to make yourself feel less responsible for it, and thus less guilty about it.

Calling an addiction a bad behavior, on the other hand, has far more pernicious consequences; bad behaviours tend to be punished, which is unlikely to help you deal with it. Even if no-one but yourself is going to punish you for being "bad", you're more likely to be trapped in guilt over it, and this will distract and prevent you from dealing with the problem.

In the end the point of calling it something is to identify it, in order to help you stop. It doesn't really matter to anyone else whether you reframe your addiction as a moral lapse, or your moral lapse as an addiction, so long as you take responsibility for it, give up guilt over it, decide to cease giving in to it, do your best to repair whatever damage you've done to others and yourself because of it, and seek appropriate help and support for doing all of this. Getting yourself punished is unlikely to help, except possibly in the service of creating an aversion.
posted by aeschenkarnos at 1:15 AM on July 11, 2012 [3 favorites]

...many people out there who believe charlatans like Dr.Drew and think their perfectly wonderful sexuality is a dirty thing.

Did Dr. Drew change markedly in the last 10 years?
posted by DU at 2:43 AM on July 11, 2012 [1 favorite]

My name is Chris, and I am a Pringles addict.

I'm pretty sure for me, there are no such things as 3 or 4 Pringles in a sitting. Its cold turkey time.
posted by C.A.S. at 2:50 AM on July 11, 2012 [1 favorite]

My name is sien.

And I am a metafilter addict.

These 12 steps you speak of.

1) No over thinking.
2) Take no offence.
3) Don't take it to Metatalk
4) Ask not for a mod.
5) Flag not.
6) Do not mention cats and scanners, or how they go into them.
7) Never refer to anyone as "Metafilter's own".
12) Practice counting.

I have to think about them.....

D'oh.
posted by sien at 4:06 AM on July 11, 2012 [5 favorites]

Reading this article through the lens of this kind of makes it difficult to take this dude seriously...
posted by catch as catch can at 4:23 AM on July 11, 2012 [3 favorites]

As I understand it, "addiction" has two basic definitions, one literal, one metaphorical.

The literal definition refers to a condition where the body has become physiologically dependent upon a certain substance. Alcohol, narcotics, heck, nasal spray. Where limiting consumption of the substance has physiological consequences. In that sense, being "addicted" to heroin may or may not be evidence of prior moral failings, but it is not, in and of itself, a moral thing.

The metaphorical definition, sometimes called "behavioral addiction," refers to a situation analogous to physical addition, where a person feels compelled to repeat actions past the point of moderation and into self-harm. Behavioral addition is potentially linked to dopamine production and uptake, but that's the only physiological dependence anyone can come up with. Drug addition uses dopamine, but it also produces a physiological change in ways that behavioral "addition" doesn't.

I've never really believed that calling the latter "addiction" made sense. Rather than being a way for "the religious right" to somehow disparage sexuality--or whatever--I've always thought it was a way for people to excuse their unacceptable behavior. "Can't blame me, I'm an addict!" So whether it's gambling or internet use or sex or whatever, there's a convenient explanation which protects one from the moral opprobium that might otherwise be coming one's way.

That's why I have to diverge from the author's analysis. He sees the whole "sex addiction" industry as a way for religious people to keep demonizing sexual behaviors they don't like. I think there's more to it than that. The author takes what he suggests is a representative sample of the questionnaire for the SAST. It's not, really. About 25% of the questions about internet porn. But many of the rest have to do with at least arguably objectively problematic behaviors, like having sex with minors, illegal activities generally, spending "considerable" time and money at strip clubs, engaging prostitutes, "cruising," etc. So yeah, there's definitely a sense in that the screening would be a bit different if it were more "sex positive," but a lot of what's on there would still be on there.

Here's the thing: the reason I'm skeptical of the "diagnosis" of sex addiction--and behavioral addiction generally--is that, as the author points out, the answer is never "go cold turkey." These are almost always things that are a normal, essential part of people's lives. They don't involve any physiological difference which we can observe. So the diagnosis depends on certain behaviors being problematic. Saying that something is fine if you can take care of it but is suddenly an "addiction" when you can't seems like a cop out, especially when the solution, as the author says, is never complete abstinence. A drug addict is a drug addict, regardless of how functional they are. And if they've got money, they can be pretty damned functional. But a sex addict is only a sex addict if and only if they're dysfunctional. That's just now how that works.

This, I think, is part of a larger trend in modern culture, i.e., that of treating what was previously considered to be a sin problem as a therapy problem. Historically, if one were having trouble with one's sexuality, the solution would be confession and repentance. Guilt has been tacked on to that, to be sure, but the core of the problem was seen as spiritual. But now, if one is having trouble with one's sexuality, the solution is... therapy? Which is weird, because we haven't actually shifted the boundaries of problematic behavior, we've just decided that the problem isn't spiritual anymore. I talked about this at some length here, when we were discussing another truly bizarre example of Evangelicals dealing with sexuality.

But this is true about a lot of things, not just about sex. He gets at this somewhat with his "Why it matters what you call it" section. Yes, it mattered when homosexuality was considered a mental illness. But that was only true for a hundred years or so. Before that, there wasn't really a category for mental illness. But concupisence, the "innate tendency of human beings to long for fleshly appetites," covers not only that but also things like gluttony, and the analysis draws a distinction between having the desire, which is neither here nor there, and acting upon the desire, which is problematic, but never obligatory. So we've punted what used to be a rather sophisticated ethical analysis for a disease model. And heck, we've done it on just about every other kind of anti-social behavior... why not with problematic sexuality too?
posted by valkyryn at 4:29 AM on July 11, 2012 [6 favorites]

Some of this made sense, but the large majority of what he said would apply to alcoholics and heroin addicts as well. Is he willing to own the entailments of his argument? (The passage about heroin addicts going cold turkey suggests he isn't.)
posted by anotherpanacea at 4:39 AM on July 11, 2012

Calling bad behaviour an addiction has always been a great way to make yourself feel less responsible for it, and thus less guilty about it.

There is a difference between making poor decisions and compulsive behavior.
posted by The 10th Regiment of Foot at 5:02 AM on July 11, 2012 [5 favorites]

There is a difference between making poor decisions and compulsive behavior.

Except the entire point of the article is that calling something an "addiction" muddies that distinction in unhelpful ways.

Similarly, this:

Some of this made sense, but the large majority of what he said would apply to alcoholics and heroin addicts as well.

...misses the point of the article. There is a categorical distinction between alcohol or heroin addition and sex addition. The former involve chemical, physiological dependency upon a particular substance. The body's metabolism actually changes. This is not true of sex "addiction" or any other behavioral "addiction" as far as we can tell.
posted by valkyryn at 5:32 AM on July 11, 2012 [1 favorite]

There's a difference between physical dependence and addiction. A person on chronic narcotic painkillers for back pain may indeed have a withdrawal syndrome, indeed one bad enough to make them want more of the drug to forestall symptoms. Actually, even patients with major depression on SSRIs like Paxil or Lexapro get withdrawal syndromes. But most people who are physically dependent on a drug are not addicts.

Addiction in the medical sense implies an unhealthy set of behaviors around use of a drug. A person who thinks about the drug all the time, is usually only focused on obtaining and using the drug the next time around, who continues to use the drug even when not medically necessary and when the consequences of drug use have been repeatedly demonstrated to be bad to them and to their personal relationships, who forgoes normal activities and relationships with others to focus on drug use, who mess up their finances and alienate others with drug use, etc. A general lack of control over use of the drug.

I don't know enough about the psychiatric/psychological state of the art to comment meaningfully on the field of behavioral addictions. But since addiction is more about behaviors and control in response to a stimulus rather than direct chemical properties, I don't see why they shouldn't exist. At the very least, adhering to the seemingly standard psychodiagnostic rubric of a mental state and/or behaviors which are distressing to the individual, affect his/her daily functioning, and which s/he would like to stop renders quite a lot of "innocent compulsions" psychopathologic, although with addictions as with other disorders in which there's very little insight in the psychological sense, one has to surmise that the healthy individual would want it to stop.

Okay, maybe I commented meaningfully despite myself.
posted by adoarns at 5:44 AM on July 11, 2012 [1 favorite]

Anyway the historical commingling of popular comment, literary criticism, morals and ethics, and psychology make it very difficult to unravel the skeins of true psychopathology today. Everyone wants to come at an issue or person with a different kind of meter, and perhaps a different agenda. It's a rhetorical exercise rather than a scientific one; which bodes rather badly for the form of popularly-understood neuro- and cognitive science which generates blog posts today, although at least the field of neurologic disorders is (mostly) not subject to the same dilettante madness.
posted by adoarns at 5:50 AM on July 11, 2012 [2 favorites]

Did Dr. Drew change markedly in the last 10 years?

My impression -- as a sometime-listener of LoveLine when it was a local Los Angeles radio program -- is yes.
posted by Slothrup at 5:50 AM on July 11, 2012 [5 favorites]

- There is a difference between making poor decisions and compulsive behavior.

- Except the entire point of the article is that calling something an "addiction" muddies that distinction in unhelpful ways.

Thanks for summing that up because I wasn't sure what he was getting at. In that case it sort of makes sense, because in the end whatever the specific activity or object of compulsion involved, the compulsive nature of the behaviour is really the problem.

For instance, the film "Shame" was summed up a story of "sex addiction" but as you watch it you realise it is really about a much more complicated bunch of psychological issues so perhaps the definition can be reductive or misleading. I also thought the kind of issues the protagonist was going through, in the way they affected his life and in the way he was unable to control them, had a lot more in common for instance with eating disorders than with substance addictions - again eating like sex is a normal healthy part of life, and for it to become the target of such screwed up self-damaging behaviour, behaviour that you keep engaging in even when it brings no enjoyment, in fact only brings more trouble and grief and anguish, well there has to be a lot more going on underneath, and you don't treat that simply by regulating use of food and sex.

If that's what he's saying, fair enough. But it's also true each of these manifestations of what you could sum up as compulsive disordered behaviour, for all they could have in common, are very specific to themselves. There were some interesting testimonies from sex addicts in the reaction to the movie on the Guardian, linked from one of reviews the film. I found that an interesting read. In the end, call it what you like, but you can't deny it can be a real issue.
posted by bitteschoen at 5:53 AM on July 11, 2012 [1 favorite]

There is a categorical distinction between alcohol or heroin addition and sex addition. The former involve chemical, physiological dependency upon a particular substance. The body's metabolism actually changes.

Yeah, most people who diagnosed as alcoholic aren't actually physically addicted to alcohol; they're not using it to combat delirium tremens. Whatever we mean by addiction, it's more than just the physical dependency, which generally lasts a very short period of time. What's more, it's the behavioral component (repeated use of the drug despite the absence of physical dependence) that produces the physiological dependence in the first place.

If the claim is that the only things that people are really addicted to are nicotine and heroin, fine, say that. But the claim seems to be that only the physiological dependence counts as addiction, not the behavioral component. And that's neither the clinical nor the common sense view.

I'm perfectly happy with acknowledging that a large portion of the media rhetoric around sex addiction is tied to living in a sex-negative culture and finding ways to escape responsibility. But why isn't it also the case that a large portion of the media rhetoric around alcoholism is tied to living in a drunk-negative culture and finding ways to escape responsibility, too? What's the difference?

And, can we just be honest with ourselves for a moment? Sex is better than alcohol.
posted by anotherpanacea at 6:12 AM on July 11, 2012

But the claim seems to be that only the physiological dependence counts as addiction, not the behavioral component. And that's neither the clinical nor the common sense view.

Again, I think the claim is that the language of "addiction" blurs the line between the two. It's one thing to say "This is a really complicated thing with physiological and psychological components, and not all 'addictions' are alike." But using the same word for heroin "addiction" and sex "addiction" can impute some of the physiological compulsion of the former to the latter, which doesn't really have a physiological component at all. It's an unhelpful way of talking.
posted by valkyryn at 6:20 AM on July 11, 2012 [1 favorite]

And, can we just be honest with ourselves for a moment? Sex is better than alcohol.

You don't have to choose, you know.
posted by Wolof at 6:29 AM on July 11, 2012 [6 favorites]

But using the same word for heroin "addiction" and sex "addiction" can impute some of the physiological compulsion of the former to the latter, which doesn't really have a physiological component at all. It's an unhelpful way of talking.

I'm sorry, valkyryn, but this is exactly wrong. Insisting that the physiological component is the most important element is the unhelpful way of talking. Even with heroin, it's relatively easy to kick the physiological element, only to find that the behavioral element rears its head later. Otherwise, there'd be no such thing as relapse, and rehab would take a maximum of 7 days.

Take a look at the physiological dependence lengths for various drugs, and then explain why that element is the most important.

Or just ask yourself: does it really seem "unhelpful" to say that gambling is addictive? It's certainly quite helpful if you run a casino. The authors of the new DSM agree that there are behavioral addictions; there are plenty of reasons to worry about the relationship between the DSM and drug companies and the law, but in that case I think they're right.
posted by anotherpanacea at 6:46 AM on July 11, 2012 [2 favorites]

The authors of the new DSM agree that there are behavioral addictions

I think that the DSM is essentially a bunch of normative ethical assumptions masquerading as pseudoscience.
posted by valkyryn at 6:50 AM on July 11, 2012 [4 favorites]

Yeah, okay, but at that point you've really departed from a grounded attack on sex addiction (which seems reasonable) into a whole-hearted skepticism about clinical psychology.

I've read my Foucault, my Deleuze and Guattari, my Hacking, and my Szasz, and I can see that there are clearly many abuses and disciplinary problems with psychology, but I just don't find that totalizing skepticism to be well-grounded.
posted by anotherpanacea at 7:02 AM on July 11, 2012 [1 favorite]

Hmm, I remember hiding out in the depths of the campus library, reading one of Patrick Carnes' books when I was in the self-hating phase of my coming out process. Pathologizing my emerging sexuality was profoundly unhelpful.
posted by sevenyearlurk at 7:06 AM on July 11, 2012

Perhaps a better tack is to reduce the implied social misconception that once someone classifies themselves as having an "addiction" that this is an excuse to continue this behavior without attempting to seek help for it or to try means to manage/rid themselves of the addiction.

To me, something can be classified as an addiction when it:

1. Results in obsessive thoughts and compulsive behavior regarding a substance or activity which makes a healthy means of living impossible and results in significant negative consequences for the individual and/or those closest to them.

2. The person continues to use a substance or activity despite a desire to stop.

There are some people who muddle up the "addict" moniker by having a life crisis/temporary substance problem/rough spot but are not actually addicts, and as such, have no idea what the root of the issues are for someone with an actual addiction.

Having an addiction is never an excuse to continue a behavior. It is a requirement to stop a behavior.

People in the midst of active addiction who do not express at least the willingness to do whatever it takes to stop, simply will not stop. They'll die, or they'll ruin their lives and those of the ones unfortunate enough to love them until the smoldering husk of a pathetic existence becomes painful enough. Then, hopefully, they'll find that willingness.
posted by Debaser626 at 7:40 AM on July 11, 2012 [6 favorites]

I have to strongly disagree with the author. What else would you call it when your libido is so abnormally high that it interferes with your life? That was me a decade or two ago. Porn wasn't enough, my partner's couldn't keep up, so I'd have multiple partners. I never engaged in risky (i.e., unprotected sex), but when I wanted intimacy there was no way I could get any relief until I actually found it. Maybe compulsion is a better word than addiction, but whatever word you use it had the hallmarks of addiction, I was addicted, albeit a functional addict. I'd skip work (when I could) to get it, spend more than I should to get it, hide it from others, and so on. This wasn't like porn, it wasn't playing out sexual fantasies, it was an overwhelming need to make deep intimate connections; sex could do it, if the other person was into it, and more importantly, into *me*.
Anyway, over time a strange, though entirely normal, thing happened, I aged. It was like a veil parting. I went from feeling like I couldn't live unless I got the intimacy I craved to what I believe is a more normal state where the feeling is no longer all consuming. I strongly suspect I had some type of hormonal or other imbalance that age (and its hormonal changes) eventually mollified.
Have you ever got really, really angry (or any other strong emotion) where you aren't able to think straight or rationally? Or maybe more similar to chronic depression, except different hormones expressing themselves in other ways. I don't know. What I can say for sure is that when I was younger it led to uncontrollable actions. Not impulsive exactly, but definitely not rational. The only things that led to short term rational behavior was when I'd start a new relationship with somebody. I'd feel like this person gives me everything I need, but a few months later and that urge would come back. At least I was able to be fairly honest about it, and I am fond of all of the relationships that I had, and I'm proud that all of those relationships either continue to this day, or ended amicably.

Anyway, back on point, and TLDR. I had an overactive libido that definitely drove my behavior in the past. As my libido declined with age, I was amazed at how much of a compelling force it was in my past. I have been in a stable monogamous relationship for many years now, but I don't attribute this to anything other than my libido relinquishing it's hold on my behavior as it wanes with age.

On preview:

People in the midst of active addiction who do not express at least the willingness to do whatever it takes to stop, simply will not stop.
I agree and believe that it applied to me as well.
posted by puppysocket at 8:16 AM on July 11, 2012 [7 favorites]

“Sex addiction” has been adopted [...] to a lesser extent by the marriage and family profession—the latter historically undertrained and uncomfortable with sexuality. You can, for example, become a licensed marriage counselor without ever hearing the words vibrator, clitoris, spanking, tongue-kissing, or panties during your education.

Because marriage doesn't involve sex, amirite?

Seriously, though, this is absolutely ridiculous and doesn't surprise me at all. When talking about what makes a healthy marriage, sex is all too often mentioned only in passing (if at all).
posted by asnider at 8:22 AM on July 11, 2012 [1 favorite]

I always assumed this was on the 'compulsion' end of addiction, the way that eating disorders, gambling or gaming addictions and so forth rely on natural body highs. I get the sordid history diagnosis like nymphomania have in the face of cultural assumptions about the right or wrongness of promiscuity (see also 'frigidity') but "I don't think it's an addiction, I think you just have shitty willpower" is not a good addiction either.
posted by Phalene at 8:54 AM on July 11, 2012

Yeah, okay, but at that point you've really departed from a grounded attack on sex addiction (which seems reasonable) into a whole-hearted skepticism about clinical psychology.

I don't think Valkryn implied any such thing. I think you are conflating the DSM with clinical psychology. They are not the same thing. They mainly intersect at the juncture of the insurance forms, and that is the DSM's main purpose.
posted by txmon at 8:54 AM on July 11, 2012

When people refer to themselves or others as “sex addicts,” what are they actually talking about? More than anything, simple narcissistic character structure: the familiar “I guess I thought I could get away with it,” “Deep down, I don’t really believe the rules apply to me,” or “When I hurt, I want relief, and I don’t care so much about breaking promises or hurting others.”

Really? If I were to term myself a "sex addict" it would mean "I can't stop thinking about or performing sex all the time and I have little control over my compulsions"

??

The rest of the people who are in pain about their sexual decision-making are generally struggling with one or more of the following: compulsivity, impulsivity, obsessive-compulsive disorder, bipolar disorder, borderline personality disorder, or post-traumatic stress disorder. An idiosyncratic response to medication can even be a factor.

So when people talk about sex addiction, they’re really talking about all of these, and more.

OK, so as a general descriptor, "sex addiction" is about right. I do agree the term is abused as a description of other conditions, and I suppose that's the article's main point.

I would say the larger problem is with the term "addiction." It's too vague.

Maybe compulsion is a better word than addiction

I guess that's the point of the article, but to me, the semantic difference is negligible.

Are you addicted to television?
Eating?
Shopping?
Smoking?
Breathing?

Addiction is a weak word.

When talking about what makes a healthy marriage, sex is all too often mentioned only in passing (if at all).

Depends on context and locale. Plenty of women I know think the importance of sex in marriage is stressed too much. It doesn't have to be perfect, etc.

In short, the world don't move to the beat of just one drum.
posted by mrgrimm at 8:55 AM on July 11, 2012 [1 favorite]

The National Council on Sexual Addiction and Compulsivity has defined sexual addiction as “engaging in persistent and escalating patterns of sexual behavior acted out despite increasing negative consequences to self and others.” In other words, a sex addict will continue to engage in certain sexual behaviors despite facing potential health risks, financial problems, shattered relationships or even arrest.

from the FPP:

An enormous percentage of the test asks about non-normative behavior, as well as ambivalence about or rejection of one’s sexuality—feelings like guilt, shame, and remorse. Sample questions inquire if:

You regularly purchase porn or romance novels
You have multiple romantic involvements
You use sex or romantic fantasies for escape
You’re a regular participant in S/M behavior
You’re worried your sexual behavior will be discovered
You feel preoccupied with sexual or romantic thoughts
You’re concerned that your sexual behavior isn’t normal
Your partner complains about your sexual behavior

For most Americans, the answer to at least some of these questions is, “sure—isn’t this normal?” And this is part of the problem with diagnosing “sex addiction”—too much common sexual behavior and experience gets pathologized.

I'm not sure that's entirely fair (though I am obviously NAE). From the Society for the Advancement of Sexual Health:

Three basic things to consider when you define sexual addiction are:

* Do I have a sense that I have lost control over whether or not I engage in my specific out-of-control sexual behavior?
* Am I experiencing significant consequences because of my specific out-of-control sexual behavior?
* Do I feel like I am constantly thinking about my specific out-of-control sexual behavior, even when I don't want to?

It is these three "hallmarks" that help to define the boundaries of sexual addiction and compulsivity.

Am I a Sex Addict?

Those are a different list of questions from an entirely different (meta) perspective.

So OK, let's just call it sexual compulsion, then, but "addiction" is a better CYA term if I get caught, lol. Compulsions connote controllability; addiction does not.

puppysocket, I really wanted to post something like your comment to the Michael Ian Black thread, but I also didn't really want to share too much. Some of us (at least at some times in our lives, as you say) really do want to fuck all the time, literally, and dealing with that level of arousal/compulsion is an easy joke but not necessary an easy path to actually walk.
posted by mrgrimm at 9:05 AM on July 11, 2012 [1 favorite]

And, can we just be honest with ourselves for a moment? Sex is better than alcohol.

The other half of the line is "...but alcohol is more reliably available."
posted by newdaddy at 9:52 AM on July 11, 2012 [2 favorites]

I think that the DSM is essentially a bunch of normative ethical assumptions masquerading as pseudoscience.

If it's masquerading, which is debatable, it's masquerading as science, not "pseudoscience." The "pseudo" is the masquerade.
posted by blucevalo at 9:59 AM on July 11, 2012 [1 favorite]

My other addictions ... food and air and water ... are much more serious.
posted by Twang at 11:18 AM on July 11, 2012

Compulsion, addiction, whatever --- the point of identifying as an addict or compulsive or whatever is not to excuse your behavior but to start the process of dealing with it.

Sex is a very strong basic urge. The idea behind this is not "anti-sex", it's about helping people who struggle with repeated destructive behavior. Just wanting sex a lot is not an issue. Pursuing behaviors that are very risky or that sabotage your other goals in life is an issue.

This is just like gambling or pot or other compulsion/addictions that are driven by behavior and not physical dependence.
posted by wildcrdj at 1:12 PM on July 11, 2012

valkyryn: There is a categorical distinction between alcohol or heroin addition and sex addition. The former involve chemical, physiological dependency upon a particular substance. The body's metabolism actually changes. This is not true of sex "addiction" or any other behavioral "addiction" as far as we can tell.

Sorry, but that's not requisite of addiction. It's relatively easy to become chemically addicted to both caffeine and nicotine, yet those who are chemically addicted to one or both of those chemicals share almost nothing in common with alcoholics and heroin addicts, psychologically.

There's chemical/physical addiction, which is a biological problem, and there's psychological addiction, which is far more complex. Unless you can provide explanation of why humans can become addicted to ingestion of substances (and the resulting effects), but not other behaviors (and those resulting effects), you haven't excluded behaviors as a source of addiction.

I bite my nails; it's a compulsive habit, but not life-threatening, and if my health is threatened, I can quit fairly easily (as I did when working on an oil well for two weeks). I'm willing to bet the same is true for most OCD sufferers: light them on fire, and they will skip "touching their special spot on the wall and turning around three times" to get to the shower.

I've known a "sex addict" who exposed himself to HIV, armed robbery, and arrest in the course of his obsessions. Another sought out anonymous, risky, gay sex with men he found physically repulsive, despite self-identifying as straight. That isn't mere compulsive behavior. It needs a categorical description in order to effectively study it, and ultimately to alleviate the problems. "Sexual addiction" is a meaningful description.
posted by IAmBroom at 1:13 PM on July 11, 2012 [2 favorites]

anotherpanacea: And, can we just be honest with ourselves for a moment? Sex is better than alcohol.

Wow, everything else you posted was so well-thought-out... and then you went for a cheap laugh.

No. Sex is not always better. For sex addicts, it's not. Addiction to life-threatening behavior - drinking until you end up in the hospital, repeatedly, letting anonymous men bareback you out of self-loathing, shooting up with shared needles - is always bad.
posted by IAmBroom at 1:57 PM on July 11, 2012 [1 favorite]

Depends on context and locale. Plenty of women I know think the importance of sex in marriage is stressed too much. It doesn't have to be perfect, etc.

Sure, but to act like it doesn't matter at all, ever...or to pretend like it is something that has no impact on a marriage at all? Sure, in some cases it might not, but in many cases it does.
posted by asnider at 3:28 PM on July 11, 2012

then you went for a cheap laugh.

It wasn't a joke, just an incomplete argument: if you can have a behavioral addiction to alcohol, and sex is better (i.e. more pleasurable) than alchohol, then you can have a behavioral addiction to sex.

People who make claims about the "physiological" grounds for addiction recognize, implicitly, that the reason alcohol or heroin are addictive is because they feel good, but then they ignore the fact that sex and intimacy feel good (better!) and so have even more addictive potential.
posted by anotherpanacea at 3:30 PM on July 11, 2012

I thought the article worked in terms of breaking down the gross oversimplification which the label "addiction" confers on a voluntary behavior.

It did cause me to wonder about the continuum of

curiosity -> interest -> habit -> compulsion -> addiction -> psychosis

What's the gateway criteria for each? When does one lose responsibility for one's behavior?

I know it's not linear like this, just thinking about the degrees of behavior and what the common unconscious uses to determine what level an individual's behavior is at.
posted by lon_star at 3:48 PM on July 11, 2012 [1 favorite]

What's the gateway criteria for each? When does one lose responsibility for one's behavior?

I don't think it works like that at all. Now, modern therapy especially cognitive-behavioural therapy doesn't really focus on the "causes" or origins of mental issues and addictions and disorders, but neuroscience and genetic research are very interested in researching that, and if you google around there is a lot of research on how there is very likely an innate predisposition, a tendency to develop addictions and compulsive behaviour (and studies seem to indicate they do have something in common).

Then of course you get environmental factors too, it's the old nature & nurture debate and it's obvious it's a constant interplay, and it's not like we are robots and the automatic products of genes and environment. But, even leaving research aside, it's obvious to anyone who's had some experience in these areas, or known people who've been affected, that there is something different and distinctive from the start in the type of personality that ends up having this kind of issues. Some people are simply more susceptible to addictions.

So there is no such "gateway" or risk in general for everyone - tons of people drink alcohol and gamble and do even some hard drugs occasionally simply beacuse they enjoy it; they don't become addicts just because of that. You don't go from curiosity, interest, enjoyment of a substance or a behaviour to flat out addiction and destructive obsession with it, just because. You need to have that kind of obsessive/addictive tendency to start with. Or, say, you could see it as something that goes wrong along the way because something was wrong to start with.

I'm not saying that removes the individual "responsibility" but I think with the most effective therapy it's just a lot more helpful to recognise that there's some behavioural glitch you have to work around, rather than attributing it entirely to your own "self control" - which is exactly what's screwed up from the start if you have a serious addiction/compulsion.
posted by bitteschoen at 12:04 AM on July 12, 2012 [1 favorite]

anotherpanacea: Ah, thank you for the better explanation of your thoughts.
posted by IAmBroom at 9:29 AM on July 12, 2012

People who make claims about the "physiological" grounds for addiction recognize, implicitly, that the reason alcohol or heroin are addictive is because they feel good, but then they ignore the fact that sex and intimacy feel good (better!) and so have even more addictive potential.

I would argue no, sex and intimacy are not as addictive as alcohol or heroin, mostly because it's much, much, much easier to get high from alcohol or heroin than it is from sex and (especially) intimacy.
posted by mrgrimm at 10:31 AM on July 12, 2012

I tend to agree, mrgrimm, but I wonder if the refractory period also reduces the potential for sex abuse (for men, at least). Evolution doing a little preventative maintenance, though it's not always enough. (There appears to be good evidence that sex and sexual thoughts otherwise would have more lasting euphoric effects.)

That said, intimacy and feelings of (especially new) romantic love are potential "highs." That's at least one reason why other 12 steps groups warn against forming quick romantic relationships after beginning sobriety: romantic attachments can serve as a substitute for other drugs of choice precisely because they supply a similar euphoric feeling.
posted by anotherpanacea at 11:25 AM on July 12, 2012 [1 favorite]

I wonder if the refractory period also reduces the potential for sex abuse (for men, at least). Evolution doing a little preventative maintenance

Interesting. Is there any (other) evolutionary explanation for the male refractory period? I can't think of one ...
posted by mrgrimm at 11:50 AM on July 12, 2012

Wikipedia claims the American Psychiatric Association has a separate category, Impulse Control Disorder, for things like pathological gambling, kleptomania, pyromania, and compulsive nail biting. I wonder if this category might be a better fit than "addiction" for people with trouble controlling their sexual behavior?

valkyryn, do you think that any of these kinds of things can be symptoms of mental illness rather than simply excuses for poor behavior?
posted by straight at 11:37 PM on July 12, 2012

This seems unreasonably dismissive of scientific research and really made me question the author's objectivity on this. It's one thing to demonstrate that the research is not even close to compelling yet; It's quite another to dismiss a whole line of inquiry because the findings may contradict your argument.

As someone who spends far too much time surrounded by neuroscientists I can tell you that the good ones tend to dismiss this kind of research as junk as well.
posted by srboisvert at 12:20 AM on July 13, 2012

Wikipedia claims the American Psychiatric Association has a separate category, Impulse Control Disorder, for things like pathological gambling, kleptomania, pyromania, and compulsive nail biting. I wonder if this category might be a better fit than "addiction" for people with trouble controlling their sexual behavior?

These are certainly different enough to justify a different category, but note that both ICD and substance abuse disorders are a subset of OCD. As the same Wikipedia article describes:

Considered to be part of the obsessive-compulsive disorder spectrum, impulse control disorders are often associated with substance use disorders because "it has been speculated that these disorders are mediated by alterations of partially overlapping neural circuits".

And cites this article, which I can't get access to from home:

Fontenelle LF, Oostermeijer S, Harrison BJ, Pantelis C, Yücel M (May 2011). "Obsessive-compulsive disorder, impulse control disorders and drug addiction: common features and potential treatments". Drugs 71 (7): 827–40.

Of course, the DSM is famously etiology-agnostic. It's a diagnostic manual, not a manual of the brain/mind/soul/ego, so it categorizes disorders by their clusters of symptoms rather than by shared causes.
posted by anotherpanacea at 5:41 AM on July 13, 2012

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You're addicted to what? July 10, 2012 9:28 PM Subscribe

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