Sex Addiction: A Disease or a Convenient Excuse?

Is it a real disease or an excuse for men to cheat and spend hours on porn sites? The inside story on uncontrollable desire

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Photograph by Gregg Segal for TIME

Melinkovich last year in West Hollywood, Calif. He has fought powerful urges for years

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When Lust Becomes a Compulsion
It was in the 1960s that the notion of sex addiction entered popular consciousness. Two men — Albert Ellis, one of the most esteemed psychologists of the late 20th century, and Edward Sagarin, a closeted gay sociologist who helped launch the gay-rights movement — wrote a book published in New York in 1964 as Nymphomania: A Study of the Oversexed Woman. The book was titillating and influential. It helped popularize the locution nymphomaniac as a slur against unreserved women, and it inspired a 1975 follow-up by a UCLA psychoanalyst, Dr. Robert Stoller, who introduced the clumsy companion term Don Juanism to describe unbridled male promiscuity.

Today the proposed APA definition of hypersexual disorder says you have an illness if you spend so much time pursuing intercourse or masturbation as to interfere with your job or other important activities. According to the working language of the diagnosis, "repetitively engaging" in sexual behaviors when you are anxious, depressed or stressed would be considered a major warning sign for the disorder.

But when it comes to sex, what could possibly be too much? The proposed definition of hypersexual disorder draws no distinction between masturbation and intercourse. Many studies, however, have shown that regular intercourse with a committed partner (up to once a day) is a sign of a good relationship. So at what point do partners in a healthy relationship become too focused on sex? And what constitutes too little sex?

In the late 1940s, the sex-research team led by biologist Alfred Kinsey said only 3% of college-age men reported a "total sexual outlet" of seven or more per week. Total sexual outlet was a euphemism for the number of orgasms. Although Kinsey's data set was famously flawed — he used a largely self-selected sample that included some prison inmates — seven orgasms a week (either alone or with someone) is still considered by many experts to be a threshold for possible disorder. In a November 2009 Archives of Sexual Behavior paper, Dr. Martin Kafka, a Harvard Medical School professor and a prominent member of the APA work group on sex disorders, defined "hypersexual desire" among men as having seven or more orgasms per week for at least six months after age 15. Never mind that by Kafka's definition, virtually every human male undergoes a period of sex addiction in his life. It's called high school.

Kafka has also reported that the average man says he has three orgasms per week — but because some men are inclined to overestimate and others to underestimate, we have little idea what the accurate average is. The data on women's sexual habits are even more meager.

Because the definition of sex addiction is unclear, it's impossible to know how many people have it, although professionals sometimes use Kinsey's data to estimate prevalence at 3% to 10% of the population. That range is too wide to be of much use, but we do know that the arrival of Internet porn in the 1990s led many into unhealthy behaviors and extreme desires that eventually spurred them to seek treatment.

Their misfortune created a challenge for psychologists, who had little idea how to help those who called themselves sex addicts. Over the past half-century, Hazelden, Alcoholics Anonymous and most other anti-substance-abuse organizations have defined recovery as 100% abstinence. But the desire to procreate is powerfully encoded in our DNA. Total abstinence isn't impossible, but it is usually unrealistic. As Melinkovich, the L.A. sex addict, told me, "When it comes to drinking, you can put the plug back in the jug. But you can't totally turn off sexual desire."

No one has figured out how to solve the conundrum of an addiction that must be mitigated but not eradicated. (A good analogy is to those who chronically binge on food and must be taught to eat moderately.) Doctors have one reliable way to stop people from having sex: give them antihormone drugs that result in what is known as "chemical castration." But because of side effects — for instance, the feminization of men who take them — the drugs are recommended only for recalcitrant sex offenders. Someone who rents too many adult films is surely different from a child molester.

So what can be done for those spending thousands on porn or seeing six prostitutes a week? According to Robert Weiss, who runs the Sexual Recovery Institute, the most seriously affected patients must enter a facility where they have no access to porn or sex workers. They start individual and group therapy that is, ideally, grounded in a cognitive-behavioral model designed to help them find rewarding activities other than sex — and consider the consequences of, say, looking at porn at work. But Weiss admits there is no simple way to teach sex addicts how to have healthy romantic relationships.

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