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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Sex Addicts Anonymous
Our limitations in understanding the nature of sex addiction haven't prevented practitioners from trying to profit from the surge in demand to cure it. The top inpatient programs — Carnes' Gentle Path in Mississippi; the resort-like Promises facility in Malibu, Calif. (where Britney Spears and Sheen are reported to have sought addiction help); the swank AToN (Aide to Navigation) facility in La Jolla, Calif., which on a given afternoon might serve grilled halibut by the pool — can run you $2,000 a day or more, with a minimum stay of a week. Fifteen years ago, none of these programs existed.

Free community meetings based on the Alcoholics Anonymous model are also thriving. Melinkovich has not only undergone professional treatment at Promises; he also presides over a regular Los Angeles meeting of Sex Addicts Anonymous (SAA), one of the four major sex-addict 12-step groups in the U.S. (The others are Sexaholics Anonymous, Sex and Love Addicts Anonymous and Sexual Compulsives Anonymous.) Together, these four groups host 5 million to 10 million Americans per year. According to the official who took my call at SAA's international headquarters in Houston — a man who requested that not even his first name be printed — the organization has grown approximately 10% per year for the past seven years. Founded by a group of men in Minnesota in the late 1970s, SAA now has roughly 1,200 meetings convening around the globe each week. Ninety percent of the meetings are in the U.S., but the SAA official told me there are regular meetings in Argentina, South Africa, the U.K. and other countries.

The SAA meeting that Melinkovich runs assembles in an L.A. church every weekday at noon. On the day I went, 38 people — only two of them women — gathered in a sun-flooded room on the ground floor. Like Alcoholics Anonymous and Cocaine Anonymous, the sex groups operate in a highly structured, almost liturgical fashion. People read aloud from manuals cum bibles — like AA's Big Book, Sexaholics Anonymous has its White Book — that are filled with harrowing personal stories and vague generalities. (From the White Book: "sexual sobriety includes progressive victory over lust.") About halfway through each meeting, a donation-collection plate is passed around, just like in church.

At the heart of every sex-addict meeting is the sharing portion, when addicts warring with longings spill stories. The need to share once hidden desires is so strong that those who run meetings designate a timer who asks attendees to stop talking after three or four minutes. One of the first speakers at Melinkovich's meeting — I'll call him Daniel — noted that when he started attending five or six years ago, only a half-dozen people regularly showed up. Now, Daniel said, approximately 40 go to each meeting, even on weekdays at noon.

Sex-addict meetings can be extraordinarily awkward. Some attendees barely look up from fingernails digging into cuticles. At one meeting I attended in New York City, I met a man in his late 40s who said he hunches over his laptop and masturbates with such intensity that he once gave himself a hernia for which he had to be hospitalized. Other sex addicts have lost spouses and jobs.

The Promises facility in Malibu searches the possessions of entering clients (no matter how famous) in order to confiscate any porn. Computer access is tightly restricted. And as though they are boys at a midcentury parochial school, clients are instructed to not masturbate.

Contrarian therapists argue that asking adults to refrain from basic urges like the desire to masturbate goes against evolutionary psychology. "Almost all U.S. treatment programs tell the client to abstain, without consideration of what the client is motivated to do," writes A. Thomas Horvath, a past director of the addiction bureau of the American Psychological Association and the author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions. (He is also the medical director of the AToN facility in La Jolla.) Instead, Horvath suggests that clients be given the choice of either abstinence or moderation. "You get the rewards; you pay the consequences; you decide," he writes.

Unfortunately, science does little to settle this debate, because the brain chemistry of sex addiction is not well understood. Your sexuality — your orientation, your level of desire, what you consider romantic satisfaction (orgasm, love, validation, all of the above) — is a complex amalgam that involves your brain's hormonal system, its frontal-lobe reward system and its limbic system, which controls mood. Genes regulate these neural pathways, meaning that sexuality is partly heritable, but the environment in which you develop sexually can affect how those genes are expressed.

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