The Sex Addiction Battleground

Sex addiction recently found itself, once again, in the headlines following reports that Anthony Weiner, the former Congressman from New York, had entered treatment for sex addiction.  On the heels of his latest and third scandal in which Mr. Weiner was discovered to be sexting with dozens of women and an underage female, not only his career, but his marriage and world as he knew it came tumbling down.  For the former Congressman, and others like him, the issue of engaging in sexual activity with an underage person when you are an adult should be parsed from any potential sex or porn addiction. Federal and state laws inevitably trump therapeutic practice.

To be clear, I am neither Anthony Weiner’s treating therapist nor the referent who suggested inpatient treatment for his sexually compulsive behaviors.  I’ve never diagnosed the Congressman, let alone from afar, and nor should I.  Healthy sexual interests and explorations evolve and change over time. Every individual has his or her right to make the determination of what is and is not healthy and/or acceptable for self.  Each person’s sexual interests and expression are personal and cannot be painted as either healthy or unhealthy or as a one size fits all.

Sex is fluid and exists along a continuum of healthy exploration, discovery and enjoyment.

Anthony Weiner’s decisions about his sexual behaviors are his alone to determine. From a distance these reasons may or may not be obvious. But, should  the diagnosis of sex addiction apply, the diagnosis of sex addiction does not have “the right” to exist as a proper condition or disease to be treated if we see it through the current lens of what is or is not currently acceptable as a treatable condition.

To be very clear and to exact a finer point; I am a certified sex addiction therapist and many of my clients are just like Anthony Weiner, Tiger Woods, Bill Clinton, and John and Jane Doe, to name a few. They have found their way to therapy with me for what is their acknowledged:

•  inability to consistently abstain from a behavior or series of behaviors,
• their impairment in behavioral control, craving or increased “hunger” for the rewarding experiences,
• a diminished recognition of significant problems with their behaviors and serious consequences to their interpersonal relationships, and
• their dysfunctional emotional response to their problems.

As a licensed practicing therapist, I, along with other certified sex addiction therapists must work within the scope of our practice when assessing for sex or porn addiction. We must practice with the full understanding that it is unacceptable to prematurely affix a condition or a diagnosis to a client before conducting a thorough screening and intake.  An intake to determine the presence of sex addiction will consist of (among other standard practices of care) administering an assessment to help determine the level and type of sexual activity into or out of consideration. The client’s presenting and other co-existing symptoms might be better accounted for as an alternative diagnosis. Finally, any licensed, certified sex addiction therapist would include a thorough client history that often involves collateral information from family members, when permission is granted by the client.

Not Recognized by the American Psychiatric Association 

Can the practice of psychotherapy be followed if a treating professional must only and myopically adhere to what is the current American Psychiatric Association’s (APA) definition of addiction? To date the APA does not list sex addiction as a bona fide or recognizable and treatable illness. Standard current psychiatric care follows the APA’s guidelines and the “Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. This manual contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system.”1

According to the APA, an illness does not exist if it is not listed as such in the DSM. But, let’s examine this a tad closer. Since an illness that does not exist in the DSM, does not exist anywhere, then the transitive nature (the opposite) of their claim also applies. A diagnosis does exist if it is listed in the DSM, and therefore, is a veritable and treatable diagnosis to be cured. The DSM listed homosexuality as a mental illness and an illness needing to be treated, cured and rid from the hearts and minds of those who suffered with their affliction, up until 1974.* Clearly, the APA was on the wrong side of history.

Still another leading medical society, the American Society of Addiction Medicine (ASAM) boasts their public policy statement and short definition of addiction as follows:

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

The short definition of addiction goes on to say:

“Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”2

Out of Control Drinking for a First Lady  

Consider Ulysses Grant, our 18th President of the United States, and former First Lady Betty Ford, the wife of Gerald Ford, our 38th President. The two shared one great thing in common.  While Grant suffered professional consequences in his military career he also suffered personally due to his out of control drinking. Although by most historical accounts his drinking was confined to quiet moments on the warring front, historian James McPherson described Grant’s problem with alcohol as his “predisposition to alcoholism.” It is important to mention here that there was no diagnosis for alcoholism back then. It is likely that many experts then would agree that Grant drank no more than other men.

First Lady Betty Ford endured public humiliation when she acknowledged a problem with alcohol and drugs.  She was the victim of stereotyping and outcry for a moral failing to honor the title and position bestowed upon her as First Lady, and that of the Oval Office and President who occupied it.

By today’s definition, most would agree that both individuals were alcoholics. Grant died a decorated military leader known for his military prowess and predilection to the bottle. Betty Ford died in spite of it. But help for the First Lady’s drinking couldn’t and didn’t wait for a diagnosis to first treat it. Instead, help came by way of an intervention by the family. There was no “valid” diagnosis of alcoholism at this time because it wasn’t seen as a bona fide illness.

In the 1980s, the APA clawed back their prior description about “problem drinking” as being a sub-set of a personality disorder in the then revised third edition of the DSM.  Medical organizations such as the American Medical Association later endorsed the proposition that drug dependencies such as alcoholism were deemed diseases and its treatment became a valid part of accepted medical practice some time later.

If diagnosis prior to medical treatment was the standard of care then the First Lady would have been deprived of medical attention and therapeutic assistance had it not been for her family and loved ones. The late President led his intervention without needing medical validation because of an obvious decline in medical and psychological wellbeing and a clear need to act.  It is safe to say that the First Lady likely would have died from her “nonexistent” but out-of-control drinking and substance dependence if left untreated. 

Research Studies Validate the Sex Addiction Diagnosis

Which brings us back to where we are today—Sex addiction is still being declared as a controversial and  nonexistent problem by those who wish to close their books and minds to the problem and the people who seek help for sex and porn addiction. But to the deniers, note the growing body of evidence in the research from neuroscience. For example, researchers at the University of Cambridge performed brain scans on 19 men watching pornographic videos. They showed that the same reward centers of the brain were activated when addicts see their drug of choice. Ongoing research at other honored institutions and universities has yielded similar results in brain scans and reward circuitry vis-à-vis sex and porn addiction. Those studies are being published as we speak.

Until such time that the diagnosis of sex addiction finds its way into the mainstream as an accepted and veritable illness along the order of alcoholism and drug addiction, certified sex addiction therapists will continue to work within their scope of practice to ethically treat the hundreds who arrive to therapy for help with their sex and porn addiction.  Time will tell, so might the science.

Debra L. Kaplan, MA, MBA, LPC, CSAT-S is a licensed therapist, author and speaker specializing in issues of attachment, sexual addiction/compulsivity, money, work, and relational currency; issues often rooted in unresolved childhood experiences and/or trauma. Debra is a Certified Sex Addiction Therapist (CSAT), a CSAT supervisor, and CSAT facilitator for the certification of professionals in the treatment of sex addiction. Debra is a Certified EMDR therapist and integrates advanced practices in EMDR as well as body centered modalities into practice to help clients heal from the neurobiological wounds of trauma.

After a successful career on Wall Street as a Commodity option-trader, where issues regarding sex, money and power are legendary, Ms. Kaplan brought her financial acumen into the clinical realm and merged her fascination with narcissism, sex, power and control with her studies in psychology. Debra works with individuals, couples, as well as intensives to help clients understand their problematic behaviors and to connect the therapeutic dots for successful and productive outcomes in relationships. Her book, For Love and Money: Exploring Sexual & Financial Betrayal in Relationships, is the inspiration for the groundbreaking clinical training, For Love and Money©, geared to clinicians who wish to understand the often hidden dynamics of sex, money and power in relationships.

She lectures nationally on trauma and addiction and is an invited guest on local podcasts and radio programing. To learn more visit www.debrakaplancounseling.com.

1 APA, (11/5/16), Retrieved from http://www.dsm5.org/about/Pages/Default.aspx

2 ASAM, (11/5/16), Retrieved from http://www.asam.org/about-us/about-asam

* The APA released the newest version of their manual, DSM-5, on May 2013 at APA’s Annual Meeting.