James Franco Isn't A Sex Addict and Neither Are You
The term sex addiction is everywhere these days. David Duchovny, Harvey Weinstein, Russell Brand, Charlie Sheen, Kanye West, Tiger Woods, James Franco… the list of public figures claiming sex addiction goes on and on. This cultural buzz term is extremely harmful, and we have to start evolving our language and meaning around it. For years now, there has been ongoing debate about whether people who feel addicted to sex should be labeled as “sex addicts” and treated under the same framework as other types of addiction*. What certified sex therapists (note: different from sex addiction therapists) implore you to realize is that the language, treatment model, and general concept of “sex addiction treatment” is deeply destructive, pathologizing, outdated, and, in some cases of the aforementioned celebrities who have claimed to be sex addicts, often excuses people from their choices and behaviors, rather than describing an accurate diagnosis and successfully treating the people who have these concerns (see AASECT’s position on sex addiction here).
You can absolutely experience significant physical, psychological, spiritual, and sexual health consequences related to your sexual urges, thoughts, or behaviors; it feels as if you are addicted to one or many forms of sexual expression, and that you cannot control yourself. That said, getting the proper treatment for these concerns helps you to have agency and ownership over yourself and your choices, and helps you build a healthy relationship with sexuality. Let’s talk a bit about some different frameworks around this particular erotic dilemma.
Out-of-Control Sexual Behavior (OCSB)
OCSB is a sexual health problem in which an individual’s consensual sexual urges, thoughts and behaviors feel out of control to them. This is typically what people are feeling when they say they are “addicted” to [consensual**] sex. OCSB typically occurs when a person has erotic dilemmas, interests, or fantasies that cause them to feel severe conflict, shame, and judgement, or even veer outside of their relationship agreements (aka infidelity). In OCSB treatment, clients develop a non-pathologizing understanding of their own sexuality and erotic identity, aligning themselves with values and principles that help them maintain healthy sexuality, and thus, positive health overall. This is a truly sex-positive, holistic, and strengths-based view of sexual expression and sexual health, and folks who engage in treatment do so individually, as well as with relationship partners.
Sex Addiction
In the 1980’s, Dr. Patrick Carnes asserted that sex addiction is similar to other forms of addiction (e.g. substance use, gambling); essentially, the addict has a pathologic relationship to the substance or process, in this case sex. “Sex addicts” are held up as powerless over their behaviors and choices. Treatment guides clients through the 12-Step Program, which typically has moral and religious undertones, and it focuses on the addict altering their behavior, putting the client at odds with their sexual behaviors (typically causing these behaviors to increase). The client is led to believe that if they return to that sexual behavior, they will relapse into sexual compulsivity. A person works to build a life around avoiding the behaviors and fantasies with strong boundaries and abstinence, rather than accepting and exploring this part of themselves and learning to control it rather than it controlling them. Recovery success is left to the therapist’s and spouse or partner’s moral judgments of the “addict.”
Compulsive Sexual Behavior
The World Health Organization’s (WHO) newest edition of the ICD-11 (2022) has recognized Compulsive Sexual Behavior (CSB) as a disorder. This CSB conceptualization keeps sex-negativity out of the diagnosis and recognizes not sex addiction, but compulsive behavior, in its truest form. You cannot receive this diagnosis when sexual compulsivity is due to moral conflicts based on social taboos of these desires, for example feeling guilt about masturbating due to religious or moral beliefs. You cannot receive it when the behavior is a symptom of a bigger issue such as anxiety, depression, bipolar disorder, etc. Finally, you cannot claim to have CSB if you get in trouble for the behavior without a long history of efforts to curtail the behaviors before getting caught. Typically, clients with CSB diagnoses are treated through cognitive behavioral therapy and dialectical behavioral therapy.
As you can see, language and treatment conceptualizations matter. Learning research-backed, positive sexual health information matters. “Sex addiction therapy” is a cure that ends up feeling worse than the problem. Many people actually enter sex therapy to recover from sex addiction treatment itself due to the trauma incurred from being separated from partners and feeling alone and/or pathologized, being put through difficult interventions such as lie detector tests, and having to ignore one’s own agency and cut off one’s relationship with sexual pleasure.
In general, people who identify as “sex addicts” don’t engage in more sexual activity than others, nor have different or more salacious types of sex. That said, there is a high presence of feelings of shame about sexuality, negative attitudes and beliefs about sex, and presence of harmful religious or cultural attitudes about sexuality in those who identify with having OCSB. Nature has a way of evolving out that which humans do not need. Throughout our existence, pleasure has persisted, and sexual expression remains as innate as eating, sleeping, and breathing. Disorder happens when sex is used for power and/or control, when sex is seen as a negative thing in general, or when sex is used as a self-soothing tool for things like anxiety, boredom, feeling like you don’t belong, feeling like you can’t discuss your sexual preferences with a partner, or feeling like you can’t authentically be yourself. You owe it to yourself to get treatment that honors you, your relationships, and helps you align your values with positive sexual health so that you can feel what we’re all wanting to feel… alive.
*The DSM-V actively elected to not include “hypersexual disorder” as a diagnosis due to concerns of over-diagnosis, lack of empirical research and evidence confirming this diagnosis is accurate, and its pathologizing stance.
** If your out of control sexual expressions are not consensual, this is a different problem called a paraphilia, and is treated differently. Paraphilias include problematic expressions of voyeurism, exhibitionism, touching others without their consent, pedophilia, and fetishes that distress the person who has the fetish. Voyeurism, exhibitionism, and fetishes are not themselves problematic, again, unless distressing to the individual or violating another’s consent.