Sex Is the Drug

By Martin Downs
WebMD Feature

Reviewed By Brunilda Nazario

In the late 1960s, Hogan's Heroes star Bob Crane was the picture of middle-class American values: a father of three, married to his high school sweetheart, dressed in alpaca sweaters and khaki pants. But after his murder in 1978, it became clear that he had been living a secret life. When police searched his apartment, they found a library of photos and home movies documenting his sexual escapades with countless women over the years. What had begun as a collection of "girlie" magazines stashed in the garage had grown to an all-consuming passion that wrecked his first marriage, a second one, and his reputation in Hollywood.

The recent film Auto Focus tells Crane's tale, which is a case study in sex addiction.

For a sex addict, the pursuit of pleasure isn't reserved for weekends. It is a preoccupation that causes serious grief, whether from guilt, or consequences like debt, divorce, unemployment, STDs, or criminal charges. And like substance abuse -- "marijuana leads to heroin" -- sex addicts not only devote increasing time and energy to sex, but they also tend to take ever bigger risks to get their kicks. So, the addict who starts out peeking at Playboy moves on to lap dances, and eventually he's arrested for picking up a prostitute.

Another sex-addiction drama played out this past season on HBO's hit series, Six Feet Under. The character Brenda (Rachel Griffiths) follows a similar path, illustrating that women can be sex addicts, too. Crane's story ends in murder, but Brenda's ends in recovery, when she joins a support group for sex addicts. Many such programs do exist: Sexaholics Anonymous, Sex Addicts Anonymous, and Sexual Recovery Anonymous, to name a few.

Some may scoff at 12-step programs for sex, but the idea that anything pleasurable can be addictive isn't just pop psychology or the legacy of puritans. It's based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the mental-health profession's main reference book.

Libertine, or Addict?

The DSM-IV does not mention sex addiction, but Jennifer Schneider, MD, a specialist in addiction medicine and author of Cybersex Exposed, says the criteria used to diagnose a cocaine addiction, for example, can also be applied to sex addiction.

Seven things describe drug addiction. Two are biological -- withdrawal symptoms and tolerance to the drug. The others are behavioral. A drug addict may over-indulge, want to cut down but not be able to, spend a lot of time getting, using, and recovering from the substance, give up important activities because of it, or continue using it even though the effects are harmful.

The manual states that only three of the seven criteria must be met to diagnose addiction. "You can generalize these three things to reflect your behavior with anything," Schneider says.

But Marty Klein, PhD, a sex therapist in Palo Alto, Calf., sees that as problem. To look at sexual behavior in terms of addiction, he says, is not helpful. "Somebody like Bob Crane is obviously self-destructive." But to call his behavior an addiction is too simple. "It limits our ability to understand what's going on." Going further, he says, "I don't think that what a lot of people think is a problem is treatable, or even worthy of treatment."

Masturbation and pornography -- which tend to go together like love and marriage -- are a big point of contention between those who accept sex addiction and those who don't. Screening tests for sex addiction and profiles of sex addicts suggest that people who masturbate a lot and relish porn should seek help. Klein, for one, bristles at the notion.

Feminist author and masturbation guru Betty Dodson does, too. "Of course, I'm going to tell them to masturbate more," she says. "I think a person has a right to do sex full-time."

But Schneider thinks there's a boundary between healthy sexuality and addiction, and she insists that sex addiction isn't something cooked up by conservative moralists. "I don't have a moral position on masturbation," she says. "I'm not out looking for people to regulate their behavior."

Can't Have It All

Whether you're sex-addicted depends not so much on what you do, but what the consequences are. If you're wracked with guilt, or if your habits harm yourself or others, then you may be a sex addict. But what about those who masturbate to pornography several times a day, and have only positive feelings about it? "If that activity is enhancing their life, that's fine," Schneider says. Yet she points out that hours spent downloading porn on the Internet can take away from important things, like a full night's sleep.

As for the argument that sex addiction isn't the same as drug dependency, she says, "All you need to do is talk to somebody whose life has become unmanageable." When it comes down to consequences, there's no difference.

Klein, however, sees a clear distinction between substance abuse and sex addiction. On the one hand, a drug addiction changes your brain chemistry, so that when an alcoholic or cigarette smoker says, "It's not me, it's the addiction talking," it's literally true. On the other hand, he says, most people described as sex addicts are just suffering from a common dilemma: You can't have it all.

He cites himself as an example, saying he's on a diet, but is often tempted to eat cookies. If he were to cave in and eat a fattening treat, it would be because the "emotional pain" was too much to bear. So he tries to get his patients in therapy to accept that, "If you want certain things, you have to say no to other things."

Klein takes issue with the 12-step method of dealing with sexual problems, because support groups will take self-described addicts who he thinks should see a therapist first. "The diagnosis and treatment of sexual issues is a highly skilled craft," not to be entrusted to lay people. "That makes it sound like a turf battle, which I don't think it is.

"My quarrel is, before we get any treatment at all, let's figure out what's going on here."

Schneider says she thinks therapy combined with a 12-step program is the best way to deal with sex addiction. And when people self-diagnose, she says, "They're often right."

Am I a Sex Addict?

Here are some questions to consider if you think you may be addicted to sex.

  • Are you ashamed of your sexual behavior?
  • Has your sexual behavior ever harmed anyone?
  • Have you tried to stop or limit a certain sexual behavior, but were unable to?
  • Have you ever paid, or traded favors for sex?
  • Do you keep secrets about your sexual activities?
  • Do you have sex with strangers?
  • Do you often masturbate to pornography?

Published Dec. 9, 2002.

SOURCES: Jennifer Schneider, MD • Marty Klein, PhD • Betty Dodson, PhD • The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV," Sex Addiction & Compulsivity, 1996. * Sexual Recovery Institute.

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