It is the height of the AIDS epidemic, around 30 years ago. Dr. Patrick Carnes, the founding father of sex addiction theory, is going to speak to the gay community. He has been invited in by a respected African American sexologist who feels that the gay community really needs to hear his message. On this occasion Dr. Carnes is transported in one of three identical limos so that if he was attacked it would be impossible to know which limo he was in.
The ridicule and harassment began early and didn’t stop. Carnes’ daughter Dr. Stefanie Carnes, now the president of the International Institute for Trauma and Addiction Professionals, remembers that when she was a teenager her father received death threats.
Even some in the AA community were angered when Dr. Carnes started a 12-step recovery program for sex addiction. So what was the idea that evoked such a violent reaction? In his 1983 book Out of the Shadows,  Carnes defined sex addiction as “a pathological relationship with a mood-altering experience.” Twenty years later in Facing the Shadow  he states:
“Today we understand that addiction is an illness– a very serious disease. Furthermore, problems such as drug, food, gambling and sex addiction are actually related and rely on similar physical processes. Most important, we know that people can get help and that a good prognosis exists. Sex addiction is the last addiction to be understood.”
How sex addiction was thrown under the bus
In an article on the politics of sex addiction Marnia Robinson describes the events inside the American Medical Association in 1992 when they were considering a new specialty: addiction medicine.
“It became clear that the AMA wouldn’t agree to approve the new specialty unless sex was excluded from the list of possible addictions…the reason was strategic. Doctors were bent on snuffing out the tobacco manufacturers’ spin. Big Tobacco was pulling out all the stops to prolong the illusion that “smoking is not addictive.” It claimed that the addiction experts’ evidence should be ignored because, “the experts are saying everything’s addictive. “Excluding sex demonstrated that doctors weren’t saying everything is addictive. Besides, sex addicts were rare, while smokers were everywhere and suffering unnecessarily.”
Some recent progress
The idea of addiction to a behavior has been around for years and gambling has been included in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association as an impulse disorder, but the diagnostic criteria parallel those of most addictions.
In 2011 the American Society of Addiction Medicine announced a new definition of addiction which included behavioral addictions like sex, food and gambling.
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain… such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.”
The research on the brain and behavioral addictions including sex/porn addiction is beginning to show that sex addiction is similar to other behavioral addictions.
So have people gotten over their indignation at the whole idea? Not hardly.
The furor continues
People seeking help for out-of-control sexual behavior are amazed that anyone would claim to have proved that sex addiction doesn’t “exist.” The addict knows it exists.
The overall historical trend will no doubt follow the same progression as that of alcoholism and mental illness. As I have argued elsewhere, this trend is from demonization to criminalization to medicalization to reintegration as the problem becomes better understood.
On the one hand there are still arguments that sex addiction is not an affliction it’s just bad behavior. On the other hand there are arguments that sex addiction is just a normal variation on the sexual continuum.
The former view is based on the fear that a diagnosis of sex addiction will be too permissive, allowing all manner of sexual behavior with no moral sanctions or personal responsibility. Ironically, the second fear is the opposite: that medicalizing sex addiction will lead to a curtailing of sexual freedom with some sex police deciding what sexual behavior is healthy and what is pathological.
Who are the current sex addiction deniers?
• Pro-pornography people
People who have a vested interest in the pornography industry. Producers and/or viewers of porn are sometimes fearful of any regulation that may grow out of the awareness of internet porn as potentially addictive. One cheating website recently solicited writers from the sexology community to promote affairs as healthy and debunk any unflattering research.
Some who wish to normalize sex addiction, the “boys will be boys” contingent, see medicalization as a feminist plot to control men.
• People with grossly mistaken beliefs
A handful of professionals who are not well acquainted with the field tend to loudly misrepresent it. One such personal communication stated:
“I’ve written extensively on the heavy moral agendas embedded in much sex addiction publications. Further, there is a strong anti-male, and anti-gay/bi male stance implicit in most sex addiction writings, labeling things as unhealthy, due to social stigma, not based on actual research or ill health.”
• Misleading Crusaders
The occasional zealot in the professional community intent on rescuing patients from the clutches of money grubbing therapists. One of these recently tweeted the suggestion that patients file complaints:
“Remind patients: can file vs. therapist (free, any state) for “false advertising”, including “sex addiction”
Sex addiction treatment does not condemn any specific sexual behavior, does not support any legislation, and has no bias about gender or sexual orientation.
I am happy to report that Dr. Carnes has an article on the diagnosis of sex addiction soon to appear in The Journal of the American Medical Association. Hopefully one more step on the rocky road to understanding.
1. Carnes, P. (1983b). Out of the Shadows: Understanding Sexual Addiction. Minneapolis, MN:
2. Carnes, P.J. (2010) Facing the Shadow. Carefree, AZ: Gentle Path Press.
Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource and at PsychCentral.com