The Rocky History of Sex Addiction in Public Awareness

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, [1] Carnes defined sex addiction as “a pathological relationship with a mood-altering experience.” Twenty years later in Facing the Shadow [2] 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.

• Anti-feminists

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”

What’s next?

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:
Compcare Publications.

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

Porn Addiction in Film: “Don Jon” Gets Intimacy Disorder Right

The new film “Don Jon” starring and written and directed by Joseph Gordon-Levitt (and hopefully its planned sequel “Sin City: A Dame to Kill For”) have the potential to do more to combat the epidemic of sexist porn and sex addiction than all the “feminist porn” movies, books and women’s studies classes put together.  The film is so well done and so entertaining that you might not notice that it is a feminist film or that it deals with intimacy disorder.

In the title role Gordon-Levitt plays a shallow young man whose life is anchored by strong ties to his family, church and male friends.   He is not a sleaze or a loser, he likes to keep his apartment sparkling clean, and he’s a nice guy with a lot of charm and innocent warmth.  It’s just that he inhabits a social world in which the sexual objectification of women and the search for sexual hook-ups are the norm.  He is also a hope-to-die porn addict, which he confesses to his Catholic priest every Sunday but which he fails to identify as a real problem.  He has no idea what intimacy is let alone intimacy disorder.

The story is one of a man whose consciousness is raised through meeting and connecting with Esther (played by Julianne Moore), a totally present and very spiritual survivor of great personal tragedy.  The theme of the film is stated toward the end: that intimacy is losing yourself in someone else not losing yourself in fantasy.

A lot of the film is taken up with the funny and poignant attempt at a relationship with Barbara, a woman he lusts after but who withholds sex.  Scarlett Johansson gives an amazing performance as Barbara, the sexy, gum-cracking, love addict who wants to mold a relationship to match her fairy tale fantasy of the great love.  As this relationship develops we see that both Jon and Barbara are totally intimacy disordered.  Neither one really knows how to get to know another person or how to move forward in a genuine courtship.

In the Julianne Moore character, Jon finds an ancient goddess archetype,  who approaches him in a night class which he is taking to please Barbara (i.e. to get in her pants).  In case there is any doubt that religion and spirituality are not necessarily the same thing.  Jon goes  to church every Sunday with his family and confesses his “sins” of pornography/masturbation and sex out of wedlock with hilarious honesty (“35 times in the last week”) and while he performs all the resulting Hail Mary’s and Our Father’s diligently, he never evolves one inch until he meets his de facto spiritual guide.

Gordon-Levitt, unlike the character he plays in the film, has feminist consciousness in his DNA.  He is the son of non-observant Jewish progressives.  His father was at one time the news director for KPFK and his mother ran for U.S. congress in the 70’s in the Peace and Freedom Party.  Gordon Levitt is quoted as saying:

“My mom brought me up to be a feminist.  She was active in the movement in the 60s and 70s.  The Hollywood movie industry has come a long way since its past.  It certainly has a bad history of sexism, but it ain’t all the way yet.”

Fighting Porn Addiction: Should Porn be Against the Law?

Even if they do not talk about the problem in terms of porn addiction, many countries are concerned about the mushrooming consumption of porn and are making moves in the direction of criminalizing internet pornography.  A number of countries already have.  The concern is not only about child porn but all hardcore online porn.

Whether governments should ban porn or not is a complicated matter that is debated on many levels.  But there is also a debate about whether it is actually possible to stop the flow of porn onto the internet. 

Let’s look at these two questions separately.

Should countries prohibit hardcore adult porn?

A number of countries are either attempting to enforce existing laws against pornography by blocking internet porn sites and/or by prosecuting those responsible for the porn sites.  A number of other countries are in the process of trying to make online porn content illegal.

Hardcore pornographic content is already being blocked in China, Hong Kong, Singapore, Gaza Strip, Indonesia and Pakistan and there is a complicated regulatory structure in Australia.   (See the Wikipedia catalog of countries and their existing porn laws.)

In other countries there is heated debate and movement toward the banning of internet porn, such as India, Egypt and Iceland.  And in the UK and the US there is controversy about and resistance to making or enforcing laws that criminalize the posting or viewing of hardcore adult pornographic content.

Some of the main arguments for making anti-porn laws (or for enforcing laws that may be on the books) are:

-Porn is socially unjust in that it is oppressive toward women (Iceland),

-Porn is causing violence against women (India)

-Porn is socially and morally corrosive (China, Egypt and others)

-Porn addiction is a problem for many adults (US, UK)

-children can be inadvertently exposed to harmful content (US, UK, Iceland and others)

The arguments against criminalizing adult hardcore porn are mainly that such laws would violate freedom of expression, that porn is personal and is something that should not be controlled by governments and that there are legitimate positive uses for pornographic content.

Is it possible to outlaw internet porn?

A 2011 International Herald Tribune headline states: “Over 1,000 porn sites blocked in Pakistan.”  Although at that time Pakistan was continuing to find and block sites, the article goes on to say that there was a list of over 170,000 websites that might be banned.  The article says:

“Blocking 170,000 sites is not feasible for any operator.  The screening time on a per request basis will essentially slow the internet down to make it unusable.”

The International Business Times last month had an article on China’s anti-porn ban which reported that the creator of China’s biggest porn site was convicted and sentenced to life in prison in 2005, and that movie producers and film studios creating erotic films can potentially lose their licenses to make movies.

But the article goes on to state:

“Still, with constantly developing technology, and the demand for pornography, Internet users are still able to access pornographic material.”

Last month the L.A. Times reported that following anti-porn demonstrations, Egypt now has a plan to implement a court-ordered ban on porn websites.  The plan is to target each individual website and will cost about $4 million.  This is a big and controversial expense for a country that is under pressure economically.  This seems like a never ending if not impossible task for any government to attempt.  And if porn cannot be interdicted at the level of the website or the internet service provider it seems like a hard sell to prosecute individuals for watching the material that is currently flooding the web.

I am convinced that porn addiction is a growing problem and that the epidemic of porn consumption around the globe shows no sign of slowing.  The process of getting the product to the customer via the internet is extremely sophisticated and difficult to regulate.

Yet we do regulate some products that are addictive and/or damaging such as cigarettes, alcohol and even the sexual content of movies.  People need to find a way to agree on some basic ideas about what content should be regulated, especially as regards children.  The problem of implement regulations on internet content, like the problem of combating porn addiction, will probably be a long and difficult process combining the efforts of research, technology, public heath and advocacy.

Icelandic Porn Law Will Strike a Blow for Gender Justice

Will Iceland’s proposed ban on violent internet pornography work?  We have heard the arguments that internet porn content is increasingly violent, depicting more sex with children, more abusive acts toward children, and can lead to violent crime.  We have also heard that it traumatizes kids who view it and that it wreaks havoc with marriages, causes erectile dysfunction in men and body image issues in women, and “hijacks” our sexuality.

What I find most interesting about the Icelandic government’s proposed legislation is that it is built on another argument as well, one that is seldom cited, namely porn promotes gender inequality.

The question of whether such legislation can “work” must be looked at not only in terms of whether it can decrease crime or other objective measures of social wellbeing.  The Icelandic proposals have the potential to go where no one has gone in a liberal western country.  That is to raise consciousness about the eroticizing of domination and the “comodification” of women.  In other words to bring a focus to what the new feminists see as the underlying woman-hating that saturates pornography and the depiction of maleness as brutal.

The British Prime Minister David Cameron had supported legislation last year which would require internet providers to block access to pornography and put in place an “opt-in” system for users.  When this effort failed to get traction Cameron in December of last year came out is support of a proposal which would leave filtering in the hands of parents and would “require” that parents with children at home provide for filtering when the obtain internet service in their home computers.

The argument that we should somehow prevent children from seeing pornography is not wrong.  However it misses an important point.  The point that gets the least attention in the whole porn debate is that pornography sanctions an increasingly cruel and degrading representation of a whole class of society—women.  Such stereotyped and prejudicial images of any other sub-group of society would be seen as intolerable and unjust.


Are We Responsible For Our Sexuality?

The two recent articles, “Head case puzzle” (7/15/2012) by Robert M.  Sapolsky (a professor of neuroscience at Stanford University) and “Do pedophiles deserve sympathy?” (6/21/2012) by James Cantor ( of the Department of Psychiatry at the University of Toronto) point the way toward what will undoubtedly become an increasingly well understood science of the way in which brain wiring, injuries to the nervous system both before and after birth, childhood factors affecting brain development and genetics are all interwoven in such a way as to produce a human being who is predisposed to particular sexual acts.

But for those who want to see sex addicts and/or sex offenders as responsible for making the right choices no matter how they are wired, Sapolsky’s Op-Ed piece in the L.A. Times is a shot across the bow.

As Sapolsky points out, “Self-discipline, impulse control, gratification postponement and emotional regulation are all just as much products of biology as anything else that emanates from the brain.  The same types of evidence that allowed us to understand the role for biology in such things as abnormal sexual urges have also demonstrated a role for biology in giving in to those urges.”

Where are we with understanding sexual compulsion?

Some sex offenders and sex addicts seem to have wiring that is so messed up that they are incapable of ever gaining any connection with or empathy for another human being.  And yet we used to claim that people with “character disorders” such as borderline personality disorder were incurable too. But we now know that these “disorders of the self” as they are sometimes called are most often related to neurophysiological  issues that may be a result of early trauma and attachment issues and that they can be treated with a great deal of success.

So is sexual compulsion a disability permanently etched in the brain?

At present I believe we operate on the basis of a kind of implicitly understood continuum of biological permanence, which goes something like this:

sexual orientation  –  paraphilia  –  arousal template  – trauma reaction

In this continuum sexual orientation (gay, straight etc.) is accepted by most if not all people as hard wired in the brain if not the genome.   At the most fluid end of the scale, a trauma reaction or behavior that is in reaction to (or a repetition of) specific traumatic experiences which are often quite amenable to change through treatment.

The middle two categories are where the sex offenders and sex addicts are usually located.  Pedophilia, attraction to children, is a paraphilia like other types of sexual fixations.   It is the object of sexual attraction that is the most or only really sexually arousing person or thing.  These are seen as learned rather than innate for the most part but have been viewed as resistant to treatment.

“Arousal template” is the word used in most sex addiction therapy to refer to the sexual preferences such as dominance and submission, voyeurism and so on, which are the result of childhood experiences, early trauma and conditioning.  They are closer to trauma reactions in that with proper treatment they can be worked through and in many cases the person’s sexual behavior can come to be more “normal.”

If there is a neurophysiologically identifiable cause of the problem, we tend to see the person as less responsible for their behavior regardless of how effectively it can be treated.  Actually, the question should be not how much or little people have control over a given behavior, but how far we have come in being able to treat it.  The question of responsibility is one that the legal and philosophical systems rely on but ultimately it has little to do with the scientific reality of the prospects for treatment and recovery.

Week-End Sex in the News: Top Headlines – Internet Pornography, Gwyneth Paltrow, and Child Pornography

My news alerts usually consist of a seemingly endless stream of stories about people being arrested on porn charges or other scintillating stories relating to sex and sex addiction such as: “New Brunswick Nearly Leads Canada for the Crime of Stalking” or “Sex Offenders go AWOL in Scotland”.

Today, however there were a few that were both sensational and in some way relevant.  Here they are in no particular order with my comments.

1.   Internet pornography ‘destroying men’s ability to perform with real women’

October 22, 2011 – 5:32 pm by News Desk | Permalink | Print This Article |

London, Oct 22 (ANI): Internet pornography is destroying men’s ability to perform with real women and creating a generation of young men who are hopeless in the bedroom, according to a new research.  Exposure to lurid images and films in the new media is de-sensitising so many young people that they are increasingly unable to become excited by ordinary sexual encounters, the report said.

The result of this over exposure is that impotence is no longer a problem associated with middle-aged men of poor health but is afflicting men in the prime of their lives.  The report explains that the loss of libido 30 years early is caused by continuous over-stimulation of dopamine, the neurotransmitter that activates the body’s reaction to sexual pleasure, by repeatedly viewing pornography on the Internet.

A ‘paradoxical effect’ is created whereby with each new thrill, or “dopamine spike”, the brain loses its ability to respond to dopamine signals, meaning that porn-users demand increasingly extreme experiences to become sexually aroused.

“Erotic words, pictures, and videos have been around a long while, but the Internet makes possible a never-ending stream of dopamine spikes,” the Daily Mail quoted Marnia Robinson, the author of the report as saying.  “Today’s users can force its release by watching porn in multiple windows, searching endlessly, fast-forwarding to the bits they find hottest, switching to live sex chat, viewing constant novelty, firing up their mirror neurons with video action and cam-2-cam, or escalating to extreme genres and anxiety-producing material.

“It’s all free, easy to access, available within seconds, 24 hours a day, seven days a week.

“In some porn users, the response to dopamine is dropping so low that they can’t achieve an erection without constant hits of dopamine via the internet,” she added. (ANI)

My Take:  This is a really important report and suggests the need for further study.  It is important for two reasons:

(1) Because it deals with the brain chemistry associated with bombarding oneself with internet pornography and sexualized imagery in general

(2) Because it points to the fact that use of sexual or pornographic imagery as a drug is creating a “tolerance” for the experience, much like the tolerance for narcotics, such that we require greater and greater amounts (or greater intensity of experience)

2. Gwyneth Paltrow rolls in the hay at former N.Y. stables for sex-freak role in ‘Thanks for Sharing’


Gwyneth Paltrow appears to be taking it off for the cameras again. A source tells us the actress shot some racy scenes for the film “Thanks for Sharing” on Wednesday, Thursday and Friday at Carriage House, a former stable at 159 W. 24th St. that’s been converted into condominium apartments. The movie is reportedly about three people who undergo a 12-step treatment for sex addiction. An insider tells us that in one of the scenes, Paltrow performs a “striptease via Skype” for co-star Mark Ruffalo, who wasn’t on the set. Hubba hubba. We wonder if Paltrow and her husband, Coldplay front man Chris Martin, ever engage in similar video chats. A spokesman for Paltrow didn’t get back to us by deadline.

My Take: So I confess that I think it’s great that there are movies being made about sex addiction. Even bad movies, movies that glamorize it, or portray the sufferers or their treatment in misleading ways.  As long as the film does not use the concept as exploitation and makes a stab at some kind of relevance, it will at least get the problem out there into the public dialogue more.  A great example was the movie “Choke” with Sam Rockwell which came out a few years ago.  I have not seen “Shame” yet…

3.  Anonymous Takes Down Massive Child Pornography Server, Leaks Usernames

by Max Eddy | 11:00 am, October 23rd, 2011

In a move that we can all get behind, hacker group Anonymous has announced that they have taken down a huge cache of child pornography and released 1,589 usernames of the website’s patrons. The action came as part of Operation Darknet, which targets illicit websites that are part of an unindexed and therefore unsearchable corner of the Internet.

The server in question is owned by Freedom Hosting, and apparently services over 40 child pornography websites. The largest of these, disturbingly called Lolita City, was said to contain over 100gb of child pornography.

Interestingly, the Anonymous hack is extremely well documented. In two separate Pastebin posts, the hackers involved provide a timeline of events, as well as some of the methodologies they used in tracking and taking down the servers…

My Take: Hackers doing what they do best and judging by the comments, people are cheering.  However, what everyone seems to want to know is now what?  Will law enforcement actually do something with the information?  And for those of us on the treatment end of things, what will happen to the suspects, when they are finally run to ground?  Maybe the next hacking enterprise could deal with collecting some data that would help with addiction research.  Call me, we’ll talk.