Sex Addiction is Real: Just Ask a Sex Addict

The concept of sex addiction came from sex addicts. It was never imposed on them by clinicians– far from it. If you read the first of the personal stories in the Sex Addicts Anonymous “Big Book,” which includes an account of how SAA was founded 36 years ago this is clear. At that time people with compulsive forms of sexual behavior were receiving other forms of psychiatric treatment that were mostly doomed to failure; treatments like aversive conditioning or psychoanalysis. The groundbreaking work of Dr. Patrick Carnes and others created SAA as a way to treat sexual addiction in order to help themselves and ultimately to help others.

Listening to addicts, lots of them

And people have been steadily joining the ranks of self-identified sex addicts. Today SAA has 1,176 groups (regular weekly meetings) in the U.S., that are registered with the International Service Organization (ISO) of SAA. In addition there are 62 in Canada, 51 in the U.K., 31 in Central and South America and 48 in other locations including South Africa. There are 101 different registered telephone meetings and other electronic meetings.

These statistics are as of last October and the ISO informs me that the number of meetings has grown steadily by 10% per year in recent years. That’s a lot of people in SAA alone. And there are currently four additional 12-step self-help programs for sex addicts all modeled on Alcoholics Anonymous:

Sexaholics Anonymous (SA)
Sex and Love Addicts Anonymous (SLAA)
Sexual Compulsives Anonymous (SCA) and
Sexual Recovery Anonymous

Even this does not represent the whole picture. Nowadays many sex addicts can get appropriate treatment with therapists who specialize  in working with sex addiction. And of course there are many people struggling with sex addiction who are not getting any help at all, often because they don’t understand the nature of their problem, or because the psychiatric establishment has yet to educate the mass of clinicians as to the diagnostic issues.

The current wave of sex addiction denial

Today there is a rash of sex addiction denialism or misinformation fueled by some flimsy studies that have been easily discredited and gaining followers among those who feel judged or pushed around by the idea that someone might call them (or anyone) a sex addict. But in fact clinicians don’t go around looking for sex addicts or labeling people just because they exhibit certain behavior. People need to be evaluated on a case by case basis. This is partly because compulsive sexual behaviors can be a symptom of at least half a dozen other psychiatric disorders that don’t have anything to do with addiction.

But the “evidence” that porn and sex addicts are not exactly like drug addicts in this one experimental response in this or that isolated experiment is really largely irrelevant to the experience of thousands of sex addicts over decades. In the attempt to save patients from being mislabeled by clinicians, the deniers have ended up undercutting the recovery efforts of bona fide sex addicts. “Sorry, what you have may not be a “real” addiction; so maybe you don’t really need any help!”

The plural of “anecdote” is “data”

Most people and clinicians generally agree that sex is a good thing. People tend to show up for treatment when they, or someone who knows them, notice that their sexual behavior is way out of control and is causing a lot of problems. Some people have had their lives taken over by pornography, some have lost a job due to sexual behavior, others have been arrested more than once for indecent exposure, and some simply spend hundreds of thousands of dollars they can’t afford on prostitutes.

But whatever brings them into the office or the 12-step meeting, they still need to be helped to figure out if in fact they are a sex addict. This can be done by pointing them in the direction of the literature on the subject, by talking to other people with the same problems, and by well validated tests.

I have listened to numerous patients of mine, read hundreds of emails and blog comments and listening to sex addicts talk at hundreds of SAA meetings over the years. Many addicts are unsure to begin with about whether they really have an addiction. But for many there comes a point when the addict realizes that they simply have no control over this or that behavior. I have heard over and over again: “This is an addiction!” ” I can’t stop even though I desperately want to!” and ” I’m ashamed of what I do because it’s not who I am, yet I do it anyway!”

Other addicts will occasionally waver in their grasp on the addictive nature of the problem. This is not at all unusual. “So am I really an addict?” “So-and-so is so much worse than I am!” But of their own accord or because of many unsuccessful attempts to quit, they come back around to the need to approach the behavior as though it were on a par with alcoholism or drug abuse. Many will tell you that it is more addictive even than these.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Do Happily Married Men Go to Prostitutes?

I’ll go out on a limb and say that a married man who visits prostitutes repeatedly is probably not the happiest kid in the sandbox.  Although the wives of such men may feel the behavior reflects on their desirability, my experience tells me that such a pattern of behavior doesn’t have anything to do with the wife’s attractiveness.  It says something about the man who, most often loves and feels committed to his partner.

Paying for sex on a regular basis is not the norm, even for single men.  And it can be a sexually addictive behavior, in which case it has to do with the man’s emotional problems including his problems dealing with relationships.

Who are these men who pay for sex?

An article published earlier this year called What Kind of Men go to Prostitutes?  reviewed some of the recent research and survey data on men who visit prostitutes.  The studies indicate that between 1 and 3 percent of men in the U.S. have gone to a prostitute in any given year and about 14 % of men have paid for sex at some point in their lives.

The studies also indicate that men who hire prostitutes are only slightly more likely to be single than married.  And furthermore they do not appear to differ much from the general population of men.  The men’s reasons for having hired prostitutes were seen as predictable: wanting more sex, being unhappily married, being insecure about dating, wanting the excitement of risk, and wanting power and control.

An outcome study of men who attended a “John School”, a criminal diversion program for men who are arrested for paying for sex, reported that:

“Johns report a variety of reasons for why they purchase sex including the feeling that buying sex is an addiction. Interviews with “Johns” revealed that 83 percent of participants identified buying sex as an addiction (my italics) (Durchslag & Goswami, 2008).  Additionally, research suggests that men who participate in the commercial sex industry often view women as commodities and feel a sense of entitlement to sex. Interviews revealed that men who did not have a regular sexual partner also legitimized purchasing sex (Monto, 2000).”

The Johns as a group also consisted of married and single men.  Were all the married men paying for sex because they were unhappily married?  This is unlikely, because Johns as a group are characterized as unhappier than other men.  And besides, if they have problems with sexual behavior this could account for their unhappy marriage as much as the other way around.

Unfortunately there is not enough known about the demographics of the John population or the prevalence of psychological problems.  These are still very much being debated.

Paying for sex and sex addiction

I feel on firmer ground talking about the kinds of relationship dynamics that are commonly seen in men who show up for sex addiction treatment where paying for sex is one of their compulsive behaviors.

As with sex addicts in general, men who visit prostitutes most often have other sexually addictive behaviors.  These can include compulsive porn use, cybersex, strip clubs, and sometimes offending behaviors like exhibitionism and others.  Going to prostitutes is thus part of an pattern of sexually addictive acting out behaviors.

The fantasy element in sexually addictive behavior

Whatever the specific behavior, sexual acting out is always largely a fantasy.  It takes place outside of the person’s “real life” and it functions as a drug.  While engaging in the sexually addictive behavior, the addict escapes whatever is painful and achieves a totally gratifying experience on his own terms.  This implies that the man has issues that he cannot resolve, or issues he would rather escape than allow his adult self to face head-on.

The avoidance of intimacy in sexually addictive behavior

Paying for sex is exactly the same as any other sexually compulsive behavior in that it is part of a pattern of intimacy avoidance.  What is the addict escaping from when he is avoiding intimacy with a partner?  It is not that the prostitute has so much more to offer than the spouse.

The sex addict experiences intimate bonds as frightening and overwhelming.  Being with a prostitute is safe, limited and controlled interaction.  The addict can relax and feel safe from the dangers of getting hurt, abandoned, rejected or feeling inadequate.   The sex addict feels unlovable and insecure and meets his needs for sexual abandon in a contrived, compartmentalized way.

Sex addicts feel bad about their addictive behavior afterward but they continue to do it.  If a man who is not an addict visits a prostitute he may feel many things but he will not be driven to repeat the experience.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Ogling Other Women Can be a Real Problem for Partners of Sex Addicts

Many wives and partners of sex addicts complain of their partner ogling other women.  A man who can’t help staring at other women may be just a rude guy or his ogling may be part of a pattern of sexually compulsive behavior.  If you are the partner of such a man you will know that it is crazy making.  There are a million ways for a man to brush aside your concern and make you feel that you are overreacting.  It is “gaslighting” on steroids.

I have worked with many sex addicts and their partners for whom ogling is a serious problem. By that I mean often the sex addict will be unable to stop looking at attractive women and will be using the images of sexy women he sees in passing as a way to be swept away, to feed a fantasy life, and to avoid the person he is with.

I saw one sex addict who admitted that he ogled in this way; that he looked at women “from the neck down”.  He was happily married yet he saw himself as being sexually compulsive in this one area.  He claimed he would do anything to stop because it hurt his wife so much.  When he couldn’t stop looking at another woman in a restaurant on his honeymoon it was a wake up call for his wife (and him).

The three second rule

Sex addicts in recovery are told to follow the three second rule, meaning that although you can’t help glancing at or noticing someone, you can give yourself three seconds to stop looking.  At that point you can hopefully manage to redirect your thoughts away from sexual objectification and into seeing the person as a person (a student, someone’s daughter, etc.) and to wish them well.

One of the partners of sex addicts who wrote to me  challenged this idea.  Her partner is a recovering sex addict who ogles women.  She wrote:

“His comment to me about three seconds was that he rarely if ever looks that long because he wants to avoid discovery. He is very subtle about his looking, yet he is able to get a potent hit, even though his eyes only “flick” briefly onto a woman’s body. So basically, someone could look for under three seconds and get a potent sexual hit. In other words, it’s really not about the amount of time. It’s about the intent, the hunting, the feeding, the drinking in, the filling up.”

She describes also:

“…a different person I know who captures image impressions of women’s bodies and files them away mentally for later fantasy use. These also could be just very brief glimpses of someone’s cleavage or of someone in an every day position that is sexually titillating to the viewer.”

This woman’s partner is not unusual.  Many sex addicts complain that they are helpless because there are just so many sexy women around and they can’t help looking at them.  And yet ogling can feed an addiction by adding to what some sex addicts call their “data base” of sexual imagery that they can call up at a later time to use for masturbation or even during sex.  It can feed what is essentially a stash of mental pornography even if they have been successful in giving up an actual pornography addiction.

One thing is for sure; if a man has already identified himself as having problematic, compulsive sexual behavior then his ogling is probably one of his array of sexually addictive behaviors.

What ogling does

Remembering images and having fantasies is not at all pathological in itself.  And to some extent the level objectification of women that is involved in ogling is an everyday occurrence in our culture.

But as I noted elsewhere, the American Psychological Association talked about ogling as one step along a scale:

with sexualized evaluation (e.g. looking at someone in a sexual way) at the less extreme end, and sexual exploitation, such as trafficking or abuse, at the more extreme end.”

Sexual objectification of women (and men) is rampant in our culture and it is probably getting worse.  As a form of objectification, ogling may or may not be a dangerous trend, but can seriously interfere with a person’s ability to relate in an intimate relationship.

Ogling as a form of sexualizing and objectifying people is so common among sex addicts as to be almost universal.  And it can also provide a direct trigger to relapse in an addict who gets swept into fantasy.

For some sex addicts looking at women in a sexual way is part of their addictive ritual.  They feel deprived of sex, even rejected by the women they look at and this paves the way for them to escape into their other sexually addictive behaviors such as internet porn.

Is ogling voyeuristic?

As I discussed in a prior post it may not be possible for most of us to tune out sexy women.  But sexual looking and sexual evaluation of strangers can be seen as unwanted and invasive in itself, quite apart form its impact on partners of sex addicts.  Some women may want to be looked at, but some may feel slimed or even violated by it.  And since the ogler has not way of knowing it’s best to assume that there is something uninvited and even potentially voyeuristic about it.

Is Masturbation OK in Recovery From Sexually Addictive Behaviors?

Masturbation  can present a problem for people with sexually addictive behaviors.

I would not encourage anyone to see masturbation as inherently bad or a problem, and yet there are some people who would see any sexual activity outside of marital sex, even masturbation as wrong.  If you hold such a view on religious or other  grounds, then you may see masturbation as wrong no matter what.

But since I do not hold such a view I distinguish between those situations in which masturbation is harmless and those in which it can complicate things for someone attempting to recover from sex addiction.

When is masturbation counter-productive?

In the early months (or maybe years) of recovery I believe it is a good idea for sex addicts to abstain from masturbation, regardless of whether compulsive masturbation is one of their sexually addictive behaviors or not.  Here are some situations where Masturbation can reinforce addictive patterns.

  • Masturbation can itself be a compulsion, meaning that it is being used to excess and as a drug.  For some sex addicts masturbation is their primary sexually addictive behavior.  Often it is done in conjunction with porn use but sometimes it is done using fantasy alone.  Compulsive masturbation often starts early in life and continues into adulthood.  The addict will often develop a pattern of masturbating numerous times per day.  In order to be free of this compulsion and lead a more normal sex and relationship life in recovery, the addict will need to “kick” the habit and allow their brain chemistry to return to normal functioning.  This means total abstinence for a period of time during treatment and recovery.
  • Masturbation can be part of a pattern of other sexually addictive behaviors.  Masturbation often accompanies other sexually addictive behaviors built around fantasy such as compulsive cybersex, sexual chat,  voyeurism, and exhibitionism.  The masturbation may be done at the time of the other behavior or it may be done later using the stimulus of the memory of the event.  In this case the behavior of masturbating is tied to whatever pattern of addictive acting out behavior exists and provides the sexual gratification for which the other behavior is the stimulus.  At least initially, the addict cannot quit one behavior without quitting both.
  • Masturbation in early recovery can prevent the process of withdrawal and lead to relapse.  Since the addict’s “arousal template” as it is called, is one of addictive sexual acting out of one type or another, it is likely that any form of sexual stimulation, at least in the beginning of recovery, can lead back to cravings and urges for the addict’s preferred sexually addictive behaviors.  Even if the addict has never masturbated compulsively, masturbating in recovery can bring on cravings for other behaviors, behaviors like anonymous sex, prostitutes, etc.   I takes a long time in treatment for the unhealthy urges and fantasies to subside or at least be less powerful.  Instead of allowing the addictive pattern to weaken, masturbation may be like taking small amounts of the drug, thus prolonging the process of withdrawal.

When is masturbation a useful part of recovery?

After a sex addict has established a period of abstinence from all sexually addictive behaviors, it is possible that masturbation can be engaged in in a normal way that does not threaten their sexual sobriety.  This is very much a subjective and individual decision to be arrived at by the addict and their sponsor or counselor.

  • Masturbation can become a more healthy activity that is not a compulsion and is not tied to another sexually addictive behavior.   It may be that the addict will find it a useful way to explore and check in with the fantasies that have driven their addiction and the memories or traumatic events that have shaped their sexuality in the past.
  • Sometimes addicts can actively change the content of their masturbation fantasies to experiment with different and healthier mental stimuli.  Some addicts masturbate while thinking about their spouse or partner.
  • Or addicts may simply be able to enjoy occasional masturbation as a positive, private experience that is different from their relational sex but is not part of a compulsion or an addictive pattern.

But many times masturbation loses it’s charm for sex addicts once they have given up their sexually addictive behaviors and no longer crave the hyper-arousal that their addictive fantasies provided.


Too Good-Looking, Too Smart, or Too Rich (to give up Sexually Addictive Behaviors)

There is an old recovery saying that you can’t get sober if you are too smart, too rich or too good-looking.   Clinicians working with clients who have sexually addictive behaviors know that these attributes can sometimes present challenges.

I’m not saying that looks brains and money lead to sexually addictive behaviors but I can see some of the ways they might operate to prevent the addict getting better.


There is no longer any doubt that success (fame, money adoration) can cause what is known as “acquired situational narcissism.”  Narcissism is a false sense of self worth which can be bolstered and encouraged by massive amounts of positive feedback from others.  This feedback promotes narcissistic self-centeredness, lack of empathy for others and over-entitlement. (See also my blog Narcissism, Sex, Power and Herman Cain.)

Any sex addict can adopt a narcissistic defense system but the process is magnified if the person is rich, beautiful, etc.  The greater the narcissistic self-importance the greater the sense of being exempt from the ordinary rules that govern behavior.

If this superiority is constantly reinforced then the addict has a hard time getting a grip on reality.  His attitude is “I’m special, I’m allowed; even my flaws aren’t flaws.”

Masking shame

Most addicts feel some level of guilt or shame about their sexually addictive behavior.  After engaging in a behavior like repeated visits to prostitutes or sexual massage parlors or the wasting of hours on internet porn and masturbation most addicts go through a period of feeling let down.  They have engaged in an out of control behavior that they must keep secret and they soothe the feelings of self-loathing in any way they can.  Often they use other drugs to numb the feelings.

The problem for the rich successful or beautiful person is that they can use these assets as tools with which to numb or mask their negative emotions and restore their facade of self worth.  The more easily the addict can dodge the feelings of self-hate, the more easily they can avoid coming face to face with their own double life.

Normalizing sexually addictive behavior

Normalizing is one of the defenses invoked by most sex addicts but with the brilliant, beautiful or rich addict it is particularly useful in certain cases.  Take the guy who engages in repeated seduction, predatory flirting, workplace harassment or serial affairs.  If he is successful or good-looking he can much more easily excuse his behavior by saying “I can’t help it, women just come on to me—what am I supposed to do?”

In this case the special attributes can function to keep the addict in denial.  Special levels of status or achievement can be seen as justifying behavior which would be reprehensible in mere mortals.  “Beauty is life’s Easy Pass,” as a New Yorker cartoon put it.  Or in the words of Henry Kissinger, “Power is an aphrodisiac.”

Never hitting bottom

For the very good-looking, smart or rich addict can to a great extent use their special advantages to avoid or greatly minimize the adverse consequences of their behavior.  These attributes give them power and that power allows them to maintain the status quo.  They may never have to confront the reality of what is wrong with their way of life let alone what they have done to others.

The very smart, successful or powerful addict will have a hard time accepting the basic fact of his or her powerlessness over the addiction.  The very smart addict is used to relying on his ability to think his way out of a problem.  There is nothing he can’t solve.  Therefore he doesn’t need to rely on others, doesn’t need to take direction or work a program.  He’s got the answers, or so he believes.

Those around the addict face a dilemma

Attractive high-achieving people often do have many strengths.  Their intelligence, attractiveness and resources can be used in a positive way to help them overcome sexually addictive behaviors.  But as a therapist—or even as a friend, colleague or partner it is  important to notice when these traits are being used in the service of self-delusion and be prepared to confront the addict directly about it.

Sexually Addictive Behavior: Do All Sex Addicts Cheat?

In the strictest sense, the answer is no, not all sex addicts cheat.   For example there is the addict whose sexually addictive behavior involves pornography and who doesn’t have sex with anyone but their partner.  And certainly there are many such sex addicts who lead the typical double life of the addict but who do not have sex with another person.  There are also sex addicts for whom actual cheating is their preferred or only acting out behavior.  They flirt, they hook up with people or they have “serial” affairs with various people outside their primary relationship.  I have previously argued that not all cheaters are sex addicts and that sometimes a cheater is just a cheater.

For many addicts cheating is one of several sexually addictive behaviors

The average sex addict has more than one sexually addictive behavior.  He or she may use internet porn and also engage in sexual chat, or he may go to sexual massage parlors and also see prostitutes.  So the porn addict may also be having affairs but only admitting to the porn as an addiction or a problem.

The addict may not see the actual cheating as being a part of his or her addiction.  The sex addict who has a very obviously compulsive behavior such as watching porn for hours on end several times a week may feel that infidelity does not qualify as part of his or her addiction.  This is almost always a mistake.  In these cases where addiction is clearly present in another form, cheating is

(a) Part of a pattern of sexual duplicity

(b) Used as a way to feel better, i.e. as a drug, and

(c) Used as a form of intimacy avoidance meaning there is no viable relationship involved.

In other words cheating is part of the addiction even when it is seen as “minor” or is intermittent.  When cheating is intermittent it is often easy for the addict and even the partner to think that it is not part of the sex addiction and is not being done as a sexually addictive behavior.  This is because it does not appear to be compulsive or preoccupying in the same way as the addict’s other behaviors might.  After all it’s only once every year or two or three.

The sex addict who is faithful may be cheating in their fantasy life

Consider the married sex addict who watches porn involving sex with several people at once, or with homosexual content, or with violent or sadistic scenarios, to name just a few possibilities.  He may be bringing those addictive fantasies into his sexual experience with his spouse or partner in order to become aroused but without telling her about it.  Or the fantasies may just flood in without the addict consciously thinking about it.

Sexual fantasies often enter into sex with a partner and to a great extent they can be private.  But for sex addicts, the inability to be mentally present becomes a form of separating their sexuality from their real life with a partner.

This is not to say that people should be fantasy-less in sex with a partner, but it is a matter of degree and of the rigidity with which the person is only capable of sexual arousal and gratification when viewing or recalling a set of fantasy scenarios that remove him or her completely from the real life situation.

All addictive sex can be seen as cheating

If a sex addict is in a relationship, then any addictive behavior can and usually will be seen as a form of cheating by the spouse or partner.  One has only to look at the many good blogs and forums by spouses of sex addicts to understand the experience as one of betrayal and disloyalty, not matter what behavior is involved, even if it is solely porn addiction.

The elements of secrecy and intimacy avoidance, i.e. compartmentalizing a part of sexual behavior and leading a double life make it clear that sexually addictive behavior usually has common features and serves a common purpose.  To the addict who says “yes, but when I watch porn I’m not harming anyone, no one else is there” the partners say “you (the addict) are there” meaning you are harming yourself and your relationship with someone you care about.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource