Addicted to sex?
Is it a genuine affliction requiring medical treatment, or just an excuse for bad behaviour?
When disgraced movie mogul Harvey Weinstein responded to the flood of allegations about his abusive behaviour by promptly seeking treatment for sex addiction, many onlookers raised their eyebrows.
Was Harvey actually suffering from a real illness that could be successfully treated, or had he simply been behaving badly - and getting away with it - for decades?
But Weinstein's not the first to claim his problems amounted to a genuine addiction. Russell Brand has written extensively about his addiction to sex, and we probably first heard the term way back in the 1990s when it was associated with Michael Douglas, and later on Charlie Sheen, Robbie Williams, and David Duchovny.
So what is sex addiction? Does it only happen to men? And is it a behavioural issue, or a neurological one? How can we become addicted to something that we are already hardwired to pursue, and without which we would become extinct?
The concept of sex addiction was introduced to the world in 1983 by Patrick Carnes in his book Out Of The Shadows. Carnes, a prison psychologist in Minnesota, advocated a tweaked version of the 12 Steps of Alcoholics Anonymous as effective treatment, where the addictive substance (booze) was replaced with the addictive behaviour (sex).
Recovery requires identifying as an addict, relinquishing all self-seeking sexual behaviours, and as with all 12-step recovery, undergoing some form of spiritual awakening.
Carnes describes the cycle of sexual addiction as preoccupation (obsessive thinking about acting out), ritualisation (preparing to act out), compulsive behaviour (acting out), and despair (wishing you hadn't acted out). In order to relieve the despair, the addicts begins the cycle again. And so it goes on. As with substance addiction, it does not plateau, but progressively worsens.
Fergal Rooney, head of psychology at St John of God hospital in Dublin, describes the problem as "a splintering of normal sexual behaviour and attitudes into something harmful to the individual."
It happens, he says, when "sexuality is split off from emotional attachment, so that other psychological issues are being played out through sex."
It is a process addiction, rather than a substance addiction, and "quite separate from typical sexual expression, where behaviours involving porn, escorts, prostitutes, infidelity and so on are normalised by the individual addict, who has become desensitised."
Causes can include childhood trauma, skewed psychosexual development, premature sexualisation, thwarted emotional development - treatment begins with identification, disclosure, acknowledgement and assessment. And, says Rooney, early recovery can be helped by 12-step treatment, which offers "structure, support, and gives language to the behaviours."
Longer term recovery for what he terms a "long slow process" involves comprehensive assessment of lifestyle, quality of life, and key relationships, with honesty and clarity.
"I see people establishing better lives, relieved that their addiction has been disclosed so that they can develop healthy positive lives," he says. "Equally I see people who have lost relationships and jobs as they are caught in cycle of abstinence and relapse. Recovery involves challenging, tough work, and the support of family and loved ones."
Sex & Love Addicts Anonymous (SLAA), originally founded in Boston in 1976, has regular meetings in eight locations around Ireland and is part of the global 12-step fellowship umbrella. It addresses compulsive sexual and romantic behaviour - not just porn addiction or compulsive sexual acting out, but also the distress caused by obsessive thinking.
"It's not substance abuse," says a longterm member. "It's not like alcohol, when you avoid pubs or keeping wine in the fridge. It's an internal job."
Unlike gambling, sex addiction is not listed in the US diagnostic manual of mental illnesses, the DSM-5 - yet brain scans conducted by Cambridge University neuroscientist Valerie Voon showed how the brains of sexually compulsive people light up when stimulated similarly to the brains of drug addicts.
The consensus is that a lot more research is required. Also, cultural and religious subjectivity means that sexual behaviour which falls within the norms of sexual diversity can still be misinterpreted and pathologised; or as pioneering sexologist Alfred Kinsey put it, "A nymphomaniac is someone who has more sex than you do."
That description would surely have applied to the celebrity TV presenter Russell Brand a decade ago. Writing in his 2007 autobiography My Booky Wook, he says he thought of sex as being "a breathing space, when you're outside of yourself and your own head."
"Addiction, by definition, is a compulsive behaviour that you cannot control or relinquish, in spite of its destructivconsequences," he wrote. "This formula can be applied to sex just as easily as it can be to drugs or alcohol."
Incessant sex, he added, "no longer seemed to have the required calming effect. I was on the brink of becoming sufficiently well-known for my carnal over-indulgences - with lapdancers and prostitutes, to say nothing of all the women who didn't sell sex for a living - to cause me professional difficulties."
In order to recover, Brand went into treatment, where he signed a contract "promising that I would refrain from masturbation, porn, 'seductive behaviour' and 'sexual contact with another person'."
But how do we define what a sex addict is? What if you have lots of sex, but don't regard it as problematic? Does using porn or being promiscuous make you an addict?
According to the Association for the Treatment of Sexual Addiction and Compulsivity, "The essential difference between the addict and the non-addict is that these behaviours feel out of control. An addict may spend an inordinate amount of time planning, engaging in and recovering from their chosen sexual activity. And in spite of the physical, emotional, relational, financial and even judicial cost of these activities, they feel unable to stop their behaviour. Or at least, unable to stay stopped.
And no, it's not an exclusively male condition - around one fifth of the 3pc-6pc of the population who identify as sex addicts are women.
Carol (not her real name), a fifty-something professional who lives Dublin, identifies as a love addict, a condition perhaps even less understood than sex addiction. "Typically women suffer from love addiction, and men from sex addiction," she says.
"It manifests by obsessive thinking around the object of your desire, so that it becomes debilitating, uncontrolled and all consuming. You get involved with unsuitable, emotionally unavailable people, because your self esteem is so low. Princess Diana was a typical love addict - couldn't function without a love interest, couldn't bear to be alone.
"It's the least written about. Yet it ruined my life until I found recovery - I took 12 months out, deleting contacts, blocking people, remaining alone. It was really tough. Now, 15 months later, I am just beginning a new relationship, and it feels significantly different. Calmer. The obsession has been removed, and I feel quite free."
Deirdre (not her real name) works in digital media, and has been attending Sex and Love Addicts Anonymous meeting for several years to address her sex addiction.
"I would get obsessed with people," she says. "My whole sense of worth centred around other people finding me desirable. I used sex as a tool and even though it was physically pleasurable, I was becoming increasingly emotionally numb; I was always planning the next one, but in the end I was just going through the motions.
"There was nothing there, just empty encounters, and they were becoming risky. In the end I felt so miserable that I began attending SLAA meetings, and stopped everything. I went sex anorexic. No sexual contact with anyone, including myself, until I was able to differentiate between sex as a meaningful interaction, and sex as a fix."
Because this is the core of what sex addiction is - the stimulation and release of the brain's reward chemicals, to comfort ourselves, or smother uncomfortable feelings, or distract from unprocessed trauma.
"You can't treat sex addiction with medication," says Dundrum-based psychotherapist David Kavanagh. "Yet is can be a deeply destructive, debilitating addiction. It's not an illness, but a chronic brain malfunction. It leads to behaviour that goes beyond the individual's own ethical guidelines, in pursuit of chemical release."
Kavanagh outlines how porn addiction desensitises the user, so that after a while, it no longer functions as effectively in the release of dopamine; the next stage can be needing the face to face contact of, say, visiting escorts. "This can in turn graduate to men visiting transsexual escorts, because they no longer become aroused by the female form, such are their levels of desensitisation," he says. "This would have been unfathomable twenty years ago."
Like all addictions, there is much shame, isolation, secrecy, and deceit. "Porn addiction can be extremely destructive, in that it can stop men having sex with their partners, but sex addiction is experienced and processed very differently by the partners of addicts," says Kavanagh.
In other words, being hooked on porn on your laptop is not as much of a relational deal breaker as paying for sex with a stranger. "The isolation and shame is overwhelming, which perpetrates a vicious circle of acting out and remorse," says Kavanagh.
It is, however, treatable. Unlike alcoholics or drug addicts, sex addicts don't need to remain abstinent forever, but can go on to have a healthy relationship. There are Sex Addicts Anonymous meetings all over the world, from Guyana to Iran.
Yet not everyone is convinced. Psychologist David Ley, author of The Myth of Sex Addiction, argues that it is a cop out for male bad behaviour, and says women are more forgiving of infidelity if it's due to an addiction rather than caddishness.
In the end, though, whether you believe you're an addict or just a cad probably matters less than whether or not you want to change.
Health & Living