Sorry Harvey Weinstein, sex addiction isn't real
Since the explosive New York Times article about Harvey Weinstein came out a couple of weeks ago, more than 40 women have come forward saying he either allegedly sexually harassed or assaulted them.
Weinstein's initial response was that he "came of age in the '60s and '70s, when all the rules about behaviour and workplaces were different." As the trickle of women's allegations turned into a deluge, his tune has changed. Now he is reportedly off to rehab for sex addiction and other behavioural issues. And before he left, this is what he told reporters, "I'm not doing OK but I'm trying. I gotta get help guys. You know what, we all make mistakes. Second chance, I hope."
Sex addiction is not officially listed in the psychiatric bible of diagnosable disorders, the DSM-5. But that hasn't stopped the thousands of people coming forward claiming to be addicted to sexual activity. So, what does the science say? Bob talks to Dr. David Ley, a clinical psychologist in Albuquerque, New Mexico and author of the book, The Myth of Sex Addiction and Dr. Eli Coleman, the Director of the Sexual Health Program in Human Sexuality at the University of Minnesota Medical School.
This interview has been edited for length and clarity.
Bob McDonald: Dr. Ley, what goes through your mind when you hear about a rich powerful man going into rehab for sex addiction?
Dr. David Ley: It's fairly consistent with what we've seen over time. Recent research suggests that 90 to 95 per cent of the people in sex addiction treatment in the United States are men. And around half of them, it appears, are white, heterosexual, married men who make over $100,000.
The sex addiction concept has over the past few decades become a label used by men of privilege to excuse, avoid responsibility for sexual misbehaviours and misconduct. And unfortunately, the American public has kind of bought into it for a long time with the idea that when someone goes away to sex addiction "summer camp," we can then pretend that everything is okay and they have paid their price and they're going to be better.
BM: Dr. Coleman, do you think there's such a thing as sex addiction?
Dr. Eli Coleman: Sex addiction is such an overused and meaningless term. It's used as a metaphor for just about anything. And it's really unfortunate that this is used as extensively it is by people, by the media. But within the scientific community, this is a term that is not accepted.
We have a number of models to describe compulsive, impulsive, driven, intense sexual behaviour that is out of control. But these models still have not been tested. We have a lot of debate about what they are. But there are many of us who do believe that there is a clinical syndrome.
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BM: What is it about the word "addiction" that you think does not apply to sexual behaviour?
EC: The problem with the term "addiction" is that it comes from the old notion of alcohol and drug addiction — that there's some sort of increased tolerance and dependency based upon interaction with the chemicals in the brain. And this is just not the case with sexual behaviour. If anything, sex is a basic drive. If you want to use an analogy, you would more look to an eating disorder. And we don't talk about "eating addicts" or things like that, or treat them in the same way that we treated alcohol and drug addiction.
DL: The thing I struggle with in all of these conversations, whether we're using the label compulsive sexual behaviour or sex addiction, is there are two problems here. One is there is an idea that there is such a thing as too much sex and that too much sex is bad for people. But in fact, research for a hundred years or more now reveals that high frequency sex, and lots of sex, is actually really good for people — that it helps them live longer, have healthier lives, healthy relationships, healthier hearts, and healthier prostates.
And secondly, that there is an idea in all of this that people don't have the ability to control themselves sexually — that these people who are getting in trouble like this are unable to exert self-control in these situations. And unfortunately, at this point, there is there's really no data to support that.
BM: Well many people have gone in for sex addiction treatment, so if they're not going through addiction sex, what's happening?
DL: You know what the dirty secret nobody wants to talk about is, after 40 years of the sex addiction model existing, there's not a single published, randomized, controlled, empirically reviewed study that reveals that sex addiction treatment works. Instead, this is an industry that frankly is built on snake oil and salesmanship.
The typical treatment is a 12-step model based on the idea of kind of addiction and Alcoholics Anonymous. They treat all these individuals the same. It is a one-size-fits-all treatment approach, rather than separating out this person is having these behaviour problems because they are engaging in sexual narcissism and selfish behaviour throughout their life, this person is a gay or bisexual man who grew up in a religious family and is really struggling with his same sex desires that he feels like he doesn't have, this man is using pornography a lot because that's the only way he has to cope with his negative feelings. Those are three very different presentations and the treatment and response for each of those should be different.
BM: Dr. Coleman?
EC: First of all I totally agree with David about the problem with sex addiction treatment and using the 12-step model. I've been very critical of that. The problem is that these kinds of problems are driven by many different mechanisms. We really need to have more individualized treatment approaches. And I think that that's also the problem with the research of really finding the exact mechanism, whether there is a failure in executive control or impulse control or mood regulation, is that we take a group of people that have had out of control sexual behaviour and we try to test them and then we don't find a lot of differences. But at least in our research, looking at even a heterogeneous population, we can find that there is deficiencies in impulse control compared to their control counterparts. So I think that maybe I am more on the side of really recognizing that this could be a clinical disorder. We don't have enough evidence to really prove all of this, but we see this clinically every day.