A Therapist on What Sex Addiction Really Is

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According to reports earlier this week, Harvey Weinstein planned to seek treatment for sex addiction (though now he’s reportedly checked into a luxury hotel in Arizona). We spoke with a therapist about what sex addiction really is, and what it isn’t.

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I’m the director of Pine Grove’s sexual addiction treatment program in Hattiesburg, Mississippi, and I’ve worked here for 13 years. The reaction when I introduce myself and my job is, “Oh, that’s an addiction I wish I had, that sounds like so much fun.” And it couldn’t be further from the truth. I’ve never met people who suffer more than these folks. It’s not like we’re going around knocking on doors looking for people. They crawl through the doors asking for help. It’s like torture.

The Center for Addiction Medicine has a definition for addiction that includes substance use and other behaviors. We have been lobbying with the DSM — it changes from time to time, they update it. Now they’ve put in gambling as the first behavioral addiction, so what we can say for a diagnosis is “impulse control disorder,” and then it has a specifier, compulsive sexual behavior, or something like that. That’s how we’re looking at it.

We have the more classical sex addiction, which is progressive over time — like going from masturbating to porn to calling chat lines to meeting people anonymously — and there’s often trauma in the person’s life. But now we’re seeing young people come in who’ve grown up looking at porn all their lives. They don’t necessarily have trauma or neglect in their childhood.
There’s no progression. But the people growing up with this porn get addicted right away, and it becomes their lives. We have a guy coming in who said he’s looked at porn everyday since he was 4 years old. When somebody comes in and says — and this is not uncommon — “I masturbate six hours a day,” do you want to call that addiction?

People want to know how I can work with these guys day after day, because they might perceive them as despicable human beings. I tell you, it has been the greatest honor of my life besides raising my children, to work with this group of people. In the years I’ve been here I can say I haven’t woken up a single day that I wasn’t excited to go to work. How many people get to work with folks who want to change everything about their lives? They’ve laid ruin to their lives trying to do this on their own. Their brains have not been working right. They come in feeling full of shame and in a sense you love them back to health. I have enormous empathy for what they are going through.

Our patients live in cottages. Each person has their own room and there’s a connecting bathroom, like a Jack-and-Jill situation. They have a nice big gazebo out front, they have cookouts out there, ping-pong, and foosball, and they can sit around a picnic table under that gazebo. Pine Grove is a nonprofit behavioral treatment wing of a hospital down here in southern Mississippi, so we’re able to be more affordable than most places.

In the morning they have breakfast and meditation for 30 minutes. Then there are three groups, depending on the day. One is an addictions group, one is a psychotherapy group, and one is for learning communication skills. Those smaller groups in the morning have maybe six to eight people. Generally it’s around 14 to 16 patients here at any one time.

We do have a few female patients. With women we see a lot of what we call relationship compulsivity or love addiction. They live at our women’s center and come over here for the day. For a couple of years we stopped taking the women, because some wives would not let their husbands come here because we had men and women living in our facility getting treatment together. It was wonderful for treatment, for folks to see each other’s timelines and trauma.

The guys could say, “Wow, her trauma is the way I treat women.” It was an eye-opener. At that time we’d have maybe five men for every one woman. Just last week we started taking women again because there are so many women calling in looking for treatment. So we’re trying having them live at the women’s center and coming over here during the day.

The first two weeks they get here, the only time patients leave campus is to go to supervised 12-step meetings. During those two weeks they’re really learning tools about how to not objectify people, what you do if you’re sitting there and you’re having fantasies, or euphoric recall, because that’s not okay for them to be out in the world doing those things. So we help them to, in a sense, sober up. Then, at that point, they can start doing things like going with staff to Walmart or to get a haircut or that kind of thing. Each day’s a little bit different.

The thing that helps with addicts is to be around another. When an addict’s prefrontal cortex — where their impulse control is — starts to go offline, and they’re thinking with the animal addict brain, you need the help of somebody else whose rational, moral brain is working. The relationships that people make here are really important. The big emphasis is on group therapy. We want you to have lifetime bonds with one another, so that when you’re going to pick up the mouse to look at porn, you pick up the phone instead, and you call somebody. Many of our patients call two or three peers a day for years after getting out of here.

We know that addiction is its own disease. It’s not secondary to laziness, or trauma, although many people with addiction have had trauma. There’s a glitch in the brain, and the person who is born with fewer dopamine receptors than others are unable to reward themselves from within. They reach for something outside themselves to fix that, starting early on in life. Sex is one of those behaviors that people can start to deal with their stress.

It’s a chronic disease, so it’s not something that’s going to be fixed. It’s like diabetes. You’re not going to walk into the doctor one day and then you don’t have diabetes anymore. This is not something we can cure. We can give people tools to use to stop doing the things they’re doing that are devastating their lives, hurting everybody they love, tearing apart their careers. Some people say it’s a choice, but they can’t decide not to crave it. People can go the rest of the rest of their lives without behaving that way, but they still have the brain they were born with.

It’s a really devastating disease. Especially sex addiction, where it has so much attached to it from our culture. You say, “My husband’s a sex addict” and people don’t understand. It feels like you should have control over your sex behaviors.

Usually a person comes to us because will they have some kind of event in their life, like maybe a spouse has discovered what they’re doing, or there’s a complaint in the workplace, or they themselves are sick of it, so they’ll call our call center to get their story down. They will call the psychologist and we’ll talk with each other about the case and ask if this person needs to come to treatment.

People who are violent, we don’t take them. We do take people who look at child pornography, voyeurs, people who have ongoing affairs. But rape is a violent assault. It’s not about sex. It’s about dominance. It’s like beating somebody up. That’s not sex addiction. Now, someone might be a sex addict with other compulsive sexual behaviors and look at porn for hours and hours a day. A person who has more assaultive behaviors could have an underlying untreated sexual addiction, but we don’t see offending behaviors and sexual addiction in the same snapshot.

There’s people who are trained and certified to work with offenders. If they’re actually rapists, they would not come here for treatment. When you are out there assaulting and raping people, that’s not how we define sex addiction.

We have had people with their face all over the TV, and they would not be here if it wasn’t for them getting caught, and they come in and you find out that there’s an element that really is addictive. We do a lot of psychological testing and inventories when they first come in, over 500 questions, and we look at all these graphs to see if this person fits in with the profile of other people who identify as sex addicts. Sometimes it takes that level of consequences for someone to finally check into a hospital and get some help. Just because they’re famous and caught doesn’t mean they’re not a sex addict, but it doesn’t mean that they are.

A Therapist on What Sex Addiction Really Is