Like a lot of people in my field, I’m getting a little tired of the sex addiction debate. There are many sides to it and they can all get to be strident and irritating, even the ones I might agree with. As a former addictions professional, there is an aspect to the arguments that I feel really needs to be addressed. Who does the word “addiction” belong to?
One camp claims that people who compulsively act out sexual behaviors are addicts. They obsess about something sexually, perform one or more behaviors pathologically and usually frequently, and their lives and functioning go down the tubes. Some people in this camp argue that “sex addiction” is a disease. Some also argue that the brains of “sex addicts” show changes in the reward centers of the brain similar to other types of addicts.
Another camp yells, “Where is the research?” Many in this camp claim that sex addiction cannot be proven to exist because there are no consistent studies that show a disease condition. They point to conflicting research about the effect of pornography on the brain, much of which shows nothing conclusive. They also say that since “sex addiction” is not in the DSM 5 (the manual used to diagnose psychological and psychiatric disorders), using the term is therefore irresponsible.
But who owns the words? Regular people who walk around in the world can see someone acting compulsively. They can observe an obsession in themselves. They notice a pattern of behavior whereby a life can be ruined. Am I allowed to call myself an addict if that’s how I feel about it? Are you justified in telling me that I’m wrong? The same therapists who would argue passionately that people should be allowed to self-identify as gay, lesbian, bisexual, straight, male, female, trans, or gender fluid are sometimes the very people who want the words “sex addict” stricken from the mouths of those who would identify this way.
I can be at odds with the addiction medicine people, too. Just because something cannot be observed in the brain does not mean that it doesn’t exist as a behavior or a phenomenon, and doctors do not hold supreme authority over our language. Don’t tell me that because “porn addiction” is not a “disease” it is therefore not an addiction. The disease concept has been misappropriated a thousand times since the AMA declared alcoholism one. It makes me nuts when someone says that compulsive shopping is a disease. But in my mind, a disease and an addiction are not the same concept. One is a term for a biological process that may have behavioral consequences, and one is a term for behavioral phenomenon that may or may not have observable or measurable biological processes. I, personally, do not feel that behavioral health practitioners must wait on the medical establishment to figure it out.
The most commonly accepted definition of the word addiction in the addictions field is “continued use of a substance or behavior despite harmful consequences.” To diagnose someone with a dependence on a substance, for instance, we do not need to see health issues or medical dependence on a drug. If the person’s functioning is affected in multiple areas and they refuse to stop, we diagnose them as dependent. One of the reasons for this is that physical health is often the very last thing to go–a life can be in tatters before the health fails. The common term for alcohol dependence (which is in the DSM) is alcoholism (which is not). The common term for obsessive-compulsive use of porn is “porn addiction.” Yet I don’t see people as upset over the use of the former the way they are over the use of the latter.
As a sexologist, a sex educator, and a person who was certified and practiced in the addictions field for a significant part of my career, I do not use the term “sex addiction.” I choose not to because the term sex addiction is too vague and/or imprecise. The fact that it is also overused, often by people who simply want to shame people with high sex drives (sometimes themselves), disturbs me but is not why I don’t use it. The fact that some people who use the term are making loads of money by shaming clients about normal behavior and calling it a disease also disturbs me tremendously, but I won’t allow them to claim the word, either.
So would I use the term “porn addiction” at this point? It’s not as imprecise. I’ve observed that many people who stop the use of internet porn do not have to stop masturbation in order to recover from the compulsive nature of their behavior, and I can observe a marked improvement in multiple areas when they stop watching certain types of porn. This suggests strongly (without proving it) that streaming porn is the mitigating factor. So would I use the term, especially if I had a student or friend who identified this way?
I confess to some cowardice here. So many of my colleagues are polarized at this point that rather than be labeled and misunderstood, I’ve coined the term “porn-exhaustion syndrome” to deal with the realities of that phenomenon. But if the shoe fits in my mind, you’re Cinderella, baby.
Dr. Roz Dischiavo, Founder/Director, Institute for Sexuality Education & Enlightenment