by Mark R. Laaser
Description and History.
Sex addiction was first described by Patrick Carnes in 1981 in his groundbreaking book Out of the Shadows (Carnes, 1981/2001). Dr. Carnes had been instrumental in establishing Sex Addicts Anonymous, the first 12-step program for people who struggle with this problem, in 1976 in Minneapolis. He and a group of other therapists adopted and adapted the principles of Alcoholics Anonymous and found them useful in helping sex addicts get â€œsober.â€ Parallel developments in California and New England led to similar 12-step fellowships there. Since their inception, these groups have spread across the country. Carnes also established the first inpatient treatment program for sex addiction in 1985 in Minneapolis.
To date, the diagnosis of sex addiction has not been fully accepted by the medical and psychological communities. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) does not include a category for it. The diagnosis, however, enjoys a wide acceptance among therapists and counselors at all levels. Most clinicians use the code for sexual disorder NOS (302.9) as an alternative for insurance purposes. Certain types of sexual behavior can be classified, such as the paraphilias.
Pornography addiction is also widely accepted as a subcategory of sexual addiction. The widespread use of the Internet has greatly increased the number of sex addicts. In fact, Internet pornography has been called the crack cocaine of sex addiction. A recent report of a case of pornography addiction described a whole tribe of aboriginal men in New Guinea who could not stop looking at pornography on their Internet connection in the jungle. Certain interventions might be unique to certain sexual behaviors, but pornography addiction can generally be treated as a subset of sexual addiction. For some, pornography is the portal that leads to other forms of deviant and addictive sexual behaviors.
Sexual addiction was first described from an evangelical Christian perspective in 1992 (Laaser, 2004). Other books have followed, such as Schaumbergâ€™s (1997). Today many authors have treated this subject from a Christian perspective, and some offer workbooks for use in churches providing support groups for sex addicts.
These are the key criteria for the diagnosis of sex addiction:
Unmanageability. This means that a sex addict will have made attempts to stop but canâ€™t, leaving the addict feeling out of control. This unmanageability is also the result of the addictâ€™s inability to completely surrender the addiction to God, which results in â€œdouble-mindednessâ€ (Laaser, 2004).
Neurochemical tolerance. Like alcoholics or drug addicts, sex addicts become tolerant to the powerful chemicals produced in the brain during sexual arousal and orgasm.
Acting out. This tolerance leads to an escalating pattern of behaviors. An addict may need more and more of the same kind of activity or may need to move on to different kinds of sexual behaviors.
Avoidance of negative feelings. Sex addicts use sexual arousal and activity to alter their brain chemistry and thus avoid feelings of sadness, fear, anxiety, anger, and the like.
Some people commit sexual sin but are not addicted. The same distinctions that we apply to drinking behaviors apply to sexual behaviors. Some can sin by abusing sex, others can go through periods of life in which they become dependent on sinful sexual activity, and finally, some can become fully addicted. Today, more and more females are becoming addicted to sex and are quickly catching up to men in terms of prevalence. The same assessment dynamics apply to women as to men. But the prevalence of shame that is culturally attached to sexual sin is different for women than for men.
Every form of sexual activity can become addictive. Even marital sexuality can be addictive if it meets the assessment criteria. Marital sexuality, regardless of frequency, is addictive if it is used to avoid intimacy and the expression of a spiritual and emotional connection. Fantasy is the cornerstone of sex addiction and can be addictive in itself as it produces sexual arousal and the resulting neurochemical high. Masturbation and pornography are the most frequent types of acting-out behavior.
Successful treatment of sexual addiction achieves total and complete sobriety or purity. Sobriety should be defined by Christians as the abstinence of any kind of sexual activity with self or others outside of the marriage of a man and woman. Treatment is multi-factored and should include the following:
Accountability. This is most successfully accomplished through support groups, either 12-step or specifically Christian. The principles of accountability are essential to recovery (Laaser, 2011b).
Neurochemical detoxification. This includes complete abstinence from any form of sex, even marital, for 90 days. The spouse must agree to this program (1 Cor. 7:5).
Evaluation and treatment of comorbid mental-health issues. Special attention should be given to attention-deficit disorder (there is a strong correlation between ADD and all addictions).
Personal therapy. The emotional roots of addiction must be healed. Group therapy has been shown to be especially valuable in this regard.
Reestablishment of control. Thoughts and fantasies must be disciplined (Laaser, 2011c).
Spiritual direction. Surrender to Christ is essential in the complete recovery of a sex addict.
Marital or relationship counseling. The spouse of an addict will also need individual counseling (Laaser, 2009).
The American Association of Christian Counseling has established a certification program for those who need more training or who wish to specialize in it.
Special attention must be paid to the following spiritual issues, which are extensively covered in Becoming a Man of Valor (Laaser, 2011a):
Unmanageability and the need for surrender (Rom. 7:15).
Personal willingness to get well (Jn. 5:1-11).
The double-minded thinking processes inherent in addiction (Jas. 1:8).
Understanding of how sex is a false substitute for the desires of every heart (Jn. 4).
Conviction of Godâ€™s grace (1 Jn. 1:8-9).
The meaning of suffering in the pain and consequences of addiction (Jas. 1:2).
People who struggle with sexual addiction need the hope and assurance that complete purity or sobriety is possible for those who are completely willing.
Carnes, P. (2001). Out of the Shadows. Center City, MN: Hazelden.
Laaser, D. (2009). Shattered Vows. Grand Rapids, MI: Zondervan.
Laaser, M. (2011a). The 7 Principles of Accountability for Men. Kansas City, MO: Beacon Hill.
Laaser, M. (2004b). Healing the Wounds of Sexual Addiction. Grand Rapids, MI: Zondervan.
Laaser, M. (2011c). Becoming a Man of Valor. Kansas City, MO: Beacon Hill.
Laaser, M. (2011). Taking Every Thought Captive. Kansas City, MO: Beacon Hill.
Schaumberg, H. (1997). False Intimacy. Colorado Springs, CO: NavPress.