For some men, it's just about impossible to keep their penises in their pants. For some women, one sexual partner isn't enough, even after marriage.
Whether sexual addiction takes the form of extramarital affairs, frequenting strip clubs, compulsive masturbation, exhibitionism or surfing the Internet for porn, it's as destructive as any other dependency. The dismissive attitude that exercising self-control is all it takes to end inappropriate behavior absolves the accuser from considering the deeper truth.
The sexual revolution of the 1960s brought about a dramatic change in how Americans view sexuality. Freeing sexual expression from the restriction of being an act of procreation to being an integral part of human existence allowed for a healthy exploration of what it means to be female or male.
Yet that freedom flies in the face of religious and some social expectations, making many aspects of sexual expression taboo and illegal.
The choices some make are difficult for others to understand. Most women know someone like Mary, who seems to have it all: a loving husband, a long marriage, children, a career. Yet she's frequently seen in bars or restaurants around town with different men.
It doesn't happen now and then; it's every week.
Most men know someone like Ken. He always has stories about a recent trip around the country. One of the guys mentioned he was in the same town but didn't know Ken was there until he saw Ken walking into a strip club.
His friends are shocked. Ken wouldn't do something like that, would he?
'A very secret life'
Without a context for understanding, the behavior of people like Mary and Ken is hard to comprehend. Acting out sexually is a symptom of a larger problem, a symptom of what some therapists consider a mental disorder.
"When somebody is acting out in a sexually addictive manner, they're acting in a way to soothe and comfort themselves," says Cincinnati psychologist Stuart Bassman. "They're acting in a way to avoid facing other problems, other conflicts, other aspects of reality that they don't want to face or accept."
As a therapist who has studied sexual behavior for 30 years, Bassman works with men, women and children who have some form of sexual addiction, have been convicted of or are victims of a sex crime and families and spouses of perpetrators and victims. He teaches in the Addiction Studies Program at the University of Cincinnati, helping train others in what he sees every day.
"There's a sense of not taking a step back and looking at the extent to which someone is addicted to pornography or sex — that there's something missing and they're trying to fill this hole, this emptiness, this abyss, and they get some comfort from doing that," Bassman says. "The relief and the soothing and comfort the person gets is because it distracts them. It's similar to other addictions.
"If you had headaches and you found a medicine that would help you, what happens is a sense of being empowered, no longer a victim of headaches. But then anxiety kicks in: 'My gosh, is there something I can do to ward off a headache? Maybe if I take that medication when I just start to get that feeling ...' Then their mind starts playing tricks on them: 'Am I getting a headache? Maybe. I'll just take that anyway.' "
Taking medication — in the form of a pill, a drink or a sexual act — becomes a precautionary measure, Bassman says.
"It gives them a false sense of power and control," he says. "They feel a sense of mastery. They don't feel like a victim any more — of their headaches, of the emotional mood, of whatever their addiction is. It provides them with a way out."
Males and females of all ages struggle with sexual addiction, according to surveys cited by the National Coalition for the Protection of Children and Families. Among those identified as addicted respondents, 58 percent are college graduates, 65 percent are professionals with college and/or graduate degrees and 42 percent earn more than $30,000 a year.
Patrick Carnes, author of Out of the Shadows: Understanding Sexual Addiction and eight other books on the topic, says a sexual addiction occurs when a person "substitutes a sick relationship to an event or process for a healthy relationship with others. The addict's relationship with a mood-altering experience becomes central to his life."
The consequences can be dramatic for the addict and those close to him.
Ken, a Clermont County man, is a retired professional who frequently traveled for his job. (Editor's note: He and other sexual addicts interviewed for this story asked that their identities be obscured.)
"Within three months after I was married, I cheated on my wife with a woman," he says. "By the time everything came down, I was attending strip clubs, using prostitutes, using pornography sites, doing Internet sex, having affairs, lying to everyone. I was a churchgoing member. I was nationally successful in my business. I was a father, but I led a very secret life that nobody knew about.
"I got caught by my wife. At the time I thought, 'What the hell? I've got money. Let's get a divorce.' But then I went into depression. I was so bad off I was carrying the suicide help number in my wallet because I was afraid of myself."
For Ken, sex was the ultimate escape from what motivated him to act out: the fact that he hated himself. He was unable to be alone in hotel rooms because he couldn't stand his own company. He reasoned that, because he was such a rotten person, his socially unacceptable behavior was a logical part of his existence.
Mark, a gay 45-year-old in Cincinnati, lost his career and considers himself lucky for not spending time in jail after having a "grossly inappropriate relationship" with one of his clients.
"I was a clinical social worker who lost my license and career after it was discovered I was having sex with one of my clients," he says. "I was trying to get the tools to walk away from that last, disastrous relationship. I was trying to break it off. Just like the alcoholic who waits too long to get help and their liver's shot or has an accident and hurts somebody driving drunk, I waited just one sick relationship too late.
"I was trying to get out of it because I knew something was wrong. I just didn't have the tools. My story has a relatively happy ending."
An active participant in Sex and Love Addicts Anonymous (SLAA), Mark started the group he now attends weekly. He has a new career and believes that some day he might find the love of his life.
Mary, who lives in Cincinnati, lost her marriage when she informed her husband he ought to divorce her after 25 years and a string of extramarital affairs. She couldn't stop the affairs, no matter how hard she tried.
"I could hide behind the fact that my husband was having affairs," she says. "But the fact was I was cheating on him whether he was cheating on me or not. When things were going good, I'd do it. When things were going bad, I'd do it. I knew it was a problem every time I quit: 'Boy, that was bad behavior. Good thing I'm done with that.' But what happened was eventually it was his fault. I knew that wasn't true, but somehow that worked for me to feel that way.
"I was more conservative than the Pope about divorce. But I said, 'You might as well divorce me. I can't stop. You're right: My word carries no weight whatsoever.' "
Driven to have sex
The reasons people get caught up in such destructive and embarrassing circumstances is as varied as the drug of choice. One person would never consider going to a prostitute yet will masturbate to the point of causing himself bodily injury. Why?
"These people aren't crazy," Bassman says. "They feel worthless. Someone needs to make himself feel like nothing, to humiliate himself, to put himself in the toilet."
Humiliation reinforces the addict's shame and belief that, if anyone knew who he really is, he'd be rejected and hated. While there are many reasons people act out sexually, many addicts believe there's nobody else out there as horrible as they are — yet they can't stop the compulsive behavior or change their thinking errors.
Addiction to a substance such as alcohol, an illegal drug or prescription medications are well known and recognized by society as a disease. Addictions to gambling, food, shopping and other less taboo activities or substances have gained mainstream recognition and acceptance to the point that support systems are available, such as Gamblers Anonymous and Overeaters Anonymous.
Sex, however, still falls into the realm of a puritanical judgmentalism that assumes the individual lacks integrity or self-restraint.
It's possible to be addicted to sex, and the experience is similar to that of any chemical dependency such as alcohol or cocaine, according to Douglas Reed, a psychologist who specializes in treating sexual addiction and teaches the neurophysiology of addiction at UC.
"All dependencies are the same," he says. "They're self-induced. They're pathological in the sense that they lead to an illness. It's like any other illness that you may have overcome; you didn't know when you started a process that it would lead to that. It's like you went out with your head uncovered, no coat on and you caught the flu. It's self-induced, but now it's pathological. You've got pneumonia."
The definition of any addictive behavior is compulsive behavior and dependency, Reed says.
"The part that's hard is some people are not addicted," he says. "They're dependent. Others are compulsive; they're not addicted. Addiction is people are doing both of those things in a pattern."
For example, the pattern for an exhibitionist, a person who exposes himself, typically follows a specific ritual. Finding a stranger, usually with no physical contact, the person exposes himself and then begins to masturbate. Such a person might expose himself 1,000 times in a lifetime.
Compulsive behavior is when a person feels driven. She's acting out a need as opposed to being impulsive, which is when a person acts or reacts without thinking things through.
"People who are in pain, discomfort, boredom will take a medication or engage in a behavior that gets them back to normal," Reed says. "That's compulsion, because it makes pain go away. That's negative, because you don't get anything from it; you just get rid of something.
"When you have a dependency and you take away the thing you're dependent on, you will have withdrawal effects. You'll have the opposite thing happening in your body that the drug does for you. So if the drug makes you calm — you take it away, you get agitated. A morphine addict pulling off morphine becomes very agitated, very upset."
Dependence is about which part of the brain gets affected by a chemical, Reed says.
"If you put morphine, heroin, alcohol into the body, it affects different parts," he says. "Addiction occurs in the so-called 'reward pathway.' Dependency is other chemical sites throughout the brain. All addiction affects the reward pathway."
Just as a chemical substance can "light up" the mesolimbic dopaminergic pathway or the reward/pleasure pathway, so can a visual image or an experience. Those things trigger the release of dopamine, a naturally occurring substance in our brain.
"There can be a religious addiction," Reed says. "By being in church, hearing fond words, it activates the reward pathway. The pastor says, 'I'm just so glad to see you here. You're doing a great job.' Dopamine is released.
"If I give you a pat on the back, a firm handshake and a $10,000 raise, dopamine's going to be a released. That's how we're supposed to get our natural highs. When you get these huge rushes, those little pats on the back don't work any more. It's not enough."
The over-simplification of dependency has given mainstream society a shorthand — addiction — that results in misunderstandings about the nature of the problem.
Human beings aren't addicted to anything but their own brain chemistry. Each person learns through trial and error what food, activities or substances give them a high.
"People prefer to be very calm and satiated, or they prefer to be aroused, turned on, excited," Reed says. "They also tend to break out on whether they want to be aware of reality or whether they want to be tuned out into a fantasy world. The guys that do pornography are over here (fantasy). The guys that like strippers are over here (reality). Usually they want arousal.
"The guy that sits home and masturbates, he wants reality. He may be listening to a phone message. Phone messages are even more arousing than the person, because you don't see them, so you don't know what's wrong with them. Your imagination is filling in and doing a much better job than reality."
People preferring reality tend to be voyeurs, exhibitionists and those having affairs, Reed explains. Just the thought of a previous experience or a fantasy can bring about a physiological reaction.
"The brain doesn't know the difference between imagination and what it's actually visualizing, because technically we see don't with our eyes, we see with our brain," he says. "So if you imagine, it's as real to the brain as if it's there. What's missing there is smell and touch. So if a guy is into touching, he won't get there with a fantasy. That's why he actually has to be touching.
"It's the mood change, whether I'm looking at pictures or gambling. People on the way to the (casino) boat, their mood is already being altered while they're driving there. They don't have to be at the boat. They can imagine the last time they had a big hand and get a rush. It's not the same — there's no tactile stimulation of the dice, the smell of the felt."
Bob is a self-titled "workaholic" who was a high level executive at Procter & Gamble. He got off on his professional achievements as much as he did going to strip clubs. A highly competitive person who sees recognition as one of his "triggers," he asked that his real name not be used — a way to avoid potential temptation.
"I was in a group of guys who went to a strip-tease joint," he says. "I was Christian at the time. I was a leader in my church, and I was shocked and I walked out — and went back at midnight by myself. I was traveling that lead to going to strip-tease joints once a year, twice a year. One of the reasons I know it was an addiction is because it was progressive. What was satisfying was no longer satisfying."
After a dramatic confession to his wife, counseling at his church and eight years of being clean, Bob's parents and younger brother died within a short period of time. His acting out started again and escalated.
"It accelerated to more strip-tease joints," he says. "Then it's asking the dancers to the table and then asking the dancers when they get off work and, in my case, I followed a particular dancer home one night."
The resulting spike in dopamine does more than give an addict a high; it also impairs his or her judgment.
"It's all crazy because the limbic part of the brain hijacks the frontal cortex, which is where we make good decisions," Reed says. "This limbic system, which is the reward pathway and all the other mood states, overrides that logic system.
"The Secret Life of the Brain, the PBS series on the brain, says that, as much as we would like to think that we're very rational people, limbic overrides logic. In adolescents, the networks aren't even actually formed yet in their frontal cortex. That's why 85 percent of the kids who get their (driver's) license have a wreck within six months. They can't foresee adverse consequences. That's how an addict works when they're impaired. The frontal cortex doesn't make good decisions. They literally don't know why they did something so crazy."
The curse of the cure
That "crazy" for a sex addict is no different than other addicts' experience — a cycle of pain or fear followed by a perceived relief brought about by the substance being abused and a return to "normal" that drives the addict in search of relief yet again.
"Once the person gets caught up in that cycle, it's their life," Bassman says. "There's a benefit in it. ... The distraction becomes the major focus of life, so the cure becomes the curse. The person is emotionally vulnerable, the person is troubled and the person wallows in an abyss."
The desire or desperation for relief leads to thoughts that aren't socially acceptable.
"They're able to rationalize and use what we call thinking errors or cognitive distortions to rationalize or justify what's going on," Bassman says. "For instance, a person who has an addiction to children, they will blame the problems on society as not accepting that sex between adults and children is normal. They see it as society's problem, and they see themselves as a victim of misunderstandings.
"The person who is addicted to pornography basically says in their mind, 'I'm not hurting anyone. I'm just looking at these images.' That's one of the things you'll continue to hear: 'I'm just ... There are no real victims.' It's these cognitive distortions that keep the cycle going."
Differentiating between normal and what Bassman calls "healthy" sexual curiosity is important.
"Parents will contact me: 'Several times a week my kid is on the Internet looking at pornography. Is he addicted? My child is always looking at these sites,' " he says. "Or women will say, 'My husband is getting up in the middle of the night and going on the Internet and keeps on looking at porn. What's going on? When I'm in here in bed, why's he going to porn?' That's the preoccupation, that's the compulsion and the addiction.
"The adolescent will go look at pornography and let it go. The adolescent who's beginning to develop an addictive cycle can't just look; they become obsessed. The extent to which they spend more and more time on it and it interferes with their daily functioning, schoolwork, other things, it starts to take over their life. Then it has far-reaching implications."
For instance, Bassman says, if a male sees females in terms of this image, he's never going to be able to find one that's good enough. Then he might become conditioned to be aroused to the images and not real people.
"That's why a lot of men who engage in this behavior rather than have sexual relations with their wife will go onto the Internet," Bassman says. "It's easier, it's cleaner, they're in control. They're departing further and further from reality."
Whether or not this departure from reality is a mental illness or a behavioral issue is still up for debate in the mental health profession.
Ken, who works with addicts and develops 12-step programs, has first-hand experience with this debate.
"My experience has been the psychiatric world, not the psychology world, isn't yet ready to say this is a compulsive behavior," he says. "They still talk about it as an impulsive behavior. ... You go to any psychologist in town and they say, 'Absolutely, sex can be compulsive behavior, overeating can be compulsive behavior.'
"But the psychiatric world isn't quite there yet. If you go to a psychiatrist, they're gonna say, 'Wait a minute. Maybe you're bipolar.' Or maybe they're gonna give you some drug. With alcoholism, though, they recognize that as a physical addiction. Ours is just as physical."
Purcell Taylor, director of the Equinox Program at the Center for Children and Families in Walnut Hills, says he believes sexual behavior isn't an addiction but something more.
"In our field, we don't generally talk about it as sexual addiction because sexual addiction has a kind of quality that it suggests it's only about sex, and it's not," he says. "It's about a lot of other things as well. The characteristics of juveniles who have committed sex offenses are far ranging. Sexually inappropriate behavior or pre-sexualized behavior is what we call it. Children who have been exposed prematurely to adult sexual themes, youngsters who are acting out adult sexual behaviors."
More than a treatment program for juvenile sex offenders, Equinox also works to educate parents, guardians and others about how to address sexual issues in young people.
"What our program is about is trying to educate parents and children on that issue," Taylor says. "There are very few, if any, at least in the city of Cincinnati/Hamilton County that address that particular issue."
Mark says he was aware of having a problem with sex as a teenager.
"I've had problems with sexual addiction probably since teenage years," he says. "I thought I was very isolated, very alone and very different — just a history of sexualizing my feelings, seeking self medication, almost like a drug addict, seeking some kind of euphoria, gratification.
"I think my lifestyle fed it as a gay man. As a gay man our lifestyle has been very, very undercover until the last several years. But if your formative years were in the olden days, no matter how wide and open it is now, you're a product of where you came from."
The cult of recovery
Bassman notes that shame is a significant hurdle to overcoming addiction and says that opening up is essential. He believes the first step in recovery is recognizing reality.
"You don't need a scale to know you're overweight," he says. "What you need is to be honest. Look in the mirror."
That mirror is as unique as each person's addictions. Mary's reality hit home when she couldn't get her "fix."
"When this nice, healthy, moral person turned me down for a date, I suddenly realized it was like a person in an amusement park in a crash car, only my little steering wheel wasn't attached to anything," she says. "I could steer left but the consequences would be totally different than what I expected. I kept thinking I had some influence over the way things were going, but I clearly realized, if I had some influence over the way things were going, they'd be going very differently than this. I did not choose for it to turn out this way.
"If you pour water out of a cup, it never goes up, it always goes down. I thought, 'Wait a minute. There's definitely a pattern. It's happening over and over and over. And I keep thinking it's going to be different.' That's when I decided I was going to learn how things truly work, the true laws of nature, the rules by which these consequences are happening. I had to quit thinking the wrong way, I had to only go by the truth, what I call 'the laws of natural consequences.' "
When that realization comes, many people turn to 12-step recovery programs. Even though some are listed in the phone book, such as Sex and Love Addicts Anonymous (www.saa-recovery.org) and Sexaholics Anonymous (www.slaa- "You've replaced an unhealthy compulsion with a healthy compulsion," Bassman says. "You still have not addressed what prompted you to do that. They may have stopped acting out but the attitude, the fear, the inadequacy is still there. If that's the way you want to live your life, that's your choice."
Not while jogging
While Bassman does "cautiously" refer to people to 12-step programs, he also endorses an alternative, SMART Recovery. Self Management And Recovery Training "helps individuals gain independence from addictive behaviors, substances or activities."
The Web site for SMART (www.smart.org) explains that the key to this form of recovery doesn't require helplessness; it teaches self-reliance and started with alcohol addiction.
"There's a classic book by Albert Ellis called When AA Doesn't Work for You," Reed says. "It's in a field called harm reduction. You don't have to believe in God. You don't have to be abstinent. You do less harm the next time than you did the last time."
Neither program has scientific backing. Success is articulated in terms of individual experiences.
Reed's support group, called Helping Eliminate Addictive Learned Toxic Habits (HEALTH), emphasizes the importance of healthy behaviors.
"We know that trying hard not to do something compulsive makes the compulsivity increase, not decrease," Reed says. "Most of the recovery programs are 'I gotta try hard not to do this thing.' What I do is DRO (differential reinforcement of other). Do something else that's incompatible with the thing you're trying to quit doing. They say, 'I'm a compulsive liar. I've got to stop lying.' And I say, 'No, you've got to practice telling the truth.' You don't fight the bad, you practice the good.
"People don't understand that it's counterproductive to fight the urge. So if a guy's lying in bed naked and praying to his god, whatever god is to him, 'Please don't let me masturbate,' you're set up to fail. What I say is you need to get out of bed and start jogging. You won't be masturbating while you're jogging, I guarantee it."
Support groups as part of a comprehensive recovery plan is what will change an addict's life, Bassman says.
"I believe, whether it's 12-step or SMART, that it needs to be done in conjunction with psychotherapy, because I do see sexual addiction is a mental disorder that needs professional treatment," he says. "That is the bottom line. That doesn't say that someone can't be helped by a 12-step or a placebo. But if someone comes to me, I see it as a mental disorder which needs help, assistance."
The World Health Organization doesn't use the term "addiction" because they feel it's a derogatory word, according to Bassman.
"There's a certain connotation," he says. "They refer to these behaviors as 'compulsive.' "
That connotation is alive and well. Many recovering addicts are quick to point out that they aren't sex offenders — specifically not pedophiles — and underscore that the majority of addicts in their groups do not have a criminal record.
"Unfortunately the media, and therefore the populace, gets exposed to the extreme cases," Bob says. "If all you've ever heard about are the fearsome and rightly reprehensible behaviors, then I can understand why the easiest reaction for any individual is to say, 'They're all like that. Put them out in a boat and burn the boat.' I understand that, but the truth is you're seeing the worst-case scenarios.
"No one becomes a pedophile on a Tuesday afternoon. We arrest them here, but there was a whole history back here."
"Whenever I hear of a pedophile, yes they've got to be stopped now," he says. "They've got to be incarcerated. But you know what? There's some really deep-seated reasons for being involved in that. I don't use the word 'blame.' The seeds of addiction were planted in me, but I'm the one who watered them and fed them and nourished them and developed them."
Reed says professionals frequently miss the seeds as well as the fully developed addiction, because most addicts have more than one "drug."
"When doctors do histories, they frequently miss the underlying pattern, which is 'I engage in a variety of behaviors,' " he says. "They say, 'I'm not addicted, I only drink once a month.' Well, what do you do the other Friday nights? 'Well, I go to the (casino) boat. When I don't go the boat, I go to the strip club.' They're doing something, but they don't do all of them all the time.
"The underlying mood state, the underlying urge, what makes this an illness, is the craving is virtually irresistible. When the craving hits, it's about as irresistible as an epileptic seizure or a migraine headache or a diabetic attack. It's that powerful. When people are in recovery, people wait until they're in that craving to fight back — it's too late. My brain was hijacked. I was already in my craving."
But with recognition of sex as a potential addiction there is some hope. For Bob, the beginning of the end came with taking a personal inventory.
"I listed about 18 bad behaviors: impatience, a sense of needing to be the star, the chosen one — which I was at work — needing to be endlessly competing with other people, needing to be hopelessly dominant in every relationship," he says. "And all 18 are dramatically better, some phenomenally better. My wife said these wonderful words, 'I'm finally married to the person I thought I was married to.' " ©