They Gotta Habit
What is sexual addiction?
I'm not a fan of the term sexual addiction. Sexual compulsion is more accurate. If you use cocaine, you get a physiological withdrawal from it. I don't think it's accurate to say that you can be addicted to sex in the same way. Physiological withdrawal means the physical discomfort experienced by drug users who suddenly stop using a drug. Sex addicts will feel anxiety when they stop acting out but not physical discomfort.
How many people have this problem?
Approximately 7 to 10 percent of men in the U.S. have sexually compulsive traits. These are people who have problems with sexuality and use it in self-destructive and maladaptive ways. There are five criteria for compulsive sexual behavior:
1) Denial—some way of convincing yourself that it's okay to do what you're doing.
2) Persistent desire to stop or control the behavior.
3) Expenditure of a great deal of time on the sexual activities.
4) Consequent reduction of important social, occupational or recreational activities.
5) Continuation of the sexual activity despite adverse consequences or significant risks.
Why is it mostly men who seem to have these problems?
That's not a simple question. The complex answer is that men look toward sexuality to meet all their needs. Sex is a panacea for them. There are women with sexually compulsive behavior, but I think it takes a different tone. It doesn't have the aggression or the high numbers. Women prefer sex that involves a strong emotional bond. Sure, there are women who go out and have anonymous sex with a number of different people. But there's a difference: Their goal is not just to have an orgasm. Their goal is to get validation that they are attractive or of value.
What do sex addicts do?
The most frequently occurring sexually compulsive behaviors are compulsive masturbation and serial affairs.
What's a compulsive serial affair?
We are not talking about somebody who's unhappy in his marriage, goes out, becomes friends with a woman, gets sexually involved and leaves his wife and lives happily ever after. That's an affair, for better or worse—the moral judgments are up to you. That's not the same as someone who has an affair, then has another at the same time and is still with his wife, then has another two after that. Someone who is always in an affair.
Why do people think they can get away with it?
It's not stupidity. Some of these people are very intelligent. But think of the level of denial you must have to think that you could be President of the United States or CEO of a big company and it will not get out in a week, a month, a year or 10 years. It will get out.
Are you saying you believe the President might be a sex addict?
I can't say that with any certainty. But the issue is certainly real. It's pervasive, and one of the fastest-growing categories of men with this problem is well-known, successful people. I think the President's alleged behavior fits the criteria. Though Clinton can be a fairly effective President, the question is whether he is achieving his potential. If he wasn't fantasizing about women, he could be a lot more effective.
Bill Clinton had an alcoholic stepfather, and his brother grew up to be a cocaine user. Why might one person grow up with a drug problem and another become a sex addict?
You would expect there would be things in a person's childhood that would lead them one way vs. another: sibling rivalry, birth order, the peculiarities of relationships. It's never just one thing. In about 80 percent of cases there is a concurrent addiction or compulsion: drugs, alcohol, gambling, shopping, even work.
Why is sexual addiction on the increase, as you say it is?
I think because society is increasingly focusing on sexual matters. Sex is the answer for everything, regardless of the question. On TV, with every product that we sell, sex is the answer. So sexualization and looking to sex as a panacea is increasing in our society. Also, in the past if a doctor touched his patient inappropriately, we may have looked the other way. Nowadays we hold those people responsible.
Isn't sex addiction really a moral failure? Are you making a pathology of bad behavior?
It's a problem, a disorder, a psychological issue. I don't think we should condone it. We should say the person has a problem. They are responsible for whatever goes wrong because of their failure to deal with the problem. If you just condemn or punish these people, it's not going to help them to stop. We need to treat them.
But are they treatable?
Even the more severe kinds of compulsive sexual behaviors, like pedophilia, can be treated. But recidivism is extremely high unless people get into specialized, integrated, comprehensive treatment programs. There is a new class of drugs commonly used to treat depression, which can be very effective. The side effects of some of them include a reduction in sex drive, which in this case is a positive.
What causes sexual addiction?
One of the main components is that these men have trouble being intimate. You and I think, "Well, if they are having sex, isn't that a way to be intimate?" But that's not what they are looking for. They are looking for the excitement, the high. And they are looking for that to replace the emptiness they feel because they don't have true intimacy. They tend to come from families where there was a lot of distance. You could use the buzzword dysfunctional, but disengaged is better. They don't know how to be intimate, and so they use sexuality, but that void is never going to be filled with this empty kind of sex.
Do sex addicts often count on their wives, for instance, to act as enablers and codependents?
Yes. I'm skeptical whenever I see one of these CEOs come into the office and the wife is furious because she's just discovered he's been having an affair for 15 years. How did she not know on some level? If she didn't know, she has a disorder of intimacy too, doesn't she? In long-term relationships there always has to be collusion.