Sex Addiction:A New Diagnosis for an Old Behavior: Is Sex Addiction Treatment a Way to Escape the Consequences of Sexual Misbehavior or to Heal?

11/18/2017 09:11 am ET

With all of the recent press around high profile celebrities, considerable attention is being drawn to the rather volatile subject of sex addiction and sex offending, but the distinction between the two remains somewhat blurry. Readers appear to feel alternately vindicated, horrified and enraged. Many understand sex addiction as a serious problem that plagues someone they know, some are in hiding/denial or questioning themselves and still others are lashing out at the whole moral (or amoral) mess and directing their anger towards what they perceive to be the use of the diagnosis of “sex addiction” as a hiding place, a way for identified predators to avoid getting their just desserts for seriously aberrant behavior.


We obviously need some clarification so the logical place to start is at the beginning, Dr. Patrick Carnes, author of The Betrayal Bond and several other books on the subject, might be called the father of the sexual addiction movement. His daughter Dr. Stephanie Carnes has taken up the family mantel and carries on the extremely important work that her father began; so I have asked Dr. Stephanie Carnes of The Meadows in Arizona, to shed some light.


TD: Can you clarify what the  difference is between sexual addiction and sex offending?


SC: First of all, it is critical to understand that sex addiction and sex offending are not the same thing.

  • Sex offenders purposefully engage in nonconsensual sexual activity. A sex offense occurs when there is a nonconsensual sexual behavior with a victim. Most of these behaviors are illegal (with laws that vary by jurisdiction).
  • Sex addicts are people who have lost control over their sexual lives (sexual fantasy as well as sexual behavior). Typically, sex addicts struggle with behaviors like pornography and masturbation, casual/anonymous sex, serial affairs, and general sexual promiscuity that does not involve offending. They tend to experience depression, anxiety, relationship trouble, problems at work or in school, financial trouble, physical health issues, etc. In most respects, sex addicts are exactly like alcoholics and drug addicts; the only real difference is in their “drug of choice.”

There can be overlap between sex addicts and sex offenders. However, most studies suggest that only around 10% of sex addicts engage in sexual offending behaviors of the type alleged with Harvey Weinstein, Roy Moore, Kevin Spacey, Louis CK, and other men currently in the news.


TD: I know that you treat sex addicts but do you treat sex offenders as well?


SC: Notably, very few people check into a treatment center asking for “sex offender rehabilitation,” even if that’s what they really need. Rather, they seek “sex addiction treatment” because that language sounds more palatable to them (and to their families, PR teams, etc.). As therapists, we’re not overly concerned with a patient’s self-diagnosis when he walks through the door. We’re far more concerned about the fact that the patient is in crisis. People don’t seek the type of help we provide until their situation is at the boiling pint, so when they do arrive, they immediately need the level of care that only a full-service residential mental health facility can provide. For instance, we have 1 to 1 suicide watches and immediate psychiatric evaluation and medication when needed. When those issues are dealt with, we will implement a highly individualized treatment regimen based on a full assessment of the patient, his behaviors, and his current situation.


When people understand the acuity of the crisis that is present with almost every person who checks into a residential sex rehab center, it becomes clear that this level of care is not a luxury, it’s a necessity on the continuum of mental health care.

One of the very first things we do when a patient arrives is to perform a full bio-psycho-social-sexual assessment. If an individual is assessed as sexually addicted, treatment will proceed accordingly. If an individual is assessed as a sexual offender (that does not present as addicted or compulsive with their behavior), it is likely that s/he will be referred to a facility that specializes in sexual offending. If an individual is assessed as both, then both issues will be treated and the appropriate referral to a sex offender specialist will be made at some point during the course of treatment.

We have a team of mental health experts capable of handling just about any sexual or psychiatric issue. Our team consists of sex offender specialists, sexologists, sex addiction therapists, psychologists, psychiatrists, nursing and trauma therapists. These diagnoses are made very thoughtfully.

TD: Some are saying that people are just using the diagnosis of sex addiction as a kind of a way to “excuse” bad behavior, “I couldn’t help it, I’m an addict sort of thing.”


SC:  I think it is important to state that sex rehab, whether it’s for addiction, offending, or both, is not a spa. Every patient we treat is required to attend and participate in approximately 50 hours of incredibly intense individual and group therapeutic work every week, with no days off. Typically, this includes numerous treatment modalities; behavioral therapies, acceptance commitment therapy, motivational interviewing, mindfulness, the 30-task model, psychodrama and other experiential therapies, intensive family therapy, trauma treatment, and more. In short, patients are there to work on their very serious problems, not to vacation. Yes, there are elements of treatment that can be relaxing and even fun, but those elements are there to emotionally down-regulate patients and to help them re-charge for the deeply painful therapeutic work to come.


TD: What is the saddest thing you see as a theme running through sex addicts?


SC: When sex addicts enter treatment, they are deeply in denial. They don’t see how their behaviors have negatively impacted them, and more importantly they don’t see how their behaviors have negatively impacted their partners, their kids, their parents and siblings, their employer, their community, and pretty much everyone else they come in contact with. Sometimes they vehemently deny what they’ve done or blame others for calling them out, and this furthers the traumatic damage they’ve created. We see this behavior in addicts and offenders alike, and it’s horrible for families and victims. As such, much of the work we do early in the treatment process with both addicts and offenders is geared toward breaking through denial—helping the patient see what s/he has done, the consequences of his or her actions, and that s/he alone is responsible for their behaviors.


TD: What is the most hopeful thread that you see running through recovering sex addicts?


SC: People do recover from both sexual addiction and sexual offending. I see it every day. They don’t do it alone, and healing does not come easily, but it’s possible for any person who wants it and is willing to put in the work. Usually, once the problematic behaviors are under control, these individuals begin working on the underlying issues (most often various forms of unresolved early-life trauma) that drove them into addiction or offending. That process is incredibly healing, and a great boost to long-term sobriety and recovery.


TD: What happens to the marriage? What happens to the kids?


SC: There is no denying that relationships and families are deeply and negatively impacted by sex addiction (or any other addiction). That said, the impact is different for every relationship and every family. Partners can be completely traumatized by the addiction and they may wall themselves off to protect themselves, sometimes they engage in addictive behaviors of their own as a way of coping with or masking the emotional pain they’re feeling. Recognizing this, we try very hard to bring families into the treatment milieu and to integrate them as part of the recovery process.

I have also asked Sean Walsh CEO of Meadows Behavioral Healthcare who is duly concerned with the need to help people to understand what treatment for sex addiction is all about to weigh in as well. ”The main thing I want the public to know,” says Walsh, “ is that the majority of patients that we treat are usually victims themselves of some type of abuse whether it is sexual assault, child abuse, rape or incest. Only 10% of those we treat for sex addiction are also offenders…. those who are only sex offenders and we are not the appropriate facility, we refer to appropriate offender treatment facilities. The core of the Meadows Model and our treatment approach is to bring healing to the trauma experienced by victims who live out the pain of their own abuse through becoming obsessed with sexual acting out.”

Walsh continues, “The benefit from times like these, is the potential for increased awareness of the issues, conversations like these. The problem itself is nothing new, for far too long men in power have been victimizing women, it’s been going on since the beginning of time. I am hopeful that increased awareness about the empowerment that comes from movements like “#me too” will lead survivors of abuse to taking a stand and seeking the healing and hope they deserve, as well as to offenders being held accountable. And that a paradigm shift will occur, where these behaviors will no longer be tolerated or enabled.”

Looking Back at my Porn Addiction

This battle, this 25 year battle has played havoc with me in every single arena of my life. I have doubted my God, my parents, my wife and my very reason for existence. It has torn my insides apart; I hated myself for needing pornography and masturbation the same way a normal person would need food and water. I did not know why I needed it, just that I did. I could stop for a while – in the same way that you can stop eating for a while, but the desire and the need would grow so strong that I would surrender to the tempting promise of the “joy” and “fulfillment” to be found on a flickering screen each and every time. I begged God with tears in my eyes to help me, I confessed my struggle to Christian friends and even to my wife, I sincerely wanted to be free – but as it turned out, wanting to be free combined with clenching your jaw and your fists and promising your wife, your God and yourself to never do it again is simply not the path to freedom. The pain, frustration and hopelessness caused by running this; this binging and purging cycle on an endless loop  is difficult to put into words.

In the beginning of 2016 as a kind of last gasp attempt to rescue my ailing marriage I walked into a Sex Addicts Anonymous (SAA) support group and found a bunch of people who knew my struggle and what is more were walking in this elusive freedom I so craved. They suggested I see Theo who is a therapist specializing in sex addiction – I did, and in hindsight it was one of the best decisions I have ever made in my life. With his help my problem finally had a name – sex addiction – and with a name there was a program. A program that lead to honesty about my addiction and a road of self-discovery, in Theo I found a therapist who was loving and understanding but didn’t take any bullshit either.  For the first time in my life I understood what my compulsive acting out was all about and how it all worked – I received tools, encouragement, support and accountability from my therapist, my therapy group, my sponsor and my SAA group. Today almost two years later, I have been completely clean for more than a year and my relationship with my wife is better than it has ever been. More than anything else however my mind and body is experiencing freedom from the torture of obsession and compulsion, this is precious indeed.  I have now finished the first phase of the program and am filled with hope and excitement about the future, and can’t wait for the second portion of the program to begin.

Ek is ‘n volgeling van Jesus en ek is ‘n seks addict!

Facing my shadows

(Ek is ‘n volgeling van Jesus en ek is ‘n seks addict.)

Ek het nooit besef hoe baie seer ek in my lewe het en dat ek nooit met daardie seer gedeel het nie. Hoe my seer weer ander seergemaak het en nog steeds maak. Ek is uit ontkenning waaroor ek dankbaar is, want nou is daar persoonlike groei.

In my groep is vir my ‘n veilige plek geskep en vir die eerste keer voel ek nie alleen nie. Ek kon my seer en skaamte deel met my terapeut, groep en vrou. Ek is saam met vriende wat ook die keuse gemaak het om ‘n lewe van integriteit na te strewe.

Ek is geleer oor grense en om daarby te bly. Ek het ook geleer om na myself te kyk, hoe om myself te kalmeer en my emosies te reguleer. Hoe om die regte keuses te maak. Ek leer ook van ander se seer en hoe hulle dit hanteer.

In die jaar is daar baie wonde oopgemaak en hanteer. Dit is die moeilikste program wat ek in my lewe nog gedoen het en ek moes reflekteer op my lewe. Ek sou nooit kon dink om so groep by te woon nie en tog nou kan ek nie wag vir die volgende sessie om verder te leer nie. Dit is ook die program wat my lewe vir my terug gegee het.

Die program het my geleer alles gaan nie net om sober te wees nie, maar het my ‘n leefstyl geleer van herstel.

Ek is ‘n beter man, pa en besigheidsman en is besig om my self respek terug te kry. Daar is weer balaans in my lewe. Ek maak nog steeds baie foute en my leefstyl is nie perfek nie, maar ek is op die beste plek waar ek vandag kan wees.

Ek is in die program want ek het waarde.