Do People Get Hooked on Sex?

By Barbara Dolan

A woman uses a vibrator so intensely that she ends up in an emergency room. A priest steals money from his church's collection box so that he can pay for prostitutes. A young father of three small children sneaks out at night for anonymous sex in public bathrooms. He contracts AIDS and infects his wife. Both of them are dying.

Why do otherwise normal men and women do such things? Why do they let their sexual desires destroy their families, their jobs, even their health? Is it possible that they are powerless to control their urges? Are they addicted to sex, just as a junkie is dependent on his next fix?

The notion that people can suffer from "sex addiction" has become one of the most hotly debated theories in psychology. Frequent reports of bizarre sexual excess have spawned competing ideas about what causes the behavior and how to treat it. Last week the controversy erupted anew as nearly 300 sex educators, researchers and clinicians met in Minneapolis for a national conference held to explore why some people are compulsive about sex.

On one side at the meeting was Patrick Carnes, a senior fellow at the Golden Valley Institute for Behavioral Medicine, outside Minneapolis, who introduced the sex-addiction theory in 1983 in his best-selling book, Out of the Shadows. Said Carnes: "What we're talking about is a loss of control and willingness to risk any kind of consequence for a pleasure that gets you so hooked you cannot stop." But other experts dismissed that argument. Contended University of Minnesota psychologist Eli Coleman, who believes compulsive sexual behaviors are types of anxiety-based disorders: "It's not an addiction. There's no substance involved. You can use it as a metaphor, but it's oversimplifying a complex phenomenon, and that could be dangerous."

The debate is not just academic. More and more people are seeking treatments for sex addiction that are modeled on those established for alcohol or drug dependency. Since Carnes opened the first inpatient sex-addiction treatment program in 1985, his method has been used with more than 1,500 patients. Four different nationwide support programs for sex addicts, patterned after Alcoholics Anonymous, boast a total membership of 20,000.

Carnes says sex addicts, generally, were abused as children. They suffer from low self-esteem and use compulsive sex as a substitute for the love and < acceptance they never got at home. They develop an elaborate system of denial to delude themselves into thinking that their behavior is acceptable.

To break out of their addiction, says Carnes, people must acknowledge that they have a problem and seek support from a group of other recovering addicts. In most sex-addiction programs, patients go through the twelve treatment steps designed for A.A. groups. The steps include admitting the nature of the wrongs committed and making amends to people who were hurt. Carnes also explores his clients' family background and helps them confront the origins of their behavior.

Critics charge that Carnes has vandalized the scientific concept of addiction and is using it to develop a pop psychology. They say the treatment does not necessarily get at the root cause of the behavior and may harm some people more than help them. "Addiction is used so interchangeably with everything that it loses its meaning," says Robert Csandl, who runs sex- offender and substance-abuse treatment programs in Allentown, Pa. "Even if you're using the word addiction metaphorically, it blurs good assessment, which is essential to starting appropriate treatment." Johns Hopkins researcher John Money sees the focus on sex addiction as a fad. "People trying to make money on it better hurry up," he says. "It'll probably dry up in five years."

Others argue that solid evidence is accumulating in support of the addiction hypothesis. Psychologist Harvey Milkman and chemist Stanley Sunderwirth, authors of the book Craving for Ecstasy: The Consciousness and Chemistry of Escape, point out that sexual arousal triggers an increase in the release of certain neurotransmitters in the brain in much the same way that the taking of mood-altering drugs does. It is possible that sex addicts try to get the high that results from those chemicals.

Whatever genetic and environmental factors are involved, says Carnes, the problem, like alcohol and drug dependency, tends to run in families. This suggests that the addictions have a similar origin. A national study he conducted found that 87% of the sex addicts surveyed claimed that other members of their families were also compulsive about sex or had some other form of addiction.

To Carnes, the most important support for the sex-addiction idea is that treatment programs based on the theory often work. The family therapist, who is featured on Contrary to Love, a TV series aired on PBS, is working on a book analyzing the kinds of recoveries made by 500 sex addicts who have been in treatment for five years or more. Among the more successful cases is Burt Schneider, 48, an author from Tucson, who sought help after going through multiple extramarital affairs. "Up to a point I could control it," he says. "After that I couldn't." Schneider learned to confront his problem and share his secret torment with his wife Jennifer, an internist. Dr. Schneider, who entered a self-help program for relatives of addicts, wrote about her experiences in the book Back from Betrayal.

Carnes admits that scientists are a long way from fully understanding the causes of compulsive sexual behavior. He cannot yet explain why some forms of treatment are successful. "What I do know," says Carnes, "is that people do get better."