By Dr. Dean Aslinia

Over the past decade much controversy has been created over the notion of “sexual addiction”.  Some believe this label is a true mental health disorder, and in fact qualifies as a “brain disease” that one cannot cure.  To these believers the only option you have left after you’ve been “diagnosed” is to cope with the disease much like one does with the Human Immunodeficiency Virus (HIV) until death. They believe there is absolutely no cure from such a “brain disease”.

This controversy took center-stage in the years of planning for the publication of the The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.  The group of believers of this disorder fought to have the diagnosis included in the DSM-5 and the non-believers fought to prove them wrong via research and science. Eventually, the non-believers prevailed as they were able to prove that “sexual addiction” is no more than a social construct, that simply is a outward symptom of many other primary diagnosis that are already included in the DSM.  Furthermore, they were able to show, that once those primary diagnosis are accurately treated, then the issue of “sexual addiction” disappeared.

In short, and simple terms, those fighting to prove such a thing did not exist were not doing it to allow more and more people to simply get away with having risky sexual behavior or to break up marriages and families.  Rather, they were operating under a scientific assumption, that to call something an addiction you must be able to prove that the major characteristic of addiction must also exist.  That common characteristic is withdrawal and physical symptoms in the absence of the addictive behavior.  Think for a second about any kind of addiction that you know of, and imagine taking that behavior away from the person struggling with their impulse control.  What you will soon realize, is that they will experience a variety of severe physiological symptoms.  For example, if you take alcohol, or even caffeine away from an addict they will quickly experience headaches and a series of other physical symptoms.  Now imagine the last time you or anyone you know didn’t have sex for a period of time.  When did they ever tell you I have headaches, body aches, or other physically painful side-effects? This is where the two camps split and those that don’t believe in such a diagnosis call it “Out of Control Sexual Behavior” meaning they acknowledge that the behaviors are problematic and need to be treated, but fall short of an “addiction, or brain disease” label that will never be treated. Instead they believe if a mental health professional can accurately diagnose and treat the primary disorders.  That by the way, already exist in the official diagnostic manual of mental health professionals (DSM-5) then not only will the compulsive behaviors be addressed, but also provide hope for the client by not condemning them to a life sentence of carrying an untreatable “brain disease” disorder, the diagnose for which is not recognized by the broader mental health community.

What this has meant for our society, and healthcare system is that because “sexual addiction” is not an officially recognized diagnosis, no mental health professional that is a credentialed managed-care provider (meaning works with insurance companies) can actually bill for treating this “disorder”.  Thus, this has created a wonderful opportunity for those that like to take advantage of this label and make vast amounts of money treating it without accepting insurance.  Research indicates that currently, the average treatment cost for an 11-day program is $37,000 and since insurance does not cover the cost, it is all out-of-pocket/cash.

This lucrative market has created a few unique realms with this “disorder”,

  • That those willing to use this label are making millions of dollars, while those that refrain from using it continue to get reimbursed their typical managed-care reimbursements, averaging $60-$75 a session.
  • This huge financial gap has created “sexual addiction” to become a “white-collar” diagnosis, perfect for celebrities, executives, and CEO’s who are willing to own the diagnosis in fears of losing everything they’ve ever accumulated. Thus they will gladly pay the $37,000 ticket price, perhaps even a few times, to be able to save their reputation, millions, and buy some public sympathy.  After all, if they say “I have a brain disease and unfortunately all of my behaviors have been out of my control” we are less likely to stop supporting them then if they were to just say “Hey, I love sex and it’s none of anyone’s business”. The other reason I call it “white-collar” is because no one seems to be concerned about the out of control and severely risky behavior of the poor people in questionable neighborhoods who choose or are forced to engage in compulsive sexual behaviors in the dark of the night and lastly,
  • This new pseudo-diagnosis has now introduced the new notion of “Commercial Infidelity”.  Meaning now we have a new way to “treat” those that have been caught having affairs, or have stepped outside their committed relationships. After all, doing a simple, traditional, evidenced-based couple’s therapy session dealing with infidelity has never carried a price tag of $30,000 + before!

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) in an attempt to help answer public questions and concerns issued a public statement on its website:

“Founded in 1967, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) is devoted to the promotion of sexual health by the development and advancement of the fields of sexuality education, counseling and therapy. With this mission, AASECT accepts the responsibility of training, certifying and advancing high standards in the practice of sexuality education services, counseling and therapy. When contentious topics and cultural conflicts impede sexuality education and health care, AASECT may publish position statements to clarify standards to protect consumer sexual health and sexual rights.

AASECT recognizes that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors. AASECT recommends that its members utilize models that do not unduly pathologize consensual sexual behaviors. AASECT 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.

AASECT advocates for a collaborative movement to establish standards of care supported by science, public health consensus and the rigorous protection of sexual rights for consumers seeking treatment for problems related to consensual sexual urges, thoughts or behaviors.”