Sex therapists group says no evidence base for sex addiction as disorder

A national association representing sexuality educators and therapists has issued a position statement concluding that the classification of problematic sexual behaviors as an addiction is not supported by science. Leaders in the American Association of Sexuality Educators, Counselors and Therapists (AASECT) go on to say that the treatment methods employed by professionals who use the sex addiction construct are not sufficiently informed by knowledge of sexuality, and that the sex addiction label often makes problem behaviors more difficult to address.

Authors of the AASECT statement stress that they by no means are questioning the existence of problematic sexual behaviors in individuals, and add that there could be a time in the future when research evidence will point to an addictive process in the brain that resembles that for substance addiction. But in the present, they say, too many professionals have been eager to affix an addiction label to behaviors simply because they consider them too frequent or perhaps even aberrant.

“Terming a high-frequency behavior as an addiction on its face doesn't make sense,” statement co-author Russell Stambaugh, PhD, a Michigan-based psychologist in private practice, tells Addiction Professional. “Context matters.”

Strong opposition

Some have interpreted the AASECT position statement as an attack against practitioners in organizations such as the International Institute of Trauma and Addiction Professionals (IITAP), which among its functions offers professional certification for sex addiction therapists.

The Association of Partners of Sex Addicts Trauma Specialists has issued a response aimed at its “recovery family and friends,” stating in part, “If the reality of out of control sexual behaviors (sex addiction) and betrayal trauma were part of your history, I would imagine that reading this professional organization's statement brings about much confusion, fear, uncertainty, and maybe anger. You may fear you won't be able to find the help you need or that you will be marginalized or pathologized when you seek help from those who may not take sex addiction and betrayal trauma seriously.”

But in interviews with Addiction Professional, Stambaugh and one of his AASECT statement co-authors, California-based sexual health author and psychotherapist Douglas Braun-Harvey, LMFT, state that while there might be several valid reasons why the sex addiction label gets used, scientific evidence is not driving this. As one example, Braun-Harvey cites a situation in which a partner has an unconventional sexual interest and this is discovered in an activity that then threatens the relationship.

“The solution is to call the erotic interest a sex addiction so that it can be abstained from,” Braun-Harvey says. “The addiction label allows the partner to take back their power.”

This of course is not the first time a professional organization has chosen not to affix an addiction-like label on problematic sexual behavior. After much consideration, the American Psychiatric Association (APA) did not include “hypersexual disorder” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Braun-Harvey believes the AASECT position statement might have a greater impact, because while physicians have been split on the addiction issue, now there is an organization representing educators that is saying the addiction construct doesn't hold up scientifically.

Research will have to do more than show that neuropathways are involved in problematic sexual behavior, since a variety of behaviors that fall short of addictions have a neurobiological component, Stambaugh says.

Origin of statement

Both Stambaugh and Braun-Harvey say AASECT has been considering the need for a position statement on sex addiction for some time. They cited numerous developments that helped to fuel the move:

• A decision by the association's continuing education committee not to certify sex addiction trainings that did not meet educational requirements for human sexuality coursework.

• The proceedings of a summer forum in which participants discussed sexual health approaches to out-of-control sexual behaviors. Braun-Harvey says that some sex addiction therapists who participated came to understand that their field requires considerably more training in human sexuality.

• Recent efforts by some conservative groups to target the wide use of pornography. “Pornography is not a real public health crisis,” says Stambaugh, in the manner of a lack of access to sexual health services, for example. “That doesn't mean that some people don't have an individual porn problem.”

Braun-Harvey believes it is often more accurate to see these issues as conflicts rather than pathologies, as many individuals experience legitimate internal conflicts between their belief system and their desires/behaviors. “We don't do 'erotic-ectomies' here,” he says.

David J. Ley, PhD, a clinical psychologist and author of the 2012 book The Myth of Sex Addiction, says AASECT's position statement “represents a very significant ethical commitment toward patient well-being.”

Ley adds, “By prioritizing the importance of sexual health, AASECT begins to significantly protect people having normal, healthy aspects of sexual behavior treated as a disease. Unfortunately, this is extremely common, usually because the therapist has no training [in] sexuality, and has been inundated by the pop psychology adoption of the sex addiction concept to describe any sexual behavior that causes a problem for someone (including the therapist).”