“We have to remember that what we observe is not nature in itself, but nature exposed to our method of questioning.” – Werner Heisenberg
The prevailing belief that guides most addiction research and clinical care is that the rewarding properties of a specific chemical (e.g., cocaine) or behavior (e.g., pornography) drive the development and continuation of addiction along with the subsequent impairments.
This view is supported by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association 2013) that categorizes different compulsive behaviors as distinct disorders such as Alcohol Use Disorder or Gambling Disorder, with the implication that some chemicals/behaviors are addictive and others are not.
The tendency to focus on whether or not a substance or behavior is addictive rather than looking at the underlying nature and origin of addictive processes leads to short-term solutions, poor treatment outcomes and perpetuates the stigma that has followed addiction over the centuries.
The American Association of Sexuality Educators, Counselors and Therapists (AASECT)’s recent position on the issue of sex addiction illustrates the divisive and distracting discourse that emerges from this traditional view of addiction.
Their position states, “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” and suggests that members “utilize models that do not unduly pathologize consensual sexual behaviors.”
Founded in 1967 at the height of the sexual revolution in the United States, AASECT is an organization that has fought to protect, nurture and understand human sexuality.
As well intentioned as the organization may be in preserving healthy sexual expression, its denial of the existence of sexual addiction has a profoundly negative impact. Unwittingly, AASECT’s lack of understanding about the nature of addiction has lead to shaming and stigmatizing those suffering with out of control sexual behaviors.
The Syndrome Model
A syndrome model of addiction proposed by Shaffer, et al. (2004) offers a different perspective that encompasses a broader view of the nature of addiction and challenges the efficacy of our current system for classifying these disorders. The syndrome model views addiction as “a cluster of symptoms and signs related to an abnormal underlying condition; not all symptoms or signs are present in every expression of the syndrome, and some manifestations of the syndrome have unique signs and symptoms” (Shaffer et al., 2004, p. 367).
Our understanding of the nature of addiction mimics the course of discovery of AIDS. In the initial stages of the epidemic, physicians were treating patients for various rare diseases and infections without a clear understanding of the underlying cause. As research progressed, it became clear that similar immune deficiencies existed in all of the patients, indicating a broader underlying syndrome.
Consistent with this understanding is the idea that the individual addictions we treat are actually manifestations of one underlying disorder. The focus on just one manifestation at a time is ineffective. Many of us treating addicts find that we are locked in a never ending game of ‘Whack-A-Mole’ – we treat one excessive behavior only to have another pop up.” We are misguided by the belief that the elimination of one compulsive behavior will cure the disorder.
Ascertaining whether or not consensual sex or pornography is addictive is not the point. Sex addiction is not about sex. Howard Shaffer, associate professor of psychiatry and director of the Division on Addictions at Harvard Medical School, made exactly this point when he said, “The idea of addictive drugs makes no sense, it’s magical thinking to imagine that drugs have this power. We don’t talk about addictive dice.” (cited in Lambert, 2000). However, we do know that for some individuals their relationship to dice can become pathological. The focus needs to shift away from the dice back to the individual holding them. It is the relationship between the person and the object of addiction that matters, not the object.
The denial of the existence of addiction is not new. Compulsive behaviors have historically been attributed to a person’s moral deficiencies, weakness in character and negative personality traits. Arguably, the biggest factor contributing to our failure to effectively treat this disorder is that we don’t have a clear sense of what addiction actually is.
Although evidence supports the notion that addiction may, in fact, be a syndrome, the current system of diagnosis and treatment prevents us from seeing the entire picture and etiological core that is shared among various chemical and behavioral addiction.
As such, debates about whether or not sex is “addictive” take center stage while millions of people suffer and billions of dollars are spent. It’s time for us to focus our efforts, come together and harness the science we have to combat this devastating epidemic.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
American Association of Sexuality Educators, Counselors and Therapists. (n.d.).
AASECT Position on Sex Addiction. Retrieved from
Lambert, C. (2000). Deep Cravings: New research on the brain and behavior clarifies
the mysteries of addiction. Harvard Magazine. Retrieved from
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton,
- V. (2004). Toward a syndrome model of addiction: multiple expressions, common
etiology. Harvard Review of Psychiatry, 12(6), 367-374.
Magen Todd, Ph.D, is an AASECT Certified Sex Therapist and IITAP Certified Sex Addiction Therapist.
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