Sexual Addiction

References

• See discussion in: Objections to the concept of sexual addiction Birchard, Thaddeus. CBT for Compulsive Sexual Behaviour (p. 10). Taylor and Francis. Kindle Edition.
  • For all the limitations and inadequacies that apply to the theory of sexual addiction, and the use of addiction language in relation to sexual behaviour, the concept of sexual addiction has some distinct advantages. It provides practitioners with a systematic model for understanding and classifying a wide range of sexual behaviours. It also provides practitioners with a systematic approach to treatment – namely, a treatment programme that is essentially cognitive behavioural. The highly subjective nature of the definitions and diagnostic criteria for sexual addiction means that the locus of treatment lies not with the medical establishment or with practitioners but with the individual client. Finally, it provides a clear and unambiguous response to individual men and women who experience profound suffering and serious harmful consequences as a result of their sexual patterns. Birchard, Thaddeus. CBT for Compulsive Sexual Behaviour (p. 11). Taylor and Francis. Kindle Edition.
• 3.5 - Existential perspectives on working with sex addiction Alex Smith in Birchard, T., & Benfield, J. (Eds.). (2017). Routledge International Handbook of Sexual Addiction. Routledge International Handbooks.
• Nicole Prause, PhD, and other researchers at the University of California, Los Angeles (UCLA) have demonstrated there is no evidence of the brain effects associated with chemical addictions in those who are self-described sex addicts and that pre-existing traits such as libido and sensation-seeking explain far more of the variance in people’s behaviours (Prause et al., 2015; Steele et al., 2013). Birchard, T., & Benfield, J. (Eds.). (2017). Routledge International Handbook of Sexual Addiction. Routledge International Handbooks.

From Florin

Re: Prause, N., Steele, V.R., Staley, C., Sabatinelli, D. and Hajcak, G., 2015. Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction”. Biological psychology, 109, pp.192-199.

In plain english, Prause et al. found that those that had problems with viewing porn AND also had a higher sexual libido were less stimulated by sexual images. Thus they had a different response than expected with substance addictions.

The authors offer several explanations for their findings (of which two are reproduced here):

1. Habituation (more porn viewing leading to a lesser brain response) -  this is inconsistent with an addiction model, according to the authors, “as other addiction studies show evidence of potentiation, not habituation, to visual cues of addiction” (p. 196)

2. Hypersexuals who also have high sexual libido might have been better at controlling themselves during the study - porn is usually accompanied by masturbation but participants in this study were asked not to masturbate during the study task which might have affected their brain reactions (according to the authors). If this is the case, that means that at least in the case of hypersexuals with a high sex drive, their behavior is within their control, which again would be inconsistent with an addiction model (my note).

Overall, the authors consider that a high sex drive (i.e., sexual libido) might offer a better explanation for impulsive sexual behaviors than the addiction model.

In terms of methodology, the Prause et al study is sound:

• Relatively large study for this type (122 participants)
• Volunteers were screened in the lab
• They used a control group
• Reliable sexuality-related measures
• Strong study procedure, EEG data

...and they had great responses to the critiques of Gola (2016).

It’s important to note the findings of Prause2005 do NOT necessarily apply to GYE, as the Prause et al. study was not conducted with a treatment-seeking sample (as it is the case with GYE members). From the study: “…it is possible that the participants in this sample ultimately experienced fewer problems, or a less severe problem, than a treatment-seeking sample.” (p. 196).

On another note, some recent neuroscience studies support the addiction mode and have even been cited in textbooks on addictive behaviors (i.e. Gola et al., 2017). Recent studies supporting the addiction model include:

• Leppink, E.W., Chamberlain, S.R., Redden, S.A. and Grant, J.E., 2016. Problematic sexual behavior in young adults: Associations across clinical, behavioral, and neurocognitive variables. Psychiatry research, 246, pp.230-235.
• Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., Makeig, S., Potenza, M.N. and Marchewka, A., 2017. Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology, 42(10), pp.2021-2031.
• Sinke, C., Engel, J., Veit, M., Hartmann, U., Hillemacher, T., Kneer, J. and Kruger, T.H.C., 2020. Sexual cues alter working memory performance and brain processing in men with compulsive sexual behavior. NeuroImage: Clinical, p.102308.
• Klein, S., Kruse, O., Markert, C., León, I.T., Strahler, J. and Stark, R., 2020. Subjective reward value of visual sexual stimuli is coded in human striatum and orbitofrontal cortex. Behavioural Brain Research, 393, p.112792.

All in all, the data are inconclusive so far and future studies should explain possible differences between fMRI studies supporting the addiction model and the Prause et al. EEG study (or other studies).

Some authors like Willimas (2020) observe: “Given this lack of scientific support for an addiction model as applied to sexual behavior, it is not surprising that neither the American Psychiatric Association (APA) nor the World Health Organization (WHO) include either “sex addiction” or “pornography addiction” within their respective official diagnostic publications, the Diagnostic and Statistical Manual of Mental Disorders (2013) and the International Classification of Diseases (Grant et al., 2014). Similarly, after reviewing the literature and considering longstanding clinical ethical guidelines, the American Association of Sex Educators, Counselors, and Therapists (AASECT, 2018), the Center for Positive Sexuality (CPS), the National Coalition for Sexual Freedom (NCSF), and The Alternative Sexual Health Research Alliance (TASHRA) have all developed official position statements against the current use of the sex/porn addiction model (Williams et al., 2017).” (p. 3)

However, some if not all of these organizations are known to be slow at evaluating, incorporating or responding to scientific progress in their respective field.