Recently I became intrigued by an article I read by Dr. Chris Donaghue titled Is Sex Addiction Just an Excuse for Bad Behavior? As a therapist working in the mental health and addictions field for about 25 years, this article stopped me in my tracks. Interestingly there was no discussion around healthy boundaries, self-reflection, morality, and the real meaning of addiction.

With all due respect to my colleagues in this interesting and challenging field, it is important for us to share differences in theoretical frameworks and treatment.  At times, we all must get back to basics and before being quick to diagnose, look at all root issues and the need to fill a sense of emptiness.   Fundamental causes that our client may be facing such as why one is self-medicating with alcohol, drugs, pornography, hording, food or other compulsive behaviors is critical to understand.

Although I and most other clinicians agree with Dr. Donagahue that “Mental health diagnoses, in general, are built on white, male, cis, hetero values and are often colonizing and pathologizing of other cultural norms. They are historically bound, and change frequently based on anti-oppression work and changing politics. Diagnoses are social constructs and exist on a continuum; they aren’t concrete truths, but fragile ways of trying to explain behaviors that often stigmatize minorities.”  Given this is perhaps true, we then must ask, “what is addiction?”  The article being challenged here is good at justifying any sexuality/sexual acts, several hours per day viewing pornography and any other sexual behaviors.  Moreover, we must not have a myopic view of sexual addiction and instead see the societal implications to it.  Societal implications such as the how it frays at our moral fabric and how morality distinguishes us from other animals.  This could be an entire article of its own so let’s get back to what addiction entails.

The hallmark feature of addiction and/or substance dependence/abuse is first and foremost whether that behavior (or sometimes a thought like with Obsessive Compulsive Disorder) is interfering with one’s quality of life. Hence, the behavior interferes with one’s professional work or school and interpersonal relationships.  We have all met men and women who have lost their careers, their spouse, their home and even children to addictions. In terms of sexual addiction, the addict cannot maintain interpersonal relationships, sees a computer at work and is triggered to masturbate at work despite the risk (and loving the risk) of bosses seeing that behavior, sleeps with every coworker in the office and every colleague, neighbor, babysitter, friend who enters his life.

The addiction becomes the priority as that person has lost healthy ways to cope with pain, aka, the root issue.  Root issues that I often see in my practice include trauma such as sexual abuse, incest, and abandonment, all of which lead to anxiety and/or depression.  In turn, women and men end up in my office with years of self-medicating with either drugs, alcohol, food, shopping or sex.  Ultimately, when one’s self medicating interferes with life functioning such as legal problems (DUI, public intoxication, child abuse, domestic violence), maintaining a career, marriage and/or family, that is when we look to diagnose one with addiction.  Often that label does not create shame but instead it can empower one to understand what is going on, educate themself about why they are drawn to that behavior, and understand how to cope with discomfort, soothe, and essentially thrive in this life while being authentic.

Coping with shame is a big part of my work with sexual abuse survivors.  This tends to be a different issue then the one who is addicted to watching pornography and is pervasively promiscuous, cheating on a spouse and putting a partner at risk for STD’s.  This person is working on gaining trust and forgiveness.  Shame can be worked through in therapy when one becomes authentic and reclaims themselves, this is a universal theme for all survivors.

Dr. Donagahue said “The sex addiction diagnosis has become a waste paper basket for all creative and non-hetero sexuality.”  This is just ridiculous, one’s private “sexual creativity” within a healthy consenting relationship with two adults is not really what is in question here.  Rather it is that yes, there is such a thing as sexual addiction and it destroys relationships and can be passed down to the next generation.

According to a Newsweek article by Chris Lee, “An estimated 40 million people a day in the U.S. log on to some 4.2 million pornographic websites, according to the Internet Filter Software Review… a kind of gateway drug…. the potential for abuse of online porn is well documented, with research showing that chronic masturbators who engage with online porn for up to 20 hours a day can suffer a “hangover” because of the dopamine drop-off… most self-identifying addicts—about 90 percent—are male.”  If someone drank for 20 hours per day would we question this diagnosis of addiction?

The implications of sexual addiction on our sons and how this type of compulsive behavior, having to seek out pornography and/or multiple sexual partners despite being in a committed relationship, hurts the next generation of boys who look to their father and grandfather for morality and the “how to live your life” as an honest man of character.

In addictions work we talk about accountability, the importance of being genuine, forthright and transparent.  If we teach others that “anything goes” then they learn that there are no limits, no boundaries and that despite being human, we do not have to be mindful about our behavior and how it effects our deepest self and others. Now, if you want by be “undiagnosed for free” by Dr. Donaghue, go for it, but your chances of living a fulfilling and meaningful life will be at risk.