Sex addiction is a concept that gets thrown around quite a bit, to justify anything from mass murder to infidelity to porn consumption. Clinical psychologist and sex therapist Dr. David Ley has long been critical of the sex addiction framework, and wrote the book The Myth of Sex Addiction to explain why. I sat down with him to explore why sex addiction is a problematic concept, and how it contributes to whorephobia.
The interview has been edited for length and clarity.
Jessie: How did you become interested in the notion of sex addiction?
David: My first book, Insatiable Wives, is about cuckolding and hot wifing. In my clinical practice, I’ve always worked around sexuality issues, and I ran into couples that were living the hot wife and cuckold lifestyle. My initial assumption, frankly, was that it was unhealthy.
Jessie: What did you think was unhealthy about it? Is it just that they were non-monogamous?
David: Yes, it was the non-monogamy, the infidelity, and frankly, some of the issues around female sexuality. You must understand that this is about 12 years ago. But when I interviewed these people, they were remarkably healthy: they had decades long marriages, incredible communication skills, healthy families. And I realized that my initial assumption—that they were unhealthy—came from a place where I had allowed social and moral values around sexuality to intrude my clinical thinking. This is in part because I, and most therapists, had never had any good training around sexual diversity, or around sexual values.
I ended up writing that first book to really explore and understand the psychology of cuckolding and hot wifing. In that book, I described this one guy—I think he'd been married three times—who was really interested in his wives engaging in cuckolding. His wives didn't want to, but it was such a focus need for him that ultimately his marriages ended. In the book, I casually said it would be easy to diagnose this guy as a sex addict, but that I don't believe sex addiction is a valid diagnosis.
David: When that book came out, we started doing media around the book, and it was interesting because the media was more interested in talking about sex addiction than about issues of female sexuality and non-monogamy. I had all these media folks asking me why I didn’t believe in sex addiction.
So, I said to myself, other people seem to think this is real, let me dive into it. I spent about a year and a half reading all the literature I could on sex addiction and interviewing people around the world. I really went in with an open mind, questioning whether I was wrong. But I ended up arguing that the concept of sex addiction is the intrusion of social values and sexual morals into clinical practice. The myth of sex addiction is a pathological view of male sexuality, sexual diversity, non-monogamy, and non-normative sexual desire.
Jessie: Who is typically diagnosed with sex addiction? What is the history of the term?
David: First, it's important to recognize that the concept of sex addiction was introduced—and became popular—in the 1980’s during the HIV/AIDS crisis. As a world, as a society, we were terrified of sexual excess, of non-monogamy, of casual sex, of sex outside relationships, and of gay male sex.
There are a few populations that get called sex addicts. One is gay and bisexual men, because again, this concept was born when we were afraid of HIV. Many of the criteria—things like anonymous sex, hook-up sex, casual sex, cruising, kinky sex, frequent sex—are extremely common in the gay male community. It is not by accident, then, that gay men get diagnosed as sex addicts, according to the research, around three times more than anybody else.
The second very large group that we now know gets diagnosed as sex addicts—either by themselves or by somebody else—are people struggling with a moral conflict over their sexual desires. These are people who grew up in religious household or communities where they were taught that any sex other than hetero sex within marriage is a sin. They were taught to hate themselves for any sexual desire outside of this norm. As they struggle to control non-normative desires, they get labeled sex addicts.
Jessie: I feel like a lot of famous men have claimed to be sex addicts.
David: This is the third group: men who get in trouble for sexual behavior, typically infidelity, but sometimes criminalized sexual behavior, who are either called a sex addict or who self-identify as sex addicts to avoid responsibility for those behaviors.
Jessie: This is who I tend to think of when I hear the term.
David: Sometimes that is just a PR campaign. When former New York Governor Eliot Spitzer got caught in a controversy, his advisors told him that he should identify as a sex addict and go to what I call “sex addiction summer camp.” Interestingly, in his biography, he said that as a prosecutor he’s always held people responsible for their behaviors. He said something like, I'm unwilling to claim to be a sex addict as a way to get out of responsibility for these choices.
I mean, good for him. But we have lots and lots of other men who choose to call themselves sex addicts to escape from consequences or responsibility. We see this in men arrested for child pornography. We see it in men charged with sex crimes.
There are a lot of people who use that label to avoid responsibility or consequences. But there are also people who use that label because they've never been given the language or the option to be able to say, Look, monogamy isn’t right for me.
David: They identify their struggles with monogamy and sexual fidelity as a disease because that's oftentimes the only language they’ve been given.
Jessie: Is there a way that you try to help your clients see it in a different light?
David: One of the things that I work on is helping my clients with these issues understand that being unfaithful or struggling with sexual fidelity is not a disease, but it is often an expression of their sexual desires, their interests in sexual novelty, their personality.
Jessie: Perhaps a mismatched desires with their spouse?
David: Yeah, mismatched desires, mismatched libido, mismatched sexual interests. Unfortunately, the sex addiction model has promoted this idea that if you can't be happy with heterosexual monogamy, there's something wrong with you.
Jessie: Why do you think that non-monogamy is pathologized like this?
David: The church and religious institutions have an incredible influence and support the sex addiction model. Sex addiction and porn addiction are diagnosed, primarily, by religious therapists. There are more sex addiction and porn addiction therapists in more religious parts of the country [with a US context].
What we've seen, particularly with churches like the Church of Jesus Christ of Latter-Day Saints, is that they’ve outsourced management of sexual morality to sex addiction therapists. One of my colleagues has a fascinating story of a Mormon man coming to him after he had gotten caught having gay sex. His church leaders said, you can go and get sex addiction treatment and if you're a sex addict, then you can stay in the Church, but not if you are having gay sex because you are gay.
Jessie: They were threatening him with excommunication?
David: Exactly. Look at Robert Aaron Long, the killer in Atlanta. He had been in religiously-based sex addiction treatment—and identifies as a sex addict—and according to reports, killed the women he did because he saw them as a sexual temptation.
This message is endemic in religiously based sex addiction treatment: your sexuality and your sexual desires are external to you; you can't control their sexual desires; sexual temptations are something that you must fight aggressively against. The language in sex addiction and porn addiction treatment contains a tremendous amount of aggression. We see the same thing in conservative religious dialogue around sexuality.
Jessie: The women that Long killed were ostensibly sex workers. Do you think that the notion of sex addiction and whorephobia are intertwined?
David: The connection is quite deep. First, going to sex workers is a symptom of sex addiction, it is literally a diagnostic criterion in the sex addiction screening test that many therapists use.
Secondly, in this dialogue, sex workers are now framed as analogous to either a drug or a drug dealer which is objectifying and dehumanizes sex workers. They are self-destructive things that help people destroy their lives. Men are taught to blame their “relapses,” their desires, and their difficulty controlling themselves on the object of their sexual desire, which, again, comes straight out of that religious-based view of sexuality.
Jessie: Do you think there is a connection between these religious organizations that are pushing sex addiction and the ones who are pushing anti-porn and anti-sex work agendas?
David: Oh, absolutely. It is largely moral organizations who have funded and driven most anti-sex work campaigns historically, and that are driving the current anti-sex work, anti-sex trafficking, and anti-porn agendas.
Jessie: How do you think that this rhetoric around sex addiction impacts sex workers?
David: I've talked to several sex workers who described clients who have come to them saying things like, “I am really in my addiction right now,” or “Coming to you is a relapse.”
Jessie: Yes, I’ve had experiences like this with clients as well.
David: As a psychologist, when I hear this, I think, “Here is a guy who is using this concept to now pursue and express the sexual desires and interests that they don't feel they can otherwise.” In other words, identifying as a sex addict is a way to give up on exerting self-control and complying with the moral demand. Again, it is a way to absolve themselves from what they’re told is immoral, condemned behavior.
Jessie: Yeah. I think it's important that you say what they're told because it doesn't have to be that way. It could just be an activity that they want to engage in occasionally.
David: Yes, and that is the core problem with the sex addiction model: it encourages people to declare war on normal, healthy feelings and desires.
One thing we know about people is the more you tell them cannot do something, the more they want to do it. The very model of sex addiction treatment and fighting these desires may paradoxically increase them and give them more power.
Unfortunately, what we see in this framework is people getting trapped into a shame spiral because they feel bad about their sexual behavior and then continue the behaviors to make themselves feel better. And then they hate themselves even more and they feel even worse, and the only way they can change their feelings is to again engage in that sexual behavior, and on and on.
Interestingly, there's a research study in Canada that looked at the concept of behavioral addiction. I largely I don't endorse or support the concept of behavioral addiction—it’s a simplistic answer to a complex situation. But what this research in Canada found was that people who identify themselves as being a sex or porn addict got better within a year's time without treatment.
Identifying as a behavior addict was predicted by life stress. The more struggles people had in life, the more likely they were to identify as a behavior addict; these are adjustment disorders.
These are people struggling with something in their life, and they are using these sexual behaviors as a way to adjust and cope. Instead of looking at the issues that are driving the behavior, this sex addiction model sees the sexual coping strategies as the problem themselves.
Jessie: Yes, this makes a lot of sense. Is there any evidence that sex addiction treatment does any good?
David: After roughly 40 years of the sex addiction treatment model, there is absolutely no evidence that the treatment works. It's an incredible waste of resources. Health insurance, by and large, won't pay for sex addiction treatment so many of these facilities are engaging in incredibly exploitive behavior. Some charge up to $60,000 dollars a month for a treatment.
Jessie: Wow, and I imagine that many patients are paying these bills to protect their marriages or their reputations.
David: Exactly. These people are desperate because they're in trouble for their sexual behaviors. They're filled with shame and fear, then the sex addiction therapists come in and say, “Oh, we know how to fix it.” They have applied the addiction concept to turn a moral conflict into a disease. This insidious and awfully deceptive.
To hear Jessie and David talk more about the notion of sex addiction, you can listen to this Peepshow Podcast episode.