Not the appropriate time, you might think, for a discussion about sex. Or maybe it is. Who knows. Funny, that was the prevailing theme of the talk I’d arranged at Walnut Creek Library, within its Las Trampas room, overlooking Broadway street. It was a bright, sunny early fall morning today. Few showed up—only four—to discuss an article in the latest issue of The Therapist, which rather decried the sex addiction treatment industry, which I was looking to promote.
One of my gigs is with a small agency in WC called Impulse Treatment Center, which for thirty years has provided group therapy for men primarily, who struggle with sexual behaviors that disrupt their lives: porn use, prostitution, visiting strip clubs, sexual massage establishments, and so on–behaviors that fit a distinctly masculine stereotype. In theory, there are female sex addicts also, but how they are manifesting is one of the unanswered questions blocking the admission of a sex addiction-like diagnosis into the APA’s Diagnostic Standards Manual (DSM-V)
I passed out some assessment tools that are used in intake processes, referring to the Sexual Addiction Screening Test (SAST) as designed and (somewhat) evolved by Patrick Carnes over the last twenty years, but focusing on a new tool called the HBI-19. This Hypersexual Disorder Inventory tool, designed by researchers at UCLA, aims less at a list of behaviors as it does an individual’s internal experience of sexual activity. The specific behaviors that are commonly associated with sex addiction are not even indicated on the HBI-19, inclining the observer to consider a more subjective understanding of a problem.
Unlike some, I’ve no problem with this, for it seems to me that assessing addiction based upon criteria of specified behaviors, or the frequency of said behaviors, misses the point of assessment. Currently, and all too often, addiction is determined via an externalized focus. What do I mean? I mean that addiction (and therefore treatment) tends to be considered when individuals cross certain thresholds: when they’ve broken the law, or been discovered by a spouse or partner—when they’ve been exposed, which presumably constitutes the loss of control watershed that so many cite as their hitting bottom experience.
Others might assert that problems exist because sexual behaviors cause conflict with values, thus leading to depression, low esteem, and social isolation. A recognition of these factors is promising as far as treatment is concerned. The more an individual’s motivation is internal—that is, not defined or mandated by others—the more available an individual is for an authentic therapy experience, whether that episode is with an individual practitioner or a group of peers.
Yet the internal motivation of those seeking care is precisely what is being attacked in some quarters. Jay Blevins, the author (or editor—it’s not clear) of the article “How concepts of sex and porn addiction are failing our clients”, asserts that “sex negative forces” (what a term!) in the sex addiction treatment field, headed by the likes of Carnes, incorporate scare tactics about ‘unsafe’ practices, and moral judgements derived from religious values, which further a homophobic (but not anti-male?) social agenda.
Blevins makes a good point that the purported medical consequences of extensive porn use (such as erectile disorder) are not supported by scientific data, but the term addiction was never intended to be used as a medical term—for that we have the term dependence. Addiction is a cultural term, drawing attention to a psychological or–as the 12-step community asserts–a spiritual problem. Whether personal distress is generated from an internal examination versus an oppressive assimilation of institutional mores, as people like Blevins assert: that’s for each person to decide.