Addicts call it a God-sized hole, a hollowness in the soul. It leaks no matter how much they try to fill it -- and at what cost. For years, George filled his emptiness with pornography, erotic massage and, eventually, sex for hire. There was no tenderness. Even pleasure was rare because every time George engaged in his obsessive sexual behaviors, he felt dirty and even emptier than before.
Heavy with shame, he'd throw used magazines into Dumpsters only to swim through the trash days later to retrieve them. George reached his edge in 2000, when, after 100 one-night stands and losing $10,000 to sex, he was warned by an Oakland, Calif., prostitute that if he continued, he would wind up dead.
George is a fictitious name used to protect this Oakland graduate student's anonymity. The fortysomething has been a recovering sex addict for 12 years and is one of 12 million Americans who struggle with it, according to the American Association for Marriage and Family Therapists. His story is a critical one, and comes at a time when mental health experts are debating whether compulsive sexual behavior is a true addiction, and celebrities such as Tiger Woods and Jesse James are rumored to be in treatment for their serial affairs.
It is likely that the term hypersexual disorder -- not sex addiction -- will appear in the updated version of the Diagnostic and Statistical Manual of Mental Disorders, the psychiatric Bible, due out in 2013. According to Ken Zucker, a Toronto psychologist and chair of the DSM subcommittee on hypersexuality, the proposed term is neutral enough to address all theoretic perspectives on compulsive sexual behavior, including addiction, and open doors for critical research.
The proposed diagnosis would apply to people who, for a period of six months or longer, meet at least four of five criteria, including engaging in repetitive, intense sexual fantasies, urges and behaviors in response to stress, anxiety or depression and without regard for physical or emotional harm to themselves or others. Also, they try to stop and are unsuccessful.
"I was a junkie," says George, who ended up in a 12-step program after he hit rock bottom: seven sexual encounters in seven days. His girlfriend of four years found out and left him. "I was using sex as a drug and couldn't stop."
Marriage and family therapist Don Mathews has been treating sex addicts at his Impulse Treatment Center in Walnut Creek, Calif., for 25 years. "I've had cocaine addicts tell me the drug high is very similar to the high they get from their sexual acts," says Mathews, whose treatment model is based on individual depth counseling and group therapy. All addiction, he says, is about escape from the pain and unmanageability of one's life.
To the nonbelievers, Mathews says this: "What else do you have to offer? Most of our clients who come to us for this have tried other treatment forms and were unsuccessful. Sex addiction is a label they can identify with and read about."
NOT ALWAYS ADDICTED
In the addictive process, substances and behaviors numb the pain until the reliance becomes emotional -- and physical. Fleeting pleasure is replaced by survival and dependency on the neurochemical reactions produced by the behavior. "All of this flourishes behind a mask of secrecy and lies," Mathews adds. If someone has an adulterous affair, hits a strip club, or makes a bad choice about sex, it doesn't make them an addict.
Rather, addicts become preoccupied with sex -- from compulsive masturbation to voyeurism and serial affairs -- despite mounting negative consequences, Mathews says. When they do have sex with a partner, it is often objectified, body-part sex that is void of intimacy. Research suggests a variety of reasons for sex addiction, but early physical or sexual abuse and a shame or guilt-based upbringing are recurring themes, according to Mathews.
"When a person is shamed, they psychologically lose their voice," he says. "They become conflict-avoidant and their basic needs and feelings go underground." As a result, sex can become the prime coping mechanism to escape bad feelings and tolerate the emptiness.
"My world got really small because nothing compared to the pursuit of sex," recalls Boston-based author Benoit Denizet-Lewis, who chronicles his sex addiction and recovery in "America Anonymous: Eight Addicts in Search of a Life" (Simon & Schuster). Addiction cost him friends and relationships. And, after two stints at inpatient treatment centers, Denizet-Lewis still struggles, he says.
"It's tricky, because, unlike drugs and alcohol, the goal here is not lifelong abstinence," he says. "The goal is to relearn to have sex in a way that is sane and doesn't destroy your life."
Marty Klein, a Palo Alto, Calif., psychotherapist and certified sex therapist, has been helping people understand their sexual behavior for 30 years. He thinks sex addiction is bogus. True addiction, he says, occurs when a person develops a physiological reliance on a substance, like drugs or alcohol, and there is a shift in the body's ability to metabolize it.
"I don't see sex addicts," Klein says. "I see people who use sex in destructive ways. I don't necessarily think that they're out of control. They really hate the consequences of their decision-making, and they keep doing it."
Before Patrick Carnes' mid-1980s book, "Out of the Shadows," which coined the term sex addiction, Klein says mental health experts used obsessive-compulsive disorder or bipolarism to discuss and diagnose a person's behavior that was not in line with their values.
But, what if sex takes over one's life? Klein's not budging. "That's terrible," he says. "It's like when work becomes your whole life or when shopping or redecorating becomes your whole life. Psychodynamically, it's the same thing."
According to Klein, if we label these behaviors as addiction, it pathologizes human sexuality, which lacks a one-size-fits-all model, and waters down the weight of all addictions, he says. "If you go to the bank right now and ask everyone what's wrong with Tiger Woods, they'll say he's a sex addict," Klein explains. "If you want to change the definition of addiction, then come right out and say that. But then the word becomes a blunt instrument in the hands of lay people."
George, who was sexually abused as a child, says he did not have power over his behaviors and that just because he calls it sex addiction doesn't mean he's trying to pathologize sex. "My addiction is about disengaging, so recovery is about learning how to connect with people," he says. "It's real."
There was no abuse in Jason's childhood, but the 49-year-old San Francisco counselor, who also used a fictitious name to protect his anonymity, grew up in a home where talk of sex was discouraged, he says. "Ever since I was 12, I was desperate to have sex, but didn't know what it meant," Jason says.
He lost his virginity at 19 to a girlfriend and recalls feeling hyper aware of when and how they would be sexual. As an adult, Jason became a voyeur, peeking in windows, dressing rooms and women's bathrooms. He masturbated to pornographic magazines several times a day and never told a soul. He was far from a ladies' man type, he adds. He was shy. He had low self-esteem. What he became addicted to was the hunt, he says.
"I just had a lot of repression around real sex with a human being," Jason says. "I couldn't talk about anything related to my feelings. It's like there was nobody home in me."
HELP IS OUT THERE
In 1997, Jason found solace in Sex Addicts Anonymous, a fellowship for recovering addicts based on the 12 steps of Alcoholics Anonymous. Recovery is spiritual, and addicts work with sponsors to personalize their goals and boundaries. For Jason, that meant abstinence from masturbation and Internet pornography. Years later, he has sponsored 20 people and is doing arguably well. He has been happily married for eight years and says he isn't interested in the current debate around his disorder.
"Is it compulsion? Is it addiction? Who knows?" he says. "The bottom line is that since I've found SAA and done the depth work, I've been able to deal with my issues and my behaviors have become less frequent. Debates around the science of sex addiction are distracting to recovery."
• The Society for the Advancement of Sexual Health. This nonprofit organization's mission statement is to promote public and professional awareness and understanding of addictive and compulsive sexual behavior and its associated negative consequences. For educational materials and referral resources, visit www.sash.net .
• Sexed.org. The online home of Marty Klein, a psychotherapist, certified sex therapist, and author of six books on sexuality. Klein is outspoken about the political and social conditions that keep people from healthy sexual expression. He believes that sex addiction is bogus. He blogs at sexualintelligence.wordpress.com and pens a newsletter by the same name.
• Impulse Treatment Center. Founded in 1985, ITC offers treatment programs for sex addicts and their spouses. www.sexaddicttreatment.net .