The term "sex addict" has been used as a punch line on television so often that it's hard to believe that it can actually be a serious addiction, like alcoholism. So when "X Files" star, David Duchovny, announced last week that he was entering rehab for treatment of a sexual addiction, it almost seemed like a fictional plotline for the Showtime series "Californication," on which Duchovny plays a sex-obsessed single dad. But for those affected, the ramifications of a sexual addiction are all too real, often leaving marriages, careers and bank accounts in ruins. For celebrities who are contending with sexual problems, there's often the added humiliation of having their difficulties made public. This summer, the tabloids were filled with lurid stories of out-of-control spending on Internet porn by Peter Cook, husband of model Christie Brinkley. And of course, in Hollywood, tales of actors risking their reputations by picking up street prostitutes are too numerous to mention.
What exactly constitutes a sexual addiction? It's generally described as obsessive sexually related behavior that dominates the addict's life. The compulsive behavior can range from obsessive use of pornography or promiscuity, to use of prostitutes or even sexual violence. Still, the notion that people can be clinically addicted to sex is controversial. Sex addiction, is not recognized by the American Psychological Association as a diagnosable disorder; and when news breaks of yet another philandering celebrity or politician, the public is likely to assume the person is suffering from an extreme case of caddishness rather than a bona fide illness. To learn more about how sexual addictions are treated and diagnosed, NEWSWEEK's Susanna Schrobsdorff spoke to Jill W. Bley, a clinical psychologist and sex therapist in Cincinnati. Excerpts:
NEWSWEEK: The term "sex addiction" isn't universally accepted among psychologists, is it?
Jill Bley: It's been controversial in our field. There's one group of people who have researched this who say that label can only be applied when there's a substance involved. They wouldn't talk about a gambling addiction; they would talk about compulsive gambling behavior. Those of us who do the clinical work, we don't care what you call it. We look at the behavior. I may tell someone they have an obsessive-compulsive sexual need. The only time the label makes a difference is if you go to court or justify something with an insurance company—then you call it obsessive-compulsive behavior.
Some people see the sex-addict label as just an excuse for a guy who cheats. What's the difference between someone who needs psychological help and someone who is just a jerk?
Some are jerks. But there's a huge difference between someone who's cheating and an addict. A person who has a sexual addiction is engaging in obsessive-compulsive sexual behavior, which causes severe stress to the addicted individual and their families, and over which they do not have control.
The statistics say that more men get help for sex addiction than women. Is there a difference between male and female sex addicts?
Male and female sex addicts are pretty much the same. Women tend to get into love addictions more, though men sometimes do too. [A love addiction] may look like a sex addiction, but what they're really in it for is the high of being adored, getting attention. Women may feel they are only valued for their bodies, so they use their bodies to attract attention or love.
Are there men who say urges are normal male biology and that they can't help pursuing sex all the time?
Sometimes it is the thrill of the chase, which is normal, but not if the pursuit becomes compulsive. This one person I work with, he had about 40 women that he was involved with. He had four cell phones. He'd give different women the numbers so he could figure out which woman was calling and keep them separate. He would tell me all the time, "I can't help it. Women are hitting on me wherever I go; I get on the plane and the flight attendant starts coming on to me." This man even said that my secretary was hitting on him when he came in for a therapy appointment, and I can say definitely that she wasn't.
Are these people unusually egotistical?
There's a lot of narcissism and arrogance with people like this. In therapy you have to help them confront that. They feel like the world revolves around them. But that's really a shield, a protection for an ego that was damaged as they grew up.
Does the kind of guy you were talking about succeed with women, if everyone isn't actually hitting on them as they think?
These kinds of men do get women because they're smooth talkers and they can be very charming. They make women feel like they're the only one, even when she's not. Secrecy is very important—that's a big part of the thrill for them.
That risk-taking thrill sounds like some of the politicians who have been caught up in sex scandals.
Yes. People wonder why [those sorts of] men … would risk everything. What it is, is that they get addicted to the adrenaline flow. The riskier it gets, the more adrenaline they get. Like all addictions, the more they get, the more they need. It may seem stupid from the outside, but that's not what someone is thinking when they're caught up in the addiction cycle. It starts with a preoccupation—they're thinking and thinking of whatever their sexual compulsion is. Then they move to the next level of the cycle, which we call ritualization. It's whatever activity they do that they think will help them find what they're addicted to. Once they get to that second stage, they're probably going to go all the way. They'll get in the car and drive toward a strip club or the street where they pick up prostitutes. Afterwards they may be very ashamed. But eventually the cycle will start all over again.
What makes them seek treatment?
Usually, it's because they get caught. Or the addiction is making it impossible for them to function.
How do you help them stop that cycle of addiction?
We try to help them stop when they are in the thinking-about-it stage, the preoccupation stage. That's when we say, "You have to call your sponsor." The other thing is that there have to be no secrets, not from their sponsor and not from their significant other. It's part of the intimacy work they have to do with their partner.
That sounds like Alcoholics Anonymous.
The treatment is somewhat different from alcoholism or other addiction treatments, yet very much the same. The first step is to acknowledge the problem. Then, if they work the 12 steps to recovery, they will go to 90 [group treatment] meetings in 90 days. It's important that they get a sponsor, too. That's the person you call for the purpose of helping you not act out sexually, and also help[ing] you work through the stresses and anxiety that lead to acting out sexually. Sometimes treatment means checking into a rehab center so [patients] can get out of their normal environment and habits.
But you can't give up sex forever the same way you can give up alcohol, can you?
When they start the process I will ask them for six weeks of total abstinence. Not even masturbation. It's really hard for the addicts, but you can't do anything till they get sober and abstinent. We have their partner agree. During that six weeks, the anxieties that led to the sexual acting out usually become very apparent to the therapist and the partner. Those anxieties are what you want to work on. Then after the six weeks you have them work on having all their sexual behavior directed toward their partner.
And after that?
A huge part of the treatment is to look for the trauma in the person's life that is creating the stress. You want to get at the cause and reprocess what has happened to them. Most of them have been victims of some kind of emotional abuse as children. That means having a parent who derides you, constantly criticizes you or calls you names. And 81 percent of those who come for treatment have been sexually abused, 73 percent physically abused. Most of them deny their abuse history. Or they might not remember it until they've been in therapy for a while.
Does insurance cover treatment for sex addictions?
No, not usually. But patients are often able to work out a payment plan.