Media requests have prompted The National Council on Sexual Addiction and Compulsivity (NCSAC) to prepare this position paper relating to President Clinton's reported sexual behavior. Reporters and others have asked professionals associated with NCSAC whether they think Clinton is sexually addicted and for information about sex addiction. While it may be tempting to diagnose a public figure's problems based on hearsay frommedia accounts, accurate assessment requires a face-to-face evaluation of the individual and knowledge of the circumstances surrounding the behaviors.
Many psychiatrists and some addiction specialists do not accept the idea that a behavior can be addictive. They use other diagnoses to describe out-of-control sexual behaviors - such as paraphilia, impulse-control disorder, or personality disorder. We believe that in many cases of repetitive problem sexual behaviors, the addiction model readily explains apparently irrational behavior, is easily understood by patients and family members, and leads to effective treatment.
Many behaviors can be normal in most people but addictive in others. Addiction is a concept that traditionally was applied only to out-of-control use of alcohol and other drugs. Now however, the term addiction is routinely used to describe and diagnose behaviors such as gambling, overeating, and sex when they are out of control. To addiction specialists familiar with these behaviors, the parallels with use of alcohol or other drugs are obvious. In many cases, addiction treatment has been successful when "will power" or traditional therapy has failed.
The key elements of any addiction, whether chemical or behavioral are:
1.Compulsivity- meaning loss of control over the behavior - i.e. continuing to engage in a particular behavior after repeated attempts to stop.
2.Continuation despite adverse consequences, such as loss of job, money, marriage, or health - or arrests or public humiliation.
3.Preoccupation or obsession with obtaining and using the substance or participating in the behavior to the detriment of other essential life activities or goals
Addictions are defined not by how much of the drug or behavior is used, but rather the effects on the person's life. An addiction can be suspected when the behavior has made the person's life unmanageable. Some clues regarding sex addiction are:
1.The problem behavior is not an isolated occurrence; there is a pattern of this behavior over a significant time span.
2.Despite a previous significant adverse consequence, the behavior is repeated. Sexual decisions do not appear to be made on a rational basis.
3.Increasingly greater risks are taken over time. For example sexual encounters may initially take place only out of town, but later closer to home.
4.The person denies to him/herself and others that there is a problem when it is evident to others, utilizing minimization, rationalization and justification to continue to engage in their behaviors while trying explain the problem away.
For the sex addict, sexual behaviors that are secretive, illicit or dangerous carry an even greater internal experience of intensity or arousal (high)which thus encourages irrational choices. This is no different than the compulsive gambler who will gamble far beyond his/her limit to do so, aroused and distracted by the intensity of the process. Some sexual behaviors that may represent an addictive disorder are:
1.Multiple extramarital affairs
2.Using a position of power to gain sexual access to multiple partners.
3.Use of prostitutes, escorts and sexual massage
4.Indecent telephone calls
5.Excessive expenditure of time and money on pornography/cyber and phone-sex
6.Multiple anonymous sexual encounters
7.Touching others without permission
The majority of sex addicts, like most other addicts, have had parents or other significant family members with histories of alcoholism, drug dependency, abuse or other significant family dysfunction. Often they are sexualized or exposed to sexual experience at an early age. This type of history works to distort their adult relationships and can encourage the isolation and superficiality, which is a hallmark of addictive disorders.
Effective treatment for Sexual Addiction involves the same approach as for any other chemical or behavioral addictions. The process brings the addicted person out of their distortions and denial forcing them to realistically confront themselves and the damage their behaviors have caused. Family members must be involved in the process, learning the full reality of the Sex Addicts disorder. There are numerous 12-step recovery programs, similar to Alcoholics Anonymous, which help the Sexual Addict to learn to live and cope in a more honest and healthy manner. Treatment is best provided by a specialist in behavioral addictions, as traditional psychotherapies are not thetreatment of choice. Most major metropolitan areas have such outpatient specialists and there also are national treatment centers throughout the United States with specialty programs in Sexual Addiction.