Sex addiction has come out of the closet.
Once spoken of in hushed and skeptical tones only, sex addicts have become the subjects of memoirs and movies ("Choke," "Black Snake Moan"). Characters defined by their uncontrollable bed-hopping now pop up on prime-time television shows like "Nip/Tuck." In the recent much-publicized case of life imitating art, David Duchovny, who plays a serial adulterer on the cable series "Californication," completed treatment for a sex addiction that he says broke up his marriage to Tea Leoni.
As addictions go, sex is the last frontier. It's the one people doubt. The one people say is just an excuse for bad behavior or a shame label pasted on the promiscuous by moralizing prudes. The one you can still make fun of without a pinch from the PC police. Health experts and therapists are divided as to whether it exists; sex addiction is not recognized by the psychiatric bible, the DSM (Diagnostic and Statistical Manual of Mental Health Disorders).
Recovery centers aren't waiting for the official word. Sex Addicts Anonymous has at least 39 Minnesota chapters -- several formed in the past five years -- and 900 worldwide. The often-cited statistic that 3 to 5 percent of the population could be considered sexually compulsive is based only on those who voluntarily seek treatment.
Robin Cato is more aware than most of sex addiction's recent pull on the national psyche -- or at least talk-show producers. As director of the Atlanta-based Society for the Advancement of Sexual Health (SASH), she gets frequent calls from radio and television employees.
"They say, 'I need a sex addict to interview in 30 minutes, and we need to fly him in this morning,' " she said (a request she doesn't accommodate).
For obvious reasons, sex addiction makes for titillating TV in a way that the now much-discussed topics of alcoholism, drug abuse, eating disorders and obsessive gambling do not. It's also major joke fodder, Will Ferrell's character in "Blades of Glory" being just one example.
"When something is laughed at and talked about on television, it means it's on people's minds," said Cato, who sees signs that acceptance is advancing in the public admission of Duchovny and its aftermath. "He came out and said what he was getting help for, and there was a lot of attention, but people accepted it because they either know about it personally or know someone else who's affected by it. It's turning less slap-down hilarious, into something people want to talk about."
While academics and therapists don't agree on whether to call it a disease or a compulsive disorder, most do generally define the problem in the same way, said Anne McBean, a psychologist and therapist who coordinates treatment for compulsive sexual behavior at the Program in Human Sexuality at the University of Minnesota Medical School.
"It's not about liking sex or being sexual a lot or what kind of sex a person might choose," she said. "It's about having an obsessive and driven relationship with sex, constantly telling yourself you're not going to do this anymore but you do it, with repeated negative consequences that most people would learn from and adjust their behavior."
Stereotypes of sex addicts fall into three categories, she said: "fools, like Sam on 'Cheers,' slobbering freaks, or monsters -- the sex offenders."
In reality, they come from all walks of life. The men whom McBean treats are often devoted husbands and fathers, well thought of at work, including doctors, professors, lawyers, plumbers -- "people with good enough jobs to have insurance coverage," she said. "For many of the people I work with, the biggest fear is if they tell someone they have a sex-addiction problem, they will be shunned and their children will be taken away."
The U's Program in Human Sexuality runs four sex-addiction therapy groups of eight men each, all there voluntarily. For about 80 percent of them, the Internet is the primary source of the problem.
"It's like slot machines are for the gambling addict -- anonymous and affordable," McBean said. "A whole lot of people who didn't have a problem before have one now, or if they had a moderate problem, it got a lot worse. "
Women and sex addiction
Two new memoirs, Susan Cheever's "Desire: Where Sex Meets Addiction" and Rachel Resnick's "Love Junkie," show that while most people who seek treatment are men, a growing number of women -- including those 40 and over -- see themselves as sex addicts.
"Most women we see come from more troubled backgrounds than the men," McBean said. "It's more acceptable for women to be compulsive with food or shopping, but with sex, the condemnation is universal: She's a slut. For a man, it's 'Boys will be boys,' or 'What a man!'"
Men are more likely to engage in obsessive activities that don't require a real-life partner, such as looking at porn, she said. "The way women act out sexually tends to be more partner-oriented, like meeting up with men they talk to on chat lines. They are more likely to understand that what they're doing is searching for love, but there's also that sense of emotional high along with sex that men also feel."
Because sex addicts are dealing with a behavior rather than a substance, withdrawal can be especially difficult, McBean said: "Just like a person with an eating disorder can't stop eating, the ultimate goal for a sex addict is a healthy sex life, not abstinence."
Sex addicts often have multiple issues, including depression and substance abuse. Treatment usually includes a combination of individual and group therapy, anti-addiction drugs such as Naltrexone and some form of the 12-step recovery process.
So far, there hasn't been much precise data gathered on sex addiction, because it's difficult to find funding for studies.
"National health institutes will fund areas in which they see a clear link to health, like AIDS research, and they're not seeing it in this case," McBean said. "But there may eventually be funding for Internet porn use, because it's so disruptive to businesses."
Kristin Tillotson • 612-673-7046