Summarising the Sex and Porn Addiction Debate

It would be safe to say that the concepts of sex and porn addiction are controversial in the field of sexology. The debate is strongly polarised between professionals who absolutely assert that sex and porn addictions exist and those that as vociferously state that sex and porn are not addictive.

No-one denies that clients access therapy for help with sexual behaviours they feel they have no control over. The issue is what label these behaviours are given.

The debate is driving research, which is generally a good thing in any professional field. However, both sides refer to research to support their positions and, in some cases, the same research is used to support both sides of the debate. Neither side is persuaded by the other.

At CICS we have close, respected colleagues and friends at both ends of this debate. 

We are a client centred, pluralistic school, which means that we honour a range of perspectives, with our main interest being in identifying approaches that help clients the most and harm them the least.

The Anti-Sex and Porn Addiction Position

 Our colleagues who assert that sex and porn are not addictive make the following points;

• The World Health Organisation did not find sufficient data to support a diagnosis of sex addiction in the ICD 11. Instead WHO included diagnostic criteria for Compulsive Sexual Behaviour Disorder (CSBD) in the ‘Impulse control disorders’ section of the ICD 11 and not ‘Disorders due to addictive behaviours’.
• Meeting the criteria of a CSBD diagnosis is difficult, particularly as the ICD 11 specifically states that ‘Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.’
• The Medical Services Advisory Committee stated that ‘materials in the ICD 11 make very clear that CSBD is not intended to be interchangeable with sex addiction, but rather is a substantially different diagnostic framework’ in their role as advisors to WHO in the development of ICD 11. 
• The American Psychiatric Association did not include any diagnostic criteria for sex addiction, porn addiction or sexual compulsivity in the DSM 5.
• The American Association of Sexuality Educators, Counsellors and Therapists position statement on sex addiction is unequivocal:

AASECT recognizes that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors. AASECT recommends that its members utilize models that do not unduly pathologize consensual sexual behaviors. AASECT 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.

• The conceptualisation of sex and porn as addictions shames and pathologises people with diverse sexualities, particularly gay men and people with kink preferences. Joe Kort, Dominic Davies, Marty Klein, Dr David Ley and Silva Neves.
• Research does not support the existence of sex or porn addiction and the research used to support the addiction conceptualisation is flawed. Dr Justin Lehmiller, Real Brain on Porn and Dr Nicole Prause.
• Language matters. Using the terms ‘sex addiction’ and ‘porn addiction’ without diagnostic criteria misleads the public. The term ‘compulsive sexual behaviour’ is current and in line with diagnostic criteria, in the same way as ‘erectile disorder’ is now preferenced over ‘impotence’. The MSAC clearly state that the terms sex addiction and compulsive sexual behaviour disorder are not interchangeable.
• Addiction therapy approaches such as abstinence and 12 Step Programmes are tantamount to sexual orientation conversion efforts, especially for gay male clients and clients with kink preferences.
• Sex addiction texts and services do not distinguish between consensual sexual behaviours and sex offences. This places two very distinct client groups with different therapy requirements in the same category.

The Pro Sex and Porn Addiction Position

Our colleagues who support the concept of sex addiction raise the following points;

• The inclusion of CSBD in ICD 11 under ‘Impulse control disorders’ is a move towards it eventually being placed in the ‘Disorders due to addictive behaviours’ section of the ICD, following the same process as Gambling Disorder. Laurel Centre
• Sex and pornography are behavioural addictions and share clinical, genetic, neurobiological and phenomenological parallels with substance addictions. Your Brain on Porn, Dr Kraus, Laurel Centre.
• Contemporary UK approaches to sex addiction do not shame or pathologise people with diverse sexualities. The Association for the Treatment of Sex Addiction and Compulsivity (ATSAC), was founded by COSRT Sex and Relationship Therapists who bring a sex therapy approach to their work.
• The term ‘addiction model’ is being used as short hand for abstinence and 12 Step programmes which is not an accurate reflection of contemporary addiction approaches. UK based sex addiction therapists use a wide range of interventions to support their clients, with abstinence and 12 Step programmes only being offered if and when a client may find them useful.
• Regardless of the chosen descriptor, both sides of the debate work with the theme in similar ways, resolving trauma, affect regulation and attachment patterns.

At CICS we prefer the term ‘compulsive sexual behaviour’, as this language is closest to the confirmed diagnostic criteria currently in place. On our Online Diploma in Compulsive Sexual Behaviour course we don’t teach the addiction framework, as our sex addiction colleagues have that covered. We teach a contemporary sexology based, sexual health approach to working with compulsive sexual behaviours, that focuses on an exploration of the client’s erotic template and the drivers behind their compulsivity, rather than on behavioural prevention. We absolutely separate consensual compulsive sexual behaviours from sex offences. These client populations are distinct and require different treatment approaches. StopSo is the go to organisation for trainings on working with sexual offending.

The CICS pluralistic perspective is that no one approach works for all clients. Some clients respond better to CBT than to Psychoanalysis – and vice versa. Some respond better to a non-addiction approach to sexual behaviour problems than to an addiction approach – and vice versa. Bias is inevitable in both clients and clinicians. A fundamentalist adherence to ‘one right way’, however, can and must be avoided.