The harm of the 12-step 'sex addiction' approach

I started the year 2020 speaking with Dr Joe Kort as a guest of his world-renowned podcast Smart Sex Smart Love about the potential harm of ‘sex addiction’ treatments.

The notion of ‘sex addiction’ and ‘porn addiction’ has been consistently rejected by the scientific communities worldwide because of the lack of evidence supporting it. A new study published in December 2020 by Grubbs et al. made a ground-breaking independent review finding that the research methodology used in supporting ‘sex addiction’ and ‘porn addiction’ over the last 25 years was poor, further questioning the validity of the conceptualisation of ‘sex addiction’.

The ICD-11 (International Classification of Disease) only endorsed ‘compulsive sexual behaviours disorder’ (CSBD) as a psychological condition. WHO (World Health Organisation) clearly states that CSBD is completely different from ‘sex addiction’ and these two terms must not be interchangeable.

This is important because clinicians offer treatments that are congruent with what they label the condition they are attempting to treat. A therapist believing in ‘sex addiction’ is more likely to offer a treatment through the primary lens of addiction, despite the science not supporting it. It is when clients can be in danger of inappropriate treatment because their sexual behaviour struggles might be seen through the therapist’s own window of morality, rather than through the evidence-based knowledge of modern clinical sexology.

Despite the science, there are still fierce disagreements and much confusion amongst clinicians. What is important to me is to alert the public affected by sexual compulsivity that they have choices about their psychological treatments.

If you struggle with unwanted sexual behaviours that cause distress, please know that the ‘sex addiction’ conceptualisation is not the only way to think about your problems. A ‘sex addiction’ treatment and 12-step support groups are not the only choices. They are not the scientifically approved choices either.

Why do I keep talking about it?

Because I am concerned.

As a result of the podcast with Dr Kort, unfortunately, I finish the year 2020 having heard stories from numerous people in the UK and Europe telling me about being traumatised by 12-step support group programmes, and by ‘sex addiction’ treatments. It is heart-breaking to hear so many people who originally struggled with sexual behaviours ended up feeling worse after their treatments. The common self-report from the victims of such treatments is feeling more shamed and more depressed about themselves and their sexuality than before. It is the dark unspoken side of the ‘sex addiction’ conceptualisation.

Many sexual practices that are non-monogamous, unusual, or even extreme may actually be functional and harmless, but may be wildly misunderstood by therapists who have poor knowledge of the current sexology science and therefore might unduly pathologise their clients, which creates more harm for them.

I heard on numerous occasions that people practicing BDSM (Bondage and Discipline, Dominance and Submission, Sadism and Masochism) were told that they were ‘addicted to BDSM’, which is grossly inaccurate.

Many were told to be afraid of their sexual thoughts and fantasies as they were ‘triggers’ to avoid when in fact these were normal processes and responses to common sexual stimuli.

A majority were told that watching pornography was bad, a piece of advice that is not clinically supported by the large body of research which found that pornography in itself has no impact on people’s mental and sexual health.

All of the misinformation mentioned above – and more- perpetuated by the ‘sex addiction’ ideology only encourage people to be erotically avoidant thus creating more problems for them. Many of the strategies employed by the people subscribing to the ‘sex addiction’ concept are in danger of doing accidental ‘conversion therapy’.

‘Conversion therapy’ is the practice underpinned by the belief that sexual behaviours must conform to a strict concept of heteronormativity. Sexual behaviours outside of that heteronormative ideology is deemed a ‘disease’ that must be cured, or something undesirable that should be changed. In its original form, ‘conversion therapy’ is typically a practice attempting to ‘cure’ homosexuality. ‘Conversion therapy’ is now considered unethical in the UK and it is banned in some other countries because of the significant psychological harm that it inflicts on people.

As you can imagine, within the wide spectrum of sexuality, many people who self-identify as heterosexual and who also have specific kinks or fetishes may be in danger of ‘conversion therapy’ disguised under the 'diagnosis' of ‘sex addiction’. For example, many people practicing BDSM consider it as an integral part of their sexuality. If a therapist calls it an ‘addiction’ and attempts to change it, they might be doing accidental ‘conversion therapy’. I call it ‘accidental’ because I believe that most ‘sex addiction’ therapists in the UK want to help clients with the best intention, however, due to poor or inadequate clinical trainings, they might not be aware that the therapy they offer can cause harm, and they might not know what to do differently.

People struggling with their unwanted sexual behaviours actually need the opposite interventions. They need help to face their erotic world, being fully erotically-aware whilst learning to manage their emotions. They need support in examining the functions of their sexual behaviours and what the underlying precipitating and maintaining issues are, instead of staying focused on stopping the symptoms. With thorough erotic-awareness, and a sexology-informed treatment, sexual compulsivity dilutes and people can start to make the right choices for themselves and the partners they choose to commit to.

A psychological treatment is not supposed to induce shame and depression. I heard many people tell me that after a 'sex addiction' 12-step programmes and/ or therapy, they felt suicidal for the first time in their lives. Some became acutely fearful of their erotic world, fantasies and ability to relate to others, freezing in sexual situations. To me, this is not a good outcome of therapy or support groups. Many of these people spoke to me in confidence. Although I have permission to write this blog, they would not speak up about their experiences themselves because of shame. Many told me that they were blamed for not following their ‘sex addiction’ programme.

If it had been one or two people reporting such things, I would really not think much of it. But the great number of people telling me similar stories is concerning. In our psychotherapy field, the terms ‘sex addiction’ and ‘porn addiction’ are not challenged enough.

There are many unheard voices who are alerting us of the great potential of harm, I think it is important that clinicians continue the conversation Dr Kort and I had, and to continue challenging the ‘sex addiction’ field, because, after all, we all have to be held accountable for the therapy we offer, and all of us must uphold our first ethical pledge: First, Do No Harm.

If you’re a therapist wanting to learn how to treat compulsive sexual behaviours efficiently, safely and ethically, please contact CICS , the only UK Institute offering a Diploma level course teaching the sex-positive, evidence-based treatment going beyond the reductive ‘sex addiction’ thinking.

Silva Neves

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