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.