How Do You Define 'Sex Addict'?

"I think I am a sex addict." John is a new client. He is 43 years old, gay, successful, and likable. He tells me he has a stable job, owns his own condo, and has an active social life. John also tells me that he spends hours at a time on social media hookup apps like Grindr and Scruff seeking anonymous sex. John acknowledges he was ambivalent about coming to see me and that he doesn't like the label of "sex addict." I tell him that this is understandable.

The word addiction generally conjures up images with which we all are familiar. A bottle of vodka. A needle. A handful of pills. But when you say the words "sex addiction," the images are not so clear. The term "addiction" in regard to sex is clumsy at best and has led to years of arguments among mental health professionals about whether it is or isn't a real addiction. Some therapists prefer sexual "compulsivity." Others shy away from any definition at all for fear they will appear sex-negative, believing that the entire concept demonizes any out-of-the-box sexual behavior (such as swinging, BDSM, polyamory, etc.)

So it's important to look at the basic definition of any type of addiction. Addiction is the repeated, compulsive seeking of a substance, thing or activity despite negative social, psychological, and/or physical consequences. This is a pretty broad classification, but the basic point is that whatever you are doing is creating some measure of havoc in your life.

For John, the impact of his online cruising and hookups was minimal at first. He might stay up late a night or two and be tired at work, but otherwise he was a reliable employee. He spent time with friends and was a boot camp devotee.

Over time, however, he found himself more and more drawn to the chase. He would glance at his phone during dinners with friends, checking to see if anyone had messaged him. He got gonorrhea from one of his anonymous encounters and chlamydia from another. He started to cancel plans and take sick days from his job. He was having sex three or four times a week with anonymous partners. He admitted that eventually his anxiety about sometimes not being able to find a sex partner was so great, he turned to hiring escorts or getting sensual massages.

The LGBT community, particularly the subsection that is gay and bisexual men, fought long and hard through the late sixties and seventies for the right to embrace and celebrate our sexuality. We came out of the shadows to express it in all its beautiful forms and, well, to have lots of sex. Therein lies the rub, no pun intended. How can you identify yourself as a sex addict when it seems like everyone around you is getting laid all the time too?

The reality is that sex addiction is not about sex. The word "sex" in this equation is the red herring. Just like the five martinis an alcoholic consumes in an hour isn't really about a love for vodka.

Sex addiction is not about the kind of sex one has. Consensual sex between adults in whatever form that is pleasurable, respectful, and consensual is not the problem. Having multiple partners or engaging in casual hookups is not the problem.

The problem is when one regularly tries to escape emotional or psychological pain through the high of sex. Sex addicts just happen to use body parts -- theirs or someone else's -- to avoid what's happening inside of them.

So what is it that's going on inside the sex addict? Those of us in this treatment field often call it "toxic shame." Many of us who grew up gay are all too familiar with shame. Being gay in a straight world, trying to fit in lest our secret be discovered, we struggled to feel good about ourselves. Especially when so many around us made it clear explicitly or implicitly that this was the exact opposite of what we should feel. The core beliefs that we are wrong, bad, unlovable -- these are beliefs that can be very hard to shake.

It is toxic shame that fuels the sex addict, a seeking to rid oneself of that feeling through the futile search for relief through sexual pleasure. Just as with a heroin addict, the sex addict is constantly "chasing the dragon." A hotter encounter. A better orgasm. More partners. It is this seeking of these intense sexual experiences that takes the sex addict down the rabbit hole. That rabbit hole has gotten deeper in the last few years as many have now turned to meth as a gateway to sex.

John grew up in a house where his parents struggled to make ends meet and had little time to pay attention to him. He was bullied at school. He had no one to talk to about his burgeoning sexual identify. He often felt completely isolated.

Because of these issues, he was struggling with a deep sense of unworthiness and a belief that the only way to feel wanted and loved was through having sex. But he was having sex with strangers, which ensured that he wouldn't have to take the risk of actually experiencing the things he so desperately wanted.

The word "trauma" often is only associated with sexual, physical, or psychological abuse. But traumas can consist of other, less obvious experiences. Emotional neglect. Dealing with an alcoholic parent or a parent with severe depression. I would argue that growing up gay is a trauma in itself.

The addict, often not aware of their trauma, finds a temporary reprieve from intolerable feelings through the chemical high brought on by acting out sexually. The brain, body, and emotional core get the fix needed to rebalance emotionally. But it's a vicious cycle. The momentary euphoria is usually followed by feelings of emptiness and shame. Life becomes unmanageable, and so the addict seeks escape all over again. Often -- as in John's case -- there is a need to increase the risk, the duration, or the frequency of the behavior to get the same psychological reward.

But to break this cycle and acknowledge one has a sex addiction is a coming-out process unto itself. It requires tremendous courage. Trust in telling the story. A belief one will be accepted. Fear of judgment, rejection, and being written off by others as "sex-negative" or being labeled as having internalized homophobia. Better to hide out than to experience more shame.

To release the shame, the addict needs to begin to tolerate being vulnerable, to take the risk of being "seen." This is at the core of learning intimacy. Just as we hid out in our youth (and sometimes into adulthood), some of us either didn't learn the notion of intimacy or didn't believe we either deserved or knew how to achieve it.

When I first recommended to John that he begin attending Sex Addicts Anonymous -- a fellowship based on the 12 steps of Alcoholics Anonymous -- he was extremely resistant. He assumed that he'd have to give up sex entirely. I explained that sex addicts don't become sexually celibate, unless that's their choice. In general, the addict is "sober" from the sexual behaviors he and his sponsor define as addictive. Just as important, SAA would provide the kind of safety to begin talking about his struggles in an environment that is accepting and compassionate. It would also help him begin to build the bridge between isolation and true connection.

His road has not been easy. On more than one occasion since he started attending meetings eight months ago, he has stumbled. But he keeps returning -- both to SAA and to therapy. It is in meetings where he is learning to be vulnerable. It's in our work together that he's continued to uncover and address his pain and sadness, and to learn how to experience it in a healthy way.

At our most recent session, he told me that he'd finally begun to believe he could have a healthy and loving relationship -- with really great sex.

For more information on SAA, visit SCISAA.org.

DANIEL LACOVARA is a licensed marriage and family therapist in private practice in West Hollywood. To learn more about his work, visit Insight-la.com.