tag:theconversation.com,2011:/ca/topics/sex-addiction-6546/articlesSex addiction – The Conversation2021-04-07T12:29:38Ztag:theconversation.com,2011:article/1581212021-04-07T12:29:38Z2021-04-07T12:29:38ZMisunderstanding addiction breeds despair and suffering – and, for alleged Atlanta shooter, violence<figure><img src="https://images.theconversation.com/files/393262/original/file-20210402-15-hrcyx0.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C4031%2C2661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A makeshift memorial to the victims of the Atlanta spa shooting shows both grief and outrage.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/MassageParlorShooting/bd69e0bbb92d45cb83dc1f050b912276/photo">AP Photo/Candice Choi</a></span></figcaption></figure><p>When a man claiming to suffer from the disease of sex addiction found that “<a href="https://hopequestgroup.org/treatment-programs/trek/">comprehensive and fully integrated treatment</a>” at a Christian recovery center could not cure him, he decided to try another approach: <a href="https://www.gpb.org/news/2021/03/17/police-suspect-charged-in-massage-parlor-deaths-planned-kill-more">eliminating the women</a> he believed were a “temptation” aggravating his problem.</p>
<p>That’s the <a href="https://www.nytimes.com/2021/03/18/us/robert-aaron-long-atlanta-spa-shooting.html">best understanding so far</a> of what drove Robert Aaron Long to <a href="https://www.cbsnews.com/live-updates/atlanta-shootings-robert-long-murder-8-counts/">allegedly murder eight women</a>, including six of Asian descent, in Atlanta, Georgia on March 16, 2021.</p>
<p>To me as a <a href="https://people.clas.ufl.edu/ttravis/">cultural historian of addiction and recovery</a>, his story highlights the two most common ways Americans think about and deal with compulsive behaviors. We like to consider them the results of temptation or treat them as diseases. </p>
<p>Although these two approaches are often treated as opposites, both stem from the most prominent effort to fight compulsion in U.S. history: the grassroots movement to ban alcohol, which led to <a href="https://www.history.com/topics/roaring-twenties/prohibition">national Prohibition from 1920 to 1933</a>.</p>
<p>The disease concept of addiction arose in the aftermath of Prohibition, in part as a way to explain why the national alcohol ban didn’t actually get rid of alcohol or its abuse. Far from being a biomedical truth, it is <a href="https://psychcongress.com/article/disease-concept-addiction-revisited">just a way of framing compulsive drinking</a>. The story of the alleged Atlanta shooter shows how well the disease concept succeeded as a public relations tool – and also how limited it is as a means of explaining human behavior.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woodcut illustration of a group of women outside a bar, where two men lean against the doorway" src="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Women were prominent leaders and members of the temperance movement, and used various tactics, including singing hymns outside bars.</span>
<span class="attribution"><a class="source" href="https://picryl.com/media/the-ohio-whiskey-war-the-ladies-of-logan-singing-hymns-in-front-of-barrooms">Frank Leslie's illustrated newspaper, 1874, via Picryl</a></span>
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</figure>
<h2>A brief history of Prohibition</h2>
<p>Beginning in the early 19th century, a broad cross-section of Americans – <a href="https://prohibition.themobmuseum.org/the-history/the-road-to-prohibition/the-temperance-movement">often led by women</a> – looked at poverty, domestic violence, labor unrest and other social problems and connected them with drinking alcohol. </p>
<p>So-called “temperance” activists worked for years to limit alcohol consumption in the U.S. by promoting moderation and voluntary abstinence. “Prohibitionists,” by contrast, pushed to restrict the times and places liquor could be sold. Interrupted only briefly by the Civil War, both groups used moral suasion and political lobbying to <a href="https://www.ncbi.nlm.nih.gov/books/NBK216414/">shift the culture and the laws around alcohol</a>.</p>
<p>Their tactics worked. Fraternal organizations promoted abstinence as a sound business principle; saloons were closed by prayer vigils; and many states enacted local provisions that allowed counties and municipalities to vote in bans or restrictions on liquor sales. </p>
<p>But by the early 20th century, “the liquor traffic” – the network of manufacturers and distributors, and the politicians who benefited from their kickbacks – seemed unstoppable. Around the nation, even in “dry” counties, “<a href="https://www.gotrum.com/the-rum-university/rum-in-history/american-Rum-27-Demon-Rum/">demon rum</a>” flowed freely. </p>
<p>When men – problem drinkers were then, as now, <a href="https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm">disproportionately male</a> – fell victim to its seductions, they abandoned their roles at home and in the workplace. This bad behavior threatened the social order.</p>
<p>In 1913, the <a href="http://www.westervillelibrary.org/AntiSaloon">Anti-Saloon League</a>, which had previously championed the local option as a way to gradually reform the nation, had had enough. It was clear they could not shame or regulate the liquor traffic into limiting its hold on men’s lives. That left only one alternative, which had first been proposed two decades before by Archbishop John Ireland of St. Paul, Minnesota: “<a href="https://www.newspapers.com/clip/4540146/evening-gazette/">there is nothing now to be done but to wipe it out completely</a>.”</p>
<p>It took just six years for Congress to pass the 18th Amendment and for the states to ratify it, banning the production, transport and sale of intoxicating liquors. In January 1920, America was officially cleansed of “<a href="https://www.davidanthembookseller.com/pages/books/00926/hon-richmond-p-hobson/the-great-destroyer-alcohol-devours-the-products-of-civilization">the great destroyer</a>.” </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Men pour bottles into a storm drain" src="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During Prohibition, alcohol was illegal but common, and when it was found by authorities, it was destroyed.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/item/2001706109/">Library of Congress</a></span>
</figcaption>
</figure>
<h2>A new understanding?</h2>
<p>Even most Prohibition advocates quickly realized that alcohol could not really be wiped out of American life. </p>
<p>The nation also learned that the cost of trying was itself sky high. Illegal and bootleg spirits were more expensive – and often toxic. Instead of turning men into hardworking teetotalers, <a href="https://www.history.com/news/prohibition-organized-crime-al-capone">Prohibition encouraged new kinds of social deviance</a>, such as organized crime.</p>
<p>When Prohibition was repealed in 1933, the liquor industry and its political patrons established and funded what historians call the “<a href="https://academic.oup.com/alcalc/article/35/1/10/142396#1129078">modern alcoholism movement</a>.” This was a group of activist scientists, public relations experts and reformed drinkers looking to promote a <a href="http://www.roizen.com/ron/postrepeal.htm">responsible solutions to the problems of alcohol</a> – while also keeping the booze flowing. </p>
<p>This movement acknowledged that some people were problem drinkers, but argued that neither the industry nor alcohol itself was to blame. Instead, during the 1940s and 1950s, movement members recast drunkenness as a personal and, significantly, a medical issue. They called it “<a href="https://doi.org/10.1111/add.14400">the disease of alcoholism</a>.”</p>
<p>This new disease was <a href="https://silkworth.net/alcoholics-anonymous/alcoholism-as-a-manifestation-of-allergy/">like an allergy</a>. It was mysterious; it was not clear why some people developed a compulsion to drink. More important, it was rare: Most people could drink socially without ill effect. Those who could not deserved help, not scorn. </p>
<p>This medicalized approach claimed that with understanding and fellowship – such as that provided by Alcoholics Anonymous – disease sufferers could remain cheerfully abstinent. The scientific community would work to <a href="https://www.theatlantic.com/health/archive/2012/02/mrs-marty-mann-and-the-early-medicalization-of-alcoholism/252286/">unlock the secrets of the disease of alcoholism</a>, just as it had with tuberculosis and polio. In the meantime, the undiseased could enjoy the three-martini lunches and suburban cocktail parties that symbolized the postwar American good life.</p>
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<a href="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man sits with a drink glass in one hand and the other hand over his face" src="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not everyone was able to drink without problems.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/alcohol-addiction-royalty-free-image/962083312">D-Keine/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>Diseases spread</h2>
<p>Billions of research dollars later, there is <a href="https://dx.doi.org/10.1111%2Facer.14246">no clear consensus</a> that the compulsive use of alcohol – or any other drug – is the effect or the cause of any <a href="https://doi.org/10.1901/jeab.2011.95-263">physiological or genetic abnormality, or whether it is just bad decision-making</a>.</p>
<p>But reframing problem drinking as a disease had helped everyone move on from the disastrous experiment of Prohibition. Alcoholics got sympathy, research scientists won government grants and the liquor industry made plenty of money marketing alcohol to Americans without the disease.</p>
<p>The disease concept was so useful to so many people that in the late 20th century, it migrated out of the alcohol and drug world. Overindulgence in anything – including work, exercise and sex – became known as “<a href="https://dx.doi.org/10.3109%2F00952990.2010.491884">behavioral addiction</a>.” </p>
<p>Near-total lack of evidence that <a href="https://doi.org/10.1016/j.euroneuro.2015.08.013">such compulsive behavior has physiological roots</a> has not stopped Americans from seeing it as disease. </p>
<p>The alleged Atlanta shooter fell into this trap. He was a man whose appetite for sex was <a href="https://www.nytimes.com/2021/03/18/us/robert-aaron-long-atlanta-spa-shooting.html">larger than he thought it should be</a>. His Christian community called that a sin. When he couldn’t pray his desires away, he appears to have borrowed a concept from the secular world and <a href="https://theconversation.com/sex-addiction-isnt-a-justification-for-killing-or-really-an-addiction-it-reflects-a-persons-own-moral-misgivings-about-sex-157543">decided to treat it as a disease</a>. </p>
<p>When that modern approach didn’t work, he took a step back in time, reverting to the old Prohibitionist tactic of eliminating what he believed to be the source of his problems. </p>
<p>The Anti-Saloon League used pressure tactics to change legislation. Robert Aaron Long got a gun and ended women’s lives.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/158121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trysh Travis has received funding from the National Endowment for the Humanities for research on the history of Alcoholics Anonymous and its offshoots.</span></em></p>The story of the alleged Atlanta shooter highlights the two most common ways Americans think about compulsive behaviors – considering them the results of temptation and treating them as diseases.Trysh Travis, Associate Professor of Women's Studies, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1575432021-03-20T18:50:36Z2021-03-20T18:50:36Z‘Sex addiction’ isn’t a justification for killing, or really an addiction – it reflects a person’s own moral misgivings about sex<figure><img src="https://images.theconversation.com/files/390700/original/file-20210320-23-16gloky.jpg?ixlib=rb-1.1.0&rect=0%2C62%2C2298%2C1438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Feeling 'addicted to sex' has more to do with one's values than frequency of behavior.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sex-shop-signs-at-night-royalty-free-image/471048321">Terraxplorer/E+ via Getty Images</a></span></figcaption></figure><p>A 21-year-old white man is alleged to have entered three different spas in the greater Atlanta area on March 16 and shot dead eight people, six of whom were Asian women. The following day, Cherokee County sheriff’s officials announced what the suspect blamed as a possible motive for the killings: sex addiction.</p>
<p>The alleged shooter has been described as a devoutly conservative <a href="https://apnews.com/article/atlanta-georgia-coronavirus-pandemic-84ea109933ce05dba5c61022f9b1d41f">evangelical Christian</a> who had, according to numerous reports, been <a href="https://www.washingtonpost.com/nation/2021/03/18/sex-addiction-atlanta-shooting-long/#click=https://t.co/kEK5FmaDqr">struggling to control</a> his sexual behaviors. <a href="https://www.washingtonpost.com/nation/2021/03/17/atlanta-spa-shootings-live-updates/?itid=lk_inline_manual_3">Law enforcement officials</a> said the suspect claimed to have been dealing with a sex addiction and ultimately killed as a way to “eliminate” the “temptation” he felt these women posed.</p>
<p>I am a researcher who specializes in <a href="https://www.joshuagrubbsphd.com">behavioral addictions</a>, <a href="https://scholar.google.com/citations?user=gCnmj3kAAAAJ&hl=en">specifically sexual addictions</a>. A lot of my research has focused on how religion interacts with sexual behaviors and feelings of addiction. Over the past decade, my research has found that religion and sexual addiction are deeply intertwined.</p>
<h2>Clinicians don’t diagnose ‘sex addiction’</h2>
<p>Right now, there is no diagnosis of “sex addiction” in <a href="https://www.appi.org/Diagnostic_and_Statistical_Manual_of_Mental_Disorders_DSM-5_Fifth_Edition">any diagnostic manual</a> that psychologists consult when working with patients. It’s not a recognized disorder in the mental health community. This may come as a surprise to some, as many people do believe that <a href="https://doi.org/10.1037/adb0000228">sex can be addictive</a>.</p>
<p>Without terming the problem an addiction, mental health practitioners do, of course, recognize that out-of-control sexual behaviors can be a real problem for individuals. Recently, the <a href="https://www.thefix.com/compulsive-sexual-behavior-">World Health Organization announced</a> that the latest edition of its “<a href="https://www.who.int/standards/classifications/classification-of-diseases">International Classification of Diseases</a>” will include a new diagnosis of compulsive sexual behavior disorder.</p>
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<a href="https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="neon signs for a sex shop" src="https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=757&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=757&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=757&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=951&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=951&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390701/original/file-20210320-15-fszc79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=951&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Whatever the label, compulsive sexual behavior can be a problem.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/neon-lights-pigalle-paris-royalty-free-image/157169264">Dutchy/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>This new diagnosis is officially an <a href="https://doi.org/10.1002/wps.20499">impulse control disorder</a> rather than an addiction, but it does cover people with excessive or compulsive sexual behaviors that most members of the public would consider addiction. Any number of behaviors could qualify for this diagnosis, ranging from excessive pornography use and masturbation to cruising for casual sex to soliciting sex workers. The key feature of the diagnosis is not the specific sexual behavior itself, but how out of control it has become in a person’s life and how much difficulty or impairment it causes.</p>
<p>Compulsive sexual behavior disorder is the only diagnosis in over 55,000 total diagnoses in the WHO manual to include a special caveat. At the very end of the disorder’s description, <a href="https://doi.org/10.1016/j.cpr.2020.101925">there’s a note</a> cautioning that “distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not enough to meet this requirement.”</p>
<p>In other words, feeling distressed about behaving in sexual ways that you find morally wrong is not sufficient for a diagnosis of this new disorder. That’s a very important caveat because, based on my research, it’s moral distress about sex behaviors that commonly triggers people to believe they have a sex addiction. </p>
<h2>What feeds a self-diagnosis of ‘sex addiction’?</h2>
<p>In the U.S. in particular, many studies have clearly shown that more religious people, people from more strict religious backgrounds and people who morally disapprove of their own sexual behaviors are much more likely to <a href="https://doi.org/10.1007/s10508-018-1248-x">interpret those behaviors as an addiction</a>.</p>
<p>What’s surprising is there’s also a lot of evidence that these same people are actually less likely to do things like watch pornography or have sex outside of marital relationships. My colleagues and I have found that more religiously devout people simultaneously report <a href="https://doi.org/10.1177/2167702620922966">less use of pornography while also reporting greater addiction to pornography</a>. </p>
<p>It seems that conservative moral beliefs about sexuality, particularly those associated with conservative religiosity, lead some people to interpret behaviors like even occasionally watching porn as signs of an addiction.</p>
<p>My colleagues and I call this disconnect between beliefs and behavior “moral incongruence.” It turns out to be a powerful predictor of whether someone thinks they have a sex addiction.</p>
<p><iframe id="gFOuR" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/gFOuR/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>In fact, we’ve now shown in two studies that used nationally representative samples that <a href="https://doi.org/10.1177/2167702620922966">religiosity</a> and <a href="https://doi.org/10.1037/abn0000501">moral disapproval of pornography</a> amplify the links between pornography viewing and feelings of addiction to pornography. For people who do not find pornography morally objectionable or who are nonreligious, there is virtually no link between how much pornography they view and whether they believe themselves to be addicted to it. Yet, for people who are very religious or who find pornography viewing to be especially wrong, even small amounts of pornography use are linked to self-reported feelings of addiction.</p>
<h2>Internal turmoil doesn’t predict violence</h2>
<p>To be clear, the distress that people may feel when they fall short of their morals is undoubtedly real and profound. However, much of this distress is likely the result of guilt and shame rather than a true addiction.</p>
<p>In the case of the Georgia shooter, there is simply not yet enough information to determine whether he had an out-of-control pattern of sexual behavior, whether he was morally distressed over his behavior, or whether it was both. Frankly, those distinctions are not that important to understanding what happened.</p>
<p>Compulsive sexual behavior disorder and moral incongruence are both real problems that can lead to <a href="https://doi.org/10.1080/00224499.2017.1295013">relationship conflict</a>, <a href="https://doi.org/10.1037/adb0000114">depression, anxiety</a> and other <a href="https://doi.org/10.1007/s10508-018-1248-x">consequences</a>. But they are not excuses for violence, murder or hate crimes – nothing is. If <a href="https://doi.org/10.1001/jamanetworkopen.2018.4468">recent estimates</a> are correct, there are <a href="https://doi.org/10.1556/2006.7.2018.134">millions of Americans</a> who are concerned that their sexual behaviors might be out of control. </p>
<p>Yet the Atlanta suspect chose to do something that these millions of other Americans have not, allegedly targeting and killing women he viewed as “a temptation.” This choice on his part is not in any way attributable to whether he had a sexual addiction, whether he felt moral incongruence about his sexual behaviors or whether he was having a bad day.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/157543/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua B. Grubbs receives funding from the National Institute for Civil Discourse and the Charles Koch Foundation.</span></em></p>‘Sex addiction’ isn’t a diagnosable disorder, but the turmoil religious men feel over the disconnect between their sexual values and behavior can lead to real psychological distress.Joshua B. Grubbs, Assistant Professor of Psychology, Bowling Green State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/864912017-11-06T15:08:29Z2017-11-06T15:08:29ZCelebrity campaigns and rape culture: the pluses and the pitfalls<figure><img src="https://images.theconversation.com/files/192821/original/file-20171101-19858-1ivm780.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An activist during Jacob Zuma's rape trial in 2006. He was acquitted and went on to become South Africa's president.</span> <span class="attribution"><span class="source">Reuters/Siphiwe Sibeko</span></span></figcaption></figure><p>The collective outcry from women on social media, using the <a href="https://www.cbsnews.com/news/metoo-more-than-12-million-facebook-posts-comments-reactions-24-hours/">#Metoo campaign</a>, to indicate that each of them has been a victim of sexual harassment, has gripped the global imagination. </p>
<p>After the revelations that film producer Harvey Weinstein sexually harassed and abused young actresses <a href="https://www.nytimes.com/2017/10/05/us/harvey-weinstein-harassment-allegations.html">over many years</a>, many of his victims came forward to tell their stories. Women in South Africa also <a href="http://ewn.co.za/2017/10/19/former-anc-mp-singer-claims-danny-jordaan-raped-her">joined the campaign</a>, sharing their experiences of sexual assault, harassment and abuse. Singer Jennifer Ferguson has spoken out and so did some of the <a href="https://mg.co.za/article/2017-10-27-00-our-women-freedom-fighters-tell-of-sexual-abuse-in-camps">ANC women veterans</a> who were in the liberation struggle. </p>
<p>The #Metoo campaign shows that we should not think of Weinstein as an isolated case, or just one bad apple. There are thousands more like him. Globally, sexual harassment has become normalised.</p>
<p>As the Chair of the Sexual Harassment Advisory Committee at Stellenbosch University in South Africa, for many years, I have seen how complicated and difficult it sometimes is to get justice for victims, even with a good policy and grievance procedure in place. </p>
<p>In South Africa it took the <a href="http://witsvuvuzela.com/2016/04/26/wits-fmf-feminists-stand-in-solidarity-with-rureferencelist-protestors/">#EndRapeCulture campaign</a> on university campuses in 2016 to show how deeply embedded and normalised sexual harassment is on the country’s <a href="https://theconversation.com/how-south-africas-young-women-activists-are-rewriting-the-script-60980">university campuses</a> which are microcosms of the larger society. It is important and significant that women have spoken out, raising consciousness.</p>
<p>What #EndRapeCulture showed is that individual men are socialised and groomed into the normalisation of sexual violence and that unless we look at this as a systemic problem, we will only remove perpetrators one at a time and still not deal with cultures that promote sexual violence.</p>
<p>The #Metoo campaign is not limited to abuse and rape. It includes the spectrum of behaviour that can be nonverbal, like leering or offensive displays of women’s objectified bodies as in advertising campaigns, or sharing pictures without women’s consent, verbal – like jokes, catcalling, flirtation and unwelcome invitations, as well as quid pro quo forms: the threat of retaliation or victimisation if women do not submit and the promise of reward if they do.</p>
<p>Given the deeply sexualised societies we live in where the media contributes to saturate society with normalised sexual abuse – most women would have experienced one or more of these types of behaviour from men. </p>
<p>How useful is it then to say “me too”? Does it trivialise the more traumatic forms of harassment, specifically rape? Does it reduce a very traumatic incident to a soundbite?</p>
<h2>Reporting sexual assault takes courage</h2>
<p>There are women survivors who actually did not join the campaign because they <a href="https://www.bustle.com/p/the-metoo-movement-doesnt-represent-me-heres-why-2933098">feel strongly</a> that it diminishes very serious trauma and re-traumatises survivors.
There has to be a balance between exposing perpetrators, showing solidarity with women who take action, and respecting due process of the law.</p>
<p>One woman was courageous enough to report Harvey Weinstein. It took another measure of courage for young women to march topless during the #EndRapeCulture campaigns in <a href="https://theconversation.com/how-south-africas-young-women-activists-are-rewriting-the-script-60980">South Africa</a>. It took a lot of courage for three young women to stand in front of South African President Jacob Zuma with placards saying:</p>
<blockquote>
<p>I am in one in three and </p>
<p>Remember Khwezi? </p>
</blockquote>
<p>Four young women clad in black <a href="http://www.news24.com/elections/news/anti-rape-protesters-disrupt-zumas-speech-20160806">silently stood</a> in the front of the podium, facing the audience when President Zuma announced the results of the 2016 local government election, holding up these placards to remind the nation that Zuma himself is deeply implicated in sexual abuse.</p>
<p>It takes enormous courage to go through a rape trial. Journalist Redi Thlabi’s <a href="http://www.loot.co.za/product/redi-tlhabi-khwezi/jspp-5038-g580?gclid=EAIaIQobChMIktPr-tWQ1wIVzLftCh0-rgisEAAYASAAEgICJ_D_BwE&c_dev=c&c_aid=185693596949&c_net=g">book about Khwezi</a>, the women who accused Zuma of rape – he was acquitted – has shown us the conspiracy of <a href="https://theconversation.com/why-a-decade-on-a-new-book-on-zumas-rape-trial-has-finally-hit-home-85262">silence around her ordeal</a>. How strong was our solidarity with these courageous women?</p>
<p>I am not diminishing the #Metoo campaign, but the question is: “What do we do now?”</p>
<p>There are demands for men to join another #Metoo campaign – to say that they, like Weinstein, are perpetrators. There are calls to name and shame men who are abusers. That was what The RU (Rhodes University) <a href="https://www.dailymaverick.co.za/opinionista/2016-06-01-we-will-not-be-silenced-rape-culture-rureferencelist-and-the-university-currently-known-as-rhodes/#.Wfm40Ite4aI">Reference List</a> was all about The RU Reference sparked the #EndRapeCulture campaign in South Africa that led to many task teams being appointed at universities to investigate rape culture, but it’s unclear if the perpetrators were prosecuted.</p>
<p>Indian feminists are worried that making dubious claims can do a lot of damage and <a href="https://kafila.online/2017/10/24/statement-by-feminists-on-facebook-campaign-to-name-and-shame/">undermine</a> years of hard work by feminists to put sexual harassment policies and procedures in place.</p>
<h2>Breaking the silence</h2>
<p>It was actually Tarana Burke, an African American woman in the US who started a Me Too campaign in 2006, after a 13 year old girl confided in her that she was abused. Burke felt guilty that she did <a href="https://www.nytimes.com/2017/10/20/us/me-too-movement-tarana-burke.html">not do enough</a>. For 11 years she has been doing the hard work that needs to be done with survivors of sexual abuse. Burke’s campaign is not part of a celebrity culture that is surrounding the current #Metoo campaign. </p>
<p>But we need to get men on board. Weinstein needed to be exposed. All others like him need to be exposed. He should not be able to claim sex addiction. He should become the “poster child” for what can happen to sexual abusers. We can only break the silence when men who know of men who harass stop colluding and speak out. Collusion enabled Weinstein. This is how rape culture works.</p><img src="https://counter.theconversation.com/content/86491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Gouws receives funding from the National Research Foundation (NRF)</span></em></p>The #Metoo campaign shows that we should not think of Harvey Weinstein as an isolated case, or just one bad apple. There are thousands more like him. Globally, sexual harassment has become normalised.Amanda Gouws, Professor of Political Science, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/552752016-03-04T10:16:50Z2016-03-04T10:16:50ZThere’s no such thing as an ‘addictive personality’ – here’s why<figure><img src="https://images.theconversation.com/files/113769/original/image-20160303-9466-4xuke6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Are you a prisoner of your habits?</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>“Life is a series of addictions and without them we die”.</em> </p>
<p>This is my favourite quote in academic addiction literature and was made back in 1990 in the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1990.tb01618.x/abstract">British Journal of Addiction by Isaac Marks</a>. This deliberately provocative and controversial statement was made to stimulate debate about whether excessive and potentially problematic activities such as gambling, sex and work really can be classed as genuine addictions. </p>
<p>Many of us might say to ourselves that we are “addicted” to tea, coffee, work or <a href="http://www.dailymail.co.uk/femail/article-2958424/I-t-stop-eating-chocolate-Mother-eats-EIGHT-family-sized-bars-day-consume-packet-biscuits-one-sitting-seeks-help-addiction-sugary-treats.html">chocolate</a>, or know others who we might describe as being “hooked” on television or using <a href="http://www.mensfitness.com/women/sex-tips/quiz-are-you-addicted-to-porn">pornography</a>. But do these assumptions have any basis in fact?</p>
<p>The issue all comes down to how addiction is defined in the first place – as many of us in the field disagree on what the core components of addiction actually are. Many would argue that the words “addiction” and “addictive” are used so much in everyday circumstances that they have become meaningless. For instance, saying that a book is an “addictive read” or that a specific television series is “addictive viewing” renders the word useless in a clinical setting. Here, the word “addictive” is arguably used in a positive way and as such it devalues its real meaning.</p>
<h2>Healthy enthusiasm … or real problem?</h2>
<p>The question I get asked most – particularly by the broadcast media – is what is the difference between a healthy excessive enthusiasm and an addiction? My response is simple: a healthy excessive enthusiasm adds to life, whereas an addiction takes away from it. I also believe that to be classed as an addiction, any such behaviour should comprise <a href="http://www.tandfonline.com/doi/abs/10.1080/14659890500114359">a number of key components</a>, including overriding preoccupation with the behaviour, conflict with other activities and relationships, withdrawal symptoms when unable to engage in the activity, an increase in the behaviour over time (<a href="https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance">tolerance</a>), and use of the behaviour to alter mood state. </p>
<p>Other consequences, such as feeling out of control with the behaviour and cravings for the behaviour are often present. If all these signs and symptoms are present then I would call the behaviour a true addiction. But that hasn’t stopped others accusing me of watering down the concept of addiction.</p>
<h2>The science of addiction</h2>
<p>A few years ago, Steve Sussman, Nadra Lisha and I published a <a href="http://ehp.sagepub.com/content/34/1/3.short">review</a> examining the relationship between eleven potentially addictive behaviours reported in the academic literature: smoking tobacco, drinking alcohol, taking illicit drugs, eating, gambling, internet use, love, sex, exercise, work and shopping. We examined the data from 83 large-scale studies and reported a prevalence of an addiction among US adults ranged from as low as 15% to as high as 61% in a 12-month period.</p>
<p>We also reported it plausible that 47% of the US adult population suffers from maladaptive signs of an addictive disorder over a 12-month period and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors. In short – and with many caveats – our paper argued that at any one time almost half the US population is addicted to one or more behaviours.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/113770/original/image-20160303-9466-114l8pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/113770/original/image-20160303-9466-114l8pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/113770/original/image-20160303-9466-114l8pk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/113770/original/image-20160303-9466-114l8pk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/113770/original/image-20160303-9466-114l8pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/113770/original/image-20160303-9466-114l8pk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/113770/original/image-20160303-9466-114l8pk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A problem in many forms.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>There is a lot of scientific literature showing that having one addiction increases the propensity to have other addictions. For instance, in my own research, I have come across alcoholic pathological gamblers – and we can all probably think of people we might describe as caffeine-addicted workaholics. It is also common for people who give up one addiction to replace it with another (which we psychologists call “<a href="http://www.emeraldinsight.com/doi/abs/10.1108/13665629610116872">reciprocity</a>”). This is easily understandable as when a person gives up one addiction it leaves a void in the person’s life and often the only activities that can fill the void and give similar experiences are other potentially addictive behaviours. This has led many people to describe such people as having an “addictive personality”.</p>
<h2>Addictive personalities?</h2>
<p>While there are many pre-disposing factors for addictive behaviour, including <a href="http://www.nature.com/nrg/journal/v10/n4/abs/nrg2536.html">genes</a> and <a href="http://psycnet.apa.org/journals/bul/136/5/768/">personality traits</a>, such as high neuroticism (anxious, unhappy, prone to negative emotions) and low conscientiousness (impulsive, careless, disorganised), addictive personality is a myth. </p>
<p>Even though there is good <a href="http://psycnet.apa.org/journals/bul/136/5/768/">scientific evidence</a> that most people with addictions are highly neurotic, neuroticism in itself is not predictive of addiction. For instance, there are highly neurotic people who are not addicted to anything, so neuroticism is not predictive of addiction. In short, there is no good evidence that there is a specific personality trait – or set of traits – that is predictive of addiction and addiction alone.</p>
<p>Doing something habitually or excessively does not necessarily make it problematic. While there are many behaviours such as drinking too much caffeine or watching too much television that could theoretically be described as addictive behaviours, they are more likely to be habitual behaviours that are important in a person’s life but actually cause little or no problems. As such, these behaviours should not be described as an addiction unless the behaviour causes significant psychological or physiological effects in their day-to-day lives.</p><img src="https://counter.theconversation.com/content/55275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Mark Griffiths has received research funding from a wide range of organizations including the Economic and Social Research Council, the British Academy and the Responsibility in Gambling Trust. He has also carried out consultancy for numerous gaming companies in the area of social responsibility and responsible gaming (including Camelot Plc). Views expressed here are his own and not those of these funding bodies.</span></em></p>Drugs, coffee, television – they can all be described as ‘addictive’. But when do they become a problem?Mark Griffiths, Director of the International Gaming Research Unit and Professor of Behavioural Addiction, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/163912013-08-11T20:05:01Z2013-08-11T20:05:01ZCan people really be addicted to sex?<figure><img src="https://images.theconversation.com/files/28313/original/hndr6ptf-1375153470.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are reasons to be sceptical that sex addiction will turn out to be anything as powerful as drug addiction.</span> <span class="attribution"><span class="source">id iom/Flickr</span></span></figcaption></figure><p>Is sex addiction real? That is, is it really a disorder, involving diminished control over behaviour? </p>
<p>Questions such as these are difficult to answer because it’s always difficult to distinguish diminished capacity to resist a temptation from a diminished motivation to resist. People who tell us they literally can’t resist might be deceiving themselves, or they might be looking for a convenient excuse.</p>
<p>There are two ways we can attempt to discover whether people who say that they can’t control their behaviour really are suffering from some kind of diminished capacity. </p>
<p>First, we can gather as much behavioural evidence as possible: with enough evidence, we might be able to build an overwhelming case that a group of people genuinely suffer from diminished capacity. </p>
<p>When we see the costs – social, financial, physical and psychological – that drug addicts pay to continue using, we have good reason to think they have a diminished capacity to resist. </p>
<p>The second way we can proceed is to use scientific evidence that bypasses people’s reports about what they can and can’t do. Again, the case of drug addiction is a good example: some of the neurological changes in the brain of addicts seem to be changes in areas involved in self-control.</p>
<h2>What about sex?</h2>
<p>Recently, a group of researchers at UCLA <a href="http://healthland.time.com/2013/07/23/my-name-is-john-and-i-am-a-sex-addict-or-maybe-not/">attempted to resolve</a> the question whether sex addiction is genuinely an addiction, utilising the second method. </p>
<p>Using EEG, which measures electrical activity on the surface of the brain, they determined that people who met the diagnostic criteria for “hypersexuality” did not find sexual stimuli any more compelling than did control subjects. </p>
<p>This is unlike the response seen in drug addicts, who find drug-related stimuli much more attention-grabbing than do unaddicted controls.</p>
<p>This research has been interpreted as showing that sex addiction isn’t real. In the terms I used above, it might be taken to show that purported sex addicts do not lack the capacity to control their behaviour. </p>
<p>They simply lack the motivation; they might be morally condemned (if they are harming their families, say) rather than given a medical excuse.</p>
<p>But we shouldn’t place too much weight on this study. The researchers looked for a likely correlate of a difficulty controlling behaviour, but there are many others possible correlates. </p>
<p>All we can conclude from the study is that sex addiction is different from drug addiction, not that it isn’t real. Much more evidence is needed before we conclude that there is no diminished control. </p>
<p>Neuroscientists know a great deal about the mechanisms involved in control, attention regulation and conflict management. Most of these mechanisms are better studied with other methods, such as functional brain imaging, than with EEG (which was used in the study). </p>
<p>Before we conclude that sex addicts have no impairment in their capacities, we should conduct appropriate studies using these methods.</p>
<h2>Addiction on the mind</h2>
<p>Still, there are reasons to be sceptical that sex addiction will turn out to be an addiction that’s anything as powerful as drug addiction. Drug addiction is so intractable in part because our brains are not designed to cope with drugs’ pharmacological action. </p>
<p>There’s <a href="http://ajp.psychiatryonline.org/article.aspx?articleID=177694">evidence</a> that addictive drugs drive up a dopamine value signal artificially, every time they are ingested. This makes it impossible for the brain to assign the appropriate value to the actual rewards drugs deliver.</p>
<p>As an aside, gambling may also cause a dysfunction in the dopamine system by delivering rewards in an unpredictable manner that’s wildly different from the reward schedule our brains evolved to predict and understand. </p>
<p>That’s how addicts can find themselves <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.95.8s2.19.x/abstract;jsessionid=47ADB40D14C85E69A07196173FCCFC11.d04t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false">wanting a drug much more</a> than they really like it. </p>
<p>Sex isn’t like that: it’s powerfully rewarding but the reward is one that our brains were designed to seek. For that reason, it’s unlikely that the rewards of sex would ever become pathological in the way or to the degree that drugs can.</p>
<p>And anyway, addictions are diseases of persons, not brains. </p>
<p>Some people may genuinely experience a diminished capacity with regard to control over their sexual desires, even if there’s no evidence that they lack the neural capacity for control. They might lack requisite skills, for reasons to do with their learning history or psychological history. </p>
<p>Not all self-control problems are best understood as neural problems: well-functioning brains can drive pathological behaviour. The recent research is one more piece of evidence, but the jury remains out on whether sex addiction is real. </p><img src="https://counter.theconversation.com/content/16391/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Neil Levy receives funding from the Australian Research Council. In the past he has received funding from the Wellcome Trust and the Templeton Foundation.</span></em></p>Is sex addiction real? That is, is it really a disorder, involving diminished control over behaviour? Questions such as these are difficult to answer because it’s always difficult to distinguish diminished…Neil Levy, Head of Neuroethics, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.