Last week, Kevin Spacey became the latest high-profile man accused of serial sexual assault to announce he was entering treatment. Like others before him—including Harvey Weinstein, who fled to a rehab program, as if to a monastery, when accused of serial harassment and rape—Spacey seemed to seek absolution (or at least to quiet the storm) by alluding to addiction at a time when the opioid epidemic is classified as a public health emergency. And if the outpouring of new accounts about sexual harassment across America is anything to go by, these two won't be the last.
But can addiction possibly be an excuse for abusing power—and specifically for sex offenses like the ones Spacey and Weinstein have been accused of? Sex addiction is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and remains the subject of great debate. And even if sex really can be addictive, there is no form of addiction—whether to sex or otherwise—that actually explains (let alone excuses) sexual violence. The reason is simple: Addiction doesn't make otherwise harmless people into violent predators.
For starters, neuroscientist Nichole Prause has compiled significant evidence that challenges the very notion of sex addiction. A former research scientist at UCLA and more recently a founder of Liberos, an independent research institute on sexuality, her work suggests what we call sex addiction doesn't fit the currently accepted model of addiction in several ways. In every other addiction that has been studied— including gambling, which, like sex, does not require ingestion of any substance that could change the brain physically—people exhibit what is technically known as "cue reactivity." For example, when people addicted to injecting drugs see a picture of a needle, they generally respond more strongly to it than they might to something they do not associate with getting high. Often, the response is to crave drugs. The same intensified reaction occurs in compulsive gamblers when they see things like roulette wheels.
People who say they are addicted to sex, however, seem to have the opposite reaction. "Cues of the proposed addiction, sexual images, evoke lesser brain response than comparison cues," Prause told me. If these findings continue to be replicated, they seriously undermine the idea of sex addiction.
Another oft-cited difference between sex and drug addiction is the question of withdrawal symptoms. But since both gambling addiction and cocaine addiction include few signs of physical withdrawal upon cessation, to most experts this difference is not dispositive. Finally, there are questions about whether sex addiction includes a sense of loss of control, which, according to the DSM criteria, is common in many addictions. On the contrary, Prause said, people who claim they are addicted to sex "report feeling they are not in control, but show better control of their sexual urges in lab studies than people who are not distressed."
It's important to note Prause is not arguing that people who feel addicted to sex are not struggling or don't need help—just that the addiction frame doesn't really fit their condition. And it may actually harm patients by increasing stigma and subjecting them to spiritual and abstinence-based programs that aren't realistic or effective.
Josh Grubbs, assistant professor of psychology at Bowling Green State University in Ohio, has focused his research on the intersections between sexuality, morality and religion. His research has shown, for example, that a man's belief that use of pornography is immoral and his level of associated religiosity is more highly linked with whether he believes he is addicted to porn than his actual level of porn consumption.
Grubbs is more sympathetic to labeling compulsive sexual behavior an addiction than Prause. "For some people, sexual behavior can become so out of control that for all intents and purposes, it looks and functions like an addiction, just like gambling," he told me. He added that Prause's work is fascinating, but thinks more data is needed to definitively prove that sexual compulsion does not fit the addiction model.
Nonetheless, regardless of whether you call it sex compulsion or addiction, both Grubbs and Prause agree that it is simply not material to allegations of serial harassment or assault.
"There is no evidence that sexual harassment or sexual assault are related to the proposed features of sexual addiction," Prause told me. "For example, people committing assault generally do not feel they are out of control [like those who are addicted]—they value harassment or assault because they feel in control."
In fact, much of the stigma associated with the addiction model comes from the way the concept is so often used as an excuse for all types of bad behavior—and the way rehab is viewed as a site to begin restitution and penitence. This is not helped by the fact that the majority of American rehabs are based on the 12 step model, in which participants are encouraged to surrender to a "higher power," take "moral inventory," ask God to remove their "defects of character" and make amends to those they have harmed. The fact that so many rehabs have historically used degrading and punitive tactics that assume participants are self-centered manipulative liars also plays into the idea that addiction is really sin.
But addiction does not actually cause zombie-like behavior, in which otherwise-normal people become capable of doing anything—no matter how harmful to others—in pursuit of their compulsion. A large body of data shows that not only do most people with addiction have a degree of control over their behavior but also that it is not necessary to be a bad person to be addicted.
Meanwhile, most people with addiction who commit crimes do so to be able to afford their addictions—and in the case of heroin addiction, most started committing other crimes before they became addicted; addiction just made the behavior worse. But for people who can afford as many drugs as they want, addiction doesn't turn say, wealthy businesspeople into shoplifters or muggers. Criminality does not just emerge, in a vacuum, from drug use.
Similarly, even though alcohol hooks about the same proportion of users as heroin or cocaine, we see rather little crime committed to get money to obtain booze. The fact that it is legal means even alcoholism is generally affordable for most people. And the idea that addiction turns people into compulsive liars is also not supported: people with addiction report their experiences honestly as often as anyone else when they can be anonymous or don't fear being punished for it.
As for the violent crime typically—but not always—associated with illegal drug use: Studies find that the vast majority of it is associated with illegal drug markets, which do not have recourse to the courts or regulators to settle disputes. In other words, much of this crime is committed by dealers and linked to the illegality of drugs, not their pharmacology or effects on people with addiction. And those people with addiction who do become involved with violent crime tend to have been exposed to violent experiences early in life such as child abuse.
Basically, addiction as we know it exacerbates and disinhibits underlying problems, rather than turning ordinary people into monsters.
Given that sex addiction is often modeled on drug addiction—or even on other types of compulsions that similarly impair choice—it would be astonishing if it led to greater loss of control than, say, heroin or cocaine. Sure, a sex addiction could make you more likely you to overspend on prostitutes or strip clubs or exclusive types of porn. It might isolate you from your family, destroy your relationships and maybe even ruin your finances. But it's not going to make you start harassing—let alone raping or otherwise sexually assaulting—others.
If America is serious about helping people with any kind of addiction—and about de-stigmatizing these disorders—the (deeply warranted) conversation about sexual assault and other abuses has to be divorced from the one about addiction and rehab. If someone has a genuine addiction and also engages in terrible behavior, that addiction may need to be treated in order for the other behavior to be controlled. But that doesn't mean addiction caused or excused the other problem—and it doesn't mean rehab cleanses your sins or should become some kind of site for remorse and penitence.
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