It's a term which has become familiar. Everyone knows what 'sex addiction' is, and the eye-rolling it tends to provoke is usually because of the celebrities and public figures who have cited it as the cause of their unreasonable sexual behaviour. Think of Russell Brand, David Duchovny. Rob Lowe and Michael Douglas (though he later denied it). Ryan Giggs is said to have agreed to undergo sex addiction therapy. When Tiger Woods was exposed as having multiple affairs, he went straight to therapy, spending 45 days as an in-patient. He reportedly underwent treatment for sex addiction, explaining in his statement to the press that he was "receiving guidance for the issues I'm facing". When the US Senator Anthony Weiner resigned in June after sending explicit photographs of himself to Twitter followers, the internet was abuzz with questions about whether he was a sex addict. When he asked for forgiveness for the "personal mistakes" he'd made to get the sexual highs that led to him losing the career he had fought hard to get, he was heckled, and shouts of "Pervert!" interrupted his speech. An admission of this kind is, it seems, difficult for an audience to take seriously. At the very least, there are raised eyebrows and sniggers; the most common reactions, to celebrities at least, are underpinned with cynicism.
And yet, here in Britain, a growing number of ordinary people – mostly men – are seeking help for what they believe is an addiction to sex. Much in the way that alcoholics or drug addicts attend 12-step programmes or group therapy to kick the habit, people who believe they are addicted to sexual highs are increasingly searching out treatment. Many come to Dr Thaddeus Birchard, a psychotherapist and consummate learner (he's embarking on his second PhD next year) who could be described as the grandfather of sex addiction therapy. He was the first to set up a programme in the UK, in 2001, and since then the Marylebone Centre, where he is Clinical Director, has seen hundreds of men, and some women, come through his door. That door is discreet; his offices are positioned on a tasteful side street in the expensive London borough of Marylebone, which is fitting, as most of the people he treats are professionals, high-flyers, otherwise self-controlled individuals.
That's not to say that unemployed people on benefits don't find themselves struggling with an unhealthily excessive appetite for sex – just that the treatment programme costs more than £1,000, and this shade of addiction isn't yet recognised on the NHS. (Birchard says he offers a low-cost clinic for those who can't afford to pay, but these clients are not the norm.) He is aware of the cynicism that surrounds the idea of being addicted to sex, and how attitudes toward sufferers can be highly emotionally charged – this is an addiction that usually involves infidelity. When there's such a blatant betrayal of trust in an intimate relationship, blaming an addiction can sound a lot like an excuse.
Birchard shakes his head at this suggestion, when I meet him one morning at his offices. "The idea of [using sex addiction as a] 'get out' never even crosses their mind at all," he says of the men and women he treats. "It's a pattern of behaviour that causes great distress, and possibly suicide." He's had two clients kill themselves: one man who couldn't stop his behaviour, and a woman who was a sex worker. "The amount of painful fallout..." He tails off. Birchard is softly spoken anyway, but his voice is very quiet now. "People think I work with sex, I don't. I work with broken hearts."
Typically, his clients attend a weekly Treatment Programme for 16 weeks, followed by an intensive weekend of counselling. Birchard found that individual therapy was not as effective as group work in this area, so it happens in groups of no more than 10 people. A new programme begins every eight weeks; the therapy is much in demand. Clients learn about harmful consequences of their actions, how to make a more healthy 'sex plan' (unlike drugs and alcohol, sex can rarely be cut out completely), and what the cycle of their addiction is. "The 12-step programmes are quite clear that while you're not responsible for your addiction, you are responsible for what you do about it," he says.
The chase for the next sexual high can have as damaging consequences as any other type of serious addiction, believes Birchard. "I have had a client who had to re-mortgage his house twice to pay for his sexual activities," he says. There was the client, too, who got his high from engaging in semi-public sexual activities, which turned out to be a dangerous enterprise: he was eventually reported by a member of the public, and charged with indecent exposure. "Other consequences are sexually transmitted infections," he continues, reading through his mental checklist, while serving freshly made coffee in china cups.
"I've had two or three men who have given chlamydia to their wives. I've had a man who'd given body lice to his wife, which is not nice... Generally speaking, it's the impact on a sense of personal dignity. What we're talking about here is not somebody who goes on the internet for 20 minutes or half an hour, but someone who consistently goes on[line] planning to spend half an hour and goes off at five or six o'clock in the morning, and then has to go to work. And so the harmful consequences are really quite severe. And, of course, the threat to the primary relationship." He is quietly adamant. "I have never heard anybody use it as an excuse."
Later the same day I speak to Robin, a client who is being treated for sexual addiction at IPCC & C, a practice run by Robert Hudson and Associates, a psychotherapist trained in this field by Birchard. The conversation with Robin is over the telephone, for the sake of anonymity. He speaks firmly and confidently, but with some jocularity – the voice of somebody in a senior managerial position. He has been undergoing treatment for sex addiction for a year. His wife does not know about his condition. There was no big revelation about his infidelity that prompted Robin to claim sex addiction, no reason why he should seek that terminology as an excuse for his many extra-marital sexual encounters.
He came to the conclusion that there was something wrong with his behaviour in a surprisingly considered way. Robin travels a lot for business, and on his way back home after a "fairly normal trip", he decided to write down everything he'd done. "Every day I'd done something slightly dubious – paying for a dodgy massage, having someone visit my hotel, picking up someone I shouldn't," he says. "Upon reflection, for someone who's married with three kids, it didn't feel right."
He'd also done something "more dangerous than usual" on the trip, and was worried about having caught a sexually transmitted disease. It put him, he says, "in a bad frame of mind". It wasn't so much a watershed moment as a nagging feeling that something wasn't right. Which might seem incredibly low-key, given the years of infidelity that preceded the thought, but Robin's experience, it turns out, is just a template. Sexual addiction seems to come hand in hand with leading a double life, which separates the 'normal' existence from the compulsive, highly-sexed, meticulously concealed one.
In his 'normal' life, Robin is, by his own admission, very successful in the financial sector. Quite powerful, even. "I have lots of people looking up to me, working for me, I'm very social, those sort of things. I'm not bad looking, I've got a wonderful wife, three beautiful children, a nice car, some property, nothing to worry about," he says. "You wouldn't think I'd need to get a dodgy massage." And yet, just about every week in the past 15 years would see him seeking something sexual outside of his marriage. Even during what he recognises as the 'happiest times' of his married life. "Sadly, some of the happiest times are the most stressful times. I think having all of my children were the most amazing times in my life but I also 'acted out' through all those times," he says. 'Acting out' is the therapeutic term for engaging in illicit sexual activity, and one which everyone in treatment uses. In this vein, when they are in group therapy, patients are not permitted to use euphemisms like "I slept with an escort". Instead, only the bare facts – "I had sex with a prostitute" – are allowed. Concentrating on specifics of language like this heightens awareness of what the sexual activities actually are, highlighting the addictive sexual behaviour as out of line with the life they want to be leading.
Robin must have been, I suggest, very disconnected from his family in order to be able to lead two such disparate lives. He vehemently denies this: "I felt completely connected with that life," he says, of his picture-perfect family existence. "I love being a father and a husband. I don't view that life as unsatisfying or unconnected with it." How, then, does he explain his infidelities? "I am flawed goods," he says. "From an early age I haven't developed the ability to know when I'm stressed and how to deal with that stress... the way I learnt to deal with that stress was by eroticising it."
The treatment process, he says, has showed him that any time he felt under pressure in any way, his response was to 'act out'. "You're living two lives, right?" he says. "You're living two lives when you meet your wife. You're not who you want to be..." That's the reason he hasn't told his wife anything about his addiction. When she met him, part of his existence was already concealed from her. Now, for a year, apart from one "slip up", he hasn't slept with anyone other than his wife, or indulged in any kind of sexual activity outside his marital relationship. His wife still knows nothing – about the past, or about the present.
"I've seen people on the news, famous politicians whose wives stay by them," he says. "Maybe it's the case you can go through this with your spouse, but I don't know if I want to shatter an image that she has, given that I've gone and fixed it."
Sex addiction is a subject area almost devoid of extensive academic research. While there is some thought, for instance, that the quest for a sexual high works along the same neural pathways as chemical addiction, this is currently still a theory. Other research is in the early stages. Dr Lique Coolen, from the University of Western Ontario, published research last year suggesting that when rats had dysfunctions in the frontal cortex of the brain, compulsive sexual behaviour resulted. There's no evidence, however, that this translates to the human brain. Some clinicians, in fact, dispute the term 'sex addiction' altogether. Phillip Hodson, a Fellow of the British Association for Counselling and Psychotherapy, is a non-believer. "There's a difference between having compulsive patterns of behaviour, and being a true addict," he says. "I think some people use 'sex addiction' as a way to cover up moral compromises."
Crucially, the American Psychiatric Association's Diagnostic Manual of Mental Disorders – a reference point for all clinicians – does not yet include sex addiction as an official diagnosis. For the revised version next year, the inclusion of the term 'hypersexual disorder' is proposed – but this definition, as outlined in an article in this month's British Medical Journal, could prove controversial. The authors, David Goldmeier and Jenny Petrak, believe there's a lack of empirical knowledge to support any such diagnosis yet.
That hasn't stopped the general idea of sex addiction gaining currency. Last year, a BBC article claimed that 6 per cent or more of the population experience it, one in five of whom are women. And there has been demand enough for the formation of The Association for the Treatment of Sexual Addiction and Compulsivity (ATSAC), founded two years ago in order to provide support and information about sex addiction, as well as a list of trained therapists on the subject. One of the founders, Paula Hall, who is publishing the first British book on the subject next year, Treating Sex Addiction, is a therapist for Relate, but has also worked with drug addicts. "I see similarities," she says, about the clients who come to her feeling their sex life is out of control. "The key word is addiction, not sex." Hall appreciates the terminological nuances currently being debated in the medical field, but says, "it feels like an addiction for clients. People are struggling with whatever it's called". Testament to this is the Sex and Love Addicts Anonymous (SLAA) group, which originated in the US, and now holds free meetings around the UK. Like Alcoholics Anonymous, there's a 12-step programme, advice on how to choose a supportive 'sponsor' (this mentor shouldn't generally be someone of the sex they're attracted to) and clear ideas about the recovery process – one day at a time, just like every other addiction. SLAA meetings across the country are well subscribed by people who feel they have lost control of their desires.
John, another self-defined sufferer I speak to, remembers very clearly the first time he heard the term 'sexual addiction', because he found it so funny. He was in his teens, and the words came from a Hollywood celebrity. "I remember laughing and thinking what a lot of crap, now the Americans have developed a concept for that," he says. "If you can't keep your flies done up you say, 'I've got a label, I'm an addict'. I remember thinking we'd lost all sense of reasonableness." He's in his late thirties now, and has been undergoing treatment for sexual addiction for about a year and a half. Dressed in an expensive suit, the confidence he exudes is, he says, part of the 'professional' image he always manages to project to the outside world.
For many years, though, John was in denial about his private sexual proclivities, which were compulsive and out of control. As a single gay man for most of his adult life, he convinced himself that he simply had a high sex drive that needed to be catered for amid a busy working life. This was his justification for his habits; he didn't have time for dates, he reasoned, so rather than going out, a good Saturday night for him was spent alone at home, hiring an escort – just a case of a few clicks online, as easy, he says, as ordering a pizza.
Then John went to New York for a business trip. In between meetings he would rush to a sex shop that had video booths where, with a stranger, he could watch pornography and masturbate, while others watched. "[It's] not the sex itself, it's the adrenalin, the excitement, it's a state of mind," he says. "You're actually aroused by the state of mind; you don't know this at the time." At the end of the trip, he realised he'd spent most of his free time having anonymous sex. "I thought, this can't be healthy." He laughs incredulously. "Hello? It's blindingly obvious, but that was a turning point. Spiritually, I was absolutely dead." At this stage in his therapy, he feels that the addiction came from suppressing his feelings as a child; any time he started to feel something a bit more extreme than usual, he sexualised the feeling, so that he didn't have to deal with it. "The addiction could be smoking, or it could be drink – it's something that stops you facing life, and that was my way of not facing life." His current partner has been fully cognisant of the treatment process from the start. He was, in fact, one of the reasons John decided to undergo therapy – when they met, he knew he didn't want to lose his boyfriend through infidelity. He told him he had a problem with monogamy, it was probably an addiction, and he was going to get help. John feels fortunate that his partner didn't balk at the challenge. "It's a work in progress... there's no magic wand, but yes, I'm healthier and happier," he says. "In the truest AA sense, you just take one day at a time."
All the practitioners I spoke to agreed that a breakdown of emotional intimacy is often what leads to sexual addiction. It's primarily a male affliction, but not solely. Anne, a young woman who works in fashion, is an exception to that rule. As a woman in her mid-twenties undergoing treatment at a sexual addiction clinic, she came to the process young, but her addiction to sex, she feels, started when she was very young. Losing her virginity at 13, she jumped very quickly into sex, without reserve. "I always knew I felt different to other girls, and the desires I had sexually and the frequency I craved it didn't seem on par," she says. "I'd read articles about how to please men, and they seemed geared towards romance and passion – I didn't find those things were me."
By the time she was 14 she was having group sex, and a year later she and her friends were engaging in promiscuous sex with both genders, operating under a slogan they'd invented: 'A hand is a hand and a tongue is a tongue – it doesn't matter who it is'. A steady boyfriend, when she was 16, introduced her to a different way of being sexual: "He was a strange individual, into dark sexual activity." Role play, guns and knives all played a part, and Anne says she loved him, but especially loved the attention. "He almost worshipped me, and fed me the attention I needed. I was very insecure, and relished the attention of men," she says. "I found it incredibly easy to manipulate men into doing what I wanted by behaving in a sexual way. I just assumed a mock sexual confidence."
After a difficult relationship with her parents – she found her father overbearing and restrictive, and she stole from her mother – she was thrown out of home at the age of 17. A couple of years later, she became a lapdancer – but not, she emphasises, because she needed to. She wanted to. "I spiralled out of control," she says. "My problem with sex was that I'd do it not even for fun. I wasn't enjoying it. I wanted the attention, I wanted men to want me. It was all adulterous sex... all friends of friends, not faceless encounters. I suppose pulling a guy in a club was never a challenge."
After a series of failed relationships, she met the man who is now her current partner. Things seemed a bit more 'normal' for a while. "After the honeymoon wore off, my old behaviour was creeping in," she says. "I got to a crash point three years ago when I reached rock-bottom, and wasn't happy not telling the truth. I went out, got drunk, and had sex in an alleyway off Leicester Square." Her partner found out about her infidelity, and in their trial separation, she decided she needed help. "I always thought I could disassociate emotion and sex. Through deep soul searching, that's much more damaging than I thought. I thought my problem was infidelity but it was my attitude to sex."
She's been attending sessions at Mr Hudson's clinic for the past 18 months. "[They've] been really hard, really difficult," she says. "It's not easy admitting to myself that I'm out of control, and I haven't been without slip-ups. There are occasions when I've been unfaithful, and my partner knows. When we got back together he never asked me to promise not to cheat, just not to lie." Part of the process, she says, is realising what her 'triggers' are. If she can recognise when she's depressed or overwhelmed, she can flag it, and ask for help, rather than succumbing to her own self-medicating techniques, which are almost always sexual. "The problem is, I'm so far along with the addictive pull. It's like red mist. It's not just that you feel horny, it's overwhelming, animalistic. It almost feels physical, I'm so overwhelmed by the need to have aggressive faceless sex with someone who doesn't care about me."
Birchard thinks that some elements of sex addiction have grown in tandem with the proliferation of the internet. "It's so simple," he says. "It just takes one click or two clicks." He calls it a 'triple A' engine: offering Anonymity, Affordability and Accessibility. "It seems to me that we get people who are really traditionally not sex addicts, but kind of wander into a process."
That theory is a familiar story for Andy, another patient I interview. In his teens, he started looking at pornography. Top-shelf magazines, some videos – not much more, he says, than an average teenage boy might. He doesn't think his sexual addiction started there. The marker for him came when he was introduced to the internet, in his mid-twenties. "That was crazy," he says. "Unbelievable. I'd go on the internet at 5pm when I was supposed to be meeting a friend at 8pm. Then I'd cancel the friend, and at 2am I'd still be in front of computer..." By the time he was in his early thirties, he was in the grip of a compulsion.
Andy is in his late thirties now, a well-spoken, suited, high-flyer in the city. His frame is imposing, but the subject makes him vulnerable. He's embarrassed, talking about his compulsive masturbation and the marked change in his personality, as time went on, from relaxed to angry. But he has found a way of speaking about it, when previously he refused to acknowledge how his life was meandering out of control. It was his girlfriend who confronted him – none of his friends know about his addiction, or the subsequent therapy he's been undergoing for over two years. "There's so much online; everyone talks about being anaesthetised – you see an amount of a certain subject and you become completely immune to it," he says. "You don't think about the person behind it, the impact, it's there for your pleasure. That was the most worrying thing. I think it just leads you on to so many different avenues you wouldn't even think about. The more you look at something, the more you think, 'That's boring, now I want to find something else'. You can end up in serious trouble."
Andy had a routine. Every night, he'd come home from work and go online to look at pornography for a couple of hours before dinner. After dinner, he'd go out for a drink or to do sport, and then he'd log on just before bed – which often lasted until the early hours of the morning. The next day at work, he'd be exhausted – and then repeat the same activities when the working day was over and he'd find himself at home again. He stopped trying to have relationships with any emotional intimacy; he went out with someone for a year and manufactured so much travel and business work that he only saw her about six times before ending it.
What was strange, Andy says, is that his personality suffered a marked change. Not that friends would notice – he saw them every couple of weeks, or once a month, and could be social when he needed to be. But internally, a new anger was bubbling, and it would often spill over. "I've always been quite a relaxed person and I'd be very quick to temper. I'd be trying to fix some little thing and get in a seething rage, shouting and screaming, which was unlike me." He used to consider himself a sociable person, yet he became withdrawn. "I was becoming a bit of a nightmare."
Now, he and his girlfriend are doing partner therapy work at Mr Hudson's sex addiction clinic. They're reading a lot of related books, and working on changing Andy's mindset. His home is now known as a 'safe environment' in therapy speak. There are blocks on his computer so that he can't access pornography – his brother is the only person who knows the password – and there's a PIN on the television for anything adult-orientated (his girlfriend knows that). He's changed jobs to travel less, and when he does, he goes on business trips with colleagues, and avoids time alone in hotel rooms. "It's weird," he says, of his new life. "I'm back playing squash again, and I'm reading a lot more again – things I've not done for so long because all my spare time was spent in front of a computer." He is quietly proud of himself, but incredulous, too, looking back at the sulphurous haze he has just stepped out of. "I just wasted 10 years of my life," he says. "I just think – why? I could have done so much more."
Names of clients have been changed
This article has been amended to correct a mistake at time of print: we referred to Mr Robert Hudson in the piece as 'Dr Robert Hudson' - this was our error, and Mr Hudson has asked us to make clear that he has never called himself doctor, or wished to be named as such.
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