The lucrative, but dubious, business of treating sex addiction

Here are three things to know about sex addiction. First, a growing body of research suggests compulsive sexual behavior affects between 3 and 6 percent of the U.S. population. Second, celebrities who often blame the condition for sexual improprieties probably don't have it, therapists say. Third, it doesn't feature much in the medical literature, making it hard to track and leaving the growing network of sex addiction treatment centers in a medical gray area lacking the formal clinical protocols found with more standard diagnoses.

To the last point, there is debate over whether the condition qualifies as an addiction. No reference to sex addiction or compulsive sexual behavior appears in the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered the definitive guide to mental health disorders. That makes diagnosing and treating it especially difficult—and makes it doubly challenging to tell legitimate practitioners from quacks.

Since it was first described in the 1980s, sex addiction has come to be defined as a condition where people lose control around sex or use it as a way to distance themselves from their lives, akin to gambling or drinking. Despite the growing consensus that sex addiction is an actual clinical disorder, however, there is still a debate within the medical community over whether it's real.

A UCLA study in 2012 found that the brain activity of self-reported sex addicts were no different from the brains of people with a high libido. But another study two years later found that so-called compulsive sexual behavior is associated with the type of abnormal brain activity associated with drug addiction. 

Meanwhile, people suffering from any number of mental illnesses, from depression to schizophrenia, can exhibit sexually aberrant behavior. And then, of course, there is simply the poor judgment, perhaps exacerbated by drugs and alcohol, that cannot be attributed to psychological disorders. 

This is where the lack of definitions in the DSM and the International Classification of Diseases becomes problematic. Because of a relative paucity of scientifically rigorous research on the subject, much of what passes for sex addiction therapy is unregulated by either government agencies or insurance companies.  

"If there's no [diagnostic] codes associated with it, there's no insurance that will pay for that," said Susan Combs, a health insurance broker based in New York. 

Despite these challenges, the number of facilities catering to self-confessed sex addicts has grown, seemingly in tandem with the number of public figures who say they suffer from the condition. Some 1,500 meetings of Sex Addicts Anonymous happen in the U.S. every week. There are 2,500 certified sex addiction therapists in the country today, up from just 900 in 2010. In the year that Tiger Woods and reality TV star Jesse James were in the spotlight for seeking sex addiction treatment, the Sexual Recovery Institute in Los Angeles saw its caseload grow nearly 50 percent. 

According to Robert Weiss, a therapist of 20 years who founded the Sexual Recovery Institute (which closed in 2015), sex addiction is not defined by the amount or type of sex an individual has, but by how it affects a person. For example, sex addicts may watch pornography, or seek out casual encounters or prostitutes compulsively, to the point where it interferes with their families or jobs. 

"The folks that I work with…. they seek the intensity around the search for sex in order to escape emotional challenges and stressors. Just like people drink," he said. "It's very much like compulsive gambling." 

Many of his clients have had their lives disrupted by their condition, he said; almost all have suffered some sort of trauma early in life. The way to treat that—through one-on-one sessions with a psychiatrist or therapist—is expensive. And that's not what many rehab centers provide.

"Some of the most expensive recovery centers in the U.S. essentially did one thing, which was 12-step recovery," said Dr. Lloyd Sederer, chief medical officer of the New York State Office of Mental Health. "They surround it with fine meals, equine therapy, but that's basically what it was. And we know that that's not enough."

A recent documentary on the $35-billion-a-year industry for treating substance abuse showed that many addiction treatment centers do not hire licensed medical staff and don't offer extensive treatment beyond a souped-up version of the 12 steps. The 12-step system, a method of total abstinence used by groups like Alcoholics Anonymous and Narcotics Anonymous, has been shown to be minimally effective for the majority of substance addicts, more than 90 percent of whom will relapse at some point in their treatment without other help.

Such programs are free when addicts attend them in their communities; at inpatient rehab centers, they can cost from $25,000 to $44,000 a month, according to the documentary. American Addiction Centers, a network of 30 inpatient and outpatient clinics, had $115 million in operating revenue in 2013, the year before it went public. Last year, that figure was $270 million. AAC also offers information on sex addiction on its site, although it does not say it treats the condition.

Treatment costs at the specialized clinic where disgraced movie mogul Harvey Weinstein is reportedly being treated—The Meadows, in Wickenburg, Arizona—runs a cool $37,000 a month. In addition to individual and group sessions, it offers equine therapy, expressive arts therapy and nutritional consultations.

"I'm not saying yoga and massage and horse riding is not helpful, but it's not treatment," Weiss said. "Treatment is very rigorous work that involves group work, and sessions, and discussions, and contracts. It is hard work." 

In Weiss' view, many large-scale treatment centers are more focused on turning a profit through marketing than investing in the trained staff required to help patients recover.

"I've been with companies that would rather hire 50 salespeople to run around the country selling programs than hire 50 therapists," he said. 

So how does a potential sex addict find the real deal when it comes to seeking help? Sederer of the New York State Office of Mental Health has a list of questions anyone suffering from an addiction should ask a treatment provider: "What percentage of your patients are receiving cognitive treatment? What percentage of your patients are getting medications? Are there psychiatrists or addiction doctors who come frequently? What is the long-term plan," he said.  

Weiss recommends looking for a therapist licensed by the International Institute for Trauma and Addiction Professionals, the professional body founded by Dr. Patrick Carnes, who was the first to describe sexual addiction more than 30 years ago. And when it comes to treatment centers, he said, "there are five treatment centers in the country who know what they're doing with sex addiction." 

And if sex addiction is really the problem at issue, a sufferer looking for treatment beyond 12-step meetings should be prepared to pay, said Weiss. "When you have a complex psychological challenge that insurance doesn't pay for, you'll only get care if you have money."