Category: Sex

Sex Addiction Equation

Sex Addiction

Recently, in the news, yet another high-profile personality was caught doing something the public frowned upon.  I say he because we almost never seem to hear about woman reporting herself as a sex addict.  What does it mean to be addicted to sex?  It is the same kind of problem as alcohol or drug addiction?  Let’s explore it just a little bit further.

Sex attracts attention or you wouldn’t be reading. If you want to get someone to read your newspaper or watch your news program or even read your blog, just put the word “sex” in it.  The interest in sex has reached new heights around the topic of addiction.

Obviously, sex is a necessary part of life.  Without copulation, there would be no reproduction of the species.  This is true not just for human beings but also for essentially all organisms on earth.  Sex is part and parcel of the will to survive.  Without it, there is no life.  In this important way it differs from drug or alcohol addiction.  A person can live his or her entire life without ever taking a drink of alcohol.  I suppose an individual person could live his or her life without ever having sex, but the species cannot survive without engaging in sex.

Alright, so it’s different from drug addiction in that important way.  But how is it similar?  People who suffer from sex addiction describe the feelings surrounding the behavior as being very similar to the feelings of the drug addict craving a drug.  They talk about compulsive thoughts, being driven to distraction and progressive breakdown in the social fabric of their lives.  The behavior patterns of a person addicted to sex or certain sex behavior, in many ways, are indistinguishable from the drug addict or alcoholic caught in his or her illness.

Pleasure Center

Deep inside the brain, in an area called the ventral tegmental area (VTA), resides the central processing unit for the perception of pleasure.  Essentially, all the pleasurable input is routed through this area for evaluation and comparison.

If pleasure is detected then a memory is made so that that pleasurable experience can be repeated.  This is true for all known drugs including alcohol as well as food, and sex. It even makes a note of laughter.  It seems in some ways the brain cannot distinguish sex from food. It also at a certain neurologic level can’t distinguish drugs and alcohol from the very essence of life.  Scientists have measured the spike in a level of a neurotransmitter or brain chemical called dopamine.  Eating and the sense of satiety following a meal will cause an approximately 50% rise of the level of dopamine through this pleasure center.  Sex bump is about 100%. Sex feels better than eating for most humans.  Alcohol is about double that and other drugs raise it up to ten-fold, especially amphetamines.

So there is simple pleasure component involved in sex and, as much as any behavior, can become addicting.  It’s reasonable that sex could drive one to addiction.  What decreases the likelihood of addiction is the cost of obtaining the substance or engaging in the behavior.  Now some of you are laughing because the case in the case of many of these athletes and celebrities included paying for sex

If the only way a person had sex was to hire it, then when you run out of money, you run out of sex. This is obviously not the case, but economics plays a central role in sexual gratification. Just ask the peacock.  In the mean time, the value of purchasing sex with time, energy or money versus purchasing something else is measured in a different area of the brain: the forebrain.  That’s the big lumpy mass of grey matter that sits a little higher and a little further forward from the VTA.

The judgment area of the forebrain, the orbital frontal cortex, is measuring and checking all the time.  It notes the fluctuating value on any particular activity that a person engages in.

In social context, there are incentives and disincentives to have lots of sex.  In the young adult years, the incentive socially is to try differe

nt partners. Dating is the ritualized process of evaluating possible mate choices. Additionally, people are expected to “settle down” after a time and pick a partner. On average the social mores support monogamy following marriage.  Most people, when surveyed, believe that they should be monogamous in a marriage.

The cost of not being monogamous in a marriage can range from trivial in an “open” marriage to the severe.  In the worst case scenario, public ostracism and dissolution of the marriage can have extremely high costs both for the individual and family and friends

Definition of Addiction

Part of how we define an addiction is through its negative consequences.  If a person abuses a substance or is engaged in a behavior and they directly suffer no ill effects and socialitally we are no worse off, then it’s hard to take issue with that specific addiction.  In the case of sex addiction, we’re referring to a set of behaviors which cause consequences for the individual.  Some of the consequences are overt in terms of distraction from work, time and money spent on the activity.

Others are more subtle and difficult to measure.  If a man has a relationship on the side, he will take away from his family time and personal time with friends in order to pursue that relationship.  Exposure to other risks increases the cost.  There are potential entanglements with the sex partners; spread of disease, and not uncommonly, increased use of mind-altering substances associated with the sexual activity.

At what point does one cross the line?  For many of the celebrities apprehended in the middle of the act or made public in their activities, the consequences seem to come all at once.  In truth, they had been building prior to public discovery.  In many cases, there are additional costs in terms of trying to keep the information private.  Sometimes a public figure will get himself into a position of being blackmailed while trying to keep the information private.  It’s clear that there are consequences to sex addiction and it is also clear that they’re difficult to define

Many political figures and celebrities may appear to be hiding behind the umbrella of sex addiction as an attempt to justify their behavior.  This doctor’s opinion is that even though the judgment center may have trouble accurately measuring the potential consequences and even though the individual may not have considered the implications for his behavior, there’s always a choice.  Nowadays with ever-present video surveillance and a heavy premium on catching the righteous, no one can expect to stay private forever.  These days just about everything is liable to make the news eventually. Given that consequences are likely somewhat forecastable by the individual and that discovery is inevitable in virtually every case, there has to be a judgment involved to commit the act or acts.

Addiction and its consequences are a choice.  The individual has a choice over whether or not to engage in addictive behavior.  No matter the extent of the compulsion or the drive, a person can always reach out for help. Help is available all around.  How much better to share privately with a friend about one’s urges in the direction of sex than it is to act them out and find out later, “you could have come over and talked with me.”


This is not to minimize the effect of upbringing and family modeling in the difficulty of making a healthy choice. It is more difficult to see clearly.  We also do not wish to burden the family afterwards with worry over possible relapse.  If we’re going to expect a person to stay clean and behave in a healthier way, then we must accept that they have the power of choice. The current neuroscience data around addiction studies indicates that the brain has a distorted reward measuring system.

Whenever we decide to do something or not, there’s a measuring process that takes place.  The economists are the best at studying this and behavioral economics is a burgeoning field. The economists are always trying to figure out what an item or transaction is worth. The neuroscientists can map activity in the brain as a p research subject is presented with options of varying cost.

If a researcher were to offer you $10 today or $11 next week, most people will pick the $10 today.  The interest rate on one week’s delay for an extra dollar is over 5000%.  The reason most people would take $10 now versus $11 later is the perception of risk. The brain comes to the idea that the researcher might not show up next week, or she might change the rules. Besides, the amounts are almost the same, right?

The process by which this measurement takes place is called future discounting.  The forebrain or frontal lobe does a complex analysis on the difference in return and the likelihood of payoff

In the case of the sex addict, the measurement of the likelihood of negative consequences comes short of the assessment of immediate gain.  Of course he knows he’s taking a risk but there seems to be a pattern of getting away with it.

The trouble with all addictions whether chemical or process-type addictions is that tolerance develops.  Tolerance can be thought of as simply needing more of the stimulus over time.  In the case of gambling, it’s placing a bigger or more frequent bet.  Eventually, it’s both.  In the case of drugs, its increase in use and as any long-term drug addiction will tell you, it’s the requirement of use to feel “normal.”

In the case of sex addiction, the same problem happens.  As a person engages in the activity which is socially, personally, spiritually and/or professionally damaging, they get a sense of exhilaration and pleasure.  Over time, the episodes become more frequent and the risks go up and the perceived need for reward goes up as well.  Sex addicts describe a feeling of withdrawal in the same way that those abstinent from a drug of choice do.

A mentor of mine, who was one of the first women in the history of her medical school, was once being given a tough time by the urology department at the medical school.  She was young and very beautiful and was rotating through as part of her medical training.  Surrounded by a classroom of her peers, all male students and faculty, the urology professor asked her what nerve mediates erection.  Even these young professionals weren’t above giggling at the question, and they watched with anticipation their colleague twist a bit.

“The optic nerve,” she replied.

We now live in the age of instant images available through any Google search. Internet pornography is jet fuel for sex addiction.  Titillating and stimulating images are available 24 hours a day and with the rush of free pornography available on the internet in three to five minute clips, there’s no need even to pay for it. While a person might have had a transient or fleeting idea of some sexual activity such as masturbation or an extra-marital affair, now there’s visual support for this activity available at his fingertips.

I have seen no study on whether or not the easy availability of pornographic materials on the Internet has led to an increase or decrease in sexual addiction.  Intuitively, it seems that there was probably an increase.

Back to the damaged reward mechanism.  Since the brain can’t distinguish between what’s imagined and what is real, the imagined sexual activity as portrayed on the internet or in television or in films for that matter to the frontal lobe is just another example of getting away with it.  When the person engaging in sex related activity is assessing the likelihood of being caught, they put in the denominator of their equation the number of times they’ve engaged in similar activity and in the numerator goes the number of times they’ve been caught.

Number of times of pleasure – Number of times caught


Number of times engaged in behavior

If a person looks at pornography and this goes one for a year or two, he has hundreds of examples for his frontal lobe of successful pleasurable sexual activity.  When the casual touch and the erotic glance of a person in a casual encounter suggests the possibility of extra-marital sex, the frontal lobe has had hundreds of “episodes” where nothing but pleasure came of the anticipated activity.  The brain does not reliably distinguish the difference between the two possibilities.

In that moment, consideration of the actual likelihood of being discovered and all of the negative consequences that will follow is inaccurately measured.

The sense of isolation is already developed in the person habitually seeking sex. Separation from his primary relations and an internal dialogue of shame are well established.  Ironically, it is this loneliness and isolation that drives his actions in seeking human contact.  Many men who seek the company of prostitutes report not seeking sex at all but someone to spend time with and to talk with them. Sexual compulsivity is driven by loneliness and fear of rejection.  There is, at the same time, a fear of intimacy as well a compelling drive to connect with another human being.

In the case of the celebrity, it can indeed be lonely at the top. Having the courage to speak honestly to a therapist or a trusted friend is difficult to muster. It is difficult enough for the less-than-famous. The end result of not seeking help is terrible emotional pain and unnecessary risk to many. The solution to the problem of the brain that has incorrect information or a skewed measurement process is to get another brain to check the work.

People need to be together. This yearning is behind both sex addiction and its antidote. What do you think?