Addiction

So, What Do We Mean By "Addiction"?

The case for treating sex as an addiction:

In the last week of treatment, he and his doctors mapped out what his life would look like back home after recovery. He sees a counselor and goes to a 12-step recovery program. "In my first 365 days after treatment, I went to 523 meetings," he says.

Early on in his recovery he did sometimes look at Internet pornography, but a software program he installed on his computer alerted his wife and sponsor in his support group, and he stopped looking at porn.

Gradually, Rogers says, he learned how to have a healthy sex life with his wife.

"That's what we aim for," Parker says. "We're not trying to turn someone into a monk. He needs to learn how to have sex like a gentleman."

The case against:

As Tiger Woods undergoes treatment, T. Byram Karasu—the University Chairman of the Department of Psychiatry and Behavioral Sciences at Albert Einstein College—says medicalizing normal human behavior doesn’t help anyone....

The treatment for sexual addiction is a form of pseudo-redemptive window dressing in which no one, especially the addict himself, really believes.

Sexual addiction is not like other addictions. Unlike addictions to alcohol, cocaine, and cigarettes, in which the craving is induced by external elements, sexual craving, by its nature, is an innate and natural phenomenon. And sex addiction is a specific situation—the frequency of erection and the intensity of orgasm—dependent on the person’s blood-level of testosterone.

It's interesting that the "for" case posits a treatment different from the similar 12-step treatment for alcoholism, which I have always heard requires you to stop drinking entirely. Medical doctors being so very interested in our animality, the assumption is that one cannot abandon sex entirely and be 'healthy,' since sexuality is normal and natural, and therefore ought to be present in reasonable amounts.

Eating and drinking are also normal and natural behaviors, and one can certainly point to gluttony as a problem not only for the glutton but those around him or her; but one really can't stop eating, whereas one actually can stop having sex. Indeed, the practice of celibacy has enjoyed a high reputation through most of human history: it is supposed to have numerous benefits, so I have heard. Fasting, the closest analog, can only ever be a temporary condition.

Would we say that the same mechanism is at work in gluttony and unchaste behavior? Sometimes there is at least the additional aspect of deception; gluttony is usually practiced openly, whereas one can openly sleep with lots of other people if and only if one is unmarried. Leaving deception aside, though, it does seem to be an unnatural focus of pleasure in only one otherwise natural process.

Here, too, we return to alcohol addiction: the enjoyment of a glass of wine or a fine ale has such a long history -- at least since the dawn of civilization, and quite possibly explaining the dawn of civilization -- that it would be a little strange to view it as non-natural behavior at this point. It would be nice if we could develop a 'therapy' that allowed a man to 'drink like a gentleman,' instead of abandoning the normal as well as the unnatural pleasure. Why can't we do that? Or can we?

There’s one element of the Sinclair Method that may surprise some people. The patient must continue drinking alcohol for the treatment to be successful. The drug naltrexone must be taken in conjunction with alcohol in order to be effective. While the drug may reduce the desire for alcohol so much that a patient eventually ends up giving up alcohol completely, abstaining from alcohol on a permanent basis is not a requirement of this treatment. One of the main goals is to get destructive, problem drinking under control so that a person can live a normal life.

It may be that there is a common root, then: the reward systems of the brain getting out of whack, and needing to be reset. Abstinence may be one way of doing that, and simply blocking the chemical rewards may be another. That would tend to explain why we can have apparently addictive behaviors in natural, innate things like sexuality or eating of food; but does it also explain unnatural behaviors like methamphetamine abuse?