Science Vs - Sex Addiction: Are They Faking It?

Episode Date: April 5, 2018

Harvey Weinstein and Kevin Spacey are said to have it. You probably have a friend who says they have it too. But is sex addiction the refuge of scoundrels? Or is it a real psychological problem? We speak to sex therapist Dr. David Ley, clinical psychologist Dr Shane Kraus, neuroscientist Dr. Nicole Prause, and someone we call Jeff. If you are experiencing troubles related to sex, you can look for support here. Check out our full transcript and its beautiful thickets of footnotes: http://bit.ly/2rvVfWD To find a list of our sponsors and show-related promo codes, go to gimlet.fm/sponsors This episode has been produced by Shruti Ravindran, with help from Wendy Zukerman, along with Rose Rimler, Heather Rogers and Romilla Karnick. Our senior producer is Kaitlyn Sawrey. We’re edited by Blythe Terrell. Additional editing help from PJ Vogt. Fact checking by Michelle Harris. Mix and sound design by Emma Munger. Music written by Bobby Lord. Recording help from Gideon Brower and Hannah Colton. For this episode we also spoke to Dr. Marc Potenza, Dr. Carl Erik Fisher, Dr. Valerie Voon, Dr. Joshua Grubbs, and Dr. Mateusz Gola. Thank you so much for your help. And an extra special thanks to Frank Lopez, Joel Werner, Joseph Lavelle Wilson, and to all the men and women who allowed us to hear their stories in meetings for sex addicts and sexual compulsives in New York. Selected readings:  Shane’s review paper on the case for sex addiction Shane’s survey on sex addiction among veteransA review paper critiquing the case for sex addictionNicole’s lab study testing whether sex addicts can control sexual response Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus from Gimlet Media. On today's show, we pit facts against fornicators. And we're looking at sex addiction. It's been in the news a lot lately. Harvey Weinstein's rep recently said that Weinstein was getting treated for sex addiction. Guys, I'm not doing okay. You're not? I'm trying.

I gotta get help. Kevin Spacey recently headed into a sex addiction rehab centre too. And in the last few years, several celebrities have said they suffer from this. Weiner reportedly has checked into an undisclosed sex addiction rehab centre. Actor David Duchovny claims he's addicted to sex. Tonight I talk to a doctor who assures us this is not only a very real psychological disorder, but also something Tiger Woods may struggle with his whole life.

But there's a group of researchers who don't buy that sex addiction is a thing. We spoke to a clinical psychologist in New Mexico who treats people with issues around sex. His name is David thing. We spoke to a clinical psychologist in New Mexico who treats people with issues around sex. His name is David Lay. The last name is spelled L-E-Y. It's a funny name for a sex doctor to have. But my story is that I only had two options. I could be a sex doctor or a politician involved in a sex scandal. David wrote a book called The Myth of Sex Addiction. And he says there's this concern that people like Harvey Weinstein are just trying to escape responsibility. Because now it takes away the accountability of these people.

You know, the reason that Harvey Weinstein got this reaction is everybody said, no, no, no, wait a minute, buddy. You are responsible and accountable for having hurt people with your behaviors and you don't get to use this out. And David is also very skeptical of this idea that people could be addicted to sex and then go through some kind of withdrawal like you do with heroin. If you take away sex from a sex addict, nothing happens. Nobody ever died in the history of the world from blue balls. And the temptation is to say, this is bogus.

These guys are just creeps. It sounds like the only time someone cries sex addiction is when they got caught hurting someone and they're trying to get out of it. But does that mean that we can totally dismiss this idea of sex addiction? Well, no. Because there's actually a lot of scientific debate around sex addiction. Like, even when it comes to withdrawal, there are reports that people who say they're addicted to sex

do have symptoms when they're not getting any. Symptoms like anxiety, the sweats and insomnia. And you can find scientific papers published in legitimate peer-reviewed journals claiming that sex addiction does exist. And this is why the International Classification of Diseases, which is used by the World Health Organization to classify mental illness,

is now considering adding something that looks a lot like sex addiction to its list. So what's going on? Is sex addiction straight-up poppycock? Or does it exist? When it comes to sex addiction, there are lots of wieners. But then there's science. When it comes to sex addiction, there are lots of wieners.

But then there's science. Science vs. Sex Addiction is coming up just after the break. What does the AI revolution mean for jobs, for getting things done? Who are the people creating this technology? And what do they think? I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI. Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI. And don't forget to subscribe wherever you tune in. It's season three of The Joy of Why, and I still have a lot of questions. Like,

what is this thing we call time? Why does altruism exist? And where is Jan 11? I'm here, astrophysicist and co-host, ready for anything. That's right. I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan 11. I'm Steve Strogatz. And this is Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Welcome back. So, sex addiction is all over the news, and at Science Versus, we wanted to know whether it really was a thing. And we found out pretty quickly that away from celebrity land,

there are people out there who say they really struggle with controlling their sexual behavior. Our reporter Shruti Ravindran, hey Shruti. Hey Wendy. She's been going on a deep dive into sex addiction. Very deep. Right, just to get a firmer grip on the situation. Precisely. And then, but quite seriously, you, as part of your reporting, you met this guy who told you about his very serious battle with sex addiction. That's right. We're calling him Jeff, but that's not his real name. And he invited me to his apartment for a cup of tea.

So I'm just making a cup or a first brew of Taiwanese gaba oolong. Really, really nice tea. Good for focus. He has this fancy water kettle that helps him heat up the water so it's just below boiling point. Any hotter and the bitter stuff would get through, he says. Are you very particular about things?

I try to seek optimal experiences. Jeff thinks his problems with sex started around puberty. He would get turned on by hardcore porn, the kind that involves ropes and chains and at least one person on all fours. And he was really ashamed of it. As time went on, he started thinking more and more about doing the stuff he was seeing in porn. But he didn't dare ask his girlfriend for what he wanted. Jeff dreamed of going to an escort, but he couldn't bring himself to do it. And then at some point I broke up with a girlfriend of a long time. And the first thing I did, she went to the airport,

I went to see an escort. And I felt horrible afterwards. But he soon got comfortable with the idea and he started going to escorts every now and then. And he was still watching a lot of porn, fantasising about hardcore stuff and masturbating a lot. But then Jeff said he met someone he really liked. They started dating, moved in together, they got married.

And he actually stopped going to escorts. He was trying to stay on the straight and narrow. But soon, he said, his old sexual urges started creeping back up again. What did that look like, where you'd wake up in the morning and then what would happen? Waking up in the morning, going to the bathroom, masturbating, to porn or to the idea of going to see an escort. He got restless. He worked from home and he would have these large tracts of time in his day that he would fill with more masturbating and fantasizing about going to the escort. I feel like most people can relate to it with food potentially the best.

It's that cycle of like, I'm going to get that donut. I'm not going to get that donut. I really shouldn't get that donut. I really want that donut. Should I get that donut? How can I get that donut? What should I justify to get that donut? And this mind space is hell if it's constant. And even though he says that he didn't want to see an escort, he also says that he just couldn't control himself. I was walking up an avenue and I passed my subway stop. I was like, you know what, I'm going to go.

And I could feel this kind of push to just go. And my feet were kind of on an automatic little treadmill. And there was this other part of me that was just like, you know what, if you just let your feet carry you, we'll just do what we need to do in a few minutes. And what he needed to do was go to see an escort. Yeah, that was a part of sort of automatic behavior. Soon after, Jeff slept with his wife. And things started going off the rails fairly quickly. You put her at risk, you're saying?

Yeah, I mean, having sex with escorts is not safe. Presumably you used protection. I sadly can't say I always did. Well, it only happened once. And that was something that I, that's, I think, the worst part of the screw up, really. I kind of agreed to not use protection. And that was kind of part of an escalation of a high of like, oh, this, you know, this is something new that I haven't done before. Jeff didn't tell his wife that he'd recently had unprotected sex. And what's messed up about it is that, as Jeff tells it, his wife had actually asked whether they should use protection. Yeah, I said no, because really, fundamentally,

those things were separate parts of my life. And so admitting yes would have been the beginning of admitting what had happened and what had been happening. And soon after that, Jeff came clean to his wife, told her what had been going on. And what she said was pretty surprising. She said, it sounds like you have a problem. Have you considered that you might be a sex addict?

He looked it up on a website for sex addicts, and everything he read there felt so familiar. It was hard for me to kind of deny it because I basically burned my life to the ground. But over time, he became comfortable with this idea that he was a sex addict. It lifted a weight off of him. He felt he could forgive himself. Jeff now goes to support groups and has a girlfriend who he adores.

He's told her everything about his past, and he says they trust each other. I've been sober three and a half years. My life has changed enormously. So when you say you've been sober for three years, what do you mean by that? I mean, I haven't masturbated to porn or gone to see an escort. The things that Jeff described sound pretty bad. And having the label of a sex addict really helped him. But do his experiences really add up to an addiction? Like, is Jeff's relationship to sex at all like a heroin addict's relationship to heroin?

It might sound a little odd that sex could be addictive like a drug, but in 2013, the American Psychiatric Association, the gatekeepers of what gets to be called an addiction, got together and declared that it's not just substances like drugs that could be addictive. You can be addicted to an activity, they said. But so far, the only activity that they've said there's enough evidence for to call it an addiction is gambling.

Still, though, the fact that gambling got over the line opened the door for other things to be considered addictive too. Things like internet addiction, eating addictions and, yeah, sex addictions. Shruti headed to Boston to meet a psychologist who's part of the group arguing that sex can be addictive. My name is Dr. Shane Krause, and I'm the director of the Behavioral Addictions Clinic at the Bedford VA. He was a little nervous to talk to me about sex addiction.

Shane is a clinical psychologist and researcher at a veterans hospital just outside Boston He treats lots of war veterans who suffer from all kinds of addictions Including sex addiction Which is something he says that a lot of his patients struggle with In fact, when Shane and his team surveyed more than 800 veterans who returned from Iraq and Afghanistan They found that around 10% of them had some form of sex addiction. I guess I'm trying to understand like what the term addiction captures that feels true to the experiences that you see.

Well, I think it gets down to the core essence of which is really impaired or lost. So addiction means, right, like to become enslaved, right, to be inbound. And I think that's the framework here, to kind of give yourself or to engage in something over and over, that to lose, to have say, I can't stop this, despite a lot of issues. So Shane says that a lot of his patients feel like they can't control their sexual urges. And this is one of the most important hallmarks of addictive behavior, loss of control. For sex addiction, Shane says that his patients have this insatiable

craving for sex or for masturbating. It's like Jeff, who is in a kind of spin cycle with this one thought circling around, telling him he ought to, deserved to, had to visit a sex worker. Shane says that for sex addicts, this craving gets so intense, everything else in their life takes a backseat. And for many sex addicts, this plays out in their porn use. It becomes almost a center, core part of their life. So do you mean that they start to organize all their life around the next hit of porn? Yeah, we've seen that. Or missing activities or going places or using pornography for long periods of time.

And using four, five, six hours at night and not going to sleep until three in the morning, but you have to go to work at 6am. Shane has studied people who could be classified as sex addicts and found that many of them had tried several times to cut back or quit their porn use, and they just couldn't. And away from Shane's clinic, when you look at other research, there does seem to be a spectrum of control here where some men can control themselves sexually better than others. And Shane says that for sex addicts, their relationship with sex is

different to yours and mine. They see a visual trigger and they get much more excited than the rest of us would. And then they can't ignore it. So if I saw some cute guy, I might get turned on. But then I could brush it aside and, you know, keep reading a scientific paper. Wendy might be able to go back to her business, but some sex addicts, Shane says, can't do that. He told us about one patient he had who would get turned on by pictures online that weren't sexual at all. It could be an image, not a non-sexual image online. It could be walking by and seeing a woman-specific type that would trigger him. And it could be four hours.

He would think about it for four hours, you know, until... That um meant the patient would masturbate. Yeah. And Shane says that there is some evidence that sex addicts do process sexual images like porn in a way that's kind of different to other people, which might point to bigger differences in how addicts' brains work. And the thinking here is that these brain differences could explain why they find it so hard to quit. When we looked at the evidence for this, though, it comes from small studies. So for the moment, there's nothing conclusive here. And just generally speaking, the case for

sex addiction doesn't have a lot of scientific evidence on its side. And Shane actually acknowledges that. But he says that he's still got a lot of patients coming in with these problems. And surely all the experiences of these veterans should amount to something. Okay, so here's what we know so far. From what Shane tells us, when he talks to some of his patients about their sexual issues, what they describe to him sounds like an addiction. They crave a lot of sex, spend a lot of time thinking about how to control those cravings, and it's just so difficult for them. After the break, we look at this debate from another position.

Doggy style! No, we talk to those who think sex addiction is rubbish. Bring them into the laboratory, you put a vibrator on them. Welcome back. We just found out that Shane Krause, a psychologist for war veterans, says that many of his patients have problems with sex and their experiences seem to fit this description of an addiction. Basically, they crave sex,

they have a lot of trouble controlling their sexual urges, and this messes with their life. But there's a big scientific debate going on here and we wanted to get the other position. Missionary! No, to get the other side of this debate, we spoke to Nicole Prowsey. She's a neuroscientist who used to work at the University of California in Los Angeles. She's since founded her own independent research organization. And Nicole has done a bunch of research into sex, including getting women to watch porn and then measuring how wet

they get. Yeah, for science. So very first thing, I'm showing older adult women porn and measuring their vaginal response. And I thought that was the coolest thing I'd ever done. And we didn't just interview her because she showed some older ladies a fine time. Our reporter Shruti Ravindran again. Nicole has written a lot about sex and the first thing we wanted to know about was this idea that there's some brain chemistry stuff that underpins sex addiction. And the thrust of the idea here is that when you do something that feels good, like gambling or having sex, it can release this chemical called dopamine. And studies have found that in some addictions, like meth and cocaine, something can go wrong with how this chemical

works in people's brains. And curiously, studies have found that some people with Parkinson's disease who take this medication that amps up dopamine in their brain end up having these strong sexual urges, and they find it really hard to control them. So could this chemical have anything to do with sex addiction? I do not believe it is possible that someone has a sex addiction just because sex involves reward and dopamine. There are literally thousands of activities and behaviors that involve dopamine. That is everything from watching your favorite movie to playing with puppies to holding a baby. These all involve those systems. And if we start calling all those things addictions, then the word is meaningless.

What Nicole is saying here is that, sure, sex releases dopamine. But if you want to make the argument that sex addicts have problems with their dopamine, then you need to do those studies. And by and large, they haven't been done. A group of researchers from Spain recently wrote that there is little empirical evidence on this. Okay, so Nicole saw that there weren't any convincing studies to show her that sex addicts have different brains to regular folk. And then she wanted to test out one of the biggest claims out there about sex addicts. It's this idea that they lose control of their own desires.

There are definitely many men and women who, if you directly ask them, you know, do your sexual behaviors feel out of control? Does your viewing of erotica feel out of control? They will answer absolutely yes, it does. And it feels out of control all the time. But at some point, you have to actually test this. And scientists like Nicole have tested whether the claims of sex addicts are true in all kinds of ways. They've strapped this contraption that looks like a swim cap with wires spouting off of it onto people's heads to measure their brain activity while they're watching porn. They've also measured how hard or rigid a guy's penis gets.

Which is a bit trickier to measure. So how do you measure that? So rigidity, creatively enough, is measured by an instrument called the RIGIScan, that device, when it samples every 15 seconds and it tightens until it feels a certain resistance and then loosens to accommodate the current penis size. Hard-hitting work. And by the way, we know this is in a lab. They're not testing penises in the wild. But if you want to get good data, you have to measure everybody under the same conditions. So the lab is what we've got. So these researchers wanted to find out how well people really could control their sexual urges.

In this one study Nicole did, she invited more than 100 people to her lab. And then she got them to watch some porn. It's mostly vanilla porn. There's no BDSM there, no fetishistic activities and no sex toys. And then Nicole and her team tell each person to react naturally to the films or to control themselves. And she looks to see what happens. So picture this. They're watching a racy film and a researcher tells them, don't get turned on and do get turned on. And Nicole found that people who felt that they were out of control could actually control themselves. It was especially the guys who said they felt out of control that actually were more in control.

That is, they reported having better decreases when we asked them to decrease their sexual responses. Wait a sec. So the guys who thought they couldn't stop themselves from getting a stiffy actually could? Yes. To Nicole, the takeaway is that many people seem to be able to control their desires, even if they really think they can't.

And this isn't just a thing that happens when people watch porn in a lab. Nicole says that when it comes to all kinds of sex stuff, people just aren't that good at judging their own behaviour and whether it's normal. There's a history of this in sex research, that is, people who are worried about, you know, am I normal, am I okay? Tell me I'm all right. When they're actually tested in a laboratory setting, we can't find evidence for

what they're worried about. Like, you see this in research on guys who think their penis is way too small, and they want to get surgery to lengthen it. And when you measure it, their penis size is perfectly normal. And then when we bring this back to sex addicts, well, researchers did this survey about people's sex lives and it found that those who considered themselves sex addicts, which was around 170 people, they were getting laid and masturbating about as much as everyone else in that study.

Yeah, they thought they were oversexed, but they were just normal. So where does this leave us? If people like Jeff or Shane's patients don't have sex addiction, is there something else that could be going on? We asked Nicole. I think the most likely case is that what people call sex addiction overwhelmingly is high sex drive in people who have a lot of shame around their sexuality. Nicole believes that what could be happening here is that these so-called sex addicts are ashamed of their desires,

maybe ashamed of how much sex they want or who they want to have sex with. They think there's something wrong with them, but they're perfectly normal. And this ties into another finding from this huge study on porn watching. Researchers followed thousands of porn watchers over time, and they found that what predicted whether or not they thought they were addicted to porn wasn't how much of the stuff that these guys were watching, but whether they had, quote, moral scruples around pornography, end quote. Nicole says that it's also possible that some people who think they are sex addicts

actually have depression or anxiety and they're using sex as a way out. And Shane, a psychologist who treats war veterans for sex addiction, he acknowledges that other mental illnesses might play a role here. So what it looks like then to Nicole is that this isn't about an addiction, but something else. Shame, depression, anxiety, a fear of not being normal. But the elephant in the room is this.

Even if these people are suffering and having a hard time controlling their sexual urges, what if following those urges leads to rape? What do we do with that? Well, for Nicole, it's pretty simple. So when you do something without someone's consent, you have crossed into sexual assault territory. And sexual assaults? That's not what this debate is about. This scientific debate is about whether sex addiction exists. That is, are there really people out there

who struggle so much to control their sexual urges that they have a disease? And the thing is, there's just not a lot of evidence here. Scientists are trying to cobble together what there is to see if it fits this model of addiction. And the cupboard is just pretty bare. And that's why when the American Psychiatric Association, the gatekeepers of what gets to be called an addiction or not, came together on this. They said, no, there's not enough evidence that sex addiction or something like it is a thing.

Shruti and I sat down in the studio to talk about the research that we've got so far. So now, where do you stand on this? Like, do you think sex addiction is real? Yeah. I don't know. It just seems like a snowflake on a sidewalk. It's appealing.

It's sparkling. But, you know, a sharp ray of sunlight and it like melts. I mean, you bring it into the lab and you poke at it and prod at it and like measure it with a rigid scan and it no longer holds. That is the most beautiful way of saying this is bull. Well, it's complicated. So given that there isn't a lot of evidence here, like why is there this group of researchers who are fighting for it and who are saying it does exist?

I think that, well, I can't speak for those clinicians, but maybe this is what's happening. They see what their patients go through, their patients are suffering, and then they see like the little signs that backs this up. And they say, well, you know, that makes sense. It rings true. And not just that, it helps my patient to know that I'm not a freak, that there's some't here to make you feel better. Like science is supposed to be leaning towards some objective truth. And if that truth isn't there or if the evidence isn't there that this condition exists, then science shouldn't just be like, we'll make you a label to make you feel better. You know, like science isn't there for that but then on the other hand I'm like well addiction's really squishy and messy and medicine is really squishy and messy and people are so if you want to give them a label and make them feel better go right ahead and I can't and I don't know what's the way to think about it what do you think ah it's it's it's nearly philosophical no

maybe it's like akin you know like this is not this is not exactly alike but it's similar it's not a twin it's a cousin yeah it's the hairy cousin sex addiction is the hairy cousin to the other real addictions. That's science versus sex addiction. And just before the credits, if you like what we're doing, we would love it if you could review us on iTunes. It really helps people to find our stuff. This episode has been produced by Shruti Ravindran,

with help from me, Wendy Zuckerman, along with Rose Rimler, Heather Rogers and Ramila Karnik. Our senior producer is Caitlin Sori. We're edited by Blythe Terrell. Additional editing help from PJ Vogt. Fact-checking by Michelle Harris. Mix and sound design by Emma Munger. Music written by Bobby Lord.

Recording help from Gideon Brower and Hannah Colton. For this episode, we also spoke to Dr Mark Patenza, Dr Carl-Erik Fischer, Dr Valerie Voone, Dr Joshua Grubbs and Matthias Goller. Thank you so much for your help. An extra special thanks to Frank Lopez, Joel Werner, Joseph Lavelle-Wilson, and to all the men and women who allowed us to hear their stories in meetings for sex addicts and sexual compulsives in New York.

We're off next week doing more reporting, but when we get back, we're looking at nuclear war. How bad could it get? This is grim science. It takes a lot of energy to vaporize a human being. We're a big sack of water. I'm Wendy Zuckerman.

Back to you next time.