Sunday, December 18, 2016

Further Discussion of the AASECT Position Statement

There has been considerable discussion of the AASECT Position Statement - Sex Addiction, and a great deal of media coverage, most of it favorable.  Despite the fact that no professional organizations were mentioned in the statement, there has been strong reaction from addiction organizations who vigorously disagree. 

The function of this post is to aggregate my further contributions to the discussion of this topic.

The International Institute for Trauma and Addiction Professionals is not a professional organization, but a privately held LLC operated by Patrick and Stephanie Carnes and directors picked by themselves.  It provides certification training in 'sex addiction'.  The link to their response can be found here:

IITAP Response to the AASECT Position Statement

That link was posted to the AASECT List on December 14, 2016 by Geoffrey Goodman, PhD, ABPP, FIPA, CST, CSAT-S, CMAT-S, RPT-S 

I responded December 16, 2016:

I, for one, am not very impressed.   That is code language for this being my official opinion, not necessarily that of AASECT.  So lets put on our decoding decoder rings.

This IITAP 'decoding' document is an attempt to reframe the AASECT statement a sort of promise of future support because it is less absolute than AASECT's previous statements on sex addiction is simply incorrect. 

1) AASECT has not had a previous advocacy position on sex 
addiction, at least as far back as 1990. But there was no time when we had the mechanism to do it before 2004.  For more on that, please see my blog post  from  Individual AASECT Members, however, have often ardently opposed it.

2). It is pure fantasy that AASECT will change its position in the light of new data that hasn't come in yet.  

That statement reflects IITAP's belief that such research is just around the corner, but that has been their position for thirty years.  I know the feeling,  I have believed that cheap nuclear fusion power was only 20 years away since the early 1970's!   Just between you and me, it's still more than twenty years away now!  

In fact, the existence of a similar mechanism for sex addiction and chemical addictions is a major piece of the puzzle neuroscientists need to achieve to make the analogy work.  They more or less have that now.  They must also reliably demonstrate that ordinary sexual response, non-addictive substance use, and other sources of pleasure that are not about drugs and alcohol do not respond in the same manner.  Otherwise, we are probably seeing evidence of generalized pleasure circuitry, not evidence of addiction.  Likewise, it would be advantageous to see overlap with other colloquial addictions in their conceptual model that addiction treatment is appropriate for the wide range of things they call addictions is correct..   

I am working on a blog post for Elephant that address this relatively high conceptual bar.   To put it very briefly, to show that correlation is probably causality you must demonstrate that your measures are reliable; that they correlate with those things you intend to predict, and they do not correlate as well or better with other measures deemed close to your concept, but yet which lie outside of it; and that they correlate even less well with extraneous things that your model doesn't include at all.  Frankly, we can rarely meet that standard with the evaluation of other treatment methods, including our prefered models.  But that is what you need to be able to do to defeat Roger Libby's awkward assertion that behavior is nearly impossible to interpret outside of its context.  Please remember that, reparative and conversion therapies have been found to be unscientific and ineffective, (here I'm referring to the late Robert O Spitzer's conclusion that 200+ anecdotes  of reparative treatment success did not constitute scientific evidence sufficient to oppose banning them altogether at American Psychiatric Association) not just inhumane, and that the overall efficacy of sex offender programs, in which treatment must be focused on changing sexual behavior, failure rates are extremely high according the O"Donahue and Law's pessimistic Chapter 1 in Sexual Deviance:  2ed (2008) Guilford Press.  There is no unambivalent changing of sexual behaviors that are persistent enough to raise problems severe enough that they might be seen as powerful as chemical addictions.

3). IITAP still comes around to implying they are much more open and inclusive than they are, mainly by grossly falsifying their history, and end by urging us to play nice. They have, in effect, over-personalized the statement.  

My brief version of the history reflects that of Eli Coleman, who lived it.  I was in grad school at the time and not at any of those meetings.  After a few years of working together on hypersexuality, the addictionologists broke with the sexologists over language, particularly the term 'addiction'.  Any characterization of AASECT minimizing that sexual problems are real is unfounded.  We demurred years ago that sex problems constituted, in and of themselves, 'addictions' and diagnosable mental disorders.  We still demure today.   Not because there are no diagnosable sexual conditions, but that that is a distinct minority of problem sexual behaviors.  Intimacy problems, relationship conflict, reaction to stigma, unmanaged stigma are all best conceptualized in psychological terms even though they have neurological concomitants.

In the meantime, members of other organizations who wish to work together on problem sexual behaviors are welcome!  This is what that work looks like.

4). When working on this statement, we were focused on principles, not organizations.   We are against shaming techniques, pathologizing sexual minorities, and over-grand conceptual schemes that are not backed by quality data and inference regardless of which organization does what.  Please do not do it here, either.  And we are for sexologically-informed treatment, not just that done by AASECT Certified professionals.

It is my opinion that the term sex addiction is indefensible.  If later proof validates the concept, well, we can rethink that.

I might add, that I do not think much of the argument that we must use the sex addiction terminology willy nilly simply because the client might bring it in.  I would not call my client a rabbit simply because he claimed to be one, and when organizations that broke with the larger community of mental health researchers over the use of this term sold it to the lay community, it is not the clients' term that we are seeing brought in, but the organizations' premature and incorrect construction.  And with it has come problems of labeling, shame, blaming, flight form personal responsibility, and confused public discourse that make treatment more challenging rather than easier in many instances.  Having resisted the term ineffectively, we are now stuck with the problem discourse.  

If we are on record as opposing this language, for every person who defensively declines to admit they have a problem because there is no such thing as sex addiction, perhaps there is a perfectionist somewhere who won't kill themselves in despair because they are too ashamed to face such a scary problem.  Perhaps routine desire differences between couples will be easier to address if one person is not prematurely labeled as having the identified problem.   Those are the hoped for benefits of putting this sex addiction Djinn back in the bottle.  Djinn gold  disappears with the sunrise, so spend it quickly if you are planning to rub that lamp!


This provoked a further post from Dr Goodman addressing sex positive activist Roger Libby and myself but talking past us directly to the AASECT Membership.  He suggested that IITAP was much bigger than AASECT, that 1000's of 12-step sex addiction groups met every week in the US and they must be helping or people wouldn't come to them, and that the AASECT Position Statement reflected a desperate bid of AASECT, an organization in decline in numbers and relevance in the face of a veritable tsunami of public and political endorsement of the sex addiction model.  He urged AASECT readers to keep an open mind about sex addiction in the face of AASECT's position statement.  I paraphrase here as it would be a violation of AASECT listserv guidelines to quote any post but my own. 


Dr Goodman also posted this excellent link to the work of Dr Voon, which IITAP feels definitively validates the sex addiction model 


I then responded:

First, the process for writing to individual members of this list is to back channel them to their private email accounts.  But Geoff is already aware of that.

Second, he lost most readers here on the 'IITAP Decoding Statement', or should have, when he suggested that AASECT and sexology had a long history of undifferentiated enthusiasm for all sex activity regardless of consequences or contexts.  He suggested maybe we are finally coming around now to right-thinking about sex addiction.  How many times we have heard this lame criticism from moral entrepreneurs in the past?  Aside from being just a trifle patronizing, its just not grounded in history.

AASECT and our sex researcher and mental health allies participated in the original efforts to define and treat hypersexuality out of belief that sometime sexual desire could be too much of a good thing. We could have simply stayed away from those initial joint meetings if we believed that too much sex couldn't ever be troublesome.  

The addictionologists are the ones who broke up these efforts when they left the other mental health professionals working of hypersexuality over use of the unproven addiction terminology.  

Neither was it minimizing of our concerns about Problem Sexual Behavior to devote an entire 2016 Summer Institute to educate about how to treat it in ways that are less exploitive of social stigma and more empowering of clients than other treatments like 12-step groups and sexologically uninformed addiction programs that have been promoting shame for sexual variations for years.

IITAP, as you well know, has a pretty poor history, up to and including the present, of failing to expel reparative and conversion practitioners and certified addiction professionals who brazenly include advertisements for attempts to change homosexual orientation in their websites and publicity materials.  In the past, IITAP has graciously cooperated with the Family Resource Center, which the Southern Poverty Law Center classifies as an anti-gay hate group.  Likewise IITAP cooperate with the ridiculous Anti-FAP, Fight the New Drug, and Your Brain on Porn cultists who's hyperbolic readings of the existing science are embarrassments to their field and to ours.  So these addiction certifying bodies and their paneyrists are in a poor position to lecture AASECT about our boundaries.

I am a Member of AASECT because it is an alternative to that kind of destructive mis-contexting and mis-conceptualization of the normal variability of human sexual behavior.

It surprises me to see that numbers argument, having just read AASECT President Debby Herbenick's eloquent and ardent defense of quality studies and sound inference over citing quantities of publications and over-interpretation on this list.  Why would anyone would suggest the AASECT Position Statement -- Sex Addiction is a response to the sheer numbers of people in our organization, or in IITAP?  The problem isn't how many lemmings are out there, but whether they are going over the metaphorical cliff.  By now, you are all aware that lemmus lemmus does not actually hurtle over cliffs to their doom in the real world, but they are doing this constantly in polemics.  You'd almost mistake them for humans!  I cite this as just one more example of why science matters!

All of this reminds me of a great Gary Larson cartoon in which a desperate lobster is saying to an obdurate chef, while the pot steams in the background.  "Did I say three? I'll grant you four wishes"!   This is not a popularity contest, the fighting for quality education and treatment for sexuality.  AASECT has always been a minority specialization, and it is our responsibility to know things most others have been discouraged from pursuing.  Our Membership is at the highest level since I joined back in the mid-1990's, but that is beside the point.  Twenty-two hundred is a small portion of 320 million.

(C) by Gary Larson, used under fair use.

Well organized political minorities, many who are allies of organizations like IITAP, have militated successfully against broader implementation of sexual health programs against the wishes of a majority of Americans.  They have opposed women's right to chose to carry their pregnancies to term.  They have opposed the right of America's youth to have scientifically valid and emotionally honest sexual health instruction.  They are claiming there is a porn epidemic and it constitutes a health crisis on the basis of zero evidence beyond the fact that porn is widely available on-line.  They claim rising crime despite the fact that the best criminology data shows a 25 year long decline of 30-70% for most offenses.  And despite Diamond's work strongly and repeatedly suggesting that the increased social availability of erotica is negatively correlated with sex crimes.  Yes, correlation is not causality.  But such statistical links as we have suggests masturbation is associated with health benefits, not harms, and erotica availability is associated with less crime, not more.

So anyone opining on this site about our history would be at an advantage to know it, and not just post material that suits the author.  

I am here to encourage you not just to keep an open mind, but to do it in the skeptical way that scientists do.  Not to just listen to some ad hoc concoction that suits your immediate personal interests.  Scientists read and review the best literature, and find the places where their skepticism can be tested.  They argue and discuss the best tests.  They develop their theories, then test against themselves, rejecting the hypothesis that they are wrong only when the evidence is too great to discard their pet theory.  They are as rigorous about their own theories as they are about those they disagree with.

Test not just with statistics, but with empathy, a knowledge of history, and with your sense of social justice.  Test with context.  Just as liking sex doesn't make you a slut, rejecting somebody's poor track record at setting boundaries doesn't make you permissive.  That is just the same old slut shaming in new drag.

You want my personal decoding of the AASECT Position Statement?

1). No slut shaming.  Often people with problems only magnify them with shame.
2). Be scientifically rigorous and conservative.  Works great with sexological treatments and addiction treatments alike.
3).  Put the client first and don't power play them, or let others power play you.
4).  The numbers that matter are in carefully constructed statistical tests, not popularity contests.  We just saw millions of voters be wrong.  Happens all the time.  Don't let it happen to you!

Having overcome my heretofore unconscious fears of declining relevance, I'll close here for the time being.

"Did I say four wishes?  I'll grant you five wishes!  They used to feed lobsters to Confederate  prisoners, you know.  We're highly over-rated.  Shrimp, now shrimp are very tasty...


Whether we agree with their reading of the data or not, there is great resonance to the observation that sex addiction advocates are not going to simply abandon their models willingly.  Certainly the collective scientific judgments that reparative and conversion therapies are not just a human rights violation, but are ineffective has not prevented their proponents from advertising them.  They claim that If the public demands snake oil, it i it is their responsibility to provide it.  I find this a disingenuous argument for these outlier sex-addiction therapists to make.  They come from a tradition in which the unrealistic demands of clients are confronted, not gratified.  

But in truth, sex addiction therapists are not coming to AASECT because they are looking to find clients for conversion therapies.  They want to do effective, sexologically-informed work.  They take the reality that people have problems sexual behaviors so seriously they have made it their life's work.  And the data suggest that, while sex addiction clients are mostly wealthy, white and male, and there is certainly defense of privilege involved in their selection of this method of treatment, our clients are often similar to theirs in race and class.  And the data show that, as of 2016, severe conflicts of desire have been difficult to treat since the inception of sex therapy.  

In this we are allied, and being scientifically open-minded means being respectful of the limits of our theoretical models and the effectiveness of our techniques.  It means subjecting our best techniques to rigorous evaluation even when it is expensive and hard to raise money for sex research. It is by no means clear that the sex addiction emperor is the only one with no clothes here.  The proof isn't all that great for calling most sexual disorders diagnosable mental disorder in the first place.  Behavior needs context.  And in the current research environment, the hope is that neuroscience will overcome this truth.  Do not bet the farm on that assumption.  We have been wrong so many times before.

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