As revelations about Rep. Anthony Weiner’s Twitter sexting continue to emerge — including private messages he sent to a 17-year-old girl — the announcement Saturday that he was entering “treatment” was almost inevitable. Expect declarations of sex addiction to ensue, along with familiar 12-step catchphrases signifying Weiner’s intent to reform.
But let’s step back for a moment. Is Weiner’s behavior really evidence of addiction? If so, addiction to what? Sex? He’s no Tiger Woods. At least Woods had actual sexual affairs with women before he dashed off to sex rehab — a treatment that exists despite the fact that the DSM-4, psychiatry’s diagnostic manual, does not recognize sex addiction as an illness or a psychological disorder. Or, if his problem is “internet addiction,” which is similarly unrecognized by the DSM, where’s the evidence for that?
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Although the Weiner case seems silly and although rehab may indeed be the only remaining solution to his political problems, it poses difficult questions for people who genuinely struggle with addictions. If anyone can go to rehab when his actions lead to public humiliation, is rehab still a medical treatment or does it become some form of absolution? If it’s a ritual expiation, doesn’t that mean it should be punitive? And doesn’t that make addiction a sin rather than a disease?
If every time someone behaves like a jerk and the reason behind it is addiction, doesn’t that mean addiction is just an excuse for bad behavior?
As a former heroin and cocaine addict, I’ve thought about this a great deal. I did some pretty stupid things while I was using. But so did a lot of my college-age peers who had no such excuse for their behavior. However, I persisted in those risky behaviors for longer, in a more extreme fashion and with greater intensity. What I’ve learned from my experience and from the research is that addiction can impair your ability to make appropriate decisions. Note that I said impair — not eliminate.
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That reduction in impulse control, that lessening of free will, makes addiction complicated because it’s not black and white. After all, I never shot up in front of a police officer or on the street, which an addict with newly purchased drugs and no control over her behavior would seem likely to do. I didn’t have no control, I had less control.
In drug addictions, there’s an explanation for such impairment, related to the effects of the substances themselves on the brain; research shows they cause brain changes in areas directly related to reward, pleasure and self-control. But even this explanation isn’t simple: most users, including those who take drugs like cocaine and heroin regularly, do not become addicted. If addiction were simply the result of drug meeting brain, everyone who used would get hooked. In reality, only a small minority does.
Consequently, one can’t even say that drugs themselves automatically produce impaired responsibility, only that a complex combination of a substance, the timing, regularity, dose and route of its administration, a person and a situation sometimes interact to reduce self-control.
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Now, substitute sex or the Internet for drugs and you’ll see why it gets even messier. If it’s difficult to determine when drugs that have clear pharmacological effects have reduced behavioral control via addiction, it’s almost impossible to tease out how sexual behavior or Twitter might do so.
Sex, in fact, is especially tricky because if there’s anything that evolution has given us a strong motivation to do, it’s reproduce. Having a strong sex drive that looks self-destructive on the surface seems absolutely stellar from a gene’s eye view: our genes don’t care if we’re happy or lose our jobs so long as they get passed on. If our pleasure systems are motivating us to do what they were intended to make us do, how can this be pathological?
Of course, what makes humans different from other animals is our ability to make choices that aren’t “natural,” or simply driven by uncontrollable urges. In the case of addicted behavior, the DSM-4 definition boils down to this: compulsive use of a substance despite negative consequences. However, when the “substance” we’re talking about is sex, the definition of the other terms become much more subjective.
With sex, total abstinence is not the treatment goal — merely conformity with social norms. So if, for instance, the norm were for powerful men (or powerful women, for that matter) to have 100 spouses, would sex be considered addictive? When the behavior itself is the addiction, the role of culture in determining the border between desire and disorder becomes immediately obvious.
A proposal for including “hypersexual disorder” in the next edition of the DSM defines abnormal sexuality as having more than seven orgasms a week over age 15 — but that would probably make so many young adults into sex addicts as to make the term meaningless.
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Consequently, cases like Weiner’s force us to ask: does a sex addict become “addicted” only when he gets caught or when a society or partner objects to his behavior? Is his desire compulsive only when it actually results in negative consequences, or would he still be a “sex addict” if he’d stopped when he got bored, before he was caught? Or, do we think that a truly sex-addicted Weiner couldn’t have gotten bored, and that his sex addiction was nipped in the bud, before it blossomed into real-life affairs?
Ultimately, the real question is: can sexual desire really take over the brain and force someone to lose control in the same way that a substance like crack does? Alternatively, is the notion of crack addiction just as fungible and flexible as the idea of sex addiction?
I personally have a hard time putting compulsive cocaine use in the same category as occasionally sending crotch shots to college students. If we define addiction down that far, we’re all addicts. The word becomes meaningless and rehab becomes just a place to demonstrate your repentance. If we can’t draw the line somewhere, the argument for addiction as a disease loses all value, and no longer helps us distinguish between behavior that is genuinely constrained by addiction and plain old bad judgment.