APR 1999


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD



This article has been published in Colorado's award winning AIDS newsletter, Resolute!
It cannot be re-printed for publication in any other form without the permission of the author.

I will call him Mark. He came to see me because he was referred by the Denver City Attorney's Office after entering a booth with an undercover police officer at one of the video arcades. He was required to see me twice to help him look at what might be the underlying reasons for his behavior. On the G-SAST, a gay version of the Carnes Sexual Addiction Scale, he scored seventeen "yes", out of twenty five. His compulsive sexual behavior was clearly out of control.

Actually the bookstores was not where Mark tended to hang out. His typical pattern after work was to get on one of the phone lines until he found a partner for sex. His frequency was close to daily. He professed to wanting a relationship, but seeking anonymous sex took so much time and energy he had little time to meet new people, date, or otherwise form a relationship. In fact, he had few people he did things with, and no confidants.

Mark is HIV+, having been infected just in the past few years. He did have a lover who died of AIDS, but they had always been carefully safe. After his lover's death he was still testing negative. Mark believes he seroconverted because two anonymous partners ejaculated in his mouth. He tries to be safe, but in the era of bare back sex Mark is often asked to go without a condom. He is not asked if he is positive, nor does he volunteer that information. He figures that his partners should know better.

Mark is a good example of how compulsive sex can be, and also how much any addiction can cloud your judgement and compromise your own ethical standards.

In the age of AIDS, there is a growing recognition that sex may be problematic, compulsive and addictive. For gay men there has been a growing evolution from the days of the Ball Park bath house, and promiscuity as a political statement. For straight men it has been an evolution from the 60's belief that only women said "no" to sex and the ethic of "drug, sex, and rock and roll". Young men in Korea or Viet Nam found prostitutes waiting for them at the gates of the base. Others were given a prostitute at their bachelor party before getting married.

But cultural permissions for anonymous sex do not make an addict. It is comparable to the difference between social drinkers and alcoholics. Much like an episodic alcoholic, sex addicts may go for days or even weeks without it, but can also be propelled to "binge" from one sexual encounter to another. The feeling is they can't get enough. And the underlying dynamic is that "enough" is really not about sex, but more likely about feeling loved, sought after, and validated.

Many of these men come from backgrounds where their parents and siblings used and abused sex. One of my clients has a brother in prison for rape. Another's parents were swapping partners when he was a little boy. Another's father took him across town when he was twelve and introduced him to a brother he had never known. His father was living with two women who didn't know about one another.

In a large proportion of these cases there is an early history of sexual abuse. It may have gone on with relatives, but may have also been the product of sex as an adolescent with a much older individual. A straight client of mine thought he was "in heaven" when at sixteen, he had an ongoing sexual relationship with a married woman who was almost thirty. However, the result was sex imprinted as something not associated with love. Sex within his marriage has been problematic. He was referred to me for soliciting a prostitute on Colfax Avenue.

I see the same phenomenon among gay men: if their adolescent experiences with sex are with older men in anonymous circumstances they have a lot of difficulty with sex within the context of a relationship. Sex is very hot -- for the first few months, or as long as the newness and infatuation exists. Then it can dwindle to nothing, at least within the relationship.

I find it interesting that there are little significant differences between straight and gay men when it comes to who seeks anonymous sex, and why. In a study I did of gay men arrested for public indecency, as compared with straight men soliciting prostitutes their demographics were almost identical: the average age was 42 years old, roughly the same proportion were in a primary relationship. The average number of years in relationship was also similar: about sixteen years.

Not all of these people were sex addicts, as being arrested can occur for the naive, for those in some personal crisis, or those in long but stale relationships, for the isolated, and for gay men in the closet. By my estimation of fifty-one cases, 16.67% of the gay men and 18.5% of the straight men were sex addicts.

Patrick Carnes Ph.D., who is recognized as the pioneer researcher and clinician in the area of sex addictions, estimates that between three and six percent of the general population are sex addicts. Even before it became a specialty in my private practice, I diagnosed 7% of the two hundred clients I saw from 1993-1994 as sex addicts. The Advocate recently did a reader poll which asked, "Are you -- or is anyone you know -- addicted to sex?" 48% said "yes", and another 16% said "maybe".

So what is a sex addict? It is the use of sexual behavior as a coping mechanism for the stresses of life. It is not just the sex itself, but the whole ritual of fantasizing about it, searching it out, and cruising. The act itself can be somewhat anti-climatic. The entire process is similar to the altered mental state of a drug. During the pursuit of sex the individual can block out emotional pain, feelings of inadequacy, and the stresses of life. In this way it is not unlike alcoholism, workaholism, gambling, compulsive eating, or drug abuse. In fact, many people have a weakness for more than one type of addictive behavior, having an "addictive personality". What I find is that sexual addictions are the most secret, the most hidden, because they carry the highest sense of shame. In an ironic way, the path towards health is through telling others. As they say in AA, "You are as sick as your secrets." The therapeutic process usually starts with a full disclosure of one's sexual encounters to a therapist, or to a Sex Addicts Anonymous group.

This, of course, is only the beginning. The sex addict must face what he's been using sex to distract himself from. What is the pain he is trying to avoid? One individual I knew with multiple addictions would get clean and sober only to face the grief of having lost two partners to AIDS. That would then send him back into the bottle, the needle, and the stranger in his bed. In one instance the stranger turned out to be arrested for murder shortly after his stay with my client.

I did a check at the Denver Health Department about the incidence of STD's and HIV among those people who are arrested for soliciting or public indecency. Those statistics, are not readily accessible, but they did refer me to an article by Dr. Kirk Elifson of the Georgia State University in Atlanta (Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology, 2/1/99; 20:195-200). He found 36.6% of the clients of male prostitutes tested positive for HIV, and also 15.9% were positive for syphilis, and 58% were positive for hepatitis B. Among the clients of female prostitutes only 2.9% were positive for HIV, but 10.1% had syphilis, and 24.6% had hepatitis B.

There are a number of other costs, and despite the addicts' best intentions he exposes himself to take these risks:


Physical Assault

Shame and Exposure

Guilt and Secrecy


Attorney's Fees and Fines

Loss of Important Relationships

One of the worst consequences is for the individual with more than one arrest to be put in a program for sex offenders. The State Mandated Guidelines for Sex Offender Treatment involves regular polygraph tests, weekly group sessions with predatory sex offenders like pedophiles, and restrictive guidelines like no alcohol or contact with children. These may be appropriate ways to treat predatory offenders, but increasingly probation departments in the metro area are requiring those arrested for victimless sex crimes to also undergo this rigorous treatment.

Sex addictions escalate. You may repeatedly but unsuccessfully resolve to curb your sexual behavior. If this is you, don't wait to "hit bottom". Help is out there if you ask for it. You can't do it alone.

Are You a Sex Addict?

You use sex to cure boredom or feel better, or a way to reward yourself.

You organize your daily life around sexual encounters.

You spend inordinate amounts of time seeking, having or recovering from sexual encounters.

Sex can compromise your values, judgement, or place you in high-risk situations.

You have a lot of sexual secrets.

You are unable to turn down sexual propositions.

You increasingly need the additional stimulation of pornography, sex toys, poppers or drugs.

Because of your sexual activity you have neglected friends, your partner or family, or your career.

For screening tests go to:

For Women:


For Men:


Resources for Help

On the Internet:

Online Sexual Addiction

National Council on Sexual Addiction and Compulsivity

Sexaholics Anonymous

Codependents of Sexual Addiction (COSA)

S-ANON International Family Groups

Colorado SAA, SLA, S-ANON & COSA Groups:

Call for information and referral 303.427.0176 for meetings in your area.

Books to Read: Both by Patrick Carnes

Out of the Shadows, CompCare, 1983

Don't Call It Love, Bantam Books, '91



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.