Defending the Diagnosis: Understanding Sex Addiction Through the Lens of Addiction Science
“Isn’t sex addiction just an excuse for bad behavior?”
“The sex addiction diagnosis is just made up for people to make money.”
“Who wouldn’t want to be addicted to sex?”
These are common reactions when the topic of sex addiction comes up. And while public discourse often trivializes or outright dismisses it, the science of addiction tells a different story—one that deserves a more thoughtful, evidence-based perspective.
What Is Addiction?
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines addiction as:
“A chronic brain disease characterized by compulsive drug seeking and use despite harmful consequences. It is a primary, chronic disease that involves complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. Addiction can lead to significant health, social, and legal problems.”
Importantly, SAMHSA also recognizes process or behavioral addictions—addictions not to a substance, but to behaviors. Gambling is the most well-known example of a recognized behavioral addiction. Sex can be, too.
Let’s take a closer look at this definition and how it applies to sex addiction.
The Two Sides of Addiction: Brain and Behavior
Addiction has two interrelated components: a physiological process and the behaviors that express it.
The physiological process—often referred to as the "disease model"—involves specific brain regions that govern our reward system. Areas like the ventral tegmental area, nucleus accumbens, hippocampus, amygdala, and prefrontal cortex are central players. These areas evolved to help us survive and thrive by reinforcing behaviors that are beneficial: eating, sex, social bonding, and exploring novelty. They do this by releasing dopamine, the brain's “that was good—do it again!” signal.
In cases of addiction, whether to drugs or behaviors, these systems are hijacked. Repeated exposure can rewire the brain's reward circuitry, resulting in compulsive behaviors that continue despite harmful consequences. Over time, what once brought pleasure becomes a compulsive need, and the joy often fades altogether.
What Makes Sex Addictive?
Sex is a natural and life-affirming part of human experience. But when someone turns to sexual behavior as a way to regulate stress, avoid emotional pain, or cope with underlying insecurities, it can morph into something destructive. In sex addiction, the behavior becomes less about pleasure and more about survival—an attempt to self-soothe in the face of mounting internal distress.
Repeated, compulsive sexual behavior can lead to:
Loss of control
Escalation (needing more or more intense activity for the same effect)
Risky or illegal behaviors
Cravings and preoccupation
Social or relational damage
Tolerance and withdrawal-like symptoms
These are not just “bad decisions” or “moral failings.” They are evidence of a physiological process gone awry—just like with substance addiction.
Misunderstanding vs. Diagnosis
Not all unwanted sexual behavior is sex addiction.
Cheating on a partner? Not necessarily sex addiction.
Having high sexual desire? Not necessarily sex addiction.
Engaging in non-traditional sexual practices? Not necessarily sex addiction.
Sex addiction is not about judging or moralizing someone’s sexual expression. It’s about looking for evidence of addiction: compulsivity, distress, loss of control, and damage.
When someone says to me, half-jokingly, “How can I get one of those?”—it’s important to know that people with sex addiction are often not enjoying themselves. They may feel deep shame, isolation, and confusion. Many hide entire parts of their lives from others. The escalation of their behavior often leads them further from connection and satisfaction—and sometimes closer to real-world consequences.
So How Can You Tell the Difference?
Differentiating between problematic sexual behavior and genuine sex addiction requires careful clinical assessment. Trained professionals, such as Certified Sex Addiction Therapists (CSATs) or Associate Sex Addiction Therapists (ASATs), use established criteria and thorough evaluation to make this distinction.
If you or someone you love is struggling with out-of-control sexual behavior, seeking a professional trained in identifying behavioral addiction is a crucial first step. Healing is possible—and it begins with understanding what you’re really dealing with.
Let me know if you'd like a headline variation, a shorter version, or ideas for a follow-up post (e.g., “What Treatment for Sex Addiction Looks Like” or “Sex Addiction vs. Shame: Telling the Difference”).