Sexual Addiction or Simply Cheating?

Sexual addiction has become the catch-all for infidelity, cheating, and promiscuity. The problem is that the experts in the field of sexual addiction have promulgated these misperceptions and misdiagnoses. The wealthy and famous appear to have mental health field in their pocket to use as a get-out-of-jail-free card, to have an excuse for having engaged in affairs or promiscuity or the use of prostitutes. Sexual addiction was defined similarly to how the DSM-5 has defined substance use disorders. Following those diagnostic criteria, as well as how Carnes et al. defined sexual addiction, it appears that the rich and famous do not meet the diagnostic criteria for sexual addiction. They do appear however to meet the criteria for infidelity, cheating, sense of entitlement, and promiscuity. And what about sexual offenders who claim to be sexual addicts? They may or may not have a sexual addition however they are also sexual offenders.


Introduction
For the purpose of this article I will use the following terms interchangeably as referring to engaging in sexual contact with someone other than a person's partner or spouse: infidelity, cheating, unfaithful, promiscuous, and affair. There are many people discussed in the media who have engaged in promiscuous and/or extramarital sexual affairs. It seems that when these people are caught they have excuses and seem to expect that everyone will simply stay out of their business and that their partners/spouses will simply forgive and forget. On the other hand, some of these cheaters actually use the exposure of their sexual affairs to justify ending a marriage and continuing a relationship with the person they were cheating with. Perhaps the worst part of cheating behavior is that the partner/spouse is often blindsided and shocked when the cheating behavior becomes known and of course when it becomes public. And of course there is the impact on the children as well as on the public who feel betrayed. I will use the terms partner and spouse interchangeably as well.
Infidelity in marriages occurs at approximately a rate ranging from 20-40% [1]. Studies have found that far more men than women engage in extramarital affairs and those men tend to have many affairs versus only one when they do cheat [1][2][3][4]. Men have also been found to express a greater interest in sexual infidelity [5,6]. However some studies indicate that the differences between females and males that engage in extramarital affairs may be closer to equal and at least one study indicated that for men and women under age forty there is no difference in the occurrence of the affair [1,4,7,8].
Atkins et al. [1] found that those who earned more than $30,000 per year were more likely to engage in extra marital sexual affairs than those who earned less. The higher the salary, the more power and control the cheating spouse would have. Also, the authors of the above study found that the rates of engaging in extra marital sexual affairs was higher when the cheater was the wage earner and their spouse was not working. It is interesting that in all literature reviewed about extra marital affairs, the identification or suspicion of "sexual addiction" not once occurred [1]. The true experts of extramarital affairs do not relate infidelity or having affairs as "sexual addiction".
Perhaps some of the spouses were aware that something was not right and that their spouse was cheating. For many reasons (e.g., disbelief, shame, embarrassment, confusion) they may not confront their spouse until the affair has occurred for a significant amount of time or until it becomes public. And of course the cheaters usually apologize and swear that they love their partners or spouses and that the affairs will end. But the affairs do not end and the cheater generally continues to engage in the same behavior even after being caught.

What is Sexual Addiction?
According to Carnes et al. [9] sexual addiction is when an individual substitutes a sick relationship for a healthy relationship. Eventually the individual (or addict as Carnes would label the person) progresses to retreating further and further from reality, distancing themselves from family, friends, and work. The addiction cycle would involve four stages: preoccupation (of sex), ritualization (the sexual routines established), compulsive sexual behavior, and despair (feeling hopeless to cease their sexual thoughts and sexual behaviors).
According to Carnes et al. [9] there are three levels of sexual addiction and most addicts do not stay within just one category. The sexual addict can have periods of time without acting out, though the acting out becomes much more compulsive. But the addict experiences distress concerning the sexual acting out (e.g., compulsive or public masturbating, pornography use, affairs, homosexual activity, exhibitionism) and as a result experiences impairment in various areas of their lives. In some ways the risk of the sexual act creates a thrill that can be in and of itself desired and addictive. The true sexual addict experiences distress and shame about their sexual acting out and generally desire help. disorders as involving "A problematic pattern of alcohol use leading to significant impairment or distress, as manifested by at least two…" of the following criteria: • the substance is taken in larger amounts of over a longer period of time than intended; • a persistence desire or unsuccessful attempts to cut down or control the use; • a significant amount of time is spent engaging in activities to obtain or use the substance; • craving or desire or urge to use alcohol; • tolerance (an increased need for the substance and needing more of the substance to gain the same effect); • withdrawal (experiencing undesirable and unpleasant physiological and psychological effects when the substance is not taken or using the substance to relieve or avoid the withdrawal symptoms); • recurring alcohol use in dangerous situations; • impact in the individual's life evidenced by impaired social, familial, occupational, or recreational activities, including not meeting expectations or obligations in order to use alcohol; • the substance is used despite knowing that that continued use of the substance causes persistent or recurrent physical or psychological problems that are exacerbated by the substance use; • tolerance is developed for alcohol; and • withdrawal symptoms upon cessation of alcohol use [10].
Sexual addictive behavior may at times appear to fit under the abuse or dependency criteria as applied to sexual addiction. However, the choice of a person to engage in extramarital affairs with one or a handful of women does not appear to meet the criteria for any of the above diagnostic categories. I challenge mental health providers to stop calling extramarital affairs a sexual addiction. Clearly cheating does not appear to meet the criteria discussed above, unless the cheating occurs with other distressing behavior and distressing thoughts, which does not appear to be the case with cheating.
Since professionals have begun to label and treat celebrities who engaged in extra marital affairs as sexual addicts, it appears that everyone now has a sexual addiction. Yet, according to the, APA's diagnostic criteria, the celebrities would probably not meet the criteria for "addiction".

Lets examine this further:
Certainly it can be argued that engaging in frequent use of pornography has some addictive qualities. Some individuals engage in the use of pornography several times per week and for hours at a time. They may use pornography to alleviate other problems (e.g., marital or occupational, or stress). The pornography can easily become the aspirin to their problems. In addition, the use of pornography allows for the individual to engage in one-way sexual contact that is, using the pornographic material to masturbate, to fantasize about engaging in sexual contact with others, which may result in a sense of entitlement and an indifference to the needs and wellbeing of sexual partners. Sex becomes depersonalized and the resulting sexual contacts with others become much more selfish and unemotional [11].
Using pornography frequently or to address other needs (e.g., marital dissatisfaction, stress, low self-esteem) could result in withdrawal symptoms when not engaged in the use of the pornography. In return, the individual is more likely in spend even more time engaged in the use of pornography to the detriment of personal obligations (e.g., less time with spouse or children, spending money on pornography that was supposed to be used to pay bills, spending too much time viewing the pornography, etc.). Certainly at some point the individual becomes aware that the use of pornography is detrimental, yet they generally continue to use it anyway [11] However, typically the impact on the marriage, relationship, or financial matters does not become apparent until the problem has manifested itself for quite some time. And even then it is unclear that the individual experienced any concern for their partner or the relationship.
Like pornography, engaging in extramarital affairs can also have addictive qualities. The power and sense of entitlement that may result from engaging in sexual affairs could be powerfully ecstatic. One affair leads to another, and the emotional distancing begins to occur between the individual and their partner or spouse. They begin to spend more time with their lovers, more time away from the home, and may spend money on their lovers rather than spend it on their obligations related to their family or primary relationship. However, the cheaters do not appear to experience significant concern or remorse about their behavior, do not appear to care how the affair might impact their spouse or relationship, nor do they appear to experience difficulties related to work, finances, or related legal problems. In fact, any problems the cheater complains about do not appear a concern until after the affairs are made public, and yet they continue the cheating behavior even after being caught.
The paucity of research identifying the difference between sexual addiction (per DSM-5 criteria relating to substance related disorders) and simply making a conscious choice to engage in extramarital affairs is concerning. Celebrities and politicians are getting caught left and right cheating on their spouses. What really is the difference between sexual addiction and cheating? The answer appears more clear than cloudy.

Examples of Famous/Infamous Cheaters
Tiger Woods cheated on his wife with numerous women. Yet he appeared to maintain the public and private image of a faithful and loving spouse. He managed to continue his work as a professional golfer, apparently was a loving father to his children and a loving husband to his wife. As fate would have it, his wife found that he had messages to other women, which lead to the truth becoming public. However, he was clever and comfortable with his cheating behavior and managed to keep it a secret for quite some time. Not even coming close to any type of addictive behavior, but rather simply a choice.
Jesse James cheated on Sandra Bullock. They were married for several years, were in the process of adopting a child, and apparently there were no or few indications of his extramarital exploits. Yet his caviler attitude was clear when interviewed or caught in public. Had he actually loved and cared for his wife, then cheating would not have occurred. And it does not appear that he engaged in numerous affairs, but rather perhaps one or two. Clearly no addiction here.
Senator Mark Sanford from South Carolina was also married for years, had a respectful political job, and apparently gave little or no indication that he was having an affair. Yet he apparently misused State money and well as personal money to engage in an extramarital affair with a woman in Argentina. Worse yet, he demonstrated no sense of remorse nor any indication that anything he did with this woman as wrong, this despite his conservative family values. He continues in this relationship and his wife apparently has filed for divorce. Perhaps even worse yet, the Republican party have not removed him from office nor has the party significantly denounced the act, again, despite the Republican party claiming conservative family values. What a contradiction! No sign of any kind of addiction here, simply a choice! Senator John Edwards, a family man by public reputation, a talented politician, found to have engaged in a lengthy extramarital affair, one that resulted in a child. His marriage is also over and he apparently is continuing in a relationship with that woman. No addictive behavior here.
And most recently, Congressman Weiner was caught sending text messages to women (some much younger than he) including pictures of himself apparently in his undies and possibly showing his penis. His actions certainly constitute cheating, as he was trolling for women and engaging in sexual acts via texts and pictures. And the unknown is at what point would he engage in direct sexual contact with other women or perhaps he has already physically cheated on his wife.
If we use the same criteria of substance abuse and dependence for sexual addiction, perhaps all of the men mentioned above met some of the criteria mentioned above for sexual addiction. And perhaps they suffer from a "sickness". Yet the significant differentiation that does not fit under addiction is that they did not appear to experience any sense that what they were doing was in fact wrong (at least not until they were caught!) In addition, they did not appear to have experienced any significant impairment in their marriages, careers, in their roles as parents, no financial impairment, and no legal consequences (again, until they were caught!) In fact, there is no evidence, at least no public evidence that any of these men were concerned about their unfaithful conduct until they were caught, with the exception of course of hiding the affair, but not concerned about the impact of the infidelity on their marriages. None expressed sincere remorse, in fact, they were fairly nonchalant and indifferent to the public attention, as if somehow they were the true victims. In addition, despite the rich and famous make their money as a result of public attention or public votes, they appear to have distain for the public that wants the truth and wants answers. Some even continued their affairs and sacrificed their marriages. Perhaps that was the long-range plan. If they were that comfortable continuing their affairs publically, then perhaps they never intended to cease their affairs.

Sexual Addiction Rehab-Dr. Drew saves the world of cheaters!
So now along comes Dr. Drew Pensky. A well-known radio show doctor, now even more famous for the celebrities for treating sexual addiction, known as "sex rehab". But were these cheaters really sex addicts or simply men who decided to cheat? Studies suggest that couples experiencing infidelity also tend to present with common relationship problems. Atkins et al. [12] points out that couples that experience infidelity tend to experience approximately the same distress following treatment than couples who present with no fidelity related issues. Fidelity issues appear to be one of the most difficult relationship problems to treat and jealousy possibly impossible to treat [13][14][15]. In addition, only approximately 50% of the couples receiving therapy for infidelity appear to demonstrate significant progress by the end of therapy [16].
Atkins et al. [2] goes on to indicate that infidelity-specific treatment is not necessary or warranted, which is also supported by other studies [17,18]. These and other studies suggest that infidelity, that is, cheating, is not a sexual addiction or any type of addiction. Unless of course you are making a lot of money misdiagnosing the problem (no names here, but guess). The primary treatment for infidelity is cognitive-behavioral therapy and marital therapy. Cheating, sexual affairs, and infidelity are not sexual addiction and do not deserve the addiction label.
Perhaps we need a better understanding of how cheaters make the decision to cheat. Not as a result of "sexual addiction", but rather a result of numerous factors, including a sense of entitlement, misogynistic views, and desire. Let's discuss this further.

Cognitive Dissonance
Festinger et al. [19] proposed his theory of cognitive dissonance. He argued that cognitive dissonance was the result of an inconsistency between an individual's beliefs or cognitions and a behavior. Dissonance is the resulting state which then motivates the person to attempt to alleviate the negative state. He believed that cognitive dissonance involved both psychological discomfort and what might be today classified as more anxiety related physical symptoms. Festinger believed that cognitive dissonance created motivation to change either the belief or behavior. It was often easier to then change one's beliefs and attitudes to address the dissonance. This was also supported by Elliot and Devine [20]. Others have described the anxiety related component as an arousal that had driven-like properties [21].
In summary, when someone engages in behavior that is in conflict with their values and beliefs, they experience dissonance: an unpleasant psychological and emotional state. The person who engages in the extramarital affair may find themselves shocked and upset that they chose to cheat. This then forces the person to do one of two things. They can cease the affair, stop cheating, and reinvest in the marriage or relationship. They can make a concerted effort to be faithful. The other option is to modify their values and beliefs about cheating, and that might sound like this: "I know it was wrong to cheat, but I have already done it. It was not that bad, in fact it was exciting and new. And she will never find out!" As a result of this type of thinking the person opts to modify their beliefs to allow for the extramarital affair. They begin to rationalize the affair and may even blame their spouse or partner for in their own mind "causing' them to cheat. In fairness, people often choose to modify their beliefs and values rather than to change their behavior-it is simply easier.
Consider dieting and exercising. Most everyone has at one time or another attempted to lose weight or to establish a consistent pattern of exercise. But much of the time, it is far easier to stop dieting or exercising and return to their prior way of life because the cost of the new investment is more than they are willing to pay. For example, it takes a lot of energy, commitment, and drive to maintain a new diet or exercise plan. It is simply easier to rationalize and justify their decision to stop dieting or exercising. The same process can be applied to cheaters. They modify their previously held values and beliefs about the sanctity of marriage or commitment and choose to continue their affairs.
One more principle applies here-the abstinence violation effect. The way this principle works is like this. When a person crosses the line of unacceptable behavior, they must make a decision, that is, to either continue to cross the line further or to stop. For example, an alcoholic has a conscious choice to be an active alcoholic or a recovering alcoholic. They can choose to establish a new, sober support system, change their behavior, change their self-talk, and actually remain abstinent from alcohol likes thousands of alcoholics have done. On the other hand, if they find themselves in a situation with alcohol present, or they actually have one drink, they may justify that because they have already crossed the line, they have already had one drink, it does not matter anymore and therefore they continue to drink. That is the abstinence violation effect. Because they violated their value or not drinking, the fact that they had one drink justifies drinking more and more. This relates to the cognitive-dissonance theory.
The second area of change focuses on cognitive strategies. This involves learning more effective coping and problem solving skills, creating positive and realistic self-talk, increasing motivation and selfesteem, and no longer justifying engaging in behavior that is related to the problem behavior. Basically, learning to stop and think before acting and not justifying engaging in behavior that is secretive in nature.
As a result, if the person is truly a sex addict, powerless to stop themselves from engaging in their extramarital affairs, how would the above strategies and techniques work? In short, they would not. The cheater, the sexual addict, and even the alcoholic have the power to not engage in their addictive behavior. In fact, they often stop drinking when they know they might get caught (e.g., drug testing), and the cheater carefully chooses when and where to see their mistresses. So in short, sexual addiction appears to be the wrong term to apply to the celebrities who get caught cheating.
The cheaters maintained the appearance of a "normal" life, did not experience occupational hardships, did not appear to experience relationship difficulties, did not experience legal problems related to the affairs, nor did any of those mentioned actually feel that what they were doing was wrong. Not until they were caught! And even then some continued their affairs.

Conclusion
There appears to be no empirical evidence that cheating, extramarital affairs, or similar behavior has any relation to sexual addiction. It does appear that the famous and wealthy use the term sexual addiction to avoid taking responsibility for their cheating behavior. Even famous doctors appear to be in on the problem, misdiagnosing for the sake of making money.
We hear far too many excuses for celebrities and politicians who made conscious choices to engage in extramarital affairs, excuses that tend to lessen the sense of shame and responsibility. Perhaps it is time to call their behavior of engaging in extramarital affairs a conscious choice, nothing more, not a sexual addiction, but a decision made. Sexual addiction does not appear to apply to cheaters, those who made a conscious decision to engage in extramarital affairs. They are not addicts! They have poor morals and values and believe that cheating is appropriate. They are not addicts, and there is no proof that cheaters are addicts or that they require sexual addiction treatment. Stop offering professional psychological excuses for cheaters.