Harvey Weinstein checked himself out of sex addiction rehab on Saturday after just one week of therapy.
The Hollywood producer had sought help for his “sex addiction” after several women stepped forward accusing him of sexual harassment.
Although sex addiction rehab centers exist, experts disagree on whether sex addiction is a real thing.
Some say that high-profile men accused of cheating on their partner or of committing a sexual assault may use sex addiction as an excuse for their bad behavior.
Others say that this is a real condition that affects many people, although it’s misunderstood by the public and sometimes misdiagnosed.
Of course, whether Weinstein has a sex addiction is separate from the accusations against him.
The main issue here is a question of consent.
Sex addiction is not a “listed” diagnosis
Other addictions, like those to drugs and alcohol, are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the mental health professional’s bible.
But sex addiction is not.
One argument against sex addiction is that abstaining from sex doesn’t create the same kind of withdrawal symptoms that happen when someone addicted to a substance like alcohol or heroin goes “cold turkey.”
And those who claim to have a sex addiction don’t seem to require larger doses (of sex) over time.
Some experts are also concerned that applying “addiction” to a normal human behavior like sex demonizes it.
And it makes sex therapists the “sex police” who decide what is and isn’t “healthy” sexual behavior.
Psychologist Marty Klein wrote in a blog post on Psychology Today that recent events with Weinstein are proof that sex addiction doesn’t exist, and that this claim is just masking his other — diagnosable — problems.
Even though sex addiction isn’t listed in the DSM, many mental health professionals are certain that this condition legitimately affects people.
“It is something that I absolutely consider real but is also very misunderstood,” Jennifer Weeks, PhD, a therapist specializing in sexual addiction and compulsivity, told Healthline.
There’s some research that suggests that the brains of people with sexual addiction respond differently to pornography, compared to people who aren’t addicted.
Weeks clarified that sex addiction isn’t about a specific behavior — like how often you masturbate or look at pornography. Instead, it’s about a “relationship” with a behavior.
Two people can engage in the same behavior but have completely different relationships to that behavior.
She said that therapists look for signs that a person’s relationship with a sexual activity is unhealthy.
For example, does a person spend a lot of time thinking about sex or a sexual activity?
Is the behavior impacting their work, social relationships, and other important aspects of their life?
If a person stops the behavior, do they keep going back to it even though they don’t want to?
Sex as a coping mechanism
Sexual addiction isn’t always a clear-cut diagnosis.
And it may just be the tip of the iceberg.
“Any addiction is pretty much a symptom of an underlying issue,” said Weeks. “It’s a very damaging symptom, but usually there’s something else going on.”
For some people, sex addiction isn’t about trying to feel good. They may be using sexual activities to escape from anxiety, stress, depression, or other emotional problems.
People with a history of trauma, especially during childhood, may try to dull their emotional pain with sex, the way others do with alcohol or drugs.
Other mental health problems — such as bipolar disorder — can also lead to the same kind of hypersexuality that’s associated with sex addiction.
And some people with strict religious or moral beliefs can feel guilty about their sexual behavior, even though it might not have the clinical characteristics of sexual addiction.
Whether you call it sexual addiction, hypersexual disorder, or sexual compulsivity, people who are struggling with these behaviors need help.
Weeks said that people who come to her with what appears to be a sex addiction are often in crisis.
The first step is to get the problem behavior into check, using cognitive behavioral therapy or behavior modification therapy.
“Once we get some distance from the behavior that the person doesn’t want to engage in,” said Weeks, “it becomes ‘what is that deeper work?’”
This deeper work may involve dealing with past trauma, family problems, or other issues.
But unlike treatment for other addictions, people recovering from a sex addiction aren’t asked to abstain from sex.
“The model for sex addiction is not abstinence-based because part of being a healthy human being is having a healthy sexuality,” said Weeks. “So it’s a more difficult recovery for people to be successful in.”
She said therapy is more about helping people learn to have a healthy relationship with sex, rather than giving it up completely.
For example, a person might continue to have sex but may give up going to prostitutes or looking at pornography.
“We want people to learn how to have healthy sexual connections with others,” said Weeks. “That is going to be different for everybody because sex is such an individual thing.”
Therapy can happen at a rehab center — what Weeks called “therapy boot camp” — or on an outpatient basis.
Either way, it’s not a quick fix.
“If there’s truly a sexual compulsivity issue, it will require years of therapy to go through and deal with all the pieces of oneself,” said Weeks.
Sexual addiction vs. sexual offending
Only Weinstein’s therapist will really know if the producer has a sexual addiction, “because that’s part of his internal world that we don’t know about,” said Weeks.
The bigger issue, though, is a question of consent.
“Engaging in any kind of sexual behavior against someone’s will or without their consent is going to be sexual offending,” said Weeks.
She said that in one psychological model of offending, “people need a certain motivation in order to sexually offend.”
This could be a sexual addiction — but not every sexual offender has a sex addiction.
And not everyone with a sex addiction is a sexual offender.
Weeks said if the allegations against Weinstein are true then “he is a sex offender. That’s unquestionable. Whether he’s a sex addict or he’s sexually compulsive, it’s hard to say just looking at his behavior. He could be both.”
Sexual offending can be driven by coercion, where somebody forces another person into a sexual activity.
This isn’t always forceful or violent. A husband can coerce his wife into having sex by badgering her and saying things like “If you loved me, you would…”
However, this is still not consensual sex.
Sex is also not consensual if one person is going along just because they’re concerned about the consequences — such as fearing that their spouse will leave them, they’ll lose their job, or they won’t get a part in a big movie.
Sex is only truly consensual when all people involved give consent.
While some critics of sex addiction say that sex therapists want to demonize sex, Weeks said that in her practice they practice “sex-positive” sex addiction therapy.
“As long as it’s consensual, I don’t tell you if sexual behaviors are good or bad, addictive or not,” said Weeks. “That’s for you to decide.”