Have you ever thought that you or someone you know may be addicted to sex?

Maybe it's because you or they watch too much pornography ("too much" according to whom, though?) or you or they seem to have problems saying no to an offer of sex when it comes along, even from strangers (slut shaming anyone?)

Sex addiction is a common diagnosis for all kinds of behaviors related to sexuality. Compulsive masturbation, high pornography consumption, and promiscuous behavior are all things that have been called "sex addiction" over the years. It's a glamorous disease, too; from Tiger Woods to Michael Douglas, celebrities who say they have suffered from sex addiction have been kept at the forefront of the news for the titillation of the masses.

Some experts, especially those who specialize in treating sex addiction, say that sex addiction is a real thing. Others argue that sex addiction (also known as hypersexuality) is a myth that is indiscriminately applied to people we wish to shame for enjoying sex too much. Most recently, however, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) took a stand on the issue saying that while "problematic sexual behavior" certainly exists (and needs to be addressed), there isn't "sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder." (Read AASECT's press release on the subject here.)

Not sure which side you're on? Let's have a look at a few fundamental concepts and some research.

Models of Addiction

Over the last century, we've had three models of addiction. The first, substance-based, argues that addictive substances like alcohol or drugs are inherently addictive because of their contents. Essentially, anyone using them will eventually develop an addiction. The treatment is to cease all consumption of addictive substances.

This model doesn't have much scientific support because many people can manage their consumption of things like alcohol or drugs without becoming addicted to them.

The second model, morality-based, argues that addiction is a failure of morality or willpower. A person using this model would say that a person who is addicted to cigarettes or alcohol is addicted by their own fault, either because they are morally deficient ("depraved") or simply because they just don't have the discipline needed to keep the addiction at bay. The treatment here is to get the person to stop by changing their morality or by increasing their discipline.

This model also doesn't have much scientific validity. Addiction has little to do with willpower or morality. Perfectly nice and disciplined people have found themselves addicted to all kinds of things despite their best intentions.

The third model, brain disease, is currently the most widely held model among scientists and psychologists. This model argues that some substances and activities are addictive because of their effect on the brain. Addictive behavior increases the effect on the brain, and the effect on the brain causes more addictive behavior. It's a self-perpetuating cycle. The treatment here is to help the patient with both biological treatment (like medication) and behavioral therapy.

This model is considered valid because it explains why some people are more susceptible to addiction. Their brains react more strongly and faster to addictive behaviors and substances. It also considers the addictive substance or behavior in question. Some things are physically addictive (like nicotine or alcohol) while others are only psychologically addictive (i.e. the body does not develop a physical dependency on the substance to function every day).

The Addiction Process

How does someone get addicted to something like, say, alcohol or gambling? The process is relatively simple. Our brains are wired to produce dopamine, a pleasure and learning hormone, when doing something pleasurable - no matter what that something is.

Things like eating, sex, smoking a joint, petting an animal, taking a walk, or playing a video game are all examples of pleasurable activities. If you think it's fun, it will activate the pleasure center of the brain.

Yet, some things, like heroin or nicotine, for example, make the brain produce lots of dopamine very quickly, which is the source of the intense pleasure we feel when taking substances of abuse.

Dopamine is also linked to learning and memory. This adds a second layer of complication. When you take addictive substances, you also teach your brain to associate the substance with a reward. The problem here is that the reward system is linked to survival activities, like eating and sex. So you are literally teaching your brain to see taking the substance as a life-or-death choice.

This process is, of course, far more complicated thatn this. But that's the gist of it. Here's a great article by Harvard Medical School if you want more details.

So... Is sex addictive?

According to the current model, any behavior that activates the addiction process in the brain can become an addiction. Gambling, for example, is a clear example of this. So, can sex actually be an addiction too?

One argument against the reality of sex addiction is that people can die of substance abuse or die because of withdrawal. However, nobody's ever died for wanting sex or having too much of it. Substances like alcohol and drugs introduce a foreign chemical into the brain, one that imitates dopamine. Sex does not.

Addiction also has a tolerance effect. The more you consume the substance, the higher the dose you need in order to feel an effect. However, this doesn't happen with sex either. No matter how many orgasms you have, they'll always feel good.

So by these basic standards of addiction, sex isn't addictive. It can't be. Having sex doesn't activate the addiction process in the brain. In fact, having lots of sex is good for you.

What about people who say they're addicted to sex?

OK. So sex in itself isn't apparently addictive. Yet, tons of people say that their sexual behavior is interfering with their normal lives. Whether it's watching porn for hours every day or taking undue risks when finding sexual partners, there sure are people whose sexual behavior is definitely problematic - and unhealthy for them.

However, problematic behavior isn't addiction. It's like saying being obsessed with, for example, skateboarding or rock climbing, is addiction.

One way that scientists have found to evaluate the presence of addiction is to put addicted people in front of images of their addiction. Usually, the addicted brain will respond with a rush of dopamine even in the presence of a simple image of, let's say, a glass of whisky or a heroin needle.

With sex, there is no such reaction. In a recent study of people with hypersexuality, brain researchers found that there was no increase in dopamine production when they were presented with sexual pictures (but not pornography).

Instead, dopamine production correlated with arousal and sexual desire (see the full study here). Basically, your body produces dopamine when you are psychologically aroused, so that your body can get ready for sexual activity. That's why sexual (but not pornographic) pictures didn't correlate with the kind of brain activity normally seen in addicted people.

So, people who say they're addicted to sex aren't really addicted to sex. That said, they probably have other problems related to sexuality, like a dysfunctional desire pattern, issues with intimacy, or another substance problem that causes them to have problematic sexual behavior.