Dear Patrick Carnes, Stephanie Carnes, Robert Weiss, All CSAT Counselors and all 12 Step Advocates for Sex Addiction,

Please consider this letter an urgent request to change the current 12 step/co-addict approach that has been perpetuated in the field of sexual addiction. The historical underpinning of Bill Wilson’s model for alcoholism has serious negative implications for evidence-based practice, even for sobriety standards, even though its evolution at a time when nothing else was available did have merit. Wilson and his partner adapted religious principles for living a sin-free life – where does religion have a role in diagnostic acumen? (Maybe it did for Bill because he was plagued with so many compulsions and addictions himself including sex).

Religion is a cultural and spiritual function of our humanity but 12 Step seems to be the only place where religion is considered part of a medical treatment plan. The modification of the phrase ‘God as you know it’ does not change this fact. Just as the Bible was written for a world that existed over 2000 years ago and deserves to be considered in the context of contemporary mores, so too must the 21st century approach to compulsive/addictive behaviors.

People who are addicted or compulsive become increasingly deceptive over time. Possibly it is the capacity to be deceptive that might lead to the compulsion, who knows which comes first? Even the descriptions of mental-health disorders in this country are subjective and highly vulnerable to great scrutiny by different clinicians, unless somebody is revealed to be acting so egregiously that they have violated acceptable legal and moral standards. Isn’t that what propels sexual acting out into a diagnostic category, acting egregiously? Prior to that it is infidelity or as you like to distinguish adultery. Sexual acting out is a form of betrayal that changes the landscape of everybody’s lives (and it is only betrayal if the partner has not signed up to be in bed with 50 other people). Its origins are complex and rarely begin with the partnership and are usually not revealed until there has been some kind of bond established and then broken.

To describe a partner as a volunteer rather than a victim is actually another egregious betrayal by the professionals who claim to be providing care. Of course this is a family problem – the family has been blown apart and prior to the explosion was living in a fractured reality that was being established without their consent. Even in cases where the partner might have known ‘something was not right’ the culture of entitlement, socially gendered norms for male behavior, and economic and family displacement after divorce, does not render a partner as a co-addict or volunteer in the hi-jacking of their lives. Would you say this to someone who has been subjected to other recognized forms of domestic violence?

Sexual acting out is about power. That has been established through many years of rape research. Someone who acts out against the partnership and family is raping the principles of said partnership, unless both people agreed to screw whomever, wherever, and whenever. At the point that couples show up for treatment, and it is usually couples, sadly there are few men or women who are putting themselves in the hands of addiction professionals who haven’t first destroyed a family as well as themselves. It is therefore often because the story has become too unmanageable to hide and the scattered pieces of everyone’s lives are strewn about the roadside.

This is not a couple problem – let me emphasize this! This is not a couple problem!

This becomes a family problem when children are created in a union that is untenable because it is built upon lies. Of course every couple colludes when they marry, it is part of the ‘happy ever after’ delusion, but this problem, sexual acting out, lies within the person who is out of control. This does not necessarily mean that there are no other influencing factors but when someone robs a bank and their partner does not know about it and did not participate in the crime what part of the law says that they should also be arrested and thrown in jail?

The pattern of diagnosis toward partners is a symptom of the patriarchy that continues to victimize men and women, because male partners of women who act out are described in gendered terms that are also typically used to describe women in general: co-dependent, enabling, under-developed, clingy, hyper-vigilant. Who wouldn’t be hyper-vigilant when they are under attack from an unknown assailant (lies) and a known assailant, their partner?

The sad legacy of this behavior leaves everyone in shreds. Perpetuating the myth that you can have greater intimacy by accepting yourself as a co-addict is also abusive. Don’t get me wrong, it might work for people who, already victimized, are now vulnerable to being victimized by the system that they have reached out to for help, but if empowerment and liberation is the goal this is not the language or kind of care that resurrects anyone’s sense of self. Not the person acting out, the partner, or the family. And, let us not forget the people on the other side of the sexual acting out equation, the sex workers and prostitutes, who in a recent survey by a sex trafficking organization say, at a rate of 98%, that they hate what they do.

This behavior is not about sex. It is about lies, ownership, entitlement, power, trauma, despair, and patriarchy. The mental health system that uses these same methods to treat the problem is also acting egregiously. I am not saying that compassionate care is not warranted for the individual who behaves this way, I am saying that compassionate care is accountable-care, and accountable-care is complex. It is not 12 Step, or 13 Steps (and I am sure you know what that means). It is a million steps of indeterminate conclusion that leaves room for the stories of loss, abandonment, neglect, and possibility on both sides of this equation. Sometimes leaving is the best answer for both partners, what is not the answer is to diagnose one person with cancer and give the other one chemo.

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