Despite the continuing taboo, there is growing concern in counselling circles about the level of sexual addiction in Ireland. Iva Pocock reports
Mention of sex addiction prompts a predictable response - a quizzical smirk or a bemused "what?". But for sufferers it is no laughing matter, says psychologist and counsellor Eoin Stephens, who specialises in both treating sex addicts and training other counsellors to deal with sex addiction. For him, theoretical discussion about the validity of the term, which is at an early stage in Ireland, is not as important as the reality that there are "people who strongly identify with the notion of being a sex addict".
What matters, in his view, is that when some people hear the description they say: "I sure identify with that. It's no joke to me. It's a struggle, it's a nightmare."
Dr Cormac Macnamara, a GP from Waterford, agrees that the term sexual addiction explains a clinical phenomenon. He believes it is more prevalent than sceptics would suggest but not something you would meet every day in a large general practice such as his.
There are no statistics about its prevalence in Ireland, but figures from the US show that "over 10 per cent of the population have some problem with sex addiction, with acute or chronically addicted people making up about 3 per cent", says Stephens. There is no reason, he believes, to think the problem is less common in Ireland.
"In fact, considering sexuality has been so repressed in this country, it is likely to be worse here rather than better," he says. "Very few people in this country, at least those over a certain age, have had a healthy sexual upbringing or education. Most families didn't talk about sexuality, which doesn't help them to have healthy sexual relationships."
As a result, says Stephens, people are more likely to become "compulsive around masturbation, fantasy, voyeurism or prostitution. Even romantic novels can become an obsession, which may not seem very serious at one level, but it can take over your life".
One celebrity whose life has been plagued by sex addiction is the actor Michael Douglas. The topic has caught film-makers' attention: the lastest movie by Paul Schrader, who wrote Taxi Driver and Raging Bull, is Auto Focus, in which Greg Kinnear plays Bob Crane, the sexually addicted star of Hogan's Heroes.
There are different levels of sex addiction, ranging from activities that do not involve another person, such as fantasy, pornography and masturbation, through minor criminal activities such as exhibitionism to major crimes such as rape and incest.
Stephens has considerable experience of working with people whose lives have been taken over by addiction, be it to a substance, such as alcohol or drugs, or to a behaviour, such as gambling. When working in the after-care programme of the Dublin-based Rutland Centre, a residential clinic primarily for alcohol and gambling addicts, he dealt with a number of people who were struggling with some kind of sexual addiction. A sex addict's life, says Stephens, shares the same characteristics as those of any addict.
"Someone with an addiction has developed an obsessive-compulsive relationship with a highly mood-altering activity or substance which leads to negative consequences and, despite the negative consequences, they can't stop," says Stephens. "One obvious activity which is highly mood-altering is sex."
That sex is not a substance, such as heroin or alcohol, makes little difference. As with gambling or high-pressure work, it is an activity that changes the body's neurochemical and hormonal system, releasing feel-good chemicals such as adrenaline and serotonin, in a similar way to drugs, explains Stephens.
Dr Macnamara agrees: "Addiction to sex is about the need for a high." As with any addiction, obsession and compulsion are other characteristics. "People who are addicted to cigarettes spend a lot of time thinking about when they're going to have their next cigarette, similarly alcoholics and heroin addicts," says Stephens. "Someone who's addicted to some kind of sexuality will obsess about it, plan it, remember it and fantasise about it." He is careful to point out that not everyone who drinks too much is an alcoholic, nor is everyone who uses Internet pornography or goes to prostitutes sexually addicted.
"The nature of addiction is to be struggling with it. Sexual addicts will take risks, such as exposure to sexually transmitted diseases or spending a lot more money than they have on sex lines." As with drug addicts, those who are chronically or acutely addicted to sex can suffer withdrawal symptoms. "People looking at Internet porn for hours a day may get the shakes, have difficulty sleeping and suffer exhaustion when they stop," says Stephens.
The accessible, anonymous and affordable nature of Internet pornography, which allows sexual thrills without the need to persuade someone to have sex with you, has increased the likelihood of people becoming sexually addicted, in his opinion. When asked about the possibility that sex addiction will be equated with addiction to child pornography, he says sex addiction encompasses addiction "to pornography which isn't illegal at all".
A vital point, he says, is that many of those who commit sexual offences may do so for reasons that have nothing to do with addiction. But regardless of their psychological profile and whether or not their behaviour is addictive, the legal implications are the same. "The fact that someone is an addict does not absolve their offensive behaviour.
"The Internet isn't the only way that people can become sexually addicted, but it is certainly upping the ante. In the US, companies are taking the issue seriously because of time and money lost by employees compulsively using the Internet for pornography at work."
Tommy McCabe, director of IBEC's Telecommunications and Internet Federation, says he hasn't come across any business that has had to take disciplinary action because of an employee's use of pornography. The federation recommends that all businesses have clear Internet and e-mail policies.
Stephens is particularly concerned about burgeoning sex addiction, given the number of young people, especially young men, who are using Internet pornography. "They're developing their sexuality, and if they're a bit isolated or lonely or shy they may turn to the attractions of Internet pornography, which is there at the click of a button."
His advice for parents is that Internet access for youngsters should be available only in the living room or kitchen, not in their bedrooms. Although they may be uncomfortable, parents should talk to their children about sex on the Internet rather than pretend it doesn't exist.
The establishment in Ireland over the past decade of Sex and Love Addicts Anonymous, an Augustine fellowship that is the equivalent of Alcoholics Anonymous, the Centre for Sexual Addictions, which is a loose network, and Sexaholics Anonymous reflects the reality that people here are seeking help for sex addiction.
It is treatable, says Stephens. The early stages of treatment focus on helping clients to "develop strategies to ease back on their behaviour", he says. The longer-term work is about learning how to have healthy intimate sexual relationships, which for many, he says, means "going into the past". For anyone concerned about being sexually addicted, he recommends seeking the help of a counsellor, reading books on the subject or joining one of the fellowships mentioned above.
The director of the Rutland Centre, Stephen Rowen, says that although sexual addiction is not treated specifically by the clinic, it is "becoming more prevalent in terms of what people are presenting".
While the Irish Association of Alcohol and Addiction Counsellors is beginning to take sex addiction seriously and has run training seminars on the topic, a spokeswoman for the Irish Medical Organisation says that it would never run such a seminar and that she has never had a query about sex addiction.
A spokeswoman for the Irish College of Psychiatrists says it doesn't run any courses on sex addiction. But despite the low profile of the issue in the medical profession, Stephens is adamant that we are far from the end of the emergence of this problem.
Sex and Love Addicts Anonymous, 01-6611289 (voicemail); Sexaholics Anonymous (SA Ireland, PO Box 92, Waterford), 051-317388 (voicemail); Centre for Sexual Addictions, 086-3924143 (voicemail)