Sex Addiction: A Disease or a Convenient Excuse?

Sex addicts like to compare their habit to substance addiction, but scientists are only beginning to show proof of this connection. In December, scientists at Binghamton University in New York released the results of a study of 181 young adults showing that differences in their DNA were linked to differences in their sexual behavior. Those with a certain variant of the DRD4 gene were more likely to report having had one-night stands and adulterous affairs. The DRD4 gene helps control how much dopamine is released when you have sex. For some, sex seems to provide more of a dopamine high. Also, we know that having sex releases endorphins, which are peptides that activate opiate receptors. Heroin and other drugs activate opiate receptors as well. But no study has proved that sex is tied to opiate receptors, and the DRD4 study hasn't been replicated.

What's more, we know that desire is more than testosterone and peptides. When evolution programmed our urge to mate, it used all kinds of tricks to make sure sexual desire would be durable: we want others not just hormonally but emotionally — so deeply that we speak of being "madly" in love. That's why the current models for treating sex addicts are so poor. As the prominent sex researcher Fred Berlin of Johns Hopkins University pointed out in a 2008 article in the journal Psychiatric Clinics of North America, "the notion that one can successfully choose to indefinitely resist an intense urge is often simply incorrect." (See a brief history of sex on TV.)

The Future of Treatment
After Melinkovich and I had spent a few hours together in Los Angeles, he started showing me some of the messages that were pinging his BlackBerry. At least three women had called him while we were eating dinner. One of them he kept calling "the 16-year-old" and then correcting himself to say "the 19-year-old." Once when his phone was ringing, Melinkovich turned the illuminated screen toward me. I saw that he had given the woman who was calling a special name — in honor of her favorite sexual position — which suggested that his treatment to date had not addressed a tendency to reduce women to sex objects.

"It's true," he told me later. "If you have this addiction, you objectify women. There's a lot of skin, a lot of beauty in this town." He said SAA has a three-second rule: you can check out an attractive person for a maximum of three seconds, "because after that, you start going into fantasy."

Melinkovich checked himself into Promises five years ago. After a relationship fell apart and he lost a $1,000-a-day job as a sober coach for a wealthy young man with addiction problems, Melinkovich's libido came roaring back. "It made me realize I was medicating depression with sexual activity," he told me. "Also, I realized I hadn't really been in love with that woman — I just had a complete sexual obsession with her." (See "Texting Leads to Sex Sooner — and Easier Breakups Later.")

Partly because of its proximity to Hollywood, where so many wealthy men and beautiful women can pursue their unhealthy sexual appetites ad libitum, Promises now has one of the most comprehensive and respected sex-addiction programs in the nation. But when Melinkovich arrived there, he found that he was the only one there for sex addiction and that the unit had little experience in treating sex addicts. That's not surprising; even today, most addict-treatment centers are still trying to develop standards of care for hypersexual conditions.

And they are still trying to address very basic questions. Should we regard out-of-control sexual behavior as an extreme version of normal sexuality, or is it an illness completely separate from it? That question lies at the heart of the sex-addiction field, but right now it's unanswerable. When I was with Melinkovich, I sometimes felt he was a normal guy who didn't quite know how to deal with the many women who find him attractive. Other times, like when he got a lascivious look in his eyes while reading a text from a woman young enough to be his granddaughter, he seemed like a guy with a debilitating illness. "I'm kind of a work in progress," he told me a few months after we first met. "I'm still trying to define a healthy sexuality that works for me." The other day, he said, his impulses were so powerfully triggered by the sight of the singer Rihanna at the Grammys that he had to change the channel to a golf program. He is also trying to use his experience with sex addiction to help others. He is working on a sober-coaching site called getneiled.com and he wants to write a book.

It wasn't clear to me whether these ventures would work out or whether Melinkovich would relapse yet again. For now, he tries to cope with his urges through simple behavioral strategies. When he sees a pretty woman, he tries to look away and then tell himself, "God bless her and her beauty."

See TIME's Top 10 Everything of 2010.

See the best pictures of 2010.