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Article Excerpt
The authors present an overview of sexual addiction and explore the relationship between Internet use and sexual compulsivity. The role of Internet use in gay men's sexual behavior is described. Implications for the counseling profession are discussed, and a clinical case study is presented.
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Given its broad accessibility and significant expansion, the Internet is altering human interaction and interpersonal relationships. In the United States alone, more than 54% of the population accesses the Internet during any 1-month period, resulting in approximately 150 million users (National Telecommunications and Information Administration, 2002). Sexuality, a significant emphasis of the Internet since its inception, continues to be a commonly searched topic (A. Cooper, McLoughlin, & Campbell, 2000; Putnam, 2000). Nearly 20% of all Internet users have engaged in some kind of online sexual activity, ranging from obtaining information on sexual health, online chatting, to viewing pornography, to arranging face-to-face encounters offline (A. Cooper, Delmonico, & Burg, 2000). Although the majority of individuals who access the Internet, even for sexual purposes, do not report negative consequences, 6% to 10% of Internet users do report concerns related to their online sexual activities (Carnes, 2001 ; Schneider, 2000). Furthermore, Carnes (2001) discovered that for 1% of users, their online sexual activity virtually "crippled" their capacity to function in their everyday lives.
Sexual addiction is presenting an increasing challenge to mental health professionals. Corley and Schneider (2002) found that therapists who work with sexually compulsive clients are often unfamiliar with sex addiction, thereby potentially prolonging the addict's denial about the seriousness of the problem. Although progress has been made in the areas of assessment, diagnosis, and treatment, research on sexual addiction is limited. Even less attention has been focused on the problems and behaviors associated with sexual addiction among gay men.
When acquired immune deficiency (AIDS) became recognized in the early 1980s as a major health problem, the sexual activities of gay men became a focus of concern to public health and mental health professionals. Although the demographics have changed of individuals who have been diagnosed with AIDS in the United States, the majority of AIDS cases and new HIV infections continue to occur among men who have sex with other men (Benotsch, Kalichman, & Kelly, 1999). As a result, investigating the sexual behavior and changing modes of sexual interaction among gay men remains an important field of investigation. Although research has shown clearly that the Internet is being used more frequently to engage in sexual activities, there is limited empirical research that has examined the effects of Internet use on the sexual behavior of gay men. In this article, an overview of sexual addiction is provided, the relationship between Internet use and sexual addiction is discussed, and the Internet's increasing role in gay men's sexual behavior is explored. Implications for the counseling profession are included, and a clinical case study is provided.
Sexual Addiction
Sexual addiction, defined as a loss of control over sex and a persistence in sexual behaviors despite adverse social, psychological, and biological consequences, is rapidly becoming recognized as a major social problem (Ragan & Martin, 2000). Affecting approximately 3% of adult women and 8% of adult men, compulsive sexual behaviors occur in approximately 15 million individuals (Carnes, 1991; Coleman, 1992; Earle & Crowe, 1990). Sexual addictions, like addictions in general, are considered progressive, chronic, and potentially fatal disorders and are characterized by high tolerance, craving, compulsion, secrecy, dependence, withdrawal, obsession, and personality change (M. Cooper & Lebo, 2001; Crawford, 1990). Although sexual addiction can result in intense psychological and physical consequences, there is no formal diagnosis within the American Psychiatric Association's (APA, 2000) Diagnostic and Statistical Manual of Mental Disorders (text revision; DSM-IV-TR). However, significant efforts are being made by addiction specialists to incorporate criteria for sexual addiction in future diagnostic manuals.
Although mental health professionals are treating more individuals who have sexually addictive disorders, research in this field is limited, but growing. Out of the Shadows (Carnes, 1983), one of the first books to address the assessment, diagnosis and treatment of sexual addiction, described varying types of sexual addictions and stages of sexual recovery. Earle and Crowe (1990) modified Carnes's initial work, providing additional information for diagnosis and clinical interventions. However, only in the last decade has empirical research been conducted to determine the etiology (Schneider, 1991), comorbid factors (Benotsch et al., 1999), psychobiology (Ragan & Martin, 2000), and optimal treatment modalities (Friedman, 1999) for sexual addiction. Various assessment tools and techniques have been developed to quantify sexual addiction (Coleman, Miner, Ohlerking, & Raymond, 2001; Delmonico, Bubenzer, & West, 1998; Garos & Stock, 1998), with a growing emphasis on how individuals use the Internet as a primary means of acting out sexually.
Sexual Addiction and the Internet
Through the use of visual and audio media, millions of people use the Internet each day to interact in a sexual way (Cooper, Scherer, Boies, & Gordon, 1999). More people have begun using the Internet to purchase sex-related goods (Fisher & Barak, 2000), find sex-related material for educational purposes (Carnes, 1999), seek sexual partners (Benotsch, Kalichman, & Cage, 2002), initiate or maintain online relationships (Schwartz & Southern, 2000), and exchange adult or child pornography (Delmonico & Griffin, 2002). For the majority of Internet users, the ease of connecting and the ability to connect with others who have similar sexual interests provide a good deal of enjoyment and self-fulfillment (Schneider, 2000). However, for individuals who have lost control over their online sexual activities, negative consequences can occur, such as social isolation, relationship conflicts, financial difficulties, and health risks, for both the user and his or her family.
Several researchers have described factors that make online sexual activity seductive and potentially addictive. A. Cooper's (1998) Triple-A-Engine, currently the most cited model in the sexual addiction literature, focuses on the access, affordability, and anonymity of the Internet. Access to the Internet is now commonplace, widespread, and efficient. Internet access can be obtained via public facilities (e.g., libraries, schools), from the home, and from the workplace with a simple software package and modern. The cost associated with accessing sexual images, sexual chat rooms, sex video clips, and live video connections is inexpensive and is becoming cheaper as a result of increased competition among Internet and Web hosting companies. The affordability of the Internet allows an individual to choose the precise medium that satisfies...
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