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Yvonne K. Fulbright, a noted sexologist, describes what life is like at a sex addiction clinic, including what the people receiving treatment are and are not allowed to do. AP

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The statements issued by accused sexual predators Harvey Weinstein and Kevin Spacey are vague to the point of obfuscation: They are "in counseling" or seeking "evaluation and treatment," their publicists' emails read.

When photographers captured Weinstein on video outside his daughter's house in Los Angeles on October 11, he was apoplectic but ambiguous.

"Guys, I'm not doing OK," he shouted to the paparazzi. "I'm trying. I've got to get help." 

Well, what does that mean? Treatment for sex addiction or alcohol addiction? Marriage counseling? Talk therapy, 12-step therapy, inpatient, outpatient? A trip to the library to read up on psychology? All of the above?

The short answer is we don't know and neither Oscar-winning producer Weinstein nor two-time Oscar-winning actor Spacey is detailing what they are doing to fix whatever it is that ails them.

But since both are under scrutiny for sexual misconduct — Weinstein has been accused by more than 70 women of sexual harassment, coercion, assault or rape dating back decades; Spacey has been accused by more than a dozen men of sexual harassment, groping, assault and at least five allegations of sexual advances on or attempted rape of teenage boys — it's a good bet that treatment for sexual disorder might be in order. 

More Who has accused Harvey Weinstein?: Harvey Weinstein scandal: A complete list of the 78 accusers

There are a broad array of treatments available in America today, according to the American Psychiatric Association, the American Psychological Association, the American Association for Sex Addiction Therapy, the Society for the Advancement of Sexual Health (SASH), and practicing psychiatrists, psychologists, mental-health counselors and sex-addiction therapists.

If you're snorting with derision about the latter, don't. "Sex addiction" is a recognized disorder  similar to drug or alcohol addiction, say many experts.

But it's not listed, yet, as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders — the way drug or alcohol addiction are — due to a lack of research into diagnostic criteria for compulsive sexual behavior, according to the American Psychiatric Association.

"Some people say the research (shows) that sex can be an addiction, but other people will argue against that," says James Olsen , a mental-health counselor and sex-addiction therapist who also treats sex offenders at his Pacific Behavioral Healthcare clinic outside of Seattle.

 

"What is not up for debate is people experience it like an addiction. So whether you believe it's literally an addiction or a metaphor, it’s a behavior people have difficulty controlling even if it's outside their moral values."

It's true the term "sex addiction" is controversial; it's only been in use since about 1983, says John Giugliano, a psychotherapist in private practice near Philadelphia and spokesman for SASH. He prefers to use "out-of-control sexual behavior."

"The disorder is real, the nomenclature may be controversial but there is no controversy about the reality," Giugliano says.  

The options for treatment can range from attending a 12-step program (there are at least five for sex addiction), going to weekly or three-to-five-day intensive therapy sessions on an outpatient basis at a treatment center, or checking into a rehabilitation center as an inpatient for up to 30 days. 

(The 12-step programs, based on Alcoholics Anonymous, propose 12 steps needed to recover from addiction and compulsive behavior, including recognizing a higher power, examining past errors with the help of a sponsor or another experienced member, and making amends for these errors.)

Among the famous who have discussed being a sex addict or checked into a rehab facility for porn or sex addiction in recent years are golfer Tiger Woods, Josh Duggar of the TV reality show family; and actors Michael Douglas, David Duchovny and Charlie Sheen

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 There are nearly 2,000 certified sex-addiction therapists, or sexologists, in the USA, says Alexandra Katehakis, a clinical sexologist and leading expert on sex addiction, and the founder and director of the Center for Healthy Sex treatment facility in Los Angeles.

"In Los Angeles, there's a Sex Addicts Anonymous meeting every day in the city, with 40, 60, even 80 men filling the rooms even on a Saturday," she says. "There's a (large) population of people struggling with this constellation of behaviors; these are men who are taking responsibility for their behaviors, not hiding out in some weird club."

Olsen and other experts say treatment for sex addiction can be effective, though it takes  a commitment; a problem is the price tag. While a 12-step program may cost little, a 30-day stay in a luxury treatment facility — such as The Meadows in Wickenburg, Az., where Weinstein spent some time recently, according to Entertainment Tonight, The New York Post and the Daily Mail  — can cost up to $50,000 a month.

"There's good help to be had for people who can afford treatment — the criticism is that 'it's for rich people,' " Olsen says. "The reality is that poor people experience (sex addiction) too; I get calls every day from people who are desperate for help who can't afford it, and that's one reason why the 12-step programs are out there."

The first step on the treatment journey, experts say, is to distinguish between a sex addict and a criminal sexual offender. Not all sex addicts are offenders and most sex offenders are not addicts. Unlike an addict, a sexual offender may be manipulative, lacking any sense of empathy, motivation to change behavior or even a basic conscience.   

"(Sex addicts) rarely engage in sex without consent or with coercion; they're using sex as a self-soothing mechanism in the way other people use drugs or binge eat," says Debra Borys , a Los Angeles psychologist and expert on sexual harassment. "A sexual predator gets aroused from the domination and the power and seeing the fear or humiliation; they're not considered a sex addict."

Examples of sexually addicted behavior could include compulsive masturbation, repeated anonymous one-night stands or compulsive consumption of pornography.    

"Sexual addiction is not an excuse for criminal behavior," says Douglas Weiss  , president of the American Association for Sex Addiction Therapy, a recovering sex addict himself and the founder of the treatment facility, Heart to Heart Counseling Center, in Colorado Springs. "Sexual criminals are still responsible for their crimes."

 

The treatment for sexual offenders, including court-ordered psychiatric hospital stays, differs from treatment of non-criminal sexual addiction because they have a "different level of pathology," Weiss says. "It's a different thought process to injure another for your pleasure."

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"The average specialist in compulsive sexual behavior should not be treating sexual offending behavior because it's its own specialty, with its own risks and tools in place (for treatment)," Olsen says.

For instance, "In our clinic, even if someone has not been adjudicated, if they engaged in felony-level sexual behavior (say, molested a child), we put them in a sex-offenders (treatment) group regardless of whether the courts do."

More Consequences for the accused: Men who’ve lost jobs or face sexual harassment claims since Harvey Weinstein scandal

Treatment of addicts starts with an assessment of the nature of the patient's issues. Weiss believes there are six categories: Biological (brain malfunction); psychological (leftover effects of childhood trauma); spiritual ("They're looking for God in all the wrong places."); sexual abuse-related (patient replays childhood abuse but as perpetrator); intimacy anorexia (withholding intimacy from partner); or mood disorder (depression or bipolar condition requiring medication). 

Katehakis describes what typically happens in therapy. Patientsgo through individual one-on-one talk therapy but they're also sorted into groups of about 20, then sorted again into smaller groups. These groups become their "community," responsible for keeping each other "accountable," she says, and studies show that the best outcomes for addicts occur in a group-therapy process.

"(Addicts) have minimalized and rationalized and justified and used their power to get what they want when they want it," Katehakis says. "So they can confront each other. It takes one to know one."  

More Who's been accused?: List: All of the Hollywood power players accused of sexual assault or harassment

Every night they're expected to do "lots of homework, reading, writing," she says. 

"They have to do a timeline history from their earliest sexual experiences to the present," she said. "They have to do a trauma history because they typically have some sort of childhood trauma they never dealt with along the way so that by the time they're in their 50s it's reached monstrous proportions."

In treatment, most addicts go through an "enormous amount of grief and pain and remorse, and that's when we know they can change," Katehakis said. "And if they're not (going through all that) then they're anti-social and that's a different problem...

"If they have no empathy or remorse, then (criminal offenders) will probably re-offend and they'll end up in jail. It's just a matter of time."

Even if the term sex addict is only about 30 years old, sexual misbehavior is as old as the species, so why does it seem like it's a growing problem now? Because we are talking about sex more openly as a society than we used to, say Olsen and Giugliano, and at the same time, the internet makes unfiltered access to sex and pornography instantaneous.

"The culture is more accepting of sexuality, which is good; people feel more comfortable talking about healthy sexuality," Giugliano said. "(But) porn is just so accessible that it makes the problem (of addiction and criminal sexual behavior) seem more pervasive."

If you have ever experienced or witnessed sexual misconduct while working in the entertainment industry, we’d like to hear from you. Send us a secure tip using the instructions at newstips.usatoday.com.

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