Circa 2006
Dear Readers,
In our office, as in offices across the nation, people can’t help wondering about former Florida congressman Mark Foley, who resigned after national news broke about sexually explicit emails he’d sent to underage congressional pages—allegedly sent over a period of years and continuing even after he had been warned by Republican leaders to stop these “overly friendly communications.”
Beyond being appalled by the revelation that this outward champion of children’s rights is himself a victimizer (ironically, Foley may be prosecuted under the very legislation he helped author as co-chairman of the Missing and Exploited Children Caucus), people are stunned at his apparent lack of common sense. In this day and age, when everyone knows that emails are trackable, how could an intelligent person do something so stupid? Something that would undermine his career so predictably?
To physicians like me who see such seemingly illogical actions regularly, the answer is usually quite simple. When otherwise rational people engage repeatedly in behavior with known negative consequences, sacrificing their functioning in multiple arenas to do so, that phenomenon has a name—it’s called addiction.
When most people think of addiction, they think of drug use and alcoholism. But a host of non-substancerelated addictions exist—for example, compulsive gambling, compulsive eating, compulsive stealing and sexual addiction.
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Throughout history there have been noted examples of compulsive sexual behavior—which often come to attention today in problems like pornography in the workplace, as well as other inappropriate or illegal sexual pursuits. The pioneer of research in sexual compulsion, psychologist Patrick Carnes, PhD, estimated that as many as eight percent of men and three percent of women are sexual addicts.
Add in other addictive disorders, and the scope of compulsive behavior as a problem becomes staggering— nearly 20 percent of Americans will have a drug or alcohol addiction in their lifetimes, five percent a problem with compulsive gambling or shopping, and two to eight percent an eating disorder. Considering these statistics, addiction is comparatively understudied, and its research and treatment is—perhaps for political reasons—underfunded, especially for non-substance-related manifestations like sexual addiction.
“Wait a minute,” people sometimes say angrily when I make these observations, “don’t give Foley an excuse. The man is a criminal, pure and simple.” To which I generally respond, “Absolutely—so what’s your point?”
More than half of the people I treat for some sort of addiction in my medical practice are motivated to see me—whether of their own volition or through a nudge from the judge—at least in part because they are facing criminal charges. For example, I’ve seen compulsive shoplifters go to jail for stealing items they could easily afford. Other patients get into fights while intoxicated, and some who cause an injury or death while driving drunk still continue drinking afterward. Should these addicted individuals be held accountable for their behavior, even though they have an illness? Of course they should! Acknowledging that someone has an illness does not give that person a free pass to injure or endanger others.
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We place legal restrictions on all sorts of people with bona fide medical conditions. For example, we prohibit people who are blind from driving or operating heavy machinery. But, of course, we still study the causes of vision loss, try to prevent it and treat it as fully as possible. Similarly, studying the mechanisms behind addictive behavior is not inconsistent with holding people responsible for its adverse effects. In fact, in the case of addiction, facing consequences is a crucial part of treatment— often they are the only effective tool in breaking down denial and starting patients on the path to recovery.
As a nation, we have to learn two lessons here. First, we need to be more cognizant of what addiction is. Not only do we have to become better at recognizing the signs, but we also can’t operate under the delusion that if we simply tell addicts to stop what they are doing, they can or will—at least without some serious external motivators and assistance. And second, we ought to devote the research and treatment resources to addiction—including sexual addiction—that the problem deserves. If good things can ever come from bad events, maybe Foley’s failings will motivate all of us for some positive change.
Sincerely,
Gillian Friedman, MD
Managing Health Editor
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