Cruise Control: Understanding Sex Addiction in Gay Men

Really great book that I use in my practice. The copy editing by the publisher keeps me from giving the book 5 stars.
Rating: 4 / 5

Okay, well, first please allow me to explain why I, a woman married to a man, am even interested in this book, much less tossing in my two cents worth here. I do it because it could possibly help someone answer some questions about why they do the things they do. (Because I am wholly unqualified to “review” this book per se, I gave it four stars, which seems to be the average.)

For almost ten years, I’ve volunteered to lead discussion groups in the ADHD community — for parents of children with ADHD as well as adults with ADHD and their partners. I’ve met thousands of people with ADHD and am fully aware that it crosses nationalities, socioeconomic backgrounds, genders, and yes, gender orientation.

So, why is it that I’ve encountered so few gay men in these groups? In the online group that I moderate for partners of adults with ADHD (some 500 members at last count, and international in scope), about 75 percent of the members are women with male partners who have ADHD, 15 percent are men with female partners who have ADHD, and 10 percent are women in same-sex relationships. In seven years, there have been two gay male members. (By the way, I’m in the San Francisco Bay Area, where being gay is regarded as nothing out of the ordinary, so that’s not the issue, I’m pretty sure.) Partly, I think, women, in general, are more drawn to discussion/support groups than men are, in general. Hence the lower number of men in the group, period. That said, I also moderate a local face-to-face group, which is almost entirely men.

At the same time, I have enough close gay male friends to know that sometimes it’s a matter of feeling a world apart from “het” norms when it comes to sexual mores — not wanting to be confined, defined, or judged by them. Fair enough. I’ve never exactly been conventional myself.

Logically, though, there’s no reason that ADHD should manifest any less in gay men than it does in straight men. The best estimates indicate that about 4% (extremely conservative) to 16% (more realistic) of the adult population in the U.S. has ADHD. Yet, I wonder if therapists and psychiatrists who specialize in gay male clientele are aware of this. From conversations with my friends, I wonder if there’s a sort of “gay cultural overlay” that obscures recognition of ADHD, especially when the same patterns that challenge straight men with ADHD appear in gay men. So, I check in with books such as this to see if ADHD is even covered.

Why? What’s the connection between ADHD and compulsive or out-of-control sexual behavior? At its core, ADHD is a disorder of dysregulation, of self-control. With key deficits in impulsivity, hyperactivity (which manifests more covertly than commonly thought), and inattention, ADHD affects one’s ability to “put on the brakes.” It also impairs motivation, initiation, and learning from mistakes. In short, it is not kid’s stuff.

For example, teens with untreated ADHD are, as a population, more sexually precocious than their peers, have more sexual partners and more STDS, and are more likely to have unwanted pregnancies. They are also more likely to develop substance abuse disorders. When you talk about “self-medicating” – which is common with untreated ADHD — you’re talking about everything from sex to alcohol to food to driving recklessly. The more stimulation, the more calm in the brain that seems to be tuning into too many stations at once.

ADHD is considered THE most highly impairing outpatient condition, moreso than depression or anxiety. Yet, it is also considered highly treatable. Trouble is, only a minimum of one in ten of the adults thought to have it have been diagnosed. And only a fraction of those pursue treatment. Still fewer are receiving good treatment, following clinical protocols. That’s why I was alarmed when I read this passage in Cruise Control: “Myth #6: Sex Addiction is a Sign of Some Other Mental Illness”

Who says that is a myth? Where is this author’s research? The author gives only one paragraph, with very short shrift, to the role that both bi-polar disorder and ADHD can play in sexual addiction — and then further minimizes ADHD by saying: “When their emotional state is stabilized with proper therapy and medication, their hypersexual behaviors usually disappear.”

The problem: Most people are misinformed about what ADHD is — and isn’t. Particularly, most have no idea that is it associated with so-called paraphilias. Moreover, it’s not as easily treated as the author suggests, especially when decades of living without benefit of diagnosis has resulted in a ton of poor coping skills, possibly including “self-medicating” with sex and bugging out of a relationship the minute that the novelty has faded.

To be clear: ADHD is a syndrome, and it includes a wide range of behaviors. It is not a “one size fits all” condition. Some men with ADHD find the “reality” of sex much more boring than the “thinking about it” — and tend to be almost assexual, especially if in a long-term relationship. But it must be said that ADHD can definitely create problems in maintaining stable relationships instead of being drawn to the “next shiny object” and stimulating source of sexual stimulation. I hope that’s clear, and sorry I’m going on so long. But I think it’s important.

Granted, I am NOT an expert in sexual addiction, and there are many issues in this book that are out of my ken. I would not presume otherwise. But I am enough of an expert on ADHD to know that this paragraph (from the next page) shows a profound lack of understanding about how much this closely describes how ADHD manifests in problematic sexual behavior:

“A sex addict’s patterns of sexual behavior are characterized by lack of control. While a nonaddicted individual can quickly see how his behavior causes problems or has the potential to do so, the sex addict continues despite the risks. He has likely experienced trouble in his life as a consequence of his sexual activities, and he is just as likely to have downplayed his troubles, even if they have brought him or others physical or emotional harm.

“He appears unable or unwilling to place boundaries around sex even when those limits would keep him and/or others safe from the possibility of physical or legal jeopardy. The amount of sex he has, the physical intensity of the sex act, and the time he spends having sex or in the search for sex often exceed what he intended, though he will often vigorously defend his activities. Unlikely healthy people who self-correct if realize (sic) they have chosen a sexually inappropriate or sexually excessive behavior, the sex addict will often return to that same behavior or worse.”

My point is: If you try the strategies in this book and they don’t work for you — or work only for a while — and if you think you might possibly have ADHD, it’s well worth getting it checked out by a competent clinician. Not always easy to find, mind you, so get educated first before you even begin to look for one.

Well, I hope this is useful to someone.
Rating: 4 / 5