by Dana Dovey, Marie Solis, Maia Szalavitz and Chris Lee

This week Kevin Spacey reportedly checked into a sex addiction rehabilitation program in Arizona following a series of accusations that he sexually harassed several men and at least one minor. The facility costs about $36,000 a month. But the expense may be in vain: experts emphasize that sex addiction is not a mental illness.

Spacey is the most recent celebrity to have checked into rehab following reports of sexual misconduct. According to The Daily Mail, the facility, called The Meadows, is the same place where Harvey Weinstein was also treated for his sexual issues. The center is reputed for having the best sex addiction treatment program in the US. But can you treat something that doesn’t exists?

Sex addiction has been turned down for classification as a mental health condition by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official classification of mental health disorders in the US, on several occasions. In addition, the American Association of Sexual Education Counselors and Therapists also released a statement on sex addiction, stating that although they understand people may experience health consequences based on their sexual urges, thoughts, and behavior, consensual sexual behaviors, whether this be “sex addiction” or “porn addiction” should not be classified as mental health conditions.

The patterns of harassment revealed by the New York Times, the New Yorker and elsewhere does not follow that seen with diseases of like drug abuse. “It’s clear at this point that it [sex addiction] does not look like an addiction,” Nicole Prause, a psychologist who studies human sexual behavior and founder of The Liberos Center, an independent research institute explained. Prause sees the roots as lying elsewhere. “This does not mean it is not a pathology but I think that it is most likely related to having a high sex drive in combination with having a lot of social shame,” she says. For example, according to Prause, the best predictor of being called a sex addict is either having a conservative religious background or getting caught cheating. Although Prause cannot speak on Spacey and his personal problem and rehabilitation program, from her experiences she does not think that sex rehab can really do much to address the problem as many of their treatments are not backed by science and randomized clinical trials. “Treatment centers use cognitive behavioral therapies, but don’t allow scientists to test them,” said Prause. “I don’t understand if you think your treatments work then why don’t you allow someone to document them?” This refudiation is not saying that individuals experiencing problems controlling their sex drives and sexual impulsions don’t need help. But the problem is not a diagnosable addiction that enables perpetrators to say they are afflicted with a condition rather than admitting to extreme wrongdoing.

Related, thirty women (so far) have accused the movie mogul Harvey Weinstein of sexual harassment, assault or rape, providing a disturbing portrait of predatory behavior spanning his decades-long career. Technically, that is not a sex addiction, by any definition of the word, because these incidents are not episodic or “a binge” so much as a continual, repeated, serialized form of behavior consistent with personality. If even part of the allegations are true, Weinstein isn’t a sex addict, but “an asshole rapist,” according to Woodbury University Psychology Chair Dr. Joye Swan. Weinstein doesn’t love sex—he loves power and intimidation, says Swan: He’s just another man who craves using his “extraordinary power” to hurt women. “This is another man falling on a nonexistent sword,” Swan says of Weinstein. “He’s using it to excuse predatory behavior.”

Over the last several years, scientists have become increasingly united in their stance that sex addiction is not a medical condition. In 2013 Nicole Prause, an assistant research scientist at the Semel Institute for Neuroscience and Human Behavior at UCLA, found the brains of supposed sex addicts do not respond to sexual stimuli the way an addict’s would. And again, just last year, American Association of Sexuality Educators, Counselors, and Therapists, considered to be the “leading national body of sex experts,” published a statement rejecting any classification of sex addiction as a mental health disorder, citing a lack of “sufficient empirical evidence.” Still, there is an entire field of sex therapists and counselors who believe that people can become addicted to sex just as they would any drug or substance. “Like alcoholism, the ‘sex addiction’ diagnosis is based on whether that individual’s behavior repeatedly creates profound problems in their day-to-day life functioning,” certified sex addiction therapist Robert Weiss told CNN in December.

Scientists who have debunked sex addiction as a medical condition, however, would say that supposed sex addicts are people who have sexual urges or participate in consensual sexual behaviors they feel are beyond their control. It can be debilitating, but, medically speaking, it’s no addiction. Doug Braun-Harvey, co-founder of sexual health organization the Harvey Institute, told Newsweek he finds it particularly disturbing that Weinstein is using the specter of sex addiction to shield himself from allegations of rape. “I disagree with the sex addiction field, in which they lump nonconsensual and exploitive behaviors together with someone who compulsively masturbates, has multiple relationships or purchases sex,” Braun-Harvey says. “That’s why this is so controversial.”

Science has little to say about why people commit sexual assault. But it’s widely considered to be about having power and control over victims—something Weinstein, a Hollywood giant, had in spades. Weinstein is far from the first powerful man to claim sex addiction amid allegations of nonconsensual sexual behavior. When former Congressman Anthony Weiner pleaded guilty to sending sexually explicit text messages to a minor in 2016, he told the judge, “I have a sickness, but I do not have an excuse.” Braun-Harvey says he understands why men like Weiner and Weinstein would want to pathologize a behavior society finds morally reprehensible. “When a behavior that conjures up great disgust and disdain can move into the purview of a disease, then people have more empathy for the person who behaves that way,” he explains. “It tends to provoke more understanding.”

Weinstein is unlikely to get any sympathy from the public, which has largely stood in solidarity with his alleged victims. But he might get some from the staff at The Meadows, the treatment center he’ll reportedly attend, where he’ll “deal both with sex and other behavioral issues,” according to TMZ. Swan, however, says Weinstein won’t get what he really needs from a facility founded on a made-up addiction.

“He needs to accept responsibility,” Swan says. “If he can say, ‘It’s me. I did it,’ then it’s under his volitional control to change it or not. Without accepting responsibility…he may refrain from his behavior, but it won’t change his mind-set.”

Much of the stigma associated with the addiction model comes from the way the concept is so often used as an excuse for all types of bad behavior—and the way rehab is viewed as a site to begin restitution and penitence. This is not helped by the fact that the majority of American rehabs are based on the 12 step model, in which participants are encouraged to surrender to a “higher power,” take “moral inventory,” ask God to remove their “defects of character” and make amends to those they have harmed. The fact that so many rehabs have historically used degrading and punitive tactics that assume participants are self-centered manipulative liars also plays into the idea that addiction is really sin. But addiction does not actually cause zombie-like behavior, in which otherwise-normal people become capable of doing anything—no matter how harmful to others—in pursuit of their compulsion. A large body of data shows that not only do most people with addiction have a degree of control over their behavior but also that it is not necessary to be a bad person to be addicted.

Meanwhile, most people with addiction who commit crimes do so to be able to afford their addictions—and in the case of heroin addiction, most started committing other crimes before they became addicted; addiction just made the behavior worse. But for people who can afford as many drugs as they want, addiction doesn’t turn say, wealthy businesspeople into shoplifters or muggers. Criminality does not just emerge, in a vacuum, from drug use.

Similarly, even though alcohol hooks about the same proportion of users as heroin or cocaine, we see rather little crime committed to get money to obtain booze. The fact that it is legal means even alcoholism is generally affordable for most people. And the idea that addiction turns people into compulsive liars is also not supported: people with addiction report their experiences honestly as often as anyone else when they can be anonymous or don’t fear being punished for it.

As for the violent crime typically—but not always—associated with illegal drug use: Studies find that the vast majority of it is associated with illegal drug markets, which do not have recourse to the courts or regulators to settle disputes. In other words, much of this crime is committed by dealers and linked to the illegality of drugs, not their pharmacology or effects on people with addiction. And those people with addiction who do become involved with violent crime tend to have been exposed to violent experiences early in life such as child abuse. Basically, addiction as we know it exacerbates and disinhibits underlying problems, rather than turning ordinary people into monsters. Given that sex addiction is often modeled on drug addiction—or even on other types of compulsions that similarly impair choice—it would be astonishing if it led to greater loss of control than, say, heroin or cocaine. Sure, a sex addiction could make you more likely you to overspend on prostitutes or strip clubs or exclusive types of porn. It might isolate you from your family, destroy your relationships and maybe even ruin your finances. But it’s not going to make you start harassing—let alone raping or otherwise sexually assaulting—others.

If America is serious about helping people with any kind of addiction—and about de-stigmatizing these disorders—the (deeply warranted) conversation about sexual assault and other abuses has to be divorced from the one about addiction and rehab. If someone has a genuine addiction and also engages in terrible behavior, that addiction may need to be treated in order for the other behavior to be controlled. But that doesn’t mean addiction caused or excused the other problem—and it doesn’t mean rehab cleanses your sins or should become some kind of site for remorse and penitence.

Josh Grubbs, assistant professor of psychology at Bowling Green State University in Ohio, has focused his research on the intersections between sexuality, morality and religion. His research has shown, for example, that a man’s belief that use of pornography is immoral and his level of associated religiosity is more highly linked with whether he believes he is addicted to porn than his actual level of porn consumption. Grubbs is more sympathetic to labeling compulsive sexual behavior an addiction than Prause. “For some people, sexual behavior can become so out of control that for all intents and purposes, it looks and functions like an addiction, just like gambling,” he told me. He added that Prause’s work is fascinating, but thinks more data is needed to definitively prove that sexual compulsion does not fit the addiction model. Nonetheless, regardless of whether you call it sex compulsion or addiction, both Grubbs and Prause agree that it is simply not material to allegations of serial harassment or assault.

The behaviors, when experienced by women (or those who do not possess the wealth and affluence of Hollywood and Washington), are often spoken of in a different light, however, because of the prevailing cultural narrative of female innocence. For example, Stephen Crane’s 1893 novella, Maggie: A Girl of the Streets, depicts women as angels and paradigms of virtue. Maggie is considered one of the first pieces of American Literature and seminal in the construction of American cultural narratives. Maggie, as a paradigm for all American women, prefers love and romance to sexual expression of affection. When women step outside of this narrative, they – like Maggie – are often portrayed as victims of circumstance who only need to be redeemed before it is too late. Underneath this narrative is a great deal of religiosity and subtext about the “better” nature of humanity, and especially women as the angelic exemplar of the home.

Valerie realized that sex was wrecking her life right around the time her second marriage disintegrated. At 30, and employed as a human-resources administrator in Phoenix, she had serially cheated on both her husbands—often with their subordinates and co-workers—logging anonymous hookups in fast-food-restaurant bathrooms, affairs with married men, and one-night stands too numerous to count. But Valerie couldn’t stop. Not even after one man’s wife aimed a shotgun at her head while catching them in flagrante delicto. Valerie called phone-sex chat lines and pored over online pornography, masturbating so compulsively that it wasn’t uncommon for her to choose her vibrator over going to work. She craved public exhibitionism, too, particularly at strip clubs, and even accepted money in exchange for sex—not out of financial necessity but for the illicit rush such acts gave her.

For Valerie, sex was a form of self-medication: to obliterate the anxiety, despair, and crippling fear of emotional intimacy that had haunted her since being abandoned as a child. “In order to soothe the loneliness and the fear of being unwanted, I was looking for love in all the wrong places,” she recalls.

After a decade of carrying on this way, Valerie hit rock bottom. Facing her second divorce as well as the end of an affair, she grew despondent and attempted to take her life by overdosing on prescription medication. Awakening in the ICU, she at last understood what she had become: a sex addict. “Through sexually acting out, I lost two marriages and a job. I ended up homeless and on food stamps,” says Valerie, who, like most sex addicts interviewed for this story, declined to provide her real name. “I was totally out of control.”

“Sex addiction” remains a controversial designation—often dismissed as a myth or providing talk-show punchlines thanks to high-profile lotharios such as Dominique Strauss-Kahn and Tiger Woods. But compulsive sexual behavior, also called hypersexual disorder, can systematically destroy a person’s life much as addictions to alcohol or drugs can. And it’s affecting an increasing number of Americans, say psychiatrists and addiction experts. “It’s a national epidemic,” says Steven Luff, coauthor of Pure Eyes: A Man’s Guide to Sexual Integrity and leader of the X3LA sexual-addiction recovery groups in Hollywood.

Reliable figures for the number of diagnosed sex addicts are difficult to come by, but the Society for the Advancement of Sexual Health, an education and sex-addiction treatment organization, estimates that between 3 and 5 percent of the U.S. population—or more than 9 million people—could meet the criteria for addiction. Some 1,500 sex therapists treating compulsive behavior are practicing today, up from fewer than 100 a decade ago, say several researchers and clinicians, while dozens of rehabilitation centers now advertise treatment programs, up from just five or six in the same period. The demographics are changing, too. “Where it used to be 40- to 50-year-old men seeking treatment, now there are more females, adolescents, and senior citizens,” says Tami VerHelst, vice president of the International Institute for Trauma and Addiction Professionals. “Grandfathers getting caught with porn on their computers by grandkids, and grandkids sexting at 12.”

In fact, some of the growth has been fueled by the digital revolution, which has revved up America’s carnal metab­olism. Where previous generations had to risk public embarrassment at dirty bookstores and X-rated movie theaters, the Web has made pornography accessible, free, and anonymous. An estimated 40 million people a day in the U.S. log on to some 4.2 million pornographic websites, according to the Internet Filter Software Review. And though watching porn isn’t the same as seeking out real live sex, experts say the former can be a kind of gateway drug to the latter.

“Not everyone who looks at a nude image is going to become a sex addict. But the constant exposure is going to trigger people who are susceptible,” says Dr. David Sack, chief executive of Los Angeles’s Promises Treatment Centers.

New high-tech tools are also making it easier to meet strangers for a quick romp. Smartphone apps like Grindr use GPS technology to facilitate instantaneous, no-strings gay hookups in 192 countries. The website AshleyMadison.com promises “affairs guaranteed” by connecting people looking for sex outside their marriages; the site says it has 12.2 million members.

This year the epidemic has spread to movies and TV. In November the Logo television network began airing Bad Sex, a reality series following a group of men and women with severe sexual issues, most notably addiction. And on Dec. 2, the acclaimed psychosexual drama Shame arrives in ­theaters. The movie follows Brandon (portrayed by Irish actor Michael Fassbender in a career-defining performance), a New Yorker with a libido the size of the Empire State Building. His life devolves into a blur of carnal encounters, imperiling both his job and his self-regard. In perhaps the least sexy sex scene in the history of moviedom, Brandon appears to lose all humanity during a frenzied ménage à trois with two prostitutes. “It’s a foursome with the audience,” says director and co-writer Steve McQueen. “What we were doing was actually dangerous. Not just in terms of people liking the movie, but psychologically.”

However powerful and queasy Shame’s odyssey into full-frontal debasement may be, the film only begins to tap into the dark realities connected with sex addiction. Take it from Tony, a 36-year-old from the affluent Westside of Los Angeles, who found his life thrown into turmoil by compulsive sexual behavior. “I was crippled by it,” he says. “I would go into trancelike states, lose track of what I was doing socially, professionally, spiritually. I couldn’t stop.”

He was ashamed of his tireless efforts to find women. “I was meeting girls on the basketball court, in the club, pulling my car over to meet them on the street,” Tony recalls. It took joining a Sex and Love Addicts Anonymous 12-step program for him to realize that he wasn’t alone.

He also learned that his fixation on sex was a way of avoiding his insecurities and tackling the emotional issues that first led to his addictive behavior. “The addiction will take you to a place where you’re walking the streets at night, so keyed up, thinking, ‘Maybe I’ll just see if there’s anybody out there,’” he says. “Like looking for prey, kind of. You’re totally jacked up, adrenalized. One hundred percent focused on this one purpose. But my self-esteem was shot.”

Most treatment programs are modeled on Alcoholics Anonymous, but rather than pushing cold-turkey abstinence, they advocate something called “sexual sobriety.” This can take different forms, but typically involves eradicating “unwanted sexual behavior,” whether that’s obsessive masturbation or sex with hookers. “We treat it very much like sobriety for an eating disorder,” says Robert Weiss, founder of the Sexual Recovery Institute in Los Angeles. “They have to define for themselves based on their own goals and belief systems: ‘What is healthy eating for me? Can I go to a buffet? Can I eat by myself?’ We look at your goals and figure in your sexual behaviors and validate what’s going to lead you back to the behavior you don’t want to do.”

Although sex addicts sometimes describe behavior akin to obsessive-compulsive disorder, research hasn’t directly correlated the two. But a growing body of research shows how hypersexual disorder can fit into other forms of addiction. At the Promises treatment centers, clinicians have observed a number of sex addicts who have relapsed with drugs or alcohol in order to medicate the shame they felt. Severe depression can also follow after an addict starts to confront the condition. “I realized I was not comfortable in my own skin,” says Valerie, who checked herself into four months of treatment for sex addiction at Del Amo, a private behavioral-health hospital in Torrance, Calif. “My depression came from the fear I was going to be alone for the rest of my life. Fighting the obsession and rumination, the fear of loneliness and abandonment.”

Sex addicts are compelled by the same heightened emotional arousal that can drive alcoholics or drug addicts to act so recklessly, say addiction experts. Research shows that substance abusers and sex addicts alike form a dependency on the brain’s pleasure-center neurotransmitter, dopamine. “It’s all about chasing that emotional high: losing yourself in image after image, prostitute after prostitute, affair after affair,” says the Sexual Recovery Institute’s Weiss. “They end up losing relationships, getting diseases, and losing jobs.”

Here’s what the experts will tell you that sex addiction is most decidedly not: a convenient excuse for sexual indiscretions and marital truancy. Chris Donaghue, a sex therapist who hosts the show Bad Sex, says Tiger Woods, for example, does not qualify as a sex addict, despite his well-documented sexcapades and treatment at a Mississippi rehabilitation center specializing in sex addiction. “Because he didn’t honor his integrity and marital boundary does not make him an addict,” Donaghue says, adding that people will say, “ ‘Because I get in trouble, because I cheat, I’ll just blame it on sex addiction. That’s my get-out-of-jail-free card.’ ”

Contrast Woods’s wild-oats sowing against the experiences of Harper, an Atlanta-born television executive who found himself caught in the grips of sex addiction for four years. After joining an online dating service, Harper fell into a pattern of juggling multiple relationships, sexting incessantly and focusing almost singlemindedly on hooking up. He discovered he could usually get his partners into bed on the first date—sometimes within the first hour of meeting. “And these weren’t desperate women,” he says.

But the fleeting ego gratification Harper derived from his conquests came at a steep price. He describes himself as living in a “stupor.” Friendships suffered, and he felt “pathetic” about his sexual urgency. The worst part, he says, was that his sex drive ultimately changed “what I think is normal,” as his tolerance grew for increasingly hard-core forms of pornography. “It really is like that monster you can’t ever fulfill,” says Harper, 30, who has avoided dating for the past eight months and attends a recovery group. “Both with the porn and the sex, something will be good for a while and then you have to move on to other stuff. The worst thing is, toward the end, I was looking at pretend incest porn. And I was like, ‘Why is something like that turning me on?!’ ”

The potential for abuse of online porn is well documented, with research showing that chronic masturbators who engage with online porn for up to 20 hours a day can suffer a “hangover” as a result of the dopamine drop-off. But there are other collateral costs. “What you look at online is going to take you offline,” says Craig Gross, a.k.a. the “Porn Pastor,” who heads XXXChurch.com, a Christian website that warns against the perils of online pornography. “You’re going to do so many things you never thought you’d do.”

Exhibit A: “We see a lot of heterosexual men who are addicted to sex and, because culturally and biologically women aren’t as readily available to have sex at all times of the day, these men will turn to gay men for gratifi­cation,” says sex therapist Donaghue. “Imagine what that does to their psychology. ‘Now am I gay? What do I tell my wife?’ ”

That wasn’t the issue for Max Dubinsky, an Ohio native and writer who went through a torturous 14-month period of online-pornography dependence. He says a big problem with his addiction was actually what it prevented him from doing. “I couldn’t hold down a healthy relationship. I couldn’t be aroused without pornography, and I was expecting way too much from the women in my life,” recalls Dubinsky, 25, who sought treatment at the X3LA recovery group and is now married.

If discussion of sex addiction can seem like an exclusive domain of men, that’s because, according to sex therapists, the overwhelming majority of self-identifying addicts—about 90 percent—are male. Women are more often categorized as “love addicts,” with a compulsive tendency to fall into dependent relationships and form unrealistic bonds with partners. That’s partly because women are more apt than men to be stigmatized by association with sex addiction, says Anna Valenti-Anderson, a sex-addiction therapist in Phoenix. “We live in a society where there’s still a lot more internalized shame for women and there’s a lot more for them to lose,” Valenti-Anderson says. “People will say, ‘She’s a bad mom’ for doing these sexual things. As opposed to, ‘She’s sick and has a disorder.’ But very slowly, women are starting to be more willing to come into treatment.”

Addicts and therapists alike say they hope a greater awareness of the disease will eventually help addicts of all genders and ages come forward and seek treatment. Many are likely to find that “sex addiction isn’t really about sex,” as Weiss puts it; it’s about “being wanted.”

X3LA’s Steven Luff says, “Sex is the perfect match for that. ‘I matter right now. In this moment, I am loved.’ In that sense, an entire culture, an entire nation is looking for meaning.”