In Israel's Anti-prostitution Drive, Pilot Program Targets Sex Addiction

Treatment has always relied on private funds, but a new legal provision affords more public recognition of a complex issue

Ido Efrati
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A brothel in South Tel Aviv, February 3, 2018.
A brothel in South Tel Aviv, February 3, 2018.Credit: Meged Gozani
Ido Efrati
Ido Efrati

Israel’s Health Ministry has for the first time launched a publicly funded program to treat people addicted to sex, as part of ongoing efforts to implement an anti-prostitution law.

The program, run by the rehabilitation organization Retorno at its treatment center in Jerusalem, opened a few weeks ago with 15 addicts, a number that is slated to go up to 38. Until now, all the country’s sex addiction programs have relied on private funding.

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The new program was established pursuant to a law passed in 2019 that is better known for criminalizing the hiring of prostitutes. Most of the provisions of that law have yet to be implemented.

Retorno has run both residential and outpatient addiction treatment programs for more than two decades. Though it is open to all patients, it is best known in the ultra-Orthodox and religious Zionist communities, and most in the new program come from those communities.

File photo: Anti-prostitution rally in memory of a murdered sex worker, Tel Aviv, August 15, 2018.Credit: Tomer Appelbaum

The addictions Retorno treats include drugs, alcohol, gambling, pornography and sex. “We have a lot of experience in treating sex addiction, and one of the ways it is expressed is using prostitutes,” said Avi Eckstein, director of Retorno’s therapeutic units.

All the men in the pilot applied to be accepted after seeing the program advertised through Sexaholics Anonymous and other support groups, or through a referral by professionals familiar with the program.

Participants will attend two meetings a week for six months, involving both individual and group therapy, and using the 12-step program common in treating other addictions. As is standard in addiction programs, some of the counselors are addicts who have gone “clean” after being treated at Retorno.

“The first goal is to stop the pattern of harmful behavior,” Eckstein says. “But the basis for treating behavioral addictions is the view that ‘it doesn’t matter where you’re running to, but what you’re running away from’.”

“Good treatment manages to move at a relatively early stage from focusing on preventing the addictive behavior to the reasons for its development and what alternatives must be implemented to avoid returning to that behavioral pattern,” he adds. “A half-year treatment can constitute a meaningful base, but the process continues even afterward, through various support and maintenance frameworks.”

The patients range in age from their early twenties to their late thirties. They include bachelors, married men with children and divorced men.

“Addictive use of prostitutes usually comes with other characteristics like compulsive masturbation or voyeurism,” says Adi Abadi-Shapira, who heads Retorno’s community support program, Mifgashim, which is running the new program. “The frequency of using such services isn’t always the measure. When someone suffers from addiction so badly that he seeks help, it’s not always connected to whether he goes once a month or every day, or how much money he spends. Some addicts spend a great deal of money, which is a source of pressure, but some don’t.”

One “clean” addict, working as a counselor in Retorno’s residential sex addiction program who is also in charge of counselors for the new program, says that more than 90 percent of sex addicts were sexually abused as children or inappropriately exposed to sex.

A sex worker's room in south Tel Aviv, September 24, 2017.Credit: Ilan Assayag

“These are people with tremendous emotional intelligence who live with a feeling of terrible sin, and their addiction to prostitution stems from great emotional pain. Addiction is a kind of painkiller. The sex addict is someone who doesn’t know how to deal with the feelings flooding him, and what calms him down are high levels of dopamine in the brain. And sex gives him that.”

Sex addicts aren’t necessarily addicted to the sexual act itself, he adds, citing one patient who told him that “as soon as I know I have an appointment and I’m going to see her this evening or tomorrow morning and it’s going to happen, my seas calm.”

The secrecy surrounding prostitution also plays a part in the addict’s emotions, he says. “The difference between a man who uses prostitutes and an addict is that the addict knows what he’s doing is unacceptable and very harmful, and doesn’t want to do what he’s doing, but simply can’t stop, just like an alcoholic or a compulsive gambler. The harm to those around him and his family is also the same – trust is badly undermined, families fall apart.”

“At the first meetings, you see addicts meeting people in similar situations for the first time,” he continues. “They might suddenly discover that someone who grew up in their neighborhood, went to school with them or did reserve duty with them also has a big secret and does those same terrible things that aren’t talked about. Suddenly it’s possible to talk about it. There’s relief in knowing you’re not alone.”

Police crackdown on solicitation in south Tel Aviv, March 22, 2020.Credit: Tomer Appelbaum

Dozens of men applied to the program, but many were rejected for various reasons. Some weren’t actually addicts, Abadi-Shapira says, but “they used sex workers once or twice and came mainly due to feelings of guilt.” Some didn’t seem ready to commit to the program. Others were referred by Retorno to psychiatrists, since their behavior seemed like it might stem from a psychiatric problem.

Abadi-Shapira said Retorno also plans to open a program for the addicts’ wives soon. “That’s very important in treating addictions,” she explained. “It’s based on the understanding that it’s not enough for the addict to change; family relationships must also change.”

The treatment is meant to give the wives tools for coping with the situation and trying to rehabilitate the relationship. Often, “the woman accepts the lie and prefers not to know,” she says, especially in ultra-Orthodox families. “They don’t know how to deal with the problem of the husband’s addiction. It’s not their fault, and it is a very human response in such a situation.”

But most addicts’ wives ultimately choose “to deal with this together with their spouse and not break up the family,” noted the counselor, who chose to remain anonymous.

He said an important part of the program is teaching the addicts to accept responsibility for their actions and its impact on those around them.

“The first stage in taking responsibility relates to the harm done to those closest to you, your wife or children, and the personal price the addict pays, of neglecting dreams and damaging his career and so forth,” he says. “Understanding and taking responsibility for exploiting women in prostitution comes only later.”

A vigil in memory of victims of the sex trade, Tel Aviv, January 28, 2018.Credit: Meged Gozani

“We have no way to turn a sex addict into an asexual person,” he adds. “Sex will continue to interest him, and it remains a significant part of the sex addict’s life. But through the process of taking responsibility and being given tools to cope, the addict places restraints on himself.”

The reason public funding has never been allocated for treating sex addicts before is that “the problem of sex addiction is less talked about,” according to Dr. Paula Rosca, who heads the Health Ministry’s addiction treatment department. “It involves a lot of stigmas, and many people aren’t quick to admit they’re addicted. Consequently, over the years, there have been fewer solutions for and responses to this addiction. But it’s apparently a widespread problem, and we’re just at the beginning of the road to understanding its scope.”

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