Sexual Addiction Assessment

Abstract

The Sexual Addiction Assessment, commonly known by its instrument name, the Sexual Addiction Screening Test (SAST), is a widely used screening test developed by Dr. Patrick Carnes in 1994. This brief, self-administered questionnaire is designed to help individuals identify behaviors and thought patterns consistent with sexual addiction or compulsive sexual behavior. The SAST is foundational to the Carnes Model of addiction, which conceptualizes problematic sexual behavior using an addiction framework, focusing on loss of control, continuation despite negative consequences, and preoccupation.

The instrument is primarily used in clinical settings and self-help contexts to determine if further, more comprehensive psychological assessment is necessary. It covers key dimensions of behavioral addiction, including difficulties in resisting impulses, efforts to control the behavior, and the negative emotional, legal, and familial consequences stemming from sexual activities.

Keywords

Sexual addiction, SAST, Patrick Carnes, compulsive sexual behavior, screening test, psychological assessment, hypersexuality, love addiction, sexual anorexia.

Authors

Carnes, P.

Purpose

The primary purpose of the SAST is to serve as a rapid, self-report screening test for individuals who suspect they may be struggling with compulsive sexual behavior or sexual addiction. It is intended to raise awareness and provide a preliminary indication of whether professional psychological assessment is warranted. The instrument is designed to be accessible and confidential, prompting users to consider the extent to which their sexual thoughts and behaviors negatively impact their lives, relationships, and emotional well-being.

It is explicitly a screening tool, not a diagnostic instrument, helping clinicians quickly triage individuals who may benefit from specialized treatment focused on behavioral control and relapse prevention regarding sexual activity.

Construct

The SAST measures the construct of sexual addiction, which is defined within the Carnes Model as a progressive pattern characterized by escalating sexual behaviors that lead to negative consequences, yet the behavior continues despite the harm. The core components of the construct assessed include:

• Loss of Control: Difficulty resisting impulses and attempts to stop or reduce the behavior.
• Preoccupation and Obsession: Spending excessive time thinking about or engaging in sexual activities.
• Negative Consequences: Experiencing problems in family, legal, or emotional domains due to the behavior.
• Withdrawal/Tolerance: Feeling anxious or irritable when unable to engage in the behavior.

This construct aligns conceptually with criteria used for substance dependence, translating concepts like compulsion and tolerance into the realm of sexual behavior, differentiating problematic behavior from normative, healthy sexual expression.

Validity

While the SAST is widely utilized clinically, detailed, independent academic studies confirming its robust psychometric validity are often debated. It exhibits strong face validity, as the items clearly reflect the common symptoms described by individuals seeking treatment for problematic sexual behavior. Early validation efforts conducted by Carnes and colleagues suggested adequate criterion validity, demonstrating that scores differentiate between clinical populations seeking treatment for sexual addiction and non-clinical control groups.

However, critics note that the lack of inclusion of sexual addiction as a formal diagnosis in the DSM-5 (where it is addressed under Compulsive Sexual Behavior Disorder in Section III) complicates the establishment of definitive concurrent validity against a standardized diagnostic criterion. Subsequent instruments, such as the SAST-R (Revised), aimed to improve the internal consistency and reliability of the original 10-item scale by broadening the scope of inquiry.

Reliability

As a brief screening test, the original SAST was designed for quick application rather than exhaustive psychometric rigor. Studies examining the internal consistency (a measure of reliability) of the 10-item measure often yield acceptable, though sometimes modest, Cronbach’s alpha coefficients, suitable for a preliminary screening tool. Test-retest reliability—the consistency of results over time—is generally considered adequate, suggesting the scale captures stable patterns of compulsive behavior rather than transient mood states.

Factor Analysis

The original 10-item SAST is typically treated as a unidimensional measure, designed to capture the overall severity or presence of behaviors associated with sexual addiction. The scoring methodology reinforces this, relying on the summation of “Yes” responses to indicate a single, escalating level of risk. Due to its brevity, detailed exploratory factor analysis on the original version is limited.

Later, expanded versions, such as the SAST-R, utilized factor analysis to explore potential sub-dimensions of the construct, such as loss of control, preoccupation, and consequences. These subsequent analyses helped refine the scale structure, but the brief version presented here primarily operates under the assumption of a single underlying factor of sexual compulsivity.

Instrument

Test Type: Self-report screening questionnaire (Non-diagnostic)

Format: 10 binary (Yes/No) items

Language Available: Primarily English (Translations exist for clinical use)

Population Group: Individuals concerned about their sexual behaviors

Age Group: Adults (typically 18+)

Population Details: Originally normed on populations seeking specialized treatment for problematic sexual behavior.

Test Methodology: The score is the total number of “Yes” responses. A higher score indicates a greater likelihood of sexual addiction symptoms, prompting recommendation for further clinical assessment.

Keywords

SAST, Patrick Carnes, sexual addiction, compulsive sexual behavior, assessment tool, screening, psychometrics, behavioral addiction.

Authors

Author ORCID Identifier: Information not provided in source.

Affiliation Email addresses: Information not provided in source. Dr. Carnes is associated with the International Institute for Trauma and Addiction Professionals (IITAP).

Correspondence Address: Information not provided in source.

Permissions & Fee and Test Year

The original Sexual Addiction Screening Test (SAST) was developed and first published in 1994. For clinical and research use, permissions are typically managed by institutions associated with Dr. Patrick Carnes and the Carnes Model. While the 10-item version is frequently made available online for free self-assessment, formal clinical administration often requires licensing or purchase of manuals. The instrument was notably cited in R.R. Perkinson’s 2004 work, Treating alcoholism: Helping your clients find the road to recovery, highlighting its integration into broader addiction treatment frameworks.

Reference’s

Perkinson, R.R. (2004). Treating alcoholism: Helping your clients find the road to recovery. Hoboken, NJ: Wiley. Page(s): 281-282.

The instrument is publicly accessible for screening purposes at the following resource: http://www.pinegrovetreatment.com/sex-addiction-quiz.html.

Items of the Sexual Addiction Assessment

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Have you experienced difficulty resisting impulses to engage in sexual behaviors?
2. Have you tried to stop‚ control‚ or reduce these behaviors?
3. Have you thought of killing yourself because of your sexual behaviors?
4. Have you experienced legal consequences due to your sexual behaviors?
5. Do you spend large amounts of time trying to get sex or recover from being sexual?
6. Do you ever feel anxious or irritable if you are unable to engage in sexual behaviors?
7. Do you worry that others will find out about your sexual activities?
8. Do you often find yourself preoccupied with sexual thoughts?
9. Do you feel that your sexual behavior is not normal?
10. Are you experiencing family problems as a result of your behaviors?