Various 12-step programs are available to sexual addicts, but it is vital to recognize the fundamental differences between such groups as Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Sexual Compulsives Anonymous, and Sexaholics Anonymous.

Sex Addicts Anonymous (SAA) is most liberal in letting clients define their own sexual boundaries. SAA welcomes everybody: men, women, gay, straight, bisexual, and others. They tend to focus on paraphilias, in which arousal and gratification depend on fantasizing about--and engaging in--sexual behavior that is atypical and extreme.

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Paraphiliacs fixate on a particular act, like inflicting or receiving pain and/or humiliation, or on fetishes like shoes, feet, and underwear. Enjoying a fetish is not the problem. Compulsivity and a preference for fetishism over a full sexual relationship with another human being are problematic, however, and SAA may be helpful in such cases.

Sex and Love Addicts Anonymous (SLAA) focuses on love addiction, an insatiable craving for the "in love with love," PEA-infatuation high. Love addicts seek the lightning-bolt, blown-away, "love at first sight" kick. Again, men and women, gay, straight, and bisexual people are all welcome. Unlike SAA meetings, where the majority of participants are men, SLAA meetings attract more women who, in our society, tend to focus on the relational, loving side of their relationships.

The SLAA program is especially useful for men and women who tend to move from one honeymoon to another. As soon as troubles arise in a relationship, they move on, hoping that a new relationship will provide what the last one failed to deliver.

Sexaholics Anonymous (SA) offers a rigid, orthodox, cookie-cutter approach that requires participants to believe that no sexual relations should occur outside heterosexual marriage. Leaders tell participants what their recovery and sobriety should look like: "Any form of sex with one's self or with partners other than the spouse is progressively addictive and destructive." Not surprisingly, many gay clients feel excluded and alienated by this particular group.

Sexual Compulsives Anonymous (SCA) split from Sexaholics Anonymous (SA) because some gay men felt uncomfortable with SA's fundamentalist, overtones. Members of SCA design their recovery program along the lines of SAA. In these groups, gay men can discuss their special needs and talk openly and honestly. Lesbians and heterosexuals are welcome, but most members are gay males.

Sexual addiction frequently prevents its sufferers from forming deep relationships. That is why it is so important to have another person to relate to on a nonsexual level. Time and again, studies show that for best results, the sexual addict should engage in individual, group, and 12-step programs simultaneously. In the company of others, he or she is forced to develop intimacy and relationship skills.

Given that sexual addiction is an intimacy disorder, it makes sense that the best, most healing "therapy" of all is an adult love relationship that demands a level of emotional commitment that casual hook-ups can never duplicate.

In recent years there has been a push for glbtq-sensitive counselor training and glbtq-affirmative counseling, which, although occurring slowly and encountering resistance, marks a significant move in a positive direction.

Glbtq family therapy is a relatively new field that merges gay-affirmative therapy with family systems theory; its goal is to help glbtq people create and maintain healthy families.

Psychotherapy, the clinical process of treating mental and emotional health problems, has recently been energized by a movement to depathologize homosexuality and to enhance the dignity and self-respect of glbtq clients.

Reparative therapy is a dangerously misguided attempt, supported by homophobic religious organizations, to change a person's sexual orientation from homosexual to heterosexual.

Straight men who have sex with men do so for a number of reasons, but in general such activity is about physical release and sexual behaviors, not about attraction or desire for another man.