Sanctuary for the Abused
Sunday, October 08, 2006
Is Pornography Addiction Real?
A client once asked me if it was possible to become addicted to pornography. The answer to this question should be considered in the context of how the word addiction is defined. The word addiction is often associated with the concept of powerlessness, illness or disease. Some of these models portray an individual as helpless or having very little control over their behavior. Many psychologists & therapists reject this model because it undermines the foundation for counseling which usually assumes people can control their behavior & have the ability to change their actions. Another risk with the concept of addiction is the possibility the client may misunderstand this label & use irrational thinking to justify engaging in the behavior we are trying to arrest. For example, a client may think, "I can't help myself because I'm an addict." Thus, we may inadvertently reinforce the behavior through such categorizations. Furthermore, the DSM-IV (Diagnostic & Statistical Manual of Mental Disorders), used by mental health professionals to diagnose clients, does not contain an entry for "pornography addiction."
Many outside the mental health profession also remain skeptical about connotations associated with addiction. In the wake of some dramatic accounts about addiction, a Newsweek headline sarcastically mocked, "Breathing Is also Addictive."
A non-clinical definition of the word addiction reads, "devotion: a great interest in something to which a lot of time is devoted." Another suggests being addicted is "to devote or surrender (oneself) to something habitually or obsessively." Both these definitions suggest that addiction is a choice & if someone is habitual about their use of pornography to the point where it is having adverse affects in other areas of their life then they must also choose at some point to get help in abandoning their behavior. If someone has become heavily involved in using pornography they will most likely have a difficult time abandoning the behavior without some outside support or intervention. They must however, choose to receive this help if the interventions are to be successful.
Although the debate about pornography addiction continues, the mental health profession is faced with determining how to diagnose & treat people whose lives are being adversely affected by their use of pornography.
One argument suggests that problematic behavior associated with pornography consumption should be categorized as an obsessive compulsive disorder (OCD). There are, however, some distinctions between the two. The difference between OCD & an addiction is defined by Dr. Shaffer who notes:
"The loss of insight among addicts & the maintenance of discrimination among OCD sufferers distinguishes these populations. While the excessive behavior patterns of OCD are disconnected from the dysphoric affect that energizes their activity, addictive behavior remains attached to these noxious emotions. Consequently, addicts escape their discomfort by acting out through excess behavior patterns, while OCD patients avoid the conscious experience of psychic pain through repetitive intemperate activity."Dr. Jennifer Schneider argues an alternative view that symptoms related to habitual use of pornography align more closely to the diagnostic criteria for substance dependence disorders. An examination of the similarities presents some interesting findings. Keep in mind that references to substance in these criteria generally refers to drugs or alcohol. Furthermore, only three of the seven criteria need be met in order for someone to be clinically diagnosed with a substance dependence disorder (an addiction). The following items are taken from the DSM-IV with some additional comments indicating how someone involved in pornography resembles the criteria.
Criteria for tolerance can include "increased amounts of the substance to achieve intoxication or desired effect." Dr. Victor Cline, a clinical psychologist who has specialized in treating clients with pornography issues, reports that the majority of clients over time generally move from soft-core pornography to more kinky, bizarre, or hard-core types of material. This type of escalation in behavior is not uncommon. I recently spoke with a client who is a freshman in college. He came to my office after he was arrested for possession of child pornography he obtained through the Internet. When I inquired about his process of escalation, he indicated at the beginning of the school year his interest was adult females. He never would have imagined that this behavior would later lead to involvement with child pornography. I asked him what changed & he reported, "The things I was looking at just got boring & I needed something more to sexually gratify myself."
The "substance is often taken in larger amounts or over a longer period than was intended." It is not uncommon to have clients report spending more time than intended on the computer in pursuit of pornography & viewing more images than they initially intended to look at. Many clients report they were curious or just experimenting but this behavior eventually led to exorbitant amounts of time being consumed by their "curiosity."
"There is a persistent desire or unsuccessful efforts to cut down or control substance use." Most individuals end up in our office because their own efforts to stop using pornography have failed. Others convince themselves that they can stop whenever they choose, but discover they are unable to successfully control their use of pornography through their own efforts.
"A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects." The emphasis again is on the amount of time being spent to obtain, use, or recover from use. Sometimes clients report a greater thrill from the pursuit to find the perfect image or picture than they derive from the behaviors associated with the image once it is discovered. They get a rush from the challenge. Time is also a factor because many clients report spending a great deal more time than they anticipated online or being preoccupied with acting out. Recovery from habitual use of pornography can take months & even years in some cases.
"Important social, occupational, or recreational activities are given up or reduced because of the substance use." Obviously if someone is spending time in pursuit of pornography there is a trade-off that takes time away from other areas of their life. This isolation actually fuels the behavior & creates an environment where the activity can continue to exist. Thus, one goal in treating clients is to have them create a structured environment that is free from isolation.
"The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance."An example of this criteria may be continued use of pornography despite the negative impact on an individual such as contributing to depression, sleeplessness, etc.
One of the obvious arguments against classifying compulsive use of pornography in the same category as substance-related disorders is the lack of evidence indicating someone can become "physically" dependent on pornography in the same way someone becomes physically dependent on drugs or alcohol. Dr. Patrick Carnes addresses this issue by suggesting a habitual consumer of pornography who uses the material to derive sexual pleasure can develop a pathological relationship with the mood-altering experience & thus the individual is physically dependent. It is also interesting to note that an extension of this concept has led several mental health professionals to work with scientists in research to explore the reactions in the neurochemistry of the brain while someone is using pornography. If the reactions are proved to be adverse, pornography could be labeled as harmful to the body under the medical model.
Another possible explanation for some type of physical dependency on pornography may be examined when an individual engages in self-stimulation while using sexual imagery. The satiation from this practice creates an association linking the pornography to the temporary euphoric feelings caused by the chemicals released during sexual climax. Thus a person becomes dependent upon the entire experience in order to obtain the "high" they desire. Similarly, a cocaine addict isn't addicted to cocaine as much as he is addicted to the dopamine released by the brain when he uses cocaine. As a result, individuals may use pornography as a trigger for fantasies that perpetuate a chain of events ultimately enabling them to obtain their euphoric feeling. This result may be why many producers of adult content encourage self-stimulation so the consumer will engage in a behavior that will powerfully reinforce the continued use of pornography as a trigger for the subsequent mood-altering experience.
Dr. Milkman & Dr. Sunderwirth, in their book Craving for Ecstasy, discuss neurobiochemical responses in the brain during the pursuit of self-gratification. They discuss arousal, satiation, and fantasy. Arousal is often associated with the neurotransmitters norepinephrine & dopamine, satiation with gamma-aminobutyric acid & endorphins, and fantasy with serotonin.
Dr. Schneider states, "It is important to observe that sex can easily fit into any or all of the foregoing categories, making it an extremely powerful mood-altering activity." Thus, although a person does not get "addicted" to pornography per se, they may get hooked on the mood-altering experience facilitated & triggered by the use of pornography.
In an attempt to be objective, it is important to observe that just as everyone who drinks does not become an alcoholic, people who may use pornography are not necessarily addicted. In fact, one study by Dr. Al Cooper found that less than 8% of individuals who engaged in online cybersex & pornography activities considered themselves addicted according to several criteria outlined in the largest online survey ever conducted on this subject. Dr. Cooper suggested that this 8% were categorized & reported as spending more than 11 hours per week & having adverse consequences as a result of their behavior. He further identified users in three categories: 1) recreational users, 2) sexual compulsive users, and 3) at-risk users (meaning there was a high risk that such users could become compulsive in their pursuit of pornography & cybersex).
Dr. Cooper suggests that some of the attraction to pornography & cybersex through the Internet results from the power of accessibility, anonymity, and affordability that is given through online activities. The 3-A's provide an opportunity for many who would not otherwise engage in consumption of pornography a chance to explore their curiosity without a high risk of being discovered. Unfortunately, too many of these same individuals get caught in the trap of pornography addiction.
Regardless of one's conclusion in the on-going controversy surrounding pornography addiction, those who are struggling, or have loved ones struggling with pornography consumption, know first hand about the very real effects & problems such behavior creates. The mental health profession must also address the ever-increasing population of clients who come into our offices with a presenting problem that appears to be a result of compulsive use of pornography otherwise identified as a pornography addiction. If we don't view pornography addiction as a reality, we must at least address the reality of the apparent problems that pornography consumption creates.
 Steven Levy, "Breathing Is Also Addictive," Newsweek, December 30, 1996/January 6, 1997, 52-53
 Encarta Dictionary
 Merriam Webster's Collegiate Dictionary, Tenth Edition
 Shaffer HJ, Considering two models of excessive sexual behaviors: Addiction & obsessive-compulsive disorder. Sexual Addiction & Compulsivity 1 6-18, 1994
 Jennifer Schneider, M.D., Ph.D., practices internal medicine & addiction medicine in Tucson, Arizona.
 Victor B. Cline, Ph.D., is a Professor Emeritus of Psychology at the University of Utah, Salt Lake City.
 Dr. Patrick Carnes is a well known psychologist who lectures & writes extensively on the topic of sexual addiction.
 Milkman H, Sunderwirth S: Craving for Ecstasy. Lexington, M.A., Lexington Books, 1987.
 Schneider, J: Addictive Sexual Disorders. Norman Miller Principles & Practice of Addictions in Psychiatry, 1997.
 Sexual Addiction & Compulsivity Vol. 7 (1-2) 2000, 7
Rory Reid has an MSW from the University of Utah; his graduate work focused on impulse control disorders with pornography & cybersex on the Internet. He is a licensed psychotherapist at the Salt Lake City Counseling Center & Program Coordinator for Sexual Addictions at the Gathering Place in Orem, Utah, who specializes in the treatment of issues related to compulsive sexual behaviors. He has previously worked for LDS Family Services, the Monarch Treatment & Assessment Center & the Utah State Prison Sex Offender Treatment Program. He teaches part time for the Religion Department of Brigham Young University & for the Behavioral Science Department at Utah Valley Community College.
He is the co-author of Discussing Pornography Problems with a Spouse: Confronting & Disclosing Secret Behaviors (from which this article is derived) & co-editor of Confronting Pornography: A Guide to Prevention & Recovery for Individuals, Loved Ones & Leaders. He has addressed the topic of sexual deviance, cybersex & pornography at conferences & workshops for religious, civic & therapeutic communities including BYU Campus Education Week, Family Expo, AMCAP, Impact America, the news media, radio programs & television talk shows. He is actively involved with continuing research on treatment of pornography problems. He is a board member for the Utah Coalition Against Pornography & sits on the executive board for Women for Decency. Rory is currently pursuing a doctorate degree in Clinical Psychology at Brigham Young University & lives with his wife, Renee & son, Craig in Lehi, Utah.