Clinician’s Alert: Addiction and Pornography
By Dr. Hunt – The Bergand Group
Time Magazine’s cover story on “Porn,” (April 11, 2016), detailed both the negative effects of excessive use of internet pornography on many males and also reported on-line forums by young men who have suffered what they call “porn induced erectile dysfunction” (PIED) with real partners. This media presentation and the subsequent discussion by sociologist, Gail Dines in the Washington Post (Monday, April 11, 2016) represents a significant step forward for clinicians in dealing with issues of sexual addiction and attempting to help affected men and women and their families.
Sexual Addiction. While some controversy exists about calling excessive sexual behavior an addiction, the behavior appears to fit The American Society of Addiction Medicine’s (ASAM) definition:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations….. (ASAM, 2014).
While not everyone who engages in excessive sexual behaviors, including the use of pornography, would qualify for a diagnosis of sexual addiction, some individuals — more men than women– do meet these criteria. This is similar to what clinicians find regarding the use and of alcohol and other drugs.
Diagnoses are useful to clinicians when they point the way for effective treatment. Calling excessive sexual behavior an addiction removes it from the shame of being considered a moral failing and places it in the framework of a treatable health problem. Since there are effective treatments for substance use disorders and clear criteria for making diagnoses, some of these can be used to identify and treat the over-use of sexual activity.
In fact, treatment for sexual addiction has existed since the mid-1980s when the Twelve Step Program Sexaholics Anonymous was founded. Modeled on the Twelve Steps of Alcoholics Anonymous, this program has spread throughout the United States and to other countries of the world. Two additional Twelve Step Programs: Sex Addicts Anonymous and Sex and Love Addicts Anonymous are currently available in the United States and elsewhere. “Anon” programs are attached to each of these programs to aid family members in recovery.
Further, many clinicians are currently treating men and women who suffer from compulsive sexual behaviors. Some clinicians are seeing couples and families affected by the excessive behavior of a member or members.
What to Expect
Men & Women. First, an increase in the number of men and women with excessive sexual behavior seeking assistance. While pornography is primarily a male pursuit, women fall prey to the “love addiction” aspect of this problem. In addition, the degradation of women portrayed in many forms of pornography, has created additional problems for many women. Some women think their partner’s erectile dysfunction reflects their lack of attractiveness. Other women have said their partners expect them to dress and act “like porn stars.”
Couples. When a man or woman’s compulsive sexual behavior is “discovered” by spouse/partner, it creates a serious disruption in their relationship. The partner may feel devalued, not as desirable as online presentations. The trust between them, a necessary element in any close relationship, may be broken or severely damaged. Some couples separate and divorce; some seek treatment.
Families. If the couple is estranged over “the discovery,” as is likely, family relationships will be negatively impacted and children adversely affected. There is also danger of children being exposed to sexual material beyond their cognitive and emotional ability to deal with it.
Current on-line pornography also includes images of children. This can be an area of even greater shame and secrecy for those who view it and presents complex legal and ethical issues for both the patient and the clinician. Patients may come to treatment after discovery by law enforcement agents.
Substance Abuse Disorders and Sexual Addiction. Addicts engage in a wide-range of substance use and behaviors that affect the brain and produce tolerance and withdrawal. Sometimes substances are used simultaneously, co-occurring with addictive behaviors. For example the use of cocaine along with sexual acting out.
Sometimes the addictive experiences are layered with an underlying addiction emerging as another is stopped. Sexual addictions may be masked and sometimes held in check by drugs and alcohol. When the substance is stopped, sexual acting out may emerge virulently. Persons with layered addictions may be unaware of the underlying disorder until it surfaces.
Sometimes, when people stop one addiction, they may switch to another, perhaps less harmful, substance and/or behavior. The overuse of sugar and other foods by persons recovering from alcohol use disorders is an example. While this may represent harm reduction, it still can create obesity with its attendant risks of heart disease, diabetes and stroke; each chronic, progressive and fatal if left untreated.
Suggestions for Clinicians. The incidence of sexual addiction is rising. The internet has made pornography available, anonymous and affordable. In addition to pornography, it is now possible to meet partners on-line with whom to engage in sexual acting out.
Drug and alcohol use disorders may go hand-in-hand with these activities; co-occurring, layered or switched. Clinicians are wise not to assume they are dealing with just one addiction when a person comes into treatment. Respectfully and sensitively asking about other compulsive behaviors, including gambling and sexual acting out, is recommended.
Not For Everyone. Many clinicians will not be comfortable treating patients who suffer from compulsive use of pornography and/or other sexual behaviors. These patients often confront us with the darker and more primitive aspects of our humanness. Human beings exhibit a variety of sexual behaviors and have a varying range of beliefs, attitudes and emotions associated with their sexual experiences. The sexual experiences of others –which, until now, have been rarely talked about— bring us face-to-face with our own specific views and outlooks.
Thus, in addition to an understanding of the bio-psycho-social parameters of this particular addiction, clinicians need an awareness of their own attitudes toward various kinds of sexual experiences and an appreciation that their experiences and beliefs are but one of many. Most importantly, clinicians need compassion for those who are caught in the trap of sexual addictive behaviors. Many therapists have developed this compassion for those whose brains have been hijacked by drugs and alcohol. Extending this compassion to those whose compulsions concern sexual acting out is a necessary component of effective treatment.
Many clinicians may find they are not disposed to treat men and women who use pornography and other forms of sexual activities compulsively. If so, a referral to another suitable clinician is required. Our mandate is always, Primum non nocere.
Dr. Jerry Hunt
Medical Director, The Bergand Group