The American Society for Addiction Medicine: New Definition of Addiction (August, 2011)

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ASAM logoA major event has occurred in the realm of addiction science and treatment. America’s top addiction experts at The American Society of Addiction Medicine (ASAM) have just released their sweeping new definition of addiction. The new definition, and associated Q&A's, echoes the major points made here at www.yourbrainonporn.com. Foremost, behavioral addictions affect the brain just as drugs do—in all key respects. This new definition, for all practical purposes, ends the debate over whether sex and porn addictions are “real addictions.”

This article excerpt sums up ASAM's view on behavioral addictions:

The new definition leaves no doubt that all addictions—whether to alcohol, heroin or sex, say—are fundamentally the same. Dr. Raju Haleja, former president of the Canadian Society for Addiction Medicine and the chair of the ASAM committee that crafted the new definition, told The Fix, “We are looking at addiction as one disease, as opposed to those who see them as separate diseases. Addiction is addiction. It doesn’t matter what cranks your brain in that direction, once it has changed direction, you’re vulnerable to all addiction." That [ASAM] has stamped a diagnosis of sex or gambling or food addiction as every bit as medically valid as addiction to alcohol or heroin or crystal meth may spark more controversy than its subtler but equally far-reaching assertions.

This section contains three ASAM documents (link to ASAM website),

  1. American Society for Addiction Medicine: Definition of Addiction - Long Version
  2. ASAM’s Definition of Addiction - Frequently Asked Questions.
  3. ASAM Press Release.

and two articles in the press

Two articles we wrote:

The following is my brief summary of the major points—related to porn addiction:

  1. Addiction is one “disease” whether it is caused by chemicals or behaviors.
  2. Both behavioral and substance cause the same major changes in the same neural circuitry: Hypofrontality, sensitization, and desensitization.
  3. Engagement in “addictive behaviors” indicates the above brain changes have occurred. Addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.
  4. Eradicates the old “addiction vs. compulsion” distinction, which was often used to deny the existence of behavioral addictions, including Internet porn addiction.
  5. Addiction is a primary illness—in other words, it’s not necessarily caused by mental health issues such as mood or personality disorders, putting to rest the popular notion that addictive behaviors are a form of "self-medication" to, say, ease the pain of depression or anxiety.

The new ASAM definition doesn’t mention Internet porn addiction, or distinguish it from sex addiction (which it mentions several times). Obviously, a policy statement can’t address everything, but it’s clear that Internet porn addiction affects a far wider group than does sex addiction. Sex is a natural reward that has been around forever, whereas Internet porn, like junk food, is a supernormal version of a natural reward (see Porn Then and Now: Welcome to Brain Training and Intoxicating Behaviors: 300 Vaginas = A Lot of Dopamine).

Let’s examine three FAQ's from ASAM related to sex and porn addiction. This first question makes it clear that all addictions share certain brain adaptation, which manifest as specific behaviors and psychological symptoms.

QUESTION: What’s different about this new definition?

ANSWER:

The focus in the past has been generally on substances associated with addiction, such as alcohol, heroin, marijuana, or cocaine. This new definition makes clear that addiction is not about drugs, it’s about brains. It is not the substances a person uses that make them an addict; it is not even the quantity or frequency of use. Addiction is about what happens in a person’s brain when they are exposed to rewarding substances or rewarding behaviors, and it is more about reward circuitry in the brain and related brain structures than it is about the external chemicals or behavior that “turn on” that reward circuitry.

Great quote - “Addiction is about what happens in a person’s brain.” How many times have we said this? The definition emphasizes that it’s not the form or quantity of a stimulus, but rather the results of the stimulus. Put simply, the common behaviors and symptoms shared by all addicts point to shared brain changes as well. (Take this quiz to see if the addiction process is taking hold in your brain.)

Internet porn use isn’t a moral issue, anymore than snorting cocaine or smoking cigarettes is. All are health issues that affect the structure and functioning of the brain. Brain changes common to drugs and natural rewards are described in these articles: The End of The Porn Debate? and Ominous News for Porn Users: Internet Addiction Atrophies Brains.

These next two questions address sex and food addictions.

QUESTION: This new definition of addiction refers to addiction involving gambling, food, and sexual behaviors. Does ASAM really believe that food and sex are addicting?

ANSWER:

Addiction to gambling has been well described in the scientific literature for several decades. In fact, the latest edition of the DSM (DSM-V) will list gambling disorder in the same section with substance use disorders.

The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. This the first time that ASAM has taken an official position that addiction is not solely “substance dependence.”

This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system. Food and sexual behaviors and gambling behaviors can be associated with the “pathological pursuit of rewards” described in this new definition of addiction.

QUESTION: Who has food addiction or sex addiction?

ANSWER:

We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors.

ASAM could not be more clear: Sex addiction exists, and it is caused by the same basic alterations in brain structure and physiology as drug addictions. This makes perfect sense as addictive drugs do nothing but increase or decrease normal biological functions. They hijack neural circuits for natural rewards, so it should be evident that extreme versions of natural rewards can also hijack those circuits.

ASAM chose to publish this new definition because mounting evidence from addiction neuroscience leads to only one conclusion. The following pages represent a sampling of the research on natural addictions: Internet & Video Game Addiction, Food Addiction, and Gambling Addiction.

ASAM’s new definition has confirmed what neurobiologists and most addiction experts already knew: Natural rewards can cause addiction. What’s missing is a discussion on the mushrooming of Internet porn use and addiction. Internet porn use is far more likely to lead to addiction than Tiger Wood’s behavior.

As explained in David Linden’s new book “The Compass of Pleasure” addictiveness is not directly tied to size of dopamine impact. Cigarettes, for example, hook nearly 80% of those who try them, while heroin hooks only a rather small minority of users. This is because addiction is learning, and smokers constantly train their brains with little “rewards” of dopamine. Heroin users get more intense neurochemical “lessons,” but far fewer of them. That’s why fewer get hooked. True sex addicts (with actual partners), like heroin users, generally can’t get unlimited “fixes.” They may also have more stimulating rituals, not unlike heroin, or other, addicts.

Internet porn use is more akin to smoking in that each novel image offers a small dopamine burst. As porn users generally view many images/video clips, often daily, they are training their brains very frequently, much as smokers do. As explained in Porn, Novelty, and the Coolidge effect, unlimited novelty allows them to override normal satiety. Moreover, Internet porn’s inherent qualities affect dopamine in ways that sex addiction simply cannot match, see Porn Then and Now: Welcome to Brain Training.

In other words, it’s not the neurochemical blast of orgasm that hooks Internet porn addicts, although the endogenous rewards of orgasm further reinforce porn use. Therefore, Internet porn addiction is not simply a "sex addiction." It hijacks circuitry relating to our genes’ top priority: reproduction—and, in particular, the program for extra neurochemical reward in response to novel mates. It’s both more like an Internet videogame addiction and more like a food addiction.

In short, it’s likely masturbation addiction would be quite rare without access to Internet porn. While masturbation addiction (without porn) might well be a sex addiction and rare, Internet porn addiction is a different—and far more neurochemically seductive—animal.

Incidentally, according to recent research, Internet addiction among adolescents in Hungary and Internet-porn-free China are at 18% and 14% respectively. (See “Confirmation of the 'Three Factor Model of Problematic Internet Use on Off Line Adolescent and Adult Samples” and “Microstructure Abnormalities in Adolescents with Internet Addiction Disorder.”) Judging from obesity rates, food addiction stands at 30+% in the States. Might the rates of Internet porn addiction be higher than we believe because of our assumption that they "must" parallel sex addiction rates?