Reid, et al are certainly correct that not all compulsive porn users are the same. In fact, I’m sure Hilton and Watts would agree that there are porn users with serious issues, such as AIDS or mental illness, who benefit from counseling and medication. We see a few of them on our forum, too. We also agree that it is not helpful to those recovering to imply they have permanent brain damage, although it’s doubtful this was Hilton and Watt’s intent in explaining the relevance of hypofrontality research.
On the other hand, we’re troubled that Reid, et al, appear to be arguing that compulsive porn use does *not* arise from addiction processes in the brain. Reid himself treats clients for “porn dependence.” Surely “dependence” arises from addiction processes at work in the brain.
Through a fluke of fate, my wife and I have been listening to hundreds of recovering porn users for five years. What began as a trickle of distraught visitors (soon after free, streaming Internet porn became available to all ages), has widened into a river, and seems likely to become a flood.
Readers may be familiar with the work of psychiatrist Jeffrey M. Schwartz who treats OCD patients. He teaches them that their behavior is due to an unwanted brain loop that gets activated by stress. He explains that if they stop using it, it will weaken, and gives them techniques to speed the rewiring of their brains in the direction of other activities.
Due to research we had been collecting for another project, we were in a position to share this, and other, brain-plasticity concepts with our visitors who were desperate to quit porn. We dubbed the concepts “rewiring” and “rebooting,” or returning the brain’s reward circuitry to normal sensitivity. (For more: https://www.yourbrainonporn.com/your-brain-on-porn-series) Many are recovering. (Self-reports here: https://www.yourbrainonporn.com/rebooting-accounts Longer accounts here: https://www.yourbrainonporn.com/rebooting-accounts)
Interestingly, our visitors have little in common in terms of personality, religiosity or childhood trauma (although a few have grave issues). What they have in common is that they would all answer ‘yes’ to the seven questions below, drawn from the American Psychiatric Association (DSM-IV) and the World Health Organization (ICD-10) criteria for substance dependence. If someone answers ‘yes’ to three of them, s/he is addicted.
1) Tolerance. Has your use increased over time (escalation)?
2) Withdrawal. When you stop using, have you ever experienced physical or emotional withdrawal? Have you had any of the following symptoms: irritability, anxiety, shakes, headaches, sweats, nausea, or vomiting?
3) Difficulty controlling your use. Do you sometimes use more or for a longer time than you would like?
4) Negative consequences. Have you continued to use even though there have been negative consequences to your mood, self-esteem, health, job, or family?
5) Neglecting or postponing activities. Have you ever put off or reduced social, recreational, work, or household activities because of your use?
6) Spending significant time or emotional energy. Have you spent a significant amount of time obtaining, using, concealing, planning, or recovering from your use? Have you spend a lot of time thinking about using? Have you ever concealed or minimized your use? Have you ever thought of schemes to avoid getting caught?
7) Desire to cut down. Have you sometimes thought about cutting down or controlling your use? Have you ever made unsuccessful attempts to cut down or control your use?
What possible brain mechanism, other than an addiction process, could be responsible for compulsive porn users experiencing all of these symptoms? It is well established that both chemical and behavioral addictions involve the same brain pathways and similar mechanisms. In fact, pathological gambling will be placed in the new “Addiction and Related Disorder” section in the next DSM.
As a physiological matter “addiction process” is the only choice available to explain these common symptoms. Any other claim would need to be supported by a unique, as yet undiscovered, evolved brain mechanism.
In our visitors, tolerance doesn’t necessarily take the form of watching for more hours a day. It tends to take the form of escalation to material the users would never have watched initially, morphing sexual tastes that do not match their underlying orientation, and vastly reduced sexual responsiveness, including delayed ejaculation and erectile dysfunction. (See self-reports collected from our visitors: https://www.reuniting.info/download/pdf/0.TOLERANCE.pdf.)
When they attempt to quit (which requires truly heroic efforts in many cases), they also report withdrawal symptoms that are surprisingly similar to drug withdrawal symptoms: severe headaches, shaking, mood swings, brain fog, flu-like symptoms, bursts of anger, radical changes in libido, etc. (Self-reports: https://www.reuniting.info/download/pdf/0.WITHDRAWAL.pdf.) These symptoms, as well as the evidence of tolerance, are most logically explained by addiction-processes.
Reid et al seem to be saying that because their test subjects have lots of issues, and because their subjects’ results on standardized tests don’t show an “addictive personality,” addiction processes cannot be the reason for their compulsive porn use. We would respectfully submit that when it comes to extreme versions of natural reinforcers, such as highly palatable foods and today’s hyperstimulating Internet porn, personality and pre-existing predisposition to addiction are not as relevant as they are in substance abusers.
It is apparent that *most* people, regardless of genetic vulnerability, are susceptible to gorging on highly palatable food and to binging on especially enticing, ever novel, sexual cues. The reason that junk food and Internet porn are not “just food and sex” (or basket ball games, for that matter) is that they have the power to override the brain’s normal satiety mechanism. Research has established that they do it by reducing D2 receptors, thus numbing the brain’s pleasure sensitivity, which, in turn, drives the urge to binge. This mechanism may have evolved to enable our ancestors to binge on rare occasions when there were lots of valuable calories or novel, fertile mates around. Alas, it leaves many of us vulnerable in today’s enticement-rich environment.
Our ancestors were not generally overweight, yet today, 79% of Americans are overweight and half of those obese. (See http://www.globalpost.com/dispatch/health/101119/fat-top-10-obese) Porn use? A 2008 survey of young computer users showed that 87 percent of men, and 31 percent of women, already viewed porn. (See http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ781137&ERICExtSearch_SearchType_0=no&accno=EJ781137) A new survey of young Swedes shows that 13% of male porn users and 5% of women are reporting problems, and a 2009 study found even higher percentages of men reporting problems among American college-student users. (See http://www.bioportfolio.com/resources/pmarticle/182044/Prevalence-Severity-And-Correlates-Of-Problematic-Sexual-Internet-Use-In-Swedish-Men.html and http://www.informaworld.com/smpp/content~content=a917251047~db=all~jumptype=rss.) Today, there are many Web threads devoted to discussions of such problems at body-building and pick-up sites, and at sites like Medhelp and Yahoo Answers.
We believe porn-problem surveys may seriously underreport the actual problems experienced by today’s users. We say this because it is very difficult for young users to connect most of their symptoms with excessive porn use—especially if they grew up masturbating to it from puberty or before and have no conception of “normal.” In our experience, unless they acquire an addiction-process framework within which to evaluate their symptoms, they simply do not realize their depression, anxiety, concentration problems, or desire for hotter and more disturbing material can be associated with their heavy use of porn. From their perspective, porn seems like the cure, not the problem, due to its short-term comforting effects on the brain.
Happily, many of these guys recover once they (1) realize their symptoms of excessive use and withdrawal symptoms are very similar to those of men who have already recovered using the addiction-process model, and (2) go through the “rebooting” process. They are greatly relieved when their tastes revert to their earlier tastes. They consistently report reduced social anxiety. (Many were extroverts who were puzzled by their transformation into uneasy introverts when they slipped into heavy use of free streaming Internet porn.) They generally report improved concentration, after the initial agony of withdrawal recedes. Moreover, they are amazed by their radical changes in perception of potential mates (who begin to look attractive, when before they weren’t as arousing as porn actors/actresses).
We’d like to address one particular symptom, erectile dysfunction, in depth, not only because it demonstrates that many users do not accurately assess porn’s effects on them, but also because it reveals the aptness of the addiction model. Many men find us while searching for information to help with their inability to perform sexually when they attempt to have sex with real partners.
Inevitably, they are surprised to learn that today’s Internet porn may be the culprit. (For more on the connection between dopamine dysregulation and impotence, see: https://www.yourbrainonporn.com/erectile-dysfunction-and-porn.) Many have been to doctors, undergone numerous tests, and been declared “just fine.” Neither they nor their health care providers have considered excessive porn use as a potential cause. Indeed, doctors assure them that “masturbation cannot cause erectile dysfunction.” This was probably true before masturbation was coupled with the hyperstimulation of the Internet. It is no longer true. In fact, Italian urologists have already made the impotence-porn connection: “Italian men suffer ‘sexual anorexia’ after Internet porn use” http://www.ansa.it/web/notizie/rubriche/english/2011/02/24/visualizza_new.html_1583160579.html.
These visitors, most of them in their 20s, but many also in their 30s and 40s, come from all over the world. They differ in education, religiosity, attitudes, values, diets, marijuana use, personalities, etc. But they have two things in common: heavy use of today’s Internet porn and increasing tolerance.
When they stop porn (and, ideally, masturbation for a time, because it is so closely wired to porn fantasy at first), we consistently see this pattern in their recovery:
1) Withdrawal symptoms and cravings: Immediately
2) Complete loss of libido and erections: Begins towards the end of week one.
3) Absence of libido and erections, increased flaccidity (“shrinking or lifeless penis”): Continues for 2-6 weeks, dependent upon age and severity of porn use.
4) Gradual return of morning erections, libido and spontaneous erections at other times, no more “semen leakage” during bowel movements, etc.
5) Complete recovery of erectile health, sexual desire for real partners, reports of extremely pleasurable sex, contented condom use even if it was once a problem.
6) Over all timeframe is 4 to 12 weeks (if the man is consistent in avoiding porn/masturbation). Shorter period for late teens, longer for those above 30. Read synopsis of a typical recovery, with a mood graph here: https://www.yourbrainonporn.com/synopsis-of-entire-reboot-with-mood-chart
The consistency of the withdrawal symptoms, their sequence and their time dependence all point to a common physiological mechanism in the brain. It’s established in animal models that the mesolimbic dopamine pathway dopaminergic neurons activate the hypothalamic erection centers. The only physiologically sound mechanism for porn-induced ED is desensitization of mesolimbic dopamine pathway. This is a hallmark of all known addiction processes.
Erectile dysfunction/recovery alone suggests that the mesolimbic dopamine system has undergone significant, yet reversible, changes in response to heavy Internet porn use in these visitors’ brains. Regardless of theory and regardless of their other issues, if any, these men are recovering when they stop using Internet porn and give their brains a rest from intense sexual stimulation.
This evidence also suggests that Internet porn is qualitatively different from sex addiction. Sex is an evolved reward-circuit stimulus; Internet porn is a supranormal version of this stimulus, at least for some users—more akin to junk food in its effects.
Frankly, we think the burden of proof now rests on Reid et al to prove that there is a different mechanism for natural rewards if they seriously care to assert that Internet porn is not potentially addictive for many users. The evidence that superstimulating versions of natural rewards can activate addiction processes in the brain has been accumulating for years in animal experiments involving fattening food and sugar, and now in human experiments involving both gambling and fattening food. [Citations available here: https://www.yourbrainonporn.com/research-articles-and-abstracts ]
This brain mechanism is well established. Peering into the brains of porn users would confirm this (if “porn virgins” could be found and included in control groups). However, the risks of waiting indefinitely are grave given the dimensions of today’s Internet porn use, and the youthfulness of many users. (Young brains release more dopamine, are more malleable and perhaps more vulnerable to addiction-related changes. http://www.mitpressjournals.org/doi/abs/10.1162/jocn.2010.21572?journalCode=jocn)
Even where patients have other issues, counseling may be far more productive after they have restored their brain’s dopamine balance. Once our visitors regain their balance, we see them confront all kinds of challenges they have avoided. The science of addiction can even help those with shame-sex issues. “Forbidden” and “risky” stimuli naturally speed learning (addiction), in part due to the release of adrenaline. Fear also releases dopamine. Once visitors understand this, they can stop blaming themselves for their behavior, which speeds recovery.
In most young users’ minds, masturbation and Internet porn use are now synonymous. Yet masturbation with, and without, hyperstimulating Internet porn appear to be very different in terms of effects on the brain. Research shows that ‘novelty’ and ‘seeking’ release dopamine, quite apart from the dopamine released during normal sexual arousal. (See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838369/?tool=pubmed.) Internet porn delivers both constant novelty and the possibility of hunting for the perfect shot for hours, allowing users to override the brain’s natural satiety mechanisms effortlessly. This is a perilous situation. A clear understanding of the addiction model would do much to help users steer for balance, even before the ideal research is undertaken.
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