Treatment of Compulsive Pornography Use with Naltrexone: A Case Report (2015)

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Naltrexone bottleComments: Here's another case study showing that the drug Naltrexone helps porn addicts control their porn use (as a last resort). For a thorough, and brilliant, discussion of Naltrexone and porn addiction see this earlier case study.


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American Journal of Psychiatry . 01/2016; In Press. DOI: 10.1176/appi.ajp.2015.15060843

Shane W. Kraus, PhD a, b *  Sarah Meshberg-Cohen, PhD a, b  Steve Martino, PhD a, b  Lantie J. Quinones, MD c  Marc N. Potenza, MD, PhD b

a VISN 1 Mental Illness Research Education and Clinical Centers, VA Connecticut Healthcare System, West Haven, CT USA

b Yale University School of Medicine, New Haven, CT USA

c McLean Hospital, Harvard Medical School, Department of Psychiatry, Belmont, MA USA

* Corresponding author: Shane W. Kraus, Ph.D., VISN 1 MIRECC, VA Connecticut Healthcare System, 950 Campbell Avenue 151D, West Haven, Connecticut 06515, United States. Telephone: 203-932-5711, Ext: 7907; Email: shane.kraus@va.gov

TO THE EDITOR:

Between 30-50% of U.S. men watch pornography regularly, and only a small subset of viewers develop compulsive use. Compulsive pornography use is characterized by craving, behavioral impulsivity, social/occupational impairment, and higher rates of psychiatric comorbidity (1). In light of two recently published cases (2, 3) suggesting naltrexone, an opioid-receptor antagonist, may reduce the intensity of sexual urges and behaviors associated with nonparaphilic compulsive sexual behavior, we report on a case of naltrexone as an adjunct to psychotherapy in a married, employed, heterosexual male veteran in his 30s who sought treatment for problematic Internet pornography viewing. Naltrexone’s effectiveness at reducing sexual urges to masturbate to pornography is largely unexplored.

Mr. D. began using pornography regularly at age 13. During the intake interview, he reported compulsive masturbation to pornography for the last 10 years despite numerous failed attempts to quit; he was viewing Internet pornography nearly daily for approximately 30 minutes. He reported a prior diagnosis of major depressive disorder, and had no history of substance abuse, risky sexual behavior, significant medical problems, nor was he taking any prescribed medications.

Mr. D began attending weekly individual cognitive-behavioral therapy delivered by a doctoral-level clinical psychologist. For 18 weeks, he completed daily self-monitoring worksheets assessing urges to view Internet pornography (1.0 = No Urge, 7.0 = Intense Urge) and whether he had viewed and masturbated to pornography. Despite reducing his baseline use of pornography by approximately 70%, Mr. D continued to report frequent sexual urges to masturbate to Internet pornography. Therefore, on the tenth week of treatment, he was prescribed naltrexone (50 mg/d).

Within two weeks of initiating medication, he reported subjective decreases in his urges to masturbate to pornography. As shown in Figure 1, over the nine weeks that he took naltrexone, the intensity of his sexual urges significantly decreased (M1-9 weeks=3.71, SD=1.28 vs. M10-18 weeks=2.37, SD=.80), t(124)=6.93, p<.0001, Cohen’s d=1.25). He also viewed pornography less often (5 days in weeks 10-18; 17 days in weeks 1-9), χ2 (1, N=125)=7.04, p<.01 (OR =.25, 95% CI = 0.09-0.73). In addition, he resumed regular, satisfactory sexual intercourse with his wife.

Our findings suggest that naltrexone may be a useful adjunctive treatment for patients reporting difficulty managing sexual behaviors such as excessive viewing of Internet pornography. A notable limitation of the current case report is that we did not employ a reversal (A-B-A) design with Mr. D. Additionally, further testing in a double-blind, randomized, placebo-controlled trial evaluating the efficacy and tolerability of naltrexone with (or without) psychotherapy for the treatment of problematic pornography viewing and other compulsive sexual behaviors is needed.

REFERENCES

1. Kraus SW, Potenza MN, Martino S, Grant JE. Examining the psychometric properties of the Yale-Brown Obsessive-Compulsive Scale in a sample of compulsive pornography users. Compr Psychiatry. 2015.

2. Bostwick JM, Bucci JA: Internet sex addiction treated with naltrexone. in Mayo Clinic Proceedings, Elsevier; 2008. pp. 226-230.

3. Raymond NC, Grant JE, Coleman E. Augmentation with naltrexone to treat compulsive sexual behavior: A case series. Ann Clin Psychiatry. 2010;22:55-62. 5

 

Number of Weeks Figure 1. Mean Scores of Craving for Pornography and Number of Days Viewed Pornography Each Week Pre/Post Naltrexone (50mg/d) Craving Score (1.0 - No Urge, 7.0 - Intense Urge) Number of days used pornography per week

Naltrexone 50mg/d

Funding

This case reported was supported by the Veterans Affairs Administration, VISN 1 Mental Illness Research Education and Clinical Centers, CASAColumbia and the National Center for Responsible Gaming. The content of the manuscript reflects the views of the authors and not necessarily the funding agencies. The funding agencies did not have input into the content of the manuscript.

Disclosures

The authors report that they have no financial conflicts of interest with respect to the content of this manuscript. Dr. Potenza has received financial support or compensation for the following: Dr. Potenza has consulted for and advised Lundbeck, Ironwood, Shire, INSYS and RiverMend Health; has received research support (to Yale) from the National Institutes of Health, Mohegan Sun Casino, the National Center for Responsible Gaming, and Pfizer pharmaceuticals; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; has consulted for gambling and legal entities on issues related to impulse control; provides clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; has performed grant reviews for the National Institutes of Health and other agencies; has edited or guest-edited journals or journal sections; has given academic lectures in grand rounds, CME events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts.