Firstly, I must apologise for my lack of content and posts in recent times. I must admit I have been feeling a little guilty about that lately. Don’t get me wrong, I’ve had some great ideas and notes I’ve jotted down here and there about things I’d like to share with you but I haven’t gotten around to actually posting them! But, in my defense, I’ve had a lot going on this year. Working full-time as a counsellor in the drug and alcohol space which is both challenging and super rewarding as well as trying to fumble through the last few subjects for my Masters (in Counselling & Psychotherapy) has, I must admit, taken up a lot of my time and energy. And now I’m about to embark on my first ever research project which is equally daunting and exciting!
My research project is going to be on testing outcome measures for “addiction” against the lived experience of a self-identified porn “addict”. I am quite aware of some of the controversy surrounding sex and porn addiction and of some of the backlash that has occurred in the recent media in the wake of the #metoo movement. I think there needs to be a deeper dialogue here and less of the name calling and semantics of whether or not something is labelled an “addiction” or not. The issues as I see it here seem to be multiple and complex. I will attempt to outline them here, forgive me if I digress as I am really just thinking out loud here (in a public forum such as a blog which is so 2018!) anyway… here we go:
- Diagnosis as a precursor to treatment.
What’s in a name? Well funding and access to treatment as it so happens. The term “addiction” is no longer used as a discreet diagnostic term in the DSM-V. Instead the term “substance use disorder” is used under the umbrella category of “addictive disorders”. If the substance of choice is alcohol then you have an alcohol use disorder. The DSM-V is the latest edition in a succession of ever expanding diagnostic categories which is used by psychologists, psychiatrists as well as government funding bodies when deciding who and what gets funding for Medicare backed treatment options. For example, if you are wanting to access treatment for mental health issues under Medicare, your doctor can only diagnose you with a condition that is recognized in either the DSM-V or the ICD-10 (or 11 as soon as it is revised). The DSM-V lists 11 categories of symptoms that relate to substance use and if the person ticks 2 – 3 then they have a mild version of the disorder, if they tick 4 -5 they are considered on the moderate side and 6 – 7 is considered severe. There is only one disorder mentioned in the DSM-V that is considered a behavioural addiction and that is gambling. (There is by-mention of internet gaming disorder however.) So as such, unless you have a substance use disorder or a gambling use disorder you are not covered under the DSM-V and therefor, less likely to have your issues covered under Medicare or recognised by a government funded treatment clinic.
That is not to say there is no treatments available for those who identify as sex or porn addicts but they will most likely get treated for their co-morbid conditions (anxiety, depression, or a co-morbid substance use issue) or if they have the means, there are many private counsellors and therapist out there that do recognise that porn and sex addiction is a real phenomenon regardless of how the DSM-V or the APA wishes to treat it.
However, I just found this interesting paper which states that a diagnosis can be made using the ICD-10 for ‘other sexual dysfunction not due to substance or known physiological condition’ which can include porn and sex addiction. Despite the fact that the ICD-10 is the most widely used and recognised world-wide the AASECT has decided to put out its position on the term “sex addiction” as a statement and states point blank that it, “does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder” leaving many self-identified porn and sex “addicts” and the therapists who profess to treat such clients, out in the cold. Perhaps it will revise it’s position when the ICD-11 is published which is likely to include the diagnosis of “compulsive sexual behaviour disorder”. See this article for a therapist’s view of classification of sex and porn addiction as a discrete disorder: Dear Anyone Who Thinks Sex Addiction Does Not Exist…
- Social factors.
In the wake of the #metoo movement, and as a result of the likes of Harvey Weinstein, Tiger Woods and Kevin Spacey to name a few of the high profile celebrities who have recently gone into treatment for “sex addiction” following being outed for sex related crimes and sexual harassment claims there has occurred a social media backlash of sorts denouncing the term “sex addiction” as just a convenient excuse for bad behviour and in some cases as a way to avoid what some would consider appropriate punishment. This writer does not mince her words when declaring, “Sex Addiction does not exist”, with the equally clearcut sub-heading which declares:
Sex addiction is a label used by rich, powerful men to avoid punishment for sexually violent behaviour.
It is quite clear that the meshing of the terms “sex addiction” with “sex offences” is occurring to the point where some people see them as one and the same thing. (Which, they clearly are not.) Not all sex addicts are sex offenders and vice versa. See this article interviewing Dr Stephanie Carnes, daughter of Patrick Carnes who first bought the concept of sex addiction to the public’s attention with his many books on the topic, for a more balanced view. The point here is that social factors are part of the reason why the topic of sex and porn addiction is so controversial. Some commentators are wary of pathologizing a normal human behaviour. Some think that sex addiction is a term used to shame people and judge people who’s sexuality falls outside of the norm. These concerns are understandable but are a little far-fetched and not backed by the most recent research evidence.
What I find interesting is that no-one would question someone who self-identifies as an alcoholic to the same extent as some researchers are questioning porn users who identify as “porn addicts” – (see this article titled, “Believing you are addicted to porn is what causes psychological distress,” for an example of the popularization of this potentially damaging idea). So why is there such a spotlight placed on sex/porn addicts? The article is basically talking about the research of Joshua Grubbs and his team who have been researching the concept of “perceived addiction” to pornography and religious morality as factors in psychological distress related to porn use. I have no doubt that for some individuals, religious faith (or religiosity as it is sometimes called) and morality does add another dimension to the harms they are experiencing due to excessive porn use, but it is not the single factor as many other studies can attest to. I could list a bunch here but just head on over to www.yourbrainonporn.com for a comprehensive list (thank you Mr Wilson for making my literature review so much easier!) The Grubbs’ studies, for some reason, ignore a lot of other research in the area of porn use where users do not feel any moral misgivings about using porn but still describe symptoms which mirror those who are in addiction to substances such as alcohol or cocaine, including symptoms of tolerance, compulsion, desire, cravings and withdrawal.
- Addiction and semantics
Words have power. For some reason there has been in recent times a reluctance on the part of some clinicians, organizations and social media to use the word “addiction” when describing what are in essence addictive behaviours. There is a reluctance to use the label “addict” or “addiction” because of its social or societal stigma. I am not sure why this is. Most addicts you talk to who are in recovery are the first to call themselves an “addict”. Speaking to recovering addicts, they welcome the label or the description of their behaviour by this one word as a way to perhaps name their demon? Following the philosophy that in order to cleanse oneself of an issue, one first has to acknowledge and accept that an issue exists in the first place. For many, the word “addiction” or “addict” best seems to do this. Whether or not the term is accepted by the clinical and scientific community is really irrelevant, when it comes to recovery and healing from the wounds both caused by and those that have predated someone’s addiction. The fact that the DSM-V lists substance use disorders under the umbrella heading of “Addictive Disorders” should be enough to give the word some credence as the most accurate, descriptive term for a set of behaviours which involve physical, psychological and neurological factors that share common features.
There-for my research question, “Is Porn Addiction Real?” is kind of tongue in cheek and more of a philosophical question, which is why my research is going to be qualitative in nature. What I am hoping to essentially explore is the nature of reality. What defines someone’s reality, if not their experience? I guess it is also questioning of the arrogance of scientists, researchers and so called “experts” and, in a sense, questioning this semantic struggle to name or not name something adequately. Words are symbols, ideas and always approximations for experience. They are not reality. Whether something is classified as a “real addiction” or not is neither here not there in terms of what is experienced by the person who is suffering. However, if it looks, walks and talks like a duck then chances are it should be recognised by that name. I would just like there to be some sense of recognition and validation for those who are suffering a genuine phenomenon to have access to appropriate and affordable treatment. That is the essence of the rationale behind my research question.
Anyone who would like to comment below or answer my poll or would like to take part in my research please feel free to email me. I welcome any discourse, feedback and questions.