Why is the word “addiction” so controversial?

Addiction-slider-702x336

At the time of writing, there are now numerous studies including several reviews of internet pornography use, which indicate that compulsive use of internet pornography, like drugs or alcohol, is addictive. Yet there are some researchers, scientists and even clinicians who refuse to accept that sex or internet pornography can become addictive. They are a relatively small group but, as the saying goes, small does not mean quiet. In-fact, they are very vocal with their assertions and are often cited in the general media as “experts” in the field. One of the more prominent ones even offered therapy advice via an internet pornography cam site. In-fact a casual search on the internet will net you many articles claiming to ‘debunk’ the ‘myth’ of sex and/or porn addiction, citing a select few researchers and studies which support their “porn is harmless” stance or to explain the reported negative effects as the “belief” that you are addicted to porn that is a problem, not your viewing habits themselves. There also seems to be a current and ongoing Twitter battle for the hearts and minds of anyone who cares to listen on what can and cannot be called an “addiction”.

Why is this so? Anyone who cares to do their own actual research into the matter will find many studies and a growing number of systematic reviews of the research (a systematic review is when you do a search of a topic, collate all the studies you find, and attempt to come to some consensus of what the studies are reporting). However, Gary Wilson of the website Your Brain on Porn has a very thorough job of collating a long list of reviews and studies on the effects of porn which you can access here – if you have a free week or so to wade through them all! One thing I can tell you at a glance is that these studies are all primarily peer reviewed research articles and some are reviews of the research. It is hard to argue against the sheer volume of literature out there now on the topic, yet the T’war (Twitter War) rages on. There are even legal proceedings underway indicating that what started out as an academic debate is now getting real-world serious, with a number of individuals filing defamation suits against one particular researcher who seems to have taken things very personal indeed.

My own thorough review of the literature, which my own study supports, is that the research on problematic pornography use is leaning towards the classification of this phenomenon as a ‘behavioural’ addiction. Meaning, the person is “addicted” to an activity or behaviour, rather than a substance. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has already included one behavioural addiction in its category called “Substance Use & Addictive Disorders” (APA, 2013). However, interestingly, the terminology of the DSM-5 does not use the word “addiction” to describe any of the diagnoses in this category, despite the use of the term “addictive” in the category heading. In fact, as Richard et al. (2019) point out, they specifically state that the use of the word “addiction” has been removed because of its “uncertain definition and its potentially negative connotation’ (APA, 2013, p. 485). Despite its seemingly awkward welcome/not welcome guest status, the word “addiction” refuses to leave the party graciously. It continues to hang around in common usage and in both academic and social media circles, lurking about like the friend that no-one wants to admit knowing.

So why is the word “addiction” so controversial?

At the centre of this academic and social media tempest seems to be the word “addiction” itself. In order to make some sense of the passionate debate that is still raging as we speak, I thought it might be time to take a closer look at this currently unfashionable, problematic yet persistently sticky word “addiction”. Firstly, I shall look at some definitions, then I will attempt to look at the history of the word and finally I will add my own, humble, opinion at the end.

The American Society of Addiction Medicine (ASAM) defines addiction broadly, as “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. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours. Addiction is characterized by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response.”

The Centre on Addiction’s definition of addiction is similarly broad, “Addiction is a complex disease, often chronic in nature, which affects the functioning of the brain and body. It also causes serious damage to families, relationships, schools, workplaces and neighbourhoods. The most common symptoms of addiction are severe loss of control, continued use despite serious consequences, preoccupation with using, failed attempts to quit, tolerance and withdrawal.”

Popular psychology website, Psychology Today states that a “person with an addiction uses a substance, or engages in a behaviour, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcoholinhalants, opioids, cocaine, and nicotine, or behaviours such as gambling.”

The APS defines addiction in terms of criteria for diagnosis relating to substance use disorders, and only mentions gambling and internet gaming as examples of behavioural addictions in line with the DSM it publishes.

Of course, there are others but I’m sure you get the idea. The common theme seems to be this: Addiction affects the reward centre of the brain, which causes the addicted person to want to engage in the activity or use the substance repeatedly, which in time causes the person to be unable to stop or reduce using the substance despite wanting to, and in the face of increasing problems caused by the addiction. But what does the actual word “addiction” mean and where does it come from?

Etymology of Addiction

According to Richard et al., (2019) the word addiction has a long and interesting history. It originally appears in the early Roman republic. The latin root addicere, was used as a legal term meaning “to speak to”. In the later Roman period, it was also used to describe indebtedness, usually in relation to gambling debts. In Roman times the person (addictus) who owned a gambling debt was in a sense, attached or enslaved to his debtor until the debt was paid. By Elizabethan times it was used to describe an intense attachment to some person, cause or object. Mostly the word “addict” was used as a verb, as in to attach or devote oneself to something. Attachments could be either positive or negative, so the use of the verb was in itself neutral. Richard et al. (2019) argue that it is the flexibility of the word addiction and its ability to be used to denote either an extremely negative or positive attachment which has led to its longevity and popularity in common usage, as well as causing diagnostic ambivalence.

The connecting of the words addiction and attachment makes a lot of sense to me clinically. While running a substance-use recovery group for offenders, I would often start the group with an activity which involved various definitions of the word “addiction” in order to facilitate discussion. There were various definitions, including some medical, some from official sources such as the DSM and some quotes from famous ex-users. I would then ask the group members to choose which quote they felt mostly described their own experience. Most often the users chose a quote by Dr Patrick Carnes, (who specializes in treating sex-addiction and has written several books on the topic including, Out of the Shadows ) in which he describes addiction as a “pathological relationship”.  That this quote, written by a sex addiction specialist, was the one that these men would choose most often is interesting to me. They would then go on to describe their relationship to drugs as the most intimate, reliable and consistent relationship they had experienced. Their attachment to their drug of choice was very real and often, it had been the only thing they could turn to for comfort. Most of these men had histories of dysfunctional, abusive family lives, and most often they were let down by the very people you and I expect to be able to trust, again and again. No wonder their attachment, their addiction to their substance was so hard to give up. Carnes goes on to say that the pathological relationship with sex is a replacement for a healthy relationship with people. The same can be said for excessive substance users, problem gambling and those who consume pornography compulsively, which is what my own research documented:

“I don’t really have relationships. That’s why I view internet porn. But a couple of times I’ve come out of short-term relationships and felt a sense of relief that came from knowing I was free to go back to internet porn, and I know that that can’t be a good thing”

If we take the word “addiction” to mean simply an attachment, devotion, or enslavement to something, whether it be a substance, like alcohol or drugs, or an activity, like gambling, gaming or internet pornography, then the term addiction does seem to fit, at least as a descriptive term if not a diagnostic one. Any negative connotation to the word may well be attached to the substance or the behaviour which becomes problematic in that case, not the word “addiction” itself. Furthermore, those headlines claiming that porn addiction “does not exist” or is a “myth” because it is not listed as a diagnosis in the DSM are technically correct, because, in the current DSM there is no disorder with the actual term “addiction” listed at all. They are all disorders attached to the substance or behaviour, as in Alcohol Use Disorder or Opioid Use Disorder etc. – even though all these disorders fall under the umbrella of Substance Use & Addictive Behaviours.

Goodman (2001) made a, still, convincing case for the term “sexual addiction” to describe the phenomena of sexually related behavioural problems. He noted the similarities between substance use disorder and sex addiction and found them to be almost identical. In the proceeding 20 years, advances in neuroscientific imaging have shown these similarities are observable in the brain. So, if the term “addiction” where to be removed from the debate what would we be left debating? That excessive and compulsive use of sex or pornography does no harm? That people who describe themselves as addicted to internet pornography are delusional or wrong? I don’t think that’s helpful at all. The fact is, problematic use of internet pornography and sex exists, and is a real problem for many. Those that are experiencing this phenomenon firsthand no doubt care less for what you want to call their affliction, but more about getting help, recovery and healing from this issue, whatever it is called. As a counsellor, it is not my job to debate with clients about whether or not their issue is a “real addiction” or not. My job is to listen, to help facilitate change and to support my client create a better life for themselves and loved ones.

 

 

 

 

 

 

 

 

 

 

American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: Author.

 

Goodman, A. (2001) What’s in a name? Terminology for designating a syndrome of sexually driven behavior. Sexual Addiction & Compulsivity. 8:191–213, 2001. DOI: 10.1080/107201601753459919

Richard J. Rosenthal & Suzanne B. Faris. (2019) The etymology and early history of ‘addiction’, Addiction Research & Theory, 27:5, 437-449, DOI: 10.1080/16066359.2018.1543412

 

 

 

 

 

 

 

 

 

 

 

 

 

Porn addiction – it’s not just you. Truth, reality and hope for addicts and partners.

In 2014 I wrote a serious article with a slightly tongue in cheek heading called  Is internet porn the beginning of the end for the human race?  Now while I admit, I may have been exaggerating slightly, the premise of the article was clearly not entirely without justification. It may seem a little far fetched but if, as I saw tonight while out at dinner, parents are using screens to placate/regulate a child’s behaviour out in public then what does that really mean for that child and their ability to engage with other humans later in life? What happens when, as a society, we are more comfortable relating to a screen or to another human being through the medium of a screen, than we are when faced with a flesh and blood human. One that you can’t simply swipe away when convenient?

How does this relate to porn addiction? Well for many years the debate on porn was centered around the notion that succumbing to the temptation of porn signified some kind of moral failing. From a religious/Christian point of view, it was a question of sinfulness.  A sign that one has allowed oneself to become infected with one or more of the seven supposed deadliest of sins, lust and/or gluttony. Or, from a feminist point of view, porn is seen as the vile exploitation of women as sexual, one dimensional objects with no humanity other than form. Exposure to pornography was seen as something that was detrimental to our morality and incremental to men’s seemingly unquenchable appetite for all things sexual. Yet as Naomi Wolf ironically points out in her article, The Porn Myth in actuality, the end result of too much exposure to pornography has had the effect, not of turning men into sexually ravenous beasts, but the complete opposite; sexual and emotional anorexics who can no longer relate authentically to a real life woman or get aroused by one. As it turns out, excessive viewing of pornography in this digital age turns men off, not on.

As numerous studies now show, repetitive and compulsive viewing of internet porn by men, (and a growing number of women) induces the opposite effect than one might expect, and just like a person who is addicted to a substance grows increasingly desensitized to the drug whilst continuing to crave it more and more, a person who is addicted to pornography finds he/she ends up on pretty much the same, well trodden treadmill. Intensely wanting something that can no longer provide the temporary relief and stimulation it once did.

Recent research implies that internet pornography is as addictive as certain drugs and affects the brain the same way. But, porn’s special hook is that it taps into that human need for attachment by adding into the mix hormones that are normally associated with bonding, love and connection. In effect, a porn addict becomes more attached to porn than anything or anyone else in their life. As a consequence, relationships, marriages, work and soon enough, the relationship with the self begins to suffer.

Porn addiction, like any addiction goes through stages – however, unlike most other addictions, the physical effects of porn addiction are virtually invisible, and the psychological and emotional effects are quite subtle, at first. In-fact, many porn addicts may seek treatment of a variety of mental health issues such as anxiety, depression, OCD, as well as physical ailments, stress, other addictions and finally sexual performance before anyone “thinks to ask about their porn viewing habits”.

But more and more studies clearly link issues related to sexual performance, including as I mention in my previous post, erectile dysfunction in men in their late teens and early twenties, (something that was almost unheard of 10 – 15 years ago) back to extensive viewing of internet porn. It is only when they can no longer get an erection, or ejaculate even with porn that some men start to make the connection between their excessive viewing of porn and other issues in their life. Often this is the only thing that eventually get’s their attention. (Their partners, if they have partners, may have known for some time that something was happening, or rather…not happening!)

This sorry state of affairs is bad news for both porn addicts and partners of porn/sex addicts, many who spend night after night lying in bed next to a partner that never seems to be ‘in the mood’ for sex. The result can be devastating to marriages, relationships and the self-esteem to both parties. The secretive nature of most men’s porn addiction may also mean that some partners may not know that they are in a relationship with a porn addict or even if they are aware of their partner’s porn habit, they may not make the connection at first either. Or they may not know the extent of their partner’s porn viewing. The damage this causes relationships is thus far unmeasurable.  One site states that 56% of divorces in the U.S. involve one party having an obsessive interest in pornography among other staggering statistics.

So, is the news all bad? Well, no. Latest brain research shows that the brain is actually very flexible, and  malleable, kind of like plasticine. In-fact the term for the way the brain can change itself, based on what is experienced is called neuroplasticity. This is good news. As I mentioned in an earlier post, the same way you get yourself into a sticky situation is largely the same way to get yourself out of it. While the allure of internet porn may have lost its charm many clicks ago, the habit that it has created will be hard to break. Hard, but not impossible. For men who have lost the ability to relate to women, emotionally and physically, and for partners of addicts there seems little alternative, other than to dissolve the relationship, which let’s face it, is fairly likely. It can’t be much fun to be in a relationship with a porn addict. However, chances are that if you leave a relationship with one porn addict, you are more than likely to run into another just as addicted, or on his way to being so, seeing as in America at least, sex addiction (which porn addiction is a form of) has reached epidemic status, according to this 2011 News Week article.

So, how do you beat a porn addiction and reverse its affects on the brain? Well the answer is simple, if not easy and this is simply to stop it. Stop all contact with porn and masturbating to porn and give your brain a chance to rewire itself and re-learn, or rediscover what comes naturally.

That is the only solution. I did say it was simple, but not easy. Recovering from porn addiction (for addicts and/or partners) takes time, courage and commitment and it is not easy to do without support. There are some very good websites now that can assist, (which I shall list below in the resources) but the assistance of a therapist who is aware of the nature of porn and sex addiction, one who will take it seriously can be fundamental to long lasting recovery. At least, having a close friend or understanding partner (if that is possible) that you know and trust is also important. The reason being that porn and sex addiction most likely mask other issues. Issues such as fear of intimacy, abandonment fears, attachment disorders, and perhaps even trauma. Once the defence of porn has left the building, then there is nothing to protect your unconscious and chances are some deeply buried emotional wounds may re-open.

It’s important to be aware of this possibility as many who try to ‘re-boot’ as it is called on websites such as Your Brain on Porn and Fight the New Drug often try many times and fail because they are inadequately prepared or lack support.

If you are experiencing porn addiction or are the partner of a porn addict, seek help from a qualified therapist and/or see some of the websites listed below for more information.

SOURCES
http://www.covenanteyes.com/2013/02/19/pornography-statistics/
http://fightthenewdrug.org/get-the-facts/#sthash.ubb4Ty3m.dpbs
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050060/
http://blogs.psychcentral.com/sex/2013/05/the-prevalence-of-porn/
http://yourbrainonporn.com/cambridge-university-brain-scans-find-porn-addiction
http://www.npr.org/templates/story/story.php?storyId=125382361
http://newsok.com/the-five-stages-of-pornography-addiction/article/5407775/?page=2
http://nymag.com/nymetro/news/trends/n_9437/index1.html
http://www.theguardian.com/lifeandstyle/2015/jun/13/a-letter-to-my-ex-husband-who-preferred-pornography-to-me
http://www.newsweek.com/sex-addiction-epidemic-66289
http://globalchristiancenter.com/mens/overcoming-temptations/16765-pornography-in-the-church-a-new-epidemic
https://www.lds.org/tools/print/article/narrow/?lang=eng&url=/topics/pornography/audiences/youth/teenagers-and-pornography-addiction-treating-the-silent-epidemic
RESOURCES
http://www.covenanteyes.com/ (Internet filtering service)
http://yourbrainonporn.com/
http://www.fightthenewdrug.org/
http://www.posarc.com/ (Partners of sex addicts resource center)

The positive side of addiction – or how to turn ‘bad habits’ into your best self

This morning I was having breakfast with a friend and the conversation turned to the topic of obesity. A rather large lady had sat behind my friend and he had no choice but to move his chair closer to our table and found himself wedged in somewhat and unable to enjoy the rest of his meal in comfort. (As is the case with most cafe’s in Sydney’s inner west, adequate space between tables to allow for people of all shapes and sizes is considered an unnecessary waste of valuable real estate.) The question was asked, Unavoidable health conditions aside, what makes some people go from merely overweight, which let’s face it most of us are, to being dangerously, uncomfortably and in some extreme cases, morbidly obese?

I posited this response, Perhaps for some people who struggle with weight, there gets a point where they feel that no matter what they do or how hard they try, they are never going to be as thin, or as perfect or as whatever as they think they ought to be and at some point they lose the battle or give up fighting and think, What’s the point in trying? I may as well just eat whatever and not give a f&^%k. And before they know it they have gone from merely overweight to obese.

Or for some people, perhaps it starts with their relationship to food and eating. They turn to food as a source of comfort, as way to self-soothe and regulate emotions. When you feel sad, depressed or hopeless, that 4 litre tub of ice-cream can seem like a true friend. Nothing like a bit of self-indulgence to make yourself feel better, at times. However, when it becomes a regular thing rather than an occasional indulgence it can become a problem.

And the problem with too much self-indulgence, whether it be food, drugs, alcohol, sex or any habit forming, mood regulating behaviour is the little hook of dependency, (When you start to depend on your self-soothing behaviour too much, or as a way of avoiding dealing with unpleasant, or uncomfortable realities). And the fact that too much of a good thing can easily turn bad. The human body/mind is a delicately balanced conscious/unconscious machine and it doesn’t take too much to throw it off kilter. So while eating food is something we all need to do and is essential to our health and well being …too much food, or too much of the wrong types of food will make us overweight, feel sick or just plain unwell and in some cases, obese.

Another kick in the shins is when we realize that we are using our ‘little indulgences’ to feel better a little too much and find that it’s not so easy to stop the behaviour just because we decide that we want to. It’s not that easy, because a habit has been formed. By the point you consciously realize that, Hey I can’t fit into any of my clothes, is that really me in that photo?! I really ought to eat better/less exercise more…. I’ll start tomorrow. Your brain, your unconscious brain more specifically, has formed some deep, well worn, neurological ridges and short cuts to feeling ‘better’ and it doesn’t see any good reason to stop or change just because you say so.

Using food as an example, however, this can apply to any addictive or habit forming behaviour, let’s say you have decided that you want to lose weight and have decided to cut out all junk food, from today! You do fine for a couple of days, and then on day three you have a particularly bad day. You forget to set your alarm, so you sleep in and run late for work. Then, you have to give a presentation and you find that because you were so rushed that morning, you have left your notes at home and so the presentation doesn’t go all that well. Your boss calls you into her office and has a serious yet well meaning chat with you about it. The rest of the day you are feeling down and just pissed off with yourself and by 3pm you are really starting to think about venturing over to the vending machine for a chocolate bar to go with your afternoon coffee. You somehow resist the urge and make it through to the end of the day without caving in. You are feeling pretty proud of yourself and positive until you get a text from a friend cancelling your dinner plans. This wouldn’t be such a big deal except this is the third time in a row they have cancelled and you suddenly get the feeling that they don’t want to see you anymore. You feel hurt and rejected and what you really want to do is call them up and ask them what the hell is going on? But, instead you slump home and make yourself dinner, it’s healthy because the day before yesterday when you decided that you were going to change your eating habits you threw out all your junk food and bought healthy, fresh food to make real dinners with, rather than the ready to eat meals in a box and snack food that would normally fill your pantry. After dinner, you feel unsatisfied. You are craving chocolate. You are craving chocolate so bad you can’t sit still. You try and take your mind off it but even your favourite TV show is just not making you laugh as much as it normally does. Your mind keeps thinking of chocolate…an ad for Cadbury’s comes on and that’s it. A sign! You can’t take it anymore. You get in your car and drive to the convenience store…

It’s not until you are sitting, staring at an empty packet of Cadbury family size chocolate, the purple wrapper sitting there on your coffee table looking crumpled and defeated, that the reality of what has just occurred sinks in. Oh no… you think. Why couldn’t I stop at just a couple of rows like I said I would. Why did I have to eat the whole thing! So the comfort once experienced has now turned into self-loathing, shame and defeat. You go to bed feeling worse than before. The sweet, indulgent treat that was once your source of comfort and escape has now turned on you and you feel enslaved to its destructive charm. Laying in bed you start beating yourself up (figuratively of course!) and reminding yourself of what a failure you are and how, No-one will ever love me and what’s the point in trying anymore, people are all f&*^k anyway and will only let you down in the end. It’s all too hard and too much to think about now and anyway, it’s time for bed. You feel so tired. May as well call this a bad day and think about it tomorrow.

And so the cycle continues…

So how to break this cycle? Well there are ways…. And the good news is the same way you got yourself into a sticky situation is largely the same way to get yourself out of it. The difference is taking control. Instead of allowing your unconscious brain to just do what it thinks it needs to do to keep you safe, (and that’s emotionally and physically safe) you need to consciously take control of your own life… The bad news is, it’s not the easy, familiar route to just ‘feeling better’ that you have become used to. It involves making some conscious, and at first un-comfortable and un-familiar choices that will eventually create new habits, new ways of being and relating to yourself and others. It involves facing those realities, or those painful memories and/or unresolved traumas that you have avoided for so long. It also involves forgiveness. Forgiving yourself, and anyone else for those hurts, slights, misguided actions, un-thoughtful words and sometimes even unspeakable acts that may have been committed against you in order to free yourself from the burden of unexpressed anger and resentment.

It’s not as easy as eating a block of chocolate, or taking a hit of heroin, or drinking yourself into numbness or losing yourself for days and days watching internet porn or staying at home, ‘working’ instead of going to that party, or spending hours in front of a poker machine or maxing out your credit card on online psychics, pornography or prostitutes or whatever it is you do to make yourself ‘feel better’.

It’s not easy to face the void, not easy at all….but, remember, no-one said you have to do it alone.

If you have trouble kicking any addictive or unhelpful behaviour remember help is available, all you have to do is ask…

IMG_1653

Thanks to Mr R Buesnel for his valuable contribution to this post, for his insight, encouragement and generosity of spirit.