Hello dear reader,
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 an exploration of the lived experience of self-identified problematic porn users. 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. Case in point, I had to change the name of my study and take out the word “addiction” to get it approved. 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”. For example, 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 newly updated ICD-11, which finally includes a diagnosis of Compulsive Sexual Behaviour Disorder, which can include compulsive internet pornography consumption. This is a positive step towards understanding, clarity and hopefully funding more more research in this area.
Despite this, there are still claims in the media that sex addiction is “not the same thing” as compulsive sexual behaviour disorder, including misleading headlines such as, “Sex addiction may not be real, but the world’s leading health group just recognised ‘compulsive sexual behaviour disorder’.
That is not to say there are 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.
In light of the inclusion of Compulsive Sexual Behaviour Disorder in the ICD-11 the AASECT position on the term “sex addiction” (that it, “does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder”) seems outdated, however, I see their position is still the same on their website. Whether or not something is called an addiction or compulsion is really a matter of semantics. The real issue is suffering. The suffering that is experienced by individuals who have developed real problems and consequences due to their use of internet pornography.
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”. It has been viewed as just a convenient excuse for bad behviour and in some cases as a way to avoid what some would consider appropriate punishment for their actions. 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” and “sex offences” is occurring to the point where some people see them as one and the same thing, (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. 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 similar to tolerance (e.g. escalation of types of porn consumed over time), compulsion, desire, triggers/cravings, inability to curb use despite a desire to do so and symptoms similar to withdrawal.
- Addiction and semantics
Words have power. In recent times there has developed a reluctance on the part of some clinicians, organizations and media to use the words like “addict” or “addiction” when describing what are in essence addictive behaviours. There is a reluctance to use these words as “labels” because of the social stigma attached to them. Most individuals I talk to as an alcohol and other drugs counsellor who are in recovery are the first to call themselves an “addict”. Speaking to recovering addicts, they appear to welcome the “label” or the description of their behaviour by this one word as a way to perhaps name their problem in the most efficient way, especially those from a 12 Step program. If this is the case, who are we as clinicians to correct them and say you’ve got it wrong? There is one word that seems to describe the behaviour most accurately for all these people, whether they are suffering from a substance use disorder or a “problematic behaviour”, and that word seems to be addiction. Following the philosophy that in order to cleanse oneself of an issue, one has to first 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 media, 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 (see Love et al., 2015).
- The importance of honouring lived experience
Carl Jung, one of my favourite therapists, philosophers and thinkers knew that statistics only tell a part of the story, the “ideal average” as he called it. In order to tell the truth of experience one needs to use words rather than numbers. As a former journalist, it is always the story that interests me most. As researchers, we should not lose fact of the importance of personal insight and experience. As a qualitative researcher, my study is in the form of an online survey asking open ended questions and my aim is to explore what problematic users of internet pornography experience.
Here is a link to the participant information page:
Update (October 2018)
The survey is now closed. I now begin the daunting task of coding and analysis of the results. The information page will remain live for the next few months in case participants need to access the support pages listed.
References & further reading:
Garcia, F., & Thibaut, F. (2010). Sexual Addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 254-260.
Goodman, A. (2001). What’s in a Name? Terminology for Designating a Syndrome of Driven Sexual Behavior. Sexual Addiction & Compulsivity, 8(3-4), 191-213.
Harper, C., & Hodgins, D. C. (2016). Examining Correlates of Problematic Internet Pornography Use Among University Students. Journal of Behavioral Addictions, 5(2), 179–191.
Kraus, S. W., Voon, V., Kor, A., and Potenza, M. N. (2016) Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction. Addiction, 111: 2113–2114.
Kwako, Momenan, Litten, Koob, & Goldman. (2016). Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders. Biological Psychiatry, 80(3), 179-189.
Love, T., Laier, C., Brand, M., Hatch, L., & Hajela, R. (2015). Neuroscience of Internet Pornography Addiction: A Review and Update. Behavioral Sciences, 5(3), 388-433.
Wilt, J., Cooper, E., Grubbs, J., Exline, J., & Pargament, K. (2016). Associations of Perceived Addiction to Internet Pornography with Religious/Spiritual and Psychological Functioning. Sexual Addiction & Compulsivity, 23(2-3), 260-278.