What does the body of research on porn addiction look like?
There’s a gross over-representation and exaggeration of research. The sex-addiction concept is a belief system, not a diagnosis; it’s not a medically supported concept. The science is abysmal. The literature on porn addiction is really fractured. There are an awful lot of pop media claims that get embroiled into what literature there is on porn addiction. It is not a very heavily scientifically driven field. One of the things I find significant is that in a recent review of basically all research on pornography, they found that less than 1 percent of the 40,000 articles that they looked at were deemed scientifically or empirically useful. The literature is weighted with moral and cultural values. There are tons and tons of theoretical statements that are made but never evaluated. The exact same thing is true for what literature there is on porn addiction. The media, the public and, unfortunately, clinicians and legal professionals are subject to the very heavy weight of all that unscientific literature. They don’t know what to sort out and how to use it. I see lots of fairly well-trained clinicians who, because the concept is so embraced uncritically in the media and general literature, don’t know what to believe.
I was asked to do this article in order to come up with something that was fair, objective and could really look at the questions of addiction, neurophysiology and general sexuality issues. I brought in two eminent co-authors: Nicole Prause, a UCLA researcher with an extraordinary level of expertise in neurophysiology and sexuality, and Peter Finn, a University of Indiana addictions researcher who has no training or approach toward sexuality but is a very established researcher with regard to substance addiction.
And what did you find?
Unfortunately, we found what I expected to find, which is that the literature is so poorly organized and uncritically produced that there is not a lot of clinical or research usefulness to the concept of porn addiction. The overwhelming majority of articles published on porn addiction include no empirical research — it’s less than 27 percent. Less than one in four actually have data. In less than one in 10 is that data analysed or organized in a scientifically valid way.
It is a very common statement in all of the porn addiction research that high rates of porn use correlate with high rates of depression, problems at work, etc. Overwhelmingly, the research, when there even is research, is cross-sectional in its structure, meaning that they’re looking at people in a snapshot of time, and we can’t generate causality from that. The common assumption in porn addiction research has been that porn is contributing to and causing those negative emotional states and life events. In fact, there have been two or three longitudinal studies that looked at this question, and what they found consistently is that porn is a symptom, not a cause. There do appear to be folks who increase their use of porn as something akin to a coping method when they are experiencing increased levels of depression or loneliness. The reason I think that is important is that it leads us to focus not on the pornography, but on the person. Instead of talking about porn causing these bad feelings, now we can say this person is using porn to manage the bad feelings. Is that a bad thing? Sexuality and sexual arousal is a very effective, perhaps the most effective, method of distracting oneself from negative emotions..
The second thread that we found, which I really think is valuable and is being missed by the porn addiction label, is that there is consistently evidence that higher levels of libido and higher levels of sensation-seeking and higher levels of sexual sensation-seeking seem to predict higher levels of porn use. Again, that is a thread that is present in some of the earliest research and writing on porn addiction, but it has been ignored. It draws us back to the person and the variables or values that they bring to their pornography use, rather than the porn itself.
What’s the worst example of the pseudo-science?
The thing that drives me craziest is that over the past year or two, [proponents of the sex addiction model] have started trying to use brain science to explain it. They’re now talking about morphological changes that supposedly happen in the brain as somebody watches porn or has too much sex. The reality is, careful scientists will tell you they are absolutely unable to identify any brain differences between these alleged sex addicts and non-sex addicts. The other thing that they’ll tell you is that the brain changes constantly — any behaviour that a person engages in, especially repetitively, changes your brain. So, identifying changes related to this sexual behaviour and distinguishing it from anything else is absolutely ridiculous.
What they’re doing is trying to build credibility. The major way that they build credibility is through metaphor. They will tell you, that sex addiction is like an eating disorder, it’s like a heroin addiction. The reality is this is an incredibly weak form of argument, because it’s so subjective; and when they tell you that sex addiction is like an eating disorder, they don’t tell you all the things that are different about it. They live by anecdotes, because they don’t have good science.
What does this tell us then about how clinicians should deal with patients who complain about compulsive and excessive porn use?
It tells us first that clinicians need to be very careful at assessing that individual within the context of their life. What we find is that individuals who are reporting or being reported as having problems with excessive porn use are likely to be male, gay or bisexual, have experienced negative life events in the past, have a high libido and a relationship mismatch around sexual desires. Clinicians, when they run into these conversations, will do best by talking to the people to identify how all these variables play a role in the person’s identification of porn as the problem. The difficulty is that if you take away porn but don’t address the issues in the relationship in communication, in coping, in emotional management, the person’s higher level of libido or desire for excitement and sensation, you have other issues that are being unaddressed or will come up, because porn is not the problem.
If there is so little empirical evidence for porn addiction, why has it become such a popular and widespread concept?
We put forth three reasons. One is that it is an easy answer. It is an easy answer and an easy scapegoat in a society and a media that applies the concept of addiction to any overuse of anything. Secondly, it is a cultural control of sexuality, and particularly the forms of sexuality that are now widely available and difficult to control due to modern technology. There is the old saying “don’t give away the milk away for free because nobody will buy the cow” as a way of controlling sexuality. Well, porn, and Internet porn in particular, doesn’t just give away milk, it puts it in a high-speed faucet right in your room. That is concerning to society, to people in relationships, because it represents a significant loss of control of sexual expression and experience. Lastly, and this is one of the ones that is gonna be controversial, there is a large, lucrative industry that experiences tremendous secondary gain from the promulgation of this concept. As part of this paper we had a grad student call porn addiction facilities around the country and get an idea of the cost — and the costs were extraordinary. The average was $675 a day. These facilities were recommending or requiring stays anywhere between 15 and 90 days. Insurance doesn’t pay for this; it is cash only. The other thing that is really troubling is that there is no data to show that these very expensive programs generate positive results. There is an industry — and unfortunately I count the media in that as well, because the media makes lots and lots of hay by touting the issue of porn addiction, and even by raising the controversy of “is it real or not?” There is a lot of money to be made in keeping this thing alive.
Did your research reveal anything about the concept of sex addiction?
The porn addiction concept is very much an offshoot, a very informal offshoot, of the sex addiction concept itself. Sex addiction likewise has not stood up very well to empirical research. What we’re finding more and more these days is that the claims of sex addiction are based on the pathologization of gay and bi males, male sexuality in general and high libido. The very same thing is true when we look at pornography; it is overwhelmingly used by men. Pornography is used more by people who either have higher numbers of sex partners or have a higher level of sexual desire. In both sex addiction and porn addiction, these are concepts that are turning being a gay or bi male into a disease again. Even with pornography, the research is very clear: gay and bi men use pornography much more than their heterosexual counterparts — but that use of pornography is not pathological, it’s part of their coming out process, their seeking out normative or consistent depictions of sexual behaviour that meets and matches their internal desires, which isn’t present in the general media. Consistently, the research shows that gay and bi men are at far greater risk of being called porn addicts than are their heterosexual counterparts, and that is troubling.
The most common argument I’ve heard for the existence of porn addiction is that it causes chemical changes in the brain. Is there any evidence of that?
Good question. As you said, it is a very common idea. Unfortunately, this is a scare tactic. It’s just like Nancy Reagan saying, “This is your brain; this is your brain on drugs.” Now it’s, “This is your brain; this is your brain on porn.” What we found is that, again, there is an awful lot of hyperbole. There are a tremendous amount of theories put out about the way porn potentially affects people’s brains, but these theories are not being critically assessed. Instead, if it sounds convincing, it’s adopted as true. The research doesn’t support it.
There is a lot of current dialogue about Delta FosB, which is a transcription factor in the development of certain neurochemicals in the brain associated with reward. There have been no studies that have looked at porn related to Delta FosB; these are all hypothetical parallels that are being drawn. There is no research that shows that porn use actually changes someone’s brain differently from any other form of entertainment, including television. There was a study that was talked about from Britain last year where they said, “We did fMRIs on the brains of people who used porn and their brains looked like the brains of alcoholics!” What that study actually shows is that these people regard pornography as something that is reinforcing in their lives. It’s something positive to them. So their brains lit up in response to pornography in the same way that somebody’s brain would light up if they collected model trains and you showed them a picture of a model train. Similarly, people’s brains light up in almost the exact same way if they’re fans of a certain football team and you show them paraphernalia related to the football team. So, what that study actually showed was the people who like porn, like porn. I’m not sure how informative that is. Secondly, that study has still not been published in a peer-reviewed journal. It is a study that was talked about in the media but there has been no critical evaluation of it yet.
In good addiction research, what we find is that there is a transition from a person wanting to use a substance to needing to use a substance, and we can see that transition in their brain. There is absolutely no scientific evidence to date that there is such a transition related to pornography. One other thing about the Delta FosB is that the model for hypersexuality in rats, which is where Delta FosB has been studied, is homosexual behaviour. The only way right now to study Delta FosB in humans as it might relate to sexuality would require us considering homosexuality and homosexual behavior as evidence of a Delta FosB brain change consistent with addiction. Again, we are terming male homosexual behavior as a disease.
The other issue that is a hot-button one, and one commonly made in the media, is that of excessive porn use causing erectile difficulties. We found absolutely no scientific evidence, not a single article of any kind published in psychological, scientific or medical research that even raises the question or suggests that pornography is causing erectile difficulties. Instead, the literature seems to suggest much more difficulties with achieving orgasm as opposed to erectile difficulties. If there are erectile difficulties, what is likely to be the case is either a process of learning and conditioning, which is possible but is not addiction. In other words, if a person is consistently masturbating with a certain stimulus present, could it impede their ability to achieve sexual arousal without that stimulus present? Possibly. It is more likely that men who are masturbating more frequently, and masturbating more frequently to pornography, are more likely to be in a refractory period where their body has difficulty becoming aroused when they try and have sex. One thing we see is the more people masturbate, the longer their refractory periods.
So, you said that there is evidence of porn being associated with difficulty achieving orgasm in men?
Delayed ejaculation, yeah. There are some past and upcoming publications that relate high levels of porn use to delayed ejaculation impeding men’s ability to orgasm. However, one of the overarching issues here is that we are commingling the idea of porn use with masturbation. That’s not good science. It’s not good clinical practice. What I’d ask as we talk about the effect of high levels of porn use is: Are we talking about porn use or are we talking about masturbation? Asking that question forces us to come back and ask, “Are we concerned here with porn or masturbation?” If the issue is masturbation, are we replicating our history where we believed that masturbation depleted people of necessary spiritual and psychic energies?
What cultural forces are bringing this to the fore right now?
I think it’s a perfect storm. It’s the media and the transparency of our society. All of these behaviors have been happening for millennium — people cheating, people having lots of sex, people viewing pornography. There’s nothing new about this. But all of a sudden we have this 24/7 media that is hungry for scandals. “Gotcha” journalism grabs an audience by putting out a sound bite, a meme, as quickly as possible, regardless of how true it is. The memes that grab the most are black-and-white, two-dimensional concepts. Rather than explaining that there are thousands of reasons a person might engage in infidelity, it’s easier to say: Sex addict
The other thing is, why are we singling out this one behaviour as a problem? There are people who do model trains obsessively: They focus their life on it, their relationships end because of their interest in this, they fill their houses with these model trains –
But we aren’t rushing to subject them to brain scans.
Exactly, right. This is a moral attack on sexuality. They it is in the interest of people to build and develop fear of sex. Because they think that if we’re not afraid of sex, people are going to go out and have lots of sex. God forbid.
Does it make people feel more secure, like the threat of infidelity is contained to a “disordered” or “addicted” population? Blaming infidelity on sex addiction might be easier than questioning monogamy or our expectations for long-term commitments.
Yep. Instead of examining the application of the concept of monogamy over a 30- or 40-year marriage, and looking at how male sexuality works, it’s much easier to say: “Well, it’s a disease.” I include a quote in my book where a woman says, “When my husband was cheating, it really was a comfort to consider it a disease and that it really wasn’t his fault. Finally, I had to realize that it wasn’t a disease, it was just him being selfish and treating my life and health casually.” If we look at it as a choice, what changes?