• “Sex Addiction” & “Porn Addiction”

    An important note: the following information pertains to individuals who understand and prioritize consent in their sexual behaviors and decision-making.

    As a substance use disorder treatment specialist with many years of training and experience in this ever-evolving field, it has become clear to me that the terms “sex addiction” and “porn addiction” are two of the most harmful and misunderstood concepts I could imagine that cause people to seek out sex therapy.

    Historically, health professions have pathologized natural and healthy human interest and curiosity about the various ways we pursue and experience sexual pleasure. At our fingertips lives a world of technological advances that can show us any type of porn we can imagine. Biologically and evolutionarily speaking, our brains are likely unable to fully comprehend, absorb, or understand the impacts this technology has on us. Nevertheless, the label of “addiction” gets thrown around way too cavalierly, and this causes real harm.

    Over the years, I’ve received a large number of inquiries from people who tell me they have a sex or porn “addiction” and either want to stop using it altogether or to choose to have sex and use porn in a different way. The “addiction” label can cause real suffering in the form of deep shame and guilt for the person using porn. This label and resulting shame also prevent individuals from reaching out to mental health providers and sex therapists to get the proper education, support, and understanding of what is truly going on with them.

    After discussing this topic with author and my sex therapy mentor, Marty Klein, Ph.D., it became clear to me that if someone without clinical training, knowledge of the clinical language, and an understanding of symptoms and symptom clusters is able to “diagnose” someone as being an “addict,” that’s probably a good indication that we have adopted too broad of a definition of what an “addiction” is. It also simultaneously perpetuates the myth that it’s an actual disorder.

    Let me be clear: there is no current diagnosis in the DSM-5 that uses terms like “sex addiction” or “porn addiction.” In fact, that word isn’t even used when diagnosing problematic substance use. Someone who calls themself an “alcoholic” or “addict” may have an Alcohol Use Disorder or an Opioid Use Disorder, but there is no diagnosis of “alcoholism” or “opiate addict.” Would it surprise you to know that there is also no current diagnosis of a “sex use disorder” or “pornography use disorder?”

    In one of his videos, Dr. Klein eloquently described some of the reasons people choose to use sex or pornography in ways that either they and/or others describe as being addictive. Imagine, for instance, someone in a manic or hypomanic phase of bipolar disorder. One of the symptoms this person might experience is impulsive decision-making that carries risks and the potential for unpleasant consequences. Without medication and therapy, these individuals have a condition in their brain that they cannot control and that prevents them from being able to effectively regulate their emotions, thoughts, and actions, to a greater or lesser extent.

    So, if that’s what’s contributing to someone making impulsive sexual decisions, we treat the underlying disorder or maladaptive coping. We don’t treat the disorder’s symptom that we are calling an “addiction.” That would be tantamount to playing a game of Whack-A-Mole and expecting the moles to just stop popping up if we whack them enough. Instead, we work to understand the function and cause of a behavior (or symptom) and then address the causal problem itself, not the symptom. 

    Another example Dr. Klein discussed in his video is individuals who have OCD and who wash their hands compulsively. This behavior can be distressing and disruptive to their lives, just as somebody compulsively looking at pornography, masturbating, or having sex could be disruptive to their life.

    Conflict in a relationship can be another cause for the behavior. One partner could be managing their emotions by choosing to escape through sex or the use of pornography and masturbation. For various reasons, this person could be indirectly communicating to his/her/their partner through his/her/their behaviors the emotion of frustration. Just a small sample of these reasons could include feeling judged for their sexual interests, feeling unsupported in their career endeavors, not wanting to be in a monogamous relationship, or simply that they have different values and preferences from their partner regarding being able to look at porn. A partner may see this as being a problem because he/she/they may not like that his/her/their significant other looks at porn, but that doesn’t mean that the person has a problem or an “addiction” to it. It simply means that we need to understand what is preventing the indirect communicator from more assertively expressing their thoughts and feelings, and then to help them learn the tools to practice doing so.

    In many cases, there exists a discrepancy between each partner’s values, choices, and preferences. That doesn’t mean that one of them is right and the other one is wrong, nor that one of them has an “addiction.” If there is any disorder, it’s potentially in the match of the partners in the relationship, or in how they are choosing to discuss the issue, challenge their own belief systems, and engage in uncomfortable dialogue.

    I don’t think there’s a “right way” to think about sex, masturbation, and pornography. I do believe we are all entitled to have our own belief system and values regarding each of them. While I also believe that we aren’t required to explain ourselves, or to even necessarily have a rationale for it, I do think it is important for people to work to understand why they feel the way they do, why they choose to do what they do, and how they go about making decisions as it relates to sex, porn, and masturbation. It’s also crucial to question if the things we say are important to us are, in fact, important to us for the reasons we believe them to be, as well as if we want to continue making similar decisions based on that understanding.

    It is clear that our society could benefit greatly from acknowledging that we have a fundamental misunderstanding of sex, sexuality, and sexual decision-making. In true form with our healthcare system’s inclination to pathologize the human experience, we could even label this as a “Disordered Understanding of Human Sexuality.” The treatment and prognosis? With proper education that is based on a comprehensive definition of what the underlying problem(s) is/are, in combination with additional research and discussions about sex with our healthcare providers, friends, family, partners, and communities, it remains my belief we actually stand a chance to beat this.