Sex addiction does exist, it is not imagined, top addiction experts have ruled.
In a new sweeping definition of addiction, the American Society of Addiction Medicine (ASAM) has noted that both behavioral and substance addictions cause the same major changes in the same neural circuitry: Hypofrontality, sensitization, and desensitization.
This the first time that ASAM has taken an official position that addiction is not solely "substance dependence," point out Gary Wilson and Marnia Robinson, who write extensively on the issue of porn addiction.
This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system.
Food and sexual behaviors and gambling behaviors can be associated with the "pathological pursuit of rewards" described in this new definition of addiction.
The fact remains that unlike the brains of gambling, food, videogame addicts, the brains of sex/porn addicts have not yet been scanned. Yet the brain mechanics of behavioral addiction are already so well defined, that experts can say with confidence that sexual behaviors are also potentially addictive. In other words, it's not the form or quantity of a stimulus, but rather the resulting brain changes, which matters.
But a clear implication of the ASAM statement is that one cannot define "porn addiction" by time spent viewing or genres watched. Porn addiction exists only if the relevant brain changes have occurred in the viewer.
Since brain scans are impractical, ASAM has created a five-part assessment to help people figure out if their brains have changed.
One must watch out for -
Inability to abstain;
Impaired impulse control;
Diminished grasp of one's problems; and
Problematic emotional responses.
In a press release the ASAM stated: The new definition resulted from an intensive, four‐year process with more than 80 experts actively working on it, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the country.
Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined by what's going on in the brain.
The new definition leaves no doubt that all addictions—whether to alcohol, heroin or sex, say—are fundamentally the same.
Dr. Raju Haleja, former president of the Canadian Society for Addiction Medicine and the chair of the ASAM committee that crafted the new definition, said, "We are looking at addiction as one disease, as opposed to those who see them as separate diseases. Addiction is addiction. It doesn't matter what cranks your brain in that direction, once it has changed direction, you're vulnerable to all addiction."
Sex or gambling or food addiction [are] every bit as medically valid as addiction to alcohol or heroin or crystal meth.
Here is a brief summary of ASAM's major points:
Addiction reflects the same brain changes whether it arises in response to chemicals or behaviors.
Addiction is a primary illness. It's not necessarily caused by mental health issues such as mood or personality disorders. This puts to rest the popular notion that addictive behaviors are always a form of "self-medication" to ease other disorders.
Both behavioral and substance addictions cause the same major changes in the same neural circuitry: Hypofrontality, sensitization, and desensitization.
Engagement in chronic "addictive behaviors" indicates the above brain changes have occurred. Addictive behaviors then become unconscious and habitual.
The new definition eradicates the old "addiction vs. compulsion" distinction, which was often used to deny the existence of behavioral addictions, including Internet porn addiction.
Addicts share common brain changes, which show up in behavior as unsuccessful attempts to control use, cravings during abstinence periods, and withdrawal symptoms.
To date, the underlying brain changes seen in all addicts (desensitization, sensitization, and hypofrontality) have already been observed in the brains of compulsive gamblers, overeaters, videogamers. It's likely they are present in today's compulsive porn users as well. If it walks, talks and acts like a duck, it's a duck.
Today's healthcare providers and popular advice columnists are often misled about the risks of Internet porn use—in part because they know that masturbation (without porn) seldom results in addiction. Trouble is, Internet porn is not mere masturbation. The belief that masturbation and Internet porn are the same demonstrates a lack of understanding of the potential brain effects of constant novelty.
Normally, masturbation leads to feelings of satiety. In contrast, Internet porn can override natural satiety. In some brains, overriding natural satiety with extreme stimulation is the slippery slope to addiction-related brain changes. This misunderstanding results in poor advice to patients/clients/readers.
When researchers someday look into the brains of Internet porn addicts, they are sure to see the changes already observed in other kinds of Internet addicts.
But only with broader knowledge of addiction, its symptoms, and its etiology can researchers and their subjects correctly connect cause with effect. The ASAM statement supports researchers in investigating porn use through the lens of brain changes.
ASAM's declaration is a step forward in helping to reeducate therapists and their clients. Many were erroneously taught that sexual behavior addictions could not arise from overstimulation of the brain via behavior. Instead, they were trained to assure clients that addiction to sexual behavior was never a risk—unless the client had other (often genetic) disorders.
Yet ASAM authors estimate that genetics only make up about half the cause of addiction. This means that addiction can develop in the absence of pre-existing conditions.
In other words, porn-related symptoms such as depression, social anxiety, youthful sexual performance issues and concentration problems need to be viewed as possible consequences of addiction, instead of being presumed always to be their cause.
The new statement thus places responsibility on therapists to help sex and porn-addicted clients make fundamental changes to their behavior. At the moment, many counselors simply refer clients to a doctor for psychotropic and sexual-enhancement drugs—while assuring them that their sexual behavior is typical and harmless.
The ASAM statement is a big step in a sound direction, conclude Gary Wilson and Marnia Robinson.