Critiquing "Self-proclaimed porn addict hopes to make porn harder to access", by TV station KPRC, Houston, Texas

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Link to TV segment (April 06, 2017).

The 3-minute segment featured Gabe Deem, Dr. Donald Hilton, and AASECT certified sex therapist Emily Deayla, MA. My first concern is with the segment's headline:

"Self-proclaimed porn addict hopes to make porn harder to access"

Two objections to this headline:

1) It spins Gabe's porn addiction as "self-proclaimed", suggesting it wasn't real. It is telling that this TV segment omitted numerous details Gabe includes whenever he tell his story (for example this presentation or this TV interview). Gabe not only experienced chronic erectile dysfunction that took over 9 months to heal, he also experienced significant withdrawal symptoms, followed (eventually) by many unexpected cognitive and emotional benefits.

2) The headline emphasizes what was probably a throwaway comment, rather than Gabe's core experience of severe porn-induced ED and how removing a single variable healed his sexual dysfunction. No doubt Gabe spent considerable time describing the forums where thousands of young men recount stories like his. Gabe also provided descriptions of many studies that support the porn addiction model, and porn-induced sexual dysfunctions. Yet the TV station chose a headline suggesting that Gabe's experience was an anomaly, and that he wants to ban porn - which he does not.

Then we have the sex therapist's opinion on want constitutes a "real addiction" (AASECT therapists are not taught addiction mechanisms or how to assess addictions):

Houston sex therapist Emily Deayla said it's wrong to label these men as addicts.

"People can die if they are not weaned off drugs or alcohol so, physiologically, the same thing is not happening when you stop a sex or porn problem. It's two different processes, which is why (you) can't label it as an addiction," Deayla said.

This is the usual spin tactic of re-labeling addiction as physiological dependence (the two are not the same), and invoking the groundless claim that, “if withdrawal can’t kill you, then it’s not really an addiction.” Before we address this ludicrous claim, know that the current state of the research fully supports the porn addiction model:

So why is it scientifically dishonest to claim, as sexologists sometimes do, that addiction only occurs with substances that might cause withdrawal symptoms leading to death?

1) While it's possible that withdrawal from alcohol, benzodiazepines, or opioids could lead to death, this would be a rare occurrence. The truth is, most drug addicts (eventually) quit without medical assistance.

2) If we follow Emily Deayla's logic, cocaine, crystal meth, amphetamines, and cigarettes (nicotine) are not addictive - because withdrawal from these drugs cannot kill you. The "withdrawal = addiction" argument falls apart when we consider that nicotine is listed by some experts as the most addictive substance, yet smokers experience relatively mild withdrawal symptoms.

3) Emily Deayla confuses 'addiction' with 'physical dependence'. It is well established in the addiction field that neither the presence nor absence of severe withdrawal symptoms determines the existence of an addiction. In saying that severe "physical symptoms" must be present for an addiction to exist, Emily Deayla is confusing addiction with physical dependence (or purposely misleading unsuspecting TV producers).

For example, millions of individuals take chronically high levels of pharmaceuticals such as opioids for chronic pain, or prednisone for autoimmune conditions. Their brains and tissues have become dependent on them, and immediate cessation of use could cause severe withdrawals symptoms. However, they are not necessarily addicted. In fact, some would much prefer not to be taking these medications at all. 

Addiction, in contrast to dependence, involves multiple well-identified brain changes that lead to what we know as the "addiction phenotype." If the distinction is unclear, I recommend this simple explanation by NIDA. By the way, men who develop porn-induced sexual dysfunctions are, in fact, dependent upon porn to become sexually aroused or to achieve an erection.

4) Emily Deayla may also be unaware that while severe withdrawal symptoms are not a prerequisite for a substance or behavior to be classified as addictive, many internet porn users are surprised by the severity of their withdrawal symptoms, which overlap with those experienced by cocaine addicts and alcoholics.

Also, researchers have just begun to ask porn users about withdrawal symptoms. Already there are 2 studies on porn users that finally asked about withdrawal symptoms – and both reported that internet porn users experience withdrawal symptoms.

5) Emily Deayla seems unaware that the 2013 DSM-5 has added pathological gambling to its newly created behavioral addiction category, gutting her unfounded claim that only drugs can cause and addiction, and with it the claim that "dependence" equals addiction. See this DSM-5 publication.

6) Emily Deayla also made erroneous claims when she said:

"so physiologically, the same thing is not happening when you stop a sex or porn problem. It's two different processes."

Each addictive drug leads to somewhat different constellation of biological changes (for example, chronic Vicodin use would lead to the brain and body producing lower levels of its own opioids, and down-regulation of opioid receptors). This means that each addictive drug and each behavioral addiction (gambling, porn, food, internet) entails some unique neurological and hormonal changes.

On the other hand, addictions (both behavioral and chemical) also lead to a shared set of neurological changes - disregarded by Emily Deayla. Two major changes that appear to occur in porn addicts are:

  1. the down-regulation of dopamine signaling, and
  2. dysfunctional stress systems (centered around CRF).

These two addiction-related brain changes seem to give rise to many of the withdrawal symptoms experienced with any addiction, such as: fatigue, lack of motivation, anxiety, depression, insomnia, irritability, cravings, restlessness, mood swings, etc. Down-regulation of dopamine signaling is associated with desensitization and habituation, which these studies on porn users reported: 1, 2, 3, 4, 5, 6. And these studies have found dysfunctional stress systems in porn addicts: 1, 2, 3.