Addiction Model For Treatment Of Compulsive Sexual Behaviours

Question 1

Marina Robinson and Gary Wilson (YourBrainOnPorn) hypothesis:

Answer 1

• natural addictions arising from needs like food and sex have same neurochemical effect on the brain as drug-related addictions
• hijack evolutionary mechanisms (eg the Coolidge Effect, binging food after a kill to survive until the next one)
• internet porn perverts the evolutionary mechanism

Question 2

How does Internet porn pervert the evolutionary mechanism for satiation?

Answer 2

• persistent spikes in dopamine trigger the release of deltaFosB
• continuous stream of new sexual mates from internet porn cause deltaFosB to accumulate
• accumulated deltaFosB -> physiological changes (numbed pleasure response, hyper-reactivity to porn, erosion of willpower) -> cravings and addiction-like symptoms

Question 3

How does internet porn differ from traditional porn to effect addiction?

Answer 3

• multiple available novel mates on the internet sensitize users to porn rather than real sex
• magazines didn’t provide as many options

Question 4

What are the underlying brain changes observed in all addicts (eg overeaters, compulsive gamblers, internet addicts, etc):

Answer 4

• desensitization (reduced responsiveness to pleasure)
• sensitization (hyper-reactivity to addiction-related cues)
• abnormal white matter (weakening of communication between reward circuited and frontal cortex)
• hypofrontality (decrease in frontal-lobe gray matter involved in impulse control/decision-making)

Question 5

What are the reasons that Dr. Marty Klein refutes the addiction model for sex?

Answer 5

• addictions are likely secondary to other root causes such as bipolar, OCD, borderline, or just masturbating too much
• focussing on porn masks the real problem: the individuals inability to deal with immature decision making
• most people who view porn have no problem with it
• porn does not cause brain damage, erectile dysfunction, or loss of sexual interest in one’s mate

Question 6

What is Dr. Pfaus’s position on porn and masturbation?

Answer 6

Porn -> chronic masturbation

- BUT masturbation is the primary problem through inhibition produced by serotonin in refractory periods

Question 7

Position of American Society of Addiction Medicine on addiction:

Answer 7

• addiction is a primary illness, not just a coping mechanism
• all addictions imply the same fundamental brain changes
• extinguishes the moral stigma around addiction

Question 8

DSM position on behavioural addiction:

Answer 8

• addiction no longer applies only to substances like alcohol but also to behaviours such as pathological gambling
• opens way for new behavioural addictions to be classified
• implies little/no conscious choice in compulsive behaviour

Question 9

Why is true compulsive behaviour equated with addictive behaviour?

Answer 9

• compulsion is same set of brain events that promotes persistent overconsumption initiated by deltaFosB

Question 10

What is Dr. Hilton’s argument for evidence of sex addiction despite the lack of randomized, controlled trials?

Answer 10

• “tapestry of research over the decades”
• applies to research on tobacco addiction despite never performing randomized control trials of giving some children cigarettes and others not

Question 11

Benefits of the addiction model for compulsive sexual behaviour?

Answer 11

• therapy and behaviour change (targeting the emotional-psychological roots of decision making while curbing the problematic behaviour)
• recognize the power of porn to condition sexuality
• refine the model and treatment through understanding what (and what is not) an addiction
• reduce the stigma of blame and “you’re making it up”

Question 12

How is the sexual addiction movement affecting professionals?

Answer 12

• people are now self-diagnosing as sex-addicts
• non-sexologist professionals are also diagnosing
• dilution of training materials (programs offered by non-sexologists)
• leads to negative climate around sex/sexuality demonstrated in anti-sex legislation, anti-porn, homophobia

Question 13

What is the definition of sexual addiction and what percentage of the population does it impact?

Answer 13

• Someone who frequently does/fantasizes sexual things s/he doesn’t like
• Someone whose sexual behaviour has become unstoppable despite serious consequences
• Sexual thoughts/behaviours more important than relationship, family, work, etc.
• Sexual behaviour doesn’t support concept of highest self
• 6% of Americans are sexual addicts by this definition

Question 14

What are the clinical implications of the sex addiction model?

Answer 14

• It sees powerlessness as a virtue (when virtually everyone has the ability to control the expression of powerful urges)
• It prevents helpful analysis by patients and therapists (prevents the treatment of underlying problems because it is the behaviour that must be fixed)
• It trivializes sexuality (prevents the recognition of splitting, or trying to remove call the darker desires that are part of healthy sexuality as addiction and dissociate from them)
• It makes a disease out of what is often within reasonable limits of sexual behaviour
• It doesn’t teach sexual decision-making skills or how to evaluate sexual situations
• It is moralistic, arbitrary, misinformed, and narrow

Question 15

What are the professional implications of the sex addiction model?

Answer 15

• It reduces the credibility of sexologists
• It replaces sexologists with non-experts (such as addictionologists and 12-steppers who have little training and are often in recovery themselves)
• Replaces training in sexuality with training in addiction only (and no differential diagnosis ability)

Question 16

What are the political implications of the sex addiction model?

Answer 16

• It strengthens society’s anti-sex forces (because porn causes addiction)
• It emphasizes negative aspects of sex (creates special-interest group of individuals victimized by their own sexuality)
• It frightens people about the role of sexuality in social problems (blame for destruction of marriages, childhood masturbation, and child molestation)
• It focuses on the dignified purpose of sex (confinement of sexual expression)
• It obscures the role of society in distorting our sexuality (institutions make guilt-free sex almost impossible)

Question 17

What are the reasons for the popularity of the sex addiction model?

Answer 17

• It distances person responsibility for sexual choices
• It provides fellowship (through structure and relaxed human contact in SA-type meetings)
• It provides pseudoscientific support for the intuitive belief that sex is dangerous (legitimizing sex-negative attitudes, supporting sexual guilt)
• It lets people self-diagnose
• It encourages people to split
• It helps people get distance from their sexual shame

Question 18

Why do so many people claim to get relief from sexual addiction programs?

Answer 18

• The recovery process may be emotionally reassuring for many people (offers structures, goals, fellowship, acceptance); people get to hear stories about others who are worse off
• People enjoy feeling like they’re heading somewhere (but without ever actually getting there) -> symptom relief without any ethical conflicts
• Addicts transfer some of their compulsively to the SA-type group meetings

Question 19

What is the difference between most self-identified sex addicts and those who are actually sexually compulsive?

Answer 19

• most self-identified sex addicts aren’t out of control but relatively normal neurotics for whom being in control is painful
• those who are really sexually compulsive are typically psychotic, sociopathic, character-disordered, etc. (Some have impaired reality testing, others have no concerns for consequences of behaviours) - undifferentiated sexual urgency can be a symptom of manic depression