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Last month I posted a blog to this site (click here to read) noting the difference between true sex addicts and those who inaccurately label themselves as addicted based on internalized and/or culturally informed shame about their sexual desires and behaviors, rather than the benchmarks used by treatment specialists when identifying, diagnosing, and treating sex/porn addiction. In that article I noted that treating non-addicted clients as addicted simply because they or the people around them want to label their “undesirable” sexual desires and/or behaviors that way is counterproductive and potentially harmful to the client.

In this post, I want to look at gradations within the sex/porn addicted population. In other words, I wish to point out that even among those who meet the generally accepted criteria for sexual addiction there are differing populations that respond to different treatment approaches—especially when we’re talking about the compulsive use of pornography.

For example, as internet pornography has become more and more ubiquitous, Certified Sexual Addiction Treatment Specialists (CSATs) have seen a corresponding increase in the number and variety of people seeking help with compulsive porn use—individuals who are looking at porn for several hours per day, for days on end, with all sorts of negative life consequences. However, not all of these individuals are created equally. Basically, it appears there are classic porn addicts, along with a secondary group of individuals, mostly younger men, that for the last couple of years I’ve been referring to as either porn conditioned or porn dependent. Others have chosen to call this secondary group contemporary porn addicts, and that may in fact be a better term.

In July, to jumpstart an academic and practical discussion of this burgeoning issue, approximately 25 CSATs from all over the country participated in a teleconference dialogue. The information below is (I hope) a representative summary of our conversation, presented in Q&A format, written primarily to inform the wider therapeutic community about this burgeoning issue.

Are There Multiple Sex/Porn Addicted Populations?

The teleconference clinical specialty group expressed a strong consensus and that yes, we are now dealing with more than one population. First we have a group that qualifies as classically porn addicted. These individuals, like most other addicts, generally have early-life trauma histories that may or may not be difficult to uncover and (eventually, after the addiction is under control) to treat. When these individuals are self-motivated to heal, sex addiction treatment—typically a combination of behavioral therapies, ongoing accountability, external support groups (like 12-step groups), and social learning—is generally effective, though establishing and maintaining sexual sobriety is still an epic struggle. If these men and women are not self-motivated, if they’re in treatment because their mate is pushing for it, or because they’re in trouble at work, or because of any other external motivator, treatment is less effective.

Beyond these classic sex/porn addicts we have a new and emerging cohort that seems less trauma driven and more able to walk away from porn use. Basically, these contemporary porn addicts (the group I have previously called porn conditioned or porn dependent), seem to be able to walk away from porn use, even extremely heavy porn use, with only a modest amount of intervention and support. And when they do walk away, many of their porn related problems (especially things like porn induced erectile dysfunction) tend to dissipate relatively soon thereafter, especially if they replace their porn use with healthy social activities (recreation, socialization, etc.) Basically, these individuals are able to “reboot” their brains and their sex lives, returning to a pre-porn baseline.

NOTE: There are also individuals with inherent and severe social deficits (like individuals on the Asperger’s spectrum). These men and women are generally happier with the non-threatening nature of porn than they would be with a real world sexual relationship. Pathologizing this group for porn use/abuse may not be appropriate, and treatment is likely to be ineffective because they are typically not motivated (or even able) to make significant changes.

How Can We Differentiate Classic and Contemporary Porn Addicts?

Discussion participants agreed that the most obvious difference between the classic and contemporary porn addicted populations is the aforementioned ability to walk away from porn with minimal struggle. Those who can easily walk away are not classically addicted.

A second noticeable difference seems to be the amount and degree of trauma an individual has experienced, though the discussion group admittedly had less consensus on this issue. Several participants expressed concern that CSATs and other clinicians working with contemporary porn addicts might be looking for trauma that isn’t there as a way to justify the behavioral compulsivity they see. In other words, clinicians who assume a client is classically porn addicted might dig for the trauma that typically underlies addiction, only to find out this trauma doesn’t exist. (Within this discussion it was noted how difficult it can be to assess for trauma, and how trauma is hugely subjective, making this process even more challenging.)

Despite the nebulous nature of trauma there was general agreement that classic porn addicts typically do have meaningful and measurable early-life trauma issues—the same as most alcoholics, drug addicts, compulsive eaters, compulsive spenders, etc.—while the newer porn addicted cohort may or may not have these underlying issues. Either way, the contemporary population seems far less challenged by behavioral change than the classic population.

There was also consensus that individuals seeking treatment related to the use of pornography, regardless of whether they’re their addiction is classic or contemporary, tend to struggle with real world relationships, especially romantic connections. They are generally unable to effectively navigate the treacherous waters of dating and sexual exploration, likely because they did not learn these skills (for any number of reasons) during adolescence. So they turn to porn, usually in their teens, as a less emotionally risky alternative to real world intimacy, only to “wake up” in the 20s (or later) with no clue about how to have a romantic relationship.

To this end, it was suggested that there is a difference between developmental trauma and delayed development, and this may be an important differentiating factor between the two cohorts. Most classic porn addicts will display both developmental trauma and delayed development. In other words, their unresolved early-life trauma creates trust issues and developmental delays. Meanwhile, contemporary porn addicts might only have the latter issue, delayed development. Probably they also have some early life trauma (doesn’t everyone?), but it may not be clinically significant. Thus, for the contemporary population the driving factor could be the supernormal stimulus provided by porn, which the user turned to during key developmental stages because it was just plain easier than getting his or her needs met with real people. As a result, relational development is delayed.

Treating These Separate Populations

The participants in the teleconference uniformly felt that classically porn addicted populations, if they are self-motivated, generally respond to the tried-and-true treatment techniques delineated above. Meanwhile, contemporary porn addicts seem to respond to certain aspects of traditional treatment, in particular “sexual sobriety plans” that clearly delineate which behaviors are problematic for that individual, along with suggestions on becoming accountable, while other aspects of traditional sex/porn addiction treatment feel like overkill. Moreover, there was a general belief that treatments focusing on rectifying aspects of delayed development would be more effective with this population.

Several discussion participants recounted illustrative stories of young men putting the porn away, even though they’d been using it heavily/compulsively, and rejoining the world in healthy ways with minimal outside assistance, very few slips, and no propensity for substitute addictions or compulsions. Their general belief, based on these case histories, is that individuals without the deep underlying trauma issues that typically drive addictions may still turn to the supernormal stimulus of pornography during their formative adolescent years, and this can take them away from normal teen development. Thus, these clients experience delayed development in terms of relational intimacy. Later, when the porn goes away and they are walked through healthy development, their issues seem to clear up. There is no fight to help them stay sexually sober. They just put the porn down and move forward.

Clients who are classically sex/porn addicted, of course, look nothing like this. Walking away from an addictive behavior is usually an agonizing process—two steps forward, one and three-quarters steps back. Often, there are multiple slips and relapses, with all sorts of lying and secrecy, deep relational deficits, and many other issue to address. Nearly always, a considerable amount of outside support (individual therapy, group therapy, 12-step recovery, and the like) is needed. Again, this goes back to the primary difference between the two populations: one group can walk away relatively easily, the other cannot.

Other Issues for Discussion

As our teleconference was limited to 90 minutes, we could not fully discuss every issue that was raised. It is hoped that future conversations will address the following issues:

  • We live in a world where porn is accessible 24/7/365 to anyone who’s interested. As such, porn is out there for kids, and for some kids it seems to be something of a go-to coping mechanism for boredom, anxiety, and everything else. What does this mean long-term?
  • As attitudes toward porn change, will our view of porn addiction also change?
  • We need much more information about female porn usage.
  • It is difficult to perform research on young people and porn because we can’t intentionally subject minors to porn. Thus, we must rely on after the fact self-reports and clinical observations. Are there ways to gather accurate data in a more timely fashion?
  • Since so many teens (and even preteens) are looking at porn, sometimes compulsively, what is all of this supernormal stimulation in one particular area doing to their brains? Is it affecting their long-term sexual arousal template? Are we creating Pavlov’s dogs, but with porn?

Your Input is Welcome

The recent CSAT teleconference is, without doubt, little more than a starting point for this conversation. In fact, the group unanimously agreed that further discussion is needed, not only with CSATs but with therapists outside the sex addiction treatment community. Notably, we expect to have another teleconference within the next few months, and I would very much like to bring commentary from non-CSATs to the table. Thus, I am hopeful that if you have thoughts on this issue you will post them below in the comments section. Or you can contact me directly through my website. All feedback is welcome.