stimulation to experience the same amount of pleasure or reward.11
Such research disproves the argument of pornography advocates that porn is just an expression of a high sexual desire. Those who use pornography most have less response to sexual images, and therefore, less sexual desire. They consume more and more pornography in order to get a brain-reward response.
As a person’s reward circuitry becomes increasingly dulled and desensitized by drugs, nothing else can compete—food, family, and friends lose their relative value, while the ability to curb the need to seek and use drugs progressively vanishes. Ironically, and perhaps cruelly, eventually even the drug loses its ability to produce pleasure, but the compromised brain leads addicted people to continue to pursue it anyway as the memory of the drug and the pleasure it no longer produces becomes more powerful than the drug itself.12
Gradually scientists are gathering evidence that the changes in the brain brought about by drug addiction are also taking place in the brains of sex addicts. While this does not give sex addicts an excuse for their acting out, it does help explain why someone who otherwise makes good decisions will engage in behavior that causes such harm. Why, for example, would a physician engage in unprotected intercourse with a prostitute? Why would a minister who is entrusted with the spiritual guidance of his flock be sexual with parishioners? Why would a successful executive engage in sexual behavior with subordinates that he knows could result in a sexual harassment lawsuit? The only thing that explains such effectively insane behavior is that sex addiction has significantly changed brain functioning—including reasoning and decision-making.
Evidence continues to mount that addiction-based changes in the brain warrant classifying addiction as a brain disease. A recent article in the New England Journal of Medicine concluded that neuroscience continues to support the brain disease model of addiction and that neuroscientific research offers new opportunities for the prevention and treatment of substance addiction and behavioral addiction related to food, sex, and gambling, and may also improve our understanding of the processes involved in voluntary behavioral control.13 It notes that “the concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act.”14 While classifying addiction as a brain disease may be understandably upsetting to partners of sex addicts who believe their partners may use the “disease card” as an excuse for their behavior, viewing sex addiction through the lens of a disease model has important implications for the treatment approaches we use.
1 K. L. Spalding, “Dynamics of Hippocampal Neurogenesis in Adult Humans,” Cell 153, no.6 (2013): 1219–1227.
2 F. Jabr, “Cashe Cab: Taxi Drivers’ Brains Grow to Navigate London Streets,” Scientific American, December 8, 2011, http://www.scientificamerican.com/article/london-taxi-memory/.
3 J. M. Schwartz, Brain Lock: Free Yourself from Obsessive-Compulsive Behavior (New York: Regan Books, 1997).
4 B. Brookshire, “Addiction Showcases the Brain’s Flexibility,” Science News: Magazine of the Society for Science & the Public, August 5, 2014, https://www.sciencenews.org/blog/scicurious/addiction-showcases-brain-flexibility.
5 G. Ciotti, “Supernormal Stimuli: This Is Your Brain on Porn, Junk Food, and the Internet,” Huffington Post, July 17, 2014, http://www.huffingtonpost.com/gregory-ciotti/supernormal-stimuli-this-_b_5584972.html?utm_hp_ref=tw.
6 V. Voon, T. B. Mole, P. Banca, et al., “Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours,” PLOS ONE 9, no. 7 (2014), e102419.
7 Ibid.
8 Ibid.
9 Helpguide.org, “Understanding Addiction: How Addiction Hijacks the Brain,” accessed September 20, 2016, http://www.helpguide.org/harvard/how-addiction-hijacks-the-brain.htm.
10 S. A. Kühn, “Brain Structure and Functional Connectivity Associated with Pornography Consumption, the Brain on Porn,” JAMA Psychiatry, 71, no. 7 (2014): 827–834.
11 Ibid.
12 National Institutes of Health, “The Brain: Understanding Neurobiology—The Essence of Drug Addiction,” accessed September 20, 2016, https://science.education.nih.gov/supplements/nih2/addiction/guide/essence.html.
13 N. D. Volkow, “Neurobiologic Advances from the Brain Disease Model of Addiction,” The New England Journal of Medicine 374, no. 4 (2016): 363–371.
14 Ibid.
IS THERE AN “ADDICTION GENE”?
We know genetics likely play a role in the development of alcoholism.15 Although there is speculation that genetics may also play a role in the development of sex addiction, there is as yet no clear scientific evidence to support this. Although genetics may make some people more susceptible to developing addiction, susceptibility does not translate to inevitability.
Furthermore, genetics alone cannot explain addiction. Environmental and social factors also play a role. Even when addiction is kept secret, as is typically the case with sex addiction, people with active addiction tend to be preoccupied, emotionally unavailable to their families, and frequently absent physically in order to pursue their addiction. Addicts are often so self-absorbed they are not able to give their children the care and attention they need. Children may never see evidence of a parent’s addiction but the consequent neglect, lack of emotional and often physical availability, and perhaps the imposition of demanding standards and harsh discipline may set the stage for addiction to develop as those children grow.
My therapist said I should see a psychiatrist. Why would he suggest that?
Being evaluated by a psychiatrist prior to or at the beginning of recovery is generally recommended. This is part of the “due diligence” process to either confirm or rule out other problems that may impact problematic sexual behavior. The presence of certain conditions may help explain a wide variety of behaviors including compulsive sexual behavior. Psychological risk factors include attention deficit hyperactivity disorder, mood disorders like depression and bipolar disorder, obsessive-compulsive disorder, anxiety disorders, and personality disorders.
