Is pornography addiction real? Do people get as addicted to Pornhub as they do, say, drugs or alcohol? Yes and no. Too much porn can certainly became issue but whether or not it’s truly addictive depends on who you ask. Dr. Suzanne Rapley, a psychologist and Certified Sex Therapist Diplomate who has been treating self-described porn and sex addicts 35 years, has taken a middle-of-the-road approach throughout her career. She knows that there isn’t much evidence to suggest that porn is a physically addictive substance in the scientific sense. But she’s also aware that her patients describe their issues with porn in the way that most people talk about addiction: craving, excitement, secretive behavior, and shame. So she deals with their personal feelings and helps them achieve help.

We spoke to Dr. Rapley about why sex addiction is such a contested issue, what different psychologists think about porn addiction, how she helps her patients, and why, above all, we should remember that sex is normal.

There seems to have been some debate about this, so let’s get it out of the way: is porn addiction real?

There are two minds about sex and porn addiction. There’s the AASECT (American Association of Sexuality Educators, Counsellors, and Therapists) method. I’ve been an AASECT member for many years. We don’t want to pathologize people, particularly around sexuality issues. It’s already such a loaded topic. We want evidence-based research that drives and informs our treatment. The other “sex addiction” method is from Dr. Patrick Cranes. He was writing about what he was calling sexual addiction, or compulsive online behavior.

Did that look like drug addiction?

Well, we know that when a person masturbates and has orgasms, there are certain chemicals that are released: feel-good chemicals, like dopamine and oxytocin, which create attachment and bonding. With new neuroscience that has been coming down the pike for many years, we’ve seen that when people are addicted to drugs and alcohol, there are brain changes. Parts of the brain light up when presented with the possibility of scoring cocaine. We don’t have the evidence that says that occurs when people are exposed to porn.

So it’s not as physically addictive as, say, heroin.

In the “sexual addiction” camp, they believe cybersex or pornography online has been the crack cocaine of the Internet. It’s intense stimulation. We know the brain gets stimulated when you’re looking at exciting images, just like when we go see, Raiders of the Lost Ark. There’s lots of chemistry.

With porn, there is visual stimulation. It’s very provocative, because of that three-letter word: Sex.

So masturbation plus porn equals addiction?

Some doctors believe the behavior of masturbation to porn begins to cause sex addiction. Professionals think of it as the precursor to change in the brain. We just haven’t been able to see it yet.

So like — withdrawal? Cravings? Obsessive thoughts? More and more hits of porn to feel good? That kind of thing?

Yes, but that’s identified by self-report. We know there are some predispositions and genetic predisposition for substance abuse. We haven’t found that with the sexual acting out.

The AASECT model believes in compulsive behavior. If we call it a compulsive issue, then we’re dealing with a mental health issue.

So… porn addiction is kind of an addiction, but it’s also kind of not.

It gets complicated. Unfortunately, people are in one camp or the other. AASECT wants to be very inclusive. They’ll call it compulsive behavior. With compulsive behavior, what matters is the motivating factor. When you’ve got a compulsive behavior, you’re trying to self-soothe, to take care of yourself in some way.

When I’m working with people, I actually swing back and forth between these two models.

In what ways do you feel that porn addiction aligns with substantive addictions?

I have patients who come in and say that they’re online for 6 to 8 hours a day or longer, or that they lost their jobs because of it. When it’s the end of the day and they’re excited to go home, have a drink, get online… All of those things that are classic drug-behaviors. These are behaviors that that build excitement and even withdrawal. We can use sex as a way to soothe ourselves.

I’ve heard from other men who identify as porn addicts that the internet really made things worse for them. Do you think that’s valid?

Anonymity, the accessibility, and affordability: that’s what porn online really offers. Years ago, people had to pay to see porn. Now, it’s everywhere,. The web doesn’t shut down. It’s 24/7. You can do it at any time.

So do you use the term porn addiction? And if you do, when do you diagnose a patient with it?

If my patients use the term addiction, I will call it that, but I will ask them to define what they mean. If my client says: “I think about it, I get excited about it, I’m planning, I make it happen, I get off, I then feel bad, I feel shame, I’m doing it secretively and I know there’s risk involved and I keep going back,” that’s how they will begin to define themselves as an addict. That’s the classic definition of addiction. A good therapist will stay where the client is.

What do you think about using an AA method for porn or sex addiction?

I will not pathologize people. Instead, I work with them, and I frequently ask: When you start getting excited about acting out, what are you feeling? I dive into the compulsive behavior that’s driven by underlying feelings, and the desire to self-soothe. We know enough about the brain that with anything that we do over and over, we’re putting down the neural pathways. Those take some time to break.

A long time ago, when the health food kick started, people started saying: “You are what you eat.” Now, I say: “You are what you expose yourself to over and over and over again.”

So why can porn addiction or sex addiction be a problem?

When I’m working with my clients, I want to get a very detailed picture of what exactly is happening. I’m looking at their cognitive life. They’re thinking about themselves, and what they’re thinking relates to the behavior.

If addicts are discussing their feelings when it comes to addiction, what they talk about is affect regulation. They’re overwhelmed. They’re trying to regulate, again, or soothe their feelings and emotional state. One of the ways we regulate our emotions is through behavior. We go running, we have sex, we go online. We masturbate. We go get a beer. We’re trying to soothe ourselves.

Usually, people I see want to change their behaviors because somehow it’s getting in the way of them living a fully healthy, productive life. Either they’re isolating, or they are feeling shame and embarrassment, or it’s eating up their time.

So if usage is getting in the way of their happiness — or their real life— that’s when you really want to start working on behavior.

Sex is not bad! Sex is simply sex. It’s a behavior. But it’s the meaning we give that behavior that creates all kinds of turmoil and angst. When people feel bad, we try to self soothe. Or if we’re bored, we try to self-soothe. I have to encourage people in treatment to get out there and start, you know, living! Part of my job is help people regain interest and enthusiasm for living.

This article was originally published on July 13, 2018