Porn addiction is arguably the diagnosis of our time. The idea has thrived in a time of anxiety about the proliferation of free, ever-intensifying adult material — and how it might be changing our relationships, our sex lives and our (zombie voice) braaains. The addiction concept shows up in Hollywood movies, celebrity cheating scandals — even news articles. But a new study suggests there is no evidence that it actually exists.

With the help of an addiction specialist and an expert in neurophysiology, clinical psychologist David Ley did a survey of the existing investigations into porn addiction. The resulting paper is published in the scientific journal Current Sexual Health Reports and concludes that research on "porn addiction" is hindered by "poor experimental designs" and "limited methodological rigor." Ouch. The burns don’t stop there: The authors argue that the porn addiction model ignores the real issues underlying compulsive smut-watching, and that the "lucrative" treatment industry that has arisen to address this new diagnosis has no evidence of effectiveness.

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I spoke with Ley by phone about morally driven research, how to address compulsive porn-watching and why the addiction concept is actually kind of homophobic.

What does the body of research on porn addiction look like?

The literature on porn addiction is really fractured. There are an awful lot of pop media claims that get embroiled into what literature there is on porn addiction. It is not a very heavily scientifically driven field. One of the things I find significant is that in a recent review of basically all research on pornography, they found that less than 1 percent of the 40,000 articles that they looked at were deemed scientifically or empirically useful. The literature is weighted with moral and cultural values. There are tons and tons of theoretical statements that are made but never evaluated. The exact same thing is true for what literature there is on porn addiction. The media, the public and, unfortunately, clinicians and legal professionals are subject to the very heavy weight of all that unscientific literature. They don't know what to sort out and how to use it. I see lots of fairly well-trained clinicians who, because the concept is so embraced uncritically in the media and general literature, don’t know what to believe.

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I was asked to do this article in order to come up with something that was fair, objective and could really look at the questions of addiction, neurophysiology and general sexuality issues. I brought in two eminent co-authors: Nicole Prause, a UCLA researcher with an extraordinary level of expertise in neurophysiology and sexuality, and Peter Finn, a University of Indiana addictions researcher who has no training or approach toward sexuality but is a very established researcher with regard to substance addiction.

And what did you find?

Unfortunately, we found what I expected to find, which is that the literature is so poorly organized and uncritically produced that there is not a lot of clinical or research usefulness to the concept of porn addiction. The overwhelming majority of articles published on porn addiction include no empirical research -- it's less than 27 percent. Less than one in four actually have data. In less than one in 10 is that data analyzed or organized in a scientifically valid way.

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It is a very common statement in all of the porn addiction research that high rates of porn use correlate with high rates of depression, problems at work, et cetera. Overwhelmingly, the research, when there even is research, is cross-sectional in its structure, meaning that they’re looking at people in a snapshot of time, and we can’t generate causality from that. The common assumption in porn addiction research has been that porn is contributing to and causing those negative emotional states and life events. In fact, there have been two or three longitudinal studies that looked at this question, and what they found consistently is that porn is a symptom, not a cause. There do appear to be folks who increase their use of porn as something akin to a coping method when they are experiencing increased levels of depression or loneliness. The reason I think that is important is that it leads us to focus not on the pornography, but on the person. Instead of talking about porn causing these bad feelings, now we can say this person is using porn to manage the bad feelings. Is that a bad thing? Sexuality and sexual arousal is a very effective, perhaps the most effective, method of distracting oneself from negative emotions. There is an assumption in the porn addiction field that using porn and masturbation is negative and unhealthy in some way -- but that is a critically unevaluated assumption that is very heavily driven by cultural bias and norms.

The second thread that we found, which I really think is valuable and is being missed by the porn addiction label, is that there is consistently evidence that higher levels of libido and higher levels of sensation-seeking and higher levels of sexual sensation-seeking seem to predict higher levels of porn use. Again, that is a thread that is present in some of the earliest research and writing on porn addiction, but it has been ignored. It draws us back to the person and the variables or values that they bring to their pornography use, rather than the porn itself.

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What does this tell us then about how clinicians should deal with patients who complain about compulsive and excessive porn use?

It tells us first that clinicians need to be very careful at assessing that individual within the context of their life. What we find is that individuals who are reporting or being reported as having problems with excessive porn use are likely to be male, gay or bisexual, have experienced negative life events in the past, have a high libido and a relationship mismatch around sexual desires. Clinicians, when they run into these conversations, will do best by talking to the people to identify how all these variables play a role in the person’s identification of porn as the problem. The difficulty is that if you take away porn but don’t address the issues in the relationship in communication, in coping, in emotional management, the person’s higher level of libido or desire for excitement and sensation, you have other issues that are being unaddressed or will come up, because porn is not the problem.

If there is so little empirical evidence for porn addiction, why has it become such a popular and widespread concept?

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We put forth three reasons. One is that it is an easy answer. It is an easy answer and an easy scapegoat in a society and a media that applies the concept of addiction to any overuse of anything. Secondly, it is a cultural control of sexuality, and particularly the forms of sexuality that are now widely available and difficult to control due to modern technology. There is the old saying "don’t give away the milk away for free because nobody will buy the cow" as a way of controlling sexuality. Well, porn, and Internet porn in particular, doesn’t just give away milk, it puts it in a high-speed faucet right in your room. That is concerning to society, to people in relationships, because it represents a significant loss of control of sexual expression and experience. Lastly, and this is one of the ones that is gonna be controversial, there is a large, lucrative industry that experiences tremendous secondary gain from the promulgation of this concept. As part of this paper we had a grad student call porn addiction facilities around the country and get an idea of the cost -- and the costs were extraordinary. The average was $675 a day. These facilities were recommending or requiring stays anywhere between 15 and 90 days. Insurance doesn’t pay for this; it is cash only. The other thing that is really troubling is that there is no data to show that these very expensive programs generate positive results. There is an industry -- and unfortunately I count the media in that as well, because the media makes lots and lots of hay by touting the issue of porn addiction, and even by raising the controversy of “is it real or not?” There is a lot of money to be made in keeping this thing alive.

Did your research reveal anything about the concept of sex addiction?

The porn addiction concept is very much an offshoot, a very informal offshoot, of the sex addiction concept itself. Sex addiction likewise has not stood up very well to empirical research. What we’re finding more and more these days is that the claims of sex addiction are based on the pathologization of gay and bi males, male sexuality in general and high libido. The very same thing is true when we look at pornography; it is overwhelmingly used by men. Pornography is used more by people who either have higher numbers of sex partners or have a higher level of sexual desire. In both sex addiction and porn addiction, these are concepts that are turning being a gay or bi male into a disease again. Even with pornography, the research is very clear: gay and bi men use pornography much more than their heterosexual counterparts -- but that use of pornography is not pathological, it’s part of their coming out process, their seeking out normative or consistent depictions of sexual behavior that meets and matches their internal desires, which isn’t present in the general media. Consistently, the research shows that gay and bi men are at far greater risk of being called porn addicts than are their heterosexual counterparts, and that is troubling.

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The most common argument I’ve heard for the existence of porn addiction is that it causes chemical changes in the brain. Is there any evidence of that?

Good question. As you said, it is a very common idea. Unfortunately, this is a scare tactic. It’s just like Nancy Reagan saying, “This is your brain; this is your brain on drugs.” Now it’s, “This is your brain; this is your brain on porn.” What we found is that, again, there is an awful lot of hyperbole. There are a tremendous amount of theories put out about the way porn potentially affects people's brains, but these theories are not being critically assessed. Instead, if it sounds convincing, it’s adopted as true. The research doesn’t support it.

There is a lot of current dialogue about Delta FosB, which is a transcription factor in the development of certain neurochemicals in the brain associated with reward. There have been no studies that have looked at porn related to Delta FosB; these are all hypothetical parallels that are being drawn. There is no research that shows that porn use actually changes someone’s brain differently from any other form of entertainment, including television. There was a study that was talked about from Britain last year where they said, "We did fMRIs on the brains of people who used porn and their brains looked like the brains of alcoholics!" What that study actually shows is that these people regard pornography as something that is reinforcing in their lives. It’s something positive to them. So their brains lit up in response to pornography in the same way that somebody’s brain would light up if they collected model trains and you showed them a picture of a model train. Similarly, people’s brains light up in almost the exact same way if they’re fans of a certain football team and you show them paraphernalia related to the football team. So, what that study actually showed was the people who like porn, like porn. I’m not sure how informative that is. Secondly, that study has still not been published in a peer-reviewed journal. It is a study that was talked about in the media but there has been no critical evaluation of it yet.

In good addiction research, what we find is that there is a transition from a person wanting to use a substance to needing to use a substance, and we can see that transition in their brain. There is absolutely no scientific evidence to date that there is such a transition related to pornography. One other thing about the Delta FosB is that the model for hypersexuality in rats, which is where Delta FosB has been studied, is homosexual behavior. The only way right now to study Delta FosB in humans as it might relate to sexuality would require us considering homosexuality and homosexual behavior as evidence of a Delta FosB brain change consistent with addiction. Again, we are terming male homosexual behavior as a disease.

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The other issue that is a hot-button one, and one commonly made in the media, is that of excessive porn use causing erectile difficulties. We found absolutely no scientific evidence, not a single article of any kind published in psychological, scientific or medical research that even raises the question or suggests that pornography is causing erectile difficulties. Instead, the literature seems to suggest much more difficulties with achieving orgasm as opposed to erectile difficulties. If there are erectile difficulties, what is likely to be the case is either a process of learning and conditioning, which is possible but is not addiction. In other words, if a person is consistently masturbating with a certain stimulus present, could it impede their ability to achieve sexual arousal without that stimulus present? Possibly. It is more likely that men who are masturbating more frequently, and masturbating more frequently to pornography, are more likely to be in a refractory period where their body has difficulty becoming aroused when they try and have sex. One thing we see is the more people masturbate, the longer their refractory periods.

So, you said that there is evidence of porn being associated with difficulty achieving orgasm in men?

Delayed ejaculation, yeah. There are some past and upcoming publications that relate high levels of porn use to delayed ejaculation impeding men’s ability to orgasm. However, one of the overarching issues here is that we are commingling the idea of porn use with masturbation. That’s not good science. It’s not good clinical practice. What I’d ask as we talk about the effect of high levels of porn use is: Are we talking about porn use or are we talking about masturbation? Asking that question forces us to come back and ask, "Are we concerned here with porn or masturbation?" If the issue is masturbation, are we replicating our history where we believed that masturbation depleted people of necessary spiritual and psychic energies?

The one last thing I would say is that there is significant evidence that porn use has positive effects far, far more frequently than negative effects.

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And what are those positive effects?

Porn use/masturbation has significant positive physical health benefits that have been talked about extensively. Porn use correlates with greater acceptance of more modern gender values and greater acceptance of varying levels of sexual orientation and expression. Porn use correlates with healthier relationships. A study that came out recently showed that couples that have talked about one or both partner’s levels of porn use have healthier relationships. One of the things that is clear is that the number of people reporting problems related to their porn use is infinitesimal compared to the people who use porn. However, what does appear to be the case is that it is much more frequent for people to report feeling as though they have difficulty controlling their porn use, as opposed to them reporting actual problems related to their porn use. What that means is that people feel like they have difficulty controlling their porn use and that scares them. But they’re not actually having problems related to the porn use.

Meaning it’s not negatively affecting their relationships or their jobs?

That’s right. Where does that feeling come from? Probably a lot of things. There is nothing like sexuality for triggering irrational anxiety. The other fact is that research, again, is pretty clear that when people are aroused, particularly men, they are more likely to make risky, impulsive decisions. Being sexually aroused affects our judgment. That is an effect of sexuality and arousal, not pornography.