# Motivation and emotion/Book/2013/Porn addiction
## Overview

Pornography addiction is a behavioural addiction characterised by an inability to resist an urge or drive to use Pornography, which causes serious negative consequences to one’s physical, mental, social and/or financial well-being (Twohig, Crosby & Cox, 2009). It shares similar characteristics to other addictive behaviours such as gambling, binge eating disorder, substance and alcohol use, compulsive sexual behaviour, kleptomania, and Internet addiction (Carnes & Wilson, 2002; Grant, Schreiber & Odlaug, 2013). While not problematic for everyone, it is evident from research and literature that viewing pornography, like other addictive behaviours, can become problematic for certain individuals (Cooper, Delmonico & Burgs, 2000; Twohig, Crosby & Cox, 2009).

## Internet Pornography

The amount of adult-entertainment websites continues to grow in recent years, according to data based on a 2006 study, it is estimated that the porn industry generates $13 billion each year, and there are more than 4.2 million pornographic websites available (constituting 12% of total websites), with 72 million internet users visiting adult sites per month (Ropelato, 2006). So what makes Internet porn addictive? According to Cooper (1998), there are three factors that can explain the tremendous growth and attractiveness of the Internet Pornography: Access, Affordability, and Anonymity. The omnipresence of desktop computers, laptops, smart phones, tablets and other electronic devices allows immediate access to millions of pornographic websites anytime, anywhere. The Internet also enables people to access pornography anonymously, therefore Internet users of all age can access sexually explicit content that is otherwise restricted for legal or social reasons. And because many pornography websites provide free content (such as images, videos, texts and etc.), it is affordable to viewers of every age and social status.

## Prevalence

It has been estimated that 87% of college age men view pornography, 50% weekly and 20 daily or every other day, with 31% women viewing as well (Hilton & Watt, 2011). According to Ford, Durtschi and Franklin (2012), seventeen percent of Internet porn users are estimated to be addicted. And approximately 9% of several million users of Internet pornography spend 11 hours searching for and viewing pornography per week.

## Why does it happen
### Neurobiology

Addiction occurs when pleasure/reward pathways are hijacked by exogenous drugs such as cocaine or opioids, or by natural processes essential and inherent to survival such as food and sex (Hilton & Watts, 2011). Considerable amount of evidence suggests that all drugs of abuse converge on a common circuitry in the brain’s limbic system. Most attention has been given to the mesolimbic dopamine pathway (reward circuit). This pathway is one of the most important substrates for the acute rewarding effects of all drugs of abuse (Nestler, 2005).

### The reward circuit

The reward circuit is a collection of brain structures that regulate and control behaviour by inducing pleasurable effects. It was first discovered by James Olds and Peter Milner in 1954 in a study to test whether stimulation of certain brain areas might influence behaviours of rats. In the study, they implanted electrode in the brainstem of a rat, when the rat received the brain stimulation, it would sit up, look around and sniff, as if reacting to a favourable stimulus. Olds and Milner later placed rats in boxes where they could press a lever to produce electrical self-stimulation of the brain. Because the rats controlled when the brain is stimulated, the rats could engage in intracranial self-stimulation, and they would sometimes press the lever as often as 2000 times per hour (Olds & Milner, 1954; Reeve, 2005). Later researchers found the brain areas that rats would work to stimulate, all have axons that directly or indirectly increase the release of dopamine in the nucleus accumbens.
The reward circuit (mesolimbic system) is consisted of the following structures:

#### Ventral tegmental area (VTA)

The VTA is the primary release site for Dopamine . It supports learning and sensitisation development and releases dopamine into nucleus accumbens and prefrontal cortex. The pattern of release is predictable in proportion to which the person expects and actually receives reward from a particular course of action. When events unfold in ways that are better than expected, an increased dopamine release serves as information that the particular course of action is producing more reward than it was anticipated to deliver. When events unfold in ways that are worse than expected, a decreased dopamine release serves as information that a particular course of action is producing less reward than it was anticipated to deliver (Montague, Dayan, & Sejnowski, 1996).

#### Nucleus accumbens

Located in the ventral striatum, it plays a prominent role in mediating the reinforcing effects of drugs of abuse, food, sex, and other addictions. It is generally believed that this structure mandates motivated behaviours such as eating, drinking, and sexual activity, which are elicited by natural rewards and other strong incentive stimuli (Blum et al., 2012). Drug addiction rewires the nucleus accumbens. Repeated use of drugs of abuse increases its ability to release dopamine in the nucleus accumbens and the individual’s tendency to seek drug (Volkow et al., 2005).

#### Prefrontal cortex

It is the anterior portion of the frontal lobe of the cortex, which responds mostly to the sensory stimuli that signal the need for a movement. It is important for the integration of information which contributes to whether a behaviour will be elicited. It appears to be the area in which motivation originates and the salience of stimuli are determined.

#### Hippocampus

Large forebrain structure between the thalamus and cortex, it is associated with learning and memory.

#### Basolateral amygdala

The amygdala is a large nuclear mass in the temporal lobe anterior to the hippocampus. It has been associated with the assignment of emotions, especially fear and anxiety. There are two, one in each temporal lobe, and their functions may be lateralized.

## Dopamine

Dopamine is a neurotransmitter that is involved in drug consumption and addiction. It is released in the nucleus accumbens and prefrontal cortex, resulted from rewarding experience such as food, sex and neutral stimuli that become associated with them (Volkow, Fowler, Wang, Swanson & Telang, 2007; Hall, 2011). Activation of the dopamine pathway plays a significant role in the biology of reward. Dopamine release following unexpected reward allows people to learn that event’s motivational significance, it defines an event as a rewarding event, when encountered in the future, will likely produce a rewarding experience (Reeve, 2005).

## Delta FosB

Delta FosB is a protein found in the nucleus accumbens related to over/compulsive consumption of two natural rewards: Eating and Sexuality. It is associated with development of addiction and control of the reward system. It was first found in the neurons of animals studied in addicted subjects but now has been found in the nucleus accumbens related to over-consumption of natural rewards (Hilton & Watt, 2011). Delta FosB is induced in the nucleus accumbens and dorsal striatum by all drugs of abuse after chronic administration. It is a relatively stable protein, as a result, once induced, it persists in the brain for a period ranging from several weeks to months and could maintained transcriptional change associated with addiction long after the last drug exposure (Zachariou, 2006).

## Neuroplasticity

Neuroplasticity is the putative mechanism behind learning and memory. It involves physical changes in the synapses between two communicating neurons, characterised by increased gene expression, altered cell signalling, and the formation of new synapses between the communicating neurons. When addictive drugs are present in the system, they appear to hijack the mechanism in the reward system so that motivation is geared towards procuring the drug rather than natural rewards (Jones & Bonci, 2005). In a study, sexual experience has been shown to induce alterations in medium spiny neurons in the nucleus accumbens similar to those seen with drugs of abuse. Another study found that sexuality specifically increases Delta FosB in the nucleus accumbens, and serves a role as mediator in natural reward memory (Hilton & Watts, 2011).

## Coolidge effect

The Coolidge effect is one of the primary reasons for the abundance and addictiveness of Internet pornography. It describes the re-initiation of sexual behaviour in a “sexually satiated” animal in response to a novel receptive mate (Fiorino, Coury & Phillips, 1997). This phenomenon can be a mechanism to distribute sperm more evenly, the males that recognise previous partners and show a preference for novel females should have a selective advantage as they can distribute sperm evenly among the females they encounter. In the original study by Wilson, Kuehn & Beach (1963), twenty-five male rats were left with 25 receptive females and allowed to copulate and ejaculate until they reached a criterion of “sexual exhaustion”. At this point replacement of the original female by a new estrous partner sometimes resulted in the resumption of mating activity. Removing and returning the original female had only a slight stimulating effect. This phenomenon has since been observed in a number of mammalian species as well (Dewsbury, 1981; Fiorino, Coury & Phillips, 1997). It explains why Internet pornography can be extremely addictive as high-speed Internet offers literally unlimited variety with an unlimited number of new “partners”.

## Tolerance and Withdrawal
### Tolerance

Tolerance is defined as a need of significantly increased amounts of a substance to achieve arousal or the desired effect; or markedly diminished effect with continued use of the same amount of the substance (DSM-IV-TR). For example, drug users initially achieve a high from the drug with a lesser portion then they would require as their addiction develop. In order to achieve the same effect, the user would need to increase the amount of drug he or she uses. Similarly tolerance can also develop to pornography. After prolonged consumption of pornography, excitatory response to pornography diminishes, the repulsion evoked by common pornography fades and may be lost with prolonged consumption. Thus what initially led to an excitatory response does not necessarily lead to the same level of enjoyment of the frequently consumed material. Therefore, what aroused an individual initially may not arouse them in the later stages of their addiction. Because they do not achieve satisfaction or have the repulsion they once did, individuals addicted to pornography generally seek increasingly novel forms of pornography to achieve the same excitatory result (Ford, Durtschi & Franklin, 2012). For example, pornography addiction may begin with non-pornographic but provocative images and can then progress to more sexually explicit images. As arousal diminishes with each use, an addicted individual may move on to more graphic forms of sexual images and erotica. As arousal again diminishes, the pattern continues to incorporate increasingly graphic, titillating, and detailed depictions of sexual activity through the various forms of media. Zillman (1989) states that prolonged pornography use can foster a preference for pornography featuring less common forms of sexuality (e.g., violence), and may alter perceptions of sexuality. Although this pattern typifies what one would expect to see with pornography addiction, not all pornography users experience this cascade into an addiction (Ford, Durtschi & Franklin, 2012).

### Withdrawal

Withdrawal is a physiological reaction elicited when the amount of a substance is less present or absent in the body. The DSM-IV-TR states that withdrawal is manifested by (a) the development of a specific syndrome due to the cessation or reduction in use that has been heavy and prolonged; (b) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and (c) the same or closely related stimuli are taken to relieve or avoid withdrawal symptoms (American Psychiatric Association, 2000). For example, a person that is addicted to nicotine commonly experiences withdrawal symptoms such as shaking, mood changes, and increased appetite. Withdrawal symptoms from pornography use may include depression, irritability, anxiety, obsessive thoughts, and an intense longing for pornography (Ford, Durtschi & Franklin, 2012).

## Physical and Psychological dependency

Stoleru et al (1999) explored and identified the brain areas active in males when interacting visually with sexually explicit films. The study found that cerebral activity during visual sexual arousal was distributed across limbic and temporal areas mostly in the right hemisphere. The areas active within the limbic system (specifically the rostral limbic system) includes the anterior cingulate cortex, the orbitofrontal and anterior insular cortices, the amygdala and septum, the ventral striatum, and several brain stem motor nuclei including the periaqueductal grey matter (Stoleru, 1999).The anterior cingulate cortex plays an important role in initiation, motivation, goal-directed behaviours and internal emotional responses. Stoleru (1999) suggests that the activation of the anterior cingulate cortex participated in the autonomic, endocrine, and affective response s induce d by the sexually explicit film. Moreover, activation of the left anterior cingulate gyrus has previously been implicated in the incitement of symptoms in OCD which may correspond the need to behaviorally respond to sexual stimulation. Additionally, three regions (orbitofrontal cortex, cingulate cortex, and caudate nuclei) and the thalamus were found to be active which are involved with perceived emotional concerns and repetitive behavior (Stoleru, 1999). In other words these specific brain areas may be partly responsible, or at least explain some of the motivations, for watching pornography and in some cases subsequent addiction.M.m.riggs (discuss • contribs) 10:14, 1 November 2013 (UTC) Stoleru, S., Gregoire, M., Gerard, D., Decety, J., Lafarge, E., Cinotti, L, …& Comar, D. (1999). Neuroanatomical correlates of visually evoked sexual arousal in human males, Archives of Sexual Behavior, 28 (1), 1 -20. doi: 10.1023/A:1018733420467M.m.riggs (discuss • contribs) 10:14, 1 November 2013 (UTC)

## Risks

* Lack of motivation
* Irritability
* Brain fog
* Inability to concentrate
* Mood swings
* Social anxiety
* Increased tendency to participate in dangerous or illegal sexual activity
* Increased attitudes of violence and objectivity towards others
* Increased risk of divorce among married couples
* Employment termination
* Development of unhealthy attitudes towards sexuality
* Erectile dysfunction, delayed ejaculation and inability to orgasm without porn

## Are you addicted to Porn? (Based on Diagnostic Criteria of Pathological Gambling in the DSM-IV)

* Tolerance: Have your use increased or escalated over time?
* Withdrawal: When you stop using, have you experienced physical or emotional withdrawal?
* Difficulty controlling your use: Do you sometimes use more or for longer time than you would like?
* Negative consequences: Continued even with negative consequences to mood, self-esteem, health, job, or family?
* Neglecting or postponing activities: Have you ever put off or reduced social, recreational, work, or household activities?
* Desire to cut down: Thought about cutting down or controlling your use? Ever made unsuccessful attempts to cut down?
* Spending significant time or emotional energy: Obtaining, using, concealing, planning, or recovering from your use? Have you ever thought of schemes to avoid getting caught?

## What can be done about it

* Internet content control softwares
* Psychodynamic psychotherapy
* Cognitive Behavioural Therapy (CBT)
* Abstinence