Treatment for Porn Compulsivity/Addiction: Part 1, Traditional Addicts

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Scott Brassart

For a long time, clinicians treating porn compulsivity/addiction found that all (or at least the vast majority) of their clients had deep and powerful underlying early-life trauma issues – neglect, physical abuse, sexual abuse, covert incest, etc. This put compulsive/addicted porn users very much in line with alcoholics, drug addicts, compulsive gamblers, and the like. In fact, there is a large body of research showing that unresolved early-life trauma is a huge risk factor for later-life addiction (of all types).

Recently, however, clinicians who specialize in sex and intimacy disorders have encountered a new and rapidly growing subcategory of compulsive/addicted porn users. These are individuals who easily meet the criteria that clinicians use to identify porn compulsivity/addiction – excessive preoccupation, loss of control, consequences – but lack the underlying early-life trauma that typically drives addictive behavior. Rather than qualifying as traditional trauma-driven porn addicts, these individuals are what we call digital-age ‘conditioned’ users.

Early in the healing process, treatment for these two groups is, in most respects, the same. The primary focus is on identifying and halting the compulsive/addictive behavior. As treatment progresses, however, the approach diverges. This divergence is necessary because although the two categories of compulsive/addicted porn users may look the same on the surface, they are quite different beneath the surface. The underlying issues driving the behavior are just not the same. Thus, longer-term treatment is also not the same.

In this week’s post, we will look at the treatment approach for traditional trauma-driven porn addiction. Next week, we will look at treatment for conditioned porn use.

Treating Traditional Porn Compulsivity/Addiction

Porn addiction is identified based on three primary criteria:

  • Preoccupation to the point of obsession with pornography.
  • Loss of control over use, typically evidenced by multiple failed attempts to control or quit the behavior.
  • Negative life consequences related to the use of pornography – ruined relationships, reprimands at work or in school, depression, shame, anxiety, social and emotional isolation, loss of interest in non-porn activities, financial woes, legal issues, etc.

Many compulsive/addicted porn users also, as stated above, have deep and painful unresolved early-life trauma issues like neglect, physical abuse, sexual abuse, etc. Over time, they’ve learned to use pornography as a coping mechanism – as a way to escape from and numb their feelings of stress, shame, anxiety, depression, loneliness, boredom, etc. This is also why alcoholics drink, drug addicts get high, compulsive gamblers hit the casino, etc.

Unsurprisingly, traditional porn compulsives/addicts respond well to the same strategies and techniques that work with other forms of addiction. Generally, early treatment focuses on:

  • Stopping the problematic behavior.
  • Breaking through the addict’s denial (justification, rationalization, minimization, and other flawed thinking that makes the behavior OK in the user’s mind).
  • Developing healthier coping skills the addict can turn to when triggered toward relapse.
  • Managing the crisis or crises that pushed the individual into treatment.
  • Identifying (though not yet attempting to resolve) underlying trauma issues that drive the addiction.

To these ends, early treatment includes both individual and group therapy – nearly always a behavior-focused modality like Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT) – paired with social learning, psychoeducation, and 12-step or other recovery-focused support groups. The initial treatment focus is on behavior modification in the here and now.

Longer-term, treatment shifts toward processing and resolving the addict’s underlying trauma issues, as these are the primary driver of the addiction – the underlying reasons the individual compulsively seeks emotional and psychological escape through an addictive substance or behavior.

Typically, trauma work begins in earnest only after the individual has established solid sobriety and developed the ego-strength and healthy coping skills needed to stay sober while doing the emotionally and psychologically stressful work of processing and resolving trauma. If undertaken before solid sobriety is established, with a sobriety focused network of support in place, trauma work can trigger the addict into relapse. That said, for traditional trauma-driven addicts, working through the trauma that underlies and drives the addiction is a longer-term necessity.

In next week’s post, we will look at the treatment of digital-age conditioned porn compulsivity/addiction, examining both the similarities and differences in short-term and longer-term recovery.

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If you or someone you care about is struggling with compulsive or addictive use of pornography, plenty of help is available. Residential treatment and online workgroups can be found at Seeking Integrity: Los Angeles. Free online podcasts, articles, webinars, drop-in discussion groups, and daily inspirations are available through SexandRelationshipHealing.com.