Pornography/Masturbation

Addiction is a Disease

One of the first questions I often get is “why can’t I just stop” or “why doesn’t my son/husband/friend just stop”.    Fathers and others who try to help these addicted individuals may scratch their heads about why “stopping” the behavior is so difficult nowadays.  Many of these fathers and others struggled with masturbation and simply had a “habit” and were able to either cold turkey or stop masturbating within a couple of months and expect others to be able to overcome masturbation or pornography just as easily.  Some of these older men may have viewed pornography in a magazine in their younger years before the advent of the internet and likewise were able to quit more easily than they’re finding with those addicted to internet porn.  These men often underestimate the difficulty those who struggle with overcoming masturbation/pornography addiction today.  This may be due to the fact that without the advent of internet porn, many men had little to no access to porn, so masturbation was something done in isolation (without graphic sexual images).  If porn was available, it was often viewed on a limited basis and was often an image from a magazine rather than readily available videos that could be viewed and masturbated to in private at any time without fear of discovery.

 

The first thing the addictive individual, their family, and those who are supporting them need to understand is that addiction is actually a disease – not a personal weakness or flaw.  And as with any disease, it requires correctly understanding the underlying causes of the disease and getting appropriate and often individualized treatment.

 

Let’s first start with the brain.  The brain is made up of multiple sections.  The outer surface of the brain is called the cortex.  The cortex is responsible for taking various input from the environment and processing it.  The rear of the cortex is the occipital lobe (yellow) and is involved in interpreting visual information.  The sides of the cortex are called the temporal lobes (green) and are involved in interpreting sounds.  The top of the cortex is the parietal lobe (blue) and is responsible for taste and smell as well as touch.  The front of the cortex is the frontal lobe (red) and is where information is processed and decisions are made.  So the frontal lobe would serve as the area of the brain that would put the “brakes” on for someone who is deciding whether or not to view porn and/or masturbate.  Finally the center portion is the limbic system (orange) which is responsible for emotions and addiction. 

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Internet pornography is particularly addictive since it triggers many parts of the cortex.  Visual images fire up the rear of the cortex (occipital lobe).  Sounds from video pornography (typically sexual sounds) fire up the sides of the brain (the temporal lobe).  The top of the brain (parietal lobe) is fired up in two different ways - first displays of oral sex (which often occur in pornography) fires up the centers near the rear of the parietal lobe, while masturbation fires up the front portion of the parietal lobe.  Hence, internet pornography accompanied by masturbation fires up the entire cortex of the brain – receiving multiple hits from multiple sources of stimulus.

On a finer level, folds within the brain are responsible for finer-tuned functions that all seem to get stimulated by the whole pornography process. 

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  • The higher mental (red) area is involved in planning an addictive slip (ensure a door is locked or that others can’t see their screen), but it most often doesn’t coming into play until after a slip has occurred and the ramifications of their actions begin to be processed. 

  • The motor function area is split in two (pink and orange). 

    • The area highlighted in pink is responsible for the eye movements in viewing pornography

    • The orange area is involved in manual stimulation.  

  • The sensory area (light blue) interprets the skin sensations during masturbation as well as flushing of the skin when sexually excited. 

  • The somatosensory area (dark blue) recognizes objects such as parts of the anatomy of individuals acting in the porn. 

  • The visual area (yellow) processes the images seen in pornography. 

  • The Wernicke’s area (lavender) processes the speech and stories told during a pornography video. 

  • The auditory area (light green) processes the sexual sounds from the pornography. 

  • The association area (dark red) helps process the emotional response being elicited from viewing sexual activity and physical feeling sexual excitement. 

  • Beneath the Broca’s area, is a part of the cortex called the insula (not shown in these portions of the brain).  The insula is involved in consciously acting out on urges (in this case, sexual urges) in the face of great risk.  This area is thought to override our conscious fears in our natural world to accomplish something rewarding but necessary (protecting the family from an intruder, hunting a dangerous animal for food, etc.).  These fear-overriding functions of the insula are thought to neutralize the negative consequences of acting out on an addiction, thus driving men back to porn \again and again. 

  • As you can see, nearly every part of the brain is fired up and is activated during a session of pornography viewing with masturbation.

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The inside sections of the brain contains structures that we collectively call the limbic system as well as the “reward” center of the brain.  The hippocampus is involved in memory.  This hardwires and even creates the ability for men with addictions to “auto-pilot” into their addictive behavior without giving it much thought.  The amygdala is the part of the brain that senses inward emotions such as joy, fear, excitement, anger, etc.  The hypothalamus on the other hand deals with outward emotions such as laughing, crying, screaming, etc.  The hypothalamus is also the master regulator in the brain – it controls sleep cycles, temperature (sweating and shivering), stress responses (heart rate), physical drive (energy), sex drive (libido), and it controls the pituitary gland.  As a reminder, the pituitary gland controls hormone secretion throughout much of the body.  FSH and LH are released by the pituitary to increase testosterone and sperm production (increases in testosterone will increase the desire for sex and thus the desire for acting out on a porn and/or masturbation addiction).  The pituitary also releases oxytocin, the bonding hormone released during ejaculation, thus bonding the man to whoever he’s with.  Or in the case of pornography, he will “bond” to whoever he’s watching when he ejaculates. 

This central area of the brain also contains the structures that are largely involved in addictive behavior.  Initially we will begin with discussing the Ventral Tegmental Area (VTA) and the Nucleus Accumbens (NAc).

The VTA is located at the top of the brainstem.  It releases a chemical called dopamine when it is stimulated by opiates or nicotine.  It is well known that people become addicted to opiates (narcotics) and nicotine (tobacco).  However, the body is able to make its own opiates in the form of a chemical called endorphin (which stands for endogenous morphine or “morphine made by the body”).  When the VTA is stimulated by an opiate, including endorphin, it releases dopamine.  Dopamine then stimulates the reward center of the brain called the NAc.  The NAc is one of the main centers of addiction in the brain.  However, this may be a little bit of an oversimplification since dopamine affects multiple parts of the brain involved in addiction.

 

Dopamine from the VTA actually travels six main areas of the brain (see the yellow arrows in the illustration below).

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  • The nucleus accumbens (NAc) perhaps gets the bulk of dopamine from the VTA.  The NAc is the pleasure center of the brain and gives the individual a natural “high” – basically an overwhelming feeling of pleasure, wellbeing, invigoration, and even relaxation.  The NAc is often regarded as the center of addiction in the brain. 

  • The hippocampus is responsible for both emotions and memories.  When stimulated by dopamine from the VTA it causes a sense of pleasure and then stores the memory of what made an addict “felt so good”. 

  • The amygdala which is responsible for our emotional response receives dopamine from the VTA which causes a flood of neurotransmitters and temporarily eliminates depressive symptoms and allows an individual to have a feeling of well-being.

  • The cingulate cortex controls behavior to ensure that we receive a pleasure reward, sometime overriding self-will.  In other words, this is the part of the brain that expects a reward and modulates our behavior to ensure that we receive that reward.[i]  In men with porn addiction, it is the part of the brain that pushes behavior forward to ensure an individual acts out on pornography and masturbation to get the necessary reward.  It may be the part of the brain that pushes a porn addict to masturbate to enhance the high or a masturbation addiction to seek out porn to enhance their high.

  • The striatum (also called the dorsal striatum) is also involved in addiction.  It is important in the decision making process[ii] and is involved in motivation and rewards.  Since it is located in the center (non-thinking part of the brain), the temporary rewards of pornography and masturbation are stored in this area.  Over time, the striatum accounts for men compulsively acting out on their addiction (“auto-piloting” into a slip).[iii]  

  • The pre-frontal cortex is responsible for thought processes (whether to act out or not act out on the addiction).  Unfortunately, the frontal cortex is furthest away from the VTA and receives its signal after the rest of the addictive centers of the brain.  However, the pathway is the slowest so it’s mostly designed to assess and process the experience after the fact.

 

Below, arrows indicate pathways between addictive centers that are excitatory. 

  • Three of these from the hippocampus, amygdala, and pre-frontal cortex (purple arrows) further stimulate the NAc.  This additional excitation of the NAc enhance the pleasure and “high” an individual gets during an slip. 

  • The pre-frontal cortex enhances or causes the VTA to produce more dopamine (light blue arrow) thus starting dopamine release in the addictive cycle all over again during a slip.

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The only inhibition in this process is shown in red.  When the NAc receives too much stimulation, it sends a signal to the VTA to stop the process.  This overload frequently occurs during ejaculation. 

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In many cases, ejaculation is when men "become clear" and realize they didn’t really want to slip and have regrets having viewed porn.  This then allows guilt and self-hatred to set in.

Dopamine

Dopamine is the main neurotransmitter (communication chemical) involved in the pleasure portions of the brain that we just discussed.  It’s also one of the three main neurotransmitters in the limbic system involved in mood.  Deficiencies in dopamine can cause clinical depression while excesses in dopamine can cause other mental illnesses like hallucinations.  Dopamine also affects someone’s ability to focus appropriately on a task. 

 

If dopamine levels are too low, people have a hard time concentrating or focusing (this is the cause of ADHD or attention deficient disorder), while people with extremely high levels of dopamine can be “stoned” or “high”. These dopamine effects continue to perpetuate the addictive cycle.  When dopamine levels become low after abstaining from porn and/or masturbation, these men become unfocused.  When dopamine levels are high (when triggered by something to act out), men are “high” and basically making decisions similar to if they were drunk.  So withdrawal and triggers tend to be an addicts two worst enemies. 

 

Dopamine is also involved in increasing sexual desire and speeding up sexual function (orgasm occurs more easily, sexual stimulation can be more intense, and ejaculation can occur more rapidly).  Dopamine is finally involved in reinforcing behavior – eating, survival instinct (hunting), and sex.  Addiction is the hijacking of these reinforcing behavior pathways by excessive indulgence in a behavior that causes an over-abundance of dopamine to be released.  Below are examples of different types of addictions and how these reinforcement pathways become hijacked:

  • Eating example – over-indulgence in eating can lead to addictive eating disorder such as binging and purging. 

  • Survival instinct example – if you’ve ever talked to a hunter, they’ll tell you that it is a rush when they get their game animal.  That one positive experience can keep them hunting even if they fail, fail, fail, fail, and fail.  That one “success” amid repeated “failures” helped hunter/gatherer societies when men went out to hunt for food.  One success was a large enough reward to keep the man hunting, even if he “failed at it” most of the time.  Gambling addiction is actually the hijacking of this survival behavior.  Gambling involves money – the modern equivalent of what is needed to “survive”.  One success (winning the jackpot) can keep someone going back to the casino over and over again despite losing time after time. 

  • Sex example – as we will discuss in the fertility section, there is a very small window in which conception can occur in humans (10 hours during the month).  For this reason, sexual relationships typically need to be engaged in repeatedly to increase the chances of successfully conceiving.  When men engage in sexual activity (seeing their sexual partner naked and experiencing orgasm), this reinforces his sexual behavior to bring him back to his spouse repeatedly in an effort to increase the chances that his wife will become pregnant.  Pornography and masturbation addiction hijack this pathway by allowing a man to “see “ a potential sexual partner by viewing porn and experiencing orgasm through masturbation – bringing him back for more and more sexual experiences repeatedly.

 

In reality, all addictions are hijacking of the dopamine pathways in the pleasure centers of the brain we’ve just discussed.  So what really causes “addiction” and why don’t people just stop?  One answer is when the brain is engaged in a larger-than-normal release of dopamine (or too frequent release or dopamine) the following occurs:

  • VTA becomes depleted of dopamine and begins to shrink

    • As the VTA shrinks it can’t make as much dopamine so dopamine levels go down

    • As the VTA shrinks it requires a “larger hit” of opiates/endorphins in order to trigger enough dopamine release to stimulate the pleasure centers (harder core porn and longer masturbation times are required over time)

 

  • Pathway to the NAc becomes faster and faster with more use

    • This enhances the instinct or compulsive pathways of the brain

    • This weakens the pathway to the frontal lobe where the thinking part of the bran can “put on the brakes”

 

  • NAc produces more receptors for dopamine so it can experience more pleasure from all the dopamine the VTA is releasing during a porn session

    • This results in the NAc wanting more dopamine.  However, the VTA is unable to provide dopamine unless the addictive behavior becomes more intense or more frequent.  In addition, triggers like seeing the device porn is watched on (computer, phone, etc.) or seeing an immodestly dressed girl, can cause dopamine to dump into the NAc in anticipate that a slip will occur (think of Pavlov’s dogs that salivated at the sound of a bell because they knew they were going to be fed….same principle).

    • When dopamine levels drop or get too low

      • It leads to poor focus --> poor judgement --> increase risk of having a slip

      • It leads to craving--> obsessive thoughts about porn --> planning a slip à a slip

    • When dopamine levels spike (increase rapidly) right after being exposed to a trigger

      • It causes the individual to enter a stoned/drunk state --> poor judgement --> increase risk of having a slip

      • It speeds up pathway to NAc and slows pathway to frontal lobe --> not putting on the breaks à a slip

 

Below is a chart that looks at the effects on the normal, high, and low levels of dopamine:

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Many addicts report that they often feel that before and during a slip they were in some type of auto-pilot mode.  They often describe it as being in a dream that you can remember when you wake up; however, for them it isn’t a dream at all, it actually occurs.  This can be especially devastating in men who truly desire to abandon porn and masturbation, but keep coming back repeatedly.  In some cases they can feel sexually assaulted by themselves, which makes them both the victim and the perpetrator – a difficult thing to sort out at times.

Because addiction is a physical disease that involves hormones and neurotransmitters, not acting out on the addiction can cause physical side effects as these hormones and neurotransmitters become out of balance.  We call this withdrawal.  Major symptoms of withdrawal from pornography and masturbation addiction can include:

  • Mental

    • Difficulties concentrating

    • Obsessive thoughts

    • Depressed mood

    • Irritability/short temper

  • Physically

    • Sweating

    • Shaking

    • Nausea

    • Loss of appetite

    • Headaches

    • Lack of regular rigid erections outside of slips (oftentimes failure of nocturnal erections to occur or occurring less regularly than would be expected)

    • Difficulties resuming wet dreams à prostatic congestion

 

Oftentimes, men don’t realize that they often will engage in their addiction to remove or reduce withdrawal symptoms.  However, many men do, and it isn’t uncommon to hear men say that they were “so depressed that they gave in” or they “couldn’t concentrate” or “just gave in to stop all the bad thoughts” they were having.  Subconsciously the mind knows that giving into the addiction can relieve many of the mental as well as physical withdrawal symptoms. 

 

Perhaps the most common complaint men have when overcoming this addiction is that they feel depressed or lose an interest in things they once enjoyed.  Even though they’re disappointed in themselves when they slip, they often notice that the depression isn’t as bad and that they have a renewed interest in things they once liked in the hours and day following a slip (even though they may feel guilt). 

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In men trying to quit their addiction, this drop in dopamine often causes depression and cravings for the addictive behavior.  Medications that help regulate dopamine levels and keep them slightly elevated are often very effective in treating depression associated with addiction withdrawal – with the added benefit of often decreasing cravings for pornography or masturbation.  The main medication used for this purpose is an antidepressant called buproprion.  This medication comes in immediate-acting and long-acting formulations which both work well for depression.  However, only the longer acting formulations decrease cravings (in fact, the shorter acting versions may actually increase cravings by increasing dopamine levels quickly which may mimic the dopamine rise seen in addictive triggers). 

[ii] Balleine BW, et. al. The Role of the Dorsal Striatum in Reward and Decision Making J Neurosci, 1Aug2007, 27(31) 8161-5.

[iii] Everitt BJ, Robbins TW, From the ventral to the dorsal striatum: devolving views of their roles in drug addiction; Neurosci Biobehav Rev; 2013 Nov; 37(9 PI A): 1946-54.

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