It’s no secret that the COVID-19 pandemic has presented challenges for patients living with addictive behaviours. There has been widespread coverage of escalating rates of alcohol and substance misuse alongside ‘behavioural addictions’ such as gambling and shopping, but the lesser-reported sex and love addiction, cybersex or problematic online pornography usage has also seen an explosion in numbers globally.
Recent media reports indicate that half of UK adults watch porn. According to Ofcom’s 2021 Online nation document, Pornhub was accessed by 15m people in September 2020 while OnlyFans saw a 75 per cent increase in new subscribers from May 2020. The pandemic has led to people becoming more introspective about their sexual behaviours, and for some this shift will develop into pathological addictive-type sexual behaviours. The problematic consumption model of online pornography benefits from the ‘triple A’ factor – anonymous, accessible and affordable.
Love and porn addiction isn’t recognised as a mental health condition by the recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, sex addiction, masturbation addiction, and porn addiction are usually referred to as compulsive sexual behaviour, hyper sexuality disorder or out of control sexual behaviour. Sex addiction can also be characterised by multiple sexual partners or interaction with sex workers, while love addiction behaviours can include returning to damaging relationships or craving attention from new or multiple relationships.
Clouds House, our residential addictions rehab, has seen an increase in enquiries for sex, love and pornography treatment. A year of lockdowns has created conditions whereby people who are feeling isolated turn to sex and porn as a method of coping, just as it has for other addictions. In addition, the fact that sex, sex and love, and porn addiction are becoming more recognised within society as a set of behaviours which culminate in destructive consequences has meant that men – and, slowly, more women – are starting to reach out for help.
Over the past five years, Clouds House has experienced an increase in people accessing treatment for sex and love or porn addiction as their primary addiction. Historically it’s emerged within the context of other addictions. Access to porn anytime, anywhere is problematic and a significant challenge – those with an addiction to pornography will access porn content in a continued quest to alter moods by searching for newer, more stimulating and sometimes violent/coercive content, and with an escalating habit their tolerance and choice of more extreme pornography increases.
This a manifestation of someone’s journey to dependency, and measurement of the true scale of the problem is challenging given the associated stigma. The shame surrounding this addiction is considerable, with significant impact on family and relationships as this dominant relationship with the online pornography behaviour takes increased salience and control.
Recovery from addiction to sex, sex and love, and pornography is possible and the community aspect of therapy is a vital part of treatment, examining how emotional experiences of addiction can often be similar regardless of how the addiction manifests. Treatment for sex/love and porn addictions is as challenging for individuals as treatment for any other addiction, and our clinical team engage patients throughout the pre-admission process. Compulsive sexual behaviours can be comorbid with mental health conditions such as depression, anxiety and bipolar affective disorder, and a robust psychiatric assessment assesses for the presence of such comorbidities in this patient group.
Abstinence from sexual behaviours during treatment impacts positively on treatment outcomes. We ask all those joining the treatment community to abstain from all sexualised behaviour including masturbation. The withdrawal experience can be similar to those more commonly recognised with substances – it can be intense and visceral. People do not always anticipate going into withdrawal and therefore need emotional support to understand what they are experiencing. It’s common for patients to experience disorientation, headaches, low mood, anxiety, irritability or depression.
Long-term recovery from sex and love addiction or porn addiction is different from substances or gambling. Sex is a human need the same as eating or sleeping, so abstinence from sex is more complex. A person needs to identify a sense of positive sexuality and be able to move forward with positive relationships, and preparing patients for different types of relationships is key to successful outcomes. Therapists look to realign behavioural reinforcers with meaningful ‘reality-based’ relationships and not the ‘online’ cybersex virtual reality.
For instance, those addicted to pornography are engaging in ‘fantasy’ rather than the reality of physical and emotional intimacy and therefore it is vital to help patients understand how sex might feel different, perhaps even disappointing, within the context of their real-life relationships. Clients can find themselves trying to substitute care, support and nurture for emotional or sexual dependence with sometimes devastating consequences – these might include engaging in physically or emotionally abusive and harmful relationships devoid of emotional intimacy.
It’s also important to consider that there may be cultural and diversity issues revealed during the therapeutic assessment, for example the subculture of ‘chemsex’ in gay communities. A social norm gives the person a sense of belonging to such a community despite the potential risks, harms and consequences. If there are chemicals involved there can be additional important questions to ask, such as what is the client’s relationship with the substances and/or the sexual behaviours? Understanding from a wider perspective than that which fits with binaries of heteronormative culture is important, and what is normal for one person, might not be for another.
Barriers to Women
There is a tendency for more men to seek treatment than women, and more needs to be done to understand the barriers to seeking treatment by women and to find better ways to support women to open up more about sex, love and pornography addictions. As conversations emerge during treatment, therapists find more women open up to their peers about their experiences.
Asking for help with a sex, sex and love, or porn addiction requires a huge amount of courage, and those who make contact with services should be treated with care and respect. Families are often deeply traumatised by their loved ones’ behaviour and it’s important that family support is given throughout the treatment period and beyond where necessary. Mutual support is vital, sustaining recovery through fellowship meetings such as Sex and Love Addicts Anonymous and Sex Addicts Anonymous, in the same way as with attendance at AA or NA.
This type of behavioural addiction is largely unspoken and misunderstood across health and social care. It needs to be recognised and understood more broadly to improve treatment and enable people to reach out for support. Recognising it can go some way to validating the experiences of those engaging in these behaviours and instil some hope that change is possible.
The sector spent many years trying to get gambling addiction properly recognised in the DSMV to legitimise treatment and lower barriers to accessing support. It is now time for sex, love and porn addiction to also be categorised as a behavioural addiction.
Clouds House and Action on Addiction are part of The Forward Trust. Find out more at www.forwardtrust.org.uk or www.actiononaddiction.org.uk/addiction-treatment/clouds-house
Pamela Walters is clinical director at Clouds House