by Lucie(n) Fielding
Is sex, to use Nine Inch Nails’ parlance, “the perfect drug”? Many sex addiction model proponents would like to think so. In this guest post, the final in a three-part series problematizing sex addiction, we delve a bit into the science. Is sex a drug? Nope. Is sex addiction a compelling metaphor? You betcha!
I promised in my two previous posts that I would bring the (neuro)science in this, my final post, and for those who have been waiting patiently for this I sincerely hope I will not disappoint. And here I think of The Shepard’s Prayer (Alan Shepard, that is): “Dear god, please don’t let me fuck up.”
But before I get started I need to emphasize one thing: I may problematize particular models for understanding OCSB, and especially the sex addiction model, in this guest post series but I am not in any way critiquing or questioning the lived, felt experience of those people who feel that they or someone they love engage in problematic sexual behaviors or feel out of control. It is, as I tried to say in my last post, neither my desire, nor my intention, nor even my job to disabuse someone of their felt sense of pain.
To those of you who are reading these posts and who may see yourselves in the descriptions of OCSB, ICSB, HD, or even SA, I see you, I hear you, and I very much hope that you will seek out the help you feel you might need. I cannot be that therapist for you right now, but there are a number of qualified folks who can be. I will be quoting from this excellent blog post by Mathis Kennington below, and I would note that there is a list of helpful sexual health-affirmative references at the bottom of the next piece.
Deep, centering breath…ok, now onto falsification…
Falsification is a concept introduced and explored by philosopher of science, Karl Popper (1902-1994). While we may think that the purpose of scientific inquiry is to prove or confirm the hypotheses that flow from research questions, Popper argued that the opposite should exemplify scientific inquiry. Namely, and as this fun video put out by the BBC 4 illustrates, the hallmark of scientific inquiry is to try to falsify (or refute) a hypothesis. “Irrefutability,” Popper explains, “is not a virtue of a theory (as people often think) but a vice.”
So take the example of swans (as the BBC video does). If the claim is made that “All swans are white,” then you wouldn’t go about the world seeking all the white swans there are; rather, you’d want to see if you could find a black swan. And finding just one black swan proves the original claim wrong.
The principle of falsification goes for any model claiming scientific standing. That is, if you can disprove a single one of the central claims or hypotheses of a model then the entire model is false.
This is just what researcher Nicole Prause (an AASECT Institute panelist) has done with respect to the addiction model as it applies to the viewing of visual sexual stimuli (VSS), or to use the more pejoratively value-laden term with which we are more familiar, porn (see Ley, Prause, & Finn, 2014; Prause et al, 2015; and Prause et al, 2016 [in press]).
The Claims of the Addiction Model
When one talks about sex addiction, or one of its behavioral sub-types, such as so-called “porn addiction,” one is essentially theorizing that certain behaviors can act on our physiology and on our personality just as a controlled substance such as a drug in the opiate class (e.g., Heroin) does. This is to say, as Mathis Kennington explains, “sex addicts crave more and more compulsive ‘dangerous’ sex […] because [they] have become desensitized to sexual behaviors, making their brains unable to regulate their need for the pleasure they receive from sex. There’s just one problem: Sex isn’t a drug.”
As David Ley has shown in The Myth of Sex Addiction (2012), the ways that SA model proponents define SA and its etiological and treatment pathways have shifted greatly over time. Given this definitional slipperiness, Ley asserts, “Sex addiction is not falsifiable, as currently identified. Because the theory is so vague and all inclusive, any challenges to the theory can be explained by reference to one of the alternate explanations” (p. 45). Falsification requires clear, fixed, testable hypotheses. So the problem with the definitional slipperiness of a model like sex addiction (or Marxism and Freudian psychoanalysis for Popper) is that its vagueness becomes obstructive, preventing any kind of evaluation other than continual confirmation.
But let’s engage in a thought experiment: let’s say that sex addiction (and its behavioral sub-type, porn addiction) does function exactly like a substance addiction, as many proponents claim it does. In that case, a sex or porn addiction model becomes testable according to the central tenets of a substance addiction model. These hypotheses or predictions include, as Nicole Prause described them in her Institute panel:
- Reward: The consumption of drugs is accompanied initially by reward sensations, namely, pleasure. With certain substances, using the substance is “associated with reward generally” and, particularly the release of dopamine (a neurotransmitter) (Prause et al, 2016 [in press]). The hypothesis here is that engaging in a sexual behavior (such as watching porn) should initially result in reward (a “liking” neurophysiological response).
- Non-hedonic over time: “A key feature of addiction,” Ley, Prause, and Finn (2014) note, “is the shift from using the drug for pleasure (liking) to using the drug due to need (wanting). […] In other words, motivation shifts towards relieving craving or withdrawal, while the pleasure once associated with the substance recedes” (p. 96). We would hypothesize, here, that a sex or porn addict would be motivated more over time to engage in sexual activity to relieve a craving than to engage in the activity for the sake of intrinsic pleasure.
- Negative consequences: Use of a substance is “often alleged to cause negative life consequences, increased health-risk behaviors, as well as social and relational difficulties” (Ley, Prause & Finn, 2014, p. 96). And, here, if you are child of the 80s and 90s as I was you may have images of frying eggs floating through your mind and a deep, resonant voice narrating, “This is your brain. This is your brain on drugs. Any questions?” In a sex or porn addiction context, we would predict, as many proponents of the SA model do, that engaging in certain behaviors would lead to work-life dysfunction along with negative health outcomes. One negative outcome Ley, Prause, & Finn discuss is the claim that there is a link between porn addiction and erectile dysfunction in cis men (p. 97).
- Loss of control: “Most addiction models,” Prause et al (2016 [in press]) note, “require that addicted individuals exhibit less control over their urge to use (or engage in the behavior).” Basically, the addicted individual becomes dependent on the substance or behavior and the urge, the need, the craving to use a substance or engage in a behavior becomes compulsive. Compulsivity (also a pathway identified by Coleman in his ICSB model ), refers to engaging in “repetitive behaviors, which individuals are compelled to perform […] and are intended to reduce anxiety” (Kingston & Firestone, 2008, p. 294). Loss of control is characterized by an irrational inability to discontinue using a substance or engaging in a behavior despite the negative consequences associated with using the substance/engaging in the behavior. In a sex or porn addiction context, we would thus expect to find such a loss of control with respect to sexual behavior or the viewing of erotic content.
- Enhanced cue reactivity: Cue reactivity, as Prause et al (2015) explain, “characterizes how individuals respond to cues of their substance or behavior,” where cues can be images of the substance or behavior or of paraphernalia related to the substance or behavior (p. 192). The hypothesis here is that reactivity to exposure to drug or behavior-related cues will be greater (enhanced) in substance abusers (or sex/porn addicts) than in a non-abuser/non-addict population exposed to the same cues.
- Withdrawal: Finally, when users of certain addictive substances cease using, withdrawal symptoms will develop. Certain proponents of the sex addiction model would hypothesize or claim, therefore, that cessation of the problematic sexual behavior or reduction of sexual activity would result in symptoms such as increased craving and dysphoric mood states.
Keeping in mind these six predictions, Prause and other research teams have undertaken numerous studies employing multiple methods to test and refute those predictions. (Prause et al, 2016 [in press). But it is crucial to remember that per Popperian principles of falsifiability one need not comprehensively disprove all aspects of a model for it to be refuted; only one prediction of a theory needs to be refuted for the entire model to be falsified.
Up next: There’s an old theater adage about audience expectations attributed to Russian writer Anton Chekhov (1860-1904). He said that if you show a gun in the first act then by the third act the gun should go off. Ever since the first post in this guest series I’ve been promising a treatment of how the sex addiction model has been evaluated scientifically. In the next post, I will finally deliver on that promise by discussing one of the sex addiction model falsification studies conducted by Prause (Prause et al, 2015).
Stay tuned, dear reader. And remember, “Don’t dream it; be it!”
Read the post series in order here: