Recently in New Zealand there has been an upsurge in concern around the downloading of pornographic material from the Internet by people in influential positions. Eight teachers have lost their employment this year, while an unknown number of managers and other employees have been dismissed as a result of this activity (1). Upon discovery such people are often viewed as unsavoury and perhaps dangerous, and are likely to have difficulty finding work in their field once their past behaviour becomes known.
Several questions arise:

• How pervasive is the accessing of pornography over the Internet?
• Why do people take such risks when the consequences can be so far-reaching?
• Is such a person ‘addicted’ to pornography, and if so how does it arise, and where may it end?
• Can such people change their behaviour with help, and should we try?

HOW PERVASIVE IS INTERNET PORNOGRAPHY ADDICTION

Before defining what may be described as ‘Internet Pornography Addiction’ it should be noted that this may not be an isolated and rare event. There is little research available to estimate the prevalence of Internet pornography access let alone research about a condition that could be described as an addiction. The reasons this is so are somewhat obvious. Such behaviour, even if casual, is frowned upon, and even with regular media reports of prosecutions there is a poor understanding of what is illegal. Disclosure by survey is therefore unlikely. Even surveys of a far less socially disapproved behaviour, pathological gambling, identified that less than 30% of those with gambling problems would respond with the truth to a surveyor (2).

Yet there are certain factors that can give an indication of prevalence. Firstly, for an addiction to develop there must be participation. If participation were low, the likelihood of vast numbers becoming behaviourally addicted may be low. A comparison of another behavioural addiction, again pathological gambling, suggests that around 90% of New Zealanders have participated in gambling (3), while around 1-3% probably develop pathological gambling behaviour (4). Upon this basis, one could draw the conclusion that pathological gambling (addiction) is a relatively rare event. However, 80% of pathological gambling appears to result from video gambling machines (5), based upon reports of those seeking help, while only 18% have played gambling machines in any year (6). This suddenly becomes a far from rare event, with, based on the estimate of the population with a gambling problem, perhaps one in nine video gambling machine players developing a serious gambling problem. Can we draw a comparison from pathological gambling?

While we do not know what proportion of the population have sometime viewed pornographic images, and while pathological gambling appears to affect both males and females equally (5), there is an assumption that pornography appears to be substantially a male domain. Secondly, is the viewing of pornography as ‘conditioning’ as playing a video gambling machine which is reinforced with money and positive messages. There could be an argument that the at-risk population in pornography addiction is smaller and while the effect of the images can be strong, unless they are replaced on a regular basis once their sensitivity has reduced, the process will be less addictive from a behavioural learning paradigm. However, there are a large number of opportunities to view pornography over the Internet, and while gambling (even Internet gambling) may be readily accessible, there is a possibility that a far larger proportion of people may be titillated by sexually explicit images than may be interested in gambling.

Currently there are thousands of pornography sites, growing daily presumably as a result of demand, that are being accessed both through computers at work and at home. Invitations to view these sites are often sent unsolicited and apparently innocuous searches of unrelated topics will sometimes result in pornographic websites being retrieved.

The growth of access to computers, their common use and assimilation into our lives, and expansion of the Internet does not need to be argued. Access to information has revolutionised our lives within the last decade. The Internet is readily accessed 24 hours a day, at home and at work, with a high level of privacy. Surfing the Internet can be immediately terminated if privacy is interrupted. In the previous comparison with pathological gambling, it is arguable that pornography is at least as accessible as gambling, requires less money, and requires no learning of rules or process to participate. Accessibility is a major factor in all addiction (2) (7); the greater accessibility for pornography may suggest more opportunities for pornography addiction.

The privacy offered by the Internet and the low likelihood of discovery, when matched to the fact of the substantial number of pornographic sites, suggests that many will be accessing pornographic sites at least occasionally, while many will be regular seekers and may be at-risk for pornographic addiction.

WHY TAKE THE RISK OF DISCOVERY?

The sexual drive is strong and primitive, with much of its control being determined by social mores. The transgression of these social mores results in disapproval when disclosed. Freud based much of his psychoanalytic work upon the sexual drive and its suppression (8). Conformity in society is a prerequisite, although its substance will vary from society to society, and society’s tolerance can also change over time. What was regarded as borderline in terms of acceptability years ago with the advent of Playboy magazine changed over time as its customers demanded more explicit images and society tolerated their publication.

Some images however are unlikely to be tolerated, such as those involving children, animals and those suggesting torture or violence. It is these unacceptable images that colour society’s pejorative view of pornography and those that access it. Laws make the downloading of objectionable images, and a division of the Department of Internal Affairs in New Zealand monitors access of these sites and initiates prosecutions (9). Because of the association with these extreme examples, a discovery of accessing any pornography can result in a person being summarily dismissed. The recent media reports referred to at the beginning contained examples of this (1).

With the potential far-reaching consequences, one may wonder why people would risk viewing pornography with the possibility of the disclosure of this behaviour. Initial participation may be explainable by the perception that discovery is unlikely. However, when viewing persists, and consequently the likelihood of discovery increases, there may be different processes at work that may be best explained within the paradigm of addiction (10) (11).

PORNOGRAPHY ADDICTION: WHAT IS IT?

The term addiction is a lay rather than scientific term (12). The description of what constitutes addiction is not defined in diagnostic manuals such as DSM-IV (13) or ICD-10 (14) however there are a number of generally accepted symptoms. These include:

• An urge often described as a craving. In pornography viewing, the initial involvement may be ego-syntonic (positive reinforcement in behavioural terms) but reason for persistence may change to escape life’s stressors (self-medication through negative reinforcement) where the behaviour is contributing to the stress as well as providing the relief. The ‘urge’, displayed as irritability, restlessness and distractedness may be symptomatic of inability to tolerate stress and the use of the behaviour as a dysfunctional coping mechanism. The need to ‘instantly gratify’ the urge commonly found in addictions can also be understood in terms of both narrowing of stress-coping mechanisms and a reduction in ability to handle increasing cycle of stress (guilt, secrecy, isolation, boredom, irritability, preoccupation, reduced effectiveness at work, receiving criticism, cognitive dissonance, relief through Internet pornography)
• A reduction in control over the behaviour. More risk is taken of discovery through, for example, the viewing of pornographic images during work-time or when others are around, when previously such viewing was restricted to home and when alone. There may be unsuccessful attempts to cut back on or reduce the behaviour such as deleting any downloaded images.
• Perseverance in the behaviour despite possible consequences. Risks in the workplace remain high even with minimal viewing, and will escalate if images are down-loaded and saved. If codes of conduct are imposed at work around pornography access and notwithstanding the behaviour continues, this may indicate addictive processes developing. Also if websites accessed may have illegal images, risk of disclosure through monitoring may arise; perseverance despite increased risk may also be symptomatic
• A tolerance develops requiring more intensive levels of aspects of the behaviour over time to meet the desired need eg dissociation from (problematic) reality. Images previously considered as shocking, lurid and graphic are considered. Sexual intimacy with a real partner may become less satisfying compared with graphic images of idealised ‘partners’ combined with fantasies, with preferred gratification obtained from self-masturbation
• Unknown neuro-adaptation that may involve neurotransmitters such as dopamine and serotonin (15). This may be linked to the craving sensation above.
• A developing preoccupation with thinking about or accessing pornography and may have consequences of reduced effectiveness at work arising from distraction in addition to the time lost accessing such sites during work-time.

There are various theories of addiction, some of which suggest underlying unresolved issues or even biological components while others may focus on learned behaviour or social factors (7) (10-12). Some suggest that lower self-esteem may contribute to addictive behaviour while others may result from fear of, or under-developed social intimacy skills which may contribute to behavioural addictions. A fear of rejection can be avoided through the use of this medium: viewers can initiate images and disconnect at will (control), while access to images of sexual partners who would not normally be available to them feed their fantasy world.

The fear of many employers, parents and others in our society is that such people may progress to pedophilia, rape or other acting out behaviours, or that they were previously unidentified examples of this category of people.

There appears to be little evidence that people may progress in this way, while the addiction paradigm suggests that people become more isolated (and therefore not seek out risky situations where rejection could occur), and are less able to relate to realty while their fantasy world expands. Self-esteem reduces as coping behaviour becomes restricted to the pornography viewing, dissociation occurs, while depression and anxiety heighten as a result of perceived loss of control in the real world.

Pedophilia (13) focuses upon involvement with an actual child rather than a virtual child, although the pedophile will often access pornographic images of children. In this case the pornography is not central to, but ancillary to the behaviour. The conclusion drawn by the writers in this article is that in Internet pornography addiction, there will be little risk to the public for the majority of people who have developed this dependence.

Internet pornography addiction is therefore described as a currently unrecognised clinical term but which fits within a clinical framework of dependence or quasi-clinical framework of addiction. That there is an indistinct category for the behaviour is somewhat irrelevant when the problem can be described and exists. Medical recognition often lags behind reality: pathological gambling was not recognised by mainstream health until the late 1970’s (ICD-9 in 1977; DSM-III in 1980) despite its existence for thousands of years. Pornography viewing has also existed over hundreds of years or more but the advent of the Internet has multiplied the risk through accessibility to graduated ranges of pornographic materials.

CAN THE BEHAVIOUR BE CHANGED?

Addictions are commonly addressed successfully in treatment. There are a range of interventions that are successful, including cognitive therapy, cognitive-behavioural therapy, behavioural therapy, motivational interviewing and others. The model used in Abacus works within the Prochaska and DiClemente Transtheoretical Model of behaviour change (16), a common framework in behaviour change therapy. The readiness to change the behaviour is identified together with the motivational barriers. This will determine the therapy model to be used – with the focus upon an eclectic approach with a range of skills that may be applied during a therapy session.

It would be a mistake to assume that those with Internet pornography addiction wish to change their behaviour on a constant basis. As with all addictions, there is a perception of positive effects as well as costs associated with the behaviour. Ambivalence is common. One way to accelerate help-seeking would be to encourage rather than punish disclosure or discovery. Currently, there is no positive outcome to disclosure: voluntary or otherwise, it is likely to result in punitive outcomes. Confrontation in addictions generally results in resistance to change.

A POSSIBLE APPROACH

The workplace: reported misuse of the Internet in the workplace is high (17) with the percentage attributable to accessing pornography sites unknown. Codes exist in many workplaces around misuse of the Internet, including pornography sites, and a draft is available on the DIA website that may be downloaded (18). Such codes are generally punitive in design and may not encourage disclosure.

Although codes should indicate that access to Internet pornography is unacceptable, employees who are accessing pornography should be treated sympathetically rather than punished. If the addictive paradigm is accepted, and this contention is supported by the writers, then the same approach should be taken as if the employee was misusing alcohol.

Although there is an awareness of loss of control over the behaviour, in many cases, escape is the goal of the behaviour. The employee should be required to attend assessment and counselling with therapists skilled in addiction treatment, and certainly be supported and encouraged to change their behaviour. If there is compliance, then punishment should not ensue.

Assessment should identify comorbid behaviour, and if depression or anxiety is concurrent, then this is addressed. If pedophilia is identified, then this too needs to be addressed. However it is our contention that this will be unlikely amongst the vast majority of these people.

Home environment: again, awareness that confrontation is likely to generate resistance. Therapy following assessment is important in order to address associated issues as well as avoiding the behaviour extending to the workplace. Therapy is likely to involve relationship counselling, where appropriate.

At-risk behaviour: because of the common access to pornographic sites either by chance or design, the curiosity of follow-up access, the range of ‘soft’ pornographic sites that may or may not be regarded as unacceptable, and irregular access that may not indicate developing dependence, there can be uncertainty around what may constitute Internet pornography addiction. The annexed screen may give some indication of behaviour level as well as raise awareness for those who may be participating in at-risk behaviour.

Internet pornography addiction is a new term that describes a behaviour that sits within the addiction paradigm. Currently it is poorly understood both in terms of what constitutes a problem and what the consequences may be, including criminal liability. Punishment at present is a consequence of even low-level behaviour, ensuring that self disclosure and help-seeking will be low. Pejorativeness and assumptions made in association with this problem means that an accurate prevalence rate will be unable to be obtained.

Self-awareness with addictions is often low, with defensiveness high. A brief self-test screen has been developed by Abacus to motivate those at-risk to consider the costs of their behaviour and the possibility of change. Appropriate therapy can increase such motivation and accelerate behaviour change to reduce harm. Codes around Internet misuse could be proactive and effective, rather than punitive and discouraging of disclosure.

Therapy is available and effective, and incidences can be treated more appropriately by employers than is currently the case. Disclosure and dismissal results in a loss-loss situation for both the employer and the employee, with long-lasting consequences for the employee. Internet pornography addiction is only one aspect of Internet addiction. With the influence that the Internet has in our lives currently together with the future pervasiveness of this medium, employers and therapists should be addressing this growing problem rather than dismissing it as applying to a small, antisocial group of people with dangerous habits.

References

(1) Herald July 23rd 2002; National Radio Programme 16th July 2002
(2) Productivity Commission (1999) Australia’s Gambling Industries. Canberra: AusInfo
(3) DIA (2001) Peoples Participation in, and Attitudes towards Gambling 1985-2000. Wellington: Dept Internal Affairs
(4) APA (1994) Diagnostic and Statistical Manual DSM-IV. Wash DC: Am Psych Assoc.
(5) PGC (2002) Problem Gambling Counselling in NZ 2001: national statistics. Wellington: PGC
(6) DIA (2001) People’s Participation in and Attitudes to Gaming, 1985-2000. Wellington: Dept of Internal Affairs
(7) Shaffer H (1989) Conceptual Crises in the Addictions: the role of models in the field of compulsive gambling. In H Shaffer, S Stein, B Gambino, T Cummings & R Custer (Eds), Compulsive Gambling: Theory, Research and Practice. Mass: Lexington Books
(8) Freud S (1905) Three Essays on the Theory of Sexuality. Std Ed Vol VII, London: Hogarth
(9) DIA: Censorship and the Internet. Objectionable material under the Films, Videos, and Publications Classification Act 1993 are banned and downloading or distributed material may result in prosecution following monitoring of Internet websites by the DIA (Censorship Compliance)
(10) Orford J, Morrison V & Somers M (1996) Drinking and Gambling: a comparison with implications for theories of addiction. Drug and Alcohol Review; 15:47-56
(11) Jacobs D (1989) A General Theory of Addictions: rationale for and evidence supporting a new approach for understanding and treating addictive behaviors. In H Shaffer, S Stein, B Gambino, T Cummings & R Custer (Eds) Compulsive Gambling: Theory, Research & Practice. Mass: Lexington Books
(12) Shaffer H (1999) Strange Bedfellows: a critical review of pathological gambling and addiction. Addiction; 94:10:1445-1448
(13) American Psychiatric Assn (1994) Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Washington DC:APA
(14) World Health Organisation (1992) The ICD-10 Classification of Mental and Behavioural Disorders:clinical descriptions and diagnostic guidelines. Geneva; WHO
(15) Hollander E, Begaz T & DeCaria C (1998) Pharmacologic approaches in the treatment of pathological gambling. CNS Spectrum; 3:6:72-82
(16) Prochaska J, DiClemente C. (1986) Toward a comprehensive model of change: In Miller WR & Heather N (eds) Treating Addictive Behaviours: processes of change. NY: Plenum.
(17) Nigel Horrocks (editor of NetGuide Magazine) reported 79% of companies surveyed in a UK study responded that there had been ‘inappropriate’ use of Internet. In NZ Herald article 17th July 2002
(18) http://www.dia.govt.nz (Censorship Compliance)