Exploring The Psychological Impacts of Pornography

Porn: The Widespread Taboo

Pornography is the most available it has ever been due to online accessibility. Consequently, the more views that pornography accumulates, the increasing amount of societal and psychological consequences people face. This includes, but is not limited to: stereotyping of gender and racial fetishes, sexual violence and misconduct, sex misinformation, content addiction, and sex worker stigmas. Solano et al. (2020) found that among a sample of 1,392 adults in the U.S. (ages 18 to 73), 91.5% of men and 60.2% of women reported that they had engaged in some type of pornography within the past month.[1] Exposure to sexual content seems to be a frequent and inevitable component of being connected to the internet. However, a wave of sexual health research indicates its usage is not inherently negative. Discussions surrounding the psychological impacts of pornography provide insights into how porn can be distributed in healthy ways while also reducing negative consequences. Understanding this research is pivotal in approaching mental health and its relationship with pornography in an exponentially growing online world.

Understanding Pornography

Pornography exists in a variety of forms ranging from written, still imagery, video and auditory content. The Merriam-Webster Dictionary defines pornography as the depiction of erotica for sexual enhancement or excitement.[2] Free online platforms invite higher usage of video content than other forms of porn.[3] Additionally, Solano et al. (2020) found that women are more likely to consume written porn than men.[4] Reasons for pornography usage were researched by Burtăverde et al. (2021), who found that many people seek content for short-term sexual enjoyment and masturbation.[5] Likely due to its increased availability, pornography viewership is also beginning at younger ages; among responses from university students, Biota et al. (2022) found that porn usage began at an average age of 10.4 years, with those partaking primarily out of curiosity.[6] Further, as many students from this study reported feeling that their sex education has been inadequate, this perceived lack of education has likely led to their increased search for sexual information online, through porn.[7] 

Opinions about users of porn, as well as actors, vary by culture and social norms. Societal attitudes about the motivations behind pornographers were studied by Evans-DeCicco & Cowan (2001) in which male performers were perceived as having more positive motivations for partaking in porn production (such as enjoying their work and being at the top of their profession) as opposed to female performers.[8] Female performers were more often than men perceived/stereotyped to come from dysfunctional families, have a lack of employment opportunities and be coerced into the work.[9] Additionally, Perry & Whitehead (2022) point out that in the U.S., the desire for anti-pornography legislation is predicted by Christain nationalism and strict values of sexual order.[10] 

The Neuroscience of Pornography & Addiction

Pornography addiction is not considered a DSM-5 categorized disorder, however, concern exists about the adverse effects of over-watching porn. For instance, Egan & Parmar (2013) note that online porn usage can be reflective of compulsive tendencies in men.[11] Market et al. (2021) also found that for men with higher sexual motivation, attention to pornographic pictures was enhanced but that there were also no connections made with symptoms of cybersex addiction.[12] A study done by Wang et al. (2022) likewise found that people with problematic internet pornography use display higher attention and brain responses to new sexual stimuli, maintaining a cycle of problematic porn consumption when they are presented with more porn.[13] Further, Biota et al. (2022) found that the self-perceived negative effects of pornography use were mainly decreased sexual satisfaction and the need for more stimuli and longer stimulation, suggesting possible reasons for cyclical tendencies.[14]

Behavioral addictions in the brain impair reward systems through the frontal lobes via hyprofrontal syndromes (i.e., cerebral dysfunctions of addiction) leading to compulsivity and flawed judgment;[15] substance abuse, internet gaming disorder, compulsive eating and trauma may change the brain in the same way.[16] More research is warranted for problematic hypersexual tendencies and pornography use, as its general consumption may be completely healthy, while its over-usage may be indicative of compulsive tendencies.

Psychological Effects of Pornography

The sheer variety of porn produced has resulted in a range of negative and positive psychological effects on viewers, reflected in several conflicting pieces of evidence in the research. Since 2016, 17 states have introduced nonbinding resolutions declaring pornography a public health crisis, with concerns ranging from infidelity, addiction and sex trafficking.[17] Conversely, Nelson & Rothman (2020) report that porn, itself, does not meet the criteria for a public health crisis and that it has also been found to increase feelings of acceptance and health-promoting behaviors such as increased intimacy, communication and safer sexual practice.[18]

However, other researchers have found negative psychological and behavioral associations with pornography. In examining the link between porn and body image, Gewirtz-Meydan & Spivak-Lavi (2023) found that increased porn usage related to more body comparisons being made as well as an increase in eating disorder symptoms in men.[19] Additionally, Rostad et al. found that porn exposure is associated with teen dating violence and aggression (with a higher effect in boys than girls),[20] and Kohut, & Štulhofer (2018) note that porn use is associated with low adult quality of life.[21] 

These associations, however, do not imply a causal relationship with porn. Such consideration may be informative of the demographics of porn users, as porn may be used to improve or satisfy already-impaired psychological states.[22] Kohut, & Štulhofer add that controlling for external factors in an individual’s life (such as family environment and impulsiveness) may help us understand what porn actually does to our mental health.[23] While Mollaioli et al. (2021) found that more sexual activity is generally related to better mental health with lower participant depression and anxiety scores,[24] one must be aware that viewing certain portrayals in porn (e.g., flawless body image, condomless sex and violent fetishization), as well as a user’s dispositions may actually result in adverse effects. 

Relationship Function & Dysfunction

Kohut et al., (2021) investigated the notion that pornography use leads to poor relationship quality and satisfaction and found that differences in partner sex drive is what actually accounts for discrepancies in relationship quality.[25] Differences in sex drive can lead to differences in porn usage among partners, which leads to varied perceptions of the relationship and each person’s sexual satisfaction.[26] Further, when respondents were generally less accepting of porn, more porn usage led to lower perceived relationship satisfaction - but when men were more accepting of porn, they indicated higher relationship satisfaction.[27] These findings provide insight into the effects of the meaning that one places on using pornography, and how the stigmatization of its usage infiltrates itself into relationships.

Addressing The Issues

While the topic of sex and pornography is incredibly taboo in most cultures, increased dialogue surrounding the effects of pornography is important to promote mental health and safe porn use. Porn that portrays harmful aspects of society like nonconsent (i.e., assault) is damaging, such as instances where porn is leaked or promoted without the consent of the people involved.[28] Gius (2022) notes these leaks are societally perceived as extremely negative due to sexism and gender inequality, leading to social pressure on the assaulted/exposed individuals and even suicide.[29] 

Hilton & Watts (2011) add that some people argue for all porn usage to be viewed from a public health lens due to factors ranging from stigmatization of sex to addiction research.[30] Others believe that explicit sexual content is inevitable and that while compulsive use can be targeted with treatment, outlawing porn will not alter its use. Reducing life-impairing over-usage of pornography may be achieved through psychotherapeutic methods and Camilleri et al. (2021) found that morals, faith, and individual motivation were the most effective factors in reducing porn use.[31] Historically, since anti-sex views have not taken away sex from people, approaching porn in an open and informed way may help younger generations form healthy practices. 

For adolescents, sex education regarding healthy, consensual sex may help to reduce the harmful effects of mainstream porn content. Consuming online porn is among the many factors for intimate partner violence among young people.[32] Pathmedra et al. (2023) note that adolescent exposure to sexual content has a large role in establishing healthy sexual and romantic relationships - but acknowledge that it also has a role in establishing unhealthy relationships.[33] A conscientious approach to the way that porn is produced would be beneficial regarding the stereotypes and values it projects to its audiences.[34]

Overall, pornography usage is self-perceived as positive among both adolescents[35] and adults.[36] Additionally, an increased amount of people are participating in generating pornography through online platforms (such as OnlyFans), where they can personally capitalize off of content creation more lucratively than many professional productions and mainstream career paths. Further, Toder & Barak-Brandes (2022) examined homosexual WhatsApp exchanges for profit and discussed how it grants users sexual freedom, escaping from paths of porn careers that promote unethical sex.[37] 

Sexual openness and literacy may help to reduce the negative effects of pornography. Biota et al. (2022) stress that since people tend to consume porn at early ages, sex education needs to be tailored so that people can have a normalized understanding of porn and what is healthy.[38] Further, this education may aid in helping people identify what is unethical and ethical in portrayals of sex so that rape culture and violence are not perpetuated by porn. Regarding problematic or compulsive porn usage, Testa et al. (2023) note that promoting media literacy is an effective strategy to use in order to develop greater critical thinking skills, reduce the shame associated with porn, recognize unrealistic productions of sex and interpret the meaning behind what is being viewed, thereby creating healthier choices. In addition, cognitive behavioral therapy (CBT) and mindfulness-based therapies are evidence-based modalities that can help with compulsive porn usage.[39] Many different factors combine to create the negative mental health and societal effects of porn, and these may be generally addressed through open and updated sex perspectives, in addition to conscientiousness surrounding porn production and distribution. 

If one is experiencing problematic pornography consumption that impairs well-being, relationships and/or daily life, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support.

Contributed by: Phoebe Elliott

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Solano, I., Eaton, N. R., & O'Leary, K. D. (2020). Pornography Consumption, Modality and Function in a Large Internet Sample. Journal of sex research, 57(1), 92–103. https://doi.org/10.1080/00224499.2018.1532488 

2 Merriam-Webster. (n.d.). Pornography. In Merriam-Webster.com dictionary. Retrieved July 3, 2023, from https://www.merriam-webster.com/dictionary/pornography 

3 Ibid.

4 Ibid.

5 Burtăverde, V., Jonason, P. K., Giosan, C., & Ene, C. (2021). Why Do People Watch Porn? An Evolutionary Perspective on the Reasons for Pornography Consumption. Evolutionary Psychology, 19(2). https://doi.org/10.1177/14747049211028798

6 Biota, I., Dosil-Santamaria, M., Mondragon, N.I., Ozamiz-Etxebarria, N. (2022). Analyzing University Students' Perceptions Regarding Mainstream Pornography and Its Link to SDG5. Int J Environ Res Public Health. Jun 30;19(13):8055. doi: 10.3390/ijerph19138055. PMID: 35805712; PMCID: PMC9265877.

7 Ibid. 

8 Evans-DeCicco, Jennee & Cowan, Gloria. (2001). Attitudes Toward Pornography and the Characteristics Attributed to Pornography Actors. Sex Roles. 44. 351-361. 10.1023/A:1010985817751.  

9 Ibid.

10 Perry, S. L., & Whitehead, A. L. (2022). Porn as a threat to the mythic social order: Christian nationalism, anti-pornography legislation, and fear of pornography as a public menace. Sociological Quarterly, 63(2), 316-336. doi:10.1080/00380253.2020.1822220 

11 Egan, V., & Parmar, R. (2013). Dirty habits? Online pornography use, personality, obsessionality, and compulsivity. Journal of sex & marital therapy, 39(5), 394–409. https://doi.org/10.1080/0092623X.2012.710182

12 Markert, C., Baranowski, A. M., Koch, S., Stark, R., & Strahler, J. (2021). The impact of negative mood on event-related potentials when viewing pornographic pictures. Frontiers in Psychology, 12 doi:10.3389/fpsyg.2021.673023

13 Wang, J., Chen, Y., & Zhang, H. (2022). Electrophysiological evidence of enhanced processing of novel pornographic images in individuals with tendencies toward problematic internet pornography use. Frontiers in Human Neuroscience, 16 doi:10.3389/fnhum.2022.897536 

14 Biota et al. (2022)

15 Hilton DL, Watts C. Pornography addiction: A neuroscience perspective. Surg Neurol Int. 2011 Feb 21;2:19. doi: 10.4103/2152-7806.76977. PMID: 21427788; PMCID: PMC3050060.

16 Ibid.

17 Nelson, K. M., & Rothman, E. F. (2020). Should Public Health Professionals Consider Pornography a Public Health Crisis?. American journal of public health, 110(2), 151–153. https://doi.org/10.2105/AJPH.2019.305498

18 Ibid.

19 Gewirtz-Meydan, A., & Spivak-Lavi, Z. (2023). The association between problematic pornography use and eating disorder symptoms among heterosexual and sexual minority men. Body Image, 45, 284-295. doi:10.1016/j.bodyim.2023.03.008

20 Rostad et al. (2019)

21 Kohut, T., & Štulhofer, A. (2018). Is pornography use a risk for adolescent well-being? An examination of temporal relationships in two independent panel samples. PloS one, 13(8), e0202048. https://doi.org/10.1371/journal.pone.0202048 

22 Ibid.

23 Ibid.

24 Mollaioli, D., Sansone, A., Ciocca, G., Limoncin, E., Colonnello, E., Di Lorenzo, G., & Jannini, E. A. (2021). Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout. The journal of sexual medicine, 18(1), 35–49. https://doi.org/10.1016/j.jsxm.2020.10.008

25 Kohut, T., Dobson, K. A., Balzarini, R. N., Rogge, R. D., Shaw, A. M., McNulty, J. K., Russell, V. M., Fisher, W. A., & Campbell, L. (2021). But What's Your Partner Up to? Associations Between Relationship Quality and Pornography Use Depend on Contextual Patterns of Use Within the Couple. Frontiers in psychology, 12, 661347. https://doi.org/10.3389/fpsyg.2021.661347 

26 Ibid.

27 Maas, M. K., Vasilenko, S. A., & Willoughby, B. J. (2018). A Dyadic Approach to Pornography Use and Relationship Satisfaction Among Heterosexual Couples: The Role of Pornography Acceptance and Anxious Attachment. Journal of sex research, 55(6), 772–782. https://doi.org/10.1080/00224499.2018.1440281

28 Gius, C. (2022). Addressing the blurred question of ‘responsibility’: Insights from online news comments on a case of nonconsensual pornography. Journal of Gender Studies, 31(2), 193-203. doi:10.1080/09589236.2021.1892610 

29 Ibid.

30 Hilton & Watts (2011)

31 Camilleri, C., Perry, J. T., & Sammut, S. (2021). Compulsive Internet Pornography Use and Mental Health: A Cross-Sectional Study in a Sample of University Students in the United States. Frontiers in Psychology, 11, Article 613244. https://doi.org/10.3389/fpsyg.2020.613244

32 Barter, C., Lanau, A., Stanley, N., Aghtaie, N., & Överlien, C. (2022). Factors associated with the perpetration of interpersonal violence and abuse in young people’s intimate relationships. Journal of Youth Studies, 25(5), 547-563. doi:10.1080/13676261.2021.1910223

33 Pathmendra, P., Raggatt, M., Lim, M. S. C., Marino, J. L., & Skinner, S. R. (2023). Exposure to pornography and adolescent sexual behavior: Systematic review. Journal of Medical Internet Research, 25 doi:10.2196/43116

34 Ibid. 

35 Dwulit, A. D., & Rzymski, P. (2019). Prevalence, Patterns and Self-Perceived Effects of Pornography Consumption in Polish University Students: A Cross-Sectional Study. International journal of environmental research and public health, 16(10), 1861. https://doi.org/10.3390/ijerph16101861

36 Hald, G.M., Malamuth, N.M. Self-Perceived Effects of Pornography Consumption. Arch Sex Behav 37, 614–625 (2008). https://doi.org/10.1007/s10508-007-9212-1

37 Toder, N., & Barak-Brandes, S. (2022). A booty of booties: Men accumulating capital by homosocial porn exchange on WhatsApp. Porn Studies, 9(2), 145-158. doi:10.1080/23268743.2021.1947880  

38 Biota et al. (2022)

39 Testa, G., Mestre-Bach, G., Chiclana Actis, C., & Potenza, M. N. (2023). Problematic pornography use in adolescents: From prevention to intervention. Current Addiction Reports, 10(2), 210-218. doi:10.1007/s40429-023-00469-4  

Examining Substance Use & Addictive Disorders: A Q&A with SAS Therapists

An Uncontrollable Use

Substance use disorder (SUD) is a mental disorder affecting one’s brain and behavior, leading to an uncontrollable use of substances such as drugs, alcohol or medications. Symptoms can range from moderate to severe, with the most severe form of SUD referred to as an addiction.[1]

The National Institutes of Health (NIH) note the prevalence of SUD among adults in the U.S.:[2]

• Nearly one-third of adults have alcohol use disorder at some time in their lives, but only about 20 percent receive treatment.

• 10 percent of adults have drug use disorder at some point in their lives, but only 25% receive treatment.

Further, nearly 6% of those aged 12+ experienced prescription psychotherapeutic drug misuse in 2020.[3]

Comorbid conditions tend to present more in those with SUD, although research has not yet found concrete causal relationships among them. Co-occurring disorders may include: anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia. In the event of comorbid conditions, treatment for one disorder may be compounded and more difficult, though is still achievable.[4]

Compared to those without drug use disorder, individuals experiencing drug use disorder are:[5]

• 1.3 times as likely to experience clinical depression

• 1.6 times as likely to have post-traumatic stress disorder (PTSD)

• 1.8 times as likely to have borderline personality disorder (BPD).

Generally, it is better to treat the SUD and co-occurring mental disorder together, not separately. Thus, health care providers need to conduct full evaluations and provide a treatment plan based on one’s specific situation, in regards to their: age, misused substance and comorbid mental health disorder(s).  Both Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) have been found to be effective in treating substance use disorder.[6]

Q&A

SAS THERAPISTS DISCUSS SUBSTANCE USE DISORDER AND EFFECTIVE TREATMENT MODALITIES

1. How does someone even become aware that they have a problematic substance/alcohol use disorder/addictive disorder versus simply enjoying ____ to relax/unwind on a frequent basis? How does someone know when it’s time to seek assistance?

“Awareness of alcohol or substance use disorder or an addictive disorder (e.g. gambling, shopping, etc.) often comes as a result of some unwanted consequence related to the behavior - for many people this looks like a DUI, concern expressed from a loved one, physician, employer, etc., a negative test result from the doctor, or just feeling so crappy the next day that you start to wonder if the substance is worth the pain. It could be an incredible amount of debt, being kicked out of a casino, or having your credit cards maxed out and shut off/things going to collection. People also become more aware of the behavior as problematic when they try to stop and can't seem to stick to that goal. It freaks them out. Generally speaking, if you're worried you might have a problem, there's a good chance you do!

It's also important to note that using a substance to ‘unwind on a frequent basis’ in and of itself is problematic - what happens if you don't use this substance? What do you feel? If you can't tolerate your thoughts or emotions or physical sensations without using a substance to ‘unwind,’ it might be a good time to check in with a therapist.” (Jennie Ketcham Crooks, LICSW, MSW)

“This is a question frequently asked, both by those who use substances themselves and concerned loved ones. There are some aphorisms from the recovery world I often quote when helping to answer the question, including: ‘If you have to control it, it is already out of control.’ While of course this isn’t absolute, it can be a helpful realization that even minor things like counting drinks or scheduling use (‘I only use on weekends’, etc.) are not common in actual recreational users. It can be a cue for us and friends/family that the ‘control’ is gone if we are talking about controlling, so that cue can lead to seeking assistance. It is a helpful reminder that merely seeking assistance is not admitting addiction or signing-on for lifetime abstinence. Many folks today are trying on a trend – with regard to alcohol – called ‘sober curious’ for instance, which highlights a period of sober time with an attention to what is lost and gained without the presence of a drug (including alcohol) in their lives. In all, seeking assistance or merely asking questions (Google can be our friend!) is unlikely to be harmful. The more you know, right?!” (Kate Willman, MA, LMHCA, HCA)

2. In your experience, what are the biggest obstacles that someone has to overcoming a substance/alcohol use disorder/addictive disorder? How can they best overcome those obstacles?

“A major obstacle is the way in which society normalizes the use of alcohol and marijuana in particular - we think as if we ‘should’ be able to ‘drink normally,’ and when we fail to do so, it is pretty crushing. So we try and try again, and fail and fail again. Yet, the biggest obstacle to overcome is the tolerance of uncertainty; we don't know if you'll ever use again (That is, not until you use! Then we know!). Intolerance of uncertainty may be one contributing factor to why the relapse rates are so high. If one cannot tolerate the uncertainty about when they will use again, the only way to gain certainty is to use.” (Jennie Ketcham Crooks, LICSW, MSW)  

“The first ‘big obstacle’ that comes to mind is that drugs work. That may sound a bit odd, but: it’s true! The substances themselves will always be potent, will always have a desired effect on neurotransmitters at various levels, and are likely to always be made available in one way or another. In fact, some addictive substances are even legal to obtain. Therefore – in part to account for the assurance that drugs work – the next biggest obstacle most folks must overcome is their own desires to keep using. Again, this might sound odd to an outsider, but many addicts even in long-term recovery readily admit that if they could still use successfully, they would! So a person might have every desire in the world to stop using, and they can still retain some desire to keep using. Behavioral addictions like gambling or pornography use are similar in that the process or ‘chase’ of the behavior stimulates neurotransmitters in much the same way as a substance would.

One of the best ways I’ve seen others face and overcome this obstacle is through mutual support. Whether friends, family, professionals (like a therapist), or simply peer support from other people who have struggled with substance use or behavioral addictions… most people simply cannot do it alone. Many people today have also been able to find help online, through anonymous forums, meetings and/or social media. In the end, however, only the individual will be able to decide for themselves when ‘enough is enough’.” (Kate Willman, MA, LMHCA, HCA)

3. In what ways has the pandemic affected substance/alcohol use disorder/addictive disorder (rates, types, recovery) that you personally have witnessed in practice?

“Many people use substances or alcohol to ‘feel better’ - socially, it's been a way to connect (‘let’s grab a beer!’), physiologically it depresses your system (Anxious AF? Let’s grab a beer!), and the pandemic has been a context in which many people have needed social connection and experienced increases in anxiety (germs everywhere folks).” (Jennie Ketcham Crooks, LICSW, MSW)

“The pandemic seemed to exacerbate existing problems and / or introduce new anxieties for people. Many of our best, most natural coping mechanisms were unavailable to us, including – for instance – the live support of family and friends, the release, productivity + enjoyment of the workplace, and various hobbies enjoyed both socially or alone. And all of this at a time when we needed to cope more than ever. The already easy access to legalized substances like alcohol and cannabis became even easier via delivery programs in many areas, and so some people came to rely on use as a coping mechanism in the absence of others.

The two-or-so years of pandemic saw a decrease in coping outlets coupled with an overall increase in anxiety and depression (amidst other social, economic and political stressors). To boot, many people found themselves isolated. In other words, a prime opportunity for addiction issues to flourish, and since addiction already breeds isolation, a lack of social accountability encouraged isolation in the pandemic even further.” (Kate Willman, MA, LMHCA, HCA)

4. Would any specific psychotherapeutic modality be better-suited for someone battling these disorders than others?  If yes, which would you recommend and why?

“I think that any therapy that supports a client to identify their values and take committed action in alignment with those values will help them tolerate the distress of overcoming an substance or addictive disorder. I often talk about substances/alcohol or addictive behaviors as a solution to some problem, so knowing what's important to you in this life can help increase your motivation and your distress tolerance; chances are if you've quit a substance or alcohol (or gambling or shopping), whatever problem substances or alcohol solved will still be there. Ultimately, behavioral therapy will be an important component of treating substance and addictive disorders because your behavior will be required to change.” (Jennie Ketcham Crooks, LICSW, MSW)

“There is clinical research to support all types of different modalities for treating addiction.

The first that comes to mind specifically is Dialectical Behavioral Therapy (DBT) for its focus on skills to promote and practice emotional regulation, mindfulness, and tolerance for distress.

Acceptance and Commitment Therapy (ACT) combined with harm-reduction practices also comes to mind as a frequently used treatment as it does not focus on symptom reduction as an outcome. This can aid in recovery from or re-evaluation of a person’s relationship with drugs in that it removes focus on the substances and/or behaviors themselves and instead brings focus back to the person themselves.

Several variations on psychodynamic therapy have also been seen in addiction treatment, including existential and narrative therapeutic approaches.

Finally, people struggling with addiction – both behavioral and with substances – are still people, right? And their use is just a symptom of what are much larger problems. The person-centered approach can assist in a practitioner’s ability to use the best modality when treating those with use issues while also taking into account the presence of comorbid conditions.” (Kate Willman, MA, LMHCA, HCA)

5. Do certain comorbid mental health conditions appear more prevalent than others in those with these substance/alcohol use disorders?  Do some conditions make treatment more difficult?

“We see a high comorbidity between social anxiety and alcohol use disorder, largely related to what I noted in question 3 - when we feel nervous about social engagement, it can be easy to ‘grab a beer.’ While beer makes that anxiety go away temporarily, it ends up reinforcing an unhelpful learning pattern wherein the person ‘learns’ that beer is what kept them safe in the social engagement (versus learning that social engagement - and the experience of anxiety! - is a safe activity). That learning then says, ‘I must drink beer EVERY time I engage socially.’” (Jennie Ketcham Crooks, LICSW, MSW)

“The observable correlations between mental health issues and substance abuse are many.

First, the most common mental health issues such as depression, anxiety, etc. can lead to use or abuse of substances as a form of neutralizing discomfort (sometimes colloquially known as ‘self-medicating’). We see similar patterns in those experiencing behavioral addictions. Second, substance use itself can contribute to the experience of one or more symptoms of mental health issues – including depression, anxiety, suicidal ideation, psychosis, obsessive thoughts, etc.

Even further, there is substantial evidence that neurological changes can occur as a result of substance use, depending on frequency, duration + severity of use, as well as what substances are used and at what age(s) use begins. There are often correlations between substance use and mental health symptomology that are etiologically indistinguishable, i.e.: there is often a reciprocity between mental health issues and substance use issues that can make it difficult to discern the specific dynamics between them, let alone causation or source of either or both.

This is all to say that there are many possible comorbid conditions – especially those in the mental health realm – that make treating addiction more difficult. Additionally, a holistic perspective shows us that this generally means the life of the client is more difficult, and we should do our best to help mitigate confusion or shame in these cases. There are certainly some conditions we see more often than others – anxiety, depression, chronic pain, and various forms of trauma – however, this might be less correlated to addiction and more because these are prevalent conditions anyway.” (Kate Willman, MA, LMHCA, HCA)

6. Can you give an example of how you may guide someone in therapy who wants to overcome a substance/alcohol use disorder/addictive disorder? 

“If someone is seeing me specifically for addiction, we will begin with a practice of noting - with gentle curiosity - the behaviors they'd like to question. We gather data, do some values mining, and a functional assessment: Is this behavior moving you closer to or further away from a meaningful life. Then, depending on that result, we make some changes and commit to action. After a period of treatment, and after you see the changes happening in your life, we will do a course of mindfulness-based relapse prevention.” (Jennie Ketcham Crooks, LICSW, MSW)

“I would start by assessing for co-occurring disorders and then – if they are present – do my best assess which has a higher acuity and therefore probably requires attention first (this may or may not be the use itself). I’d also assess a client via the Stages of Change model to attempt to decipher ‘how ready’ they are to stop using. For instance, if a person is in ‘precontemplation’, we wouldn’t want to start jumping into recovery strategies. Once I’ve assessed where someone is in the process, we can collaborate on options to move forward. Sometimes a client needs support, needs to experience trust and empathy before they are willing to face the big world ahead of them without their drug or behavior of choice. Therapy, thankfully, is a great place to receive these, and even if a strong desire to change isn’t first apparent, it can develop over time through an informed and cooperative relationship.” (Kate Willman, MA, LMHCA, HCA)

7. Is there anything else you’d like to share with those interested in learning more about treatment and/or may be battling substance/alcohol use disorder/addictive disorder, themselves?

“Now, more than ever, there is more information about [and less stigma surrounding] the prevalence of substance use issues and the insidious nature of the disease of addiction. For those readers who don’t, themselves, identify as struggling with either of these issues, I urge you to become informed anyway, because the likelihood that you or someone you know will at some point face one or more of these issues is essentially guaranteed.

Support, accountability, empathy, and inclusion are paramount in treating the very real (and, too often, fatal) diseases of substance abuse + mental illness. We can all help by informing ourselves and others about the perils of addiction, the resources available for recovery, the universality of mental health issues, and the reality that love and understanding are key in facing these successfully.” (Kate Willman, MA, LMHCA, HCA)

Contributed by: Jennifer (Ghahari) Smith, Ph.D.

Jennie Ketcham Crooks, LICSW, MSW & Kate Willman, MA, LMHCA, HCA

Editor: Jennifer (Ghahari) Smith, Ph.D.

For more information, click here to access an interview with Psychiatrist Lantie Jorandby on Addiction Recovery.

Additionally, you may click here to access an interview with Psychologist Robyn Walser on Trauma & Addiction.

REFERENCES

1 National Institutes of Mental Health (NIH). (n.d.) Substance use and co-occurring mental disorders. (accessed 9-20-2022) https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health#:~:text=A%20substance%20use%20disorder%20(SUD,most%20severe%20form%20of%20SUDs 

2 National Institutes of Mental Health (NIH). (n.d.) 10 percent of US adults have drug use disorder at some point in their lives. (accessed 9-21-2022) https://www.nih.gov/news-events/news-releases/10-percent-us-adults-have-drug-use-disorder-some-point-their-lives

3 NIH: National Institute on Drug Abuse. (n.d.) What is the scope of prescription drug misuse in the United States? (accessed 9-21-2022) https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse 

4 NIH. Substance use and co-occurring mental disorders.

5 NIH. 10 percent of US adults have drug use disorder at some point in their lives.

6 NIH. Substance use and co-occurring mental disorders.