Pornography on the Rise: A Growing Mental Health Problem

Wendy Maltz on the Need to Address Porn Addiction as a Public Health Threat

Pornography on the Rise: A Growing Mental Health Problem

When I began counseling in the mid-1970s, hardcore pornography was difficult to obtain. But in recent decades, new electronic technologies, such as cable television, computers, and iPhones, have transformed it into a product that’s available to anyone—anytime, anywhere, and often cheap or free. It’s become a substantial part of our economy, boasting annual revenues in excess of $13 billion in the United States and $100 billion worldwide.

The revolution in accessibility has led to record consumption. According to statistics on the Internet Filter Review site, 40 million Americans visit Internet porn sites at least once a month. Some porn users visit sites for only a few minutes at a time. Others, like Scott, visit porn sites daily, spending more than 15 hours per week. One-third of all downloads each month and one-quarter of all online searches each day are for porn. And, according to a 2008 Nielsen Online survey, a record-breaking 25 percent of employees in the United States are accessing porn at work, despite the risks involved.

Not surprisingly, concerns about the effect of porn on individuals and relationships are also on the rise. According to a 2004 survey in Men’s Health, more than 70 percent of the men surveyed said they’ve looked at more porn since the advent of the Internet, and one in two expressed concern about their use of it. The American Academy of Matrimonial Lawyers and the British Nielsen NetRatings organization have identified it as a major cause of divorce and relationship difficulties. No wonder sexual addiction experts, such as Patrick Carnes, have begun calling pornography addiction “our newest and most challenging mental health problem.”

Changes in how people access and use pornography have taken the therapeutic community by surprise. The explosion in porn use has happened so fast that many therapists have been caught unprepared; they may not yet comprehend the extent of the problems porn can cause, or how deeply its use can harm individuals and their intimate partners. Despite the increase in the number of people suffering from anxiety, depression, sexual problems, relationship distress, and other serious consequences of habitual porn use, few therapists feel comfortable and confident addressing porn-related concerns.

How We Feel about Porn

Pornography draws strong responses—from the public at large and within the therapeutic community. Many of us have such strong feelings about pornography that we automatically label, condemn, or reject anyone who sees it differently. If we’re critical of porn, we might judge people who like it as “excessively permissive,” “exploitive,” “addicted to sex,” or “misogynistic.” If we’re supportive of porn, we may see those who don’t share our view as “sexually uptight,” “religiously conservative,” “radically feminist,” or “against free speech.” Unlike other common mental health concerns, such as depression or substance abuse, we have no reasonably coherent and agreed upon clinical perspective for what constitutes a “porn problem” or how to approach it.

A Drug

Pornography seems to have a drug-like effect on the body and mind. Despite being ingested through the eyes and ears instead of the mouth or bloodstream, porn stimulates the reward and pleasure centers in the brain, instantly and dramatically, increasing the production of dopamine, a neurotransmitter associated with both sexual arousal and drug highs. In addition, using porn for sexual stimulation has been shown to increase production of other “feel-good” chemicals, such as adrenaline, endorphins, testosterone, and serotonin; with sexual climax, it releases powerful hormones related to falling in love and bonding, such as oxytocin and vasopressin.

My newfound knowledge of pornography’s drug-like effects helped me bring more compassion to the issues porn users faced. Not only were their partners in distress: anyone trying to quit using porn faced his or her own difficult emotional and physiological struggles. I started recommending that clients supplement their individual and couples counseling work with attending 12-step sexual addiction recovery programs, such as Sex Addicts Anonymous, Sexaholics Anonymous, and Recovering Couples Anonymous, or porn recovery groups of their own choosing. I began encouraging intimate partners to attend Codependents of Sex Addicts meetings and to check out supportive websites, such as With my background in drug and alcohol counseling, I know that support groups can be critical to successful recovery, helping overcome social isolation and shame, building accountability supports, and sharing triumphs.

A Threat to Public Health

I never wanted to be out beating the drum against pornography. In the beginning of my career, if anyone had suggested I’d be here now, I’d have laughed at them. But from my own clients, my research, and my personal experience, I’ve come to the conclusion that pornography is moving from an individual and couples’ problem to a public health problem, capable of deeply harming the emotional, sexual, and relationship well-being of millions of men, women, and children.

The only way to prevent the spread of porn-related problems is for people to be informed and to get help early, and for society to be alert to the problems. I see a great need for parents, teachers, employers, clergy, healthcare workers, law enforcers, and therapists to start addressing pornography problems with the same kind of shame-free directness with which we’ve learned to tackle other public health concerns, such as cigarette smoking, alcohol consumption, domestic violence, and drug abuse.

As therapists, perhaps our most important role is in providing clients a safe place to discuss and examine their concerns. It’s best to analyze porn-related situations on a case-by-case basis, taking into consideration a client’s personal values, sexual experience, sexual orientation, and relationship status. As mental health professionals I believe we’re most helpful when we resist our tendencies to automatically condemn or advocate porn. Our effectiveness depends on our ability to join with clients in regularly evaluating porn’s impact on their lives. While I remain aware that porn use isn’t a problem for everyone, I keep in mind that, given its unprecedented power and accessibility, it can become a problem for anyone.

Wendy Maltz

Wendy Maltz, LCSW, DST, is an internationally recognized psychotherapist, sex therapist, and author of numerous books on sexuality, including The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography (with Larry Maltz, HarperCollins, 2008). Wendy and Larry Maltz offer professional training seminars on treating pornography problems.