Just a few days ago, The American Society of Addiction Medicine (ASAM), announced its new definition of addiction. When you read it, you will find that the top addiction experts in America agree with Naomi Wolf’s version of addiction.
You can read ASAM’s definition here: http://www.asam.org/DefinitionofAddiction-LongVersion.html
Read ASAM’s FAQ’s on the new definition here:
http://www.asam.org/pdf/Advocacy/20110816_DefofAddiction-FAQs.pdf
A lay article on the changes here:
http://www.thefix.com/content/addiction-gets-medical-makeover8004

ASAM clearly states that:
1) Both behavioral and chemical addictions involve similar brain changes
2) These changes occur in the same circuitry – the reward circuitry
3) Dopamine, with its “little pats on the back,” is central to all of these brain changes

When reading the ASAM definition, please note that:
1) Like Wolf (in her 800-word-limit article), ASAM’s eight-page document did not delineate the numerous unrelated functions dopamine.
2) Like Wolf, ASAM used the term “reward.”
3) Like Wolf, ASAM clearly states that all addictions lead to the same alterations in the same neurocircuitry – the reward circuitry
4) Like Wolf, ASAM states that sex addiction exists.

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Quote from the lay article making it clear that behavioral addictions exist (sounds more like Wolf than you):
The new definition leaves no doubt that all addictions—whether to alcohol, heroin or sex, say—are fundamentally the same. Dr. Raju Haleja, former president of the Canadian Society for Addiction Medicine and the chair of the ASAM committee that crafted the new definition, told The Fix, “We are looking at addiction as one disease, as opposed to those who see them as separate diseases. Addiction is addiction. It doesn’t matter what cranks your brain in that direction, once it has changed direction, you’re vulnerable to all addiction.” That the society has stamped a diagnosis of sex or gambling or food addiction as every bit as medically valid as addiction to alcohol or heroin or crystal meth may spark more controversy than its subtler but equally far-reaching assertions.
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Here ASAM states that addiction is all about what happens in the brain. The source of the addictive brain alterations is irrelevant. All current research (my links above) points to the same brain alterations: hypofrontality, desensitization, and sensitization, occurring within the reward circuitry.

1. QUESTION: What’s different about this new definition?

ANSWER:
The focus in the past has been generally on substances associated with addiction, such as alcohol, heroin, marijuana, or cocaine. This new definition makes clear that addiction is not about drugs, it’s about brains. It is not the substances a person uses that make them an addict; it is not even the quantity or frequency of use. Addiction is about what happens in a person’s brain when they are exposed to rewarding substances or rewarding behaviors, and it is more about reward circuitry in the brain and related brain structures than it is about the external chemicals or behavior that “turn on” that reward circuitry. We have recognized the role of memory, motivation and related circuitry in the manifestation and progression of this disease.
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ASAM says (as did Wolf) that this very same neural circuitry, the reward circuitry (MFB), is involved with all addictions. From the new ASAM definition:

”Most clinicians have learned of reward pathways including projections from the ventral tegmental area (VTA) of the brain, through the median forebrain bundle (MFB), and terminating in the nucleus accumbens (Nuc Acc), in which dopamine neurons are prominent. Current neuroscience recognizes that the neurocircuitry of reward also involves a rich bi-directional circuitry connecting the nucleus accumbens and the basal forebrain. It is the reward circuitry where reward is registered, and where the most fundamental rewards such as food, hydration, sex, and nurturing exert a strong and life-sustaining influence. Alcohol, nicotine, other drugs and pathological gambling behaviors exert their initial effects by acting on the same reward circuitry that appears in the brain to make food and sex, for example, profoundly reinforcing.”
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In these two FAQs, ASAM parallels Naomi Wolf’s description of addiction and the pesky reward circuitry that is altered by ALL addictions. It clearly states that behavioral addictions, including sex, cause addictive brain changes.

5. QUESTION: This new definition of addiction refers to addiction involving gambling, food, and sexual behaviors. Does ASAM really believe that food and sex are addicting? ANSWER:
“Addiction to gambling has been well described in the scientific literature for several decades. In fact, the latest edition of the DSM (DSM-V) will list gambling disorder in the same section with substance use disorders.
The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. This the first time that ASAM has taken an official position that addiction is not solely “substance dependence.”
This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system. Food and sexual behaviors and gambling behaviors can be associated with the “pathological pursuit of rewards” described in this new definition of addiction.”

2. QUESTION: How is this definition of addiction different from previous descriptions such as DSM?

ANSWER: The ASAM definition of addiction does not exclude the role of environmental factors in addiction – things such as neighborhood or culture or the amount of psychological stress that a person has experienced. But it definitely looks at the role of the brain in the etiology of addiction – what is happening with brain functioning and specific brain circuitry that can explain the outward behaviors seen in addiction.
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I believe that porn addiction is more common than sex addiction and closely parallels the growth of the Internet. Here ASAM addresses sex addiction:

6. QUESTION: Who has food addiction or sex addiction? How many people is this? How do you know?

ANSWER:“We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors. So, anyone who has addiction is vulnerable to food and sex addiction. We do not have accurate figures for how many people are affected by food addiction or sex addiction, specifically. We believe it would be important to focus research on gathering this information by recognizing these aspects of addiction, which may be present with or without substance-related problems.
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In this FAQ, and throughout its policy statement, ASAM emphasizes that all addictions share common underlying brain processes.
8. QUESTION: What are implications for treatment, for funding, for policy, for ASAM?

ANSWER:“The major implication for treatment is that we cannot keep the focus just on the substances. It is important to focus on the underlying disease process in the brain that has biological, psychological, social and spiritual manifestations.

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Maybe it’s time for you to do a new post based on current, conclusive research, even if it upsets iamcuriousblue.

Having read the posts that you and your colleague/friend Philo have posted, and having had a good conversation with Philo about the points you are both raising, I can see why you are so concerned about this issue. Clearly, and evidently from your website and the men you have had contact with, some men do seem to have problems with porn. I think that “porn addiction” is a very vague term, as its hard to define exactly when indulging in something you like becomes an addiction. However, erectile dysfunction (ED) is a clear and physical symptom, so lets discuss that a little.

I think there are a few points that need to be researched more, in order to determine how prevalent a problem this is for men in the internet age. Specifically, I think the following research needs to be conducted:

1) How common is ED in porn using men? Is it a problem that 10% of porn users have, or 1%? Because masturbation and pornography are taboo subjects to discuss in our society, its hard for us to tell this anecdotally. You could questionnaire the men that visit your website, but this would be a bit of a biased sample, as men visiting that site are possibly far more likely than average to have a problem with porn (perhaps). To get around the problems of a biased sample, we’d need to questionnaire men from a variety of groups, probably through a porn forum or other forum where there are lots of men. Just to repeat, we need to know if this is a very common problem caused by internet porn (30%), or if it just affects minority of men (10%) or a very small minority (1%)

2) You’ve cited a really good paper about internet addiction and dopamine receptors:
[b]Reduced striatal dopamine D2 receptors in people with Internet addiction.[/b]
http://www.ncbi.nlm.nih.gov/pubmed/21499141

This is good evidence of receptor abnormality in people who have problematic internet use. Unfortunately the article is behind a paywall (can you get this Vaughan?) so we can’t tell if the internet addiction is due to pornography, games like World of Warcraft, or social network sites like Facebook (or a combination of all of those). Your point about this is still valid though, that there are abnormalities in the brains of people with internet addiction (however the authors define this).

However, the abstract says: “An increasing amount of research has suggested that Internet addiction is [b]associated[/b] with abnormalities in the dopaminergic brain system.”

Associated is the key word here. We can’t conclude that internet use is *causing* receptor downregulation. It might be, but it could also be that people with diminished D2 receptors are more likely to become addicted to internet use, or that a third factor is causing both effects. This is a critically important point in all neuropsychological and/or cognitive neuroscience studies – does the brain abnormality cause the behaviour, or is the behaviour causing a brain abnormality?

3) Another thing that is critically important in psychology, is that behaviours are basically never caused by one factor acting alone. If this were the case, then psychologists like Vaughan and I would easily be able to predict people’s future behaviours (and we’d probably be very rich as a result). Instead there are multiple biological, psychological and sociological causes (and effects) of behaviours.

In relation to porn addiction, lets assume that you or some other researcher has done the research I suggest in point 1 above, and determined that 12% of men suffer from porn addiction to the point where they have ED in their real life sexual relationships. This would represent a large and significant minority of men (given that about 90% of men watch porn) and would be a health problem that should not be ignored. But could we easily conclude that the porn is causing the problem?

Well, in that situation, given that 88% of our sample didn’t have the problem, we’d probably conclude that there are other factors, as well as the porn, that are involved causally. Do these 12% of men have other addiction problems? Do a large proportion of them suffer from ADHD? Are a large proportion of them single, with no real life sexual relationships? Are a proportion of them sex offenders who need a safe outlet? Have any of them suffered a frontal lobe brain injury? (common following car crashes) which can cause problems with self control. Finally, did some of these men have ED prior to developing a porn addiction?

4) Finally, I think we need to consider again what is common, and what is different about about addictions and the involvement of dopamine. Sure, dopamine is common to all reinforcement of behaviours, and probably evolved to be used in that way because dopamine is critical to movement (as people with Parkinson’s disease discover). However, its not as simple as dopamine=addiction, which was the point that I feel Vaughan was originally trying to make.

Parkinson’s patients don’t become addicted to L-Dopa medication (although it often boosts their sex drive). People can develop eating addictions and disorders, but not all people do. I suspect that porn is similar to food in this respect.

Instead, you cherry-pick material from the “Reuniting” site, so that you can avoid discussing the merits of our posts here. “Reuniting” is for those interested in both traditional sexual wisdom from many cultures and the intriguing modern neuroscience findings that may lend support to that wisdom. We created http://www.yourbrainonporn.com to separate the porn material from the sexual-relationships material. Two different audiences, 2 different sets of material. What you are trying to do is take science and experience-based content addressed to porn addicts (YBOP) and mix it in a misleading way with content related to tantric traditions (as you simplistically characterize them). I understand your resorting to this sleight of hand. After all, there is so much annoying, solid data to be found at yourbrainonporn.com.

Not trying to intimidate you, blue, just trying to steer you to the actual debate on Vaughanbell’s misleading use of science. To recap, there’s lots of bluster about how vaughanbell is correct and Naomi is misguided, but no specifics. One problem: the “data dumping” and “expert quotes” refute blog Vaughanbell’s post. I know, I know, “screw data when it gets in the way of a cherished opinion.”

Our page you cite was written for those practicing tantra traditions – that’s why it’s on the Reuniting site. Talk about cherry-picking. We never say masturbation is evil, or any nonsense like that. How ironic is it that we run a site (yourbrainonporn.com), which helps men recover from porn-induced ED so they can masturbate and have orgasms with real partners? We cheer them on as they return to full erectile (brain) health and resume orgasmic sex (not tantra) with real partners. That’s the part of the story you don’t want to touch.

Speaking of masturbation: Most of the men who wash up on our sites have porn-induced ED. They are the ones in a panic. They masturbated happily to porn for years. Now, after a few years of Internet porn, they can’t get it up for the real deal. Experts (and para-academics) say it’s all in their heads. They are half right – it’s an addictive process occurring in the brain’s reward circuitry, not a performance issue. (Some of these guys can’t even get it up now for solo sex.)

It’s true that the men have to understand the science behind their symptoms, stop porn and drastically reduce masturbation for a few months in order to return their brains to normal sensitivity. Once they heal, they are back in saddle and can have sex with real partners—or even experiment with other approaches to sex. Contrary to your spin, we encourage them to masturbate once their penises return to full strength. Above all, we encourage them to find balance (a word that may no longer be in your vocabulary). Incidentally, we were intrigued to find that today’s standard advice encouraging masturbation to Internet porn ad libitum is supported by neither anthropology, evolutionary biology nor the biology of sperm production. Alarmingly, today’s sexperts are not studying any of those fields.

Only in a very twisted worldview would masturbating to a screen with a limp penis be declared “sex positive” (what you are defending), while recovering the balance needed for healthy erections, strong libido and sex with a real partner be “sex negative.” We promote the latter. What are you advocating?

By the way, thanks for your opinion of our book. You may find it interesting (and revolting) that it is endorsed by three experts in the field of biology and neurobiology:
-AJ Reid Finlayson, MD, Division of Addiction Medicine professor, Vanderbilt University
-Russel Razzaque, MD, Consultant Psychiatrist (meaning he has an additional degree in neurobiology), London, England
-Jay Phelan, PhD, UCLA professor, co-author of “Mean Genes,” and author of a university biology textbook.

It seems the more neuroscience you know, the more our material makes sense.

We have already stated how Vaughanbell misled readers. We have backed it up with expert statements and research. I’ll be back when you do the same, or begin to discuss the specifics of this blog post.
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WARNING! More (highly relevant) data dump: The first link is to a talk by a well known addiction expert that refutes Vaughanbell’s spin. The next 3 studies refute Vaughanbell’s assertion (just like the many already posted) that that drug addiction employs different mechanisms from natural rewards. The last 3 studies found brain changes in Internet addicts that mirror those found in drug addicts.

NPR’s interview with noted research neurobiologist David Linden. In this 30-minute ‘Fresh Air’ segment, Dr. Linden states that that sex can be an addiction. Like Nora Volkow, his wording and descriptions of the reward circuitry, dopamine’s function parallel Naomi Wolf’s, not Vaughanbell’s.
‘Compass Of Pleasure’: Why Some Things Feel So Good- http://www.npr.org/2011/06/23/137348338/compass-of-pleasure-why-some-things-feel-so-good
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Is there a common molecular pathway for addiction? Nat Neurosci. 2005 Nov;8(11):1445-9, Nestler EJ. Drugs of abuse have very different acute mechanisms of action but converge on the brain’s reward pathways by producing a series of common functional effects after both acute and chronic administration. Some similar actions occur for natural rewards as well. Researchers are making progress in understanding the molecular and cellular basis of these common effects. A major goal for future research is to determine whether such common underpinnings of addiction can be exploited for the development of more effective treatments for a wide range of addictive disorders.

Reward Circuitry Dopaminergic Activation Regulates Food And Drug Craving Behavior.
Curr Pharm Des. 2011;17(12):1158-67.
Neural circuits implicated in drug conditioning, craving and relapse overlap extensively with those involved in natural reward and reinforcement like food. Similar regional activation patterns occur in humans in response to cues associated with foods. Furthermore, drug- and food-related cues not only activate common neuroanatomical regions but also result in similar activity-regulated gene expression programs within these shared areas.

The Neuroscience of Natural Rewards Relevance to Addictive Drugs
The Journal of Neuroscience, 1 May 2002, 22(9): 3306-3311;
Addictive drugs act on brain reward systems, although the brain evolved to respond not to drugs but to natural rewards, such as food and sex. In a quirk of evolutionary fate, humans discovered how to stimulate this system artificially with drugs. Many molecular features of neural systems instantiating reward, and of those systems affected by addictive drugs, are conserved across species
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Reduced Striatal Dopamine D2 Receptors in People With Internet Addiction, Neuroreport. 2011 Jun 11;22(8):407-11.
An increasing amount of research has suggested that Internet addiction is associated with abnormalities in the dopaminergic brain system. Consistent with our prediction, individuals with Internet addiction showed reduced levels of dopamine D2 receptor availability in subdivisions of the striatum including the bilateral dorsal caudate and right putamen. This finding contributes to the understanding of neurobiological mechanism of Internet addiction.

Microstructure Abnormalities in Adolescents with Internet Addiction Disorder.
Our results suggested that long-term internet addiction would result in brain structural alterations, which probably contributed to chronic dysfunction in subjects with IAD

Enhanced Reward Sensitivity and Decreased Loss Sensitivity in Internet Addicts: An fMRI Study During a Guessing Task. J Psychiatr Res. 2011 Jul 16.
As the world’s fastest growing “addiction”, Internet addiction should be studied to unravel the potential heterogeneity. The results suggested that Internet addicts have enhanced reward sensitivity and decreased loss sensitivity than normal comparisons.

And it is pretty clear that the latter is the category you two (Robinson/Philo and Wilson/Glarion) fall into, with even the most cursory look at the theories expounded in Robinson’s book “Cupid’s Poisoned Arrow“. This book makes the rather tall claim, based on the odd theories of Tantric sexology, that orgasm is physically harmful, and that there is supposedly some sort of neuroscientific basis for this idea. These oddball views of the neuropsychology of sex dovetail into to the view that masturbation is harmful, and the current atmosphere of panic and pseudoscientific claims around pornography provide a wedge issue to espouse what would otherwise be seen as some very fringe ideas on sexuality.

It is quite clear on the very face of it that Naomi Wolf was espousing a “marijuana leads to heroin” view of pornography use, based on a very simplistic “dopamine is dangerous” framing of neuroscience, and I commend Bell for calling it out. As with similar false claims about the role of oxytocin, making such claims about the role of dopamine is irresponsible, alarmist, and deployed in the service of a larger agenda.

I will note, Glarion, that you have a clear advantage over most commentators here, myself included, in that you are better versed in the minutiae of the literature on dopamine, and it allows you to make some specific claims that are not easily challenged. However, one does not need to go very far into the claims the two of you make in your writing to note that your are prone to making very grandiose leaps of logic based on very specific and limited studies. I’ve seen enough pseudoscientists who use this technique of obfuscation to recognize it in action, and it is clear that you are doing it here.

All spin no content.

I’m glad you have been perusing our websites. Maybe you will learn something. First, we don’t hide who we are, as several of our above-posted links lead to our articles. In fact, we posted the debate on yourbrainonporn.com, identifying who we are – http://yourbrainonporn.com/naomi-wolf-porn-debate-2011

We chose to use nicknames here to avoid ad hominem attacks (like yours, and now Vaughan Bell’s). Such remarks assert a lot, but fail to take on the specifics. I’ve read your post several times, and cannot identify one substantive argument. My alarm bells go off when I see a post filled emotion-driven buzzwords, such as “grossly distorted”, “pseudoscientific”, “creation scientists,” “strongly invested”, “ostensibly scientific,” “claims”, etc.

We covered the relevant scientific substance, in detail, in our above posts. Care to dispute substance instead of engaging in empty rhetoric?

QUOTE: Iamcuriousblue: “Like many who are highly knowledgeable about a very specific area of science, they know claims made based on that specific knowledge are not easily refuted by non-specialists”
Really? We came here to exchange ideas with an expert on his own blog. Please note that Vaughanbell’s only substantive response was to cite a 1963 study (before the role of dopamine in addiction was elucidated) discussing an irrelevant definition of *psychological* desensitization.

The other expert, Tom, only responded with a to cite to Heterogeneity of Reward Mechanisms,, which Vaughanbell relied on to mislead Wolf’s readers. It does not say what he would have you think it does. I have the entire study and have read it. Vaughanbell cites it as evidence that not all addictions involve the reward circuitry. All addictions do, and this study actually affirmed this.
The study also explained that all addictions cause dopamine dysregulation and desensitization of the reward circuitry. “Heterogeneity” refers to the mechanisms that each drug or natural reward employ to cause dopamine deregulation within the reward circuitry. For example: Cocaine increases dopamine directly; heroin increases dopamine by reducing reward circuitry GABA; nicotine increases dopamine by increasing glutamate. Nowhere in this study does it say the reward circuitry is *not* involved, or that dopamine is not central to all addictions.
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Before you consider engaging in a substantive debate, you may want to educate yourself on the latest research on behavioral addictions. As noted and cited, all researchers who study the neurobiology of addiction agree that *all* addictions involve the same neural pathways and similar mechanisms.

I suggest starting with this 7-minute segment (“The Unyielding Power of Dopamine”) of a longer video presentation by the head of NIDA, Nora Volkow MD. http://bigthink.com/ideas/17404
Be prepared. Her description of dopamine functioning and the reward circuitry will more closely match Naomi Wolfe’s “pseudoscientific” description. Hopefully you can get past that.

Once you have watched Nora’s longer presentation, I suggest moving on to some actual research. This is a good place to start. Shared brain vulnerabilities open the way for nonsubstance addictions: Carving addiction at a new joint? http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2009.05420.x/full

From that study:
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For more than half a century, since the beginning of formal diagnostics, our psychiatric nosology has compartmentalized the compulsive pursuit of substance (e.g., alcohol, cocaine, heroin, nicotine) from nonsubstance (e.g., gambling, food, sex) rewards. Emerging brain, behavioral, and genetic findings challenge this diagnostic boundary, pointing to shared vulnerabilities underlying the pathological pursuit of substance and nonsubstance rewards. This review discusses how neurobiological data from problem gambling, obesity, and “normal” states of attachment (romantic infatuation, sexual attraction, maternal bonds) may help us in the task of carving addictions “at a new joint.”
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As far as being interested in “tantra”, a lot of people are interested in the neurobiology of various sexual behaviors including porn addiction. The author of this post (Vaughanbell) has taken hallucinogens and blogged about it. Should we discount what he has to say?

And while their knowledge of neuroscience does seem impressive, there is quite a bit that sets off alarm bells. Why are they so quick to defend grossly distorted presentations of neuroscience, such as those made by Naomi Wolf? Why do they never turn up to correct the grossly simplistic, and often pseudoscientific, claims made about the roles of dopamine and oxytocin? In their counterarguments, are they presenting a full picture of the current research, or are they simply cherry-picking from research that favors their views?

Furthermore, if one looks at Reuniting.info, one is immediately struck by the overwhelming “New Age” and “Tantric” ideas about sex on this site. Are these two really about defending a scientific point of view around sex? They strike me as the equivalent of “creation scientists”, notably Michael Behe and his rhetoric about the bacterial flagellum. Like many who are highly knowledgeable about a very specific area of science, they know claims made based on that specific knowledge are not easily refuted by non-specialists, and hence use that as a wedge to make larger unfounded claims about the larger state of scientific knowledge.

I will also note that Robinson and Wilson seem to be very strongly invested in promoting a wide application of the addiction model to a wide range of compulsive or simply pleasurable behaviors, as well as a “relational” view of sexuality. I highly doubt these views have been arrived at via dispassionate scientific inquiry, and one has to wonder just how much they are bending the science to fit these views.

(Moderator – I think I posted this twice, the first time with improper formatting. Could you remove the first one?)