How worried should we be about internet pornography use? There is no question of its prevalence. Over 66% of American men report using it at least monthly, and 40% of women  and reportedly about 50% of internet traffic is porn use . For many adolescents pornography is how you learn about sex, what to do, what to expect, how to be with the opposite sex.
Recent studies by Valerie Voon and colleagues have shown clearly that the processes involved in internet pornography users’ drive for porn are remarkably similar to other forms of addiction , using the very same brain circuitry, particularly the dopaminergic circuits, areas such as the nucleus accumbens and the VTA . This system involving dopamine can drive us towards things, sex, food, pleasure, but in itself does not necessarily lead to pleasure. However the drive can become addictive and we know that people will turn towards their addictive pleasure (alcohol, food, shopping, drugs, gaming, pornography) in attempts toward of emotional states that are hardtop bear, such as feelings of depression or despair.
One major worry is the ease of access to internet pornography from an early age, and what this can do to the teenage brain. The adolescent brain is forming and developing and is vulnerable to stimuli. The parts of the brain involved in emotional regulation, particularly the pre-frontal areas, are not fully formed until the mid-twenties, while on the other hand the dopaminergic circuits are particularly prone to be active. This makes sense. This is an age for adventure, for learning to be outside the family, take risks, find your identity. However this dopaminergic circuitry can be hijacked in addictions such as of pornography.
Adolescent internet use tends to be high anyway, but more so in those with psychological issues and a propensity for riskier behaviours generally (Dufour et al., 2014). The centrally involved brain areas are nucleus accumbens, involved in dopamine release and part of the ventral striatum, and the VTA (ventral tegmental area), a central site of dopamine neurons. Most recreational drugs work on these pathways which are central to wanting and craving. Removing the nucleus accumbens in other animals seems to inhibit addictive cravings and has even led to surgical treatment in humans with some success (Li et al., 2013). Risk-taking adolescents have higher connectivity between the nucleus accumbens and prefrontal areas (DeWitt et al., 2014).There are clear links between addiction, early childhood problems and activation of this circuitry when cued by substances to which young people can become addicted (Leyton and Vezina, 2014). For example in sexually compulsive behaviour we see higher activation of the ventral striatum as well as the amygdala in response to sexual cues (Voon et al., 2014b), just as one sees in other forms of addiction.
These issues make adolescence a particularly vulnerable time for addictions of any kind (Chambers et al., 2014). This risk is increased by diminished prefrontal and emotional regulation skills, again especially in more vulnerable youth.
In fact high use of social media alone, such as Facebook, is linked to lower self-control (Wilcox and Stephen, 2013). Interestingly there is also a link between receiving facebook ‘likes’ and nucleus accumbens activity (Meshi et al., 2013), ‘likes’ presumably giving a dopamine buzz that is then sought again and again. Over-activity of the dopamine circuitry is linked to what is called hypofrontality, or in other words less activity in prefrontal brain areas and less emotional regulation. This has been shown in pornography (Hilton and Watts, 2011; Voon et al., 2014a) and other addictions. Any cue suggesting the imminent presence of the thing craved, whether a drug like cocaine or pornography or other online addictions such as gambling, gives rise to this circuitry firing up, and in time leads to lessening of executive functions (Brand et al., 2014). The ventral striatum, central to the mesolimbic pathway, is much more activated in high internet users, as it is in other forms of addiction (Kühn and Gallinat, 2015).
Voon’s most recent work shows another worrying aspect of pornography use. People involved in such sexually compulsive behaviour easily become habituated to certain kinds of images which no longer excite them, and they can then be drawn to ever more worrying images to re-gain the initial thrill . Where I work at the Portman clinic we often see a progression from more ordinary pornography use to more dramatic examples, often towards more violence, and then even bestiality and child pornography, as my colleague Heather Wood, an expert in this area, has often outlined . In the worst cases we can see a movement towards contact offences.
There is a clear link emerging between male pornography use and increased likelihood of being excited by sexual aggression towards women . Males who use more pornography not only are more likely to be aroused by violence generally, but also in a range of tests were shown to be less likely to help another person who is in trouble . Indeed the same is true for women; those who view a lot of pornography are less likely to come to the rescue of those needing help . Almost by definition pornography treats people as sexual objects rather than as human beings to relate to. Many of us working clinically with such cases find that internet pornography and sex sites, as well as other electronic media, are used as substitutes for relationships . A common clinical finding is that internet sex becomes compulsive and can escalate, leading to profound deterioration in the capacity to manage ordinary real relationships.
Of course what is cause and effect is uncertain, these are chicken and egg issues. Not surprisingly those who suffered harsh parenting indulge more in internet pornography, and are also more likely to get involved in coercive sexual relationships . Pornography tends to be used as a desperate attempt to ward off difficult emotional states and anxieties, as a rather unhelpful and unsuccessful antidepressant, and the dopamine fuelled buzz of this and other addictions is often pursued in manic attempts to flee psychic states which can feel unbearable. For these and other reasons we need to be able to take this seriously and offer help where needed. We thus need services that can do this, and these are few and far between, there is too little expertise and funding cuts are posing a huge threat. Because there is a lot of shame and secrecy about pornography use, including in parents, these issues often remain undiscovered and left to develop in worrying ways. It is maybe time for these issues to be talked about more publicly
Addendum: For anyone interested, the last 10 minutes of this All in the Min Program features a discussion between Valerie Voon and myself about sexually compulsive behaviour, link here
 ‘Pornified: How Pornography is Damaging Our Lives, Our Relationships, and Our Families: Amazon.co.uk: Pamela Paul: 9780805081329: Books’. [Online]. Available: http://www.amazon.co.uk/Pornified-Pornography-Damaging-Relationships-Families/dp/0805081321/ref=sr_1_1?ie=UTF8&qid=1448316784&sr=8-1&keywords=pornified. [Accessed: 23-Nov-2015].
 S. Kühn and J. Gallinat, ‘Brain structure and functional connectivity associated with pornography consumption: the brain on porn’, JAMA Psychiatry, vol. 71, no. 7, pp. 827–834, 2014.
 D. J. Mechelmans, M. Irvine, P. Banca, L. Porter, S. Mitchell, T. B. Mole, T. R. Lapa, N. A. Harrison, M. N. Potenza, and V. Voon, ‘Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours’, 2014.
 V. Voon, T. B. Mole, P. Banca, L. Porter, L. Morris, S. Mitchell, T. R. Lapa, J. Karr, N. A. Harrison, and M. N. Potenza, ‘Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours’, 2014.
 M. Dufour, A. Gendron, M. M. Cousineau, and D. Leclerc, ‘Adolescent technology use: Profiles of distinct groups and associated risky behaviors’, J Addict Res Ther S, vol. S10:010, 2014.
 N. Li, J. Wang, X. Wang, C. Chang, S. Ge, L. Gao, H. Wu, H. Zhao, N. Geng, and G. Gao, ‘Nucleus Accumbens Surgery for Addiction’, World Neurosurg., vol. 80, no. 3, pp. S28.e9–S28.e19, Sep. 2013.
 S. J. DeWitt, S. Aslan, and F. M. Filbey, ‘Adolescent risk-taking and resting state functional connectivity’, Psychiatry Res. Neuroimaging, vol. 222, no. 3, pp. 157–164, 2014.
 M. Leyton and P. Vezina, ‘Dopamine ups and downs in vulnerability to addictions: a neurodevelopmental model’, Trends Pharmacol. Sci., vol. 35, no. 6, pp. 268–276, Jun. 2014.
 V. Voon, T. B. Mole, P. Banca, L. Porter, L. Morris, S. Mitchell, T. R. Lapa, J. Karr, N. A. Harrison, M. N. Potenza, and M. Irvine, ‘Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours’, PLoS ONE, vol. 9, no. 7, p. e102419, Jul. 2014.
 R. A. Chambers, J. R. Taylor, and M. N. Potenza, ‘Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability’, Am. J. Psychiatry, vol. 160, no. 6, pp. 1041–52, 2014.
 K. Wilcox and A. Stephen, ‘Are Close Friends the Enemy? Online Social Networks, Self-Esteem, and Self-Control’, J. Consum. Res., vol. 40, no. 1, pp. 90–103, 2013.
 D. Meshi, C. Morawetz, and H. R. Heekeren, ‘Nucleus accumbens response to gains in reputation for the self relative to gains for others predicts social media use’, Front. Hum. Neurosci., vol. 7, 2013.
 D. L. Hilton and C. Watts, ‘Pornography addiction: A neuroscience perspective’, Surg. Neurol. Int., vol. 2, Feb. 2011.
 M. Brand, K. S. Young, and C. Laier, ‘Prefrontal Control and Internet Addiction: A Theoretical Model and Review of Neuropsychological and Neuroimaging Findings’, Front. Hum. Neurosci., vol. 8, May 2014.
 S. Kühn and J. Gallinat, ‘Brains online: structural and functional correlates of habitual Internet use’, Addict. Biol., vol. 20, no. 2, pp. 415–422, Mar. 2015.
 P. Banca, L. S. Morris, S. Mitchell, N. A. Harrison, M. N. Potenza, and V. Voon, ‘Novelty, conditioning and attentional bias to sexual rewards’, J. Psychiatr. Res., 2015.
 H. Wood, ‘The internet and its role in the escalation of sexually compulsive behaviour’, Psychoanal. Psychother., vol. 25, no. 2, pp. 127–142, 2011.
 N. M. Malamuth, G. M. Hald, and M. Koss, ‘Pornography, Individual Differences in Risk and Men’s Acceptance of Violence Against Women in a Representative Sample’, Sex Roles, vol. 66, no. 7–8, pp. 427–439, Apr. 2012.
 J. D. Foubert, M. W. Brosi, and R. S. Bannon, ‘Pornography Viewing among Fraternity Men: Effects on Bystander Intervention, Rape Myth Acceptance and Behavioral Intent to Commit Sexual Assault’, Sex. Addict. Compulsivity, vol. 18, no. 4, pp. 212–231, 2011.
 M. W. Brosi, J. D. Foubert, R. S. Bannon, and G. Yandell, ‘Effects of women’s pornography use on bystander intervention in a sexual assault situation and rape myth acceptance’, Oracle Res. J. Assoc. Fratern. Sorority Advis., vol. 6, no. 2, pp. 26–35, 2011.
 L. G. Simons, R. L. Simons, M.-K. Lei, and T. E. Sutton, ‘Exposure to harsh parenting and pornography as explanations for males’ sexual coercion and females’ sexual victimization’, Violence Vict., vol. 27, no. 3, pp. 378–395, 2012.