All of these points are already common knowledge among addiction experts, although Dr. Ley is right that members of the DSM still aren't on board. This could be another unfortunate instance of "science advancing one funeral at a time."

It is the existence of underlying brain changes that define the presence of addiction...whatever the activity. This is why the American Society of Addiction Medicine opined that sexual behavior can be an addiction, despite the absence of brain scans of porn-addicts and the woefully limited brain scans of sex addicts. Scant as the brain-scan studies on sex addicts are, however, they (and a lot of clinical evidence) point to the same addiction-related brain changes seen in other behavioral addicts. That is, the research does not support Dr. Ley's position that sex addiction is a myth.

If all signs and symptoms of porn/sex addicts match those of other addicts, then so do their brain changes. Or to state it differently, unless Dr. Ley can point to some other possible physiological mechanism that could cause sex/porn addicts to demonstrate all the signs and symptoms that mark addiction to drugs, pathological gambling and food addiction, it is reckless to insist that porn/sex addiction is a myth.

It's becoming imperative that we look beyond the superficial differences in addictions and see them all as one disease. Since sexual behavior is such a loaded subject, let me make this point differently. Suppose a video game were created that played on our fundamental parenting instincts. Imagine it offered gamers virtual babies that were so adorable that gamers spent hours watching and "feeding" their superstimulating virtual infants to the exclusion of caring for their real children, keeping their jobs, or sustaining their marriages.

Suppose their behavior met the various addiction-diagnostic tests, but brain scan studies hadn't yet been done. Would Dr. Ley wait to diagnose these people as addicts because no empirical research on Internet-baby addicts had yet been done? (In fact, with science-fiction bizarreness, a couple hooked on such an online game allowed their real baby to starve to death. And another video-gaming couple sold their children to enable them to keep playing an online game in an Internet cafe.)

Researchers in other countries have realized that a key issue at the heart of porn addiction isn't sexual content, but rather Internet delivery. They aren't sitting around demanding brain scans of porn users versus cyber-sex users, or brain scans of particular kinds of gamers. They're already measuring the existence of Internet addiction. Summary of recent Internet-addiction studies.

The DSM resists the idea that addiction is fundamentally one disease, dependent upon brain changes. Traditionally it has defined disease by lists of behaviors, not by underlying disease physiology. Should an alcoholic be defined by driving drunk, passing out or drinking before noon? Of course not. Many alcoholics engage in none of these specific behaviors. Similarly, other addicts should not be defined by lists of specific behaviors. Thanks to its piecemeal approach, however, the DSM has so far only managed to acknowledge gambling as a potential behavioral addiction.

The reality of addiction doesn't wait for researchers to "discover" it, so research will always be well behind new addictions. This no longer matters because brain changes are so similar across addictions. Indeed, it would be irresponsible to presume that sex/porn and gaming addicts who meet the addiction experts' tests do not have underlying addiction-related brain changes. This is not to say that healthcare givers shouldn't consider what other conditions may be influencing their clients/patients. However, where general addiction tests are met, the possibility of addiction should be on the table from the outset and patients informed this is possible cause of their symptoms.

It's regrettable that some experts are clinging to the idea that addiction research should be a piecemeal endeavor. It hurts their clients and it may well turn out to be unfortunate for them professionally. As a lawyer, I fear that that some healthcare practitioners are so attached to their philosophies that they will only align with today's empirical brain-science findings on behavioral addiction after they are the subjects of lawsuits brought by misdiagnosed or incorrectly assessed behavioral addicts.

As unlikely as it seems, porn addicts may lead that charge—simply because Internet porn use is so ubiquitous and compelling. They'll have a case, because the 3000 addiction specialists of ASAM have spoken. The medical profession is no longer in denial about the addictive potential of sexual behaviors. Second, Internet porn use is now so mainstream and shame-free that the publicity of filing a lawsuit is little deterrent. Already, people have sued when poor medical advice led to reckless sexual behavior.

Third, today's Internet porn appears to be causing extreme symptoms never before seen in young porn users. They are very unhappy about their distress. They are likely to be even more irate when they learn that

(1) their porn-related sexual dysfunction could have been reversed early on if their healthcare givers had been keeping abreast of the latest addiction brain science, and

(2) they have been prescribed expensive, irrelevant therapy, or treated with psychotropic drugs inappropriate for their condition, which produce various damaging side effects—without resolving their symptoms.

In this regard, here are actual statements from former porn users: