Pornography addiction is still controversial, but it is undeniable for those living within its destructive reach.
Sex therapist Mary Hodson says we need to act quickly to tackle pornography's skyrocketing casualty list.
During the past five years, there has been a dramatic increase in the number of people seeking help for pornography-related problems, she says.
Hodson runs two North Island clinics and is spokeswoman for Sex Therapy New Zealand's nationwide network of clinics.
''When I first started it was just the odd person coming through,'' she says.
''Now my guess is that it is up to 40% with some porn component. The growth has particularly been in the area of porn.''
When it comes to pornography, Hodson prefers the label ''Out-of-control sexual behaviour'' (OCSB) rather than ''addiction''.
She says research is yet to conclusively prove that the brains of people experiencing problems with porn are showing all the classic signs of addiction. A chemical change in the brain, probably linked to the feel-good hormone oxytocin, is likely to be proven soon, she says.
There is, however, no argument about the devastating impact porn is having on some people and on those around them.
''In my Wellington clinic it is not uncommon to see a high percentage of people with some type of out-of-control sexual behaviour,'' Hodson says.
''You might have a young man of 23, for instance, who walks into your counselling room and says he is having a problem ejaculating. It's either taking a very long time or it's not happening.
''That would be a problem that was rarely seen 10 or 15 years ago. It has suddenly become much more common.
''You talk to these young men and they are probably in their first or second long-term sexual relationship and they have met their own needs pretty consistently since adolescence with internet porn and masturbation.''
She believes it is not the porn itself that is the problem, but the extent to which it is used and the problems that develop as a result.
''And also, the underlying problems that lead a person to overusing it.''
Porn use is out of control when it starts causing problems in a person's life, she says. Signs can range from a partner complaining that the porn user is always on their device and spends less time with them, through to being found with inappropriate material on their work computer.
Clients frequently tell Hodson about longing for unstructured time so they can get on to their device and look at porn and masturbate.
''The person's mind is becoming aroused entirely around sex, hyperarousal. For these people, their interest in sex has soared way above the norm. They are much more interested in sex and sexual things than others.''
There are also changes in the nature of their sexual thought.
''Once they've started therapy they talk about how they used to see someone and think, `I'd like to have sex with that'. It's objectifying.''
For others with porn-related OCSB, real people are no longer desired.
If you spend a lot of time looking at porn and masturbating, you get very good at pleasing yourself, Hodson explains.
And if you've been doing a lot of that, to a large extent your sexual needs are met.
''I say that with a proviso. Because the more they do it, once they fall into that hyperarousal bracket, often they don't feel satisfied for very long. And there can be feelings of guilt. So, sometimes they masturbate again to get a good feeling. So, it is often a cycle that goes round and round.''
There is also some evidence that once hyperaroused, the person needs more stimulation to get the same result so they progress to increasingly hardcore porn. This progression needs further research, she says.
Out-of-control porn use, which is predominantly but not exclusively a male problem, is inevitably damaging to relationships.
''It is very harming for many women [partners],'' Hodson says.
''To many women, porn is offensive. They see it as dreadful, unethical and immoral. They've been taught to think that way, and so it is very damaging for them.
''It is common to work with people who, when the problem has been discovered, the partner has left, end of story.''
Her experience as a therapist suggests the problem is much more widespread than many might like to believe.
''People come along and see a sex therapist when they can't actually get away with it any more. Their partner is calling them out on it, or it's disrupting life so much that they are thinking, I've got to get some help.
''And the increase we have seen, even in just the last five years, is so marked I have to think there must be a lot of people we don't see who are struggling with this.
''As a therapist, I am only seeing the tip of some sort of iceberg.''
The internet, which makes porn readily and freely available, is fuelling the exponential growth of porn-related OCSB.
It is also bequeathing its toxic legacy to an increasingly younger age group.
''My youngest client was 13. He'd watched a porn movie with a group of friends. Initially, he was really shocked by what he saw. But two or three months later, he was replicating some of the same behaviour.''
The time for urgent action is now, Hodson says.
Sex education has improved ''out of sight'' but it does not yet address porn.
''It really needs to happen very quickly. Because, if you are a young person and you've got most of your sex education and practical sexual experience from porn, you haven't got much idea how to be in a relationship. We need to teach young people how to be in a caring relationship and how to give and receive pleasure lovingly and respectfully.''
Young people need to be taught about the dangers of porn, she says.
''We should talk about the ethics and the morals, of course, but we also need to talk about some of the problems we are beginning to see with porn and how easy it is to fall into that problem trap.''
And treatment for problem porn use needs to be funded.
''We see alcohol and drugs as a threat, but we don't see the damage porn can do to relationships and people within those relationships.
''There is lots of research that shows that strong sexual relationships create strong families, and strong families create strong communities and strong communities create a strong New Zealand. And yet there is no money for this.''
A spokeswoman for Minister of Health Jonathan Coleman said the minister had not received any advice on the rapid rise of pornography addiction. She suggested questions could be directed to the Ministry of Health.
A Ministry of Health spokesman, in an emailed response, said that the ministry recognised pornography addiction ''is a real phenomenon''.
Although the so-called psychologists' bible, The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, did not list sex addiction as a diagnosable condition ''there is growing literature about the behaviour'', the spokesman said.
As such, people with a pornography addiction should be able to seek help from community-based providers, ''some of which are funded by district health boards (DHBs),'' the spokesman said. A rider was added.
''Addiction treatment services delivered by DHBs are generally designed to meet the needs of people with more severe addiction problems.''
Whether pornography addiction would be considered severe was not stated.
Mrs Hodson believes problem porn use, whether it is called an addiction or OCSB, is treatable.
''But it has to be done at the point where the person really believes they need help.''
A life turned upside down
A male porn addict, in his forties, speaks out.
About 16 years ago, a guy introduced me to a porn site. Porn and I go way back.
It started as a youngster, finding girlie magazines at the family holiday house.
And then I remember as a teenager, a neighbour wanting to put on a porn movie.
In my heart, I didn't want to but there were mates around and I thought I could handle it.
But major porn addiction really stems from this point about 16 years ago.
The website had photos and videos and everything. The guy said,"You can have a bit of a perv''.
I was married. I thought, "Oh yeah, I'll go and have a bit of a look''.
But I never guessed how much of a grip it would have on me.
It was instant.
It just became, all the time wanting to go back and check out different things.
Before I knew it, I was literally finding myself thinking things like, "Right, once my wife's in bed or, when she's away, I need to quickly jump online and go and check out this or that''.
Masturbation was always part of it.
Pardon the pun, but the two go hand in hand.
It led to what I didn't expect; being unfaithful to my wife.
Porn was the catalyst because it was constantly feeding the feeling that I needed more stimulation.
I think my wife had an idea about the porn.
She would come downstairs and I'd quickly close pages on the computer.
We tried to sort our marriage out after the affair.
I was still viewing the porn.
So I wasn't physically having an affair anymore, but in my head I was with these women.
The marriage ended not long after.
The addiction deepened.
I was scared about what pornography was doing to me and how it was changing the way I viewed women.
I had it in my head, if I saw women in the street that I was going to have my wicked way with them no matter what.
I thought, am I on the verge of becoming a sexual predator?
That was a very dark place for me.
I know for me, when I'm in that place of using pornography, it is driven by an insatiable lust.
It is not a healthy loving thing, it is very self-centred.
Pornography has drained me financially, emotionally and mentally.
I'm an able-bodied person, but I am crippled in all those ways by porn.
It would be nothing for me to spend $100 on magazines, go and park up somewhere and do my business and then throw all the magazines away.
I would click on a website for a three-day trial and then find it had taken $180 dollars from my credit card.
I have literally spent thousands on this, one way or another.
Emotionally it is so draining.
I've spent so much time on the computer and I'm not getting the sleep I need.
It's very hard to function when it consumes you.
Basic necessities like making your own lunch go out the door.
There's lots of sacrifices to feed this addiction.
And it is so hard trying to be two people; one person on the outside and another one on the inside.
It's a hard act to play, day after day.
Mentally, I was so unhappy doing what I didn't want to be doing.
It spiralled down into depression.
For a time I was part of a support group for dealing with addictive behaviours.
That was a good start.
But what changed things more was having to tell my family.
Once I exposed everything to my family, it didn't have as strong a grip on me, that's the truth.
For me, it's realising that it comes down to a matter of choice.
I had a period of being pornography and masturbation-free for 10 months.
That was absolutely significant for me.
I went to a counsellor and had intensive counselling for a year.
It got down to some of the nitty-gritty that was driving why I wanted to use porn.
A need to be loved seemed to be a key driver.
I'm still processing that.
I'm due to go back shortly.
Right now, porn is invading my life again.
I feel I'm at another crossroads.
Some people seem to be able to just let it go.
Others, like me, find it so much harder to get free, even though they want to.
Living with the lie
Female ex-partner of a porn addict, central Otago, in her thirties
I met a guy a couple of years ago. He told me early on that he watched quite a bit of porn. I had nothing against it.
He was a normal, successful, lovely, intelligent guy.
As we went into that relationship and I started spending more time with him, I started to see some very strange, unsettling behaviours. We'd be watching a movie and he'd get quite aroused. And I'd think, great, he's keen. But then he wouldn't be. Because this, the screen, was his thing.
So, he'd be sitting in front of his laptop ... and not aware of what he was doing. That doesn't make a woman comfortable.
He'd been doing it for a couple of years before we met.
I believe he had no idea it was addictive.
By the time we moved in together, I'd already mentioned it. He wasn't keen for me to talk about it. He was very evasive. So I started researching it.
I was reading that three times a week is the cut-off for addiction. He was watching three times a day. It's as powerful as smoking crack. It's highly addictive.
That's when I started asking him to stop. And he would become very aggressive. There was a cycle of him saying he would stop, but not stopping. Lots of lying. Typical addictive withdrawal behaviour. Trying to get on his own to watch it. Trying to get me away. Aggressive rages, out of nowhere.
Here's a statistic, from the United States: 72% of women who have been in a relationship with a porn addict are diagnosed with PTSD [post traumatic stress disorder]. The brain sees it as an actual betrayal.
How do you become traumatised by something you were fine with? You think if you say to the person, ''can you stop this please'', that they will, because they love you. But they have been taken over by the porn. Their whole mind has changed. The way they look at you has changed. They don't find you as attractive any more and sex doesn't feel as good because to masturbate to porn is like having a drug, and the real thing can't live up to that. I'd walk into the lounge and see him on the couch ... and I'd just start shaking with fear and go into the bathroom.
And not wanting to go out of the house. That wasn't me at all. And wanting to get home before him at the end of the day because part of my mind thought if I was there he wouldn't watch it. So, I became trapped. And he could see I didn't want him to be on his own in the house, so he felt trapped.
We broke up earlier this year. It got to the point where I thought, this has to stop. There was a lot of lying, and believing the lies. You're trying to trust, but you can see the behaviours.
Then I found it again. There was complete denial and rage. I kicked him out.
For me the impacts have been massive. A massive feeling of rejection, when your partner doesn't want to see you naked but then goes and looks at a woman on his phone.
If I talked to him about it, he could be more with me. But otherwise it was like I was just a vessel for his entertainment. He would wake up in the middle of the night having some porn dream and want to have sex, but when he properly woke up and realised it was me he wasn't keen any more.
So I felt extremely devalued. You've had someone choose a screen thing over you as a person.
In these porn movies the women are very submissive. In the end, even if I had an opinion it used to annoy him.
When you've got it on your phone, you've got any woman you want for however long or short you want, then you can shut it down.
A real woman just becomes a pain. She's in the way, she gets sick, she gets her period, she has complaints and feelings.
I felt like I may as well have been wearing a burqa. I felt like I needed to hide my opinions and my body. It's very sad. It's an illness. It's very toxic.
He was an amazing person. We could have had ... But I don't know if he will ever recover from this. And I know I'm not the only person who is going through this.
I was willing to speak out. But there will be women in relationships who see their partner isn't interested any more, she suspects something is wrong, but she's too scared to say something. She doesn't want to lose the kids and everything she has so she doesn't say anything. I think it's very prevalent.
In my work, I help bring about change. And in the area of porn addiction, I'd like to see this come out. [New Zealand Olympic middle distance runner] Nick Willis came out. I'd like to see this come out. Because it is a dirty, dirty underbelly and people don't want to talk about it.
I talked to my brother and he said he had a couple of friends who watch a lot of porn, and their wives and partners don't know. It's done in secret and in preference to a real-life experience with a person. It is normalised, but it's not normal at all.
This is not manly, but there are a lot of men equating this with manliness. If you need to look at porn to feel good about yourself as a man. And you need to turn women into a thing on your phone ... We need men to say, this is not manly, this is not how we deal with life.
Let's start to think about what makes a man a man.