MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Pornography existed long before the Web arrived. But in the Internet era, it's grown dramatically. Millions of American men, women, and teenagers have viewed porn on the Web. For most, it's not a problem. But psychologists report that, for an increasing number of people, viewing porn has become an addiction.

MS. DIANE REHMJoining me from a studio in Hartford, Conn. to talk about the use and abuse of online pornography, David Greenfield of the University of Connecticut School of Medicine. He's also the founder of The Center for Internet and Technology Addiction. I do invite you to join us. Call us, 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or Twitter. And welcome to you, Dr. Greenfield.

DR. DAVID GREENFIELDThank you for having me.

REHMDr. Greenfield, give us a sense of just how widespread viewing Internet pornography actually is.

GREENFIELDWell, there's all sorts of statistics out there talking about how widespread the use is. But it's almost universal that by the time an adolescent reaches 16 that he or she, in many cases, has seen hundreds of sexual acts depicted on Internet pornography. Most adults, by the time they hit their 40s and 50s have seen pornography on the Internet. So I would say it's almost universal that people have seen it. The degree to which they use it, whether they abuse it and whether they become addicted to it, of course, varies.

REHMNow, there certainly have been magazines. There have been movies. There have been videos. There have been all kinds of things out there for years and years. But now you've got the Web entering into it. How has the Web changed the viewing, the awareness, and the following of pornography for both men and women?

GREENFIELDWell, the Internet is a game changer with regard to pornography. First of all, the Internet and -- well, the pornography industry particularly was one of the early adopters of Web-based technology. So they were really some of the early driving forces behind popularizing the Internet because it's a perfect medium for pornography in the sense that it -- the ease of access, the perceived anonymity, the relative low cost, and the privacy that the Internet affords has really changed the game in terms of people feeling comfortable in accessing pornography.

GREENFIELDIn addition -- you mentioned women -- it has changed the game with regard to the consumption of pornography by women. Previously it was believed -- and there's data to support this -- that women didn't really find visually-based pornography all that appealing. But that has changed since the Internet has existed. And more and more women are looking at pornography. And there are estimates as high as 50 percent for women using pornography.

REHMAnd, of course, in the news, we tend to hear about child pornography. Just this past week, Sen. Lamar Alexander's chief of staff was arrested on charges of both possessing and distributing child pornography. I understand he was released on bail today on his own recognizance and will go back to his parents' home. Is the percentage of those who are viewing pornography -- those who are viewing child pornography much, much smaller?

GREENFIELDYeah. The percentage of people that view child pornography is much, much smaller, and it's much harder to get at on the Internet. There are specific ways to find it, which I will not mention on the air, but, in general, it's harder to find. You have to really be looking for it.

GREENFIELDAnd the other thing that people need to recognize is that some of the child pornography that's on the Internet are -- is sponsored and monitored and operated by governmental agencies or law enforcement agencies, so -- in order to catch people who are looking for child pornography. So it's a very unsafe place to go both in terms of if you get caught as well as in terms of the potential harm that it's doing to the victims.

REHMSo if we're talking about, you know, probably millions of people viewing pornography online, how do you know where the line is crossed from simply viewing it or indeed enjoying it for couples who may choose to enjoy it together? What's the line where you cross into addiction?

GREENFIELDThe line that you cross into addiction is the same for really any addiction. There has to be several components that are operating. One is that you have to be using the drug -- or in this case, the behavior -- in a compulsive fashion. In other words, you're using it in spite of negative consequences in a way that you don't feel in control of it. You have to use it.

GREENFIELDThe other thing is you have to experience some degree of tolerance, meaning that you need a more -- a greater degree of stimulation in terms of either the amount of pornography you're viewing or the nature of the stimulating content, in other words, more novel, unusual, or specific content. So that would be tolerance just like the tolerance for a drug or for alcohol use.

GREENFIELDIn terms -- then you would experience withdrawal. So if you stopped using it, you'd feel a sense of ill at ease or discomfort or anxiety or agitation in stopping. And the fourth and most significant one is that there has to be some deleterious or negative consequence in your life, one of the major life spheres, whether it be your home life, relationship, work, legal, financial, or health status. There has to be some negative consequence. In other words, it has to be interfering with your life in some way.

REHMAnd what about teenagers? What about young kids?

GREENFIELDNow that's a big issue because, you know, first of all, at what age are teenagers ready to -- first of all, they're seeing the hardest core sex imaginable online with little or no explanation. And I call this the pornification of America. So the teenagers that are viewing this in many cases, I think, are viewing it prematurely, and they're viewing it before they have the intellectual or frontal lobe capacity to really understand the nature of what they're viewing.

GREENFIELDAnd it can create, depending on how young the individual is, a precocious stimulation. In other words, they become hypersexual or hyper-aroused too early in their development, which can lead to sexual acting out or sexual addiction or a degree of promiscuity. It doesn't always occur in that direction, but it can.

REHMBut, of course, you do have blocking mechanisms that parents can install.

GREENFIELDThey -- there are blocking mechanisms, blocking filtering, and monitoring mechanisms that parents can upload and download from either their Internet service providers. There are freestanding companies that provide that. We, at our clinic, have an IT person that is dedicated to doing that for families and patients that come in to see us because it is often necessary to block these things.

GREENFIELDThe problem is blocking is not 100 percent fool-proof, and it's not a substitute for parents being aware of what their kids are using and what they're doing online. And it's -- in many cases, because the children have more knowledge of this technology than the parents, it reverses the power hierarchy in the family.

REHMHmm. Hmm.

GREENFIELDAnd so the kids kind of run the show technologically in a home. And I see this every day.

REHMDavid Greenfield, he is founder of The Center for Internet and Technology Addiction. He is assistant clinical professor of psychiatry at the University of Connecticut School of Medicine. I do invite your calls, 800-433-8850. Perhaps you have a young child in your family about whom you're concerned.

REHMMaybe you're thinking about yourself and the amount of time you spend online watching pornography and whether, in fact, it's become a problem in your own life. Give us a call, 800-433-8850. Dr. Greenfield, is addiction to pornography a medically recognized diagnosis as is drug addiction, for example?

GREENFIELDNot formally. There are various sexual diagnoses in the Diagnostic and Statistical Manual that speak to sexual behavior. There are diagnoses that sort of speak around the issue of impulsive or compulsive sexual behavior but not specifically online pornography addiction. There really are no diagnoses yet, with the exception of gaming addiction, which we talked about a few weeks ago, that appear in the DSM.

GREENFIELDI don't think that it's likely to appear immediately. But at some point, I would imagine it would have to be dealt with because sexual addiction and the subcategories of sexual addiction, which online pornography use would fall under, are a growing problem and do impact people significantly.

REHMDavid Greenfield, founder of The Center for Internet and Technology Addiction and assistant clinical professor of psychiatry at the University of Connecticut School of Medicine. Do join us, 800-433-8850.

REHMAnd welcome back. we're talking about pornography addiction, especially online. David Greenfield is with me. He founded the Center for Internet and Technology Addiction. He's assistant clinical professor of psychiatry at the University Of Connecticut School Of Medicine. And that's where he joins us from. Here is our first email, Dr. Greenfield. "Do young women use online pornography to learn how to be sexual? And is this beneficial?"

GREENFIELDThat's a great question. That's one of the things that I talked to one of your producers about. There are some benefits to being exposed to online pornography in the sense that it does provide and educational exposure to the youth culture. Obviously, the problem with that exposure is that it presents an unrealistic and unemotional expression of sexuality. Pornography is not known to depict loving relationships. Rather it depicts very graphic sexual content. But even still, there's probably some benefit, in terms of providing an educational experience, but it's pretty potent stuff.

GREENFIELDAnd it's important that parents and other professionals indicate to these kids that are viewing it that this isn't the way people really have sex. That people don't have sex with camera angles in mind. And they don't have sex, you know, like an acrobat. Most people consensual sexual contact is done in the context of a relationship and it doesn't look so fancy and crazy as it does on porn films.

REHMDo you believe that there's any connection between internet pornography availability and the increasing reports we hear about rape?

GREENFIELDYeah, I mean, I'm not up to date on the latest statistics with regard to rape, but I do have theory that in our culture, unlike some other cultures, we have a tremendous schism between overt sexuality and the acceptance of overt sexuality and covert feelings of sexuality, in terms of how people feel inside themselves. We have a somewhat Victorian and puritanical inner state. In other words, people don't feel all that comfortable with their sexuality. It's still a very taboo topic. It is a topic that even my patients, even my adult patients, have a hard time talking about or dealing with.

GREENFIELDYet, our culture celebrates sexuality and, of course, online pornography is part of that, but it's used in advertising. If you go into the supermarket, all of the magazines at the end cap of the checkout counter have half naked women on them. So it's in the movies, it's on television, it's everywhere. So my theory is, is that the schism, the split between this overt sort of promotion of sexuality, yet the inner sense of discomfort with it creates a sexual dysfunction and at times can create sexual problems, and as well as sexual violence.

REHMI gather you've done some research in exactly what's happening in the brain to make pornography so appealing to people.

GREENFIELDYes. I have looked into this subject. And you have to remember that sexual behavior and sexual arousal are hardwired forces that are wrapped around our DNA. I mean they are about--it's about as primitive of a force as there is in human behavior. And I call it the procreative force. So sexuality, unlike alcohol, I mean, you can live the rest of your life without alcohol and I don't know that we're hardwired to love alcohol, but we are hardwired to find sex appealing and to have a desire for sex.

GREENFIELDSo it is a very, very potent force. And what sex does, or sexual arousal does, as well as orgasm, is that it releases dopamine in the brain, which is the same pleasure neurotransmitter that's released from certain drugs, as well as other forms of addiction. So what we really become addicted to in a sense, is that elevation of dopamine and that flooding of dopamine that we experience. Because most people, at least males that use pornography, couple it with masturbation. So they're experiencing not only the visual stimulation, but then they have an orgasm which further reinforces that reward system in the brain to enact that behavior over and over again.

REHMAnd I do want to caution that we are talking about very explicit sexual matters in this hour. So you out there may have some young people in your presence. I caution you about the content of the conversation. Dr. Greenfield, tell us a little about the history of pornography here in the U.S. and the role that technology has played going right along.

GREENFIELDPornography has a very interesting history. I mean, first of all it's very old. There's evidence of hieroglyphic and pictographic pornographic depictions on cave walls and on rocks, scrawled. So basically as soon as humankind had the capacity to record sexual images, we've been doing it. So it seems to be a pretty hardwired drive for individuals, but technology or rather the technological advances in society have brought pornography forward, along with increases in technology. So for instance, when motion pictures were invented, some of the earliest adopters of the motion picture format was the production of very early and primitive pornographic films.

GREENFIELDThey would be considered benign by today's standards, but they were, by those standards in those days, very risque. And also, even when the printing press was invented, some of the earlier books that were published were erotic. So there's been an attraction with and interface between technology. And then as we move forward, obviously motion pictures have been around a long time. The next major leap occurred when the VCR was invented. And it's kind of interesting story. There were two formats for video tape when it first came out. There was the VHS, which was promoted by one company. And Beta, which was promoted by another company.

GREENFIELDBeta was the superior format in terms of quality, but the porn industry decided to adopt the VHS format. And they saw the opportunity -- this was the first time that individuals could buy easily pornographic content, either through the mail or rent it in stores and view it in the privacy of their own home. And that really started the in-home personal use of pornography at a new level. And then as the DVD came out, the same thing. They were early adopters of a DVD format that ended up being the winning format. And where the pornography industry puts their attention and their money and their content, that's where the technology seems to be supported.

GREENFIELDAnd, of course, the internet. They were some of the earliest users of the internet format. And continue to be a huge part of the internet.

REHMSo as you think about or even learn about young people viewing porn these days, are they doing so to try to learn about sex and yet, as you said earlier, seeing sex portrayed in artificial ways without the bond of affection, but purely as a mechanical, physical exchange, if you will?

GREENFIELDYeah, I think that's exactly the way it's depicted in pornography. There are attempts at trying to make it more realistic in some films, but the majority of the stuff that kids are looking at and the free websites on the internet, depicts it in a rather mechanical way. And it has changed the way this -- what I call Generation D, the kids 20, 25 and under -- the way they view sexuality. It has really changed the way they see it. And has changed some of their sexual behaviors and attitudes towards sexuality. In some ways perhaps more positively. They're more open, but in some ways they have an unrealistic or pornified way of viewing sexuality to an extent that they have an unrealistic expectation and an unrealistic view of what human sexuality is about.

REHMAnd, of course, you have young people, perhaps young men, quite young, teenagers, finding their father's pornography.

GREENFIELDAll the time. I mean that's how people used to get introduced to it. They would find their father's magazines or, you know, old movie reels of pornography. I can't tell you how many people have come to my office telling me that story. But they don't have to do that now. They don't have to find their father's pornography because it is so prevalent and so easily accessible and easy to get around blocks and filters. So even if their computer is blocked or their Wi-Fi at home is blocked, they can go to a friend's house who isn't blocked.

REHMSo even if one teenager thinks he or she is using pornography to learn about sex, how can that affect what happens realistically? Doesn't that change the expectation? Doesn’t that change the norm? Doesn't that…

GREENFIELDIt does.

REHM…affect what one thinks sex is going to be?

GREENFIELDIt does. And we don't have any research yet that I know of that looks at this generation and their overall sexual health and behavior. It'll be interesting to see, as this Generation D, this first generation raised on the internet enters adulthood and forms permanent relationships and marries, it'll be interesting to see how their sexual behavior is different -- if it's different. I do think it's okay for parents -- in fact, I would encourage parents to tell their kids, look, I know you've seen online pornography. The kids are not going to admit to and they're not going to want to talk about it.

GREENFIELDI have two teenagers and they would never talk about it, but I can tell you that by the time I tried to have the birds and bees talk with them, they've already -- they had already probably seen more than I could ever tell them about.

REHMInteresting. And you're listening to "The Diane Rehm Show." I want to open the phones now, Dr. Greenfield. We have lots of listeners with questions. First let's go to Owosso, Mich. Hi there, Heather. You're on the air.

HEATHERHi, Diane. Thanks for taking for my call.

REHMSure.

HEATHERI'm interested because I just left work on a break and I work an internet filtering and accountability service. So I know firsthand what pornography and the whole culture of pornography online has done to families. So I found it really interesting that I would be on a break from work and then I would hear that this was the topic. Basically I just called to make a comment. And that was that I, prior to working -- I work for Covenant Eyes. It's a company based in Owosso, Mich. And like I said, we do filtering and accountability for users online to kind of keep their family accountable and keep their integrity online and so parents can kind of guard what their kids are seeing, what they're doing.

HEATHERBecause, you know, people can't be everywhere all the time. So before I started working there last year I always kind of thought, oh, porn, what's the big deal, really? I mean I wasn't a user of it myself, but I didn't really see what the big deal was when people would really complain about it. I've been there a year and I'm appalled at the profound effect that it has on families. We have women calling in crying that they found out after 30 years of marriage their husband is addicted to pornography and looking to use our service to help them guide him out of that trap.

HEATHERParents calling in with teenagers that are, you know, they caught them online looking at some really disturbing and violent images that's affected school work, the way they socialize with their family. It's amazing to me. Like I said, I never really considered it before I started working for Covenant Eyes. And it's just amazing to me how detrimental it really is on our culture and how a lot of people, I think, kind of like me, used to have an attitude of who cares, you know.

REHMInteresting.

HEATHERIf you don’t like it, don't look at it.

REHMRight. Heather, thanks so much for your call. Dr. Greenfield?

GREENFIELDYes. I think that it does have a profound impact and obviously I do get the same calls that the caller was talking about from typically wives or girlfriends when they've discovered their partner using, abusing or being addicted to online pornography. And it can be quite impactful on the marriage or relationship. In addition, I have seen it in adolescence to a point where it has interfered with their ability to perform in school and where they become addicted to a point where it really has a negative impact. So it is very potent, very powerful, mood altering, therefore potentially addictive content.

GREENFIELDIt is very powerful. Without getting into the moral, religious or theoretical aspects of it, just as a content medium it is very powerful and people need to be conscious of that.

REHMBut, you know, at the same time there are an awful lot of people who would argue perhaps that violence viewed constantly would have an even more detrimental effect.

GREENFIELDYeah, well, obviously, with violence on television and movies and as well as in interactive internet based video games, there is mixed research on the impact of violence, but I think it's pretty clear that prolonged exposure to violence on a repetitive basis in media -- whatever form of media -- desensitizes people to violence. So it can't be necessarily a good thing.

REHMAnd of course violence in pornography is one of the aspects that people worry about so incredibly much. David Greenfield, he's founder of the Center for Internet and Technology Addiction. When we come back we're going to talk about how treatment may help those who are addicted to pornography. Stay with us.

REHMAnd welcome back. In this hour, Dr. David Greenfield, who is the founder of the Center for Internet and Technology Addiction at the University of Connecticut School of Medicine, joins me as we talk about addiction to pornography. I do want to caution our listeners that some of our conversation may be graphic, even offensive to some people. And certainly you would want to think about youngsters listening to the program.

REHMHere, Dr. Greenfield, is an email from Shawn in Phoenix, Ariz. who says, "I developed an addiction to online porn since I bought my first computer in 1999 at the age of 19. It's something I've tried on numerous occasions to stop. I've consistently failed. It seems to be something I am compelled to do a few times a week at least, sometimes for up to three to four hours at a time. I feel I have little control over it. What can I do to unburden myself to his," Dr. Greenfield?

GREENFIELDWell, it's -- I'm not going to mislead the caller. It is -- the individual -- it's a very powerful addiction to kick. And it -- unfortunately it's not something that you can go from habitual or addicted use to moderated use. It seems that it has to be all or none as opposed to other forms of behavior. So the individual would have to probably set up some kind of block or filtering mechanism so that when he has an urge or craving to go online -- because don't forget, it's an -- it's so easy to click from one website to another. And you have that access almost instantaneously.

GREENFIELDSo if you have an urge and the ability to get to one of those websites without it being blocked, you're going to probably relapse and start to use. In other words, willpower will not be sufficient. There'll have to be some block that'll allow the frontal lobes to come online because when you're in that addictive sort of pattern, the pathways from the medulla, from the pleasure centers of the brain to the frontal lobes block your thinking. So you're not really thinking very clearly. So you need...

REHMSo give me -- if you can, what are the steps that can be taken to address this kind of pornographic addiction? Is some form of therapy necessary?

GREENFIELDI think in many cases if it's an addiction to a point where it has interfered with your life in a serious way, yes, I think intervention with a doctor or other mental health or addiction professional, preferably somebody that has experience with addictions particularly sexual or online addictions, would be indicated. It's very hard to treat addictions yourself and to -- because you can't really see yourself objectively. And you're not -- it's too easy to deceive or mislead yourself.

GREENFIELDSo I would say that, yes, getting help -- provided it's with somebody that has experience. The average doctor or therapist may not have the expertise so it's very important that the person ask them, do you have experience with addictions, particularly sexual or online addictions?

REHMAll right. And let's go back to the phones to John in Harrisburg, Pa. You're on the air.

JOHNDiane, first I would like to thank you because I love your programs. And then I would also like to thank you for tackling this subject. I would like to think I'm not addicted to porn. I do look at porn. I was abused as a child by my stepfather many, many years ago and I am madly, deeply in love with my wife. But the -- watching porn and looking at porn over the years as I've done, that arouses me at the moment. But I still have trouble performing with my wife and I think it's because of the expectations from what you see on the internet or in movies than in real life.

REHMAnd that's the issue, isn't it, Dr. Greenfield?

GREENFIELDYeah, because you've got to remember that the people that write and direct and produce pornography, they're not stupid. They know what people like and they're able to depict people's fantasies and have women and men act in ways that reflect those fantasies. So people live and are aroused vicariously through those -- through the exposure to those film clips. So they know what they're doing and they're designed to be arousing and they are arousing.

REHMTo John in Jacksonville, Fla. You're on the air.

JOHNYes, hello. This is my first time to call you and actually get through. And I enjoy your show and the topics that you bring up.

REHMThank you.

JOHNThe reason I’m -- thank you. And I'm familiar with Dr. Greenfield's work in that I have a foundation and we do work with sex traffic children. And there's a whole myriad of issues that pornography intersects with that, as well as I guess the question or just the topic here, I could bring up many. But the one that kind of came to my mind most is just the whole issue of how this impacts women and the view of women. And particularly being a guy and seeing and realizing that is not unique.

JOHNBut I just know and as I've gotten more and more involved in issues, particularly related to trafficking, that the slights and the comments and vernacular around the office are just on a day-to-day basis that I hear, it just doesn't sit well with me, and increasingly so. And there's a direct tie-in -- I think Dr. Greenfield would reiterate this or confirm it -- that pornography has a direct impact on the view of women. And I just wanted to leave that with you and thanks for your show.

REHMAll right, John. Thanks for calling. A direct impact on the view of women, Dr. Greenfield, especially as violence against women is at times shown in these pornographic videos.

GREENFIELDYeah, there are some pornographic videos obviously that are more violent than others, most of the times in mainstream pornography, not films that are paraphilic. In other words specifically addressing sadomasochistic or bondage discipline type of paraphilias or sexual preferences. But in general pornography there are sort of mild depictions of violence. Typically the woman is shown as enjoying it. And I think in many cases it's questionable whether in real life a woman would enjoy it or not.

GREENFIELDSo I think it can portray an unrealistic expression of sexual behavior in the sense that it appears to be consensual and desired. On the other hand, there are -- in the realm of human sexuality there can be roughness and harder forms of sexual behavior that is desirable and is consensual. In terms of objectifying women, there's no question. I mean, women are objectified in these films. And, you know, from -- there's no way to not see women as being objectified in these movies. And that is a problem.

GREENFIELDThe interesting thing is, there is an increase in consumption by these -- by online pornography by women themselves. And I'm not sure how this is going to all play out.

REHMTo Ryan in Silver Spring, Md. You're on the air. Ryan, are you there? I guess not. All right. Here's an email from Lynn who says, "Online porn has almost destroyed my life. My spouse's porn addiction was extreme and escalated to behaviors beyond the home. Like most addicts he had certain behaviors that had an impact on our entire family. And like most addictions this one thrives in secrecy and it's very possible to live with an addict who carefully guards the secret for years. There is help for both addicts and the family members of addicts through therapy and 12-step groups."

REHMWhat about that, Dr. Greenfield? Do the same processes perhaps work for alcohol addiction work for pornographic addiction?

GREENFIELDThe answer is yes and no. There are differences between alcohol and pornography addiction. It's -- again because human sexuality is so integrated into our -- the fibers of our being it's trickier to treat. I think it's harder to treat in some respects. There are 12-step programs like -- similar to AA. There are three main ones with regard to sex addiction which online porn addiction would be a subcategory of. One is sexaholics anonymous. One is sex addicts anonymous and one is sex and love addicts anonymous, all of which are available online.

GREENFIELDIn addition, if they go to virtual-addiction.com there are a lot of resources on my website that can lead people to information and further resources.

REHMNow here's another view from Mercedes in Tampa, Fla. who says, "I have two sons, now 21 and 23. When they were in middle school they each went through a phase where they were obsessed with online porn for a year or two. I did not interfere with it. They got over it on their own. I've always spoken openly with them about sex. I was willing to answer any questions. They were able to step away from it and realize it wasn't for them. I think if I had tried to make it taboo or tried to suppress it, they might still be obsessed today."

REHMWhat's your feeling about that, Dr. Greenfield? To what extent should parents step in and indeed go to the extreme of forbidding or blocking when, as you said, they could go to a neighbor's house or a friend's house where it wasn't blocked?

GREENFIELDI think that's a very interesting question and a tricky one. I think that the -- and I think there are some individuals that do experiment, expose themselves to it and then sort of grow out of it and lose interest in it. I don't know -- and then there's a smaller percentage that don't lose interest and they become regular consumers, and a smaller percentage that become addicted. I think the person writing in is on the right track. I think the idea is to not make a huge deal out of it and make -- and shame the child for looking at it. But the desire to look at these images, I think, is hardwired. I don't think it's abnormal in any way to want to see them.

GREENFIELDSo I think the important thing for a parent to say is, look I know you likely have seen these images. And I want to just let you know that these are not realistic depictions of what human sexual behavior in relationships is about. I realize I can't stop you from doing it. I don't want to, at the same time, encourage you. So you want to sort of give them the message that you know that they might've seen it or might be looking at it. At the same token, I think providing blocks in the home can sort of convey, look we know you're going to look at this and you may still find it but I also don't want you to have too readily easily -- ready and easy access to it.

REHMAll right. And you're listening to "The Diane Rehm Show." And of course part of that as our caller -- our emailer points out is talking openly with your child about sex so that perhaps they don't turn to the internet if the conversation within the household is shut down. Let's go to Theo in Flint, Mich. You're on the air.

THEOHi, Dr. Greenfield, Diane. Thanks for taking my call. I'm a little bit older than your generation D. I'm 29 and my first introduction to porn was through literature and magazines, like just photographs. And so I'm wondering if you think that there's a hyper-addictive nature to video with audio in that everybody has to use a computer all day. And so -- but I think that -- you know, so access is probably a problem too. But I'm just wondering if you think there's a difference between the different formats and how you get more senses through video with audio.

REHMThat's a very interesting question, Theo. Thanks for your call. Dr. Greenfield.

GREENFIELDYeah, I think without a doubt it is more potent. It is a more direct and multisensorial experience. Seeing video and audio depictions, I think, are far more addictive than still photos or erratic literature. I think it's sort of the crack cocaine of sexual behavior.

REHMSo are you seeing lots of teens brought in by their parents who are concerned about their youngsters?

GREENFIELDI see more -- probably percentage wise 80 percent -- among the teen group of patients that come in about 80 percent video game, 20 percent, 25 percent pornography. Among the older -- slightly older generation, beyond generation D as your caller was, you know, mid 20's, 30's, 40's, 50's and 60's we're more likely to see issues with pornography.

REHMWell, I'm glad to have talked with you today and to know that there are people who are concerned about this. And there are solutions available. You can go to our website which has a link to Dr. David Greenfield's website. Go to drshow.org and you'll find that information. Dr. Greenfield, thank you so much for joining us.

GREENFIELDThanks for having me.

REHMAnd thanks to all of you for listening. I'm Diane Rehm.