Treatment for Porn Addiction: What Has Actually Been Tested
Two randomized trials, one small pilot, and no approved pill anywhere on earth.
You finally decide to get help. You search for treatment for porn addiction. The first result costs more than a car.
Thirty days inpatient, private rooms, a form that wants your insurance before it tells you anything.
Here is what those pages never say. Almost nothing has been tested for this. Two randomized trials, one small pilot, no approved medication anywhere.
That is not a reason to skip treatment. It is a reason to know what to ask for, because the person across the desk is working from the same thin evidence you are.
Everything that has ever been tested
The biggest study is Swedish. 137 men, seven weeks of group cognitive behavioural therapy (CBT), against men who got nothing. The therapy group came out better, and was still better six months on.2
The best numbers came from a smaller room. 28 men, twelve sessions of acceptance and commitment therapy (ACT, a cousin of CBT that trains you to let the urge pass instead of arguing with it), viewing down 93%.
A third were still at zero three months later.3
Before you get excited: 28 people, almost all from the same church, counting their own sessions.
Then a mindfulness course. 13 men, eight weeks, less porn and less anxiety at the end.4 Thirteen people, nobody to compare them to.
Medication is one sentence. Nothing is approved for this, anywhere.5
Add it up and you get about 180 people, worldwide, over twenty years. That is the foundation the whole industry stands on.
Therapy is one hour. You live in the other 167
Something jumped out at me reading those trials back to back.
They argue about everything, then end the session the same way. They send you home with work.
Your week has 168 hours. Therapy is one of them, and it is not the one where you get into trouble.
So compare programs by what they change about your Tuesday at eleven at night, not by the theory in the brochure.
Six questions before you book
Most people ask the price and the next opening. Then they are six sessions deep, paying for a nice chat.
- Which protocol, how many sessions? You want a name and a number. "We will see where it takes us" has nothing behind it.
- What do I do between sessions? If the answer is nothing, you are buying one hour instead of the other 167.
- How often do you see this? Weekly means calibrated. Once a year means you spend the hour managing their face.
- Are we aiming at the same thing? Say your goal out loud and listen for it coming back unchanged.
- What gets measured? A score at the start, then every few weeks. Otherwise progress is just a good mood.
- What else are we looking at? Depression, ADHD, trauma, drinking. Leave that running and you will be back.
Do you need rehab?
Usually not. It costs the most and has the least behind it.
It earns the money when you are a danger to yourself, when things are escalating into legal territory, when a substance problem needs medical supervision, or when home is a place you cannot be sober in.
Otherwise the format with the best study behind it is the cheapest thing in the building, an outpatient group.2
Short version: treatment for porn addiction comes down to two randomized trials and one pilot.
Group CBT beat a waitlist in 137 men, ACT cut viewing 93% in 28 men, a mindfulness pilot in 13 men helped, no medication is approved, and all of it runs on what you do between sessions.
My bias, stated plainly: I built X Reset, and it is not treatment.
It blocks porn at the DNS level, off the device where deleting an app is easy, and puts a charge you choose on a relapse (DNS is the layer that turns a web address into a server, underneath the browser and the apps).
It makes the 167 hours survivable while the treatment does the actual work.
If you want somewhere to start instead of something to compare, the help guide is the map, and the self-check asks what an intake appointment asks.
Common questions
Does insurance cover porn addiction treatment?
Depends what gets billed. The diagnosis exists in ICD-11 (the World Health Organization's diagnostic manual) and not in DSM-5 (the American psychiatric manual),1 so US claims usually go in under something else, like depression.
Ask which code they submit before the first appointment.
Is there a pill for this?
No. Naltrexone turns up in case reports, usually in people being treated for drinking. Anything you are offered is off-label and belongs to a psychiatrist who knows your history.
How long does it take?
Seven weeks in a group, or twelve sessions one to one. Shorter than most people brace for. Six months in with nothing measured, ask why.
Is group therapy the cheap version?
It is the version with the biggest study behind it, and where the shame drops fastest. Twelve-step groups are a different animal: free, peer-run, not treatment.
Can I do this on my own?
Plenty of people do. Take away the access, track what happens, tell one other human. What a clinician adds is spotting what is underneath. The do-it-yourself version is here.
One thing before you book
People spend weeks picking between therapies nobody has ever compared, and no time on the thing every trial had in common.
Decide what changes tonight at eleven. Then book the appointment anyway.
Thin evidence is still evidence, and those 137 men in Stockholm did better than the ones left waiting.
Source 1
Compulsive Sexual Behaviour Disorder in the ICD-11
The WHO working group paper setting out the 6C72 criteria: persistent failure to control intense repetitive sexual impulses over an extended period, with marked distress or functional impairment. It is classified as an impulse control disorder, and there is no equivalent diagnosis in DSM-5.
Read the paperSource 2
A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men
137 men randomized to seven weeks of group CBT or to a waitlist. The treated group showed significantly greater reductions in hypersexual disorder symptoms and sexual compulsivity plus better psychiatric wellbeing, stable at three and six months, with the authors noting low follow-up response rates as a limitation.
Read the paperSource 3
Acceptance and Commitment Therapy for Problematic Internet Pornography Use: A Randomized Trial
Twelve individual ACT sessions against a waitlist in 28 adult men, all but one of them members of the same church. Viewing fell 93% in the treatment condition against 21% in the waitlist, with 54% reporting complete cessation at post-treatment and 35% at three-month follow-up.
Read the paperSource 4
A Pilot Study of Mindfulness-Based Relapse Prevention for Compulsive Sexual Behaviour Disorder
Thirteen men with a CSBD diagnosis completed an eight-week mindfulness-based relapse prevention program. Time spent on problematic pornography use fell, as did anxiety, depression and obsessive-compulsive symptoms. Uncontrolled pilot, and the authors call for randomized trials.
Read the paperSource 5
Compulsive Sexual Behavior and Alcohol Use Disorder Treated With Naltrexone
A case report with a review of the pharmacotherapy literature for compulsive sexual behaviour. It states plainly that no medication is approved for the condition, and that naltrexone evidence consists of case reports and small series rather than controlled trials.
Read the paperSources
- Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Atalla, E., & Reed, G. M. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17(1), 109–110. DOI
- Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., Jokinen, J., & Öberg, K. G. (2019). A randomized controlled study of group-administered cognitive behavioral therapy for hypersexual disorder in men. The Journal of Sexual Medicine, 16(5), 733–745. DOI
- Crosby, J. M., & Twohig, M. P. (2016). Acceptance and commitment therapy for problematic internet pornography use: A randomized trial. Behavior Therapy, 47(3), 355–366. DOI
- Holas, P., Draps, M., Kowalewska, E., Lewczuk, K., & Gola, M. (2021). A pilot study of mindfulness-based relapse prevention for compulsive sexual behaviour disorder. Journal of Behavioral Addictions, 9(4), 1088–1092. DOI
- Sultana, T., & Sahib Din, J. (2022). Compulsive sexual behavior and alcohol use disorder treated with naltrexone: A case report and literature review. Cureus, 14(6), e25804. DOI