Treatment of Compulsive Pornography Use With Naltrexone: A Case Report

Mr. D began using pornography regularly at age 13. During the intake interview, he reported compulsive masturbation to pornography for the previous 10 years despite numerous failed attempts to quit; he was viewing Internet pornography nearly daily for approximately 30 minutes. He reported a prior diagnosis of major depressive disorder and had no history of substance misuse, risky sexual behavior, or significant medical problems. He was not taking any prescribed medications.

Mr. D began attending weekly individual cognitive-behavioral therapy delivered by a doctoral-level clinical psychologist. For 18 weeks, he completed daily self-monitoring worksheets assessing urges to view Internet pornography (1=no urge, 7=intense urge) and whether he had viewed and masturbated to pornography. Despite reducing his baseline use of pornography by approximately 70%, Mr. D continued to report frequent sexual urges to masturbate to Internet pornography. Therefore, on the 10th week of treatment, he was prescribed 50 mg/day of naltrexone. Within 2 weeks of initiating medication, he reported subjective decreases in his urges to masturbate to pornography. As shown in Figure 1, during the 9 weeks that he took naltrexone, the intensity of his sexual urges significantly decreased, from a mean rating of 3.71 (SD=1.28) for weeks 1–9 to a mean rating of 2.37 (SD=0.80) for weeks 10–18 (t=6.93, df=124, p<0.0001; Cohen’s d=1.25). He also viewed pornography less often: 17 days in weeks 1–9, compared with 5 days in weeks 10–18 (χ²=7.04, df=1, 125, p<0.01; odds ratio=0.25, 95% CI=0.09–0.73). In addition, he resumed regular, satisfactory sexual intercourse with his wife.