Sex, Drugs and Addiction: The Doctor Is In

If you could ask anything about sex, drugs and addiction, what would it be?

Maybe you're wondering what porn does to relationships. Or why some people can stop at one drink and others can never drink enough. Or if sex addiction is real or just something made up by cheating spouses.

No matter where your curiosity leads, there's a pretty good chance an answer awaits at a no-holds-barred Reddit "Ask Me Anything" forum featuring David Sack, MD, a triple board certified expert in psychiatry, addiction psychiatry and addiction medicine and the chief medical officer of Elements Behavioral Health, a nationwide addiction and mental health treatment network.

The online conversation drew close to 3,000 questions and comments, with Dr. Sack weighing in on everything from marijuana laws to the science behind why people get better looking at closing time. The forum also allowed participants to engage with each other, sharing stories, encouragement and cautionary tales. And that kind of openness is powerful, Dr. Sack believes.

"Now more than ever, with addiction at epidemic levels, stress levels rising, and technology changing the way we conduct relationships, people need to know about the risks they face and how sex and drugs can get tangled up in each other," Dr. Sack said. "And the great thing about a format like this, where everyone can jump in, is that people learn they're not the only ones who have questions or problems."

Surprising Truths

Among the most popular topics on the AMA was pornography, with many wondering about the difference between really liking it and being addicted.

There's no bright dividing line, Dr. Sack answered. Rather, most experts focus on how it affects other areas of your life. "Does it disrupt your relationships? Does it interfere with getting other things done? Do you spend too much money on it?" Another troubling effect: Porn's ability to overstimulate the brain's dopamine centers can make the real deal seem less rewarding.

Other discussions included:

• Whether food -- especially sugar -- is a drug.
• How drugs and sex can fuel each other in ways you may not expect or like.
• How being a drug addict compares to being an alcoholic.
• How much TV and gaming is too much.
• The truth about marijuana. (Short answer: "It's insidious.")

Many in the forum asked that age-old question: "Why are some people addicts and some people not?"

There's no single answer, Dr. Sack explained. Rather, several variables come together:

"No matter which drug you choose, only a small proportion of the people who try it will become addicted. The risk is somewhere between 1 out of 8 to 1 out of 12. Genetic factors can account for up to 50% of the risk of becoming addicted but we have yet to identify the specific gene/genes involved. Two other factors that are often cited are the age of first exposure (the younger you are when you try a drug the more likely you are to become addicted) and a history of other psychological or emotional problems before you start using a drug."

While some commenters thought those were odds worth risking, others brought them down to earth. Drugs, wrote one, "can trigger the response "THAT WAS GOOD DO THAT AGAIN!!!" a thousand times more powerfully than any normal natural experience."

Another agreed: "That's how I got addicted but I didn't realize I was getting addicted. I loved the way pain pills made me feel, so I started doing them everyday to the point where I needed them everyday to function."

And if someone you care about does get addicted, whether to a substance or a behavior, what then?

You'll likely feel both fear and anger as you struggle to keep the person from hurting themself and hurting you, Dr. Sack said. The key is supporting their recovery, not their addiction, and getting them to a place where they can receive the help they need.

It's also crucial to see addiction for what it is -- a disease -- rather than a moral failing or a lack of willpower, he said.

"If someone is 5 feet 6 inches tall do we say they lacked the will to be 6 feet? My personal view is that people don't choose to become addicted any more than they choose to be diabetic."

View the entire Reddit conversation with Dr. Sack here.