Whether regular, ongoing use of progressively more graphic pornography is actually an addiction like alcoholism or a hypersexual disorder more akin to compulsive gambling, its impact on the spouses of those who use it can be lost in a focus on the behavior itself.

An ongoing debate about whether porn is addictive the way drugs or alcohol are has included U.S. Senate hearings, and professionals who treat compulsive porn users in Utah remain divided on the "a" word.

But spouses — to date, mostly women — who wonder why the glare of a computer screen has stolen the hearts of their partners don't worry much about the semantics debate when the pain of personal betrayal won't go away.

To them, it feels like it must be an "addiction" because their spouses simply can't stay away from it and consequently, the relationship suffers. Often they debate whether to seek help or stay silent, particularly in Utah, where the "religious culture makes it a little taboo to talk about this," according to Rory Reid, a research psychologist at UCLA and director of the Provo Counseling Center.

"It's OK to stand up in a church meeting and say, 'I'd like to bear my testimony, I'm a recovering alcoholic and I'm so grateful for the atonement of Jesus Christ.' That's fine and everyone applauds you for it. But just try doing that with pornography," said Reid, who regularly counsels clients with damaged relationships.

Keeping quiet to avoid embarrassment means that if spouses seek help at all, it is often from those closest to them — trusted friends or church leaders who have no formal training in how to help.

That's one venue where the debate over whether pornography is "addictive" has its roots. As with other political battles that involve semantics, money and reputations are at stake inside a growing treatment industry that caters to compulsive porn users and their spouses.

Reid, whose current research includes assessing motivations for pornography use among hypersexual men, said that while substance abuse often becomes addictive, the use of porn can't be compared to drugs, alcohol or cigarettes because "you're not taking anything physical into your body."

Some argue that the use of pornography creates permanent changes in brain chemistry, but "there is no evidence whatsoever" for that assertion, he said. "We have the best MRI scanners in the world (at UCLA) and I can promise you if we scan (a pornography user's) brain, we won't see any structural differences."

Neurotransmission inside the brain is impacted, "but you do that by eating chocolate or watching a football game or a horror movie," he said. "Anyone who says otherwise is grossly overstating it."

By lumping excessive use of pornography together with substance abuse, "what you're really saying is that everyone who walks in the door is struggling with the same thing, and we use the same model to treat them," Reid said.

Using the term addiction "assumes the underlying problem is the same for everyone. Our data say some people do it for this or that reason, this or that issue."

Yet many professionals do label it an addiction.

Donald L. Hilton, a medical doctor specializing in neurological surgery, said that pornography is as addictive as any drug.

"Whereas we know that alcohol, tobacco, cocaine, methamphetamines and other drugs can cause physical changes in the brain, we really haven't thought in the past that natural addictions, to use that word, can do the same thing," he said. "In other words, cocaine and methamphetamine can cause changes in the way the brain functions, in the way the brain behaves, works. But what about pathologic gambling, what about overeating, what about sexual addictions? Can those behaviors also cause actual changes in brain chemistry, in brain function, in the size of the brain itself? The answer is overwhelmingly yes."

Hilton said science in the last few years "has vindicated those who for years have noted that natural and drug addictions behave the same."

"Now we know that functionally and physically they are very much the same," he said.

In a congressional briefing earlier this summer, Mary Anne Layden, director of the Sexual Trauma and Psychopathology Program at the University of Pennsylvania's Center for Cognitive Therapy, also argued that pornography is, in fact, addictive.

"The mental health field is coming to realize that the central issue of addiction is not that you ingest a substance through your mouth or veins but that, however the substance is delivered, it has an effect on your brain that causes terrible negative consequences and yet you continue to ingest it anyway.

"Pornography may be ingested through your eyes," she wrote, "but its impact is not just on your genitals but also on your brain, so it fits the addiction definition perfectly."

In fact, Layden labels pornography "a versatile drug" whose "impact on your brain chemistry makes it be both an upper and a downer.

"Unlike other drugs, we can never completely remove it from the system. It is permanently implanted in the brain. No detox is possible. This is the first time that the mental health field has been asked to deal with an addictive substance that is irremovable," she wrote.

Whatever the semantics, Reid, Layden and a host of other treatment professionals are happy to see that the American Psychiatric Association is considering a proposal to add hypersexual disorder to its new Diagnostic and Statistical Manual-5 (DSM-V), giving credence to the fact that excessive porn use harms those who use it.

Jill C. Manning, author of "What's The Big Deal About Pornography? A Guide for the Internet Generation," said the term "hypersexual disorder" would be a welcome addition to the new diagnostic manual, but "part of the reason they've called it that is there's just not enough research behind justifying the use of the word addiction."

After her research on hundreds of families dealing with the impact of excessive porn use, she said the proposed DSM-V listing would be "a huge step forward. It's historic and will legitimize this as a problem. It will open the doors for people to get access to treatment."

Reid doesn't believe the proposed listing will necessarily mean that insurance companies will cover treatment; Manning believes they will "because it's a proper diagnosis."

The two agree that some in the psychological community see the proposed diagnosis as an effort by "right wing extremists who want to pathologize sex," and both say those claims are misguided.

"There is nothing prudish about saying porn can be a destructive force in relationships and have a huge cost to society...," Manning said. "They're greater than any benefit we can see."

e-mail: carrie@desnews.com