Substance Use Patterns Among Individuals With Problematic Pornography Use: A scoping review

By Cerina Dubois , Elizabeth C. Danielson, Tim Schwirtlich, Molly Beestrum, Dean T. Eurich

Pornography consumption is a highly prevalent behavior in developed countries, with studies indicating that up to 70% of men and 40% of women have viewed pornography within the past year. Substance use in individuals with problematic pornography use (PPU) is an area that warrants further investigation due to the potential for its compounded negative effects including risk for addiction and potential negative effects on mental and emotional health. This scoping review examines substance use patterns and associations among individuals with PPU; and to summarize the different operationalizations of PPU. This is one of the first reviews to evaluate the empirical research on this relationship. Four primary databases were used to conduct the search: MEDLINE (PubMed), Embase, CINAHL, and PsycINFO, up to December 4, 2024. Included studies investigated the association between substance use and PPU or chronic pornography use. After deduplication, 949 references were retrieved, however, only 8 cross-sectional studies were eligible for this review. Substance use classification varied across studies and included: alcohol, smoking, cocaine, substance use disorder, cannabis use disorder, and general drug use. Alcohol was the most frequently studied substance. Although alcohol, cocaine use, and smoking were positively correlated with PPU, the findings were not significant for other substances or substance use disorders. Studies used a variety of PPU definitions. The Problematic Pornography Use Scale was the most frequently used measure to capture PPU. This review suggests there is a large knowledge gap in understanding the intersection between PPU and substance use in both the volume of literature available and a lack of standardization of measuring PPU. Indeed, PPU is currently not officially recognized as a stand-alone disorder in the DSM-5. Longitudinal studies utilizing a consistent definition and measure for PPU are warranted to fully understand its association with each substance use type. 

PLOS Global Public Health, 2025.