Addiction can occur in many forms. Often, it is assumed that physical dependence characterized by withdrawal symptoms is required in order for someone to be diagnosed with an addiction disorder, but the fact is that behavioral addiction can occur with all the negative consequences in a person’s life minus the physical issues faced by people who compulsively engage in drug and alcohol abuse.It is the compulsive nature of the behavior that is often indicative of a behavioral addiction, or process addiction, in an individual. The compulsion to continually engage in an activity or behavior despite the negative impact on the person’s ability to remain mentally and/or physically healthy and functional in the home and community defines behavioral addiction. The person may find the behavior rewarding psychologically or get a “high” while engaged in the activity but may later feel guilt, remorse, or even overwhelmed by the consequences of that continued choice. Unfortunately, as is common for all who struggle with addiction, people living with behavioral addictions are unable to stop engaging in the behavior for any length of time without treatment and intervention.
Though almost everyone engages in all of the activities listed above – shopping, gambling, and certainly eating and exercise – to a certain degree and may even enjoy the behavior very much, it is not termed an addiction until the following is true:
The person struggles with mental health or physical health issues as a consequence of the behavior and/or the inability to stop.
The person has difficulties in significant relationships at home and, in some cases, at work because the behavior is so disruptive.
The person experiences other negative consequences that are directly caused by continued, extreme, or chronic engagement in the behavior. For example, a person with a gambling addiction may gamble away the house, lose a job, and be forced into bankruptcy due to the extreme nature of the gambling.
The person is unable to stop engaging in the behavior despite these consequences.
If you believe that you, or someone you love, are struggling with a behavioral addiction, the good news is that treatment is a powerful tool. Learning how to manage the behavior and begin to address the issues caused by the long-term behaviors begins with intensive and integrated treatment.
Why Are Certain Behaviors Considered Addictions?
Most people engage in hundreds of different behaviors throughout the day, each one with its own set of consequences. In general, people make choices about which behavior to engage in next relatively thoughtfully and with the intent to improve their experience. For example, if you are hungry, you may choose to get a healthy snack that will not only satisfy your hunger but also give you energy to continue your day. However, someone who is living with a food addiction may choose to eat even when not hungry and may binge eat unhealthy foods in large amounts. Though this is an unhealthy choice, many people can and will overeat, or eat when they aren’t hungry, and do not struggle with a food addiction. When the behavior becomes impulsive in nature and begins to contribute to the development of a range of physical and mental health problems and the person is unable to stop, it is termed an addiction.Does this mean that you can be addicted to any behavior? It is a question that fuels an ongoing debate. Many do not feel that characterizing a behavior as an “addiction” is correct; they believe that a little self-control is all that is needed. Unfortunately, the fact is that if a little self-control were the only issue, then people struggling with behavioral addictions would certainly stop engaging in their behavior of choice long before it harmed their physical health, ended primary relationships, and caused a host of financial, legal, and mental health problems.
Whether or not any behavior can become an addiction that is harmful to a person’s ability to function is still open to debate. What we do know is that there are several behaviors that are commonly reported as occurring at an addiction level, wreaking havoc and destroying lives for as long as they remain untreated.
Gambling addiction, also called problem gambling or gambling disorder, is an addiction that refers to any and all types of gambling or choices related to gambling that endanger or compromise a person’s life, job, or family. Whether it’s going to the casino and playing the slot machines, staying up for overnight poker games, gambling online, or sports betting, if the choice is characterized by the following then it is termed a gambling addiction:
Placing bets more and more frequently
Betting more than originally intended
“Chasing” losses by continually betting beyond the ability to pay
Feeling irritable or aggressive when unable to gamble or when losing
Being preoccupied with gambling
When gambling turns into an addiction, those who seek treatment often report huge losses, including legal problems, foreclosure, bankruptcy, divorce, lost careers, and more. Additionally, many who struggle with gambling addiction may consider or attempt suicide.
Though we all have to eat, and many people are prone to overeating on occasion or eating out of boredom or for pure enjoyment, people who struggle with food addiction cannot control their compulsive eating behaviors. They tend to crave foods that are high in fats, sugar, and/or salt and often describe feeling “high” while engaging in the activity.
Additionally, people who are addicted to food may develop a tolerance for food, as is characteristic of people who are addicted to drugs or alcohol. That is, they require more and more of their favorite foods in order to experience the “high” they seek.
People who struggle with food addiction may be obese, but people who have a normal BMI may also struggle with the disorder. Damaged relationships, issues of self-esteem, and other health problems may also result.
Risky Behavior Addiction
Sometimes it’s the thrill of a new or potentially dangerous – or actually dangerous – activity that creates a high in the person. While roller coaster rides and adventure sports like parachuting out of an airplane or snowboarding off cliffs may be the lengths that most people will go with the intent of catching an adrenaline rush, some people take it further. Risky driving like driving under the influence, having unprotected sex with strangers, and choosing other activities that clearly put them at risk can indicate an addiction to risk when the person is unable to stop engaging in these activities despite the increase in negative consequences.
Video Game Addiction
Addiction to the fantasy and escape provided by video game play is a growing phenomenon. Graphics are getting better all the time, new games are always coming out, and the ability to communicate with others via headsets while playing the game with people who would otherwise be strangers from all around the world is uniquely interesting to people who may have a hard time connecting with others in person. Similarly, taking on the role of someone else and living a virtual life can also be alluring.
As compared to a substance abuse addiction or even to other process addictions, video game addiction may seem relatively harmless, and certainly many people can play video games on occasion without ever developing a problem. However, compulsive video game play can interrupt a person’s ability to connect positively with others and have healthy relationships, maintain responsibilities at work, and make choices that support their physical and mental health (e.g., eating regularly or healthfully, going to the doctor, etc.). Ultimately, those who don’t get treatment may end up completely isolating themselves from the real world, losing their ability to function, be with family, and achieve any goals outside of the video game world.
When Addiction Is Out of Control and Help Is Needed
Identifying when a behavior has turned into a problem issue and that problem has developed into an addiction can be tricky.
It can be easy to be too close to the person and unable to recognize when things have gone from occasionally upsetting to a diagnosable disorder that requires treatment.The fact is that addiction is defined as a disease of the brain, a chronic illness that requires intensive therapeutic and medical treatment. It can quickly spiral out of control, causing problems in every part of the person’s life. When this happens, and the person is still unable to stop engaging in the addictive behavior even with a genuine desire to stop or great fear or remorse about what has and will happen, it is time to seek treatment.
What Type of Programs Are Offered to Treat Behavioral Addictions?
Detox support: Some clients describe insomnia, feelings of agitation, panic, angry outbursts, headaches, and other withdrawal symptoms when they stop indulging in the addictive behavior. Therapeutic support through this transitional period can assist the client in reaching stability in treatment and improve the capacity to focus on growth and healing going forward.
Diagnosis and evaluation: Just as with substance abuse and addiction, there are often co-occurring disorders at play that may be impacting the person’s compulsivity and ability to remain abstinent in recovery. A thorough evaluation process can help to identify any co-occurring substance abuse issues and/or mental health disorders that may be contributing to, causing, or in any way impacting the person’s experience with behavioral addictions.
Family support: It is often just as important for loved ones and family members to engage in their own healing processes as it is for the person living with the behavioral addiction. Family members are encouraged to not only take part in their loved one’s recovery but also to engage in support groups designed for family members, personal therapy sessions, and family therapy sessions with the person in treatment.
Choosing a range of therapies that assist the client in reaching treatment goals, and staying in treatment for as long as necessary to ensure that the client is strong and stable in recovery are key to an effective behavioral addiction treatment program.
What if Substance Abuse Is a Part of a Co-Occurring Disorder?
If a substance abuse or addiction disorder is a part of the experience of a client seeking treatment for a behavioral addiction, it is essential that treatment for that substance abuse disorder is integrated into the overall treatment plan.
For many clients, the urge to drink or do drugs is coupled with the urge to engage in the process addiction. For example, some say that as soon as they get a drink in hand, the next thought is gambling. Others may include the use of stimulant drugs as a part of their ritual when they engage in behaviors triggered by or related to sex addiction. No matter what the combination of disorders is, it is often recommended that the person enroll in a residential treatment center that is equipped with the staff, resources, and experience to empower healing on all fronts.
Statistics, Facts, and Data
Gambling addiction may impact up to 2-3 percent of the American public. Its signs, symptoms, and impacts may vary across genders, age groups, and other populations. Men are more likely to develop a gambling problem and at an earlier age as compared to women, but women make up about 25 percent of those living with a gambling addiction. Risk factors for the disorder include mental health disorders like bipolar disorder, mood disorders, and substance abuse disorders, especially cocaine and/or alcohol abuse or addiction.
Though similar in many ways, food addiction is different from binge eating disorder. Though both may result in obesity, people who struggle with food addiction may also be of normal weight. The period between sessions of eating large amounts of food may be characterized with different eating behaviors among patients living with BED as compared to food addiction.
It is estimated that about one in 10 young people who plays video games has an addiction to the behavior. Some people in treatment for video game addiction report experiencing something like withdrawal symptoms when they are unable to play – angry outbursts, sweating, etc.
Compulsive shopping is often believed to be a female problem, but CNN reports that about 6 percent of women struggle with the problem – and so do 5.5 percent of men. Unfortunately, because shopping is a common and normal behavior, and compulsive shoppers often go out of their way to hide the evidence of their purchases, it’s not always easy to identify the problem. Even one of the common signs of the disorder – frequent arguments over money with a spouse or significant other – is a normal issue. However, alcohol use disorders and/or an eating disorder like binge eating or bulimia often co-occur with shopping addiction, so these issues may be signs of the disorder as well.
People who struggle with sex addiction are often also living with other significant mental health disorders such as bipolar disorder or borderline personality disorder. Engaging in potentially self-injurious behavior during manic periods or in general may be a sign of these other disorders and must be considered as a possibility during evaluation and diagnosis at the outset of treatment.
Social media use can lead to addiction if it is compulsive and disruptive to the person’s ability to function in everyday life. Well before it becomes an addiction, however, chronic social media use can contribute to anxiety in users who describe feelings of discomfort and agitation if they are unable to connect – an issue that could potentially be termed a withdrawal symptom.
Some studies suggest that medication may be helpful in the treatment of some process addictions even if they do not co-occur with other mental health disorders. For example, some studies suggest that naltrexone may be an effective choice in the treatment of online sex addiction.
Individuals may report a number of behaviors that they compulsively engage in that contribute to their inability to move forward or focus on other parts of their lives. For some, it is a behavior that is at the base of the addiction. For others, it is a ritual that comes before or after indulging in a destructive behavior.For example, some clients in recovery from heroin addiction report feeling nostalgic about the process of “cooking up,” loading the needle, and tying off that comes before the actual high. Others describe their process prior to engaging in sex addiction (e.g., the “hunt”) as a ritual they enjoyed; others talk about the ritual of rolling a cigarette prior to actually smoking as being just as addictive as the behavior itself. Still others define the obsessive and compulsive behaviors engaged in due to OCD as being addictive.However, in general, though the cravings for different aspects of a behavioral addiction may play a large role in recovery, the top behavioral addictions are often reported to include:
Sex addiction: Anonymous sex, sex with multiple partners, and other sex acts designed to be as highly stimulating as possible are often the focus of sex addiction. Often, this is a risky behavior connected to other mental health disorders as many do not use protection and thus open themselves up to the possibility of contracting STDs, including deadly viruses like HIV.
Love addiction: Some clients prefer to feel emotionally attached to the partners they connect with. Often serially monogamist with little time spent in ensuring that the person will be a positive partner, the person craves the love and attention of the prospective partner before it is clear that there is any genuine connection.
Porn addiction: Porn addiction may start small and be a relatively normal behavior among Americans, but when people find it impossible to engage one on one without the use of porn, compulsively engages in the use of porn to the detriment of their ability to engage in other activities, and/or begin to experience health issues as a result, it is an addiction that requires treatment.
Gambling addiction: There are different levels of gambling that can indicate problem gambling and, ultimately, a gambling addiction. As indicated above, when it reaches the point of destroying the person’s financial status, career, and family, it is time to seek treatment.
Shopping addiction: There is usually a “good” reason for the copious purchases made by someone who struggles with a shopping addiction: “It was a great deal I couldn’t pass up.” “We can use this later/on vacation/in this specific circumstance.” “So-and-so would love this.” “You can never have too many of these.” Unfortunately, the end result is usually totes, bags, and boxes of items with the tags left intact that are forgotten because the need is not necessarily the item but the feeling of acquiring something and filling a perceived hole in life.
Video game addiction: As indicated above, addiction to playing video games is a growing problem, and one that can negatively impact the person’s ability to have functional relationships with others, remain employed, and to prioritize physical and mental health.
Social media addiction: Similar to internet addiction, some people are compulsive in their use of social media. They may post even the minutest details of their life, spending hours taking pictures to post on Instagram, editing videos to upload to YouTube, updating their posts to Twitter and Facebook, and responding to others on those same social media forums. Unfortunately, it can mean that they do not make positive in-person connections and may ultimately reduce their options in life.
Food addiction: As indicated above, the compulsive need to eat high-fat, high-sugar, or high-salt foods in large amounts when not hungry can be an addiction that leads to copious health problems especially related to obesity and mental health issues.
Because almost everyone engages in the behaviors listed above – social media use, shopping, etc. – it is not always easy to recognize when someone’s engagement with these behaviors reaches an addiction level and thus requires treatment. Though the signs of an addictive issue may vary depending upon the behavior at the focus of the addiction, it is time to get help for a behavioral addiction when:
Practice of the behavior becomes an obsession.
Practice of the behavior becomes frequent – daily and/or multiple times per day.
The person chooses to engage in the behavior rather than work, spend time with family, or engage in other activities that were once enjoyed.
Relationships are harmed by the person’s chronic engagement in the behavior.
Other serious consequences result from an inability to stop the behavior (e.g., problems at work or maintaining a job, financial issues, health problems, legal issues, etc.).
In some cases, genetics and growing up in a home where other family members regularly engage in a certain behavior may contribute to a person’s development of a behavioral addiction. However, it is not guaranteed that because a sibling, parent, or other family member struggles with addiction that someone else in the family will have the same problem. Additionally, it is possible to develop an addiction disorder and have no known hereditary contribution to the issue.
Personal therapy: Discussing the acute issues that may be triggering the urge to engage in the behavior during treatment while also discussing childhood and other past events that may have contributed to its development can empower the person to take responsibility for behaviors and institute new, healthier coping mechanisms.
Family therapy: Often, relationships at home are negatively impacted by the person’s chronic engagement in the behavioral addiction. It can contribute to feelings of broken trust and resentment that must be addressed therapeutically if the family unit is to continue and thrive in recovery.
Support groups: Connecting with others who also struggle with behavioral addictions, especially those who are in recovery for the same behavioral addiction, can help the person to feel less alone and increase the support network that is necessary for long-term healing.
How Can a Family Help a Member with a Behavioral Issue?
Family members can be instrumental in the person’s ability to accept that there is a need for change and understand that enrollment in an integrated treatment program can be a positive agent of that change. Additionally, the client’s loved ones can play an active role in that person’s recovery by attending family therapy sessions and going to support groups for family members to learn more about the disorder and what to expect during the first years of recovery at home. When family members are empowered to help their loved one in recovery, they can heal themselves and also help to heal the family as a whole, whether or not the client remains actively in treatment.
Are There Medications that Can Help Treat a Behavioral Addiction?
In some cases, depending upon the specific nature of the behavioral addiction and the impact it has on the client as well as the nature of any mental health symptoms experienced and/or the diagnosis of a co-occurring mental health disorder including addiction, medication may be appropriate during some or all of the treatment process. However, this varies significantly from client to client, and medication is never the focus of treatment. Rather, it is used to assist in transitional periods of recovery that may be difficult, to address underlying chronic issues, and/or to help increase the client’s comfort level during the therapeutic process. Therapy, not medication, is almost always the primary focus in the treatment of behavioral addictions.
What Kinds of Relapse Preventions Skills Exist for Behavioral Addictions?
Avoiding relapse is a daily task, sometimes an active task that takes place minute by minute. Some of the ways that people can improve their ability to avoid relapse in recovery from a behavioral addiction include:
Identifying the people, places, situations, feelings, and other events that can trigger the urge to engage in the behavior
Determining how best to eliminate those triggers
Creating an actionable plan to mitigate the impact of those triggers and deal with the urge to relapse that may occur
Building a support system in recovery that includes people who genuinely support the client’s desire to avoid relapse and engage in more positive behaviors
Learning how to return to recovery if a relapse should occur
What Support Groups Exist for Behavioral Addictions?
For almost every type and style of behavioral addiction, there are both online and in-person support groups that range from informal meetings to formal therapy sessions that are designed to create a support base for people who would like to learn how to live without engaging in the behavioral addiction. For example, for people who live with food addiction, some support group options include Food Addicts Anonymous and Food Addicts in Recovery. Those who are addicted to gambling can find support in SMART Recovery’s Gambling Addiction group or Gamblers Anonymous. Similarly, those living with a shopping addiction can attend Shopaholics Anonymous meetings, and those living with a sex addiction can find support at Sex Addicts Anonymous groups.