Dr. Robert Weiss LCSW, CSAT

Can a Behavior Really Be Addictive?

Sadly, the American Psychiatric Association is not overly accepting of behavioral addictions, excluding them, except for gambling addiction, from the latest edition of its Diagnostic and Statistical Manual of Mental Disorders (the DSM-5).[i] In fact, the APA has recently shied away from using the word addiction in general, now labeling alcoholism and drug addiction as “substance use disorders”[ii] and gambling addiction as “gambling disorder.”[iii] However, most other psychotherapeutic professional organizations are considerably more forward-thinking, in particular the American Society of Addiction Medicine. In fact, ASAM’s general definition of addiction, adopted in 2011, addresses behavioral addictions quite clearly, opening with the following language:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors [emphasis added].[iv]

Thanks in large part to the APA’s behind-the-times stance, there is often a good deal of confusion among not only the general public but clinicians when it comes to understanding, identifying, and treating behavioral addictions, including sexual addiction. However, this is largely unnecessary if/when one understands addiction’s basic causes and origins.

In truth, addictions of all types form and manifest in the same basic ways. For starters, the risk factors for substance and behavioral addictions are the same – most often a combination of genetic and environmental factors.[v] In other words, people are at-risk when there is a history of addiction (any type) or mental illness (any type) in the family, and/or they have unresolved early-life or severe adult trauma. A lot of the time, these at-risk individuals turn to alcohol, prescription medications or illicit substances as a way to self-medicate stress, emotional discomfort, or the pain of their underlying psychological conditions, but they may also turn to an intensely pleasurable pattern of behavior.

Addictive substances and addictive behaviors trigger the same basic neurochemical pleasure response – primarily the release of dopamine (pleasure), along with adrenaline (excitement), oxytocin (love and connection), serotonin (emotional wellbeing), and a variety of endorphins (euphoria) – resulting in feelings of pleasure, excitement, control and, most importantly, distraction and emotional escape. Over time, some people learn that the easiest way to avoid feelings of stress and emotional discomfort is to ingest an addictive substance or engage in a highly pleasurable (and therefore potentially addictive) behavior. These individuals begin to use substances and/or behaviors not to feel better, but to feel less (i.e., to control what they feel). This is a sure sign of addiction. So, the only significant difference between substance and behavioral addictions is that substance addicts ingest alcohol or drugs to create an emotionally escapist neurochemical reaction, whereas behavioral addicts rely on an intensely pleasurable fantasy or activity.

Part of the confusion around behavioral addictions arises because certain addictive behaviors are (for most people, most of the time) healthy and essential to life. For instance, eating and being sexual contribute to survival of the individual and the species. (This is why our brains are programmed to register/experience pleasure when we engage in these activities.) Unfortunately, for vulnerable people (people at-risk for addiction thanks to genetics and/or their environment), this inborn pleasure response can become a go-to coping mechanism used to deal with any and all forms of emotional and psychological discomfort, turned to time and time again until the individual loses control over it.

To further understand the link between substance and behavioral addictions, consider a cocaine addict on payday. After receiving his check, he runs to the bank to exchange it for cash, perhaps skipping out of work early to do so. Then he dashes off to his dealer’s house to spend money that he really ought to set aside for food, rent, childcare, and the like. As he approaches his dealer’s house, his heart races, he’s sweating, and he is so obsessed and preoccupied with using that he doesn’t even notice the police car parked a block away. He is so completely focused on cocaine that the day-to-day world, with all of its problems and obligations, has temporarily receded. In most respects this individual is high already. He has escaped from his life, his decision-making is distorted, and he has lost touch with reality. It doesn’t matter that there are no actual drugs in his system, because his brain is pumping out dopamine and other pleasure-related neurochemicals as if there are. This neurobiological state of distraction and emotional escape, no matter how it is induced, is the goal with all addictions.

Addiction is about the manipulation of neurochemistry, and this can happen with or without an addictive substance. Sex addicts in particular “get high” based more on fantasies and ritualistic preparations than anything else. In fact, sex addicts experience more pleasure and escape through anticipating, chasing and preparing for sex than from the sex act itself. They even have a name for this condition, referring to it as either the bubble or the trance. In other words, sex addiction is not about the sex, it’s about losing touch with reality for an extended period of time. For sex addicts, engaging in sex and reaching orgasm actually ends the high and throws them back into the real world, where they must once again face life and all its problems – which is what they were trying to avoid and escape in the first place.

Common Behavioral Addictions

Sex is not the only behavioral addiction. Others include:

• Gambling Addiction: Gambling addiction, also called gambling disorder and compulsive gambling, is an uncontrollable urge to gamble. Typically, gambling addicts will play whatever game is available, though their preference is fast-paced games like video poker, slots, blackjack, and roulette, where rounds end quickly and there is an immediate opportunity to play again. Digital technology offers these games in abundance.
• Love Addiction: Love addiction is the compulsive search for romantic attachment. (This disorder is discussed in detail in chapter seven.) Love addicts sacrifice time, health, money, self-esteem and more in their pursuit of the perfect partner.
• Social Media Obsession: Social media obsession is the quest to have the most friends or followers on sites/apps like Facebook, Twitter and Instagram, to have one’s lovingly constructed posts and tweets responded to in positive ways, and to “look good” through an endless series of (often) narcissistic posts. Social media addicts sometimes choose to bypass real world relationships, recreation and social engagement for their online life.
• Spending Addiction: Spending addiction, also called oniomania, compulsive spending, shopping addiction and compulsive buying disorder, occurs when people spend obsessively despite the damage this does to their finances and their relationships.
• Video Game Addiction: Video game addiction is the extreme use of computer and video games. Typically, gaming addicts play for at least two hours daily; sometimes they play four or five times that amount. They often neglect sleep, personal hygiene, diet, relationships, jobs, financial obligations, exercise and life in general.

Behavioral Addictions Can Be Tricky to Identify

Even though behavioral addictions are in most respects similar to substance addictions, they are often more difficult to identify. After all, they’re easier to hide, they’re (usually) more socially acceptable, and outside observers (even some therapists) don’t always recognize the behaviors as potentially addictive. As such, behavioral addicts typically must experience serious directly related consequences before anyone is willing to confront them and help them admit they have a problem. Sometimes behavioral addictions are only uncovered during treatment for a substance use disorder or some other psychiatric condition. For instance, a woman in treatment for depression and alcohol abuse may find herself acting out sexually with other patients or even staff, leading to an evaluation for sex and love addiction, or a man attending Alcoholics Anonymous may find himself continually relapsing at the local casino, leading to a realization that he has an intertwined alcohol and gambling addiction.

Another major obstacle in the identification and treatment of behavioral addictions is the fact that most people view them as being less serious than “real” addictions (i.e., substance addictions). In actuality, nothing could be further from the truth. Behavioral addictions create the same types and degree of havoc as substance use disorders – relationship trouble, issues at work or in school, declining physical and/or emotional health (depression, anxiety, loss of self-esteem, etc.), isolation, financial woes, loss of interest in previously enjoyable activities, legal trouble and more.

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If you or someone you care about is struggling with sex, porn, or substance/sex addiction, help is available. Seeking Integrity offers inpatient treatment for sex, porn, and substance/sex addicts, as well as low-cost online workgroups. At the same time, SexandRelationshipHealing.com offers a variety of free webinars and drop-in discussion groups, podcasts, and more.

References

[i] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, p 481. Washington, D.C.: American Psychiatric Association.

[ii] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, pp 481-584. Washington, D.C.: American Psychiatric Association.

[iii] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, pp 585-589. Washington, D.C.: American Psychiatric Association.

[iv] “Definition of Addiction,” American Society of Addiction Medicine, accessed Dec 31, 2014, asam.org/for-the-public/definition-of-addiction.

[v] National Institute on Drug Abuse. (2007). Drugs, brains, and behavior: The science of addiction. Retrieved September 3, 2014, from drugabuse.gov/publications/topics-in-brief/drugs-brains-behavior-science-addiction; Clay, S. W. (2010). Risk factors for addiction. Osteopathic Family Physician, 2(2), 41-45; and numerous other studies.

[vi] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, pp 235-264. Washington, D.C.: American Psychiatric Association.