The longstanding, widely accepted criteria used to diagnose an addiction are:
- Preoccupation to the point of obsession with an addictive substance or behavior, with that preoccupation lasting six months or longer.
- Loss of control over use of the substance or behavior (typically evidenced by multiple failed attempts to quit or cut back).
- Directly related negative life consequences – relationship trouble, problems at work or in school, depression, anxiety, social and emotional isolation, loss of interest in other previously enjoyable activities, financial issues, legal woes, etc.
Other common signs of addiction (that are not necessary for an addiction diagnosis) include:
All of these criteria can be satisfied through substance abuse and also through behavioral compulsivity. If you are struggling to wrap your head around the idea that a behavior can be just as addictive as a substance, consider a cocaine addict. It’s Friday afternoon and the addict is at work. It’s payday. At three p.m., he sees that his employer has deposited his paycheck into his bank account. So what happens next? If you can’t fill in the blanks on your own, we’ll do it for you.
- He cancels his afternoon appointments.
- He calls his wife and tells her he is going to work late.
- He calls his drug dealer and makes plans to meet.
- He leaves work early and goes to the bank.
- Instead of putting money in the bank to pay bills, he cashes the check to party.
- He drives to the dealer’s house, entirely focused on cocaine.
- His heart rate is elevated, his palms are sweaty, he is not thinking clearly.
- He enters the dealer’s house, not noticing the police car parked a block away.
- He buys cocaine.
- He uses cocaine.
At what point is this individual high? At first glance, we might think that he’s not high until the final step in the process – using cocaine. In reality, however, he is high long before that moment because the fantasy of using cocaine causes an adrenaline and dopamine rush that impacts his thinking and behavior as if he were using already. Why else would he risk his job by sneaking out early? Why else would he risk his marriage by lying to his wife? Why else would he choose to spend money that he needs for rent, food, and childcare on cocaine? Why else would he not even notice a police car parked outside his dealer’s house? Etc.
The simple truth is that this addict is high the moment he realizes it’s payday and he’ll have money for cocaine. The fantasy of using gives him an adrenaline and dopamine rush, impacting his ability to think rationally and, more importantly from his perspective, separating him from feelings of stress, anxiety, depression, loneliness, boredom, and anything else he would prefer to not feel. And this is all driven by anticipatory fantasy, not actual drug use.
Interestingly, with sex and porn addiction, the high is based almost entirely on anticipatory fantasy. Sex and porn addicts think about and plan for the sex they’re going to have and the pleasure of orgasm, and this gives them the escapist dopamine/adrenaline rush they seek. Sex and porn addicts even have names for this fantasy-induced high, referring to it as either the bubble or the trance. When they’re in the bubble/trance, they’re detached from emotional discomfort and they’re unable to make rational choices. In other words, they are high. No substance necessary.
If you or someone you care about is struggling with sex, porn, or substance/sex addiction, help is available through our free resources website, SexandRelationshipHealing.com, our low-cost online workgroups, and our residential treatment center.