Contrary to the commonly held belief that addiction is a dependence on alcohol, illicit drugs, prescription drugs or nicotine, behavioral science experts believe any source capable of stimulating an individual has the potential to become addictive.1 Although process or behavioral addictions can cause devastating psychological effects, they are not associated with a high incidence of mortality like substance use addictions. Some of the more common activities identified as potential factors in the development of process addictions include gambling, sex, work, spending/compulsive shopping and use of the Internet.
Research has identified the presence of psychopathologies such as depression, substance dependence or withdrawal, social anxiety and a lack of social support as precursors to behavioral addictions. Furthermore, the high comorbidity of behavioral addictions and substance-related addictions suggests comparable underlying etiological mechanisms.1,2
Evidence shows people who excessively participate in non-substance-related pleasurable activities undergo lasting chemical changes in the neural pathway of the reward system in the brain. There is increasing evidence individuals with a genetic predisposition to addictive behaviors have an inadequate number of dopamine receptors or have an insufficient amount of serotonin/dopamine. Therefore they cannot experience normal levels of pleasure from pursuits most people would find rewarding and seek out pleasure through activities that can be highly addictive.3
Currently, a universal process addiction definition does not exist. According to the Textbook of Anxiety Disorders, process addiction consists of a compulsion to repeatedly engage in an action until it causes negative consequences to the person’s physical, mental, social and/or financial well-being.4,5 They typically involve the following characteristics:
Studies conducted on gambling in the 1980s and 1990s yielded the following six criteria to help define and diagnose behavioral addictions:6,7
An estimated 2 million (1%) of U.S. adults meet the criteria for pathological gambling in a given year. An additional 4 million to 6 million (2% to 3%) are considered problem gamblers in that they do not meet the full diagnostic criteria for pathological gambling, but exhibit one or more of the criteria and experience problems due to gambling behavior.8
Individuals diagnosed with this disorder are frequently highly competitive, prone to other addictive-type disorders and overly concerned with others’ approval. The symptoms of pathological gambling include persistent gambling despite mounting difficulties and problems with financial, vocational and interpersonal functioning. There are biochemical and etiological commonalities between pathological or compulsive gambling and substance dependence. Co-morbidities in people addicted to gambling include major depression, anxiety or personality disorders and attention-deficit hyperactivity disorder (ADHD).
An estimated 3% to 6% of the general U.S. population suffers from some form of addictive sexual behavior with themselves or others.9 People affected by sex addiction have a form of non-substance-based behavioral addiction centering on compulsive and harmful involvement in sex-related conduct, thoughts or fantasies. Sexual addiction/ hypersexual disorder is an umbrella term encompassing various types of problematic behaviors including excessive masturbation, cybersex, pornography use, sexual behavior with consenting adults, telephone sex, strip club visitation and other behaviors.
Some people engage in sexual practices that may not follow cultural norms. However, this does not mean they have a sex addiction. There is a good deal of variance among people with respect to sexual interest and appetite. Sexual activity may turn into addiction when it becomes the sole source of pleasure in life, or replaces other healthy interests (e.g. work, relationships or recreation). While the DSM-5 does not recognize sexual addiction as a distinct mental disorder, many certified sex addiction treatment specialists identify sexual addiction based on the following three measures:10
Although there is no clinical definition and it is not recognized by the American Psychiatric Association (APA) in the DSM-5, work addiction shares similarities with other related compulsive or impulse control disorders. The term ‘‘workaholism’’ was derived from alcoholism and was first introduced in academic literature as an ‘‘addiction to work, the compulsion or uncontrollable need to work incessantly.’’ Workaholism has been defined as “being overly concerned about work, driven by an uncontrollable work motivation and investing so much time and effort into work that it impairs other important life areas.” While there is paucity in the number of reliable prevalence estimates of workaholism, systematic reviews and meta-analyses tentatively report estimates from 5% to more than 25%.11
In the largest study done to date on 16,400 adults, workaholics scored significantly higher on clinical levels of all psychiatric symptoms than non-workaholics, suggesting underlying psychiatric disorders are associated with work addiction. A combination of individual (1.2%), work-related (5.4%), and mental health (17.0%) variables contributed to the 23.7% variance of workaholism in the study group. Overall, 7.8% of the participants were classified as workaholics. Of this group, it became evident individuals who were younger, female, not in a relationship, managers, self-employed, and met clinical cut-offs for ADHD, obsessive-compulsive disorder (OCD), anxiety, and depression, had a higher propensity for being workaholics than other people.11
The frequency of compulsive buying disorder has increased worldwide during the two last decades, with an estimated prevalence of 4.9% in the adult population. This equates to about 12.3 million people ages 18 and older in the U.S. alone.12 While it is not recognized by the APA in the DSM-5 as a separate disorder, according to the organization, compulsive shopping is a pattern of chronic, repetitive purchasing that becomes difficult to stop and ultimately results in harmful consequences.
Shopping gives compulsive buyers a feeling of euphoria and a rush of positive emotions, similar to what a drug addict feels when he or she gets high. The individual becomes consumed with an insatiable desire to shop despite lack of money, maxed-out credit cards, an inability to pay bills and arguments with partners. Past emotional trauma, high levels of stress or anxiety or feeling powerless due to a bad relationship may cause people to shop to gain control. Like other addictions, a spending addict may experience guilt, shame, remorse, lie constantly to cover up the addiction, deny there is a problem or seek to shift blame to others.13
Internet addiction can involve various behaviors such as excessive online gaming, online buying and gambling, frequent email checking, prolific use of social media and viewing pornography. Internet addiction disorder (IAD) is also known as problematic Internet use (PIU), computer addiction, Internet dependence, compulsive Internet use or pathological Internet use.14 Surveys in the U.S. and Europe have indicated IAD prevalence rates of 1.5% to 8.2%, while others report rates between 6% and 18.5%.15
Researchers believe digital technology users experience multiple layers of reward when they use various computer applications. Regardless of the application (general surfing, pornography, chat rooms, message boards, social networking sites, video games, email or texting), these activities support unpredictable and variable reward structures. The reward intensifies when it is combined with mood enhancing/stimulating content. Examples of this are pornography (sexual stimulation), video games (e.g. various social rewards, identification with a hero or immersive graphics), dating sites (romantic fantasy), online poker (financial) and special interest chat rooms or message boards (sense of belonging).14
Many Internet activities have been observed to have compulsive elements and share commonalities with impulse control disorders. Moreover, a variety of mental disorders co-occur with IAD. However, there is disagreement about which came first, the addiction or the co-occurring disorder. In one study, researchers surmised higher scores for depression, anxiety, hostility, interpersonal sensitivity and psychoticism were a consequence of IAD. Some experts believe for IAD to be regarded as its own disorder, it should likely be categorized within the impulsive-compulsive spectrum.15
Treatment for process addictions, unlike treatment for alcohol or drug addiction, does not have the goal of abstinence. Rather, the goal is elimination of compulsive unhealthy behaviors. Treatment varies somewhat depending on the type of process disorder, but often includes cognitive behavioral therapy, 12-step programs, group counseling sessions and support groups specific to the addiction such as Spenders Anonymous or Workaholics Anonymous. Since many individuals who have process addictions also have other types of addiction (e.g. alcohol, drugs), co-occurring treatment programs may be the best option. If the person has a co-occurring mental health disorder such as OCD or depression, medications may prescribed along with psychotherapy.
It is important that all addictions are treated before the detrimental effects take hold and destroy a person’s life. If you or somebody you know is exhibiting behavior indicative of a process addiction, call us today at 888-478-7519.