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Some addictions are based entirely on behavior.
By Robert Weiss — Written on Sep 13, 2019
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).
In fact, the APA has recently shied away from using the word addiction in general, now labeling alcoholism and drug addiction as “substance use disorder” and gambling addiction as “gambling disorder.”
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 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].
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.
However, this is largely unnecessary when one understands the basic neurochemistry of addictions.
Stated simply, addictive substances and addictive behaviors trigger the exact same neurochemical response – primarily the release of dopamine (pleasure), along with adrenaline (excitement), oxytocin (love and connection), serotonin (emotional wellbeing), and a variety of endorphins (euphoria).
This results in feelings of pleasure, excitement, control, and, most importantly, distraction and emotional escape.
Over time, addicts learn that the easiest way to distract themselves from emotional discomfort is to ingest an addictive substance or engage in a highly pleasurable (and therefore highly distracting) behavior.
They learn to use addictive substances and behaviors not to feel good, but to feel less.
Addictive substances and behaviors become their go-to coping skill for stress, anxiety, depression, loneliness, boredom, and all other forms of emotional discomfort.
So, at the end of the day, 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.
Addiction is about the manipulation of neurochemistry. Period. 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 neurochemical condition, referring to it as either the bubble or the trance.
Thus we see that sex addiction is not about sex; like all other addictions, it’s about losing touch with reality for an extended period of time.
Sex is not the only common 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.
- Love/relationship addiction: Love/relationship addiction is the compulsive search for romantic attachment.
- Social media obsession: Social media obsession is the quest to have the most friends or followers on sites/apps like Facebook, Twitter, and Instagram. 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.
It may seem from the above discussion that almost anything can be addictive – substances and behaviors alike.
This is not, in fact, the case.
For a substance or behavior to be addictive, it needs to trigger the experience of pleasure (the neurochemical response discussed above).
Without that element, a behavior may be compulsive, but it does not qualify as an addiction.
For instance, compulsive hand washing does not create pleasure.
Thus, it is not an addiction.
Even though behavioral addictions are in most respects similar to substance addictions, they are typically more difficult to identify.
One obstacle is the fact that most people view behavioral addictions as being less serious than “real” addictions (i.e., substance addictions).
In reality, nothing could be further from the truth.
Behavioral addictions create the same types and degree of havoc as substance addictions – 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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Robert Weiss PhD, MSW, CEO of Seeking Integrity LLC, is a digital-age sex, intimacy, and relationship specialist.