Behavioral Addiction: What We Know and What We Don’t

The post was written by Cameron Johnson and Dalanna Burris.

Source: Boris_Zhitkov

Over the years a plethora of research into substance use disorders has greatly increased the ability of the healthcare system to promote recovery from addiction and decrease the likelihood of relapse. Yet, for all that the scientific community knows about substance addictions, there is so much more to uncover about behavioral addictions and their underlying mechanisms. In fact, there’s even contention whether behavioral addictions exist.

Currently, only gambling addiction is officially designated as a disorder, listed in the DSM-5 as a diagnosable condition. But other problematic behaviors such as shopping addiction, problematic sexual behavior, and internet/gaming addiction have garnered significant attention as well.

Clinical practitioners and researchers have had sprawling debates about the validity of grouping repeated destructive behaviors—excessive shopping, overeating, harmful gambling habits—with substance addictions. Historically, addictions have been defined as chemical dependency on a substance (such as cocaine or methamphetamine) leading to destructive behaviors in pursuit of the next fix. However, as technology has improved, f-MRI data along with mounting evidence suggests that behavioral addictions (also called "process addictions") are more like substance addictions than initially believed.

Substances typically produce their mind-altering effects by attaching to receptors in the brain and either preventing reuptake of certain chemicals or encouraging the release of chemicals. f-MRI data suggests that brain activity in people who were experiencing withdrawal from drugs was similar to that of people who had recently stopped gambling or shopping. Even the anticipation of the high (induced, for example, by watching videos of high-stakes gambling) produces imaging results similar to those of people with alcohol use disorder seeing pictures of a beer.

The primary similarity between process addictions and substance addictions is that the natural reward system of the brain is skewed to reward the high-inducing substance or behavior and reduce inhibitions. In effect, the brain is encouraging the person to seek out their high regardless of the cost. However, such a wide variety of behaviors can induce an addiction-like state that scientists debate where to draw the line between a habitual coping mechanism and addiction.

For some people, the accessibility of online shopping provides an outlet to relieve stress. However, the use of a behavior to remove or replace negative emotions can lead to an dependence on the behavior, which can ultimately lead to the formation of an addiction.

Sexual activity can become problematic behavior if it interferes with a person's ability to keep promises, violates personal values, feels beyond personal control, or continues despite negative consequences. Like shopping and sex, video games have become an activity that people use to manage distress or cope with the rest of life. Although patterns of brain activation are similar to that seen in other addictions, video gaming is not listed as an addiction in the DSM-5 due to lack of compelling research into what a viable criteria would be for discerning patients with an addiction from patients with other primary issues. So far, there have not been consistent results suggesting that those who meet the criteria suffer adverse emotional, physical, or mental effects, and one study estimated that only 0.8 to 1.0 percent of people would meet the proposed criteria.

Overall, if the behavior becomes pervasive and overwhelming it could be a result of other mental health issues, such as depression, anxiety, agoraphobia—or the behavior could be the root of the issue as well. Whether cause or effect, a problem behavior merits treatment from a qualified professional.

Further, the COVID-19 pandemic and increasing social unrest pose stresses that magnify the risk of recurrence or development of a behavioral addiction—as they have substance addictions.

While more research is needed on the best way to diagnose behavioral addictions, there are treatments available to help reduce problematic behaviors. So far, people have experienced some relief from cognitive behavioral therapy (CBT), which allows individuals to not only identify and understand their basic template for understanding the world but also to modify and develop healthier ways to cope and adapt to it.

Additionally, CBT has proven helpful in identifying and treating mental health issues that often accompany addictive behaviors. Many individuals engage in addictive behaviors—whether gambling, compulsive shopping, gaming or others—to escape or avoid uncomfortable emotions. CBT can address those psychological issues, and by managing the contributors to addictive behaviors, assist in reducing potential for relapse.

About the Authors

Cameron Johnson is a research assistant at The Menninger Clinic. Cameron collects and manages treatment outcomes survey data, which Menninger uses to help track the symptoms of patients. Cameron earned a bachelor's degree in Psychology from Rice University in Houston.

Dalanna Burris, MS, LCDC is an addictions counselor at The Menninger Clinic. She has expertise in substance use treatment, problematic sexual behavior, and gaming addiction, and she serves on the Comprehensive Psychiatric Assessment Service.