The Addictive Nature of Rewarding Behaviors

Historically, when people heard the word “addiction” they immediately thought of an individual misusing illicit drugs or alcohol. The concept of addiction was always linked to the ingestion of a substance—specifically, a substance that was pleasure-inducing (e.g., marijuana, opioids, nicotine).

As a mental health profession, we have come a long way in our understanding of addiction. Rather than only referring to the compulsive misuse of substances, we now know that addiction can manifest in compulsive engagement in rewarding behaviors. Indeed, addiction is a disorder with many different faces.

Now, some individuals may question the idea of behavioral addictions and wonder how someone could be addicted to drug-less activity. The purpose of this post is to illuminate the nature of behavioral addictions so that we as clinicians (and as a society), will be more prepared to identify and respond to addictive behaviors in effective ways.

Behavioral addiction and the scientific community

First, it is important to note that a variety of scientific communities have recognized the existence of behavioral addictions. Gambling addiction is widely accepted (first introduced in the Diagnostic and Statistical Manual of Mental Disorders, third edition, as an impulse control disorder) and other addictive behaviors have been proposed with varying degrees of empirical support (e.g., sex, gaming, shopping, social media, food, pornography, exercise, nonsuicidal self-injury). The American Society of Addiction Medicine (ASAM) first included behaviors in their official definition of addiction in 2011 and retained that inclusion in the newest version released in 2019. Additionally, the DSM-5 (American Psychiatric Association, 2013), includes a chapter titled, Substance-Related and Addictive Disorders, which, by its name, acknowledges that not all addictive disorders include substances. Moreover, the International Classification of Diseases, 11th revision (World Health Organization, 2018), includes a section titled, Disorders Due to Addictive Behaviours, again, giving credence to behavioral addictions. Finally, accrediting bodies of professional training programs, such as the Council for Accreditation of Counseling & Related Educational Programs (CACREP; 2016), include standards mandating that students be familiar with addiction and addictive behaviors.

Although debate exists regarding which behaviors constitute addictions, and if the best conceptualization is an addiction model or an impulse control model, clinicians and 12-step programs have been responding to addictive behaviors for decades. Indeed, for a small subset of the population, engagement in certain activities can become compulsive, out of control, continue despite negative consequences, and induce cravings when the individual is not engaging (Griffiths, 2005; Kardefelt-Winther et al., 2017; Sussman & Sussman, 2011). These individuals likely have a behavioral addiction. Yet, how is it possible to be addicted to an activity devoid of drug use? The answer lies in the brain.

Addictive behaviors and the brain

Drugs of abuse, like alcohol and cocaine, are extremely rewarding, meaning they activate the brain’s reward circuitry (which involves the mesolimbic dopaminergic pathway and several structures such as the ventral tegmental area, nucleus accumbens, and prefrontal cortex). Illicit drugs and alcohol are exogenous chemicals, meaning they originate outside of the body.

When individuals engage in rewarding behaviors, they trigger the release of endogenous chemicals, which originate inside the body (specifically, in the same reward circuitry activated by drugs of abuse; Berridge & Kringelbach, 2015; Karim & Chaudhri, 2021; Wise & Robble, 2020). These endogenous chemicals often are neurotransmitters such as dopamine, opioids, endocannabinoids, serotonin, and GABA, which are implicated to various degrees in the experience of reward.

In essence, individuals with behavioral addictions use pleasurable behaviors to activate their reward system in the brain as a means of changing the way that they feel. Indeed, potentially addictive behaviors both induce pleasurable feelings and ward off distressing feelings, thus, like drugs of abuse, addictive behaviors are both positively and negatively reinforcing (Goodman, 2001; Parylak et al., 2011; Wise & Koob, 2014).

Vulnerabilities to behavioral addiction

Now, it is important to reiterate that not everyone who engages in a rewarding behavior develops a behavioral addiction. Likewise, not all behaviors have the same degree of addiction potential. Instead, when a vulnerable individual engages in a highly rewarding behavior, there is a risk of developing a behavioral addiction (Schüll, 2012).

So, what makes an individual vulnerable? There are many hypothesized factors including genetic predispositions (such as reward deficiency syndrome; Blum et al., 1996), adverse childhood experiences, specific personality traits, psychological distress or mental health concerns, or the availability and social modeling of particular behaviors. In sum, there is no one determining factor to identify those at risk of developing a behavioral addiction. Instead, the biopsychosocial model of addiction asserts that many factors could play a role and clients should be conceptualized holistically.

Addiction Essential Reads

A Vaccine Against Fentanyl!

Substance Use Prevention in Teens With ADHD

Okay, but which behaviors have high degrees of addiction potential?

Types of addictive behaviors

Potentially addictive behaviors are those that stimulate the reward circuitry in the brain and are associated with natural or learned rewards (e.g., gambling, sex, pornography, internet gaming, shopping, social media, food; Comings & Brum, 2000). Some of these behaviors involve what has been coined supernormal stimuli (Barrett, 2010), which refer to artificial exaggerations of natural instincts such as processed foods high in fat and sugar, internet pornography with enhanced sexual partners, highly stimulating virtual worlds of Massively Multiplayer Online (MMO) games, or fast-paced electronic gambling machines.

Importantly, depending upon the susceptibility of an individual, engagement in a particular behavior can lead to varying degrees of reward (e.g., one person may play an MMO and feel extremely euphoric while another may play and feel mildly entertained). Thus, both the traits of the individual and features of the rewarding behavior contribute to the development of behavioral addictions.

In conclusion, behavioral addictions are a global phenomenon affecting individuals across the lifespan (many first engagements in potentially addictive behaviors begin in adolescence and can continue throughout older adulthood). Like chemical addiction, it is proposed that individuals with behavioral addictions lose control over their behavior, engage compulsively in the behavior, crave the behavior when not engaging, and continue to engage despite negative consequences (ASAM, 2019; Griffiths, 2005; Kardefelt-Winther, 2017; Sussman & Sussman, 2011).

As we become more informed about behavioral addictions, we can provide effective prevention, intervention, and advocacy efforts for those with addictive behaviors. Raising awareness about behavioral addictions is one of the first steps toward destigmatizing the disorders and reducing the shame that may keep affected individuals from seeking treatment. To learn more, consider exploring the references listed below.