What are “Behavioral Addictions”?
Sometimes called “Process Addictions” – they are conditions in which a person repeats certain typically pleasurable activities to an extent that it causes negative consequences. These negative consequences accumulate and the initial pleasure from the activity diminishes or disappears; yet the behavior continues. Ultimately, as a result of the accumulation of negative consequences the person’s life, in one or more dimensions, becomes unmanageable. The most common and recognized behavioral addictions are gambling, overeating, self-cutting, and sexual addiction.
Although there is some professional disagreement and controversy concerning calling these problems “addictions”, the more they are studied, the more they appear to share commonalities with chemical dependence/addiction. The clinical course of these problems parallels those of chemical dependence or addiction. Some common characteristics are:
- These behaviors appear to activate the reward center of the brain to release the neurotransmitter, dopamine. Dopamine is the neurotransmitter most associated with the experience of pleasure.
- The prevalence of the behavior or chemical use is typically high in the population, yet the path towards unmanageability appears in a minority of people, typically 5-15% depending on the study. Thus, for most people the behavior or chemical use is limited and remains pleasurable, but for the 5-15% it remains neither limited nor pleasurable and ultimately leads to a great deal of suffering.
- There is a high degree of shame and guilt attached to the behavior, which contributes to the emotional pain that perpetuates the behavior causing a vicious cycle leading to ever more destructive results.
- Denial is a hallmark of the person’s self-assessment of whether there is a problem with his or her behaviors. The gambler is always one bet from recouping his losses. The sex addict is merely serving a high sexual appetite or “natural desire” for sex. The overeater who becomes morbidly obese claims a ‘low metabolism” for her problem and so on. Typically, the behavior is not addressed directly until an intervention is made by concerned others and after much damage is done to the person in personal, family and occupational spheres of life.
- These behaviors and their accrued negative consequences typically lead to social isolation and a “double life” where lying and deception are common. This undermines relationships and trust causing ever more social isolation and abandonment. This contributes to the personal sense of hopelessness and helplessness and then even more pain.
- There is a high degree of comorbidity such that anyone with one of these “addictions” has a much higher degree of risk to having one or more other addictions including chemical addiction.
- Once treated or intervened upon, high rates of relapse are seen in the course of removing the behaviors.
Fortunately, agreement on a common etiology for all of these conditions is not required or necessary in order to intervene or to successfully treat these conditions. The course of “recovery” is often fraught with relapse risk and identifying the underpinnings of what triggers the behaviors. It is typically a life long course of progressive improvement and navigating through risk situations while maintaining abstinence from the behaviors. There is also risk of “cross addiction” to another of these behaviors or to chemical usage and dependence.
Current approaches to treatment often combine the use of psychiatric treatment that includes but is not restricted to group therapy, cognitive behavioral therapy, pharmacotherapy, and family therapy. Treatment is also typically supplemented with the use of fellowship participation modeled on the AA and NA, 12 step, approach to chemical dependence recovery. These fellowships provide support and grassroots help with the typical obstacles and challenges that the recovering addict faces over the course of his recovery and repair of his life.
In summary, behavioral addictions are challenging, but treatment has proven successful in stopping the ever-downward spiral into life destruction that they can create. A comprehensive treatment plan including group therapy, cognitive behavioral skills training, family therapy and fellowship participation and supplementation can prove life saving for the person and his or her family.
Dr. Paul F. Giannandrea
The Bergand Group