Article
Behavioral Addiction – Recognizing and Treating Non-Substance Dependencies
Behavioral addictions are similar to substance use addictions, except with behavioral addictions a person compulsively engages in a behavior or activity, rather than using a substance problematically.
Like substance use disorder, the compulsion for behavioral addiction is driven by a dysfunction of the brain’s reward networks, especially the dopamine system. Common behavioral addictions include gambling, shopping, sex, internet, and social media use.
Behavioral addictions can have many negative consequences, such as financial issues, poor health, and medical issues, and can interfere with interpersonal and familial relationships. Behavioral addictions are complex, but with proper treatment, individuals can go on to live normal, healthy, and productive lives.
What is Behavioral Addiction (BA)?
Behavioral addiction is a chronic mental health condition caused by a change in the brain’s chemistry. It involves intense, persistent, and compulsive urges to seek out or perform a behavior or activity, such as viewing pornography, gambling, or gaming. People keep engaging in the behavior even though it’s interfering with their lives and relationships.
According to The American Society of Addiction Medicine (ASAM), addiction is a chronic brain disorder. With addiction, the chemistry of the brain changes. The area of the brain affected includes the neurotransmission of dopamine. This area of the brain impacts the reward system, motivation, and mood regulation
According to The American Society of Addiction Medicine (ASAM), addiction is a chronic brain disorder. With addiction, the chemistry of the brain changes. The area of the brain affected includes the neurotransmission of dopamine. This area of the brain impacts the reward system, motivation, and mood regulation
The DSM-5 and ICD-11 only recognize gambling disorder and internet gaming disorder. However, there are at least 9 other behaviors that can also become addictive, including:
- Out of Contol Sexual Behavior (OCSB)
- Addiction to specific foods
- Compulsive shopping
- Stealing (kleptomania)
- Social media addiction
- Smartphone addiction
- Pornography addiction
- Adrenaline addiction (caused by dangerous and exciting activities)
- Cosmetic surgeries
How Behavioral Addictions Affect the Brain
Behavioral addictions affect the brain by overstimulating the brain’s reward system by flooding the brain with dopamine.
This process is similar to the mechanism of substance abuse disorders. The dopamine spike associated with substance intake or gambling is short-lived. The dopamine levels quickly fall below the baseline.
The abrupt reduction, or “crash” in dopamine leads to feelings of emptiness and depression, which can lead to craving for that feeling of euphoria again. One may re-engage in the problematic behaviors as a way to cope with the negative feelings associated with the crash.
Key Brain Regions Involved
The following regions are involved in the establishment and maintenance of behavioral addictions:
- The basal ganglia, involved in the formation of habits
- The prefrontal cortex, responsible for impulse control
- The amygdala, involved in emotional regulation
Symptoms of Behavioral Addiction
The following regions are involved in the establishment and maintenance of behavioral addictions:
- Engaging in addictive behaviors consumes a significant amount of time
- Lack of impulse -control—inability to stop at will
- Numerous, unsuccessful attempts to stop engaging in a behavior
- A significant degree of psychological distress associated with the behavior
- Degradation of social relationships
- Increased tolerance—to achieve satisfaction, more and more time is spent on compulsive habits.
- Withdrawal symptoms, such as irritability and anxiety when unable to engage in a behavior or activity.
- Preoccupation and obsessions (cravings) about particular addictive behaviors.
Causes and Risk Factors
The causes of risk factors for behavioral addictions are complex and may be determined by the following factors:
- Genetics—researchers discovered several genes associated with behavioral addictions.
- Family history—witnessing parental addictions increases a child’s risk of developing addictions later in life.
- Childhood trauma and neglect—adverse childhood experiences (ACEs) can lead to a predisposition towards addictions
- Peer pressure—social circles, especially during adolescence, can push individuals to experiment with different addictive behaviors.
- Stress—Chronic stress can lead to behavioral addictions as a way to cope or escape.
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Diagnosis of Behavioral Addictions
Diagnosing behavioral addictions is a complex clinical process that involves thorough assessment and testing conducted by a mental health professional, usually a psychiatrist, clinical psychologist, or social worker trained in this area.
Clinical assessments usually involve:
- Examining family history of addictions and other mental disorders
- Inquiring about early life experiences (e.g., relationship with parents, early traumas, school)
- Making notes about adolescent functioning and early romantic relationships
- Pinpointing early engagement in addictive behaviors
- Assessing current level of functioning, professional life, and productivity
In the process of diagnosing mental disorders, mental health professionals may utilize the following assessment tools:
- Structured Clinical Interview for the DSM Disorders (assessing the presence of symptoms of the DSM-5 disorders)
- Psychosocial Assessment
- Self-report scales that target specific behaviors such as the South Oaks Gambling Screening (SOGS), Problem Gambling Severity Index (PGSI), Behavioral Addictions Questionnaire (BAQ), and Internet Gaming Disorder Scale (IGDS) among others.
Mental health professionals will also assess the presence of co-occurring mental disorders, as it is common for mental health conditions to occur together. For example, suicidal ideation and suicide attempts are common in people struggling with severe gambling disorders when they have lost significant sums of money and are in severe financial circumstances. Using a comprehensive approach to diagnosing behavioral addiction helps a practitioner gain a full understanding of a person’s condition. This process helps experts create a personalized, well-rounded treatment plan that addresses all aspects of the patient’s struggle.
Treatment Options for Behavioral Addictions
Treatment options for behavioral addictions may include a variety of therapeutic approaches, such as individual therapy, group, couples, and family therapy, support groups, and medications. Treatment for BA is a personalized process and will be different for everyone.
Research from the National Institutes on Drug Abuse (NIDA) shows that comprehensive and patient-centered treatment is the most effective.
The goal of treatment should be to help people understand their addiction and empower them to increase their internal motivation, develop healthy coping skills, make positive, long-term changes, and live a healthier life.
Evidence-based approaches commonly used to treat behavioral addictions include:
- Cognitive Behavioral Therapy (CBT)
- Group Therapy
- Support Groups
- Mindfulness and meditation practices
- Medication
- Community Reinforcement and Family Training (CRAFT) for the family
Cognitive Behavioral Therapy (CBT)
CBT is a behavioral therapeutic approach used to help patients identify and examine unhelpful patterns of thoughts, feelings, and behaviors and create new patterns that are more productive.
CBT has become the gold standard for treating a variety of mental health conditions, including addiction.
CBT therapists help patients explore automatic thoughts (e.g., “I won’t last one day without my smartphone.” “I’ve got a hot hand, I need to keep playing!” “I’ve had so many losses, I’m due for a win!”) and the core irrational beliefs (e.g., “I’m a horrible person!”) that accompany addictive behaviors.
A therapist using CBT guides patients through challenging thoughts and feelings as a way to gain insight into their motivations.
They work together to develop more constructive thought and behavior patterns and new coping skills. Over time, the patient makes small, incremental improvements and adjustments to their thinking that eventually override the negative thoughts and tendencies.
Group Therapy and Support Groups
Group therapy and support groups are two major ways to participate in peer support for behavioral addiction recovery. Peer support is a crucial element of successful rehabilitation of behavioral addictions.
Group Therapy
Group therapy is usually led by a mental health practitioner. Types of group therapy include:
- CBT DBT and other skills based groups
- Psychodynamic therapy groups including Mentalization Based Therapy and Supportive Expressive Therapy
- Couples therapy
- CRAFT Family training in groups to teach family members how to support their loved one
- Group therapy for behavioral addictions emphasizes that addictions exist in a social universe, being caused by social factors (e.g., trauma) and having several negative social consequences (e.g., interpersonal conflicts).
Mutual Support Groups
Mutual support groups are also an effective method of treating behavioral addictions. Support groups where a group of people who have common experiences or concerns (such as addiction) gather to share their experiences with healing, offering comfort and encouragement through the healing process. Support groups are facilitated by volunteers, not mental health professionals.
Support groups are available for a variety of BAs, such as:
- Gamblers Anonymous
- Sex Addicts Anonymous
- Debtors Anonymous
- Spenders Anonymous
- Media Addicts Anonymous
Mindfulness Therapies
Mindfulness is a practice that involves becoming fully present and aware of one’s internal state of being and surroundings without judgment. Incorporating this practice into therapy for BA assists with helping individuals learn to observe negative thoughts and feelings without reacting to them.
Mindfulness practices, like meditation or breathing exercises, are often used as part of a comprehensive treatment program for addiction. Mindfulness supports traditional psychotherapy by helping patients become relaxed and centered, which helps patients become more receptive to other therapeutic techniques, like CBT.
There is a growing recognition of the benefits of integrating different types of behavioral addiction treatment. Research shows that mindfulness practices can help prevent relapses or complications from mental health conditions.
Medications
Medication is used alongside counseling and behavioral therapies in the treatment of some cases of behavioral addictions. This is known as Medication Assisted Therapy (MAT). MAT is not the same for everyone. It is tailored to each patient’s needs for a whole-person approach. MAT is an effective component of a comprehensive treatment plan and contributes to long-term health outcomes for patients.
Medications that have shown promise in reducing urges and cravings that accompany BAs, like gambling addiction, include:
- Antidepressants
- Opioid antagonist medications, like Naltrexone
- Mood stabilizers, such as sustained-release lithium carbonate
Long-Term Management and Prevention
Long-term recovery is possible with comprehensive individualized treatment. Recovering from a behavioral addiction is a process, and setbacks are normal. Integrating aftercare programs and ongoing support for BA is essential to long-term treatment outcomes.
A support team that includes friends, family, mutual support groups, and providers makes treatment and recovery more effective and manageable.
Lifestyle factors, such as exercise, healthy nutrition, and stress management are strategies that should also be integrated with all types of BA treatment.
Research supports that comprehensive aftercare strategies help people to develop a lifestyle, and can help to prevent relapse.
Incorporating a relapse prevention plan is a crucial component of aftercare for anyone recovering from a BA.
A relapse prevention plan will help you recognize behaviors and triggers that may put you at risk for future relapse and provide a course of action to get back on track when cravings and triggers occur.
Relapse prevention may include:
- Educating friends and family about signs and symptoms to watch for. Limiting high-risk activities (e.g., avoiding casinos or drinking if this precipitates gambling; not buying an addictive video game; blocking porn websites; joining self-exclusion programs to block online sports betting)
- Regularly practicing mindfulness and self-management techniques, like meditation, deep breathing, or Progressive Muscle Relaxation)
- Building a support network (e.g., opening up to friends and family about the problem; finding a support group)
Conclusion
Behavioral addictions are serious mental health conditions that can significantly impact your physical and mental health, relationships, and overall quality of life.
There are many different forms of behavioral addictions, but all have several core shared symptoms— loss of self-control, intense urges for the activity, built-up tolerance, withdrawal symptoms, and the inability to stop the behavior.
Brain chemistry changes with behavioral addictions, causing dysfunction with the areas of the brain that play a key role in the reward center of the brain.
A variety of factors can contribute to BAs, such as the presence of another mental health condition, trauma, adverse childhood experiences, and chronic stress.
Behavioral addictions can be successfully treated. Overcoming addiction requires a commitment to comprehensive care for rewiring the brain. Creating new thoughts and behavior patterns can take time and diligence.
Wholeview in NYC offers compassionate, high-level addiction treatment to anyone living in the state of NY. We offer treatment services in person and online.
If you or someone you know is struggling with addiction, contact Wholeview to explore your treatment options and start recovering today.
FAQ
Behavioral addiction is a mental disorder where a person compulsively engages in behaviors such as gambling or gaming without being able to stop.
Behavioral and substance addictions have similar symptoms, such as tolerance, withdrawal, and craving, as well as similar neurological foundations.
Examples of behavioral addictions are gambling disorder, internet gaming disorder, sex addiction, social media addiction, and shopping addiction.
Behavioral addictions are caused by various contributing factors, including genetic and socio-psychological factors (i.e., family history, trauma, peer pressure, stress).
If you are unable to control your impulses around a behavior or activity, such as the amount of time you spend on a habit, or if it interferes with your daily life, your life becomes significantly worse because of this habit, you may have a behavioral addiction.
Effective treatments for behavioral addiction are CBT, group therapy, support groups, family therapy, and medication.
Yes, SUD often co-occurs with anxiety, depression, and PTSD, and requires treatments that take both into account.
Effective prevention strategies for SUD include education, parental guidance, community programs, and early intervention.
Behavioral addictions often co-occur with other mental disorders such as depression, anxiety disorders, personality disorders, bipolar disorder, and post-traumatic stress disorder (PTSD).
Behavioral addiction can be prevented by being educated about the signs and symptoms of addiction, and self-monitoring, while also engaging in healthy activities.
The DSM-5 recognizes one behavioral addiction, gambling disorder, and offers internet gaming disorder as another potential behavioral addiction.
The dopamine system participates in the pleasure response associated with behavioral addictions, contributing to the emergence and perpetuation of the disorder.
OCD is not a behavioral addiction; symptoms of OCD are compulsive rituals (e.g. handwashing) and obsessions unrelated to addictions (e.g., worrying about bacteria and germs on the furniture).
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