Contrary to what one may believe, addictions do not just exist in the realm of problematic alcohol and drug use. Any problematic behaviour, known as addictive behaviour, can develop into an addiction. Addictions that exist separate from compulsive alcohol and drug-using behaviour are known as behavioural addictions.
Currently, the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) only discusses gambling disorder, in addition to substance use disorder (SUD), as a mental disorder. Internet gaming disorder is only mentioned in the research appendix. However, a research article published in the Annual Review of Clinical Psychology argues that many behavioural addictions — including sex, shopping, and overeating, for example — share defining characteristics with these conditions.
It is important to understand the potential consequences, effects, and other concerns that can arise with chronic behavioural addictions. Understanding the different types, risks, and warning signs of behavioural addictions can be instrumental for an individual’s overall health and well-being. Additionally, people must recognise that treatment and recovery are possible for both substance addictions as well as behavioural addictions.
Understanding Behavioural Addictions
What is a Behavioural Addiction?
A behavioural addiction, also known as a process addiction or impulse control disorder, is characterized by a compulsive engagement in behaviours or activities that lead to significant damage to one’s physical, emotional, or financial well-being. Unlike substance use disorders, which involve the consumption of drugs or alcohol, behavioural addictions revolve around actions that become repetitive and uncontrollable. These actions can range from gambling and shopping to internet use and sexual activities. Despite the absence of a physical substance, the compulsion to continually engage in these behaviours can be just as powerful and destructive, often resulting in severe negative consequences.
Behavioural Addictions vs Substance Addictions
When working to understand behavioural addictions, it can be helpful first to understand the central elements of substance addictions. The National Health Service explains, ‘In the case of drugs, alcohol and nicotine, these substances affect the way you feel, both physically and mentally. These feelings can be enjoyable and create a powerful urge to use the substances again…In the case of substance misuse (for example, drugs and alcohol), an addiction can have serious psychological and physical effects.’
Substance use produces significant chemical surges in important brain areas. As a result of these surges, the brain changes its structure and function. This makes it easier for an individual to use substances repeatedly without considering the potential consequences, similar to drug addiction.
The International Journal of Preventative Medicine explains, ‘Behavioural science experts believe that all entities capable of stimulating a person can be addictive; and whenever a habit changes into an obligation, it can be considered as an addiction.’ In other words, any behaviour has the potential to develop into an addiction.
It may seem that certain behaviours are incapable of producing the same severe brain changes that result from substance abuse; however, behavioural addictions are, indeed, capable of causing lasting harm to an individual’s brain and body. Therefore, behavioural addictions must be taken seriously and addressed as quickly as possible to prevent worsening harm.
Understanding Addiction in the Brain
As mentioned previously, the brain becomes changed as a result of engaging in problematic alcohol use, drug use, and addictive behaviours. Becoming familiar with specific examples of this can help individuals better understand the full picture of addiction rather than solely substance addictions. For example, internet addiction can lead to significant changes in brain function, similar to those seen in substance addic
The Reward System
Some brain structures most notably affected by addictive behaviours are the basal ganglia, also referred to as the brain’s reward system. As most of the brain works together to perform specific functions, it is essential to understand that the basal ganglia are strongly interconnected to other important brain regions. Therefore, dysfunction in this system can contribute to dysfunction elsewhere.
The brain’s reward system is responsible for forming habits and routines and recognising and motivating individuals to engage in pleasurable behaviours. Naturally, this system encourages interaction with healthy activities, such as eating, socializing, and having sex. Dopamine, an important neurotransmitter, is central to the experience of pleasure.
Simply put, substance use sends these brain structures into overdrive. Alcohol and other drugs produce abnormal surges of dopamine, inducing feelings of pleasure beyond any feeling experienced from natural rewards. These dopamine surges signal to the brain that behaviour is pleasurable and needs to be remembered, a mechanism also seen in drug addictions. With repeated use, the brain’s reward system adapts to alcohol and other drugs and reduces overall sensitivity, making it difficult to experience pleasure from anything besides substance use.
Alcohol and drug use are not the only behaviours that have the potential to produce long-lasting changes to this system, however. According to a systematic review in The American Journal of Drug and Alcohol Abuse, ‘Several [behaviours], besides psychoactive substance ingestion, produce short-term reward that may engender persistent [behaviour] despite knowledge of adverse consequences, i.e., diminished control over the [behaviour]. Diminished control is a core defining concept of psychoactive substance dependence or addiction.’ Behavioural addictions can also cause detrimental consequences on the brain’s reward system.
The Prefrontal Cortex
Impulse control is strongly connected to the prefrontal cortex. The prefrontal cortex is a brain region that plays a central role in cognitive control functions like thinking, planning, solving problems, making decisions, and controlling impulses. This brain region is also the last part of the brain to reach full maturity, which explains why teens are increasingly vulnerable to impulsive decisions.
There is no question that alcohol and drug use compromise this brain region. Many may wonder why individuals with SUD struggle to deny alcohol and drug use. The effects of these substances on this brain region make it easier for an individual to seek substances compulsively with reduced impulse control. Although they are still deciding to use substances, people should understand that their decision is a result of a faulty prefrontal cortex.
Behavioural addictions also compromise this brain region. According to the aforementioned systematic review, ‘The essential feature of [behavioural] addictions is the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others.’ Often, individuals struggling with behavioural addictions don’t realise how harmful engaging in such behaviour may be to their brains and their overall well-being. This compromised impulse control is also seen in obsessive-compulsive disorders, which share similarities with behavioural addictions.
Causes and Risk Factors
Genetic and Environmental Factors
Behavioural addictions are complex mental health disorders influenced by a variety of factors. Research indicates that genetics can play a significant role, with certain genetic variations increasing an individual’s susceptibility to developing an addiction. Family history of addiction can also be a contributing factor. Environmental influences, such as exposure to trauma, chronic stress, and social pressures, further compound the risk. Additionally, underlying mental health conditions like depression, anxiety, and obsessive-compulsive disorder can predispose individuals to behavioural addictions. Understanding these genetic and environmental factors is crucial in identifying and addressing the root causes of these addictive behaviours.
Signs and Symptoms
Identifying Behavioural Addiction
Recognising a behavioural addiction can be challenging, as the signs and symptoms often vary depending on the specific behaviour. However, there are common indicators that can help identify a potential addiction:
A strong, often overwhelming urge to engage in the behaviour
Difficulty controlling or stopping the behaviour despite efforts to do so
Feelings of anxiety or irritability when unable to engage in the behaviour
Experiencing guilt or shame after engaging in the behaviour
Neglecting responsibilities and other areas of life due to the behaviour
Persisting in the behaviour despite experiencing negative consequences
If you or someone you know exhibits these symptoms, it may be beneficial to seek professional help from a mental health expert. Early intervention can prevent the escalation of the addiction and promote a healthier, more balanced life.
Examples of Behavioural Addictions
As mentioned previously, any behaviour can become addictive behaviour. However, many behavioural addictions are well-researched in their effects and consequences.
Many of the following behavioural addictions share similar risk factors, such as genetic vulnerabilities, imbalance of brain chemicals, exposure to trauma, and isolation. Still, each type may have unique underlying causes and risks to consider.
Gambling Addiction
As mentioned previously, gambling addiction is one of the only behavioural addictions acknowledged in the DSM-5. According to the Harvard Review of Psychiatry, the following warning signs may indicate the presence of gambling addiction:
Frequent preoccupations with gambling
Inability to regulate spending when gambling (also known as increased tolerance)
Unsuccessful efforts to control or cease gambling
Restlessness or irritability when trying to stop gambling (also known as withdrawal)
Impaired life function due to gambling
Using gambling as an escape from reality
Relying on others to fund gambling
Lying about gambling behaviour
Gambling to regain recent gambling-related losses
One publication by Psychiatry (Edgmont) explains that ‘pathological gamblers are at increased risk to develop stress-related conditions, such as hypertension, sleep deprivation, cardiovascular disease, and peptic ulcer disease’, as well as co-occurring depressive disorders, anxiety disorders, and SUDs. Other consequences can include worsening feelings of guilt and shame, deceptive behaviour, and heightened risk-taking behaviour.
While gambling can be an exciting way to celebrate an accomplishment or life event, it can quickly open the doors to developing a devastating gambling addiction. Fortunately, treatment is available to help individuals recover from gambling addiction and its lasting effects.
Sex Addiction
According to another publication by Psychiatry (Edgmont), ‘Compulsive sexual behaviour, otherwise known as sexual addiction, is an emerging psychiatric disorder that has significant medical and psychiatric consequences.’ Since sex is a primal function, it releases chemicals that can create addiction. As the action is repeated, it can create a problem behaviour for those with a high predisposition towards addiction.
The publication also states that ‘In many ways, sexual expression has become a form of accepted entertainment similar to gambling, attending sporting events, or watching movies.’ Considering this, many individuals fail to recognize the consequences that sex addiction can have on their lives. These warning signs may indicate the presence of sex addiction:
Inability to control sexual urges and act impulsively
Sexual choices and impulses are interfering with other areas of life
Preoccupation with sexual thoughts
Planning sex involves specific rituals and can be as exciting as the act itself
Sexual acts have progressed in frequency or risk-taking to an uncontrollable level
Continuing sexual patterns despite experiencing negative consequences as a direct result of sexual choices
Additionally, while shame, guilt, and frequency of engagement can all play a significant role in indicating addiction, it’s worth noting that these are unreliable indicators of sex addiction due to purity culture.
Sex addiction can be distressing for several reasons. First and foremost, it can create high-risk behaviours, like causing individuals to have sexual contact with multiple partners at the same time. When proper precautions aren’t taken, this can increase the risk of spreading sexually transmitted diseases (STDs) and infections (STIs). It can also sometimes increase the risk of unwanted pregnancy.
Further, sex addiction can contribute to worsening problems in interpersonal relationships. Like substance use addictions, an individual may feel compelled to engage in sexual behaviour repeatedly, even if a sexual partner or spouse is not in the mood. This can lead to latent resentment or infidelity. If an individual’s sex drive begins to interfere with their relationships or other aspects of their life, it is crucial to seek professional treatment and support for sex addiction.
Shopping Addiction
Also referred to as compulsive buying disorder (CBD), shopping addiction ‘is a mental health condition characterized by the persistent, excessive, impulsive, and uncontrollable purchase of products despite severe psychological, social, occupational, financial consequences’, according to a Frontiers in Psychology study. As shopping addiction can have profound effects on an individual’s life, it is essential to recognise when buying behaviour becomes compulsive.
The following warning signs may indicate the presence of shopping addiction:
Self-medicating emotions, such as anger or sadness, with shopping
Thinking obsessively about money
Maximizing credit card limit
Experiencing a rush of euphoria when spending money
Lying about shopping habits
Stealing
Experiencing financial issues as a result of shopping
Shopping to feel normal or to increase self-esteem
The Frontiers in Psychology study also highlights several consequences that can result from shopping addiction, including feelings of regret and remorse over purchases, worsening feelings of guilt and shame, legal and financial implications, as well as issues in interpersonal relationships. Individuals struggling with compulsive buying may also be at increased risk of developing co-occurring mental health disorders and addiction transference.
While recovering from a shopping addiction is challenging, it is possible. Treatment will help individuals learn how to budget their spending while working to reverse brain changes associated with compulsive behaviour.
Digital Addictions: Internet, Social Media, and Video Gaming
Addictions related to electronics, such as internet addiction, are quite possibly the most challenging types of addictions to identify and address. Technology is central to society. The internet and social media keep us connected and informed, while video games keep us entertained. Despite its pros, digital media can produce varying consequences for an individual’s life—including addiction and its effects.
The following warning signs, which can be tailored uniquely to each type of digital addiction, may indicate the presence of a digital addiction:
Preoccupation with digital media
A compulsive need to use digital media with increased amounts of time to achieve satisfaction
Unsuccessful efforts to control, cut back, or cease digital use
Experiencing withdrawal symptoms when attempting to decrease screen time
Engaging with digital media for durations longer than intended
Risking the loss of a significant relationship, job, or opportunity due to compulsive use
Using technology to escape from problems
Neglecting self-care and other important responsibilities to use digital media
Unregulated technology use can cause a host of consequences. These include an increased risk of isolation, losing touch with reality, difficulties with interpersonal relationships, unhealthy comparison to others, and developing co-occurring anxiety and depression.
For those struggling with digital addictions, complete abstinence is often suggested to begin the recovery process. However, this is not realistic long-term, especially for those that may need to use technology for work or school. A professional treatment centre can develop an individualized recovery plan which establishes and maintains recovery from these types of addictions.
Food-Related Behavioural Addictions
Food addiction validates the fact that any behaviour can become an addictive behaviour, making it one of the many types of behavioural addictions. Food addiction is characterised by frequent and recurrent obsessions with food. These obsessions must interfere with an individual’s ability to function in daily life.
The following warning signs may indicate the presence of food addiction:
Experiencing cravings despite feeling full
Consuming more than what was intended
Feeling guilty after binge-eating but repeating the behaviour over again
Repeated failures at controlling food intake
Hiding eating behaviours from others
According to Nutrients, ‘There is a substantial body of evidence demonstrating the similarities between addictive drugs and food on reward and control pathways in the brain and subsequent behaviour such as craving and impulsivity.’ Because humans need to consume food to survive, compulsive eating behaviour can be challenging to treat.
Additionally, it is important to address the overlap between food addictions and other eating disorders, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. Each of these eating disorders is characterized by unique preoccupations with food, including restricting, compensatory behaviour following eating, and overeating. Nonetheless, both eating disorders and food addictions can produce detrimental effects on an individual’s physical and mental health.
Treatment for Behavioural Addictions By PCP
The process of treatment and recovery for behavioural addictions is not all that different from substance addictions. Still, the Perry Clayman Project (PCP) treats all manners of addiction. PCP offers the following evidence-based treatments for treating both behavioural and substance addiction:
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Detox programs
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Comprehensive psychiatric assessment
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24/7 care and support from qualified counsellors, nurses and support workers
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Dual diagnosis assessment and treatment
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Cognitive behavioural therapy (CBT)
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Person-centred therapy
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Psychotherapy
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Group therapy
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12-Step programmes
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Integrated therapy
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A selection of holistic therapies proven to be effective in treating addiction
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Free, life-long aftercare on completion of treatment
PCP utilises individualised care for all clients, which means that programs are designed and tailored to fit each individual’s specific needs and goals. Often, there is an underlying, co-occurring mental health problem that needs to be addressed to fully recover from addiction. Fortunately, our dual diagnosis treatment program ensures that these co-occurring conditions are identified and addressed throughout treatment.
Behavioural addictions share many similarities with substance addictions in that they cause devastating consequences to an individual’s overall health and well-being. Admitting you need help is the first step in healing. The Perry Clayman Project (PCP) has expertise in treating both behavioural and substance addictions. We offer a wide variety of treatments and interventions for clients to choose from. Our centres across the UK are designed to facilitate your unique recovery journey. Whether you require treatment, support, or general guidance in healing, we can help you curate a treatment program to fit your needs. Reach out to us for more information or treatment assistance. Call us today at 08000 380 480.
