Behavioral science experts believe any source capable of stimulating an individual has the potential to become addictive. Behavioral or process addictions involve an individual repeatedly engaging in a normally harmless, non-substance-related pleasurable activity and subsequently undergoing lasting chemical changes in a part of the brain called the pleasure center. Although process or behavioral addictions can cause devastating psychological effects, they are not associated with a high incidence of mortality like substance use addictions.
Currently, gambling is the only behavioral disorder officially classified with substance misuse disorders in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Other addictive behaviors with closely related traits include sex, work, spending/compulsive shopping and use of the internet. In all cases, the activity is pursued excessively, inappropriately or compulsively and often recklessly without concern for the repercussions. From sex addiction questions to gambling help, we’ve compiled thoroughly researched questions and answers to address commonly encountered concerns.
What Is the Definition of a Process Addiction?
A universal definition of a process addiction does not currently exist. According to the Textbook of Anxiety Disorders, a process addiction consists of a compulsion to repeatedly engage in an action until it causes negative consequences to the person’s physical, mental, social and or financial well-being. Process addictions do not cause the same dangerous physical health repercussions as substance use disorders, although they involve negative behaviors impacting many other aspects of life.1,2
- An obsessive need to participate and plan the activity
- An inability to control participation in the activity in question
- Negative consequences as a result of the activity (e.g. being late to work due to gambling late the night before)
- Behavior interfering with relationships (e.g. infidelity, neglect of children or a loss of friendships)
- Engaging in illegal activities to satisfy the addiction (e.g. illegal gambling, shoplifting or prostitution)
- Preoccupation with the activity while doing other things
- Use of the activity as a means of escaping unpleasant feelings or situations
- Continued participation in the activity despite highly negative outcomes1,2
What Is Sexual Addiction/Hypersexual Disorder?
Although skeptics claim sexual addiction is nothing more than an excuse used by libidinous people to justify their infidelity, growing evidence shows it is a troubling behavioral disorder. Sexual addiction/hypersexual disorder is an umbrella term encompassing various types of problematic behaviors including excessive masturbation, cybersex, pornography use, sexual behavior with consenting adults, telephone sex, strip club visitation and other behaviors. An estimated 3% to 6% of the U.S. population suffers from some form of addictive sexual behavior.3
In the behavioral health field, considerable disagreement still exists regarding the clinical diagnosis of sexual addiction. Many certified sex addiction treatment specialists identify sexual addiction based on the following three measures:4
- Sexual preoccupation to the point of obsession
- Loss of control over sexual urges, fantasies and behaviors (typically evidenced by failed attempts to quit or cut back)
- Negative life consequences related to compulsive sexual behaviors, such as ruined relationships, trouble at work or school, loss of interest in nonsexual activities, financial problems, loss of community standing, shame, depression, anxiety or legal issues4
Do Brain Changes Occur With Process Addictions?
Evidence shows people who excessively participate in non-substance-related pleasurable activities undergo lasting chemical changes in the neural pathway of the brain’s reward system. Imaging studies indicate the function of brain regions involved in desire are altered in those with substance addiction and behavioral addictions, specifically the prefrontal cortex and subcortical reward circuits. It is theorized that individuals with a genetic predisposition to addictive behaviors have an inadequate number of dopamine receptors or have an insufficient amount of serotonin/dopamine. Therefore, they cannot experience normal levels of pleasure from pursuits most people would find rewarding and seek out pleasure through activities that can be highly addictive.5,6
How Common Is Gambling Disorder and What Is the Treatment?
An estimated 2 million U.S. adults, or 1% of the population, meet the criteria for pathological gambling in a given year. An additional 4 million to 6 million (2% to 3%) are considered problem gamblers in that they do not meet the full diagnostic criteria for pathological gambling, but exhibit one of more of the criteria and experience problems due to gambling behavior.7
Unlike traditional detox and rehab for substance addictions, treatment for behavioral/process addictions including gambling disorder does not have the goal of abstinence. Rather, the goal is elimination of compulsive unhealthy behaviors. Treatment varies somewhat depending on the type of process disorder, but often includes cognitive behavioral therapy, 12-step programs, group counseling sessions and support groups specific to the addiction such as Spenders Anonymous or Gamblers Anonymous. Since many individuals who have process addictions also have other types of addiction (e.g. alcohol or drugs), dual diagnosis treatment programs may be the best option. If the person has a co-occurring mental health disorder such as depression or anxiety, medications may be prescribed along with psychotherapy.7
What Is Internet Gaming Disorder?
Internet gaming disorder (IGD) is the excessive use of computers or other devices with access to the Internet (e.g. tablets and smartphones) for online activities, to the extent daily life activities and responsibilities are profoundly compromised. Much controversy surrounds IGD from a clinical standpoint and experts have not reached a consensus on diagnostic criteria, therefore it is not officially included in the DSM-5. Experts cannot even agree on the terminology, with some suggesting the term “excessive web use” is more appropriate, since not everyone who spends too much time online plays games. For example, some people surf porn sites excessively. Experts know IGD is tied to a disproportionate release of dopamine, the neurotransmitter in the brain regulating pleasure. Various online activities including gaming and social media are believed to provide intermittent brain-chemical reinforcement, although more research is needed.8
- Process Addiction Treatment. Process Addictions website. http://www.processaddictions.com/process-addiction-treatment/Accessed March 8, 2017.
- What is a Process Addiction? Process Addictions website. http://www.processaddictions.com/ Accessed March 8, 2017.
- Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration website. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm#idtextanchor032 Published September 2015. Accessed March 8, 2017.
- Can Therapists “Officially” Diagnose Sexual Addiction? Psych Central website. http://blogs.psychcentral.com/sex/2016/07/%E2%80%A8%E2%80%A8%E2%80%A8can-therapists-officially-diagnose-sexual-addiction/ Accessed March 8, 2017.
- Cash H, Rae CD, Steel AH, Winkler A. Internet Addiction: A Brief Summary of Research and Practice. Curr Psychiatry Rev. 2012;8(4):292-298. doi:10.2174/157340012803520513.
- Seok J-W, Sohn J-H. Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior. Front Behav Neurosci. 2015;9:321. doi:10.3389/fnbeh.2015.00321.
- Help and Treatment: FAQ. National Council on Problem Gambling website. http://www.ncpgambling.org/help-treatment/faq/Accessed March 8, 2017.
- Internet Gaming Disorder DSM-5. Theravive website. http://www.theravive.com/therapedia/Internet-Gaming-Disorder-DSM–5Accessed March 8, 2017.