Behavioral Addictions: Types and Treatment
Behavioral addictions can fuel substance misuse, urging the ongoing compulsion to engage in disruptive behaviors despite any adverse consequences. In this article, we will discuss what addiction is and what constitutes behavioral addiction, including the differences and similarities between substance and non-substance addictions, as well as behavioral addiction treatment options.
What Is Addiction?
Addiction is defined as a chronic, relapsing brain disorder, and both substance and non-substance-related addictions are characterized by a person’s compulsion to continue use despite experiencing negative consequences in one’s life as a result.1 Behavioral addictions are similar to substance addictions in that they both increase activity in the reward center of the brain.
Some individuals begin engaging in potentially addictive behaviors because it makes them feel good. Others may try to self-medicate with certain substances or behaviors to mitigate anxiety or stress. Cravings or urges to continue the addictive behavior may become consuming.2 A loss of control of the behavior also accompanies addiction. A person may have the desire to stop but is not able to. In some cases, the behavior becomes so automatic that they may feel they need to engage in the behavior just to feel “normal.”2
The Diagnostic and Statistical Manual, 5th Edition (DSM-5) is used to diagnose mental health and substance use disorders. It contains the criteria for each disorder and identifies various levels of severity within each disorder. Behavioral addictions are classified within the category of Substance-Related and Addictive Disorders.3 The International Classification of Diseases (ICD) is the foundation for identifying health trends and statistics on a global scale and includes approximately 55,000 codes for identifying injuries, diseases, and causes of death.4 The 11th edition (ICD-11) of this publication defers to the DSM-5 for secondary mental and behavioral health disorders.5
Types of Addiction
Substance and non-substance addiction share some similarities and also have differences. The American Society of Addiction Medicine (ASAM) defines addiction as a treatable but chronic condition that involves changes in the structure and function of the brain, genetics, environmental factors, and unique life experiences.6
Behavioral addictions resemble substance addictions in many ways. Both disorders are characterized by a compulsion to continue to engage in the behavior despite adverse consequences in one’s life as a result.7 Both behavioral and substance addictions have an onset in adolescence or early adulthood.7 Both have natural histories that show chronic, relapsing patterns of use, yet many people recover without formal treatment.7 Cravings are another similarity people with non-substance and substance disorders experience before engaging in a particular behavior or substance use.7
While some people can engage in certain behaviors (like gambling, recreationally), others may develop a gambling disorder. One way to differentiate between recreational and pathological gambling is to determine whether a person has met 4 of the 9 diagnostic criteria from the DSM-5 during a 12-month period.8
What Is Behavioral Addiction?
One of the fundamental features of behavioral addiction is the inability to resist the urge or impulse to engage in behavior that is detrimental to oneself or others.7 The addictive behavior eventually interferes with functioning across multiple dimensions of one’s life.7
Behavioral addictions are typically preceded by feelings of arousal before a person engages in the addictive behavior, and they will likely experience pleasure or relief while participating in the behavior.7 This represents another similarity with substance addictions. For example, a person with a substance use disorder may feel tension prior to using their substance of choice and relief once they do. Emotional dysregulation may contribute to cravings in both substance and non-substance addictions.7
Impulse control disorders encompass many behavioral addictions, including, pathological gambling, kleptomania, pyromania, trichotillomania, compulsive sexual behavior, and compulsive buying, among others.
Concepts such as compulsivity and impulsivity are often discussed when addressing behavioral addictions. Compulsivity refers to a tendency towards repetitive, habitual actions that are repeated despite negative consequences, while impulsivity refers to actions or behaviors that are inappropriate, risky, and poorly thought out, sometimes leading to disastrous outcomes.9
Types of Behavioral Addiction
People who have behavioral addictions often have co-occurring mental health or substance use disorders as well.10
Common behavioral addictions may include:10
- Compulsive sexual behavior. Those who seek treatment for this disorder are typically male. Sexual urges and behaviors are often distressing and uncontrollable and triggered by certain moods, often sadness or depression.
- Internet or gaming addiction. Gaming disorders tend to affect males more than females. Addictive gaming has been associated with anxiety, depression, social phobias, loneliness, low self-esteem, and sleeping disorders.11
- Pathological gambling. Many people gamble for years before it becomes problematic. People often begin gambling during their adolescence or young adulthood; however, the mean age for people with pathological gambling disorders is 30. While more men than women are diagnosed with pathological gambling, women tend to progress faster from recreational to problematic gambling.
- Trichotillomania. Characterized by excessive hair pulling that results in noticeable hair loss, trichotillomania affects up to 3.9% of the population, and more than 93% of those affected are female. This issue often begins in early puberty, between the ages of 11 and 13. It is associated with low self-esteem and interferes with normal social interactions. Despite the distress trichotillomania causes, only 65% of those experiencing this behavior seek treatment.
- Food addiction. Food addiction shares characteristics with some eating and substance use disorders that may include cravings, reduced control over intake, increased impulsivity, repeated use despite negative consequences, and altered reward sensitivity. Overeating and obesity can also result in social impairments and stigmatization.12
- Pyromania. In a study of psychiatric patients, it was found that nearly 6% met lifetime criteria for pyromania, or the deliberate, purposeful setting of fires. It is most common in males and usually develops during adolescence. People who meet the criteria for pyromania often have high rates of psychiatric comorbidity.
- Compulsive buying. Compulsive buying or shopping affects nearly 6% of the population in the U.S. Between 80%, and 95% of those with a compulsive buying disorder are women.
- Kleptomania. Nearly 75% of people who suffer from kleptomania, or the uncontrolled and repetitive stealing of items that are not needed, are women. Onset usually begins between the ages of 16 and 20.
Behavioral Addiction Treatment
Cognitive behavioral therapy (CBT) can be effective in treating behavioral addictions. CBT helps people identify the relationship between their thoughts, feelings, and behaviors.13 People will begin to recognize unhealthy patterns of behavior and how those may contribute to self-sabotaging or destructive behaviors.13
It should be noted that a person who is suffering from a behavioral addiction and a co-occurring substance use disorder, for example, will also need treatment to address their substance use in addition to their behavioral issues.
Many behavioral addictions have a high rate of co-occurring substance use disorders.7 For example, approximately 35% to 63% of people diagnosed with pathological gambling have a lifetime estimate of substance use disorder as well. For those with kleptomania, the lifetime rate of also experiencing a SUD is between 23% and 50%. Compulsive sexual behavior has a 64% lifetime estimate of also developing alongside a substance use disorder. That same rate is 38% for those experiencing an internet addiction.
Since there is such a risk of people with behavioral addictions also developing a SUD, it is important to understand what substance use disorder treatment involves.
Treatment for a SUD may include:14
- Medical detox. A medically supervised detox is when a person goes through the detoxification process while under the care and supervision of trained medical staff. They monitor withdrawal symptoms and psychological complications of withdrawal from drugs and/or alcohol.
- Treatment. This may involve residential or outpatient care. Inpatient services provide 24-hour support and structure. During inpatient treatment, a person stays in the facility overnight. It is also sometimes referred to as residential treatment. Outpatient treatment, by contrast, is when a person visits a facility to receive treatment services but still lives at home. There are varying levels of outpatient treatment, and this type of treatment may be best suited for people who still need to work and live at home.
- Aftercare. Aftercare establishes additional support services so that people stay engaged in the recovery process. This may include relapse prevention programs, support groups, and individual and group therapy sessions.
It is essential that treatment be individualized to meet the unique needs of each person.14
How to Find Addiction Treatment
A good question to ask any treatment facility or provider is, can they address co-occurring conditions? It’s important to treat multiple issues simultaneously in treatment. Behavioral therapies are often a vital piece of the treatment process to address an individual’s personal motivations for change and develop healthy coping and problem-solving skills for themselves, and to help facilitate building healthy relationships with others.14
The first step in finding treatment is to let someone you trust know you are struggling. A family member, friend, or doctor can help provide some initial support when you begin to seek treatment options. Remember, it’s okay to ask for help. There are treatment facilities all over the country where you or your loved one can get the help they need to regain their mental and physical health. Call to find help today.