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What Is a Process Addiction?

Posted in Dual Diagnosis Help on September 8, 2016
Last modified on May 12th, 2019

When most people think about addiction, what typically comes to mind is the abuse of drugs and alcohol — and perhaps cigarette smoking. Certainly, this type of addiction is a serious public health crisis in the U.S., as evidenced by the alarming number of people with diagnosable substance addictions. In 2014, there were an estimated 21.5 million people ages 12 or older with a substance use disorder, including 17 million with an alcohol use disorder and 7.1 million with an illicit drug use disorder. An additional 32.5 million smoked cigarettes daily in 2014, of which 292,000 were adolescents.1 Like most abused drugs, nicotine is highly addictive because it increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure.2

There are other types of addictive behaviors that do not involve substance use and these are called process addictions or behavioral addictions. Although these addictions can cause devastating psychological effects, they are not associated with a high incidence of mortality like substance use addictions. Therefore, they typically do not garner as much attention. In fact, these behaviors are often the subject of widespread ridicule, e.g., the infamous shoe collection of Imelda Marcos, the former first lady of the Philippines. While the media pokes fun at compulsive shopping and sometimes even glorifies it, there is a dark side to this compulsion. This behavior can take over a person’s life to the exclusion of everything else, and can lead to a recognized mental health condition called compulsive buying behavior. Experts place this behavior in the spectrum of impulsive control and behaviors disorders, citing similarities to substance abuse, obsessive-compulsive disorder, eating disorders, gambling disorder, Internet gaming/Internet addiction and sexual addiction.3

Process Disorder Facts and Stats

  • The frequency of compulsive buying disorder has increased worldwide during the two last decades, with an estimated prevalence of 4.9% in the adult population. This equates to about 12.3 million people ages 18 and older in the U.S. alone.3
  • An estimated 3% to 6% of the general U.S. population suffers from some form of addictive sexual behavior with themselves or others.4
  • An estimated 2 million (1%) U.S. adults 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 or more of the criteria and experience problems due to gambling behavior.5
  • Surveys in the U.S. and Europe have indicated Internet addiction disorder prevalence rates of 1.5% to 8.2%, while others report rates between 6% and 18.5%.6

How Do Process Addictions Differ From Substance Addictions?

The most obvious difference between substance use and what we call process or behavioral addictions is the devastating physical toll drugs, alcohol and nicotine can impart on the human body with associated mortality. While sexual addiction can cause unwanted pregnancies and sexual transmitted diseases including potentially deadly ones, most behavioral disorders cause nonphysical side effects. Eating disorders are thought to be a form of addiction and can result in detrimental and even deadly physical side effects. Studies show that a precursor to behavioral addiction is the presence of psychopathologies such as depression, substance dependence or withdrawal, social anxiety and a lack of social support.7

Select Research Findings

Although epidemiological studies on behavioral disorders are scant compared to substance abuse, there are commonalities to all types of addiction as evidenced in research findings.

  • As with substance use disorder, brain imaging studies in people with process addictions have yielded consistent abnormalities in frontoparietal regions, reward processing and limbic systems.3
  • Early onset of problematic behavior is considered a common feature of addictive activities and epidemiological research has found that addictive behaviors tend to become problematic in late adolescence.3
  • People with compulsive buying, gambling disorder and sexual addictions score high on impulsivity, novelty seeking and compulsivity along with high levels in both positive and negative urgency traits.3
  • There is increasing evidence 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 that most people would find rewarding and seek out pleasure through activities that can be highly addictive.6
  • Patients suffering from behavioral addictions describe addiction-specific traits and diagnostic criteria including craving, excessive behavior, psychological and physical withdrawal symptoms, loss of control, development of tolerance and the expectation of psychotropic effects related to the activity.7
  • It is estimated that as many as 50% of pathological gamblers have co-occurring mental health symptoms such as depression or anxiety. For some people, gambling may be an attempt to alleviate the symptoms of depression and anxiety, while for others, compulsive gambling can lead to anxiety and depression as a result of increasing problems (e.g. financial, work, relationships) caused by the behavior.8

Until recently, non-substance related behavioral addictions were not included in either of the two internationally used diagnostic manuals of mental disorders. Contrary to the commonly held belief that addiction is a dependence on drugs and chemical substances, behavioral science experts believe that any source that is capable of stimulating an individual can lead to addiction.7

In context with studies conducted on gambling in the 1980s and 1990s, the following six criteria were devised to help define addiction:7,9

  • Salience: Domination of a person’s life by the activity
  • Euphoria: A ‘buzz’ or a ‘high’ is derived from the activity
  • Tolerance: The activity has to be undertaken to a progressively greater extent to achieve the same ‘buzz’
  • Withdrawal symptoms: Cessation of the activity leads to unpleasant emotions or physical effects
  • Conflict: The activity leads to conflict with others or self-conflict
  • Relapse and reinstatement: Resumption of the activity with the same vigor subsequent to attempts to abstain, negative life consequences, and negligence of job, educational or career opportunities

There is compelling evidence that process addictions and substance abuse share more in common than previously thought. The basis for all addictions includes a genetic predisposition, underlying pathological/biological traits, co-occurring mental health issues, environmental factors and cultural/peer influences. As such, it is important that all addictions be treated before the detrimental effects take hold and destroy a person’s life. If you or somebody you know is exhibiting behavior indicative of a process addiction, The Right Step offers a wide array of therapies that can help.

  1. 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 August 21, 2016.
  2. Drug Facts: Cigarettes and Other Tobacco Products. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products Published May 2016. Accessed August 21, 2016.
  3. Granero R, Fernández-Aranda F, Mestre-Bach G, et al. Compulsive Buying Behavior: Clinical Comparison with Other Behavioral Addictions. Front Psychol. 2016;7:914. doi:10.3389/fpsyg.2016.00914.
  4. Who Is a Sex Addict? Psych Central website. http://psychcentral.com/lib/who-is-a-sex-addict/ Accessed August 22, 2016.
  5. Help and Treatment: FAQ. National Council on Problem Gambling website. http://www.ncpgambling.org/help-treatment/faq/ Accessed August 22, 2016.
  6. 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.
  7. Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M. Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views. Int J Prev Med. 2012;3(4):290-294.
  8. Cunningham JA, Hodgins DC, Bennett K, et al. Online interventions for problem gamblers with and without co-occurring mental health symptoms: Protocol for a randomized controlled trial. BMC Public Health. 2016;16:624. doi:10.1186/s12889-016-3291-7.
  9. Brown RIF. Some contributions of the study of gambling to the study of other addictions. In W. R. Eadington WR, Cornelius JA, eds, Gambling behavior and problem gambling. Reno, NV: University of Nevada; 1993:241-272
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