Alcohol, drugs, and smoking are obvious addictions that can destroy a person’s life and health, but there is more to addiction than only substance use. Despite posing a lesser immediate health threat, behavioral addictions can be equally crippling, insidious, and damaging. In this article, we discuss the signs and symptoms of behavioral addiction and how the latest research compares/contrasts it to substance use disorders (SUD). We also highlight our interview with a behavioral addiction expert on topics including COVID-19, prevention, and efficient ways to assess and treat those suffering from this disorder.
What is Behavioral Addiction?
According to The American Journal of Drug and Alcohol Abuse, behavioral addiction, also known as non-substance addictions or process addictions, is recognized as the failure to resist an impulse, drive, or temptation to perform an act harmful to the person or others. The repetitive engagement in these behaviors ultimately interferes with functioning in other domains. Examples of behavioral addictions often include (but are not limited to):
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Gambling
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Technology (internet, media, video games, online chat)
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Shopping
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Eating Disorders
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Pornography
In general, having an addiction is the fact or condition of being addicted to a particular substance, thing, or activity. Addiction is also a primary and chronic disease of the brain circuitry responsible for motivation, reward, and cognition changes. With these definitions in mind, many researchers believe that there are several similarities between substance use disorders and behavioral addictions.
Like substance-related addiction, behavioral addiction affects the brain’s reward system and release of its primary neurotransmitter – dopamine. Additionally, like SUDs, behavioral addiction also affects other brain areas that regulate attention, impulsivity, and compulsivity. According to Current Behavioral Neuroscience Reports, certain behavioral addictions resemble drug and alcohol addictions intolerance, neurobiological mechanisms, and withdrawal. The next question is, what are the signs and symptoms of non-substance addiction? Are they similar to SUDs?
Signs and Symptoms of Behavioral Addiction
How do experts currently feel about the connections between behavioral and substance addiction? Moreover, what does the latest research say about these similarities? Endominance interviewed Joshua Andrus, a 20-year behavioral addiction specialist and author of the kid’s book series on media and families titled Liv and Gavin Adventures, to understand the similarities and differences between SUDs and behavioral addiction.
Withdrawal, Tolerance, and Cravings
Andrus sees clear signs of tolerance and withdrawal symptoms similar to those in SUD recovery in his patients with behavioral addictions. He offers this example, “When looking at adolescents and adults, we can see their tolerance levels by witnessing how long they are playing videogames. If they are doing this activity for more than 8-12 hours a day – there is a tolerance level there.” On the opposite side of this comes withdrawal. Andrus states, “I also see similar symptoms to SUD withdrawals in patients after being away from their devices such as crankiness, agitation, and frustration. They are looking for those neurochemicals they are used to. I also see gamers who are up for 12 hours at a time crash in the same way a person crashes after a drug high.”
According to Current Behavioral Neuroscience Reports, research reveals that pathological gaming (PG) shows similar symptoms to SUDs, including tolerance, craving, reduced control, and disruption of significant (personal, social, and vocational) activities. Individuals with PG also experience physical withdrawal symptoms, including restlessness, headaches, and irritability, at comparable levels to individuals with alcohol use disorder (AUD). The research also shows evidence of tolerance, withdrawal, and social problems in adolescents who meet internet-related addiction criteria compared to non-addicted peers.
Impulsivity, Compulsivity, and Cognitive Issues
An article in Science Direct suggests that behavioral addictions lie on the border between compulsivity and impulsivity. As in the case of SUDs, an argument can be made that impulsive traits are key to initiating the behavior, which then develops compulsive characteristics. Impulsivity is the tendency towards unexpected behaviors separated from sufficient forethought and occur despite adverse consequences. Compulsivity is where individuals perform certain acts repeatedly without control despite negative results. According to Current Behavioral Neuroscience Reports, compulsivity and impulsivity are demonstrated in behavioral addictions, most notably in individuals with PG and binge eating disorders (BED). Another study showed similarities in cognitive issues between those with PG and SUDs, including poor performance on neurocognitive tasks, impulsive choices, response tendencies, and compulsive features.
Social, Physical, and Psychological Signs and Symptoms
Andrus also notes other similar social, physical, and psychological signs and symptoms (according to the DSM-5) between SUD and behavioral addictions, including:
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Individuals keep engaging in the behavior despite social, economic, and interpersonal problems or losses.
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Sleep disturbances.
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Social/occupational activities are reduced or stopped as a result of behavior.
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Obsessing about the behavioral addiction.
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Continued behavior despite knowing it interferes with safety and causes hazards.
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Persistent psychological problems continued by behavior and dissociation from reality.
Barriers in Assessing and Treating Behavioral Addiction
Unfortunately, treatment is lacking far more for behavioral addictions than with substance addictions. Andrus states, “Most centers offer co-occurring disorder treatment (as they often go hand in hand), but there are none that offer treatment just for behavioral addictions.” According to Verywell Mind, when treatment is offered, it may include:
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Cognitive-behavioral therapy
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Medications
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One-on-one counseling
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Self-help groups
The DSM-5 lists varying criteria for different addictions and the number of criteria a person demonstrates defines the severity of the dependence. However, when assessing SUDs and behavioral addiction, specialists run into similar issues, including:
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Patients not being truthful about their use.
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Patients worrying about confidentiality and stigma associated with a diagnosis.
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Minimizing or denial of the problem.
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Lack of awareness.
When assessing a non-substance addiction, most health professionals utilize the same tests they use for diagnosing SUDs. Unfortunately, most tests used are based on “yes/no” answers, limiting their ability for an accurate and holistic diagnosis. In terms of identification and detection, Andrus does point out how SUDs and behavioral addiction differ, “Only two years ago, video game addiction was classified as a disorder. This example is just one of many where identification and detection are more prevalent and commonplace in substance use disorders. Behavioral addictions are harder to detect as they are more normalized in the individual. For example, it’s difficult to abstain from using the internet because the internet is so pervasive in our society.” Detecting a behavioral addiction is also challenging as “the level to which damage is caused is extended over a longer period of time. The behavior takes a longer time to wreak havoc,” states Andrus.
Treating Behavioral Addiction – We Can Do Better
Prevention
The International Journal of Preventative Medicine suggests like substance use prevention programs, specialized training can educate adolescents about the warning signs of behavioral addiction, such as online addiction, to assist early detection. These may include:
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Parents informing their children about the negative consequences of the overuse of the internet to prevent addiction.
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Prevention programs for online abuse can reduce future incidents and decrease the risk of internet addiction.
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Treating risk factors such as loneliness, stress, depression, and other mental health disorders which may trigger the addiction to the internet.
Andrus also believes that prevention is key in dealing with a behavioral addiction. He reveals, “Having initial conversations with your kids about media addiction [and other process addictions] is the best way to create awareness around the issue and hopefully prevent it.”
Exercise and COVID-19
Growing research reveals how physical activity can be vital in mitigating negative health consequences, preventing relapse, and improving the mind-body connection in those with SUD. But what about behavioral addiction? How can we mitigate its effects, especially during COVID-19? According to the Association of American Medical Colleges, COVID-19 has left many flooded with anxiety and uncertainty. With this shift, SUD experts are also seeing signs of relapses and rising overdoses. This pandemic is also causing an increase in behavioral addictions, namely media addiction. “COVID-19 has increased media addiction because it has given a permissive amount of access to it. It’s now a means to education and communication as well as entertainment. Just as if an alcoholic is in a bar all day, access to round-the-clock media also comes with a risk of addiction,” states Andrus.
According to John J. Ratey MD, an associate clinical professor of psychiatry at Harvard Medical School and author of the book Spark: The Revolutionary New Science of Exercise and the Brain, “For those in SUD recovery, exercise not only helps physically, but it also engages the mind – helping it move in a direction other than towards the drug. It wires in an alternative reflexive behavior.” This action is vital in resisting the urge to use and preventing relapse, especially during a pandemic. Andrus also feels that physical activity may benefit those with behavioral addictions. He states, “Exercise helps build healthier routines and interrupts the dopamine reward circuit. For example, parents can offer an hour of videogames for an hour of outside activity – it’s all about teaching balance, creating healthy boundaries, and doing what’s best for your family.”
Holistic & Personalized Assessment
One limitation of current assessment tools used in diagnosing SUDs is that they do not look at the patient holistically. Understanding an individual’s unique cognitive orientation (view of the world) and how they make decisions based on certain beliefs and environmental factors can pinpoint the root cause of their issue. By identifying all these factors, we can better understand the cycle of drug and alcohol use from initiation to relapse. Since behavioral addiction specialists tend to use the same assessment criteria as SUD professionals, a similar approach needs to be utilized in this setting.
At Endominance, our COSEC assessment analyzes a person at the granular level by harnessing the relationship between cognitive processes, the environment, and human behavior. The benefits of our personalized diagnostic tool include:
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Improving long-term treatment outcomes – reducing addiction relapse rates and overall societal and healthcare costs.
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Assisting healthcare professionals, in all fields, including behavior and SUD addiction recovery, work more effectively with their patients to improve their overall mental health and promote healthier lifestyles.
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Through our predictive and preventative analytics, clinicians can find personalized and cost-effective treatment options that fit their patients’ needs.
Treating the whole person through exercise, prevention programs, and targeted assessment during behavior and SUD addiction recovery is the best way to keep the mind and body connected, prevent relapse, and live a long and healthy life.