Certain behaviors like gambling, sex, or even video games and porn can become problematic for some people, causing a loss of control. Many experts use the lens of addiction to understand why this happens, citing the many similarities between the experiences of these people and those addicted to substances. Behavioral addiction is a relatively new concept, and one that researchers are still trying to understand.
What Is a Behavioral Addiction?
Behavioral addictions (sometimes called process addictions) describe behaviors that become compulsive and problematic. The telltale sign of addiction is the continuation of a behavior after it has had negative impacts on a person. These impacts might show up in their work, their relationships, or even in their physical or mental health. Part of the reason that people continue behaviors even after they become problematic is explained by the brain chemical dopamine.
The release of dopamine is largely responsible for the “high” that people experience when they use drugs, and is also in response to specific behaviors. Almost all of the behaviors that are suspected to have addictive qualities are believed to cause the release of dopamine.6,4 Dopamine creates a strong reward pathway in the brain in response to a specific drug or behavior, making it more difficult (although not impossible) to stop.
Behavioral addictions exist in a gray area in the field of addiction. Technically, the only medically recognized behavioral addiction is gambling disorder. Formerly classified as an impulse control disorder, gambling disorder was reclassified in 2013 as an addictive disorder in the DSM-5 (the official reference guide for diagnosing mental illnesses). This reclassification was seen as significant because it was the first formal recognition that behavioral addictions exist.
Research continues to be done to determine the existence of other behavioral addictions, including things like:
- Sex addiction/porn addiction
- Internet/mobile phone addiction
- Video game addiction
- Social media addiction
- Shopping addiction
- Food addiction
Those who believe in the existence of behavioral addictions argue that while a physical addiction may not develop, a psychological addiction can. This can result in the same experience of cravings, the development of tolerance, and even withdrawals common in drug addiction.4
Those who deny the existence of these other behavioral addictions often cite the lack of conclusive research on these behaviors. Still, the research is beginning to catch up, and it is likely that in the future, some of these behavioral addictions will be formally recognized.
Types of Behavioral Addiction
While there is only one formally recognized behavioral addiction, the existence of several others is suspected. Some behavioral addictions have been researched more than others, resulting in more “evidence” to suggest that they exist.
Some of the more substantiated behavioral addictions include:
Gambling disorder is formally recognized as a behavioral addiction.1 This disorder is characterized by a pattern of compulsive gambling that tends to become increasingly problematic over time. Many people with this disorder accrue large gambling debts, frequently borrowing money under false pretenses in order to sustain their habit, “win back” losses, pay or give collateral for other debts.
They continue chasing the “high” of placing bets, especially risky ones, convinced that they will come out on top. In many instances, people with gambling disorder lose more than just money, but also their assets, jobs, or even relationships.
Some researchers believe that it is possible to become addicted to certain kinds of food, especially to processed foods high in fat, sugar and calories. The concept of food addiction closely resembles Binge Eating Disorder. Binge Eating Disorder is a disorder characterized by eating large amounts of food in a short amount of time, but is not always specific to a certain type of food.
Food addiction, on the other hand, is thought to be an addiction to certain foods that activate the reward pathways in the brain involved in addiction.5 This results in a preoccupation and loss of control any time these foods are present, as opposed to the specific “episodes” common in binge eaters.
Sex and Pornography Addiction
Sex addiction has been a source of controversy for several decades, with intense debate among experts who believe that sexual addiction is either possible or not. Those who believe in the existence of sex addiction tend to define it in similar ways as addiction to substances are defined: as a pattern of compulsive and problematic sexual behaviors.
Porn addiction is believed to be a subtype of sex addiction, and is defined as the compulsive use of porn. Use of porn is continued despite causing problems to a person, their relationships, or other important areas of life. Aside from the obvious “symptom” of excessive porn use, other key features that may indicate porn addiction include an inability to perform with real life partners (mainly in men) and sexual dissatisfaction with real life partners.2
Addiction to Phones and Devices
According to 2019 data from the Nielsen Company,8 Americans spend close to 10 hours each day in front of screens, with cell phones and mobile devices accounting for at least half of this time. The sheer amount of time spent on these devices is cause for concern, suggesting that if device addiction is possible, most Americans are at high risk.
Anecdotal reports suggest that some people also experience a loss of control over their use of devices, unable to abide by limits they set for themselves. Some even have reported experiencing psychological cravings and withdrawals related to their phones, tablets, or other connected devices.3
Research suggests that excessive device use is associated with many physical and mental health problems, which is relevant because experiencing consequences related to use is a key component of addiction. Children and teens seem to be especially vulnerable to these effects. Young people who spend 7 hours or more on devices are twice as likely to be depressed or anxious, and they struggle more with regulating emotions, making friends, and have trouble focusing and completing tasks.7
There are a variety of uses for cell phones and mobile devices, and some activities are more closely linked to problematic use. Generally speaking, emailing, texting, or using other basic features are unlikely to lead to addiction. The activities more likely to lead to addiction include porn (discussed above), social media, and video games. These activities are also believed to interact with the brain’s dopamine reward centers in similar ways as drugs and alcohol do.3,4
Less Common Behavioral Addictions
The list of behaviors that could become addictive continues to grow, but some are less common. These include behavioral addictions that are less often reported, as well as those that have not been researched much. Some of these behaviors are also more commonly attributed to other known conditions (like impulse control disorders).
Other behavioral addictions that have received less attention include:
- Shopping addiction
- Compulsive stealing
- Exercise addiction
- Love addiction
- Work addiction
- Plastic surgery addiction
Signs & Symptoms of a Behavioral Addiction
Because there is only one classified behavioral addiction (gambling disorder), there is no formal list of symptoms used for diagnostic purposes. Gambling disorder has a few symptoms more specific to gambling patterns, like chasing losses, placing higher/riskier bets and a pattern of borrowing money, but otherwise the symptoms mirror those of substance use disorders.
It is likely that behavioral addictions that are recognized in the future will also include many of the symptoms currently used to diagnose other addictions.
The symptoms currently used to diagnose substance or alcohol use disorders are:1
- Using more of a substance than intended, or for longer than intended
- A desire to cut back or stop and previous unsuccessful attempts to do so
- Spending a great deal of time thinking about, obtaining, using or recovering from the effects of a substance
- Cravings or a strong urges to use the substance
- Recurrent use that may interfere with fulfilling major role obligations
- Persistent use despite experiencing problems in important relationships which are caused or exacerbated by substance use
- Reduction or withdrawal from important social, occupational, or recreational activities because of time devoted to substance use
- Use of the substance in situations that are potentially dangerous
- Continued use despite having knowledge of negative effects to health or mental health
- The development of tolerance to a substance (needing more to get the same effects)
- Experiencing symptoms of withdrawal (physical or psychological discomfort when stopping use of a substance)
It is important to note that a person does not need to have all 11 symptoms in order to be diagnosed with a substance use disorder. Anyone describing two or more of the above symptoms could be struggling with an addiction. It is likely that a similar list would be used in the future to diagnose behavioral addictions, if and when they are formally acknowledged by the American Psychiatric Association.
Other signs of behavioral addictions could include:
- Efforts to hide the behavior or how often it is engaged in from friends and family
- Feeling an inability to resist urges to engage in the behavior
- Relying on the behavior to relieve stress or cope with difficult emotions
- Becoming defensive when questioned about the behavior
- Experiencing excessive guilt after engaging in the behavior
- Making promises to cut back or stop but not keeping them
- Becoming moody, irritable, or upset when unable to engage in the behavior
Causes and Triggers of Behavioral Addictions
No one cause explains why some people develop compulsive or addictive tendencies, although there are different social, biological, and psychological factors that make some people more vulnerable to them. For starters, those with a family history of addiction or mental health issues are generally thought to be at higher risk for addiction, as are those who experienced childhood trauma, abuse or neglect.
There is a high rate of comorbidity between mental health and addictive disorders, so those with an existing diagnosis are likely at higher risk. Those with existing substance use disorders are also more likely to develop behavioral addictions.6
Of course, behavioral patterns and personal choices also influence a person’s risk. In order to develop a behavioral addiction, they need to have engaged in the behavior, usually on multiple occasions. Those who do so often and for long periods of time are also probably more likely to develop a problem.
If research on substance addictions holds true for behavioral addictions, why people engage in these behaviors might also help to determine their risk. Specifically, those who use the behavior as a method of coping with stress or other difficult emotions could be more likely to develop problematic patterns and addictions.
Certain personality traits could also heighten a person’s risk for developing a behavioral addiction. Research on drug, alcohol, and behavioral addictions suggests that people who are more impulsive and prone to risk-taking are more likely to develop addictions.6 Across all behavioral addictions, teens and young adults are overrepresented, suggesting that young people are especially vulnerable.4
Treatment of Behavioral Addictions
Even though many of the behavioral addictions listed in this article are not formally recognized as diagnosable conditions, a surprising amount of treatment options for these issues exist. In most communities in the US, it is possible to find individual or group therapy, outpatient treatment, and even residential and inpatient treatment facilities that treat behavioral addictions. Research suggests that many of the treatments used for substance use disorder also are effective in treating behavioral addictions.4
The drawback to some of these treatment options is that because many behavioral addictions are not diagnosable conditions, insurance might not cover the costs of treatment. Still, a range of treatment options exists, and many might offer sliding scale or discounted rates for those who are unable to afford treatment.
Some of the more common treatment options for behavioral addictions include:
Outpatient therapy is typically provided by a licensed counselor, social worker, or psychologist. Sessions are usually office-based and could include individual, group, or family sessions, or even a combination of these. It is important to find a counselor who specializes in addiction, and to make sure they are able to treat behavioral addictions. Typically, outpatient therapy sessions last about an hour and are offered once or twice a week, although some intensive outpatient programs could offer treatment 3-5 days per week.
Psychiatric medication is not typically considered a frontline treatment for behavioral addictions, but some people are interested in exploring their options. Medication can only be prescribed by a licensed medical provider with the appropriate license and qualifications.
Typically, medication evaluations and follow-up appointments occur in office settings, and appointments tend to be shorter than therapy sessions (often 15-20 minutes). Medication might not be the right option for you, but can be an important part of treatment when combined with therapy, especially for people with other underlying mental health conditions.
Residential and Inpatient Treatment
Residential and inpatient treatment occurs in 24 hour facilities that usually are staffed by addiction counselors, health and medication prescribers. People needing more intensive treatment or who feel they need a structured environment to be accountable for changing their behavior might benefit from a stay in one of these facilities.
The length of treatment varies depending on the person and the structure of the program, but could range between a week or two up to a month or longer. Inpatient and residential treatments tend to offer a combination of group therapy, individual therapy, and structured therapeutic activities.
Many communities offer support groups, often at no charge. These are informal gatherings of people who are struggling with a common issue, and can be a great way to get support from other people who have had similar experiences. These groups are usually voluntary and often are peer-lead, meaning they might not have a trained professional leading them.
Many people who are in recovery from an addiction find that support groups are a helpful resource when combined with other treatment, or use these groups as a step-down when completing formal treatment.
How to Get Help for Behavioral Addictions
Getting help for a behavioral addiction can be more challenging than finding help for a substance use problem. More research might need to be done to find a therapist or treatment option that specializes in behavioral addictions. Going to a trained and experienced provider is really important in getting the help you need, so don’t settle for the first option. Call around and find a few options, and don’t be scared to ask questions or for more information that helps you identify the right option for you.
Those who are interested in using their insurance will need to do some investigation to find an in-network treatment provider and then to call and inquire whether behavioral addiction treatment would be covered. The best starting place to find an in-network provider is often to go through your insurance company, calling the number on the back of your card or using their online search tools. You can also use an online directory and filter your search by insurance, speciality, and other preferences.
Those without insurance or who are unable to get their treatment covered may need to explore options for sliding-scale therapy. Even if a provider or treatment facility does not advertise a sliding scale or discounted rate for “self-pay” clients, you should ask anyway. There might be some options available to help reduce the financial burden.
Living and Coping with a Behavioral Addiction
Having a behavioral addiction is hard. The stigma of addiction makes it difficult to come clean to friends and family, but going it alone might be even harder. Consider talking to at least a few people in your inner circle about what you are going through and how they can help support you through your recovery. This will ensure you have a built-in support system for times when it is difficult to stay on track with your recovery, and can also help keep you accountable.
Also, keep in mind that recovering from an addiction usually isn’t as simple as stopping the behavior. Be prepared to also encounter some of the underlying emotions and stress that might have been partially driving the addiction, and work on finding healthier ways to cope.
Activities like exercise, meditation, hobbies, and even just seeing friends more often can help relieve stress and boost your mood and energy. These activities also promote the release of mood-enhancing neurotransmitters that can help you rebalance your brain chemistry, providing a less intense but more lasting (and safe) reward than the one your addiction provided.
Finally, remember that any change begins in the mind, as you come to realize that change is necessary, possible, and will be worth it in the end. Strengthen your mindset by acknowledging these facts, and also by preparing yourself for some difficult days as you work to rebuild a healthier lifestyle. On days when change is particularly hard, remind yourself of your “why,” or the top reasons why you are making this change. Remembering what matters most to you, and how this depends on your recovery, can help you get through the hardest of days.