Process addictions, also referred to as behavioral addictions, share striking similarities with substance use disorders. They impact the same brain regions as substance use disorders, respond well to addiction treatment, and even respond to medications commonly prescribed for opioid use disorders.
The key difference between a process addiction and a substance use disorder is that psychoactive substances don’t cause the addiction; instead, people become addicted to a behavior. People experiencing process addictions face unique challenges in their recovery.
What Is a Process Addiction?
Process addictions refer to compulsive behaviors that people have trouble stopping on their own. While the specific behaviors of a process addiction vary, they generally share the same psychological symptoms. These symptoms closely parallel the symptoms of a substance use disorder and usually include the following:
- Cravings for the problematic behavior
- Engaging in the behavior more frequently than intended or for longer than intended
- Withdrawal symptoms
- Engaging in the behavior more and more to achieve the desired effect (tolerance)
Many people with a process addiction cannot stop the behavior without professional help.
Process Addictions and Co-Occurring Disorders
Process addictions and substance use disorders often co-occur. This relationship goes both ways – some people first develop a problem with substance use, then later struggle with a process addiction. Conversely, some people who have process addictions may fall into substance addiction.
Sometimes people in substance use recovery develop a process addiction as a replacement behavior; it’s not uncommon to see recovered alcoholics develop an exercise addiction or compulsive sexual behavior, even though they have remained abstinent from substances.
Co-occurring disorders could be a result of changed reward network processing. Many people who have had their reward networks altered due to substance use disorder feel a need to engage in highly rewarding behavior after achieving sobriety because the brain becomes addicted to the high amounts of dopamine.
If a behavior like sex or gambling feels particularly rewarding, they may overindulge to the point of developing a process addiction.
Examples of Process Addictions
There are several different types of process addictions, though they are not all recognized as psychological disorders. Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) only recognizes kleptomania, pathological gambling, and binge eating disorder as mental disorders.
Video Game Addiction
Like sex addiction, the DSM-V does not recognize video game addiction as a disorder. Yet the parallels between video game addiction and other addictive behaviors are striking. Those with a video game addiction cannot stop on their own and may pursue gaming over other activities or hobbies, even when their addiction damages their relationships.
Video games are addictive by design; game designers often consciously create conditions that mimic gambling, particularly in mobile games. Gamers are encouraged to collect loot boxes and prizes with a random chance of large rewards, which explode with light and color when they “hit.” This experience mimics a slot machine; many people can spend thousands of dollars in real money chasing the high of a win.
Kleptomania is a disorder that describes a repeated impulse to shoplift. Its key diagnostic features include a compulsive desire to steal items that aren’t required for personal or financial use, a sense of tension before stealing, and a sense of pleasure after committing the theft.
People who experience kleptomania aren’t stealing out of necessity or desperation. Instead, they steal because they chase the feeling that shoplifting produces. Researchers believe between 4% and 24% of people arrested for shoplifting have kleptomania, though it affects less than 1% of the general population.
Also referred to as pathological gambling, the DSM-V categorizes gambling disorder as an addiction under a separate category: “Non-Substance-Related Disorders.”
The diagnostic criteria for a gambling disorder include:
- Needing to gamble with more and more money to achieve the desired level of excitement
- Feeling irritable or restless when trying to stop gambling
- Making multiple attempts to stop gambling without success
- Being preoccupied with gambling
- Gambling when feeling distressed
- Returning to gambling after losses in an attempt to get even
- Lying to hide how much they gamble
- Losing jobs, relationships, or other opportunities due to gambling
- Relying on other people for money to finance their gambling
Gambling disorder is estimated to be prevalent in between 0.4% and 1% of the general population.
Binge Eating Disorder
Although included in this list, in the DSM-V, binge-eating disorder is listed under the category of “Feeding and Eating Disorders.” Still, clinicians often refer to binge eating disorder as a food addiction. People with this disorder may feel a lack of control over their food intake and will eat much more than the average person in a short period, even if they aren’t hungry.
In addition, people who have binge eating disorders may experience negative effects after a binge, such as feeling distressed, uncomfortably full, and embarrassed.
Sex addiction is a widely recognized disorder in the public sphere, but the DSM-V doesn’t define this condition as an addiction due to insufficient documentation in academic literature. Yet sex addiction has its own 12-step support groups, and several treatment centers specialize in supporting patients with this disorder.
People who suffer from sex addiction may experience substantial problems similar to the consequences of other substance use disorders. Those addicted to sex have more sex than they originally intended to, engage in risky sexual behavior, and often cannot stop or cut down when they want to.
In addition, they experience frequent cravings for sexual activity and may suffer significant personal and social consequences due to their compulsive behavior.
Exercise addiction refers to a compulsive need to engage in exercise. People will obsess over the behavior, exercise even when it causes physical harm, and continue exercising even when they want to cut down or stop.
Exercise addiction can have severe health consequences, including:
- Injuries and chronic pain
- Anxiety, depression, and social impairment
- Extreme weight loss and other health issues related to extreme weight loss
- Heart problems
- Irregular periods with possible reproductive issues
In addition to the health consequences listed above, exercise addiction often co-occurs with other addictions:
- 39 to 48% of people suffering from eating disorders also suffer from exercise addiction
- 15 to 20% of exercise-addicted individuals are addicted to nicotine, alcohol, or illicit drugs
Other co-occurring disorders include sex addiction, shopping addiction, and caffeine addiction.
The Overlap Between Substance Use and Process Addictions
Process addictions and substance use share one key similarity: both behaviors create large spikes in the neurotransmitter dopamine, which creates feelings of reward and encourages the brain to seek out high-reward behavior.
In substance use, the brain releases dopamine in response to a chemical agent, such as opioids, alcohol, or amphetamines. In process addictions, the brain releases dopamine in response to a specific behavior.
Essentially, the same brain regions associated with substance use disorders are associated with process addictions. Both addictions primarily affect the brain’s reward network, making it harder for people to enjoy other activities and encouraging them to repeat the behavior even when it is harmful.
Neuroscience shows that process addictions can result in the same brain changes associated with substance use disorders; they can escalate to a point where the average person cannot stop without professional intervention.
Treating a Process Addiction
Treating a process addiction follows a similar structure to treating a substance use disorder. Process addiction treatment typically includes:
- Individual therapy
- Group therapy
- 12-step support groups
- Family counseling
- Medication-assisted treatment
However, there are a few differences in treating process addictions. Abstinence is often not an option, particularly for people suffering from binge eating disorders or sex addiction; you can’t simply stop eating, and sex is a basic human need.
To treat certain process addictions, you must change your relationship with the behavior rather than attempt to stop the behavior altogether. People with a food addiction need therapy and counseling to rediscover a healthy relationship with food while getting to the core issue that causes the addiction.
Similarly, sex addiction treatment doesn’t call for total abstinence. Instead, it tries to decrease undesired sexual behavior while keeping healthy sexual relationships intact.
In either scenario, a therapist can help provide strategies to manage triggers and cravings.
Other process disorders, such as gambling disorder or kleptomania, often include an abstinence-focused approach. For most people, removing these behaviors doesn’t cause significant harm – it’s sometimes easier to maintain your recovery if you avoid the behavior entirely. A therapist will help find healthy behaviors that help build recovery capital so you feel more supported and less likely to fall back into addictive patterns.
Medication for Process Addictions
Process addictions vary greatly, and each client has unique needs; just like there is no single treatment plan for process disorders, there is no single medication to treat all process disorders. Many people benefit from medications to treat co-occurring mental health disorders, such as depression or anxiety, but healthcare providers often prescribe them on a case-by-case basis.
However, one medication has an impressive effect on several process addictions. The opioid blocker naltrexone can improve the symptoms of pathological gambling, kleptomania, sex addiction, opioid use disorder, and alcohol use disorder.
The fact that this medication benefits so many different addictions further points to the close relationship between these disorders, and how addiction, as an umbrella term, can adequately describe various behaviors.
Finding Support for Process Addictions
If you’d like to know more about how All Points North uses various techniques to help people with both process addictions and substance use disorders, reach out to our team via live chat, fill out our online contact form, or call 855.235.9792.
There is a way forward, and you don’t have to struggle alone. We can help you get to the root of process addictions and find healthy strategies that support your recovery.
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- Konkolÿ Thege, Barna et al. “Co-occurring substance-related and behavioral addiction problems: A person-centered, lay epidemiology approach.” Journal of behavioral addictions vol. 5,4 (2016): 614-622. doi:10.1556/2006.5.2016.079