What is a Process Addiction?
You may have noticed in our social media posts that we used the term “#AddictivePersonality.” Did it catch your attention? It was designed to! It is a widely accepted myth, this notion of an “addictive personality.” Current scientific literature does not support it[1]. We have no robust evidence of the existence of an addictive personality per se, but rather a set of biomedical processes driven largely by neurochemicals, specifically dopamine, that sets some of us up for a much higher risk of addiction to various substances and/or processes.
Addictive behavior is described as a preoccupation which takes over a person’s ability to moderate or stop use or behavior. Additionally, continued use or behavior results in negative consequences. The preoccupation with use of a substance can be with the use of alcohol or drugs (legal or illegal). And the negative consequences or use or behavior are predictable including those that result in relationships issues with friends and family as well as those that involve work, health, and legal matters.
Process addictions, a.k.a. behavioral addictions, are currently diagnosed following criteria similar to addictions to drugs and alcohol. Notably, if a person meets criteria for a substance addiction or process addiction, then the person is at significant risk for another addiction. Let’s explore the characteristics of and risk factors for addiction, common types of process addictions, and treatment availability.
Common Characteristics of Addiction and Risk Factors
It is largely understood that the risk factors of addiction are a complex combination of biological, psychological, and social components. Biology is responsible for as much as 50% of the risk in the case of a substance use disorder to alcohol (and potentially higher risks for other drugs of abuse).[2] Those diagnosed with a substance use disorder to alcohol and/or other drugs experience a supra-physiological release of dopamine when exposed to certain processes and/or substances; this is highly suggestive of an underlying biomedical condition driving a repetition compulsion, what we refer to as addiction in our everyday parlance.
Research into process addictions such as gambling disorder, internet use disorder, or compulsive shopping is limited but ongoing. Therefore, the contributory factors are still being studied. However, the research that is available matches the results of all other available addiction research. In other words, process addictions are established in the same ways for the same reasons – neurobiological mechanisms involving a combination of biological, psychological, and social components.[3] But, there is still much to learn.
Common Types of Process Addictions
Dopamine is our brain’s way of experiencing happiness and pleasure. When you spend time with good friends or a loved one, your brain produces dopamine. Repetition of a behavior that produces dopamine is sometimes referred to as “medicating” or using a “medicator” because we may be engaging in the activity to distract us from something uncomfortable that is happening in our lives. Thus, any activity (a.k.a. process) that creates dopamine, is potentially addictive, especially for individuals with a biological predisposition for addiction.
As noted above, the criteria for diagnosing a process addiction is essentially the same as it would be for a substance use disorder. These criteria are: impaired control over activity, prioritization of the activity over other life interests or activities and continued or escalation of time and/or resources spent engaged in the activity despite consequences. For example, over-shopping which causes financial consequences can lead to Spending Addictions. Over-working to the point that relationships are affected could be workaholism. Uncontrollable relationships with food resulting in health or other consequences could possibly result in Food Addiction. Compulsive betting on a sports event to “win back” prior losses to the point of bankruptcy? Gambling Addiction. Unable to leave a video game due to anxiety? Gaming Disorder. Problematic sexual relationships or compulsive use of pornography? Sex and Pornography Addiction.
Addiction is about our brain’s reward circuitry, regardless of the type of addiction.
We have less of an understanding with respect to the etiology of process addictions but suspect there are strong biological risks associated with these as well. Understanding risk is essential to both the creation of preventative measures for those who have a history of process and/or substance abuse in their families, as well as in the design of treatment approaches for those who have a current substance use disorder and/or process addiction. The DSM V (The current diagnostic manual used in the identification of mental health and substance use disorders) has included gambling as a diagnosable process addiction[4], and others are expected to be recognized in future diagnostic manuals, especially gaming and online pornography.
According to the Mayo Clinic, an addiction is defined as “a person's inability to control use of a substance or behavior despite negative consequences. Some people who are engrossed in screen time or video games while ignoring other normal activities could be close to meeting this definition. This is the result of releases of dopamine secondary to a pleasurable experience or a sense of hyper arousal.”[5] If we experience hyperarousal while playing a video game or gambling due to a dopamine release, the result can be a powerful craving and an incredible drive to repeat that behavior. Craving is the central feature that drives people to repeat a behavior. This understanding is critical because it informs our approach to the treatment and care of individuals who suffer from these disorders. It also allows us to have compassion for them as we would for anyone with a biomedical condition. It takes addiction decidedly out of the realm of character and places it squarely in the realm of a biologically reasoned explanation. One leading addiction expert who trained at the Mayo Clinic and later as the Medical director of a renowned treatment center explained addiction this way: “The brain doesn’t know it’s out of whack because of the stimulus (dopamine). It only knows there is a lot of dopamine associated with the stimulus.” [6]
Treatment Availability
Treatment for process addictions is complicated. When substance use disorders get diagnosed but process addictions get overlooked, the prognosis for long term recovery from addiction is guarded. Even if both addictions are diagnosed, most addiction treatment is tailored to substance use disorders and clinicians may not be trained to handle process addictions. This is especially true for food-related process addictions which co-occur with eating disorders.
Treatment for process addictions as a primary addiction is limited. Most treatment for process addictions is at the community level which includes 12-step programs, hospital-based partial hospitalization programs and intensive outpatient programs. Residential treatment programs for process addictions are rare. Gambling, sex, gaming, and food-addiction are the most likely process addictions for which to find residential treatment, however, the number of treatment centers is extremely limited and often costly. People with other process addictions including work, spending/shopping, or other less common behaviors are even less likely to find specific help. Treatment centers that are not available to adequately address process addictions often prioritize the primary addiction and then refer to another program for the secondary addiction.
Treatment modalities for process addictions aim to address the underlying psychological and behavioral patterns of the individual. Detoxing in the form of abstinence from engagement in the activity is required. Cognitive-behavioral therapy (CBT), motivational interviewing (MI), Group Therapy, and Family Therapy. Mindfulness and other coping strategies are also incorporated into recovery from process addictions. Medications may be used in combination with other treatment modalities.
Our next blog will feature the impact of process addictions on families, support and coping strategies, as well as the direction and urgency for research into process addictions. To be a part of the conversation, join the Family Recovery Collective.
References
[1] Some research indicates that there may be an identifiable general proclivity to certain behavior addictions including gender-specific profiles. However, research varies due to lack of officially recognized diagnostic symptoms, among other factors. Chamberlain, S. R., Grant, J. E. (2014) Co-occurring addictive behaviors: a systematic review and synthesis of prevalence studies. Comprehensive Psychiatry. Volume 55, Issue 3, pp 453-468. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394473/
[2] Deak, JD, Johnson, EC. (2021, April 21) Genetics of substance use disorders: a review. Psychol Med. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477224/
[3] Grant, J. E., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to Behavioral Addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–241. https://doi.org/10.3109/00952990.2010.491884
[4] In the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling disorder was identified as a behavioral addiction (American Psychiatric Association, https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t39/ )
[5] Speaking of Health (2022, July 1) Are video games, screens another addiction Mayo Clinic https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/are-video-games-and-screens-another-addiction
[6] Let’s Talk Addiction and Recovery Podcast (2019, March 19) Hazelden Betty Ford Foundation (https://www.hazeldenbettyford.org/podcasts/addiction-affects-body-mind (quoting Dr. Marv Seppala)
