Most people can easily comprehend addiction to a substance -- alcohol, illicit drugs, prescription medications, cigarettes, and even something like chocolate. If they've not dealt with such an addiction themselves, they know someone who has, or they've at least seen a fairly accurate depiction of the problem on TV or in movies. But behavioral addictions? That's another story. In fact, trying to explain sexual addiction, gambling addiction, spending addiction or any other behavioral addiction is sometimes a difficult task. Yet these addictions do exist, they are relatively common, and they typically wreak just as much havoc and destruction in the lives of those who deal with them (and in the lives of those around them) as alcoholism or drug addiction.
But still, addicted to a behavior? Really? Don't you have to swallow, smoke or inject something to get addicted?
Sometimes I find that it helps, when explaining behavioral addictions, to first talk about addiction in general. Essentially, addiction occurs when three primary criteria are met. (The American Psychiatric Association lists 11 diagnostic criteria, but in reality it boils down to these three.)
1. Preoccupation to the point of obsession with a pleasure-inducing substance (or behavior).
2. Loss of control over use of a pleasure-inducing substance (or behavior), typically evidenced by failed attempts to quit or cut back.
3. Directly related negative consequences -- relationship trouble, issues at work or school, declining physical health, depression, anxiety, diminished self-esteem, isolation, financial problems, loss of interest in previously enjoyable activities, legal woes, etc.
More importantly than the diagnostic criteria, for purposes of our discussion here, is the fact that addicts are people who no longer use their substance (or behavior) of choice to feel pleasure, they use it to feel less (e.g., to control what they feel). In other words, addictions are not about having a good time, though use generally starts out that way, they're about escaping from the vicissitudes of life -- stress, disappointment, depression, anxiety, etc.
Unsurprisingly, this "numbing out" process is tied to a neurochemical reaction in the brain. For instance, when a person drinks alcohol, a neurochemical pleasure response is triggered -- primarily the release of dopamine (causing feelings of pleasure), along with adrenaline (energy and excitement), serotonin (well-being) and oxytocin (trust and connection). This causes the user to feel better about life and to not focus on the negatives that he or she might otherwise be dealing with.
And folks, there is nothing wrong with this behavior until it is taken to an extreme. For a non-alcoholic, having a cocktail after work as a way to temporarily de-stress is a perfectly normal reaction. Unfortunately, for some people -- in particular those who are vulnerable to addiction thanks to a genetic predisposition and/or environmental influences -- this alcohol-driven neurochemical escape can be turned to time and again, eventually becoming the go-to coping mechanism for any and all forms of emotional or even physical discomfort. Over time, these people may lose the ability to just say no -- even after they've started to experience negative consequences related to their drinking (arrests for DWI, arguments with loved ones, getting warned or fired for being drunk at work, etc.) When this occurs, addiction has set in.
But what does this have to do with behaviors? I mean, if you take a drug (like alcohol), of course your brain is going to be affected, and of course you can eventually become addicted. But if you're not ingesting a substance, there's nothing to worry about, right?
Unfortunately, that's not the way it works. Potentially addictive behaviors trigger the same neurochemical response as potentially addictive substances -- resulting in feelings of pleasure, excitement, well-being, connection, and, most importantly, distraction and emotional escape. The only significant difference between substance and behavioral addictions is that substance abusers ingest alcohol or drugs to create this emotionally escapist neurochemical reaction, whereas behavioral addicts rely on an intensely pleasurable fantasy or activity to induce it.
Still confused? Try thinking about a cocaine addict on payday. Let's say he gets his paycheck at noon. Flush with money, he immediately calls his drug dealer to set up a purchase. Then he skips lunch so he can run to the bank and turn his check into cash (instead of depositing it to cover his monthly expenses). For the remainder of his workday, he is jittery, unfocused and highly unproductive. At 5 p.m., he zips out of work and drives not home to see his wife and kids, but to visit his dealer. All the while his heart is pounding, his hands are clammy, and he's sweating bullets. He is filled with nervous energy, and he's so focused on cocaine that he doesn't notice the police car parked near the spot where he meets his dealer.
Hmmm.
Is this man not high already, even before he's taken any cocaine? After all, his day-to-day world, with all of its obligations and problems, has temporarily faded into the background, and he has effectively escaped from his life. Even though there is no cocaine in his system (yet), his brain is pumping out dopamine and other pleasure/escape related neurochemicals as if there were.
This is the same "anticipatory high" that occurs with behavioral addictions.
Put simply, addictions (of all types) are about the manipulation of neurochemistry, and this manipulation can occur with or without an addictive substance. Once this is understood, behavioral addictions are much easier to fathom. Essentially, behavioral addicts get high in the same way as the pre-use cocaine addict described above, manipulating their neurochemistry without ingesting a substance; the neurochemical anticipation of pleasure provides the escape from life that they are seeking.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He is the author of numerous books, including Always Turned On: Sex Addiction in the Digital Age, co-written with Dr. Jennifer Schneider. He also writes a blog on addiction. For more information you can visit his website, www.robertweissmsw.com.