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Behavioural (Process) Addiction Treatment


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Behavioural (Process) Addiction and Treatment

What makes an addiction?

Addiction is generally understood as a repeated behaviour that has 3 core characteristics:

1) Preoccupation: the person with an addiction is often consumed by thinking about, planning to, or engaging in the addiction behaviour.

2) Negative consequences: the time spent thinking about, planning, or engaging in the behaviour begins to interfere with life, such as creating mental distress, relationship disturbances, work performance, obligations or other tasks such as hygiene or meeting certain goals.

3) Tolerance: the temporary effects of the behaviour reduce in intensity or duration over time, and the person has to engage in more, engage more frequently, or increase intensity in some way to get the same effects over time.

When we examine these key elements of addiction, it is common to think about substances we may have engaged with or witnessed others engage in as part of this process.

However, these key elements of addiction are also present in compulsive behaviours – behaviours that over time, the person has lost control of.

Behavioural Addictions

Common behavioural addictions may include sex, relationships, pornography, internet usage, video games, gambling or shopping/spending.

The behaviour is often initially used as some sort of distraction or attempt at self-soothing, and often experienced as a reward.

The distraction is often sought out in a difficult time; during conflict in personal life, during times of major change or stress, when experiencing life dissatisfaction, or when something unresolved from our past has been triggered.

Using such behaviours as stress relief or to self-indulge at certain times is not inherently problematic. For this reason, it is easy to justify these behaviours and miss the warning signs that they may be becoming unhealthy.

For example, it may not be an issue to dive into work obligations when wanting to avoid an issue at home for a day or two, or to go shopping after a difficult day.

However, when these behaviours become habitual, and become the main way you are attempting to cope, or a main avenue of avoidance from what may be causing stress in your life, this can result in problems both internally and externally.

Internally, the natural emotions or symptoms you may be experiencing as a result of the issues in your life (past or present) are ignored and thus remain inside where they can become exacerbated; externally, you may notice that others are complaining about your lack of presence emotionally; your relationship behaviour or work performance; you may notice that your finances are negatively impacted, or be experiencing additional emotional problems such as shame and depression as the behaviour spirals out of control.

Behavioural addictions can co-exist with substance addiction in what we call ‘addiction interaction’.

Common examples may include cocaine and sex, cannabis and pornography, alcohol and gambling, etc.

Addiction interaction can include many different substances and behaviours all co-existing, or moving in cycles.

While many people are aware of what substance addiction looks like, behavioural addictions tend to be less understood and less obvious; as mentioned above, this can result in it being easier to justify their use.

For example, telling ourselves or our loved ones that “at least I’m not using drugs and alcohol”, or “everyone gambles sometimes”, or “I just have a high sex drive”. This can make it difficult to know when your behavior has crossed the line of what you are truly comfortable with.

Additionally, behavioural addictions may vary across time – if you notice that you currently have a certain behaviour that you use to cope, for example, overworking, it may be valuable to think about if there have been other behaviours across your life time that have been attempts at coping, for example, as a child playing video games for extended periods of time to cope with issues at home.

Cross-Addiction or Addiction Replacement

Behavioural addictions can also arise as a result of sobriety; while true recovery involves engaging mindfully with emotions and using emotion-related skills, if you find yourself having quit cigarettes for example, but shopping much more, you may be engaging in addiction substitution and may find that eventually more issues can arise.

As more issues arise, you may notice your need or desire to ‘escape’ increases, as does the behaviour, or, perhaps the behaviour becomes more complex and has additional behaviours added.

Can I build a tolerance with behaviours?

Tolerance in behavioural addictions can be hard to conceptualize.

Tolerance occurs because part of the addiction pathway in the brain involves the novelty circuitry, in which the brains natural craving for novelty is satisfied with behaviour that distracts from pain and stress.

However, that part of the brain is often asking us for “more” as it is a fundamental part of our survival brain in which “more” = survival.

Because addiction provides a false sense of satiation, that part cannot be truly satisfied and it continues to ask us for ‘more’ before it will reward us with the satiation signal.

Examples of how behaviours increase with ‘tolerance’ can include:

Pornography Use: “Tolerance” may refer to time spent watching videos, number of times a day videos are viewed, and content becoming more “taboo” or against your values. You can read more about how pornography use can evolve into addiction and its resulting issues here.

Sex: While you may initially seek out sex from your partner when feeling stressed for other reasons, you may notice that without addressing the underlying issue, your need for sex grows to more times in a day, involving more role play or other additions, or more partners. You may find that you’ve begun to seek sex outside of your primary relationship. Issues here may be guilt, shame, loss of relationships, or sexually transmitted infections or other physical side effects.

Relationships: You may find that you move from relationship to relationship quickly. Perhaps engaging in more than one at once; you may find that it is difficult to leave relationships that are unhealthy or abusive as you search for more of the “love” or non-abusive moments.

Working: You may find it very difficult to take time away from your work, to truly “unplug” from connections from work, and become irritable when forced away from work. Issues here can be relationship disturbance, lack of self-care resulting from lack of time to engage in hygiene or other tasks, and ultimately work performance issues.

Through various brain studies conducted since we have become aware of the addictive nature of behaviours, we know that certain behaviours stimulate the same circuits of the brain that substances do; our reward and novelty centers in particular.

This means that when you do make attempts to ‘control’ or stop engaging in behaviours that have become compulsive, you may notice withdrawal signs such as irritability, sleep issues, fatigue, emotional turmoil and changes in appetite.

The root of behavioural addictions looks very similar to the root of substance addictions; both often originate in attempts to distract or self-soothe from trauma, pain, and other life stressors.

Because of the way the reward circuitry in our brains work, and because of our human nature to escape pain, these attempts can become ongoing and lead to other life issues.

These life issues also need to be avoided, or distracted from, and thus the behaviour continues and amplifies often until the pain it has caused outweighs the original pain and we are compelled to address it to move forward healthfully.

As renowned addiction expert Dr. Gabor Mate says, “the question is not ‘why the addiction?’, but ‘why the pain?’”

Treatment

Treatment of behavioural addictions looks much like substance addiction treatment; depending on severity, resources, and personal preference, you may choose either inpatient or virtual outpatient treatment.

One difference is that while you may go through a withdrawal phase, you will not need or go through a formal ‘detox’.

Once in treatment, you and your therapist will work together to create recovery goals.

This may be where substance and behavioural treatment approaches differ in a significant way; unlike those that may choose to seek abstinence from their substance of choice, seeking abstinence from behavioural addictions may be just as problematic as the acting out.

For example, in sex addiction, seeking full abstinence can be harmful as it may evolve into what we term sexual anorexia – the unhealthy avoidance of and/or aversion to meeting sexual needs.

Having sexual needs is fundamentally human and to abstain completely would be harmful.

A period of abstinence is typically encouraged, to allow the brain to ‘re-wire’ away from the addictive cycle, but an important goal in recovery is the reintegration of healthy sexual behaviours in a safe way.

This is similar to shopping (at some point you will need to spend money to avoid self-neglect), internet (much of our lives are online, especially during the pandemic), and relationships.

Once goals are developed, you will learn skills to manage cravings and urges as you and your therapist move into the deeper work of uncovering and processing the underlying pain and stress that led to seeking the reward behaviour in the first place.

This is greatly insightful work and often results in a better understanding of yourself, your needs, and healthy ways to meet needs.

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Behavioural (Process) Addiction Treatment

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