Process Addiction Assessments - A Guide to Behavioral Addiction

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Introduction

Addiction has two main categories: substance addiction and process addiction. Substance addiction includes abuse and dependence to alcohol or drugs. Process addiction includes compulsive behaviors such as gambling, excessive shopping, eating disorders, exercising too much, sex addictions, and various addictions involving computer devices. These are serious mental health issues that usually require treatment.

It's important to understand that process addictions can be just as serious as drug addiction problems in how they impact life. In both cases, addictive behavior develops because of one or more underlying issues that need diagnosing and behavioral addiction treatment.

What is Process Addiction?

Process addictions are defined by behavioral issues that don’t involve substances. Also known as behavioral addictions, process addictions are typically impulse control disorders. Let's start by taking a closer look at the definitions of addiction, behavior, and compulsiveness as they relate to psychiatric disorders.

Addiction

Addiction is present when a person struggles to control one or more behaviors. There are mental, behavioral, and physical symptoms that cause compulsive drug abuse and behaviors despite causing physical problems and negative consequences.

Withdrawal syndromes are also an aspect of addiction. When substance abuse is suddenly ended, withdrawal symptoms appear that can range from mildly distressing to very painful to potentially fatal. In addition, addiction is a chronic and relapsing disease.1

Behavior

While in the past, addiction was commonly associated with substances such as drugs or alcohol. More recently, behaviors have been included in identifying addictions. Experts in the field believe that anything that can stimulate a person has the potential to become addictive. Internet surfing, gambling, pc gaming or chatting  can be considered addictions if they become a dominant habit and begin to negatively impact quality of life.2

Therefore, many behavioral scientists believe that addiction doesn’t require drug abuse, but can have a behavioral focus.2

Compulsive

Compulsive behavior is where individuals perform certain acts repeatedly without control. They realize that these acts are not good for their lives but perform the acts anyway.3

Compulsive behaviors are present across a wide range of psychiatric disorders, including:3

Substance use disorders

Behavioral disorders

Obsessive-compulsive disorders

Not all repetitive behaviors are compulsive,  healthy repetitive daily behaviors, such as meal or bedtime rituals may also become compulsive.

Common Features of Substance Use Disorders and Process Addictions

Process addictions are similar to substance addictions in many ways:2

The activity dominates the person's life

The person experiences euphoria (a high or a buzz) from doing the activity

Tolerance develops so the activity must be performed to a greater extent to obtain the same euphoria

Stopping or cutting down on the activity leads to distressing emotions or adverse physical effects

The activity causes conflicts with others or self-conflict

Resuming the activity happens at previous or worsening levels after the person tries to stop due to negative consequences that damages their job, school, or family obligations

Why a Process Addiction Assessment is Important to Comprehensive Diagnostic Testing

Because behavioral addictions look like substance use disorders, a process addiction assessment must be done as part of comprehensive diagnostic testing. While drug and alcohol abuse may be easier to spot, it’s still vital to uncover process addictions before establishing a treatment plan.

Sex Addiction vs. Pornography Addiction 

Sex Addiction

Sex addiction is also known as compulsive sexual behavior. Sexual addiction is characterized by frequently engaging in sexual activities, even if they cause negative consequences.

Engaging in sexual behaviors is one way of dealing with stress or physical or emotional pain. Sexual behavior becomes the major way of dealing with problems, but unfortunately, when done unsafely can lead to more problems and feelings of shame and desperation.4

Pornography Addiction

Pornography addiction has been a growing problem because of how easily pornography can be reached on the internet. Some terms that are related to pornography addiction include cybersex, porn, online sex, and internet sex. Since pornography addiction behaviors are usually done in private, data is hard to find.

People struggling with porn addiction excessively view pornography. From this, negative consequences develop such as feeling isolated, neglecting important areas of daily life and creating relationship issues.5

Gambling Addiction

Gambling is legal across the United States, and many gamble for fun and recreation. When gambling crosses the line into excessive wagering, a process addiction may be developing.

Also known as problem gambling or gambling disorder (GD), this type of process addiction means that gambling has put job, finances, or family life at risk. Many forms of gambling are easily accessible: casino games, slot machines, poker games, online gambling, and sports bets. A pathological gambling addiction may be present if the following symptoms occur:

Placing more and more bets

Betting more money than first intended

Chasing losses by frequent betting over one's ability to pay

Feeling irritable or aggressive when losing or can't gamble

Being preoccupied with gambling

The negative consequences of problem gambling can be life-changing. People in gambling disorder treatment talk about losing large amounts of money, legal problems, lost homes, bankruptcies, lost jobs, and divorces. Suicide risks are higher among people who struggle with gambling issues.6

Internet Addiction vs. Social Media Addiction

The internet is part of daily life for many Americans.

According to the Pew Research Center, of those who are ages 18 to 29, 81% of people report they go online every day. 7

%
Go online nearly constantly
%
Go online a few times daily
%
Go online once a day
%
Go online a few times a week or less

Only 10% of Americans report they don't use the internet

Handheld devices make it much easier for people to be connected to the internet. According to the Pew Research Center, 86% of Americans use mobile devices to connect to the internet. This includes those who are:7

%
Online Every Day
%
Online Almost All the Time

Internet Addiction

When individuals spend so much of their time online that it interferes with their daily lives, internet addiction may be present. If going online or wanting to go online becomes more important than work, school, or loved ones, close relationships, an addiction may be present.

Social Media Addiction

Social media addiction differs from internet addiction in that it involves specific types of websites that are based on social sharing or, in some cases, lurking to see what everyone else is sharing. Constantly visiting sites like Facebook and Twitter are major signs of social media addiction.

Many people like to pop in to see what's the latest in their social sharing world, but when it starts to take up large amounts of time and impacts important relationships, it may be time to seek professional help.

Gaming Addiction

Gaming addiction is like social media addiction in that large amounts of time are spent on specific types of sites (gaming) that negatively impacts work, home, and family life. While games can be played offline, many popular games are played on the internet with teams and virtual environments.

Popular online games that can become addictive include:

Fortnite

World of Warcraft

Guild Wars 2

Final Fantasy 14

Eve Online

Black Desert Online

Minecraft

Star Wars: The Old Republic

To some, the fantasy world can become more important than real life. Unfortunately, gaming addiction can lead to an inability to connect with others, a lack of healthy relationships, difficulties at work or school, and neglecting personal health (not eating regularly or eating junk food often, little exercise).

Without treatment, many people struggling with gaming addiction can end up completely isolated, unable to function, and with too many goals focused on gaming accomplishments.

Food Addiction vs. Eating Disorders

Food-related disorders are especially difficult to unravel since we all must eat to survive. When a process addiction involves overeating (food addiction) or compulsive eating habits (eating disorders), eating becomes a main focus in life.

Food Addiction

Regularly overeating and challenges controlling eating behaviors are food addictions. Foods high in fats, sugars, or salts are more likely to be over-consumed. People with food addictions describe euphoria when they are eating their favorite foods.

Also, food addiction can cause a tolerance to develop, which is also characteristic of substance use disorder. With food addiction, more and more food is needed to reach the euphoria being sought. Negative impacts on self-esteem, damaged relationships, and health problems can come from food addiction.

Eating Disorders

Many different forms of diseases come under the term of eating disorders.

Anorexia Nervosa: Based on eating behaviors, such as restricting the amount of daily calories, people with this disorder show a low body weight. They also have an overt fear of gaining weight, resulting in the development of behaviors that interfere with weight gain.

Bulimia Nervosa: This disorder is characterized by binge eating and then purging. Purging is removing the food from the body soon after eating, which prevents nutrients from being absorbed.

Binge Eating Disorder: Recurrent episodes of eating large amounts of food in a short time are the hallmarks of BED. While individuals are in one of these episodes, they report feeling they have no control over their behaviors as well as feelings of embarrassment, shame, and guilt. Some people with binge eating disorder may eat very fast even when not hungry.

Shopping Addiction vs. Kleptomania 

Shopping addiction and kleptomania are similar in the fact that both are related to obtaining items through compulsive behaviors. The major difference is that shopping addiction involves legally purchasing the items where kleptomania involves stealing the items.

Shopping Addiction

Compulsive buying disorder (CBD) is indicated when excessive shopping and buying behaviors cause problems or damage to a person's life. More than 80% of people with CBD are women.8

Shopping addiction may be present when individuals constantly, excessively, and impulsively purchase items. These uncontrolled buying sprees continue despite the psychological, social, and financial consequences they create.

While people without a shopping addiction make purchases to get useful or valued products, people with CBD buy items to boost their mood, gain social approval from those around them, or to cope with stress.

After a shopping spree, a person with CBD experiences long-lasting feelings of regret over their purchases, as well as shame and guilt. People with CBD can't stop compulsive buying on their own.

Kleptomania

Kleptomania is distinguished by the illegal nature of this behavioral disorder: namely, the desires and actions to steal items. Classified as an impulse control disorder, people with kleptomania try, but fail, in stopping themselves from stealing items that aren't needed or have little value.

People struggling with kleptomania experience anxiety-driven impulses to steal, and when they act upon these impulses, they feel pleasure. Afterward, serious distress and troubles arise.

It is estimated that about 1.2 million people (6 per 1000 adult Americans) have kleptomania in the United States.9

Kleptomania is thought to be the cause of about 5% of shoplifting.

In 2002, the total shoplifting costs were estimated at $10 billion. At 5%, kleptomania would be responsible for $500 million in economic losses every year.9

Exercise Addiction

Exercise addiction involves excessive workouts that lead to negative effects on a person's life. Exercise release endorphins and dopamine that cause a sense of well-being. People with exercise addictions compulsively seek the high caused by the endorphins and dopamine. They are not improving their health, but rather are harming themselves. It's estimated that 3% of adult Americans suffer from exercise addiction.10

Exercise addiction is characterized by:

Excessive exercising that increases over time to obtain a buzz or high or sense of accomplishment.

When the person can't exercise, he or she feels anxious, irritable, restless, and may have trouble sleeping.

Attempts to stop or reduce workout time fails.

A reasonably long exercise routine increases to an extended time consistently.

A large amount of time is spent in the preparation, engagement, and recovery from exercise sessions.

Other activities involving friends, family, or jobs, suffer because exercise consumes so much time.

Health Problems Associated with Process Addiction 

The health effects of process addictions are many, and common to all of them is the anxiety and distress that can cause physical problems if allowed to continue. Health problems can include:

Sex Addiction: Venereal diseases, AIDs, unwanted pregnancies, risky sexual behaviors

Internet, Social Media, and Gaming Addictions: Lack of exercise and poor eating habits can produce many different health issues.

Food Addiction and Eating Disorders: Food addiction can create morbid obesity and its related health issues. Eating disorders can lead to a wide range of health problems and can be fatal.

Exercise Addiction: Exercise addiction can cause cardiovascular and other health issues related to the excessive amount of stress on the body due to over-exercising.

Treatment for Process Addiction

Mental Health Treatment

Psychotherapy sessions, such as cognitive-behavioral therapy (CBT) can help people with behavioral addictions analyze the reasons behind their addictions. These sessions can also help them discover what triggers these behaviors and what helped control them in the past. Participants also learn coping skills to manage any compulsions and how to avoid relapse.

Medication Treatment with Naltrexone or Topiramate

Medications can also help people stay in recovery for process addictions.

Naltrexone is a medication that is typically used in addiction treatment for alcohol and opioid addictions.11 Naltrexone also has shown to be effective in treating gambling, kleptomania, compulsive buying, sex addiction and internet addiction.11

Topiramate is an anticonvulsant drug that affects receptors in the brain. Research has shown that it helps treat problem gambling, kleptomania, and compulsive buying and internet addictions as well as helping reduce alcohol, cigarette and cocaine use.11

12-Step Programs

While the 12 Steps were created by Alcoholics Anonymous for alcohol addiction, they can be adapted to process addictions as well. Attending 12-step meetings work because the support and guidance people receive from their peers is invaluable for developing coping skills and for avoiding relapse of process addictions.

Diagnosing Process Addiction and Finding Help

If you or a loved one is struggling with a process addiction, with the right mental health treatment, a renewed and rewarding life that is free from addictions is possible. Talk with your doctor or a treatment center about the first step: a process addiction assessment.