Updated: Jan 10, 2019
Behavioral Addictions are frequently overlooked, but are an important part of addiction treatment. These behaviors may be primary or ancillary, but they remain important to address as they have the same affect on the brain as substances.
Behavioral Addictions and Processes Addictions
Behavioral Addictions and process addictions affect the same area of the brain. If you look at brain scans of these areas during these behaviors, your will see the same activity as in substance use. These addictions include gambling, sex, pornography, and codependency. These behaviors, while they do not have a physical manifestation, limited physical consequences except when they are ancillary like violence, and no withdrawal, they still have the ability to cause extreme consequences and problems in the individual's life.
All behavioral addictions have a process addiction that goes along. You may have heard the phrase “people, places, and things.” This is very real and is something that will need to be addressed when a substance is removed or a behavior is ceased. Consider vaping, which can easily not include nicotine. If the nicotine is removed from vape liquid, a process addiction may remain. This could include association with breaks at work, the social time before and after meetings, or after food/sex. The same argument can be made for substances. If you remove the alcohol from beer and an individual continues the same drinking pattern, this will remain a process addiction. It may have less consequences on the body and those around the individual, but the family will still most likely feel the impact of this behavior.
It is easy to take behaviors or substances that have less damaging effects like this, and minimize their use by comparing them to substance use. “I'm only smoking and drinking a lot of coffee, at least I'm not shooting dope.” Excuses such as this are heard every day in treatment centers and counseling offices around the world. Some behaviors are seemingly healthy as well. Going to the gym or dieting can easily spiral out of control, become their own addictions, and begin to have adverse health effects on the individual.
Codependency is a behavioral addiction all on its own. An individual using substances or behaviors may be codependent, but they are more likely to be dependent. The family member or loved ones are more likely to experience this form of addiction. Codependency may be best understood as addiction to people. In AA, people are powerless over alcohol. In Al-Anon, which is the family program, individuals are powerless over the alcoholic. Interestingly, either can get better while the other remains sick, as they are their own addictions. Ideally both will be treated and both will recover.
With behavioral or process addiction, while there are no physical consequences, the brain will definitely feel the impact. This is true particularly in the areas of the brain that process reward, which will in turn compromise areas of the brain that are involved in healthy decision making, such as the frontal cortex. So as this behavior continues, the individual will be prone to continue the behavior, but also make additional unrelated poor decisions. These decisions will have consequences, such as losing relationships as behavior continues. Additionally, some unhealthy relationships may have to go, whether they are a part of behavioral addiction or not.
While these behaviors may be behaviors in and of themselves, they may also occur at the same time as substance use, or after substance use. If these cross-addictive behaviors continue after substance use, the brain may pick these up as primary, or they will lead back to primary behaviors or substances. This is because of the way these behaviors affect the reward system and hamper the brains ability to return to optimal and appropriate functioning and reward processing. Ideally, in order for the brain to heal as quickly as possible, the individual would be secluded in an environment where they only have access to food, water, and perhaps some exercise and counseling. This will provide the brain with time to acclimate back to normal levels of dopamine and hierarchical reward prioritization.
Since of these behaviors will co-occur, some will continue after the primary substance or behavior is put down, and some will be picked up to fill the void that may be left in recovery. This needs to be filled with something that is healthy and will bring about a sense of connectedness, rather than isolation and emptiness. As long as the individual continues to use other behaviors or justifiable substances, the brain will have a hard time healing. The individual will stay in this cycle as the brain continues to experience dopamine releases in an abusive way and it will remain in a state of seeking.
Treatment and Aftercare
Treatment for these behaviors will occur in a very similar way. Treatment facilities exist for eating disorders, counseling exists for sex addiction, and 12-step fellowships exist for gambling. There is no real difference, though on a 12-step level, we recommend finding a group specific to your substance or behavior. It will not be helpful to walk into an AA meeting for your gambling problem, that is what Gamblers Anonymous is for. Additionally, 12-step recovery will provide opportunity to meet supports that will understand the uniqueness of your issues and be able to support you in this change. Don't do this alone, because you don't have to!
We also highly recommended some form of counseling in conjunction with 12-step recovery, either after treatment, or as primary treatment. We also recommend working on your recovery environment. It will be difficult to walk right back into a trigger infested home, work, or friend group. So, changes will need to be made in people, activities, places, and even things within the household that were associated with active use.
At Independent Recovery, we're emphasize treating the whole person, and all of the associated behaviors that are supporting active use or preventing recovery. If you or a loved in have additional issues that need to be addressed, please reach out to us for a free consultation. Head on over to our Get Started page and we will be in touch with you shortly!