Non-Substance Addiction

Overview

Addiction generally describes a medical disease where interactions between brain circuitry, genetics, the environment, and a person’s life experience can cause a person to be unable to stop an activity that has harmful consequences.[1,2] The compulsive nature of addiction can make it very difficult for an individual to handle on their own, but treatments for addiction are generally successful.[3] The inability to stop an action that has a strong negative impact on someone’s life could be a sign to reach out for professional help.

The DSM-5 is the first DSM to officially recognize the existence of non-substance use disorders.[4] They can be defined as, “Compulsive, excessive, and repetitive engagement in a risky behavior or activity while being unable to stop the activity.”[5] Behavioral addictions belong in one of two groups: passive or active.[6] Passive addictions include television and internet usage, whereas active addictions include playing computer games and nail biting.[7] Addictions usually contain features that are usually “inducing and reinforcing features” which makes the addictive tendencies more likely.[8]

There are also two systems of thinking, System 1 and System 2. System 1 thinking is a near-instantaneous process driven by instinct and experiences. It occurs automatically, intuitively and with little to no effort.[9] Conversely, System 2 thinking is conscious, logical, slower to occur and requires more effort.[10] The mental processes of addiction tend to be primarily done through System 1 thinking.[11]

Examples & Prevalence

Researchers from Jönköping University reviewed and analyzed peer-reviewed papers between December 2019 and July 2022 that combined participants from over 40 countries.[12] The average age of the participants was 25 years old, and 57.41% were females; from the data, the researchers noted the prevalence of the following behavioral addictions:[13]

Smartphone (30.7%)
Food (21.0%)
Social Media (15.1%)
Internet (10.6%)
Sex Addiction (9.4%)
Pathological Gambling (7.2%)
Shopping (7.2%)
Exercise Addiction (7%)
Gaming (5.3%)

Behavioral addictions are not limited to these examples and can include any activity that a person is unable to control or stop and puts an unnecessary strain on their personal or professional life.[14] For example, roughly 85% of 12 to 17-year-olds use social media every day, for an average of about 3 hours (166 min); girls tend to utilize social media more than boys (182 min versus 151 min).[15]

Prevalence of addiction also increased, in part, due to the recent pandemic. Daglis (2021) explains that during the lockdown of COVID-19, many people were stuck inside, and therefore their lifestyles changed tremendously. This increased the likelihood of participating in some addictive behaviors that have continued to worsen and rise in occurrence to this day.[16]

Symptoms

There are many symptoms of a behavioral addiction, many of which are associated with substance abuse. Such symptoms include being unable to stop the activity and often being unable to recognize how the activity has a negative effect on the individual. With an addiction, a person develops an intense and insatiable craving for the activity or behavior. This craving causes the person to be unable to recognize the consequences of the health, financial, emotional, and physical impacts of a behavior.[17,18] This may strain personal and work relationships, and can make people around them uncomfortable.[19,20]

An addiction can also result in an increased tolerance to the activity, meaning a person might need to participate in the addiction more to feel similar euphoric feelings to the beginning of their addiction.[21] An intense focus on the activity can take over a person’s thoughts and actions, which can cause them to feel overwhelmed by their addiction and helpless to stop it.[22] This can cause feelings of guilt or depression, and often makes a person’s life more difficult.[23] As a result, people tend to minimize the impacts of their addiction.[24]

Causes

The causes of a non-substance behavior addiction are wide-ranging and can be difficult to prevent in advance. Psychologists believe that the wiring of the brain can predispose certain individuals to a “Combination of reward, motivation, and memory in an unhealthy way.”[25] This addiction to thrill and potential dopamine spikes cannot be prevented or even avoided, but can be dealt with from proper treatment from a professional therapist. There are, however, certain environmental triggers (e.g., adverse childhood experiences) that can be identified by the individual or mental health professional that can be the psychological or neurological basis for the addiction.[26]

Another risk factor for addiction is impulsivity, which is defined as impulsive action with a lack of behavioral inhibition without regard to potential negative consequences or an an impulsive choice by a failure of self control or inability to delay gratification.[27] While impulsivity is much more common in younger individuals, regardless of age, it is considered one of the leading predisposing causes of behavioral addictions.[28]

Neural Factors/Risk Factors

There are many similarities between both substance and non-substance use disorders. It is possible that they have an effect on each other, and potentially occur through similar neural pathways.[29]

The Cleveland Clinic notes that the factors that go into addiction can be very complex and that it alters a person’s brain chemistry.[31] Biologically, humans are motivated to seek rewards, and specifically, the pleasurable feelings that come from the release of dopamine.[32] An unhealthy cycle can be created where rather than being driven to do what we need to survive (e.g., work, eat), we seek out unhealthy activities that create big dopamine spikes that cause us to become desensitized to their effects over time.[33]

Certain factors that can make a person more susceptible to risk of addiction include genetics, mental health conditions, and environmental factors. The Cleveland Clinic suggests that genetic factors are responsible for up to 40-60% responsible for the development of an addiction.[34] Furthermore, there is a strong link between addiction and specific mental health conditions such as PTSD, bipolar disorder, and depression; roughly half of people with a mental health disorder will develop an addiction and vice versa.[35] Additionally, environmental factors such as easy access to potential addictors and the addiction occurring in one’s household can further increase the likelihood of developing an addiction.[36]

Components of Diagnosis and Treatment

Overcoming addictive behaviors typically occur in the Four Stages of Change:[37]

Precontemplation - People in this stage do not feel that their behavior is a problem.
Contemplation - People in this stage are beginning to think about modifying their behavior and are more open to considering the consequences of their behavior.
Preparation - People in this stage begin to plan what kinds of change are necessary. They obtain the resources necessary and remove the triggers of their addiction.
Action - People in this stage attempt to overcome their addiction and is the stage where a real change in behavior begins to occur.

Potential additional stages:
Maintenance - People in this stage are trying to uphold and continue the intentions and processes made in previous stages. Many consider it the most difficult stage.
Relapse - People in this stage have made one or multiple lapses in the maintenance stage. This stage could send a person back to any of the prior stages.

Behavioral addictions and substance use disorders usually respond similarly to the same psychosocial and pharmacological treatments.[38] Certain treatments typically used for opioid dependence and alcoholism were shown to be effective in the treatment of kleptomania and pathological gambling. They also showed potential in addictions such as compulsive buying, compulsive sexual behavior, internet addiction, and skin picking.[39]

When patients are in the process of detoxification from their addiction, they have reported “feelings of insomnia, depression, anger, and panic.”[40] Having support from a therapist while in the process of detoxification can help the patient stick to their treatment program through positive reinforcement while also being available to answer the patient's questions and help decipher their emotions.[41]

Treatment should be highly specific to what the patient is reporting. Psychologists suggest using certain therapies like cognitive-behavioral, group, and contingency management.[42] Even though drug and alcohol addictions are more common, there are often opportunities to utilize support groups that assist overcoming a particular behavioral addiction.[43]

Self-care

BoardPrep Recovery suggests the following self-care measures for those suffering from addiction:[44]

Surround yourself with positive influences
Make connections with others a priority
Regular exercise
Sufficient sleep
Healthy diet

It’s important to note that certain non-substance addictions (e.g., nail-biting) may be extremely difficult to avoid the stimulus. One potentially effective way one can try to interrupt the System 1 thinking common with behavioral addictions is through practicing mindfulness. There are many ways to practice mindfulness, such as through:[45]

Yoga
Practice gratitude
Deep breathing exercises
Progressive muscle relaxation
Meditation

The effects of non-substance use disorders can be devastating if untreated. However, further research and wider understanding of the subject can help greatly improve the diagnosis and treatment of people who suffer from these kinds of addiction.

If you would like to explore more about behavioral addictions, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for additional guidance and support.

Contributed by: Jack Eisinger

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Smith, C. (2018, October 8). Behavioral Addictions, What Are They? - Addiction Center. AddictionCenter. https://www.addictioncenter.com/community/behavioral-addictions/.

2 American Society of Addiction Medicine. (2019). Definition of Addiction. ASAM. https://www.asam.org/quality-care/definition-of-addiction.

3 Ibid.

4 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.

5 Staff, Familydoctor. org E. (2023) Non-substance addiction, familydoctor.org. Available at: https://familydoctor.org/condition/non-substance-addiction/#:~:text=A%20non%2Dsubstance%20addiction%20includes,stop%2C%20it%20becomes%20an%20addiction. (Accessed: 23 October 2023).

6 Alavi, S. S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., & Setare, M. (2012). Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views. International Journal of Preventive Medicine, 3(4), 290–294.

7 Ibid.

8 Ibid.

9 Available, N. (2023). System 1 and System 2 Thinking - The Decision Lab. The Decision Lab. https://thedecisionlab.com/reference-guide/philosophy/system-1-and-system-2-thinking.

10 Ibid.

11 Ibid.

12 Alimoradi, Z., Lotfi, A., Lin, C.-Y., Griffiths, M. D., & Pakpour, A. H. (2022). Estimation of Behavioral Addiction Prevalence During COVID-19 Pandemic: A Systematic Review and Meta-analysis. Current Addiction Reports. https://doi.org/10.1007/s40429-022-00435-6.

13 Ibid.

14 Staff (2023)

15 Geisel, O., Lipinski, A., & Kaess, M. (2021). Non-substance addiction in childhood and adolescence—the Internet, computer games and social media. Deutsches Aerzteblatt Online. https://doi.org/10.3238/arztebl.m2021.0002.

16 Daglis, T. (2021). The Increase in Addiction during COVID-19. Encyclopedia, 1(4), 1257–1266. https://doi.org/10.3390/encyclopedia1040095.

17 Staff (2023)

18 Cleveland Clinic. (2023, March 16). Addiction. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/6407-addiction.

19 Staff (2023)

20 Cleveland Clinic (2023)

21 Ibid.

22 Ibid.

23 Ibid

24. Elizabeth Hartney. (2023, September 6). How to Live With and Treat Behavioral Addiction. Verywell Mind. https://www.verywellmind.com/addictive-behaviors-4157291.

25 Staff (2023)

26 Ibid.

27 Chuang, C.-W. I., Sussman, S., Stone, M. D., Pang, R. D., Chou, C.-P., Leventhal, A. M., & Kirkpatrick, M. G. (2017). Impulsivity and history of behavioral addictions are associated with drug use in adolescents. Addictive Behaviors, 74, 41–47. https://doi.org/10.1016/j.addbeh.2017.05.021.

28 Ibid.

29 Staff (2023)

30 Levinson, P. (2016, June 29). Addictions. Clayton Therapy. https://www.claytontherapy.com/addictions/.

31 Cleveland Clinic (2023)

32 Ibid.

33 Ibid.

34 Ibid.

35 Ibid.

36 Ibid.

37 Elizabeth Hartney. (2022, September 16). The Different Stages of How to Overcome Addiction. Verywell Mind. https://www.verywellmind.com/the-stages-of-change-model-of-overcoming-addiction-21961.

38 Grant et al. (2010)

39 Ibid.

40 "admin". (2020, April 15). What You Need to Know About Non-Substance Addiction. Calm Rehab Bali. https://calmrehab.com/what-you-need-to-know-about-non-substance-addiction/.

41 Ibid.

42 Ibid.

43 Cleveland Clinic (2023)

44 Recovery, B. (2020, February 21). Self-Care as a Preventative Measure Against Relapse. BoardPrep Recovery Center®. https://www.boardpreprecovery.com/rehab-blog/self-care-as-a-preventative-measure-against-relapse/.

45 Staff, M. (n.d.). Relaxation techniques: Try these steps to reduce stress. Mayo Clinic. Retrieved October 26, 2023, from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-technique/art-20045368#:~:text=Other%20relaxation%20techniques%20may%20include.