Are Addictions to Behaviors or Activities Real Addictions?
Updated September 03, 2013.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Case For
The patterns of development of each addiction, the thought process involved, the reward cycle that maintains addictive behaviors, the social and relationship consequences, and the process of recovery have a great deal in common across addictive behaviors. If we recognize that the addiction process itself, rather than the particular substance or behavior, is what is causing the problems that people with addictions face, many difficulties with the current system of classification and treatment can be overcome.
Understanding, for example, that it is not gambling per se that is causing the gambling addict to lose everything, but a process of avoiding the reality of his situation, allows a therapist to work with him in facing up to, accepting, and improving his life. In the same way, understanding that a drug user, binge eater, excessive exerciser, or obsessive bargain hunter are all using these behaviors to try and avoid the stress of their lives, and in the process, are making things worse, allows therapy to focus on resolving this, rather than fixating on the behavior itself.
An inclusive model of addiction also allows us to adequately prepare people for the risk that they will not only relapse to their previous addictive behavior, but that they also risk developing another addiction. This common problem is a result of not learning effective coping skills to deal with life stresses, and, with the focus on the previous addictive behavior, to develop the same addictive pattern with another behavior.
Treatment approaches, such as the stages of change model and motivational interviewing, are successful in treating addictions of all kinds. Recognition of the addictive process as the primary driving force behind all addictive behaviors, whether they are focused on a substance or an activity, allows many more people to be helped in integrated addictions services. Some of these services already exist, and the inclusion of different addictions in group therapy is highly advantageous to the therapeutic process, as people disengage from the specific behavior and recognize instead what it is doing for them, and how to meet this need in a healthier way.
Another positive aspect of the recognition of behavioral addictions as real addictions is that it de-emphasizes the inadequate disease model of addiction, which has run its course and no longer serves its original purpose.
Case Against
An important argument against the inclusion of a range of behaviors in a concept of addiction is that they may not be addictions. While the patterns might be the same, it is possible that addiction to substances is a completely different process from compulsive behaviors. As Dr Christopher Fairburn stated: "The fact that things are similar or have properties in common does not make them the same. And focussing exclusively on these similarities... distracts from the difference between these behaviors."
Another argument against including non-substance behaviors in a theory of addiction is that the physical consequences of alcohol and drug use are so severe that including less harmful activities dilutes the importance of "genuine" addictions, and makes them more socially acceptable. This trivializes the severity of alchol and drug dependence, making these substances seem as harmless as spending too much at the mall or overindulging in chocolate cake.
Also, some people think that including non-substance activities as addictions means that the term is used so loosely that it could be applied to any behavior, and everyone could be seen to be addicted to something. Jim Orford quotes another psychologist, Hans Eysenck, as saying, "I like playing tennis and writing books on psychology; does that mean that I am addicted to tennis and book writing?"
Where It Stands
As we await the DSM-V, the word "addiction" is part of popular culture. The media continues to use the addiction label to describe excessive behavior, and it is used in everyday language as people seek help for their own excessive behavior, and that of their loved ones.
In response to critics of the inclusive addiction approach:
Individual and special aspects of each addictive behavior can be addressed while people work on the psychological aspects of their addiction, and can be integrated with medical approaches.
The facetious argument that addiction could be applied to anything anyone enjoys is missing the point. It is not enjoying an activity that makes it an addiction, it is engaging in it so excessively that other areas of life suffer. If Hans Eysenck was playing so much tennis that his health and relationships were suffering, absolutely, he could be addicted to tennis playing. The same goes for his book writing.
Sources
American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders." (4th Edition – Text Revision), Washington DC, American Psychiatric Association. 1994.
Bradley, B. "Behavioural addictions: common features and treatment implications." British Journal of Addiction. 85:1417-1419. 1990.
Fairburn, C. Overcoming Binge Eating. New York: Guilford. 1995.
Hartney, E., Orford, J., Dalton, S. et al. "Untreated heavy drinkers: a qualitative and quantitative study of dependence and readiness to change." Addiction Research and Theory 2003 11:317-337. 25 Aug. 2008.
Holden, C. "'Behavioral' Addictions: Do They Exist?" Science, 294:5544. 2001.
Klein, Ph.D., Marty. "Sex Addiction: A Dangerous Clinical Concept." Electronic Journal of Human Sexuality 5. 2002. 27 December 2009.
Kreitman, N. "Alcohol consumption and the preventative paradox." British Journal of Addiction 88:349-362.
Marks, Isaac. "Behavioural (non-chemical) addictions."British Journal of Addiction 1990 85:1389-1394. 25 Aug 2008.
Orford, Jim. “Excessive Appetites: A Psychological View of Addictions” (2nd Edition). Wiley, Chicester. 2001.
National Institute on Drug Abuse (NIDA), Research Report Series - Heroin Abuse and Addiction. 2005.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Case For
The patterns of development of each addiction, the thought process involved, the reward cycle that maintains addictive behaviors, the social and relationship consequences, and the process of recovery have a great deal in common across addictive behaviors. If we recognize that the addiction process itself, rather than the particular substance or behavior, is what is causing the problems that people with addictions face, many difficulties with the current system of classification and treatment can be overcome.
Understanding, for example, that it is not gambling per se that is causing the gambling addict to lose everything, but a process of avoiding the reality of his situation, allows a therapist to work with him in facing up to, accepting, and improving his life. In the same way, understanding that a drug user, binge eater, excessive exerciser, or obsessive bargain hunter are all using these behaviors to try and avoid the stress of their lives, and in the process, are making things worse, allows therapy to focus on resolving this, rather than fixating on the behavior itself.
An inclusive model of addiction also allows us to adequately prepare people for the risk that they will not only relapse to their previous addictive behavior, but that they also risk developing another addiction. This common problem is a result of not learning effective coping skills to deal with life stresses, and, with the focus on the previous addictive behavior, to develop the same addictive pattern with another behavior.
Treatment approaches, such as the stages of change model and motivational interviewing, are successful in treating addictions of all kinds. Recognition of the addictive process as the primary driving force behind all addictive behaviors, whether they are focused on a substance or an activity, allows many more people to be helped in integrated addictions services. Some of these services already exist, and the inclusion of different addictions in group therapy is highly advantageous to the therapeutic process, as people disengage from the specific behavior and recognize instead what it is doing for them, and how to meet this need in a healthier way.
Another positive aspect of the recognition of behavioral addictions as real addictions is that it de-emphasizes the inadequate disease model of addiction, which has run its course and no longer serves its original purpose.
Case Against
An important argument against the inclusion of a range of behaviors in a concept of addiction is that they may not be addictions. While the patterns might be the same, it is possible that addiction to substances is a completely different process from compulsive behaviors. As Dr Christopher Fairburn stated: "The fact that things are similar or have properties in common does not make them the same. And focussing exclusively on these similarities... distracts from the difference between these behaviors."
Another argument against including non-substance behaviors in a theory of addiction is that the physical consequences of alcohol and drug use are so severe that including less harmful activities dilutes the importance of "genuine" addictions, and makes them more socially acceptable. This trivializes the severity of alchol and drug dependence, making these substances seem as harmless as spending too much at the mall or overindulging in chocolate cake.
Also, some people think that including non-substance activities as addictions means that the term is used so loosely that it could be applied to any behavior, and everyone could be seen to be addicted to something. Jim Orford quotes another psychologist, Hans Eysenck, as saying, "I like playing tennis and writing books on psychology; does that mean that I am addicted to tennis and book writing?"
Where It Stands
As we await the DSM-V, the word "addiction" is part of popular culture. The media continues to use the addiction label to describe excessive behavior, and it is used in everyday language as people seek help for their own excessive behavior, and that of their loved ones.
In response to critics of the inclusive addiction approach:
Individual and special aspects of each addictive behavior can be addressed while people work on the psychological aspects of their addiction, and can be integrated with medical approaches.
The facetious argument that addiction could be applied to anything anyone enjoys is missing the point. It is not enjoying an activity that makes it an addiction, it is engaging in it so excessively that other areas of life suffer. If Hans Eysenck was playing so much tennis that his health and relationships were suffering, absolutely, he could be addicted to tennis playing. The same goes for his book writing.
Sources
American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders." (4th Edition – Text Revision), Washington DC, American Psychiatric Association. 1994.
Bradley, B. "Behavioural addictions: common features and treatment implications." British Journal of Addiction. 85:1417-1419. 1990.
Fairburn, C. Overcoming Binge Eating. New York: Guilford. 1995.
Hartney, E., Orford, J., Dalton, S. et al. "Untreated heavy drinkers: a qualitative and quantitative study of dependence and readiness to change." Addiction Research and Theory 2003 11:317-337. 25 Aug. 2008.
Holden, C. "'Behavioral' Addictions: Do They Exist?" Science, 294:5544. 2001.
Klein, Ph.D., Marty. "Sex Addiction: A Dangerous Clinical Concept." Electronic Journal of Human Sexuality 5. 2002. 27 December 2009.
Kreitman, N. "Alcohol consumption and the preventative paradox." British Journal of Addiction 88:349-362.
Marks, Isaac. "Behavioural (non-chemical) addictions."British Journal of Addiction 1990 85:1389-1394. 25 Aug 2008.
Orford, Jim. “Excessive Appetites: A Psychological View of Addictions” (2nd Edition). Wiley, Chicester. 2001.
National Institute on Drug Abuse (NIDA), Research Report Series - Heroin Abuse and Addiction. 2005.
