The characterization of excessive or compulsive behaviors as non-substance addictions is a current controversy in psychological research. During the development of the DSM-5, workgroups were assigned to determine if any behavioral “addictions” could be listed with comparable criteria to substance addictions. Only one, gambling disorder, was considered to have sufficient evidence to support its inclusion as a separate disorder (Potenza, 2014). Another behavior, internet gaming, was identified as a potential disorder that required further research before it could be specified with its own criteria.
However, there are a number of behaviors that laypersons and some clinicians and researchers view as potentially addictive: eating, food, sex, love, shopping, general Internet use, social media, pornography, television, and work (Thege et al., 2015). At least some of these behaviors, when carried to extremes, can be considered at least as damaging to a person’s life as drugs and alcohol. For example, a person who is addicted to food may die of complications from morbid obesity. People who are addicted to sex often have frequent affairs that can ruin a “monogamous” relationship, engage in unsafe and sometimes anonymous sexual relationships that can lead to serious disease, and may lose their jobs if they are accused of sexual harassment. A person addicted to pornography may be unable to stop viewing it a work and therefore lose his or her job.
Addiction is thought to occur when a substance stimulates receptors in the dopaminergic and endogenous opioid-based reward systems of the brain (Karim & Chaudhri, 2012). These are the same systems of the brain that motivate people to get their survival needs met. Some, though not all, imaging studies such as fMRI and PET scans have shown similarities between the brains of substance addicts and proposed behavioral addicts (Fisher, 2015). The mesolimbic dopamine pathways appear to be especially important, including the neurons that connect the ventral tegmental area of the brain to the nucleus accumbens (Potenza, 2015). These neurons are networked with other regions, such as the amygdala (which provides the emotional context), the hippocampus (the memories which lead to anticipatory pleasure and cravings) and the frontal cortex (including decision-making and impulse control centers). If the reward system goes into overdrive, the natural limiting factors such as satiety can be pushed out of the way, leading to out-of-control behaviors and cravings (Karim & Chaudhri, 2012). According to Potenza (2015), features that are common between substance and behavioral addictions are cross-sensitization, brain function, and neurochemistry. Cross-sensitization is an important factor in co-morbidity of both substance and non-substance addictions; evidence shows that a person exposed to an addictive substance can become sensitized to a natural reward such as food or sex.
Whether a person is addicted to a substance, a behavior, or both, the first step in recovery is the understanding that the substance or behavior is damaging to his or her life and relationships. Some individuals can stop their addictions suddenly, while others must gradually reduce their intake or behavior. Behaviors such as eating or sex, which are part of human survival, are especially problematic because stopping completely may be impossible (Potenza, 2015). People can experience psychological and physical withdrawal symptoms with both substances and behaviors. The other crucial part of addiction recovery is the treatment of comorbid mental illnesses such as depression, bipolar disorder, or schizophrenia (Karim & Chaudhri, 2012).