What is Process Addiction and its Ties to Substance Abuse?Anna Ciulla
At first glance, it might seem like an addiction to substances like alcohol, cocaine, heroin and prescription drugs has nothing in common with process addiction. However, there is increasing scientific evidence that process addictions share important similarities, as well as differences, with substance abuse and substance use addiction.
DEFINITION OF PROCESS ADDICTION
Use of the term “process addiction” is a recent phenomenon. Previously, nonsubstance addictions were called “impulse control disorders,” and later, “behavioral addiction.” A process addiction is any compulsive behavior that interferes with everyday functioning and causes significant and continuing negative problems or consequences.
TYPES OF PROCESS ADDICTIONS
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling and gambling disorder (GD) is the only nonsubstance addictive disorder described and classified in the section covering substance use disorders.
Other process disorders that may be considered in future editions and now listed as conditions that may need additional research include Internet gaming disorder and Internet addiction. Compulsive sexual behaviors (which include problematic pornography use) are likely to be considered, particularly with respect to the next revision of the International Classification of Diseases and Related Mental Health Problems (ICD-11) currently under development by the World Health Organization (WHO). Other behavioral addictions that were previously classified as Impulse Control Disorders Not Otherwise Classified either stay in this category or are otherwise reclassified.
Behavioral addictions often discussed, although scant research is being done on these types of process addictions at present, include shopping addiction, other forms of technology addiction like smartphone addiction, exercise addiction, compulsive eating and other eating disorders.
HOW IS PROCESS ADDICTION SIMILAR TO SUBSTANCE USE DISORDERS?
Research shows close similarities between substance use disorders and behavioral or process addiction, particularly gambling disorder, currently the only nonsubstance-use behavior classified with substance use disorder (SUD) in DSM-5. Shared genetic and/or environmental factors may link gambling disorder and SUDs. In fact, twin studies show a common genetic vulnerability for both disorders in men with pathological gambling and alcohol dependence, suggesting the two may co-occur. Another study of pathway analysis agreed with previous genetics studies research that showed a genetic overlap between nonsubstance- and substance-related addictions.
As with SUDs, researchers have proposed that specific neurotransmitters contribute to gambling disorder, including dopamine influencing reward behaviors, norepinephrine for arousal and excitement, and serotonin, thought to be linked to impulse control, and opioids, hypothesized to link to cravings and motivations. In addition, according to findings, dysfunction involves similar brain regions, including the ventromedial prefrontal cortex, striatum, and neurotransmitter systems. Similar deficits in neurocognition occur in nonsubstance-related behavioral addictions and SUDs, including the area of executive function. Characteristics of process addictions include compulsive and repetitive rewarding behavior that’s not related to substances, and continued use despite ongoing and increasingly negative consequences of use. Obsessive preoccupation with the activity and an inability to control behavior are other similarities between process addictions and substance abuse.
Taking gambling disorder as an instance, the following criteria are mentioned in DSM-5 for diagnosable criteria (significant impairment or distress as indicated by four or more criteria in a 12-month period):
- A need to gamble with ever-increasing amounts of money
- Feeling restless and irritable when trying to stop or cut down
- Repeated unsuccessful efforts to stop
- Preoccupation with gambling
- Gambling when feeling distressed
- “Chasing” losses to recoup or win big
- Gambling jeopardizes relationships
- Gambler relies on others to solve financial problems or fix problems caused by gambling
Similarities between Internet gaming disorder and pathological gambling have focused on impulsivity, compulsivity and reward/punishment sensitivity. Many similarities in brain functioning and behavioral alterations have been noted, such as decreased sensitivity to loss, increased reactivity to cues of gambling and gaming, increased instance of impulsive choice behavior, maladaptive reward-based learning, and no cognitive flexibility changes. However, more research is needed to address the neurobiological underpinnings of Internet gaming disorder before it can be included as a second behavioral addiction (after gambling disorder) in the DSM-5.
With smartphone addiction, hearing the constant ring or notification of an incoming message, call or text, say experts, likely releases dopamine in the brain, making the user feel good and indicating that there’s a reward there. Over time, just the anticipation of the ping can become more powerful than the actual reward, as research has shown that dopamine levels in the brain can be double when anticipating reward versus receiving the reward. In this way, whether it’s anticipating the win in gambling, or playing Internet games, how good a buzz will feel from alcohol or the euphoria from doing drugs, both process and substance abuse are similar.
HOW DO PROCESS ADDICTIONS DIFFER FROM SUBSTANCE USE DISORDERS?
The most obvious difference between process addictions and substance use disorders is that there is no substance involved in process addictions. The person addicted to gambling or shopping or Internet or technology use isn’t consuming a substance that’s addictive, although he or she may be addicted to alcohol or drugs and concurrently engage in addictive behavior along with a compulsion to gamble or shop or other process addiction. In other words, they may have a second (or more) addiction beyond the behavioral addiction. Yet, it’s not a substance that’s responsible for the addiction with gambling, for example. It’s the rush, the compulsion, the aberrant reward-learning involved with the activity.
In addition to the consumption or use of the substance, another difference is the harmful direct effects of the drug on the brain and body with continued use of alcohol, illicit or prescription drugs used for nonmedical reasons. That additional chemical dependency doesn’t occur with process addictions, although there are brain changes associated with both types of addiction, such as neurochemical and psychological processes that are visible on brain imaging.
Another key difference between process addiction and substance abuse is that there’s no physical withdrawal experienced with the former, while the latter carries varying types and levels of intensity of withdrawal. For example, withdrawal from heroin or other opiate drugs may precipitate withdrawal symptoms ranging from early mild agitation, anxiety, muscle aches, insomnia and sweating to later moderate or stronger ones such as vomiting, diarrhea, nausea, dilated pupils, goose bumps and abdominal cramping. Long-term heroin changes in the brain and body include impaired memory and emotions, decreased decision-making ability, kidney failure and intestinal problems. Alcohol withdrawal, on the other hand, can be serious and life-threatening, with the symptoms ranging from mild to severe, including hallucinations, delusions, seizures, fever, high blood pressure, racing heart and more.
TREATMENT CAN HELP
What may have started as a way to pass time, socialize with others, serve as a distraction or to numb pain may have developed into a full-fledged addiction. Sometimes, becoming dependent on substances and/or psychologically compelled to engage in certain behaviors takes over your life to the extent that consequences mount and you feel overwhelmed and unable to change. Treatment is available to help in overcoming physical dependence and addiction, learn to cope with psychological and physical cravings and urges, identify triggers to use, how to cut down or eliminate usage, adopt healthier behaviors and lifestyle, and find new meaning and purpose in life.
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