Behavioral Addiction Basics
Marc Kern (Addiction Expert, Director of Addiction Alternatives) gives expert video advice on: How is a behavioral addiction similar to a substance behavioral addiction?; What is an "addictive personality"?; What can be done about an addictive personality? and more...
What is "behavioral addiction"?
Addictions are not neccessarily bad things, or at least they never intend to be bad things. They are ways people look to "elixers", I call them, to cope with life, bad feelings, bad events, and they're always adaptive at first.The way I define addiction is "an adaptation to life that has gone awry." What happens over time is that adaptation goes down a wrong road or a bad road or a "Y" and the person is locked into it.
How do I go from participating in a behavior to developing a behavioral addiction to it?
Virtually everybody has addictions. It's normal to have habits, and people engage into these habits all the time. And we actually need habits to survive, otherwise we would wake up every day and say, "Well, how do I tie my shoe?" We have to habituate. So people go into these activities pretty much like they go into any new activity: they learn it, it works, they do it again. Now, what evolves over the course of time is they learn to lean on that one methodology, that one coping skill, all too much. There is sort of a back end that addiction has, where you can't extricate, you cannot unravel yourself, and a force called tolerance starts to act, where you need more and more of the same thing to get the same outcome. So there is a snowballing effect, where you're locked in and you can't do anything to go forward.
How is a behavioral addiction similar to a substance behavioral addiction?
In actuality, all addictions are the same and a substance is no different than a behavior. There must be something reinforcing, it must make you feel better for you to do it again. If you go gamble and you go to Las Vegas, you get excited, you win a big amount of money, you're gonna feel good, it's just like doing a drug. There is an emotional component or people don't to return to it. People don't become addicted to celery because it doesn't make them feel better. So a process or a behavior is just as addicting as a substance because it has the ability to change the way the person feels or experiences something.
Is the physical experience of behavioral addiction the same as the physical experience of substance addiction?
Pharmacologically, biologically, it's exactly the same with substance versus a behavior. One is just with the outside substance; the other one is sort of part of the process, part of doing it over and over again. There is a reward in it. People do not do things if there's no reward in it unless they feel better after it's all done. Like video games, it's fun. What's fun? A feeling.
What is an "addictive personality"?
That's a very controversial topic in the field. Research has not shown to be that there is a specific addictive personality but the reality is there are some people that are looking for good feelings all the time. They kind of organize their life around good feelings. So, there's part of that addictive personality, part of the addictive personality is very impulsively do things without a lot of forethought, there's not thinking about consequences.
What is the cognitive-behavioral approach to behavioral addiction?
First of all, it's a distinct discipline. It is based on the assumption that thinking leads to feelings that leads to behavior. It's sort of like a triangle. And that if you change one's thinking about something, you can change the way they feel about it. You can change the way feel about it, you can change the way they act upon it. An addiction is just a thinking method or a belief method. Certain beliefs lead to feelings that lead to behaviors, and they are often irrational, illogical, excessive, exaggerated beliefs. A cognitive behavioral therapist will focus primarily on the thinking component, will intervene first, talk about the thinking that leads to these feelings or behaviors.
What does "obsession" or "obsessive" mean?
It's just sort of a high faluting technical term that just sort of means sort of excessive thoughts. Thoughts that go around and around and around that are about a particular topic, over and over again, obsessing about a belief or a thing that happened. It's just more of a repetitive idea, or can even be thought of as an obsession.
What does "compulsion" or "compulsive" mean?
Compulsive means to do the behavior over and over again. I know people who find comfort, a good feeling, by straightening out pencils on a desk. That could become compulsive if that's the only way you can bring about calm inside and good feelings. So behaviors are compulsive, and thoughts are obsessive.
Am I at risk for behavioral addiction?
At risk is a very interesting term. The reality is that anybody could, in theory, become, be at risk for developing a behavioral addiction. Certain societies though lend themselves to certain behaviors, for example, gambling is very large in certain populations. That would put someone more at risk for developing a gambling or behavioral addiction. Looking at your mom or dad and what they did on a behavioral level or biological relatives on a behavioral level puts you at risk to develop one behavioral addiction over another behavioral addiction or a substance addiction.
What role do genetics play in behavioral addictions?
The reality is that in all addictions and behavioral addictions included, there is a strong genetic component and a strong social, psychological, component. The research is inconclusive, but it varies to a small percentage to 5-50. If you grew up in a monastery, would you become a gambler? Chances are you wouldn't, even though you might have a biological leaning. So both environment and biology or genetics have a strong bearing on that propensity, that leaning into a particular ritual that we are now calling a behavioral addiction.
Is behavioral addiction driven by the mind or by the body?
It's very difficult to be absolutely concrete about behavioral addiction. Everybody's different. For some people, there's a small genetic component and a large part is psychological or sociological. For others, it's the opposite, where a large part of behavioral addiction is genetically driven and a small part is socially or psychologically driven.
Why are some behaviors more addictive than others?
The reason people get addicted to anything is because it makes them feel good. The reason why people get addicted to gambling is there's a potential for them to feel better at the end of the involvement with the gambling, at least at first. Things don't make you feel better, chances are that you won't repeat it. But the reality is, it's what happens during the first couple of involvements with the behavior. Like, again, genereally speaking, a gambler who wins big toward the beginning of their career has a greater likelihood of becoming an addict. A child or a kid who has video games as a child and he likes the sensations inside, the feelings that it brings about has a larger potential of becoming addicted to that versus me who will pick up a video game and oh well, you know it's kind of corny, I'll put it down. I don't get a positive warm feeling from playing video games right now.
Why does an addict cling to a behavioral addiction, even when their life is in danger?
It's part and parcel of why it's so difficult, is because you have pushed away more adaptable, healthier ways to feel good. You have nothing left, you don't have your family, you don't have your job, you don't have your bank account. Well, you've got this one little, miniscule way of coping with life, of feeling good and you return to it over and over again because you don't have anything left. People with a healthy life have a multitude, I call it a 5 finger approach to life, if they have a little problem with their spouse, they turn to another way of feeling good. But over time that 5 finger approach turns to a 1 finger approach, which we are calling an addiction. It's the only way they know how to bring about a good feeling now, they don't have any other resources.
Why is it so difficult to give up a behavioral addiction?
During the course of involvement in an addiction and we start to give up friendships and ballgames and other ways of feeling good. We go through a process I call "unlearning." We unlearn ways of coping with life. I work with many people that knew how to ask a girl to dance and by the age of thirty they are afraid to. They have unlearned through the course of the addiction working efficiently, effectively, predictably, how to do that. They have unlearned how to go and enjoy a ball team, how to cope with life, how to do hundreds and hundreds and hundreds of things they knew at the age of fifteen, but by the age of thirty, they no longer know how to do because they didn't work as efficiently and effectively as their drug of choice. So, they are now in a stage of unlearning. They feel completely handcuffed, not only by the reinforcement of knowing how to feel good, but by the resources that they once had, or the resources that they would have used or learned at 18, 19, 20, never were developed.
If I'm deeply involved in a behavior but am functioning well, am I an addict?
Some people would consider a person deeply involved in a behaviour but functioning well an addict. I wouldn't consider that person an addict. Just because somebody's become extraordinarily involved in something does not mean, by definition, that they're addicted, especially if all the rest of the domains of their life are being sustained and fulfilled. It would be like saying someone who's an artist and paints all the time is an addict to their art. I think that's a misuse of the term "addiction". Again, as long as the other domains of an individual's life are still maintained, and the behaviour doesn't cause the exclusion of other life and health promotive domains, even though the individual is engaging to it more often than perhaps preferred, it doesn't necessarily mean that it deserves the term "addiction".
What is an "impulse control disorder"?
Impulse control disorder is having low impulse control. Children may say, "I see something I like, some ice cream, I want it, I will go get it". That's what people refer to as "low impulse control" or "impulse control disorder". When one cannot integrate something inbetween the thought and the action that's impulsive behaviour. People do not lose impulse control over night. They do not become addicted over night. That's a very naive sort of concept. People learn better impulse control over certain activities and certain objects, and lesser impulse control over certain activities and certain objects. The better it makes you feel the less impulse control you're going to have over it. Ask any dieter. It doesn't evolve over night, so over time there's a practice of not listening to your own better judgment, and acting upon that which you think or feel. Strong impulse control problems develop, and ultimately can turn into an addiction such as impulse control disorder.
Could a person who has control of their behavior become an addict?
Yes, in fact some addiction can even be a part of that ultimate control. Let's take work addiction for example. In a sense, work addiction is a -you're in control but what are you in control of? You're in control of doing the work that brings you, again key feature, a good feeling. I get a pat on the back, I make more money, or whatever, so impulse and control are sometimes blurred and confused, and it can be actually not an impulse problem, but rather looking to control everything, to control every feeling that could ultimately eventuate in the addiction.
What is a "cross-behavioral addiction" or "dual-behavioral addiction"?
Cross-behavioural addiction, or dual-behavioural addiction, is pretty much the same. Let's say you have an addiction to alcohol, there is a big chance that you might smoke cigarettes or gamble too. The reality is very few people have one addiction and one addiction only, they have cross-behavioural addiction or dual-behavioural addiction. There are particular propensities – biological, genetic propensities, and psychological, social propensities. But, generally, people have multiple ways of making themselves feel good – which we call cross-addiction or dual-addiction. Sometimes, if you ask someone to give up one addiction – in other words, give up the way they know how to make themself feel good – they pick up a cross-addiction, and that way they're substituting one way of feeling good for another way of feeling good.
How do friends and family influence behavioral addictions?
In many respects I don't believe that we should even conceptualize behavioral addictions without conceptualizing in terms of friends and family - your friendships and the network of people that you socialize with. It might even be said that they are addicted too and are enabling the phenomena to go on. But the reality is if you have a behavioral addiction to gambling or spending for example, you're going to associate with gamblers and big spenders and your family may have a leaning to go somewhere like Las Vegas twice a year - the way your community and your family condemn or endorse an activity.
How do addicts lose control of themselves?
Addicts who have lost control of themselves will find they have no more friendships or far fewer friendships - their relationships are destroyed. Their bank account has become empty in order to fuel their addiction. They have no other way of feeling good about themselves other than to return to the singular activity that is the addiction. Over the course of time, addicts lose control or let go of healthy ways of making themselves feel good and suddenly find they're balancing their entire life on this one theology.
Can a person suddenly become an addict?
In my opinion, I don't think that someone can suddenly become a compulsive gambler. I do believe that it can be a sort of hidden or less obvious state of affairs, and life circumstances could be such that, they've suffered maybe a big financial loss, and now they're more susceptible to be looking for a quick fix, a quick out of the particular emotional behavioral dilemma they happen to be in. That may appear as something happening quite quickly, but actually the foundation was laid down years and years ago, and just circumstances set the stage for it.
What is the cognitive-behavioral view of behavioral addiction?
A cognitive psychologist or a cognitive-behavioral psychologist looks at addiction, not as a biological phenomenon, but rather a function of learning and reinforcement, and thoughts and feelings and beliefs that are associated.
What is the cognitive-behavioral goal for an addicted patient?
The cognitive-therapy goal for treating addiction is to reorchestrate the thoughts in such a way that they are reinforcing adaptive healthy behaviors and encouraging letting go of unhealthy behaviors and thoughts. The goal is not necessarily to discontinue one hundred percent, though that may be the case for some people. It's easier to stop at a hundred percent, but the goal is to reorientate the thoughts into a more healthy organization that we all seem to share. But over the course of time, an individual may have evolved into the belief that gambling is the place that makes them feel good as opposed to home life and a white picket fence.
Are addicts allowed to continue their behavior in cognitive-behavioral therapy?
In a cognitive-behavioral therapy framework or harm reduction framework, the idea is management of behavior, thoughts and of the way the addict interfaces with the world. Cognitive-behavioural therapy does not encourage total denial of the leaning or propensity. But, when the thought or the feeling arises, it is not encouraged that the addict should punt it or immediately engage in the behavior, but understand and bring to bear rational, logical thinking about re-engagement of the behavior.
How does cognitive-behavioral therapy work for behavioral addicts?
Cognitive-behavioural therapy is not a single body of techniques. It is grown from a very small number to quite a different sort of pool of interventions. Yes, it maybe one-on-one talk therapy, but unlike dynamic therapy it's not about what happened in childhood. It's all here and now. It's what you can do tomorrow. You talk about triggers; you talk about feelings and thinking that leads to involvement in destructive behaviour. Cognitive-behaviour therapy goes beyond all that talking. Educational homework; assignments will be given with the expectations that you would practice certain strategies about how relax yourself or how just to be with your feelings. A big tool today in cognitive behavioural therapy is to just be with your feelings. Lots of people with addiction hate being with their feelings and they use these behaviours to escape uncomfortable feelings. So, cognitive behaviour will sort of focus on groups, meditation for example, and bio feedback to help one regulate and to stay with just uncomfortable feelings and be able to manage without escaping them.
What happens to a behavioral addict in a cognitive-behavioral therapy session?
A typical cognitive-behavioral session will be nothing more than a therapist and a client talking about their beliefs and how those beliefs lead to a feeling and/or behavior. In part of the orientation in a cognitive behavioral session though will be to suggest external, outside things such as biofeedback, meditation, progressive relaxation, spirituality, religion-anything to foster a re-orientation of the belief system.
What are the "stages of change" and how do they apply to behavioral addiction treatment?
Stages of Change' was developed by Prochaska & DiClemente. It basically was a basis of research about cigarette smoking literature, and it helps cognitive behaviour therapists, in particular, understand the motivation of an individual who's coming in for treatment. The first stage in the 'Stages of Change' is called precontemplation, meaning the client just says, "Well, I don't really think I have a problem." In the twelve steps of the disease model, we call that denial. "I don't really have a problem. You think I have a problem, then that's your problem." The next stage is contemplation. Contemplation is, "Yeah, I've got a problem, but I don't know if I want to do anything about it." That's often the case. Lots of people come in and say, or they say to their spouse, "I know I have a problem, but I don't know if I really want to go through all the misery, or all that stuff to stop." Some people stay in the contemplation phase for years. Sometimes they even go to the grave in the contemplation; they never even evolve out of it. Then the next stage, if there that balance beam of the contemplation phase eventually tips it up, is that they'll then go into the preparation. In other words, they'll pick up a self-help book, or they'll maybe go to a therapist and start to learn about the resources that are available to discontinue this behaviour. If that's successful, they'll move on to what's called the action phase, with action being doing something. They stop gambling. They stop internet surfing. They stop something. That's generally a short phase. From that we can either go to a maintenance phase, where they sustain the change in the behaviour, or there's a relapse. If there's a relapse in the 'Stages of Change Model', we try to bring them back around to not going back to the precontemplation phase, but actively into the preparation phase, and start the cycle all over again. The idea is that we bring to bear certain strategies at certain stages. Most treatment centres assume that the individual is ready for the action phase when they walk in the door, and that's not the case. Rarely does a client, whatever the addiction is, walk in and say "I'm ready to stop." They have to hit bottom; they have to do a variety of different things to get to that place. That's why so many treatments go awry, because there's a false assumption about the motivation of the individual with the addiction.
How does the cognitive-behavioral approach work for behavioral addiction?
Oh, absolutely not, no, a cognitive therapist will bring to bare their tools, their expertises, but appropriately to the stage of change if they're remanded to because of legal complications to a rehab or something like that. We would start with, you know, just exploring is there a problem? Or do you see there being a problem? We wouldn't start, though by saying we gonna start changing your thoughts. We just gonna start with where you at or how you see the problem and as they emerge out of it or not emerge out of it, we'll adjust the innovations to fit their real motivation not the motivation of the person that put them in the treatment center.
To recover from a behavioral addiction, do you have to go through all the stages of change?
Generally speaking, people go through these stages of change when recovering from a behavioural addiction several times. They go all the way from pre-contemplation to action, sometimes to maintenance, and maybe even have a couple of weeks, or months, or years of maintenance and fall prey to the addiction again, then they have to start back all over again. They're not precise, sometimes you skip over certain stages, but they are a general orientation to help the clinician, or the individual, understand. Or the housewife, who wants to understand how to engage her husband, she should not assume that her husband's motivation is, again, the action stage, or necessarily in the contemplation phase, when she approaches him.
What does "harm reduction" mean in behavioral addiction therapy?
Harm reduction is basically a model that has just recently been brought to the field of addictions. Harm reduction is the standard orientation or philosophy of relating to clients or people with addictions. The goal is not necessarily abstinence. The goal with someone with an addiction and going through a harm-reduction approach is that they reduce the harm that it's causing them. For example, we get in our car and we put on our seatbelt not because there's no danger out there, but rather we're going to minimise the danger by putting on our seatbelt so we don't get hurt that bad if there should be an accident. That's the orientation in general medicine. That's brand new or fairly new to the field of addiction because the addiction field has been very biased in that moral, bad-person, sort of philosophy. To suggest anything other than 100 percent abstinence implies that there may be something else going on other than the biological or disease component. So, harm reduction is very progressive, and very provocative, but it is the cutting edge, I believe, of how addictions will be worked with in the future.
How does harm reduction work in behavioral addiction therapy?
In the harm reduction model, again, anything in a positive direction is seen as positive. There is nothing in harm reduction that doesn't suggest that abstinence might be good, but it's not necessarily a criteria. When you walk into a treatment center and it's not harm reduction based, you're asked to become abstinent immediately. There is no conceptualization of anything short of 100% stopping. In the harm reduction model, reducing the amount, frequency, the dangerousness of the method you're using to obtain your drug or whatever it may be, it's seen as progress. It unfolds, and you may stop treatment well before you achieve complete abstinence, and that's alright.
What are the consequences of untreated behavioral addiction?
The results of untreated addictions range dramatically, from virtually nothing, meaning people grow out of them, they mature out of them, they no longer engage in the behavior, they're not age-appropriate; to others that manifest continued escalation and potentially, ultimately, death or serious life consequences. So it varies considerably about what happens to the individual, based on the addiction, and everything about what are the ultimate consequences.
Is behavioral addiction just a developmental stage?
Some people mature out of them, meaning something that's important like video games might be very important during adolescent years, it may turn into a different addiction in their early adulthood, or they may mature out of it and not have any sort of addiction at all. Other people with alcohol problems or other kind of addictions, you know, as they age, they mature out of it. But that's not to say that there aren't people that, as they age, it actually escalates. It's a very individual sort of phenomenon that you can't really sort of say, "This is always what happens." In fact, that's one of the things I get upset about is because in the disease model, they always say it will eventuate in death or something very serious, and that's not what the research says, and many people have even been diagnosed as alcoholics actually return to moderate drinking, or some sort of less problematic association with their addiction.
What are the warning signs of behavioral addiction in a friend or family member?
There is no singular line that I can say "Once this happens then you should intervene as a loving family member". It's mostly about: the severity of the behavioral addiction, the consequences of it, the amount of time being spent on the involvement with the behavior and the type of behavior it is. To be frank, most family members don't even know what's going on, they just sort of suspect something is going on without knowing the specifics. It's generally better to just sit a family member (if you can) down and just talk about it rationally and (of course) non-moralistically to get an answer about what they think is going on. Again, your definition of behavioral addiction may not be their definition, and it's important not to put labels on the addict - "You're in denial because you're not in agreement with me". Rather, accept their perspective on it and move from there, and be available as the addict says "I want more and more help."
What is the role of family in a person's behavioral addiction?
We can go so far to say that there are actually schools of thought that say that addictions do not lay within the individual, they lay within the family. It is not that we have sort of a scapegoat or an individual who has the addictive problem, but in actuality there is an active collusion with everyone that interacts with the addict and they too are engaged in many sort of ritualistic behaviours, we call them even addictions, that support or endorse the addictive behaviours; look the other way when they shouldn't be looking the other way. So, the family is intimately involved, especially if it's a close family rather than someone who has left home, become self-sufficient and gotten involved in these addictive behaviours. I can't stress enough actually how important the role of the family is, and any time I recommend a client to get into treatment for their addiction, I recommend the family do it as well. Yet, it's amazing to see how resistant the family is to own any component of the problem. They don't want to have anything to do with it. "It's that person's problems, they're off, they should be fixed, and we have nothing to do with it." That's not the case, and that's part of the denial of the family that keeps the perpetuation going.
What role can a family play in helping a behavioral addict?
Ultimately, a good program would include the involvement in probably one-on-one work for the addict, as well as perhaps even one-on-work with the wife. And then some family work, where the extended family, and perhaps even the children, are involved, as well as the grandparents, where everybody is sort of on the same track. Part of the problem with recovery is, somebody goes into a treatment center or whatever, and they return to the the same dynamic, the same set of forces that set the stage in the first place. They relapse, not because they can't recover, but because the family is not on the same wavelength or on the same track, and they undermine what changes really need to really occur in the family as a whole.
What changes do family members need to make to support the recovery of an addict?
It is essential that the family be very much involved within the family to recreate a new environment, a new lifestyle, for the addict, and for the family as a whole to be really successful in the long run. A change would primarily be seen in the interaction between the addict and the spouse. They would probably look like they're getting along better or would hopefully really be getting along better. There would be more openness about the addiction, but there would be more openness about the feelings that might lie below it; about not getting their needs met within the relationship, or about their ambivalence about being married to one another.