To further understand the similarities between substance addictions and behavioral addictions, it may help to consider the individual who, cash in hand, has found a source for the addictive substance he so desperately wants. He leaves work early without informing his boss, hops in the car, and speeds to the source of purchase. The brain dopamine release is occurring prior to the purchase,in anticipation of  substance use. The brain adapts, (neuroplastic changes occur) to the surge of the dopamine from the expectation of substance use. After all, his thinking is impaired (he’s making bad decisions), his pulse racing, and he desires/feels compelled to purchase and use the substance, no matter the consequences. The closer he gets to using, the higher the pusle, respiration, body temperature, and the more tunnel-visioned and impulsive his thinking becomes. Yes, indeed, he is becoming mind altered in anticipation. Yet at this point there has been no current use of substance !

Behavioral addictions operate on the same “anticipatory high” principle. For instance,  sex addicts find as much (if not more) pleasure and relief (from stress and emotional pain) in the fantasy and pursuit of sex as in the sex act itself. They sometimes refer to this elevated, fantasy-driven state of neurochemical excitement as “the bubble” or “the trance.” They simply lose touch with reality for hours or even days at a time – high on the idea of sex – with little or no actual physical contact. Very similar changes are described by gambling addicts. Thus we see that for both substance addiction and behavioral addiction, the fantasies and actions that lead up to actually using/acting out (the ritualized process of the addiction) are every bit as compelling and desirable as the actual drug or behavior.

Identifying Behavioral Addictions

Behavioral addictions are often initially identified during substance abuse treatment or soon thereafter. Usually they pop up as either a cross-addiction or a co-occurring addiction. (Cross-addictions are when the addict uses one addiction to replace another; co-occurring addictions are when two disorders are present at the same time.)

• Cross-Addiction: While in residential treatment for alcohol addiction, Sydney gains 20 pounds, replacing her drinking with compulsive eating. Later, when she eventually decides to go on a diet, she suddenly finds herself drinking again.
• Co-Occurring Addiction: Jack leaves treatment for cocaine abuse, thinking he is cured. Once home, he calls up a sexual partner, thinking he’ll “treat” himself because he’s been sober for 30-plus days. Within minutes of partner arrival, he’s doing lines of cocaine, little realizing that his cocaine use and his sexual behaviors are directly linked.

As is the case with substance abuse recovery, the journey toward sobriety from behavioral addictions is a long-term process that typically requires professional counseling with a clinician or team of clinicians experienced in addressing the specific addiction, along with any cross- or co-occurring disorders that may be present. Happily, such treatment is now available at facilities, which we can refer to.

 One significant treatment difference between substance and behavioral addictions lies in the definition of sobriety. Whereas complete abstinence from the addictive substance, is typically expected in drug and alcohol treatment, those addicted to things like food and sex must  learn to carefully identify the behaviors that do and don’t compromise the values and relationships they hold most dear. Then they contract to not engage in the problematic activities and to limit their engagement in the non-problematic activities to moderate and appropriate levels. Otherwise, the treatment and recovery process is incredibly similar for both substance and behavioral addictions…