Behavioural addictions can be just as serious as drug addictions

For many people the concept of addiction involves taking drugs. However, there is now a growing number of psychologists like myself who view a number of behaviours as potentially addictive including those that don’t involve drugs such as alcohol, nicotine, cocaine and heroin. These include behaviours diverse as gambling, overeating, sex, exercise, videogame playing, internet use, and work. In fact, if the rewards of engaging in the activity are constant, I would argue that some individuals can become addicted to almost anything.

For the past 25 years I have been studying gambling and I passionately believe that gambling at its most extreme is just as addictive as any drug. The social and health costs of problem gambling are large and show many commonalities with more traditional addictions. These can include extreme moodiness and irritability, problems with personal relationships (including divorce), absenteeism from work, neglect of family, domestic violence, and bankruptcy. Adverse health consequences for gamblers and their partner include anxiety and depression disorders, insomnia, intestinal disorders, migraine, stress related disorders, stomach problems, and suicidal ideation. If behaviours like gambling can become a genuine addiction for some people, there is no theoretical reason why some people might not become genuinely addicted to activities like video games, work or exercise.

Research on pathological gamblers has reported at least one physical side effect when they undergo withdrawal, including insomnia, headaches, loss of appetite, physical weakness, heart palpitations, muscle aches, breathing difficulty, and chills. In fact, pathological gamblers appear to experience more physical withdrawal effects when attempting to stop their behaviour when compared directly with drug addicts.

But when does an excessive healthy enthusiasm become an addiction? Excessive behaviour on it’s own does not mean someone is addicted. In fact, I can think of loads of people who engage in excessive activities but I wouldn’t class them as addicts as they don’t appear to experience any detrimental effects in their life as a result of engaging in the behaviour. In a nutshell, the fundamental difference between excessive enthusiasm and addiction is that healthy enthusiasms add to life whereas addiction takes away from it.

For any behaviour to be defined as addictive, I would expect there to be specific consequences as a result of the person’s relationship with the behaviour. More specifically I would expect to see all the following things:

• Salience (when a particular activity becomes the most important activity in the person’s life)
• Mood modification (the use of the activity as a way of either getting a ‘high’ or ‘buzz’ and/or using the activity to escape, de-stress or numb)
• Tolerance (needing more and more of the activity over time to feel the mood modifying effects)
• Withdrawal symptoms (psychological and/or physiological consequences such as excess moodiness and irritability if unable to engage in the activity)
• Conflict (with other activities – such as work and hobbies – and personal relationships, that may lead to a loss of control)
• Relapse (i.e. returning to addictive patterns of use following a period of abstinence)

The way addictions develop – whether chemical or behavioural – is complex. Addictive behaviour develops from a combination of a person’s biological/genetic predisposition, the social environment they were brought up in, their psychological constitution (such as personality factors, attitudes, expectations and beliefs), and the activity itself.

Many behavioural addictions are “hidden” addictions. Unlike (say) alcoholism, there is no slurred speech and no stumbling into work. However, behavioural addiction is a health issue that needs to be taken seriously by all those in the health and medical profession. If the main aim of practitioners is to ensure the health of their patients, then an awareness of behavioural addiction and the issues surrounding it should be an important part of basic knowledge and training.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Psychology Division, Nottingham Trent University, UK