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Hilarie Cash, Ph.D.
Hilarie Cash Ph.D.

Why Is It So Hard to Believe in a Behavioral Addiction?

Behaviors can be just as addictive as ingested drugs.

I was recently at a conference talking to others about our reSTART program for Internet and video game addicts. Everyone there was working with teens and young adults who were not doing well and needed special services. Many of their clients were struggling with drugs and alcohol. These service providers saw and understood the problem of Internet addiction because they constantly had to deal with it. There was one man there, however, (a speaker) who, after asking questions about our program, told me, essentially, that he didn't agree with what we were doing because, according to him, the only real addictions were to drugs and alcohol. When I began to explain to him the brain science that allows us to call this a true addiction, he walked away. His mind was made up and he was not open to learning about the concept of a behavioral (or process) addiction. I was mad, of course, but he, an academic psychologist, retired, and lacking expertise in addictions, was simply voicing what many people believe. So, in today's blog, I thought I would explain to readers why it is that we can call Internet and video game addictions true addictions.

Most people do not have a hard time accepting that gambling addiction exists. For decades now we've seen and heard stories about the crazy things done by gambling addicts. What you might not know is that it is not in the DSM-IV, the Diagnostic Statistical Manual used by clinicians all over the world to make diagnoses of mental illnesses. However, that is about to change. The latest version of this manual is being created as we speak, and gambling addiction is finally going to be given its rightful place in the DSM under non-substance addictions. They are seriously considering placing Internet addiction there, as well. Those of us working with this disorder hope this will be the case and are advocating for it.

The reason a behavioral addictions like gambling and potentially others, will be recognized is because the research results (including neurological evidence) are now irrefutable. It turns out that there is a "pleasure pathway" in the brain that lights up when we experience pleasure. The body releases a combination of neurochemicals, including dopamine and the opiates, which are picked up by receptors in the brain and elsewhere in the body. These chemicals make us feel good. If a lot is released and picked up, we call it feeling "high". This high occurs through the ingestion of certain psychotropic chemicals, like alcohol, and also through behaviors and thoughts. When we "fall in love" we are high on these neurochemicals. When we enjoy playing video games or get caught up in gambling, we experience a similar euphoria. These highs are not something to be worried about, in moderation. The addiction begins to take hold, however, when we do it too much. Then the brain is forced to withdraw neuro-receptors in an effort to restore balance. This is what we call tolerance, and we no longer get the high from the same level of activity or drug use. Now, we need more. And if we go without, we go into withdrawal. In the case of behavioral addictions, that withdrawal involves primarily psychological symptoms (irritability, restlessness, poor concentration, increased anxiety and depression, etc).

Once an addiction takes hold, the addict is either chasing another high or trying to avoid withdrawal. This, in turn, leads to obsession and engaging in the behavior in spite of negative consequences. The pleasure pathway, now overused, has become highly sensitive and responsive to cues that trigger a craving for the drug or behavior. So, for instance, if you've become addicted to Farmville or World of Warcraft, then merely sitting down in front of your computer, or merely opening up the internet on your smart phone, can trigger the release of neurochemicals that make us crave engagement in those games. These cravings are very strong and tend to override the executive functioning of the brain, that is, the part of the brain that makes rational decisions. Thus, even though you may have recognized that your video game play or other internet use is harming your life in some way, it can be very difficult to resist the urge to engage anyway. Afterwards, the addict feels remorse, shame, regret, etc, because the rational mind is now functioning again. This is the classic pattern in all addictions, whether chemical or behavioral.

I'll give you an example of this. Some years ago I got a call from a young woman who made an appointment to come in with her husband, saying he had a problem with gaming. It turned out that this man, only 24, had gotten a scholarship to an Ivy League university. In high school he gamed a little, but he was also a great student, an athlete, and socially popular. He was really the star of the school. When he got to the University he suddenly found himself the little fish in a big pond. Rather than dealing with his anxiety by trying his hardest to succeed, he distracted himself from his emotions (fear) by playing video games. When he found Everquest, a multiuser game played over the internet with many others, he became addicted. He stopped going to classes and rarely emerged from his room. Consequently, he failed out of the university pretty quickly. Next, he married his high school sweetheart and moved to Seattle where he found a job in the computer industry. He had made a commitment to his wife to never game again, since he was clearly an addict. He kept this promise for a year, but never got outside support for staying "sober". Instead, he did what so many addicts do: he believed he could do it alone, through sheer strength of will. But, it turned out that the addiction trumped his will-power and he returned to Everquest, only now he did it in secret. He went to extraordinary lengths to keep his secret, pretending to go to work, making up stories about his work day after he had been fired, paying their bills with credit cards, and so on. He kept up this charade for months, driving them into deep dept. His shame grew until he felt suicidal. That is the point at which he finally confessed to his wife what was going on and she found him help.

So, next time you have a conversation with someone who discounts the idea of a behavioral addiction, like video game or Internet addiction, assure them that they are wrong and refer them to me. I'll do my best to set them straight.

About the Author
Hilarie Cash, Ph.D.

Hilarie Cash, Ph.D., is co-founder and executive director of reSTART, the first in-patient treatment facility devoted exclusively to video game and internet addiction.

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