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Behavioral addictions or process addictions, is a term that has gained increasing use over the past decade, spawning a sprawling international treatment industry, offering treatment for everything from sex addiction or Facebook, to shopping, exercising and Internet addictions. An international conference on behavioral addictions is going on even as I write this article, with symposia about pornography addiction, eating addiction and video game addictions. Much of this industry grew from the commercial and social success of the sex addiction treatment model, and it has many of the same problems and limitations embedded in sex addiction. Namely, there’s extremely little scientific support for most of these concepts, with great variability about how they are diagnosed or treated.
The APA DSM-5 contains the following statement: “Other excessive behavioral patterns, such as Internet gaming, have also been described, but the research on these and other behavioral patterns is less clear. Thus, groups of repetitive behaviors, which some term behavioral addictions, with such categories as “sex addiction,” “exercise addiction,” or “shopping addiction,” are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.”
In contrast however, the American Society for Addictive Medicine has included behavioral addictions in their definition of addictive disorders, stating that: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
Because these behavioral addictions are not diagnosable, they typically cannot be billed to insurances in the United States. As a result, most treatment for behavioral addictions is provided either through free 12-Step groups, or by clinicians who charge self-pay. Because the behavioral addiction industry operates in this way, there has been little research on the etiology of these problems. Like the sex addiction treatment industry, there has also been surprisingly little research on the outcomes of behavioral addiction treatments.
In 2015, a group of Canadian researchers published a remarkable study that looked at people over time, using data from the Quinte Longitudinal Study, involving 4,121 randomly selected adults from Ontario Canada, who were followed by the researchers for a period of 5 years. The individuals in the study were a non-clinical population, but included a group identified as “at risk for gambling problems” and control group of those not at risk. Because of this sampling methodology, the results can be generalized to the general population without the effects of sample bias. Respondents identified, each year of the 5, whether they had problems with excessive behaviors, including exercise, sex, shopping, online chat, video gaming or eating. They also identified if they had sought help for these problems.
Results of this study offer some compelling insights. First, rates of reported problems were extremely low, with cross gender totals across the 5 years of 1.9% (exercise), 1.8% (sex), 3.5% (shopping), 1.0% (online chat), 1.4% (video gaming) and 6.5% (eating). In contrast to the often proclaimed epidemic and pandemic of sex addiction, internet addiction and video gaming addictions, rates of these problem behaviors are tiny. In this research, there’s no evidence that these problems reflect the kind of sweeping global problems that is trumpeted in much of the media.
Secondly, the severity of the reported problems decreased significantly over time. In fact, among men reporting sexual behavior problems, it was only reported every year by 5.4% of the males who had experienced the problems. For women, where shopping problems were the most stable, only 3% of women reporting the problems reported it over all 5 years. This suggests strongly that the idea that these problems are extremely stable and persistent is inaccurate, for a great majority of the people experiencing them.
In contrast to the clinical notion that there is an “addictive personality” and that these behavioral addictions often occur in “clusters,” a very small percentage of 2.3% of these respondents identified having two or more excessive behavior problems.
The overwhelming majority of people in this study who reported experiencing behavioral problems did not seek help for them. Eating and exercise problems led to more help-seeking, but even those problems rarely led to high levels of people seeking out support, from professionals or informal resources such as family or friends. Significant sex/gender differences were noted, with eating and shopping reported two and three times more in women versus men, whereas excessive sex was reported four times more in men.
The real challenge to the modern behavioral addiction industry lies in this study’s findings that these excessive behavior problems are transient, and typically resolve on their own, without treatment. For instance, 95% of the men who had reported excessive sexually behaviors showed a spontaneous recovery within the next five years, with the greatest change within only one year. Of those individuals in this study who DID seek professional help, they didn’t get better at any greater rates than those who didn’t seek help. This might explain why there are no outcome studies in this area of behavior addiction treatment - if spontaneous recovery is already so high, it’s probably difficult for treatment efforts to improve on this
The American Addiction Centers websites states: “Unfortunately, as is common for all who struggle with addiction, people living with behavioral addictions are unable to stop engaging in the behavior for any length of time without treatment and intervention.” As cited above, ASAM states that “Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
According to this well-crafted, longitudinal study these catastrophic proclamations just don’t appear to be true. At all. Indeed, based upon these results, it appears that we can actually predict that most so-called behavioral addictions will not persist, get better on their own over time, and do not in fact require treatment. Behavioral addictions and process addictions at this point appear to reflect an over-focus on transient, limited behavior problems. Indeed, a follow-up study by these same researchers found that amongst 6,000 randomly selected Canadians, 50.8% reported at least one of so-called behavioral addictive problem behaviors over the last year, including sex, shopping, gambling, eating or work. In this study, age and well-being were the only statistically significant correlates, and appeared to act as protective factors: in other words, being older, and having a generally healthier, happier life, reduced rates of these behavioral addictions.
Thus, labeling these problems as addictions, or calling them the results of brain diseases, may lead to inaccurate perceptions. Painting these problems as requiring medical treatment appears to be largely unnecessary. Instead, in today’s constantly changing world, it appears that it is extremely normal for people to struggle with managing their lives and behaviors. However, almost all of the people who struggle in this way do adapt, and do find themselves able to exert more control over these behaviors, on their own, without having to seek or pay for professional help. Rather than fighting these behaviors, declaring war on them, or identifying yourself as an “addict with an incurable disease,” your best strategy is to let time do its work, while you focus on improving your life as a whole.
