Process Addiction and Substance Abuse

Process addictions are patterns of compulsive behavior that resemble substance addictions in several ways and often respond to many of the same interventions.

Process addictions, also sometimes called behavioral addictions, are patterns of compulsive behavior that resemble substance addictions in several ways, including how they impact brain activity and function, how they develop over time and how they respond to treatment.

Mental health professionals debate whether to classify these disorders as addictions, impulse control disorders, obsessive-compulsive disorders or something else altogether. Regardless of how they are classified, these behavioral disorders typically require treatment — which is usually modeled on treatment for substance use disorders.

In addition to their similarities, another connection between process and substance addictions is how often they occur together. Anywhere from 25 to 66 percent of people with a behavioral addiction have a substance use disorder at some point in their lifetimes. This overlap can have significant effects on the course and consequences of each kind of addiction.

Effects of Drug Abuse on Process Addiction

In general, co-occurring substance and process addictions intensify one another and increase the risk of negative outcomes including legal, occupational and interpersonal problems. These combined addictions also heighten the risk that people will develop a secondary psychological condition, such as a depressive or anxiety disorder.

Gambling and Substance Abuse

Currently, gambling disorder is the only non-substance-related addictive disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the primary reference guide for mental health professionals. Researchers have studied the relationship between gambling disorder and substance use disorders for several decades.

Research shows that co-occurring gambling and substance use disorders lead to greater risk-taking and increased impulsivity as well as heavier gambling overall. This may be because many substances lower inhibitions or because of shared psychological factors that affect personality development, mood and cognition.

Cultural factors also affect the relationship between gambling and substance use. Whether people play poker at home or go to a casino, social gambling frequently combines gaming with alcohol. Many casinos provide patrons free alcoholic drinks as long as they are gambling. This can become an incentive for people with alcohol use disorders to go to local casinos to drink and can lead to secondary gambling disorders. It can also cause people with gambling disorders to develop secondary alcohol use disorders.

Sex & Love Addiction and Substance Abuse

Research suggests that sex and love addiction has higher rates of co-occurring substance addiction than any other behavioral addiction. Many factors link these different kinds of addiction, including the relationship both sex addiction and substance use have with post-traumatic stress disorder (PTSD), especially PTSD stemming from childhood sexual abuse.

Even when people with co-occurring sex and substance addiction do not have histories of trauma, they often struggle with other psychological issues, including anxiety, depression and negative self-image. They may use substances to temporarily reduce their anxiety, decreasing their resistance to engaging in dangerous or self-destructive sexual behavior.

Many substances can enhance sexual experiences through their effects on sensation and physical performance. This combination can lead to tolerance as people seek increasingly intense or dangerous sexual encounters to experience the same degree of stimulation.

The risk-taking that follows from co-occurring substance use and compulsive sexual behavior can lead to higher rates of infidelity, infection and injury. Severe substance addictions can drive some people into sex work, increasing the risk of assault and other dangers.

Internet Addiction and Substance Abuse

As increasing numbers of people use smartphones to regularly access the Internet, it becomes harder to determine what distinguishes Internet addiction from regular patterns of Internet use. Many proposed models use similar criteria as those used to define substance use disorders. For example, a person with internet addiction is likely to have:

• Felt irritable, dysphoric or guilty after using the Internet
• Used the Internet for longer periods of time than intended
• Made unsuccessful attempts to control or cut back Internet use
• Continued using the Internet despite negative effects on work or relationships

Research has shown that adolescents who engage in excessive or compulsive Internet use are at an increased risk of having substance use disorders. Many develop a substance use disorder before they develop an internet addiction. In either case, these combined addictions increase the risk of problems at school or home.

As technology continues to improve, the lines between Internet addiction and other process addictions become blurred. For example, people who gamble online can develop gambling use disorders without leaving home. Compulsive use of internet pornography can link Internet and sex addictions. Access to online shopping can trigger or intensify shopping addictions, while remote work can allow people with work addictions to remain engaged with co-workers and work activities from the time they wake up to the time they go to sleep.

Being able to do these activities at home also makes it easier to combine them with substance use. There are fewer barriers to drinking or using other substances while working or shopping from home than there are to using them at work or in public. This can create a dual pathway to cross addiction. First, people with both kinds of addictions may be able to use substances more frequently. Second, the disinhibiting effects of substances can increase the intensity of Internet addictions, leading people to make larger purchases, gamble more money on online games or engage in other Internet-based activities for longer periods of time.

Exercise Addiction and Substance Abuse

Exercise addiction can be hard to diagnose. Many physically and psychologically healthy people enjoy exercising for many hours every week. However, as with other behavioral and substance addictions, there are signs that a positive or neutral behavior has progressed to an addiction:

• Engaging in the behavior more often or with more intensity than intended
• Using the behavior to numb, dampen or avoid negative psychological states
• Continuing that behavior despite negative personal or social consequences

People who describe themselves as having an exercise addiction are more likely to report withdrawal symptoms after missing an exercise session. Exercise addiction often develops secondary to eating disorders like anorexia nervosa as a way to control calories or weight.

People with co-occurring exercise and substance addictions are more likely to be drawn to substances that complement or enhance their exercise routines or goals. For example, many people who exercise excessively misuse stimulants and steroids to increase exercise-related gains or to increase the intensity with which they can exercise.

Others who exercise in excess may misuse opioids to numb pain that would otherwise prevent them from exercising or cause them to have to exercise at a lower intensity. This can increase the rate of exercise-related injury and health problems related to chronic overexertion.

Compulsive Shopping and Substance Abuse

Most people occasionally overspend, often in response to heightened stress. People with compulsive shopping disorders or shopping addictions become psychologically dependent on the way new purchases make them feel. They overspend so regularly that it wreaks havoc on their personal finances, interpersonal relationships and psychological health. Shopping addictions can fill people’s homes with clutter, even to the point it becomes dangerous.

The stress associated with these problems can cause people with shopping addictions to develop secondary substance use disorders. Conversely, people with primary substance use disorders may start shopping compulsively when they are under the influence of a substance. As with other behavioral addictions, substance use can lower inhibitions and make it possible for people to escalate their behavior beyond the point they otherwise would have. Sometimes, people with co-occurring shopping and substance addictions make purchases during periods of substance-induced dissociation or during total blackouts, especially when they shop online.

Work Addiction and Substance Abuse

As with exercise, people can dedicate a significant amount of time and effort to work without any negative consequences. However, people with work addiction or workaholism overwork in ways that cause problems in other areas of their lives, including relationships, physical health and mental wellness.

One early warning sign of work addiction is when a person works significantly more hours than a job requires. Another is when people take on more work assignments than they can manage. Some researchers suggest that the cycle of deadline-induced stress and achievement activates the same reward pathways in the brain as alcohol and other drugs. Unfortunately, this chronic stress makes people with work addictions more vulnerable to depressive disorders and alcohol use disorders.

Specific substance use disorders that co-occur with work addiction vary based on individual differences and the nature of the work. For example, people with physically demanding jobs may use opioids or stimulants to allow them to work harder or for longer hours. People whose jobs allow them to drink during business lunches are at increased risk of alcohol use disorders.

Some people develop work addictions after overcoming substance addictions. People who do not address mental health issues like depression or trauma-related disorders in the course of recovery from drug or alcohol addiction are at increased risk of developing a behavioral addiction to cope with their symptoms.

Porn Addiction and Substance Abuse

Research shows that pornography use and substance use cause similar patterns of brain activity. Chronic pornography use can overstimulate reward pathways, temporarily depleting dopamine and leading to psychological withdrawal symptoms. Some people become addicted to pornography simply as a result of the powerful effect it has on the brain. Others may develop a pornography addiction in the course of another sex addiction or in response to depression or unresolved sexual trauma.

Many factors can cause people who are addicted to pornography to develop secondary or cross addictions to alcohol or other substances. Some people use substances to heighten their sexual response or enhance the sensory stimulation of pornography. Others use substances to lower inhibitions and overcome feelings of anxiety, shame or guilt that can accompany pornography use, especially when it conflicts with a person’s moral or spiritual beliefs. These cross addictions significantly increase the risk of interpersonal, financial and psychological problems.

Statistics on Process Addiction and Drug Abuse

Researchers have found that people with behavioral addictions have a higher risk of substance use disorders than the general population:

• From 35 to 63 percent of people with a gambling addiction have a substance use disorder in their lifetimes.
• Approximately 64 percent of people with sex addiction have a co-occurring drug or alcohol use disorder in the course of their lives.
• About 38 percent of people with internet addiction have a substance use disorder at some point in their lifetimes.
• From 21 to 46 percent of people with a shopping disorder have a substance use disorder at some point in their lives.
• From 15 to 25 percent of people with an exercise addiction have a co-occurring addiction to alcohol or other drugs.

In the general population of the United States, less than 10 percent of people experience a substance use disorder in their lifetimes.

Similarities Between Process Addiction and Substance Abuse

Like substance use disorders, behavioral addictions develop over time in response to biological and psychological rewards. Many compulsive behaviors activate the same reward pathways and elevated dopamine levels as substance use. Over time, the brain and body adjust and a person must increase their substance use or the intensity of a behavior to elicit the same rewards.

Many people first notice that their substance use or behavioral compulsion has become an addiction when it starts having a negative impact on their lives. Both substance and process addictions can cause occupational, interpersonal, legal and health problems. The hallmark of both kinds of addiction is that a person is unable to stop using a substance or engaging in a behavior even after they recognize its negative impact and try to quit.

Differences Between Process Addiction and Substance Abuse

Compulsive behavior has a more indirect impact on brain chemistry than substances do and does not lead to physiological dependence, even in the case of highly stimulating behavior like pornography use or intense exercise. For this reason, people with behavioral addictions never require medically supervised detoxification even when they quit a behavior “cold turkey.”

The social acceptance and biological normalcy of the behaviors involved in process addictions can make them more difficult to overcome. While friends and family often support a person’s effort to stop using a substance, they are more likely to question whether a process addiction is a problem, especially if a person is addicted to work or exercise.

For many people with a substance addiction, the goal of recovery is to abstain from using that substance. The goal of recovery from a behavioral addiction is usually to learn how to engage in a behavior in a healthier way. For example, a person with a sex addiction may choose celibacy but is more likely to try to establish a healthy sexual relationship with an intimate partner.

This can be more difficult, especially in early recovery. A classic goal of early recovery from substance addiction is to completely avoid “people, places and things” associated with the addiction. In recovery from behavioral addiction, a person has to learn how to face triggering environments and situations, sometimes on a daily basis, without resuming previous behaviors.

Can Behavioral Addiction Lead to Drug Addiction?

Behavioral and substance addictions can lead to one another. Current studies show that substance addictions often precede process addictions. Frequent substance use dysregulates brain function in a way that can cause people to engage in other activities more compulsively, especially during withdrawal periods or during early recovery from a substance use disorder.

In other cases, people develop a behavioral addiction first, often during a period of heightened stress or depression. Over time, they may find that psychological tolerance makes a compulsive behavior less psychologically rewarding. They may start using substances to achieve the same relief from anxiety, depression, loneliness or boredom that they used to get from working long hours, using pornography, shopping online or doing high-intensity exercise. Already primed by the power of a process addiction, they may develop a substance addiction more quickly than they otherwise would have.

Treating Process Addiction and Co-Occurring Substance Use Disorders

Process and substance addictions respond to many of the same interventions. Support and 12-step groups for behavioral and substance addictions help people find fellowship, accountability and encouragement as they learn how to cope with triggers and change their behavior. Group treatment helps people explore their reactions to interpersonal and social stressors, while cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) help them learn which thoughts and environments are most likely to trigger the recurrence of a compulsive behavior or substance use disorder.

Studies show that integrated treatment programs are more effective than programs that treat behavioral conditions separately. In integrated programs, clinicians communicate with one another and coordinate interventions to address multiple disorders. These interventions may include treatment groups, individual therapy, complementary therapies, peer support groups and medication management.

The Recovery Village operates many facilities across the United States that provide integrated treatment for co-occurring disorders. If you need treatment for a substance addiction and are concerned you may also have a behavioral addiction, please contact a representative from The Recovery Village to learn about treatment options that can address all of your needs.

Editor – Devin Golden

Devin Golden has worked for various print and digital news organizations. Devin's family has been affected by addiction and mental health disorders, which is a large part of why he wants to help others who have either directly or indirectly been affected by these diseases. Read more

Medically Reviewed By – Stephanie Hairston, MSW

Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more