Substance Addiction vs. Behavioural Addiction

How Prevalent Is Addiction?

According to a study by the UK’s Action on Addiction, one in three people struggles with an addiction. This is a staggering statistic, considering the world’s population currently sits at over 7.7 billion. If you do the math, this means that over 2.3 billion people in this world struggle with an addiction in some form. What does this mean for you or your loved one? You or they are not alone.

While substance addictions, such as a physical dependence on opioids, benzodiazepines and alcohol, can be easier to see in a person’s life, other addictive behaviours, such as sex disorders, internet addiction disorders and gambling disorders, can be much more insidious and easily hidden. Since so much of today’s global population struggles with a dependency, it is important to understand and examine substance addiction, behavioural addiction, and their similarities and differences.

Definition of Addiction

The American Society of Addiction Medicine describes addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry.” An addiction can start innocently enough: an extra drink or hit at a party, stumbling upon a risqué website or chatroom, a fun night out at the casino. As the brain experiences pleasure in response to these activities, the drive for more can start to set in, thus initiating the addictive cycle.

In its simplest form, the addictive cycle can be broken down into three stages:

• Stage 1: the binge or intoxication stage. In this initial stage, an individual consumes an intoxicating substance or indulges in a certain behaviour. The brain experiences an increase in dopamine and the high sets in.
• Stage 2: the withdrawal stage. As the addict comes down from the high, a negative emotional state sets in.
• Stage 3: the preoccupation and anticipation stage. This stage is characterized by compulsive behaviours and the craving for more of the intoxication. In an effort to experience the high of intoxication again, the addict may once again seek out more substances, chat sites, game rooms, and so on.

People progress through the addiction cycle at different rates. Some may take months or years, where others may go through this cycle multiple times a day. For those that go through the cycle faster, the addiction can be stronger and the need for more extreme experiences can take hold. This can turn a gram into an 8-ball, one credit card into two or three, or one sexual partner into multiple.

What is Substance Abuse?

Perhaps the most obvious forms of addiction are those related to psychostimulants, or psychoactive substances. Substance abuse is characterized by the use of a physical substance that is either smoked, inhaled, eaten, drank, injected or otherwise ingested into the bloodstream. Substance use disorders can include alcohol abuse, and abuse of nicotine, heroin, amphetamines, benzodiazepines, amphetamines, hallucinogenic opioids, and stimulants, among others.

If you are concerned that a friend or family member may be experimenting with illicit drugs, some signs and symptoms of substance use to watch out for include:

• Red eyes, dilated pupils, or involuntary eye movements
• Dry mouth
• Slowed reaction time
• Extreme anxiety or agitation
• Psychotic and violent behaviour
• Panic attacks
• Rapid or rambling speech
• Mouth sores, gum disease and tooth decay from smoking drugs
• Poor judgment
• Hallucinations
• Lingering odour of inhalant material
• Rash around the nose and mouth
• Physical symptoms such as seizures, headaches or nausea

(Please note: this list is not exhaustive and can vary greatly from substance to substance)

What is a Behavioural Addiction?

According to the American Psychiatric Association, “The essential feature of behavioural addictions is the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others.” Like addiction to substances, behavioural addiction is directly related to the ‘high’ one feels when engaging in an activity. Behavioural addictions or impulse control disorders can include sex and pornography addiction, pathological gambling disorders, technology (internet addiction disorder, computer or video game use, television), exercise addiction, food disorders (such as anorexia and bulimia), anxiety disorder, kleptomania, and OCD (obsessive compulsive disorder), among many others.

If you are concerned that a loved one may be struggling with an impulse control disorder, some signs and symptoms of behavioural disorders to watch for include:

• Easily getting annoyed or nervous
• Often appearing angry
• Putting blame on others
• Refusing to follow rules and questioning authority
• Arguing and throwing temper tantrums
• Having difficulty in handling frustration
• Increased financial strain

(Please note: this list is not exhaustive and can vary greatly from person to person)

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5 or DSM-V), released in 2013, includes the updated ‘Substance-related and Addictive Disorders’ category. At this time, it only lists gambling disorder as a recognized behavioural addiction. As a result, there is an ongoing debate as to whether other impulse control disorders are considered addictions. Regardless, impulse disorders and substance abuse addictions contain some similarities.

Similarities Between Drug Abuse and Impulse Control Disorders

The brain’s reward system

Dopamine is the neurotransmitter in our brain that directly tells us ‘this is good’, even in the presence of negative consequences. Both drug addictions and behavioural addictions cause a surge in the brain’s reward centre by flooding it with dopamine, which contributes to the ‘high’ an addict experiences. Over time, it interacts with another neurotransmitter, glutamate, which is linked with activities needed for human survival and completes the chemical circle. Addictive disorders stimulate and link these two neurotransmitters. This cues the brain that what they are doing is good and that they need it to survive.

This cycle physically creates new neural pathways in the brain and ‘neurons that fire together, wire together.’ This is partly why overcoming addictive disorders is so difficult. In order to break the addiction, new neural pathways in the brain that stimulate dopamine need to be created. The addictive substance or behaviour offers the path of least resistance, making the task of rewiring the brain challenging to say the least.

Increased Tolerance

As the brain’s reward pathways develop in response to the substance or behaviour of abuse, a tolerance to the increased dopamine can be established. Over time, the dopamine spikes are no longer sufficient to produce the same effect they once did. To meet the brain’s need for more of this natural reward, the addict is compelled to seek out new inputs. This results in heavier drinking or larger gambling wagers. The cycle continues as new neural pathways are created and the senses are once again overloaded.

The Addictive Cycle

The addictive cycle is a common link between all manner of addictions. They result in the same compulsion for the activity, object, or substance of choice, and can drive addicts to great lengths to maintain the pleasurable sensations and avoid the feelings of pain and discomfort that come with withdrawal symptoms. The addictive substance or activity becomes the sole focus of drug addicts to the exclusion of work, friends, family members, and finances.

Differences Between Drug Abuse and Impulse Control Disorders

Substance vs. Behaviour

Perhaps the most obvious difference between substance addiction and behavioural addiction is that those with a substance disorder rely on the consumption of a physical substance, such as drugs or alcohol, to get their ‘fix’. Conversely, the behavioural addict relies on an action or behaviour to get their ‘hit’. Since many impulse disorders do not take the same physical toll on the body that substances do, they can be hidden with comparative ease. Loved ones may not realize there is a problem until the addiction has taken on a life of its own, causing significant issues in relationships, careers, or finances.

While both substance addictions and behavioural addictions can produce a variety of withdrawal symptoms, behaviourial issues are less likely to result in the detoxing effects associated with substance abuse.

Effects on Physical Health

While some behaviour addictions can result in physical health problems, they are less likely to have the same long-term detrimental physical effects that addictive substances can have. A substance like cocaine can cause permanent damage to blood vessels in the heart and brain, liver, kidney and lungs, and cause severe tooth decay and sexual dysfunction, among many other effects. Crystal meth can cause body temperatures to rise to the point of causing coma and death. Substance abuse may cause changes to the brain structure, premature aging, develop hard to heal sores, dry mouth, and stained, broken or rotting teeth, among others.

Addiction Treatment Plans

The road to recovery is different for each individual and treatment, which can include a combination of pharmacological treatment, psychotherapy, support groups and other methods, needs to be tailored accordingly. There are key considerations in how effective treatment plans are developed. While abstinence can be implemented for a drug addiction, this is not always possible for those with behavioural issues. A compulsive eater cannot completely avoid food, and the compulsive shopper cannot avoid buying necessities. Someone with an exercise addiction has to maintain a reasonable level of physical activity. Healthy moderation and positive lifestyle changes must be practiced in order to progress in recovery and reduce the risk of relapse.

Conclusion

Addiction is faced by many people today. It does not discriminate based on age or economic class. It can affect the homeless, the celebrity, the blue-collar worker, seniors, young adults, adolescents, and anyone in between. An addiction can take many forms and exhibit itself in many different ways. Trust your instincts, and if you think you or a loved one is struggling with a behavioural or substance use disorder, reach out for help. Success in recovery is significantly more likely when completed in a group setting. No one is ever ‘too far gone,’ you are not alone, and recovery is always possible.