A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
Addictions are no longer limited to "substances." People can become addicted to activities such as sex or gambling. We have also heard of Internet addiction and shopping addiction. The list goes on and on. DSM-5 calls these behavioral addictions. However, the only behavioral addiction included in the DSM-5 is gambling. Internet gaming disorder is listed as a possible diagnosis for future consideration and further research. The primary reason that other activity (behavioral) addictions have not been included in the DSM-5 is because there is an insufficient research base to establish diagnostic criteria. Clinicians usually diagnose these other activity or behavioral addictions using imprecise diagnostic labels such as "other specified impulse control disorder."
According to our definition of addiction, people can develop addictions to activities as well as substances. Activities such as gambling, eating, and sex increase levels of dopamine in the brain just like cocaine or nicotine. In fact, most drugs of abuse affect Dopamine. Dopamine is a neurotransmitter that causes pleasurable feelings. Dopamine is integral to the brain's reward system. The reward system has evolved over thousands of years. The brain's reward system reinforces certain types of behaviors to ensure survival (e.g., eating, sex). For more information about the biology of addiction and the brain's role in addictive disorders please refer to the Biology of Addiction and Recovery.
It may be difficult to understand how someone might become addicted to an activity. It is helpful to recognize that people do not actually become "addicted" to a substance itself. Instead, people become "addicted" to the effect of those substances on the brain. From this more accurate perspective, it becomes easier to understand how activities can become addictive. This is because certain activities create a chemical effect in the brain that is very similar to drugs of abuse. Therefore, while some addictions occur because substances are added to the body that alter the brain's functioning, certain activities can achieve a similar effect. These activities alter brain chemistry in the same way addictive substances do.
Abstinence is an achievable (and often desirable) recovery goal with substance use disorders. Recovery from activity addictions is a bit more challenging because abstinence isn't always possible or practical. For instance, it isn't possible to be abstinent from all food and still survive. It isn't practical (though possible) to completely refrain from sexual activity. Therefore, it is quite sensible to wonder: When does a pleasurable activity become an addiction?
A simple way to distinguish between ordinary pleasurable activities and addiction is to review the definition of addiction. A more complex way is to consider the previously discussed criteria for substance use disorders (addiction). When a person continues to perform a pleasurable activity even when negative consequences outweigh the benefits, we can begin to speak of an activity addiction. When an activity takes on a compulsive quality, we can speak of an activity addiction. However, professionals can best determine these sorts of distinctions. If you wonder whether you or someone you love has an activity addiction, get a professional evaluation. It is best to choose someone who specializes in addictive disorders. Some professionals are highly specialized. Their practice may be limited to certain types of addictions such as gambling addiction or sex addiction.