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Behavioral addiction, process addiction, or non-substance-related disorderAmerican Psychiatric Association (2022). 9780890425756, American Psychiatric Association Publishing. . ISBN 9780890425756 is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a natural reward – despite any negative consequences to the person's physical, mental, social or financial well-being. In the brain's reward system, a gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations.
Addiction canonically refers to substance abuse; however, the term's connotation has been expanded to include behaviors that may lead to a reward (such as gambling, eating, or shopping) since the 1990s. Still, the framework to diagnose and categorize behavioral addiction is a controversial topic in the psychopathology field.
Similar to the changes in DSM-5 , the eleventh revision of the International Classification of Diseases (ICD-11) introduced the category "Disorders due to substance use or addictive behaviours", based on the diagnostic framework of impaired control, repetitive harmful behavior, and continuation or escalation despite negative consequences. The new sub-category "Disorders due to addictive behaviours" included gambling disorder (formerly under the habit and impulse disorders), gaming disorder (a new diagnosis), and two residual categories (other specified and unspecified) to raise attention among clinicians and the public and to facilitate further research.
In 2019, the American Society of Addiction Medicine (ASAM) revised its definition of addiction including substance use and compulsive behaviors, stating: "addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences."
Other addictive behaviors which have received research attention but with insufficient or inconclusive evidence include pornography use disorder, compulsive buying disorder, social network use disorder, Workaholic, exercise addiction, compulsive sexual behavior disorder, and food addiction.
Exercise addiction is not listed as a disorder in the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This type of addiction can be classified under a behavioral addiction in which a person's behavior becomes obsessive, compulsive, or causes dysfunction in a person's life.
The DSM-5 has re-classified the condition as an addictive disorder, with those affected exhibiting many similarities to those with substance addictions. The term gambling addiction has long been used in the recovery movement. Pathological gambling was long considered by the American Psychiatric Association to be an impulse-control disorder rather than an addiction. However, data suggests a closer relationship between pathological gambling and substance use disorders than exists between PG and obsessive–compulsive disorder, mainly because the behaviors in problem gambling and most primary substance use disorders (i.e., those not resulting from a desire to "self-medication" for another condition such as depression) seek to activate the brain's reward mechanisms, while the behaviors characterizing obsessive-compulsive disorder are prompted by overactive and misplaced signals from the brain's fear mechanisms.
Problem gambling is an addictive behavior with a high comorbidity with alcohol problems. A common tendency shared by people who have a gambling addiction is impulsivity.
Another form of treatment is recreational therapy. A Certified Therapeutic Recreation Specialist (CTRS) uses leisure and recreation to help individuals recover from their injuries, ailments, or addictions. Therapeutic recreation can help an individual struggling with addiction to improve their self-esteem, confidence, motivation, resiliency, autonomy, enjoyment, and overall emotional state.
A recent narrative review in 2017 examined the existing literature for studies reporting associations between behavioral addictions (e.g., Problem gambling, problematic internet use, problematic online gaming, compulsive sexual behavior disorder, compulsive buying, and exercise addiction) and psychiatric disorders. Overall, there is solid evidence for associations between behavioral addictions and , , as well as substance use disorders. Associations between ADHD may be specific to problematic internet use and problematic online gaming. The authors also conclude that most of current research on the association between behavioral addictions and psychiatric disorders has several limitations: they are mostly cross-sectional, are not from representative samples, and are often based on small samples, among others. Especially more longitudinal studies are needed to establish the direction of causation, i.e. whether behavioral addictions are a cause or a consequence of psychiatric disorders.
A systematic review in 2021 investigating the correlation between autism and behavioral addiction found inconclusive evidence for a general correlation. However found evidence of correlation when comorbid mental health conditions were present. Another systematic review in 2022 estimating the prevalence of behavioural addiction during the COVID-19 pandemic found the prevalence to be 11.1%.
One of the major areas of study is the amygdala, a brain structure which involves emotional significance and associated learning. Research shows that dopaminergic projections from the ventral tegmental area facilitate a motivational or learned association to a specific behavior. Dopamine neurons take a role in the learning and sustaining of many acquired behaviors. Research specific to Parkinson's disease has led to identifying the intracellular signaling pathways that underlie the immediate actions of dopamine. The most common mechanism of dopamine is to create addictive properties along with certain behaviors. There are three stages to the dopamine reward system: bursts of dopamine, triggering of behavior, and further impact to the behavior. Once electronically signaled, possibly through the behavior, dopamine neurons let out a 'burst-fire' of elements to stimulate areas along fast transmitting pathways. The behavior response then perpetuates the striated neurons to further send stimuli. The fast firing of dopamine neurons can be monitored over time by evaluating the amount of extracellular concentrations of dopamine through micro dialysis and brain imaging. This monitoring can lead to a model in which one can see the multiplicity of triggering over a period of time. Once the behavior is triggered, it is hard to work away from the dopamine reward system.
Behaviors like gambling have been linked to the newfound idea of the brain's capacity to anticipate rewards. The reward system can be triggered by early detectors of the behavior, and trigger dopamine neurons to begin stimulating behaviors. But in some cases, it can lead to many issues due to error, or reward-prediction errors. These errors can act as teaching signals to create a complex behavior task over time.
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