Nearly everyone is familiar with and understands to some degree the concept of a substance addiction – abuse of and dependency on chemicals such as nicotine, alcohol, illicit drugs, and even prescription medications. More difficult to comprehend is the concept of a behavioral or "process" addiction – compulsively engaging in a potentially pleasurable activity such as gambling, working, spending, eating, or sex.
Contributing to the confusion is the fact that many potentially addictive behaviors are (for most people, most of the time) healthy and perhaps even essential activities. For instance, eating and sex – two of the most common process addictions – contribute to both individual survival and survival of the species. In fact, these activities are so inherently necessary to human existence that our brains are pre-programmed to encourage them.
This encouragement occurs via the release of dopamine into the rewards center of the brain, which causes us to experience a sensation of pleasure. When we eat, we get a squirt of dopamine to let us know that the consumption of food is a good thing. The same goes for sexual fantasy and behavior. This biochemical pleasure process is necessary for survival. Without it, we would neither eat nor propagate.
Unfortunately, individuals who struggle with underlying emotional and/or psychological issues such as depression, anxiety, low self-esteem, and early-life or profound adult trauma sometimes utilize the pleasurable dopamine response brought on by sexual fantasy and behavior (or eating, working, exercising, etc.) not as an incentive to engage in these life-affirming acts in a healthy fashion, but as a way to manage, escape, and otherwise cope with the uncomfortable feelings brought on by their underlying condition. Over time, repeatedly using a behavior in this fashion teaches the individual that the most effective way to feel better (i.e., to feel less) is to engage in more of that same dissociation-inducing behavior. For some, sex becomes the default response to any stressful situation; at that point, the brain is hardwired for sexual addiction.
When attempting to understand the power and compulsion of a behavioral addiction, it is sometimes helpful to consider the more easily comprehended drug addict. Picture this person – a cocaine addict, perhaps – cash in hand, on the way to "scoring" his drug of choice. Is he not high already? After all, his heart is pounding, his blood pressure is elevated, his hands are clammy, etc. Furthermore, his thinking is already impaired in that he feels compelled to purchase the drug regardless of monetary expense or any other potential negative consequences. He is detached from real life, even though there are no actual drugs in his system.
Behavioral addictions function in much the same way. Sex addicts in particular are hooked on the anticipatory high associated with their behavior. Typically, they find as much (perhaps more) excitement in the fantasy and rituals associated with their sexual acting out as in the sex act itself. Individuals addicted to sex sometimes refer to this as "the bubble." While in the bubble sex addicts are completely removed from the reality of life. Typically they spend many hours, sometimes even days, in this elevated state – high on the idea of sex – without engaging in any actual sex act. Oftentimes, the sex act is postponed as long as possible, as orgasm ends the rush created by the addiction.
Interestingly, the brain scans of people who are sexually aroused are almost indistinguishable from the brain scans of people who are high on cocaine – further evidence that sexual anticipation creates the same basic neurochemical high as certain illicit drugs. Additionally, the core elements of addiction are seen in both substance and process addictions:
- Preoccupation to the point of obsession with the behavior or substance
- Tolerance and escalation
- Loss of control (failed attempts to curtail the behavior or quit the substance)
- Continuation despite negative consequences
- Cravings and other symptoms of withdrawal
Sadly, our culture has limited understanding and little compassion for process addictions, typically viewing them as either "moral failings" or "less serious" than substance addictions. Neither belief is true. Process addictions are not character flaws; instead they are (like all addictions) maladaptive behaviors utilized for emotional stability and survival. Furthermore, process addictions are every bit as destructive as chemical addictions, with out-of-control compulsive behaviors wreaking the same type and degree of havoc on families, careers, and lives as alcoholism and drug addiction.