A person may experience different types of addictions, which can be either substance dependence or compulsive behavioral issues. Here we will take a closer look at the various combinations of these addictions.
Types Of Addiction
Most of us tend to think of either drugs or alcohol when the term ‘addiction’ is mentioned. However, there can be various other manifestations of this mental disorder with the same negative consequences. Primarily, addiction is of two basic types –
- Substance addiction
- Behavioral addiction
Substance or chemical dependency refers to the process of using, ingesting or consuming substances with addictive properties, such as drugs and alcohol. The behavioral variation involves behaviors that become repetitive and compulsive for the sufferer, such as gambling or gaming. For both types, the person is unable to control or stop themselves in engaging in their addictions even when it is causing them harm. Regardless of the types, this condition can be devastating and can adversely affect various aspects of the sufferer’s life, including education, work, relationships, health etc.
Manifestations Of addiction
Understanding the specific type of addiction in a person can help them seek treatment and implement specific coping strategies to overcome their disorder. Here are some of the most common manifestations of substance and behavioral addictions 1 –
A. Types of substance addiction
Some of the basic variations of chemical addictions include the following types:
Although some people recreationally consume certain drugs like cocaine and cannabis. Others may become seriously addicted to these substances. Drug craving is “extremely difficult to control, much more difficult than any physical dependence. For an addict, there is no motivation more powerful than drug craving,” explains the research 2 . Drugs are powerful substances that can easily lead to dependence and obsession. As a result, people addicted to drugs lose their willpower and mental strength to fight their urge for repeated consumption. Drug addiction can not only affect a person’s mental and physical health, it can also hamper their relationships, education, career, social reputation and lead to financial instability and poverty. Some of the most common addictive drugs are:
- Cocaine 3
- Opioids ( heroin and morphine)
- Hallucinogens (LSD MDMA/ecstasy and ketamine)
A 2009 study 4 states “Drug addiction is considered to be a chronic, relapsing disorder characterized by compulsive drug-seeking, by continued use despite serious negative socio-economic and health consequences, and by loss of control over drug use.” Identified as “substance dependence” instead of “drug addiction” by the American Psychiatric Association and the World Health Organization (WHO), drugs like opioids and cannabinoids can change the endocannabinoids levels in the human brain.
As alcohol is a legal substance, it is more easily accessible even though it can be highly addictive leading to various health issues, both mental and physical. “Alcoholism, also called dependence on alcohol, is a chronic relapsing disorder that is progressive and has serious detrimental health outcomes,” explains a 2008 study 4 . Alcohol abuse can cause psychological and physical dependence making someone drink excessive amounts of alcohol regularly even when they are aware of the negative consequences. Being a psychoactive substance, alcohol has certain properties that can cause strong dependence. According to WHO 5 , harmful alcohol use is “a pattern of psychoactive substance use that is causing damage to health. The damage may be physical (e.g. hepatitis) or mental (e.g. depressive episodes secondary to heavy alcohol intake). Harmful use commonly, but not invariably, has adverse social consequences.”
Alcohol use disorder results in 2.5 million deaths 6 yearly across the globe. According to research 7 , alcohol addiction is a dynamic and complex process. Continuous and uncontrolled alcohol consumption results in different neuroadaptive changes in the stress and reward system of our brain. Alcohol dependence is associated with an allostatic state, where persistent alcohol consumption constantly challenges the regulatory systems which attempt to maintain balance in internal processes, but in vain. “In the dependent individual, this allostatic state is fueled by progressive dysregulation of the brain’s reward and stress systems beyond their normal homeostatic limits,” adds the research.
3. Prescription drugs
Although prescription medications are generally recommended by doctors for the treatment of specific conditions like chronic pain or sleep difficulties, some people can become addicted to painkillers and sleeping pills. People who get addicted to prescription drugs consume the medications longer than recommended which causes severe and harmful addictions that can be difficult to control for the sufferer. It has been found that approximately 3% of people 8 in the United States abuse or misuse medications and face negative outcomes.
According to a 2014 study 9 , similar to other substance abuse, prescription drug abuse typically develops during adolescence 10 and is associated with certain risk factors. It has also been observed that youth with substance addictions have higher chances of abusing prescription drugs. Research on reasons of prescription drugs abuse have revealed that “much like for other drugs of abuse, there are a range of reasons for abusing prescription drugs, such as to getting high, regulating pain and negative affect, and improving sleep,” explains the study.
4. Caffeine & nicotine
According to a 2013 study 11 , “Caffeine is the most commonly used drug in the world.” Although caffeine is not necessarily an addictive substance, some people can abuse caffeine, consumed through coffee or energy drinks, and may get addicted as caffeine releases a small dose of the neurotransmitter dopamine. When consumed in excessive amounts for a prolonged period of time, it can affect our health and other important aspects of our life. Although there are some benefits 12 of caffeine consumption, caffeine overdose can lead to serious negative consequences. According to a research 13 , caffeine is scientifically not considered as addictive as “users are not compelled to consume it.” However, withdrawal can lead to certain adverse effects, such as lethargy and headache. Yet, another study 14 explains that “The majority of addiction professionals believe that caffeine withdrawal and dependence disorders exist and are clinically important.”
Nicotine, on the other hand, is a highly addictive plant-based chemical. Primarily available in tobacco, nicotine is mainly consumed by smoking cigarettes, cigars and pipes. Nicotine addiction is typically both physical and mental as the addicted person consciously craves and desires the substance. However, unlike caffeine, tobacco is dangerous and leads to around 435,000 premature deaths 15 every year in the United States due to smoking-related diseases. It has been observed that around 50% of lifelong smokers tend to die prematurely from smoking-related complications. According to research 16 , nicotine, the drug found in tobacco causes addiction. The researchers explain “Nicotine addiction is the fundamental reason that individuals persist in using tobacco products, and this persistent tobacco use contributes to many diseases.” Studies 17 have also shown that smoking dependence is a behavior sustained by “the direct pharmacologic effects of nicotine and by learned responses.” In fact, research 18 has also found that there is a significant and strong association between caffeine and nicotine dependence.
B. Types of behavioral addiction
Some common types of behavioral addictions are mentioned below:
Gambling is one of the most common behavioral addictions across the world. According to a 2010 study 19 , “pathological gambling (PG) has been considered as a behavioral addiction having similarities with substance use disorders (SUDs).” Not only can the thrill, hope and expectation of winning the “jackpot” make someone obsessed with gambling, losing money repeatedly can also make a person more prone to Grambling frequently in the anticipation of winning big. However, unlike substance dependence, gambling can be easily hidden from loved ones as there are no specific physical health symptoms. As a result, this can lead to some serious financial difficulties for the family and can cause relationship problems. People who are addicted to gambling may run into debts, lie, steal or engage in other criminal activities to get money for gambling.
Currently, pathological gambling or gambling disorder (GD) is the only behavioral addiction identified by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in the diagnostic category “Substance-Related and Addictive Disorders 20 .” Gambling addiction is marked by maladaptive, repetitive gambling behavior resulting in substantial clinical distress. Even though gambling can be a harmless pursuit for most individuals, people who are addicted and suffer from GD “are often characterized by cognitive distortions, such as illusions of control, impulsive behavior, and dysfunctional personality traits (for example, high harm avoidance or high novelty seeking),” according to research 21 .
Food addiction, also known as eating disorders, can be seriously harmful for someone’s physical and mental health, leading to disorders like anorexia nervosa & bulimia nervosa. This can involve an irrational & unhealthy attitude towards eating. “Food addiction has been implicated in craving, bingeing, and obesity,” explains a 2009 study 22 . While some people may eat constantly, others may avoid food altogether. Eating disorders can involve bulimia, anorexia, emotional eating and compulsive overeating or binge eating. Certain foods items high in starch, fat and sugar can trigger eating disorders due to their flavor, although they may not be addictive.
Research 23 has found that certain foods known as hyperpalatable foods can lead to addictive behaviors, similar to substance abuse. According to a 2018 study 24 , “The results of the current systematic review generally support the validity of food addiction as a diagnostic construct, particularly as it relates to foods high in added sweeteners and refined ingredients.”
Video game addiction or internet gaming disorder refers to the uncontrolled use of digital games which can cause various impairments in life. According to a 2019 study 25 , “Internet gaming disorder is characterized by a severely reduced control over gaming, resulting in an increasing gaming time and leading to negative consequences in many aspects of the individual life: personal, family, social, occupational and other relevant areas of functioning.” Gaming disorder has become a serious issue for numerous parents globally as mostly children and adolescents are addicted 26 to video games. Individuals with gaming disorder participate in gaming for prolonged periods of time, almost daily. They avoid their regular duties, responsibilities and other interests. Moreover, it can make people, mostly, teenagers, socially withdrawn & isolated. It can also affect their education, lifestyle, health, sleep, diet, personal hygiene and overall development.
Regarded as a type of internet addiction, gaming disorder has become a significant mental healthcare concern 27 . It involves negative behavior patterns associated with gaming and is characterized by a loss of control over the activity or the time spent. It is associated with certain psycho-physiological mechanisms, such as reward, stress, sensitization, emotional reactions and coping mechanisms. “Computer game playing may lead to long-term changes in the reward circuitry that resemble the effects of substance dependence,” explains a 2010 study 28 .
Compulsive sexual behavior 29 is marked by a loss of control over sexual behavior, thoughts, impulses and urges. Sex addiction can negatively affect a person’s ability to function in daily life, hold a job and have healthy relationships. Also known as hypersexual disorder, it is “a common disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual’s life,” explains a 2015 study 30 . Although it is not identified by the DSM-5 as a mental health condition, it is still analyzed in psychology. People addicted to sex compulsively feel the need to be stimulated sexually. However, it should be noted that this particular disorder is separate from bestiality and pedophilia.
Regardless, compulsive sexual behavior can still be dangerous for a person’s mental and physical well-being. They may feel a strong urge to engage in sexual acts multiple times throughout their day with negative outcomes and are unable to control their actions. According to a 2006 study 31, 3(11), 51–58. )) , “Compulsive sexual behaviors can present in a variety of forms and degrees of severity, much like that of substance use disorders, mood disorders, or impulse-control disorders.” Another 2014 study 32 found that prevalence for this disorder is around 3-6% and the condition may involve a wide range of dysfunctional behaviors, like excessive masturbation, cybersex, telephone sex, sexual behavior with multiple consenting adults, prostitution etc. This can even involve pornography addiction which can also be equally damaging.
With advancing technology and easier access, more and more people nowadays are becoming addicted to smartphones, social media or the internet. “Internet Addiction Disorder (IAD) ruins lives by causing neurological complications, psychological disturbances, and social problems,” explains a 2012 study 33 . Due to instant internet accessibility, almost all of us are hooked to our phones, whether we are checking the time, emails, social media profiles or making important calls. Although a computer, tablet or smartphone can be highly productive, it can be hugely addictive as well. Compulsive and constant use of technology can impair our education, work, social life, health and relationships. Being addicted to smartphones can cause a psychological condition known as nomophobia 34 (NO MObile PHone PhoBIA), where the person develops an intense fear of being away from their phones. Smartphone addiction can also cause phantom vibration syndrome 35 , also known as phantom ringing syndrome, which makes the addicted person believe that their phone is vibrating or ringing even when it’s not, causing anxiety.
According to a 2018 study 36 , “smartphone addiction ranges from anywhere between just above 0% and 35%.” It was also found that among undergraduate university students, 48% were addicted to smartphones. Another study 37 found that adolescents are more likely to get addicted to smartphones and engage in overuse. The study explains “Adolescents are strongly attached to their smartphone, and they regard a smartphone as their second self. Many smartphone users have reported that they would not be able to live without a smartphone.” Misuse of smartphones is also directly associated with compulsive overuse of the internet, gaming and social media.
6. Social Media
Research shows that around 10% of individuals in the United States are addicted to social media. Problematic social media use is a serious cause for concern around the world as it can lead to a number of mental health issues, such as anxiety, stress, depression and even suicidal ideation38 . Although most people use social media to share important moments from their lives and to connect with loved ones, it has now become a popular pastime, especially among children, teenagers, young & middle-aged adults. It is a damaging behavioral addiction that can affect how our brain functions and influence different aspects of our lives, like education 39 , work, relationships etc. Although most people using social media may not become addicted, most of us tend to use it compulsively without even realizing it. Social media use increases the release of the neurotransmitter dopamine which is related to happiness and pleasure. Hence, using social media can appear rewarding especially when you receive positive reactions on a post. This can soon turn into an addiction and become problematic.
According to a 2011 study 40 , increasing use of Social Networking Sites (SNSs) can be especially addictive for young people 41 . “Negative correlates of SNS usage include the decrease in real life social community participation and academic achievement, as well as relationship problems, each of which may be indicative of potential addiction,” explain the researchers.
Compulsive shopping or compulsive buying disorder is commonly observed more in women 42 than men. Although not officially identified by the American Psychiatric Association (APA), shopping addiction can be a debilitating condition that can affect relationships, mental health and lead to financial problems. However, according to a 2017 study 43 , compulsive buying “refers to a tendency toward long-term, repeated buying behavior, which has become the individual’s primary response to negative events and emotions. Many researchers regard CB as a behavioral addiction.” People addicted to shopping, whether online 44 or through physical stores, typically tend to be addicted to particular products like clothes, jewelry or beauty products regardless of need. However, they may also compulsively buy other products like stocks, food or real estate. Addicted individuals are unable to stop their urge for shopping even when it leads to mounting debts or the end of relationships. Although it may be a thrilling experience initially, the addiction can lead to severe stress, anxiety and trauma in the later stages.
A 2012 study 45 explains “Increased accessibility, hyperstimulating marketing techniques, a loss of the protective delay between impulse and purchase, and overvaluing of the shopping process and objects purchased may all contribute to the potentially addictive nature of shopping.” Other studies 46 recognize pathological buying as a pervasive mental health disorder marked by uncontrollable, impulsive and excessive purchase of items regardless of serious financial, social and psychological consequences
8. Cosmetic surgery
Research 47 reveals that around “21 million surgical and nonsurgical cosmetic procedures were performed worldwide, including 15.9 million in the United States,” in 2015. Plastic surgery addiction is regarded as a behavioral disorder as it makes someone feel compelled to repeatedly alter their physical appearance through cosmetic surgery 48 . It is typically observed in people with body dysmorphic disorder 49 , a mental health condition that makes sufferers constantly focus on their perceived flaws & defects in their appearance. People can often become obsessed with plastic surgery resulting in severe financial burdens and debts. Driven by their insecurity and negative self-perception, people feel compelled to fix one flaw after another and attend multiple procedures, even if they can’t afford it. Some individuals may even try to change their appearance to look more like their favorite celebrity or idol.
However, being addicted to plastic surgery can lead to some serious psychological issues. According to a study 50, 4(12), 65–68. )) , in the past several years, “a series of studies have consistently suggested an increased risk of suicide among women who have undergone cosmetic breast augmentation surgery.”
Although exercise can help someone get over other addictions, exercise itself can become an addiction. A 2013 study 51 states “Exercise dependence is defined as a craving for physical activity that leads to extreme exercise intensity and generates physiological and psychological symptoms.” It refers to an unhealthy and abnormal obsession with fitness and physical activity. Mostly driven by eating disorders and body image disorders, people addicted to exercise can exhibit symptoms similar to addicted to drugs. As regular exercise can release particular brain chemicals resulting in a sense of reward or pleasure, a person may become dependent on such pleasure response.
However, it is important to distinguish between fitness enthusiasts or athletes and exercise addicts. According to a 2016 study 52 being addicted to physical exercise “is a pattern of uncontrolled exercise that involves a craving for overwhelming exercise with addictive attributes.” Research 53 shows that around 3% of the general population are addicted to exercise.
Research shows that about 5-10% of the general populace are addicted to work. This form of addiction is separate from being dedicated to work or being a passionate worker. Identified as workaholics, these individuals are obsessed with their work and are unable to detach from their professional lives. They overwork repeatedly and are unable to take breaks from their work. Common signs may include working late when not required, strong fear of failure, obsessed with success, worried about work performance, isolation and sleep difficulties. Workaholics experience a “high” by working excessively, similar to drug addicts. Due to this sense of pleasure, they repeatedly engage in such behavior and are unable to stop. Mostly observed in perfectionists, such behavior is often driven by their need for success, admiration, social status and to avoid emotional stress. However, this can seriously affect their physical & mental health, relationships and personal life 54 . It can also lead to burnout syndrome causing depression in the long run.
According to a 2012 study 55 , “Negative consequences of workaholism may include subjective emotional pain or feeling burned out, restriction of social activity and/or complaints from significant others, and may even lead to dangerous action.” However, as they are financially and socially rewarded through salary increases, job promotions, recognitions from employers, the sufferers may discount the negative aspects by using the work rewards and affirmations. “Workaholism may have contradictory psychological, physical, and social effects/outcomes for the person in question and for those closest to him/her. It may also negatively affect the work environment,” explains a 2014 study 56 .
Recovery Is Slow, But Possible
Addiction, whether substance or behavioral, is a complex and persistent mental illness that requires effective treatment. As the addicted person lacks the willpower or control to stop, it is important to consult a doctor, mental health professional or therapist. However, it is possible to recover from addictions and get their life back in order. The recovery journey will require a lot of patience, determination and support from loved ones, but it will be worth it. With proper treatment, the sufferer can live a more meaningful, healthier and happier life.
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