What is the difference between substance addiction and behavioural addiction? Though both conditions feature similar changes in the brain and processes of addiction, they present varying physical effects and distinct treatment goals.
Also known as impulse control disorders, behavioural addictions aren’t widely accepted by the public. Even many addiction researchers disagree about the nature of these disorders.
Substance use disorders still have many misconceptions attached to them, too. Still, they are comparatively more well-understood.
Today, we want to shine some light on the similarities and differences between these types of addiction. Our goal is to help loved ones of people with substance or behavioural addictions find the best treatment options available.
Definition of Addiction
Addiction is a chronic medical disorder. It features changes to brain structures involved in impulse control and pathways that regulate reward. People with addictions continue to seek out substances or engage in addictive activities despite negative consequences.
Experts divide addiction into two primary categories: substance and behavioural addictions. Substance addictions involve drugs and/or alcohol. Meanwhile, behavioural addictions involve activities like gambling or computer gaming.
The good news is that substance and behavioural addictions are treatable. Experts have found that treatment can help people with addictions manage their symptoms. Patients in recovery remain healthy at rates comparable to other major chronic diseases.
What Is Substance Addiction?
Substance addiction is a medical condition where someone compulsively seeks and uses drugs or alcohol despite negative life consequences. Also known as a substance use disorder (SUD), addiction features at least two of the following diagnostic criteria:
- Uncontrolled use, or using substances in larger doses or for longer than intended
- Unsuccessful attempts to quit or wanting to quit but feeling unable to
- Significant time spent obtaining, using, or recovering from the use of substances
- Cravings or an intense need to use one’s substance of choice
- Inability to meet work, school, or home life obligations
- Continued substance use despite negative social or interpersonal consequences
- No longer participating in previously enjoyed activities
- Continued substance use in unsafe environments
- Continued substance use despite negative physical or mental health consequences
- Tolerance, or needing increasing amounts of a substance to feel the same effects
- Withdrawal, or uncomfortable symptoms that arise after suddenly stopping or cutting back on substance use
Experts use these criteria to diagnose people with SUDs. A mild SUD features two or three of these symptoms, and a moderate SUD features four or five. Someone who meets more than six of these criteria would be diagnosed with a severe SUD.
What Is Behavioural Addiction?
Behavioural addiction is a medical condition where someone compulsively engages in an activity like gambling, internet gaming, or porn consumption. Experts may also refer to them as impulse control disorders.
Impulse control disorders are controversial. Some experts disagree about whether these disorders should be categorized as addictions. Others have differing opinions about what criteria should be used to diagnose them.
Over the past 30 years, researchers have come up with a few different ways to diagnose behavioural addictions. One of them divides criteria into the following six categories:
- Salience, or when someone’s life becomes dominated by the addictive activity
- Euphoria, or when someone feels ‘high’ when engaging in the addictive activity
- Tolerance, or needing increasing amounts or a higher intensity of the addictive activity to achieve euphoria
- Withdrawal, or negative physical or mental symptoms after stopping the addictive activity
- Conflict with oneself or others over the addictive activity
- Relapse and Reinstatement, or resuming the addictive activity after a period of abstinence
Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) only recognizes gambling and internet gaming disorders as behavioural addictions. The WHO’s eleventh version of the International Classification of Diseases (ICD-11) also recognizes these disorders in their ‘disorders due to addictive behaviours‘ category.
Symptoms of Impulse Control Disorders
The above criteria are not the only possible symptoms of an impulse control disorder. Researchers have also found that the following may indicate a behavioural addiction:
- Significant impairment or distress
- Withdrawal symptoms, such as moodiness, irritability, or ‘the shakes’
- Cravings, or a feeling of intense need to participate in the addictive activity
- Failing to resist the impulse to participate in the addictive activity
- Experiencing significant tension immediately before engaging in the addictive activity
- Feeling out of control regarding the addictive activity
- Frequent mental preoccupation with the addictive activity
- Failed attempts to reduce or control the addictive activity
- Spending significant amounts of time preparing for, engaging in, or recovering from the effects of the addictive activity
- Neglecting occupational, academic, home, or social obligations to engage in the addictive activity
- Feeling restless or irritable when unable to engage in the addictive activity
- Experiencing multiple of these symptoms for at least one month
Comparing the possible symptoms of behavioural addictions to the criteria for SUDs shows many similarities. These conditions are also highly comorbid, meaning they often occur together in the same person.
Some People Do Have Addictive Personalities
Behavioural and substance addictions may occur together more often in people with so-called addictive personalities. These individuals possess traits that may increase the risk of addiction. The most common traits listed as increasing someone’s risk of addiction include but are not limited to:
- Impulsivity
- Insecurity
- Irritability
- Mood swings
- Social non-conformity
- A lack of coping skills
- Low self-esteem
- Selfishness
- Social isolation
- Thrill-seeking
Being at an increased risk does not guarantee that someone will develop an addiction. Addiction is a complex condition involving a combination of factors like genetics, environment, availability, and socioeconomic status. Moreover, not everyone who develops an addiction has these traits.
Still, some studies have found correlations between these traits and addiction. For example, a 2018 study of 209 teens and young adults found that impulsivity is related to multiple types of addiction, except for internet gaming disorder.
A more recent review investigated the connection between addiction and many of the traits listed above. The researchers found that social non-conformity and thrill-seeking increase addiction risk.
Mental Health Symptoms and Addiction Risk
Experts do not entirely agree on which traits increase addiction risk. We need more research to understand the link between personality and behavioural and substance use disorders.
However, we do know that people with addictions disproportionately suffer from mental health symptoms. Some studies have found that more than 60% of teens who qualify for an SUD also have a mental health disorder.
Compare that to the risk of mental illness in the Canadian population at large. According to the latest statistics, less than 35% of Canadians experience a mental health disorder in their lifetime.
Similarities Between Substance Abuse and Impulse Control Disorders
SUDs and impulse control disorders affect the brain similarly, leading to a common cycle of addiction. Next, learn exactly how these conditions impact the brain and what their effects mean for tolerance, cravings, and withdrawals.
The Brain’s Reward System
The brain has a built-in reward system telling us when something is ‘good’ or ‘bad.’ Known as the mesolimbic system, the brain’s reward center involves a neurotransmitter called dopamine. When the mesolimbic system releases dopamine, the brain experiences a pleasurable sensation.
Unfortunately, these signals don’t always get it right. In other words, the brain sometimes tells us something is good, even if it isn’t good for us. Such is the case with substances and activities that can lead to addiction.
Good food, exercise, social interaction, and sex naturally activate this system, which is good because we need them for survival. Drugs, alcohol, and addictive activities cause an even greater release of dopamine and feelings of pleasure.
Cravings and compulsiveness come about as a result of this process. Cravings are intense desire to use a drug or participate in an addictive activity. Over time, the brain also associates drugs or addictive activities with survival, resulting in someone compulsively seeking it out.
Increased Tolerance
Tolerance also happens because of the brain’s reward center. As the reward center becomes desensitized to the dopamine drugs and addictive activities release, the person needs to increase the ‘dose’ (e.g., drink more or gamble increasing amounts of money) to feel that initial sense of pleasure.
The process of desensitization happens when the reward system stops producing as many dopamine receptors. These receptors are required for the brain to experience pleasure. The more someone exposes their brain to drugs or addictive activities, the more dysfunctional this system becomes.
A side effect of the tolerance process is that other pleasurable activities may become less enjoyable. Like drugs, rewarding activities, such as eating or having sex, may not feel as good. Also known as anhedonia, no longer feeling good in response to pleasure can also lead to depression.
Process of Addiction
Compulsiveness and tolerance might not be as concerning if someone could ‘just quit’ the addictive substance or activity. Recovering from a behavioural or substance addiction would allow the brain’s reward center to return to normal, though some brain changes can be permanent.
However, cravings and withdrawals make it difficult for people to quit. Withdrawals are uncomfortable and even painful physical and psychological symptoms that happen after reducing or stopping the addictive activity or substance. Many attempt to self-medicate withdrawals by resuming use.
What Is the Difference Between Substance Addiction and Behavioural Addiction?
The difference between substance addiction and behavioural addiction comes down to their objects of abuse and physical effects. While many programs offer addiction treatments for both conditions, the goals and methods used are often distinct.
Behavioural Addiction vs. Substance Addiction
A major difference between behavioural and substance addictions is the object of abuse. In substance addictions, the person becomes dependent on alcohol, cannabis, prescription medications, or illicit drugs. Behavioural addictions feature compulsively engaging in addictive activities.
Physical Effects
As mentioned, behavioural and substance addictions impact the brain in virtually identical ways. However, they do not have the same effects on the body. Substance addiction produces both short- and long-term physical effects; it’s not as clear if behavioural addictions do the same.
Someone with a behavioural addiction can hide their problem more easily. Addictive activities are not physically intoxicating, making them harder for loved ones to spot. Meanwhile, acute alcohol and drug intoxication produces visible changes to speech, gait, and other signs.
Long-term substance use also shows up differently than long-term behavioural addictions. Chronic alcohol or drug use may lead to brain damage, liver or kidney dysfunction, or lung disease. Changes to someone’s appearance, such as tooth decay, skin disorders, or premature aging, are also possible.
Signs of behavioural addictions are not so obvious. Someone with an exercise addiction might experience injuries, and porn addictions may lead to sexual dysfunction. However, these physical effects often indicate other mental or physical health conditions.
The presence and severity of behavioural addiction withdrawal symptoms are also debatable. Some experts have found that unpleasant physical effects (e.g., ‘the shakes’) may occur when someone quits the addictive activity, but we need more research to understand the extent of these symptoms.
Treatment Options
Treatments for SUDs involve detoxification, medication, and counselling. Most programs also include some form of aftercare (e.g., ongoing group therapy). Some people may also undergo treatment for a co-occurring mental health disorder in drug or alcohol rehab.
Most substance treatment programs share in common a primary goal of helping patients get sober and stay abstinent. However, the exact treatment regimen depends on the individual.
Behavioural addiction treatment plans are similarly tailored to an individual’s unique situation. They may also involve medication, counselling, aftercare, mental health treatment, and some form of detox. The difference is that abstinence is not always possible.
Take a food addiction as an example. The individual has to achieve a healthier relationship with food, but they can’t stop eating altogether. Instead, the ultimate aim may be promoting moderation rather than abstinence.
Help for Substance and Behavioural Addictions
So, what is the difference between substance addiction and behavioural addiction? Substance addictions involve physical and psychological dependence on drugs or alcohol. Behavioural addictions are similar, but the object of abuse is an activity, and they do not always affect physical health.
Does your loved one need help with addiction in Ontario? Simcoe Addiction and Mental Health offers customized treatment programs for a variety of SUDs and impulse control disorders. We also specialize in dual diagnosis treatments for comorbid behavioural and chemical addictions.
Contact us to learn more about our offerings and get your loved one the help they need to start recovering today.