What are the different types of addiction?
Addiction can take shape in two ways: overusing or misusing substances or excessively engaging in behaviors despite the negative consequences either results in. These two types of addiction are typically recognized as chemical or behavioral.
As you probably know, chemical addiction involves substances like alcohol, tobacco, and prescription drugs. What you might not know is that every substance has a different effect on both our bodies and our brains, Ernesto Lira de la Rosa, Ph.D., a licensed clinical psychologist in New York City who is part of the media advisory group at the Hope for Depression Research Foundation, tells SELF.
In particular, he explains, substances tamper with your brain’s communication system, altering the way your brain sends, receives, or processes information. “Substances can either mimic your natural brain chemicals or overstimulate your brain’s reward system,” Dr. Lira de la Rosa says.
Outside of the brain, this can manifest in certain behaviors that you or a loved one may notice. According to the National Alliance of Mental Illness (NAMI), symptoms of chemical addiction or substance use disorder include:
- Intense cravings
- Sudden behavior changes
- Withdrawal from family and friends
- Relationship, school, and work difficulties
- Developing a high tolerance to the substance
- Experiencing withdrawal symptoms when not using the substance
- Needing the drug to function
- Engaging in high-risk behaviors
Behavioral addiction, on the surface, may be harder to pinpoint. That’s because we all engage in behaviors that drive pleasure and enjoyment, like eating delicious, comforting foods and exercising for those post-run endorphins.
Someone with a behavioral addiction, put simply, can’t stop without outside help.They compulsively participate in the behavior over and over again, no matter the consequences. The same neural circuits that underlie chemical addiction can be activated by other activities, such as gambling, David Mou, M.D., a board-certified psychiatrist and chief medical officer of Cerebral, tells SELF.
There are some general signs to watch out for if you suspect you or someone you love might be struggling with a behavioral addiction. They include:
- Preoccupation with the behavior
- Using the behavior to mask or avoid negative feelings
- Compulsive or excessive participation in the behavior despite adverse consequences
- A feeling of pleasure or relief while engaged in the behavior
- Feeling out of control while engaging in the behavior
- Restless or irritable if unable to engage in the behavior
What are the types of chemical addiction?
Chemical addiction refers to substances that can be addicting and is often what people think of when talking about addiction in general. This includes:
This is an addiction to any alcoholic beverage such as beer, wine, or hard liquor, resulting in alcohol use disorder (AUD). According to the National Institute on Alcohol Abuse and Alcoholism, AUD is an impaired ability to control or stop using alcohol despite adverse health, occupational, or social consequences.
While you may have heard that definition, what you might not know is there are varying levels of AUD, including mild, moderate, and severe. You might think that only severe AUD is a cause for concern, but things like drinking more or longer than you intended, feeling unable to cut down or stop drinking, and feeling a compulsive urge to drink can be signs of mild or moderate AUD.
This is considered an addiction to any tobacco product—like cigarettes, cigars, and chewing tobacco—that contains nicotine, an addictive ingredient that increases the level of dopamine, a chemical in the brain that makes you feel good, and primes you for a reward, according to the National Institute on Drug Abuse.
In 2019, the Centers for Disease Control and Prevention (CDC) reported that 14% of U.S. adults smoked cigarettes—that’s 34.1 million people. It’s also the leading cause of preventable disease, disability, and death in the U.S.
Prescription drug addiction
This type of addiction encompasses the misuse of prescription drugs by taking a higher dose than prescribed, using someone else’s prescription, or taking a medication to feel high. Examples of commonly misused prescription drugs include opioids, stimulants like amphetamines, and central nervous system depressants like sedatives and tranquilizers
This type of addiction specifically involves the abuse of cocaine, which is an illegal stimulant drug. According to the NIDA, in 2014, 913,000 Americans met the criteria for having a cocaine addiction. It also noted that in 2011, 1 in 3 drug misuse-related emergency visits were due to cocaine.
Cannabis use disorder (CUD) is the term used when a person experiences symptoms of withdrawal when not using marijuana. In other words, it’s considered a dependence—or when your brain adjusts to large amounts of the drug and decreases sensitivity and production of its own neurotransmitters, which basically makes it harder for you to feel a pleasurable “high” without it.
Cannabis addiction occurs when the use of the drug interferes with important aspects of your life, such as work and relationships. It’s important to note that a person can have a dependence on cannabis and not have an addiction, according to the NIDA.
This involves the overuse of stimulant medication, including the prescription drug Desoxyn and the street drug known as crystal meth (think Breaking Bad), and is included under the umbrella of prescription drug misuse. Stimulants are classified as Schedule II controlled substances which means they have limited medical use and a high risk for addiction, according to the United States Drug Enforcement Administration.
According to the NIDA, in 2017, 964,000 Americans had a methamphetamine use disorder.
Types of behavioral addiction
Behavioral addictions share some similarities to chemical addictions, but there’s still uncertainty in the medical community about whether or not engaging in a particular behavior can lead to a true addiction. That stems from a lack of current research into the various types of behavioral addictions, which is needed to first determine whether they are unique from other mental health disorders, and then establish criteria for an accurate diagnosis and recommendations for evidence-based treatments.
In fact, gambling addiction is the only behavioral addiction identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, the DSM-5 does recognize internet gaming disorder as a condition for further study.
While further research is needed in this field, experts believe the following behaviors are or could be considered addictions and warrant further investigation:
- Gambling addiction is characterized by a compulsion to bet on sports, play slot machines, buy lottery tickets, visit casinos, or participate in any other gambling behavior despite any negative consequences, according to the American Psychiatric Association.
- Sex addiction features a need to engage in sexual acts regardless of the risks or negative consequences created by the activities. While not an official diagnostic term, many experts link it to compulsive sexual behavior disorder (CSBD), which is a recognized diagnosis. CSBD is the preferred term because there is debate within the mental health world about whether this behavior is categorized as an addiction or an impulse control disorder. Pornography addiction is also sometimes bucketed here.
- Video game addiction, also known as internet gaming disorder, is a relatively new disorder characterized by reduced control over gaming leading to adverse consequences in family, social, personal, or work life, according to the American Psychiatric Association.
- Internet addiction is also not an official diagnosis, but is used to describe excessive internet use and a compulsion to be online followed by adverse consequences like anxiety, irritability, and depression when not using it5.
- Shopping addiction, or compulsive shopping, involves compulsively buying items as a way to mask or get relief from negative feelings. While not a diagnosable disorder, it can have severe consequences like financial damage, increased stress, and increased anxiety.
- Plastic surgery addiction is an urge to change physical appearances by undergoing plastic surgery. While not a clinical diagnosis, it’s most likely a sign of body dysmorphic disorder (BDD), a condition that leads to persistent and obsessive thoughts about perceived flaws in your appearance.
- Food addiction refers to compulsively eating or bingeing on food to ease negative feelings and emotions. It’s not an official diagnosis, but it is closely related to binge eating disorder (BED).
- Exercise addiction describes an unhealthy relationship and obsession with participating in exercise and fitness activities to the point of being harmful both physiologically and psychologically.
What happens in the brain with chemical addiction?
The sneaky thing about chemical addiction is that your body starts to require more and more to feel the same effects.
Here’s why: When you use a substance, there is a release of dopamine (a feel-good chemical) in your brain that results in euphoria or a “high,” Dr. Lira de la Rosa says. However, this release of dopamine later changes to not only when we use substances but also to cues associated with the substance. Here’s an example: Let’s say you always go out drinking with a certain friend at the same bar. Just walking past that bar—without your wingman—could trigger an intense urge for a drink.
“When you continue to use a substance, your brain begins to adjust to the changes in dopamine levels, and you begin to build a tolerance,” he says. In addition to tolerance, Dr. Lira de la Rosa says the brain makes less dopamine or reduces the number of dopamine receptors in the brain.
“When you build a high tolerance, you may not experience the same pleasure as you did when you first used the substance,” he says. Your brain then adapts, and you find yourself needing to continue to use the substance just to feel ‘normal.’”
What happens in the brain with behavioral addiction?
Behavioral and chemical addictions share some similar features, but there are also some key differences. In behavioral addiction, there is no substance at the core of the addiction—it is the behavior that becomes problematic.
However, Dr. Lira de la Rosa says the same principles of chemical addiction apply to behavioral addiction. “There is still a release of dopamine in the brain when the person engages in the addictive behavior, such as gambling, sex, internet, shopping, or video games, and with repeated use, the person continues to engage in the behavior seeking the same ‘high’ or pleasure from the behavior,” he says.
After repeated use, the person builds a tolerance, and if they try to stop or decrease the behavior, they may experience withdrawal symptoms like unpleasant emotions, including irritability or anxiety. This is how someone could get to a place of engaging in a particular behavior—like playing video games—for hours on end. It may only become noticeable when you or a loved one starts withdrawing from important relationships or neglecting responsibilities.
What are the treatment options for chemical addiction?
There are a variety of treatments for chemical addiction, but finding the right one depends on many factors, including:
- The person’s unique personality, genetics, and medical history
- The drug of choice
- The amount and length of use of the drug
- A personal and family history
In severe cases, Dr. Lira de la Rosa says the person will need to check into a medical detox treatment facility and be monitored by medical staff while they withdraw from the chemical. The physical effects of withdrawal can be serious—including seizures and hallucinations—and depend on the type of substance and duration of use, so it’s important the person is monitored by a professional. After the person detoxes, the psychological aspects of addiction can be addressed, such as the mood changes associated with withdrawal and establishing new ways to handle urges.
In general, treating addiction from a psychological standpoint can include a variety of approaches, such as individual psychotherapy, group psychotherapy, and medications
Dr. Lira de la Rosa recommends working with both a psychiatrist and a therapist for the most effective recovery treatment. A psychiatrist can prescribe medications that help with withdrawal, cravings, anxiety, and depression if needed. A licensed counselor or psychologist specializing in substance use disorders can help address negative patterns of thought and behavior with cognitive-behavioral therapy (CBT). A combination of those two treatments can help you understand your triggers, learn how to manage your triggers and cravings, and find healthier ways to cope while in recovery, says Dr. Lira de la Rosa.
During the process, you may also need to address other parts of your life that have been neglected, including underlying medical conditions or mental health issues. Therapy may also help you to mend relationships that were impacted while using substances.
Dr. Lira de la Rosa also points out that some people may not be ready to live a life of sobriety. In these situations, he says harm reduction strategies can be used to help people cut back on substance use and have a healthier relationship with substances.
On another note, relapse is often a part of the recovery process. It doesn’t mean a person or their treatment has failed. It simply means their treatment plan needs to be adjusted or revisited.
Perhaps the most important part of recovery is that the person has to want to get better. “Sustained motivation is the cornerstone to treatment,” Dr. Mou says, but the onus is not only on the person in treatment. The treatment team also has a responsibility to help keep the person motivated in their recovery journey, he says.
What are the treatment options for behavioral addiction?
Treatment for behavioral addiction is typically centered around therapy, but can also include medication. “You may benefit from individual therapy to address triggers and withdrawal symptoms, as well as learning new ways to engage in healthier behavior,” Dr. Lira de la Rosa says.
Like chemical addiction, common treatments for a behavioral addiction include cognitive behavioral therapy and motivational interviewing. The goal is to change the patterns of thought and behavior and develop new coping skills.
How to help yourself or a loved one during addiction recovery
If you’re concerned about substance misuse or behavioral addiction, know that you are not alone. Finding support and practicing self-compassion can help you on your journey to recovery. Here are a few tips that can help you get started:
Find a support person
Confide in a family member, friend, or mentor who you trust. Forging a bond with a close contact can help you through difficult moments, but keep in mind that professional help may also be necessary.
If you’re helping a loved one through addiction recovery, Dr. Lira de la Rosa says it’s also a good idea to seek support for yourself. “You may experience a range of emotions in this process, and having your own space to talk about your experiences can be beneficial,” he says. You can also then model positive behavior for your loved one.