Substance addiction is a well-established concept long recognized by mental health professionals, researchers and the general public. Behavioral addiction is a form of recently acknowledged, non-substance-based addiction that has a strong scientific foundation but relatively little recognition in society as a whole. In a study published in November 2014 in the journal Addictive Behaviors, a team of Canadian researchers used a large-scale project to compare public attitudes held toward people affected by substance addiction to public attitudes held toward people affected by behavioral addiction. These researchers uncovered attitudinal differences that may impact the lives of people affected by addiction in important ways.
Drug and alcohol addiction are firmly entrenched as diagnosable mental health problems with definitions provided by a professional organization called the American Psychiatric Association (APA). However, the acknowledged relationship between addiction-based substance problems and non-addiction-based substance problems has changed considerably in recent years. Prior to 2013, APA definitions called for a clear separation between the diagnosis of substance addiction and the diagnosis of substance abuse in people not affected by addiction. However, for a number of years prior to 2013, researchers and doctors had noted that the real-world manifestations of substance problems don’t necessarily fit into an addiction vs. abuse paradigm. Instead, some of the symptoms of physical dependence-based addiction can also appear in people who otherwise qualify for a substance abuse diagnosis. At the same time, some of the symptoms of substance abuse can also appear in people who otherwise qualify for an addiction diagnosis.
The American Psychiatric Association resolved the logical inconsistencies of this situation by eliminating substance addiction and substance abuse as separate phenomena and creating a new condition, substance use disorder, that incorporates symptoms of drug and alcohol addiction into the same disease definition as symptoms of drug and alcohol abuse. Doctors use a sub-typing system to label the substance responsible for any given person’s symptoms; specific conditions identified as offshoots of substance use disorder include alcohol use disorder, cannabis use disorder, opioid use disorder and stimulant use disorder.
A person diagnosed with a behavioral addiction has some of the same relevant behavioral and brain function problems that doctors use to diagnose various forms of substance use disorder. However, their problems don’t stem from substance use; instead, they stem from a dysfunctional level of involvement in certain popular, pleasure-producing activities not strictly associated with substance intake. One source of behavioral addiction, gambling, has received official attention from the American Psychiatric Association. Other possible sources of non-substance-based addiction supported by significant amounts of research include shopping, using the Internet, playing games on the Internet, eating and having sex.
Do Public Attitudes Differ?
In the study published in Addictive Behaviors, researchers from Canada’s University of Calgary, University of Ottawa and University of Alberta used information gathered from an Internet-based survey of 4,000 adults to determine if public attitudes toward substance addiction differ considerably from public attitudes toward behavioral addiction. The researchers asked all respondents to register their opinions on addiction related to the use of four specific substances: alcohol, cannabis/marijuana, cocaine and nicotine/tobacco. They also asked all respondents to register their opinions on forms of behavioral addiction associated with food consumption, gambling, having sex, video game use and shopping, as well as behavioral addiction associated with work-related activities. For each form of addiction under consideration, the researchers asked the survey respondents to describe how they thought addiction developed, how responsible each person was for his or her addicted state and how many people they believed were affected.
After analyzing the results of the survey, the researchers concluded that the general public believes that people affected by substance addiction are more responsible for their dysfunctional condition than people affected by behavioral addiction. Conversely, they concluded that the general public also believes that people affected by behavioral addiction are more likely than people affected by substance addiction to have fixed personality defects that substantially account for their condition.
The study’s authors believe that, overall, the average person has a fairly sophisticated understanding of the nature of substance addiction and behavioral addiction. However, they note that the general public still considers substance addiction as fundamentally different from behavioral addiction in certain key respects. This attitude (not supported by the growing scientific consensus on the underlying nature of addiction) may substantially impact the life experiences, treatment-seeking actions and treatment outcomes of people affected by each form of addiction.