October 2, 2021
By Karolin Susan
I walked into an enclosed space of a men’s rehabilitation center, sat in the waiting area, where some of them were lurking around. They were glaring deep into my eyes, skimming through my femininity. I began feeling very restless. Speaking to the head counselor at the center, however, calmed my flared nerves, and my goal of learning addiction patterns in people was reiterated. Nonetheless, I was engulfed with feelings of both fear and scorn toward the in-mates. Having had extended family members subjected to the wrath of a substance use disorder, the thought of their loved ones enduring worries, social exclusion, and humiliation as a result of the disease of the men in their lives, naturally hovered over me. Over the next four days of my time, the inmates morphed into humans, with intense stories of sexual abuse, losses, anxiety, other co-morbidities, loveless marriages, incompetence, and a burdening amount of shame resting on their masculine stature.
Among them was Anto*, a 25-year-old, suffering from mild psychosis and severe Substance Use Disorder (SUD); He was fairly new at the center, thus would often isolate himself from the rest. In his room, he would engage in behavior that involved chipping paint off the wall or bending iron rods of the window. As a result, he would routinely receive a mouthful from the officials at the center. To Anto, this activity is compulsive and mindless yet provides him much relief, familiarity, and calm; To the officials, this behavior is disrespectful, disobedient, and an intentional choice. In retrospect, I see this as another addiction he could be indulging in, a substitute for psychotropic substances.
Introducing Behavioral Addiction
Anto’s itching need to participate in deviant behavior is commonly overlooked, frowned upon, or seen as a rather selfish choice. To our relief, these addictive experiences are classified under behavioral addiction (BA) or process addiction. Behavioral addiction was first introduced to me by one of my supervisors. As an RCI (Rehabilitation Council of India) certified counselor, he asked me a very poignant although simple question, “how does your client profit from this behavior?” Subsequent to realizing the harmful nature of the behavior, without therapeutic interventions, it is an arduous task for the struggling individual to simply put a full stop to the addictive experience. The involuntary nature of the behavior is what is determined to be a behavioral addiction. Experiences namely sex, social isolation, power, approval, altruism, religiosity, perfectionism (purity), self-righteousness, emotional suffering, acute physical pain, information, indignation, people-pleasing, gleefreshing, cognitive distortions (binary thinking), picking nasal cavity, pimple popping, consumerism, etc. can be categorized under behavioral addiction.
Beginning to feel a lot like behavioral addiction
According to the American Addiction Centre, “The compulsion to continually engage in an activity or behavior despite the negative impact on the person’s ability to remain mentally and/or physically healthy and functional in the home and community defines a behavioral addiction.” Many reasons coerce the individual to engage in a particular behavioral experience; Typically, it is often psychological rewards that soothe the person, along with other social rewards, all of which fulfill primary emotional needs. This would look harmless at a glance; Although, since the behavior is often an overindulgence, physical and mental wellbeing is challenged, either in the form of unhealthy interpersonal relationships, a volatile temperament, or a loss of self-concept. This is then followed by intense feelings of remorse, guilt, shame, and overwhelmed by other consequences of the continued behavior. This formula reminds me of the analogy of human relationships – it can be both rewarding and weaponizing.
The relationship between the respondent and the stimuli
If the modus operandi of addiction has to be summarised, it is solely an emotional attachment, which means there is very little scope of welcoming a contrasting rationale. The relationship between the object of dependence (behavior) and the subject (individual) looks more like an anxious attachment style than a secure one. Here the individual clings onto the other lest they leave. This relationship between the two can also be seen in the context of trauma bonding, a Stockholm syndrome, where the exploitative partner is manipulative either inflicting further trauma on the victim, (i.e, the person addicted) or causing trauma as a consequence of the emotionally abusive relationship. E.g. The romantic relationship between Japanese soldiers and Korean women in World war II, the soldiers received emotional relief and the women had their life safe-guarded. Therefore, the individual is protected and provided their emotional survival needs by the object (psychotropic substances or behavior) of addiction.
At its crux, Addiction is also emotional coping. The emotional response in the face of stressful events, trauma, and/or social dislocation to soothe the self when experiencing uncomfortable emotions. Here the individual employs this coping strategy primarily because of the belief that the issue is beyond their purview of control or expertise. What is more, is that the process of addiction is a fear of isolation rearing its head when the self is on the hunt for gratifying emotional needs; A shortcut to run to the apex of the pyramid for self-actualization. Isolation angst propels one to fight, fawn, or flee from intense emotions (guilt, and shame) arising as a result of a lack of social skills, a personality style, being uninformed about human intimacy, isolation as cultural appropriation, indifference toward the self, an inability to accept the self with all of its dysfunctional parts, etc. Addiction is, then, a disbelief in the plurality of human agency, faith in one’s ability to enter or exit a relationship, to create, to pave a road for hope to prevail, and unacquainted with uncertainty. Mind you, the strife to gratify basic emotional needs aren’t always an outcome of trauma; Not everyone addicted has had trauma but anyone addicted can have trauma.
The process of addiction
Behavioral addiction indirectly stimulates the neurotransmitters of the Central Nervous System (CNS). Neurotransmitters have two functions, either inhibitory or excitatory; Both BA and SUD stimulate the coddling Dopamine (excitatory neurotransmitter) and reduce the effect of the disciplining Serotonin neurotransmitter (inhibitory neurotransmitter), which plays a key role in regulating behavior. Irrespective of the nature of addiction, these idiosyncratic neurochemicals are responsible for neurotransmission, critical to human cognition, emotions, and behavior.
Our nervous system is a body in itself, they are the CEO of the human anatomy, intervening in communications, motivation, moods, involuntary movements (like your muscle memory), pleasure, regulating pain, desire, etc. of the larger body. As a collective, they are quite interconnected and detail-oriented. Within this integrated system, a panjandrum like the dopaminergic modulators is alerted upon a perceived stimulus, carrying out behaviors that they think befits the moment.
Why is Behavioral Addiction not as black and white for our liking?
These addictive experiences are complex, as many a time, some behaviors are also acceptable and backed by cultural etiquettes. To illustrate further, in the western world, idiocentrism is applauded, specifically, during stressful times self-reliance is preferred over inter-dependence. In the face of it, these coping tools would appear normal and benign; For this reason, these socially acceptable addictive behaviors go unnoticed as generally Addiction is acknowledged as a strategy of dependence on psychotropic substances. Regardless of the voluntary or involuntary use of the behavior, what should be considered dubious is the co-dependent relationship with the behavior.
What classifies as Behavioral Addiction at the moment?
Even though behavioral addiction is most times camouflaged, core indicators of behavioral addiction as pathology is ubiquitous to that of SUD as well. Various clinical studies assert that common mechanisms present in the duo (BA and SUD), sustain, develop, and alter the biochemical responses in the human system. A study between gamblers and alcohol-dependent individuals gathered that both the parties showed slowed performance on the tests of inhibition, cognitive flexibility, and planning tasks. Nonetheless, researchers convey, to make a diagnosis of BA, functional impairments must be present at work, social, or intrapersonal relationships. Although Gambling as a BA under Addiction disorders has been mentioned, the diagnostic manual (DSM) is yet to formally acknowledge and state the known ones such as internet addiction, shopping, hypersexuality, food et al, a behavioral addiction. Amongst the sea of shreds of evidence for BA, we can hope that DSM-5 is making space for the rest of the common BA’s. Until then let’s not forget Dr. Stanton Peele’s take on addiction and Griffth’s diagnostic criteria for the same.
- Salience: Domination of a person’s life by the activity
- Euphoria: A ‘buzz’ or a ‘high’ is derived from the activity
- Tolerance: The activity has to be undertaken to a progressively greater extent to achieve the same ‘buzz’
- Withdrawal Symptoms: Cessation of the activity leads to the occurrence of unpleasant emotions or physical effects
- Conflict: The activity leads to conflict with others or self-conflict
- Relapse and Reinstatement: Resumption of the activity with the same vigor subsequent to attempts to abstain, negative life consequences, and negligence of job, educational, or career opportunities.
Additionally, all BAs have pain/pleasure components intertwined and together share the dopaminergic pathway, which contributes relief while the body is engaged in either a painful or a gratifying activity. Therefore, during pain or pleasure, a certain amount of Dopamine is released. A study on how paracetamol affects emotions discovers that the good ol’ pain-relieving pill comes in handy with the potential to provide relief to emotional pain, whilst also dulling the feelings of pleasure.
What is the ultimate road to recovery?
After careful consideration, I’d like to conclude that all of us are in the spectrum of Behavioral Addiction, in such a way that self-righteousness, or shaming the other won’t spare us from the clutches of one’s destructive anonymous vices, barring the reward of an instant dopamine rush and vandalized relationships. In addition, we ought to factor that these inhibitors in our nervous system are why we are intrinsically resilient creatures, rhythmically making it to the other side of grief, pain, and other agonizing forms of life. Ergo, the road to recovery is not in shaming this organic part of yourself, it is indeed in acceptance and courageously having dinner with the devil, i.e. making room for the fragmented elements of the self. Since predatorial parts of ourselves are shunned and shamed frequently in our culture, admitting to yourself is the scariest thing to transpire; Yet it is also a mammothian execution of courage.
- Maybe you can begin by keenly looking into involuntary responses in yourself that momentarily comfort you during a stressful event.
- Ask yourself, if the response will yield you limited or durable comfort from the problem? What are the negative consequences when indulging in this experience of temporary comfort?
- Take note of factors that often lead you to this response.
- Consider making necessary changes with the help of a counseling psychologist and other support systems.
I’d like to remind you that this is merely a self-alignment on the road less traveled, to embrace a side of the compulsive experience that is beneficial while being aware of the weaponizing component of it.
At the end of my time at the rehab center, I had the honor of listening closely to their stories of shame and violation, taking note of their body language, their voice modulations, tears, and smiles at certain segments in the story. Needless to say, I walked out of the rehab a somewhat compassionate person toward parts of myself I deemed reprehensible.
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