A new wave of addictions has been identified in recent years known as 'process addictions'. Psychiatrist and Head of Addiction Services at St John of God Hospital Professor Colin O’Gara told Brendan O’Connor what these behavioural addictions look like, how they arise and what treatments are available.
Addiction is normally associated with substance abuse, but in the case of process addiction it relates to behaviour. There is often an online element and the addiction can arise around exercise, work, shopping, gambling, gaming, watching porn and other activities. The problem can be difficult to spot at first, as secrecy and shame often surround the behaviour. It can also be hard to distinguish 'normal' from 'abnormal' phone useage.
Brendan asks how will people know if there is a problem? When does online gaming, say, or frequent exercise cross over into addiction? Prof O’Gara says the biggest tell is how it affects not just the addict, but the people around them:
"With a lot of addictions, it’s the people around the individual who are affected."
He says that a process addiction happens when something people enjoy doing becomes problematic:
"We have a definition around process addictions. If a process adds to your life, you’re generally OK. But if it starts to take from your life - this is a kind of central tenet – well, then you are running into difficulties."
Conflict with other people is very prevalent with process addictions Prof O’Gara says:
"If the problem is causing conflict in your life, in other words, if you are working 70 hours a week and somebody in your family is affected by that, you’re narky and ratty with the people around you and children are being neglected, well obviously that process then is affecting your life."
Some people develop what the psychiatrist calls "excessive maladaptive behaviours" in relation to certain activities or processes in their lives. Prof O’Gara takes the example of exercise:
"I would see people who would use that process, which can be highly reinforcing and highly positive, but people take that to excess. So you’re taking cortisone shots in various joints and you’re going out running, often running these ultra events you shouldn’t be doing."
Brendan zeroes in on the concept of reward at the heart of an addiction, particularly in the initial stages. Prof O’Gara says, yes, there is a "hit" from behaviours that are enjoyable. With some people, this reinforcement cycle can turn into an addiction:
"Certain processes, and these could be biological processes - if it’s gaming, gambling or consuming porn on the internet - these can be incredibly reinforcing behaviours. And in some individuals, this is called the Dopamine Theory or the Dopamine Hypothesis, some people when they get that release or that surge of dopamine, their system is calibrated at a level maybe slightly lower than other individuals, so when they get this hit of dopamine, they say, ‘I need to go back to that and I need to reinforce more.’"
Brendan asks if this means that some people are more likely than others to get addicted? They are, the psychiatrist agrees. And what’s more, people with one process addiction often have multiple addictions; sometimes they will have substance abuse issues at the same time:
"50-80% of addiction that we would see, Brendan, in the clinic would be what we call dual diagnosis or poly addiction."
Research on these addictions needs to catch up with the numbers they are now affecting, Prof O’Gara says. It can also be hard to talk about them, as the international classification system for process addiction is still emerging.
Another problem that arises is that people don't take some process addictions seriously and there is a degree of shame attached to process addictions involving porn consumption and even excessive shopping, Dr O’Gara says:
"I would see individuals that are very distressed that they’ve got a house full of jumpers. Some people will find that, they’re going to find it funny, it’s as simple as that. But it’s not funny for the people who are suffering from these addictions."
People who have this addiction persist with it, even where it has very negative consequences for their loved ones, Prof O’Gara says:
"Family members will be very aware that is not good for them, they’ve spend a load of money on this. These are things they don’t need, but it might be the eBay process, where they are watching a clock tick down and they win the auction, so it’s not really jumpers, they are looking for a buzz."
Brendan asked if addiction to screens and mobiles is at the heart of it and Prof O'Gara explains:
"We've got two pieces to it - we have the different things that people go online to do: so often it would be gambling, gaming, accessing porn. But there is an entity that is becoming more focused on, which is called Internet Use Disorder. So that's basically surfing, social media sites, it could be YouTube or whatever."
The prevalence of 'internet use addiction', for example, could range from 4% to 30% in some populations, depending on how it’s measured, Dr O'Gara says, and so more research is needed.
The original process addiction is gambling, and even though it's been recognised for some time, Prof O’Gara says society is still struggling with its consequences:
"The impact of these addictions as a process addiction is plain to see. In terms of gambling, It’s been quite substantial, particularly on young men."
The internet has "turbo-charged" process addictions and smartphones have given everyone access to a portal in their pockets to access any number of addictive processes. Some of these addictions are relatively new, and there can be huge stigma surrounding them; but they are still addictions and people need help over coming them:
"I hope that people are listening who are affected by these conditions. Increasingly, process addictions are real addictions, I would say that. And people who suffer from these addictions deserve compassionate support. There is a fair amount of trivialisation, even ridicule out there."
Treatment options are available, like medication, therapy and support groups and you can hear more about those in Brendan's full interview with Prog O'Gara, here.
If you’re affected by anything raised by Prof O’Gara, helpline information is available here.