When we’re talking about mental health disorders, it’s not unusual that we run into Substance Use Disorders and, even if we don’t fully understand how these work, we generally understand their consequences. An “addict” is usually seen as someone who starts using substances and, at some point, because of some changes to brain chemistry and other factors, they have difficulty stopping the use of those substances and sometimes really lose almost all control or do completely lose control of their ability to stop using. A Process Addiction has really the same feel as a Substance Use Disorder, except without a substance, at least not with a traditional substance like alcohol or heroin or cocaine or something like that. Common examples of process addictions would be gambling or shopping or someone who has difficulty cutting back their usage of the internet. We can also see Process Addictions with eating, gambling, pornography, etc.
With Process Addictions, because they’re not all categorized really as mental health disorders, it becomes difficult to distinguish them from just overuse of the internet, or overeating, or shopping too much. Another problem with identifying and treating some types of Process Addictions is that they’re oftentimes part of a person’s life – someone needs to eat to survive, someone needs to shop to survive and, for many people, they need to go on the internet to survive. Now, gambling or something like that is a little different – you don’t need to gamble to survive (even though someone who engages in pathological gambling will “feel” that it is), but for other behaviours, which, in moderation would be normal, we really have to look at a Process Addiction as a compulsive expansion of those behaviours, where cutting back can be difficult and oftentimes impossible.
Also, with the presence of a substance, most people understand the concept that the substance has an effect on the brain, therefore somebody’s ability to control their use is compromised. With Process Addictions though, many people are a little more sceptical: can somebody really be addicted to the internet? Can somebody really be addicted to gambling? In a sense, somebody could look at these behaviours and say: why not simply stop? It’s not the introduction of a chemical into the body, it’s a behaviour that somebody has to actively engage in without, in theory, any negative impact on the brain… But what is found in the research about Process Addictions is that there IS a change in the brain when somebody becomes addicted to a process, even without substances being involved, so it appears that Substance Use Disorders and Process Addictions have a lot in common and when you look at how we would treat a Process Addiction as compared to a Substance Use Disorder, the treatments have similarities as well: cognitive behavioural therapy (which is basically bringing awareness in), trying to reduce the triggers in the environment – for example, if someone is using the internet to a point where it has become a Process Addiction, we may put a plan to restrict how much internet access is available. If someone has a Process Addiction to shopping, we may limit how much can be spent in a specific month – the counsellor may work this out with a client and then come to some sort of agreement and that would be a way of trying to reduce the exposure to the situation that’s causing the addiction – exactly as in the case of Substance Use Disorders, where we cut off the supply of alcohol or the chosen drug.

What is crucial to understand is that, according to serious recent studies, what we call “the reward cycle” of the brain, triggered by dopamine increase, is not provoked by the administration of the stimuli (be it a drug or alcohol or whatever else), but by the anticipation of the circumstance, by the context and props that are involved… The administration of the substance itself, its impact on the body does not result in the increase of dopamine levels and thus in the “feeling good” state – rather, the choosing of the (e.g.) type of alcohol, the company we have, the place we get to go to in order to have that drink, the sense of comfortable familiarity, etc – that is what brings in the dopamine and thus “the reward”. Alcohol itself DECREASES the level of dopamine and here you can observe the infernal cycle: the addict THINKS that he is being soothed by the alcohol, when, rather, his brain enters that reward circuit BEFORE administering the liquid itself, only to produce decrease of dopamine at the actual engaging with the substance. Crudely put, we get high through the anticipation and low through the administration. Excitement triggering shame/depression/dis-ease.

Process Addictions can be, in some ways, more difficult to treat than Substance Use Disorders, simply because they are not recognized as a problem, especially, as I was mentioning, when the addiction can be viewed as harmless due to its “normality” in the person’s life. For instance, someone who works on the internet could have a very hard time recognizing that, above and beyond professional and casual use, they are engaging in numerous activities (social media, porn or whatever else it might be) that make them lose time online, weaken their relationships with family and friends, lower their professional performance, affect their health, etc. As in the case of an alcoholic, they will find reasons to keep engaging in that usage under the cover of “this is my job”.

Another issue that I see very commonly in “spiritual circles” is something that is potentially extremely dangerous: “LOVE YOURSELF” and the myriad of its alternative formulations. Why dangerous? Let me clear that up. For an alcoholic, it would not make sense to say, I love my alcohol consumption, this is who I am and everyone should love and admire me for that, because alcohol is clearly seen as destructive and dangerous. For some who, for example, engages in pornography though, it might come easier to, first, hide that use better and for a longer time, while affirming to themselves (and to those who know about their use) that they are simply a more sexual being than most, that they need that “harmless” pick-me-up, that they won’t judge themselves for being the way they are, etc. The process that the person engages with, might not be seen as destructive in the same way that alcohol is, which makes it so that it can be pictured as a unique feature of the individual’s life that is acceptable or even healthy. Exactly as in the case of the alcoholic, they rationalize their usage of the chosen prop, refuse to take responsibility for all the problems that their pornography addiction causes, and, most importantly, they cannot see the cycle I was referring to above, where their own excitement about indulging in the addiction brings about a host of problems like depression, low levels of inspiration, confusion, shame, sexuality issues – not to mention relational problems and the physical and mental fatigue engendered by the compulsiveness and the expansion that are characteristic of all addictions.

There are two processes that take place here: defense mechanisms and cognitive dissonance.
Defense mechanisms protect the ego from non-socially acceptable urges, thoughts and impulses, by keeping those urges, thoughts and impulses out of conscious awareness. Up to a point, defense mechanisms are normal and they operate in the unconscious mind. However, when defense mechanisms occur too often or at a high level of severity, they can lead to pathology, meaning they can lead to mental health symptoms. To understand defense mechanisms, we have to understand clearly the role of the conscious, subconscious and unconscious minds. If something’s in someone’s conscious awareness, then they’re thinking of it right now; the subconscious contains information that you have access to, but you’re not thinking about it right this moment – it can move into conscious awareness, but only if something prompts it internally or externally. By definition, unconscious urges are, well, unconscious, they can’t be retrieved, the person is totally unaware of them.

An “addict” – to a substance or to a process, will use (generally) rationalization, in order to make their addiction seem like the only rational thing that can be done to relieve their issues. For some, alcohol is seen as the only thing that helps them relax or sleep, or be able to cope with stress. For others, engaging with pornography or shopping or whatever else in ways that are compulsive and destructive for the individual’s life, might be rationalized through, for example, “this is my only pleasure and what makes me cope with reality better”… etc! We see, in both people, some sort of explaining away of their mental disease through an excuse for why their addiction is acceptable and even healthy. This is where cognitive dissonance may incur, where, to put it in a way that is easy to understand, something in the person knows that their addiction is destructive and that their explaining it away doesn’t make it healthy. Cognitive dissonance occurs when someone’s beliefs are different from their actions – an alcoholic knows, at some level, that drinking excessively and regularly is making him sick, but he might be unable to change their action. For someone who has a Process Addiction though, it might be a lot more difficult to even see the incongruency between their belief system and their actions. As long as we don’t see a problem, we won’t attempt to solve it. This blindness regarding the malignancy of their actions is what brings the discomfort they are trying to escape from. The principle of Cognitive Consistency states that individuals are sensitive to cognitive dissonance, which means that the psyche will continuously try to alleviate cognitive dissonance, it will continuously show the person the discrepancy between what they think about themselves and what they do. In the case of addictions, individuals may be unwilling or unable to change either their beliefs or the actions that keep the cognitive dissonance in place, so the cognitive dissonance becomes chronic, bringing along the corresponding discomfort, tension, anxiety, often culminating with physical dis-ease.

In my experience, Process Addiction can only be treated through awareness, which, in this case, consists of the courage and determination to mentally break down what one is engaging with, in order to bring in the level of honesty necessary to break the cycle of excitement vs toxic shame. An added layer to this is that awareness, in this case, cannot be achieved by the addict themselves, as the urges that come through addiction are, again, UNCONSCIOUS, so they need to be dealt with by a professional counsellor.