Finding a behavioral addition treatment program is not always a simple task, since many addiction treatment programs focus primarily on drug and alcohol abuse recovery, and most mental health programs more commonly attend to psychiatric issues such as depression or schizophrenia. In the realms of behavioral health and addiction treatment, behavioral addiction treatment is a relatively new concept, so clearly specified treatment protocols have yet to be implemented for all the various forms of addictive behavior.
Behavioral addictions—sometimes referred to as process addictions—encompass a diverse set of problematic behaviors, including gambling, sex, video gaming, and habitually viewing pornography. This heterogeneous pool of potential compulsions can make treatment design somewhat more complex and challenging. Two of the most frequently treated behavioral addictions are gambling and sex addiction, with the latter now more commonly referred to as hypersexual disorder.
Gambling addiction is currently described by the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), with the following criteria, 5 of which you would need to experience within the last 12 months to receive the diagnosis:1
- The need to increase the amount of money you spend on gambling to increase your sense of excitement about the activity.
- Feeling restless or irritable when prevented from gambling.
- Ongoing or persistent thoughts about gambling, including planning the next gambling binge or reliving past gambling experiences.
- Using gambling to improve your mood when feeling anxious, distressed, or depressed.
- Following a gambling loss, returning the next day in an effort to even your losses.
- Dishonesty with significant others to conceal the extent of your gambling activities.
- Jeopardizing or losing an important relationship, job, or educational opportunity due to gambling.
- Relying on friends or family for a bailout to avoid severe financial consequences caused by gambling.
A sex addiction (or hypersexual disorder) is another behavioral condition for which people seek out treatment. Since it is not formally recognized in the DSM-5 as such, common signs and symptoms were identified by a study conducted through the Semel Institute for Neuroscience and Human Behavior at UCLA. The most common issues presented when interviewing patients believed to have hypersexual disorder were:2
- Excessive use of pornography and excessive masturbation.
- Frequent sexual encounters with consenting adults (approximately 15 partners in 12 months).
- Participation in cybersex.
- Having sex with escorts or other paid professionals.
- Having multiple anonymous partners.
- Using sexual behavior to reduce or cope with anxiety, depression, or other unpleasant emotions.
In both gambling and sex addictions, the urge to up the ante persists—you need to increase the risk, excitement, and intensity to get the desired level of enjoyment, which aligns with the concept of tolerance in substance abuse.2
What Most of these Programs Have in Common
Cognitive Behavioral TherapyCBT incorporates the most effective aspects of behavior therapy and cognitive therapy and operates on the premise that your thoughts create emotions, which lead to behaviors. Read More
Treatment for behavioral addiction may begin with a period of withdrawal management. For some, this might additionally involve a chemical detox from substances that have been used in conjunction with the behavioral addiction. Even without concurrent substance abuse issues, the initial period of treatment involves helping someone cope for the first time in a while without the support of their maladaptive behavior—a duration of time that can prove quite challenging. For some, that involves detoxing from substances that have been taken in conjunction with the behavioral addiction. For everyone, it is the initial period without the addictive behavior, which is the most challenging.
It is also a time of assessment and close monitoring to ensure your body and emotions adjust adequately to the changes that occur when you stop feeding your addiction. When certain addictive substances are also involved, it is imperative to have medical attention, and receive the comfort and support of an experienced detox team.
With the withdrawal management stage complete, you can move to the next step that involves learning to live life without resorting to old addictive behavior patterns. Just stopping the behavior is not enough. You will work toward accepting the addiction, letting go of thought patterns that keep you stuck, and choosing a more stable and healthy lifestyle. This typically involves standard forms of behavioral therapy (that you will have the opportunity to engage in during your individual, group, and family therapy sessions) that may include:
- Cognitive Behavioral Therapy (CBT): Understanding the connection between thoughts, feelings, and actions; identifying harmful ones; and replacing them with healthy ones.
- Dialectical Behavioral Therapy (DBT): Takes many principles of CBT and introduces specific emotional and behavioral techniques, such as mindfulness and distress tolerance.
- Motivational Interviewing (MI): Identifying the positive motivations in your own life that you can use to sustain you and propel you forward in your addiction treatment.
To help your treatment professionals tailor the best behavioral health treatment for your needs, you will be evaluated for any other conditions such as depression, anxiety, or PTSD. Part of the intake and treatment process involves uncovering underlying factors that may contribute to your addictive behavior. Many people get drawn into behavioral addiction to alleviate some kind of emotional pain that often resulted from a previous trauma.
If your addiction is to sex, you obviously can’t maintain total abstinence. Someone recovering from alcohol addiction knows that in order to stay sober, they must completely abstain from alcohol and avoid bars, liquor stores, and wild parties. But with a sex addiction, it is not realistic or healthy to forevermore avoid sex.
So, solutions to maintaining your recovery from a behavioral addiction must incorporate learning how to make necessary lifestyle changes that allow you to engage in previously addictive behaviors in moderation. You must also gain an understanding of the emotional baggage that is driving your addiction and then learn to deal with those feelings of anxiety, depression, insecurity, or frustration without resorting to old habits.
Does everyone with a substance or behavioral addiction need inpatient treatment? Not necessarily. There are a wide range of programming options to choose from and that type and severity of your addiction will dictate:
- Inpatient Treatment: Inpatient treatment—also known as residential treatment—is a program of 24-hour care that provides constant medical observation and support during the first few days (often during your detox). If you have co-occurring health issues, a medical team will provide the necessary professional care. After detox, you are evaluated for further treatment, which may include continued inpatient care that consists of daily groups and therapy, outings, and activities (e.g., yoga). Residential treatment may consist of stays ranging from 90 days to 6 months or more.
- Partial Hospitalization: Some people can attend partial hospitalization treatment, which, as you might guess from the name, provides access to hospital services and medical care during treatment hours (including help with medical management, if needed) but allows you to return home in the evening hours to spend time with loved ones. Treatment generally takes place about 6 to 8 hours a day, Monday through Friday.
- Intensive Outpatient Treatment (IOP): While still providing relatively intensive treatment, intensive outpatient programs entail fewer treatment hours throughout the day than partial hospitalization programs and sometimes provide a schedule that allows you to continue to work. IOPs generally run 4 to 5 days a week for several hours a day, and consist of numerous counselor-run therapy groups to help you strengthen your healthy coping skills. Certain IOP programs require you to do your medication management offsite, while others include a psychiatrist in your treatment team; be sure to ask how the IOP you are considering handles this component of treatment.
- Non-Intensive Outpatient Treatment: It may be possible for you to begin your behavioral addiction treatment on a strictly outpatient basis, while others may graduate to this level after completing a more intensive program. Still others opt to find a therapist in the community and commit to seeing them 1 to 2 times a week; this can include individual, family, couples, and group therapy.
- Social Support Groups: There are many social support groups for people suffering from behavioral addiction, many based off popular 12-step programs. Examples include Gamblers Anonymous and Sex Addicts Anonymous. Most people, especially in their first year of recovery, attend a support group in combination with regular professional counseling.
These program options range in cost and support level. Inpatient programs tend to cost the most, ranging between $200 and $900 per day depending on the program length, but they also provide the highest level of personal medical and psychological care.3 Intensive outpatient costs $100 to $500 per session, so the cost will vary based on how frequently the program arranges sessions.3 Other forms of outpatient care will vary in cost depending on the level of medical care required and the length of the program.
Treating Specific Addictions
Behavioral addiction currently does not get the same amount of public attention as do addictions to drugs or alcohol, which have been in the public eye for decades. Addictions to the internet or video gaming were unheard of 30 years ago, for obvious reasons, and while pornography addiction existed before the internet, online options make porn far easier and less expensive to access today, causing porn addictions to increase.
If your behavioral addiction is to gaming or the internet, you are not alone. Many people, both teens and adults, have allowed the internet to become the sole focus of their lives, either through social media or gaming or obsessive shopping and spending. Part of your treatment will be to learn how to use the internet in moderation, when to avoid turning on your computer, and how to find other activities to replace time spent online. You will work with therapists who have an excellent grasp of these behaviors, and you will begin to acknowledge that there is much more to life than phones, laptops, and other electronic devices. You may be introduced to new and different forms of recreation and spend time learning to appreciate people, places, and activities that you have abandoned in favor of the net.
Many people have become addicted to pornography and sex. Learning to cope with this type of addiction opens the door to a deeper exploration of your sexuality, discussion of intimacy issues, and achieving a greater understanding as to why you are drawn to this form of behavioral addiction. Treatment also focuses on mending relationships with long-term sexual partners who have been harmed in some way by the addictive behavior, and strengthening those emotional ties. Couples counseling can be beneficial for both partners as you learn how to be sexual without behaving in an addictive way. You will learn strategies for making your current or future intimate relationships happier and healthier.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Edition). Arlington, VA: American Psychiatric Publishing.
- University of California Los Angeles Newsroom (2012). Science supports sex addiction as a legitimate disorder.
- American Addiction Centers. (2017).