Behavioural addiction: Types, causes, signs, and treatment
Understanding behavioural addictions
Most people associate addiction with substances like alcohol or drugs, but addiction can develop around behaviours just as readily as around chemicals.
Gambling, pornography, gaming, shopping, sex: when a person loses meaningful control over a behaviour despite clear negative consequences, the clinical picture, the neurobiology, and the treatment principles are the same as in cases of substance use disorder.
What is behavioural addiction?
A behavioural addiction is a condition in which a person compulsively engages in a behaviour despite significant negative consequences to their health, relationships, finances, or functioning. The key feature of such addictions is the loss of control over the behaviour, not the behaviour itself.
Clinically, behavioural addictions share the same core characteristics as substance use disorders:
- Preoccupation
- Tolerance (needing more of the behaviour to achieve the same effect)
- Withdrawal symptoms when stopping the behaviour
- Repeated failed attempts to cut down
- Continued engagement despite harm
Writing in the American Journal of Drug and Alcohol Abuse (2010), Joe E. Grant and colleagues defined behavioural addictions as disorders characterised by “the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others.”
How behavioural addiction affects the brain
The neuroscience of behavioural addiction closely mirrors that of substance addiction. At the centre of both is the brain’s dopaminergic reward system (the mesolimbic pathway), which evolved to reinforce survival behaviours like eating and reproduction.
Addictive behaviours hijack this system, triggering dopamine release in ways that progressively override a person’s capacity for conscious control.
Neuroimaging research has consistently shown structural changes in the brains of people with behavioural addictions.
A meta-analysis of structural imaging studies across multiple types of behavioural addiction found shared reductions in gray matter volume in the prefrontal cortex, anterior cingulate cortex, and orbitofrontal cortex. These brain regions are responsible for decision-making, impulse control, and the ability to weigh consequences.
These findings help explain why overcoming behavioural addiction is not a matter of willpower or moral failure. The areas of the brain most affected are precisely those that govern self-regulation, and treatment needs to account for this.
The neurotransmitter systems involved (dopamine, serotonin, noradrenaline, and the opioid system) are the same systems targeted by evidence-based treatments for substance use disorders. This is partly why the same therapeutic approaches work across both categories.
Types of behavioural addiction
Behavioural addictions span a wide range of activities. Recognition of individual types within formal diagnostic systems is evolving.
The International Classification of Diseases 11th Revision (ICD-11) — adopted by the World Health Organisation in 2019 and in jurisdictional use as of 2022 — formally recognises gambling disorder and gaming disorder under the category “disorders due to addictive behaviours.”
Compulsive sexual behaviour disorder is included in the ICD-11 as an impulse control disorder, though researchers like Matthias Brand continue to debate whether it more accurately belongs within the addictions framework.
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), gambling disorder remains the only behavioural addiction with full formal recognition.
Other types of behavioural addictions are increasingly well-evidenced in the research literature and treated clinically, even where formal diagnostic status is still being established.
Gambling disorder
The most extensively researched and formally recognised behavioural addiction. Gambling disorder involves persistent and recurrent problematic gambling behaviour that causes significant distress or impairment.
South Africa has a growing gambling industry, with 38 legally operating casinos and a rapidly expanding online gambling sector, making gambling addiction an increasing public health concern.
Gaming disorder
Recognised in the ICD-11, gaming disorder is characterised by impaired control over gaming, increasing priority given to gaming above other activities, and continuation of gaming despite negative consequences.
Gaming disorder disproportionately affects young men and adolescents, and is distinct from high levels of recreational gaming.
Compulsive sexual behaviour disorder
Often colloquially referred to as “sex addiction”, compulsive sexual behaviour disorder (CSBD) involves an inability to control intense, repetitive sexual urges and behaviours, resulting in distress or impairment. CSBD is included in the ICD-11 as an impulse control disorder.
Whether compulsive sexual behaviour disorder is better classified as a behavioural addiction remains an active area of research, with clinicians and researchers largely aligned on the treatment principles regardless of diagnostic category.
Pornography addiction
Porn addiction is closely related to CSBD but distinct in focus. Problematic pornography use refers to compulsive consumption of pornography that the individual feels unable to stop, despite it negatively affecting their relationships, sexual functioning, or self-image.
Pornography addiction is not yet formally classified as a separate disorder, though research interest is growing.
Internet and screen addiction
Problematic internet use, social media addiction, and smartphone addiction describe compulsive engagement with online platforms or devices to the point of functional impairment.
Neuroimaging studies have found gray matter reductions in the prefrontal and anterior cingulate regions of individuals with internet addiction consistent with those found in other behavioural addictions, supporting a shared neurobiological basis.
Compulsive buying and shopping disorder
Often called “shopping addiction”, compulsive buying and shopping disorder is characterised by an inability to resist impulses to buy, resulting in financial harm, interpersonal conflict, and significant distress. This disorder follows the same preoccupation, escalation, and loss-of-control pattern seen in other behavioural addictions. Research supports its classification as a behavioural addiction, though it has not yet been formally included in either the DSM-5 or the ICD-11.
Other behavioural addictions
Exercise addiction, food addiction, and work addiction are also discussed in the clinical literature. Each involves the same core pattern of compulsive engagement, escalation, and continued behaviour despite harm, though their formal diagnostic status varies.
Common signs of behavioural addiction
Across all types, the signs of behavioural addiction follow a recognisable pattern:
- Preoccupation: thinking about the behaviour constantly, planning the next opportunity to engage
- Loss of control: repeated attempts to cut down or stop, without success
- Tolerance: needing to engage more frequently or intensely to achieve the same feeling
- Withdrawal: feeling restless, irritable, or anxious when unable to engage
- Escalation: the behaviour takes up increasing amounts of time and mental energy
- Continued engagement despite harm: persisting even when the consequences to relationships, finances, work, or health are clear
- Concealment: lying to others about the extent of the behaviour
- Use as an emotional coping mechanism: turning to the behaviour to manage stress, boredom, loneliness, or difficult emotions
If several of these apply to you or someone you know, a professional assessment is the appropriate next step.
Who is at risk of behavioural addiction?
Behavioural addiction does not develop in a vacuum. Several factors increase vulnerability:
- A personal or family history of addiction (either substance or behavioural)
- Co-occurring mental health conditions, particularly depression, anxiety, ADHD, OCD, or PTSD
- A history of trauma, particularly childhood trauma
- High impulsivity as a personality trait
- Social isolation or a lack of meaningful connection
- Early exposure to the behaviour in question
- Chronic stress without adequate coping resources
This is why thorough clinical assessment matters. Behavioural addiction rarely exists in isolation, and treating it effectively means understanding the full picture.
How is behavioural addiction treated?
Treatment for behavioural addiction draws on the same evidence base as treatment for substance use disorders. The strongest outcomes are consistently associated with a combination of approaches:
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is the most extensively researched psychological treatment for addiction, with a strong evidence base across both substance use disorders and behavioural addictions.
CBT works on the principle that thoughts, feelings, and behaviours are interconnected: a distorted or unhelpful thought triggers an emotional response, which triggers the behaviour.
By learning to identify and challenge those thought patterns, a person can interrupt the cycle before it leads to compulsive action.
In practice, CBT for behavioural addiction involves mapping out the specific triggers, thoughts, and emotional states that precede the behaviour, developing concrete coping strategies for high-risk situations, and practising those strategies until they become habitual.
CBT is typically delivered over a structured course of individual or group therapy sessions, and its effects tend to be durable because the skills learned in therapy continue to work after treatment ends.
Dialectical behaviour therapy
Dialectical behaviour therapy (DBT) was developed by psychologist Marsha Linehan and is built around a central tension: accepting yourself as you are, while also committing to change. The word “dialectical” refers to this balance between acceptance and transformation.
In addiction treatment, DBT is particularly effective for people who turn to compulsive behaviour as a way of managing overwhelming emotions. Rather than simply telling someone to stop, DBT teaches concrete skills across four areas:
- Mindfulness: Developing awareness of thoughts and urges without immediately acting on them
- Distress tolerance: Getting through a crisis without making it worse
- Emotional regulation: Understanding and managing intense feelings
- Interpersonal effectiveness: Navigating relationships without compromising recovery
For behavioural addiction specifically, the distress tolerance skills are often the most immediately useful. Many people with behavioural addictions describe a build-up of tension or emotional pain that the behaviour temporarily relieves. DBT gives them alternative tools for riding out that discomfort until it passes.
Medication
Pharmacological treatment has shown promising results in reducing the frequency and intensity of behavioural addiction episodes.
Naltrexone is one such medication. It has been used in the treatment of gambling disorder, compulsive sexual behaviour, and other types of behavioural addiction. Naltrexone works by blocking opioid receptors, which reduces the dopamine-driven reward response that reinforces the behaviour.
12-step work
12-step frameworks and peer support provide community, accountability, and a structured recovery pathway.
Programmes such as Gamblers Anonymous and Sex Addicts Anonymous are modelled on the AA framework and provide ongoing peer support alongside clinical treatment.
Family therapy
Family therapy is important in cases where the behavioural addiction has significantly affected close relationships, and where family dynamics may be contributing to the maintenance of the behaviour.
Dual diagnosis treatment
Treating co-occurring mental health conditions is non-negotiable. Dual diagnosis treatment addresses depression, anxiety, or trauma while treating the behavioural addiction.
This approach produces substantially better outcomes than treating either in isolation.
Understanding readiness to change: the Stages of Change model
One of the most useful frameworks for understanding why people with addiction struggle to seek help is the transtheoretical model of change. This model, also known as the Stages of Change model, was developed by psychologists James Prochaska and Carlo DiClemente in the early 1980s.
Originally developed through research on people who quit smoking without professional help, this model has since become one of the most widely used frameworks in addiction treatment worldwide.
The model proposes that change is not a single event but a process that unfolds across five stages:
- Pre-contemplation: The person is not yet considering change. They may deny that a problem exists, or feel that the costs of changing outweigh the benefits. External pressure from family, employers, or health consequences may bring them into contact with services at this stage, but genuine motivation has not yet developed.
- Contemplation: The person acknowledges that a problem exists and begins to weigh up the pros and cons of changing. This stage can last a long time. Ambivalence is its defining feature: the person can see the need to change but is not yet ready to act on it.
- Preparation: The person has decided to change and begins making plans. They may research treatment options, speak to their GP, or reach out to a rehabilitation centre.
- Action: The person actively engages in changing their behaviour, often with professional support. This is the stage most people associate with “treatment.”
- Maintenance: The person works to sustain the changes they have made and to prevent relapse. This stage can last months or years and requires ongoing support structures such as aftercare, peer groups, and continued therapy.
Critically, the model treats relapse not as failure but as a normal part of the process. Most people cycle through these stages more than once before achieving sustained recovery. Understanding this helps both patients and the people supporting them respond to setbacks with perspective rather than despair.
Resistance to change: Why people with behavioural addiction struggle to seek help
Even when someone recognises that a behaviour is harming them, seeking help can feel impossible. Resistance to change is a well-documented and entirely normal feature of addiction, not a sign of obstinacy.
Research identifies several factors that influence how ready a person is to change:
- The level of distress they are experiencing
- Significant life events that shift their perspective
- A growing awareness of the consequences across different areas of their life
- The presence of external support from people they trust
The Prochaska and DiClemente stages of change model (pre-contemplation, contemplation, preparation, action, and maintenance) describes how people move towards recovery, often non-linearly. Many people cycle through these stages more than once before achieving sustained change.
For those supporting someone with a behavioural addiction, trying to force change often entrenches resistance. Working with resistance, rather than against it, and meeting the person where they are, tends to be more effective.
A professional intervention can help families navigate this process.
Frequently asked questions
Is behavioural addiction a real diagnosis?
Yes, the current literature recognises several specific behavioural addictions as official diagnoses. Gambling disorder is formally recognised in both the DSM-5 and the ICD-11. Gaming disorder is recognised in the ICD-11. Compulsive sexual behaviour disorder is included in the ICD-11 as an impulse control disorder.
Other types, including pornography addiction, shopping addiction, and internet addiction, are increasingly well-supported in the research literature and treated clinically, even where formal diagnostic status is still evolving.
The clinical presentation and treatment principles are the same regardless of diagnostic label.
Can someone be addicted to a behaviour and a substance at the same time?
Yes, and this is common. Co-occurring substance use and behavioural addictions share overlapping neurobiological pathways and often reinforce each other. Both need to be addressed in treatment.
Is behavioural addiction treated differently from substance addiction?
No. While the specific focus of therapy may differ depending on the behavioural addiction involved, the clinical approach is closely aligned with that of substance addiction. The core treatment principles are the same: CBT, DBT, peer support, pharmacological support where appropriate, and treatment of co-occurring mental health conditions.
Does Houghton House treat behavioural addictions?
Yes. Houghton House’s programme addresses gambling addiction and other behavioural addictions as part of a comprehensive, individualised treatment approach.
Get help for behavioural addiction
Houghton House is one of the few addiction treatment facilities in South Africa with full psychiatric hospital licensing and on-site medical staff available around the clock.
Co-occurring mental health conditions, trauma histories, and complex dual diagnoses can all be assessed and treated as part of a single, integrated rehabilitation programme. It also means patients can claim from medical aid for a broader range of services than a standard rehabilitation centre can provide.
If you or someone you care about is struggling with a behavioural addiction, our clinical team is available for a confidential conversation. We can help you understand what is happening, what treatment looks like, and what your options are.
Call us on +27 11 787 9142 today — or fill in our contact form and we’ll get back to you.
