The Difference Between Physical Addiction, Behavioral Addiction and Impulse Disorders

The Difference Between Physical Addiction, Behavioral Addiction and Impulse Disorders

by Laura Geftman, LCSW

Addiction has long been related to substance abuse with a physical dependence (with withdrawal symptoms.) We see various depictions of addicts in every form of pop culture and anti-drug propaganda. From the television show Intervention to “Just Say No,” we’ve created an idea of addiction that doesn’t tell the full story. There are two types of addiction- physical and behavioral addiction. Impulse disorders can also look like addiction.

What is addiction?

These days it’s pretty common to hear someone say they’re addicted to avocados, binge watching TV, travel, makeup, working out, tattoos… It’s even become common practice to add “-aholic” to thing you claim to be addicted to like “shoeaholic” or “workaholic.” Really our attitudes about being compelled to do or use things too frequently has become all “sex, drugs and rock-n-roll.” All jokes aside, there’s a thin line between over use and addiction.

Addiction is a crippling disease that involves what you’re doing or using taking over your life.

In 1956, the American Medical Association first recognized what we now call “addiction,” “substance abuse,” “chemical dependency,” and “substance use disorder.” While the terminology has changed, the chronic brain disease continues to cause compulsive activity despite health, social and legal consequences. The disease is caused by a variety of factors and lead to long-term negative consequences that can be deadly. 

The American Society of Addiction Medicine has described addiction as “a primary chronic disease of brain reward, motivation, memory and related circuitry.” It is all too common to think that addiction is only about a substance you can’t stop using. The brain disease causes those suffering from it to a need toward compulsory behavior or use of a substance.

Physical Addiction

Physical addiction is synonymous with “addiction,” “chemical dependency” and “substance abuse.” No matter what you call it, the compulsive use of alcohol, over-the-counter medications, prescription drugs, illegal drugs, or any other mood-altering substance is what is most commonly what we refer to when talking about addiction. In physical addiction, a person feel a desire or craving in their body such that they have to engage in the addiction. There is a loss of control over whether or not a person uses a substance. The body becomes dependent on a substance and builds a tolerance to that substance. The addict then seeks out larger doses to chase the same effect. Like other chronic diseases, addiction involves a cycle of relapse and remission that can be treated and managed successfully.

Regular use of drug and alcohol not only leads to the cravings of physical addiction but also withdrawal. The body learns to work with the substance but without it there are a surge of symptoms that can be life threatening if not properly treated.

Common physical addictions include:

  • Alcohol
  • Tobacco
  • Opioids (OxyContin, Vicodin, Norco)
  • Prescription medications 
  • Benzodiazepines or “benzos” (Xanax, Valium, Ambien)
  • Barbiturates 
  • Buprenorphine
  • Ketamine
  • 4-MTA 
  • Cocaine / Crack
  • Cannabis
  • Heroin
  • Amphetamines / Methamphetamines (“meth”)
  • Hallucinogens
  • Inhalants
  • Phencyclidine or hallucinogens (LSD, PCP, Angeldust)
  • Stimulants (Ritalin, Concerta, Adderal, Dexedrine)

Behavioral Addiction

Behavioral addiction – also called process addiction- is defined by the compulsion to continually engage in an activity or behavior despite the negative impact on a person’s ability to remain mentally and physically functional. The repeated activity may provide a “high” while engaged. However it’s often followed by overwhelm, guilt, shame and/or remorse of the constant choice. Those struggling with a behavioral addiction are unable to stop engaging in the harmful behavior for any length of time without intervention and treatment. Common behavioral addictions include:

Sex Addiction Diagnosed as Hypersexuality- this disorder is representative of people who engage in sex or think about sex (fantasies and urges) more commonly. The symptoms of sex addiction — including loss of control and disregard for risks and consequences. 

Love Addiction Falling in love creates an emotional intoxication involving hormones, neurotransmitter and other bodily chemicals. The feeling of euphoria creates a craving and can become a sole focus. Individuals addicted to love often seek out love-avoidant partners who are emotionally unavailable to continue to create a dynamic that feeds their addiction.

Shopping Addiction Also known as Oniomania, the uncontrollable need to shop seems to be the most acceptable form of addiction. However shopping doesn’t make you as happy as all the advertisements would make you believe it could. Shopping addiction involves compulsive buying as a way to feel good and avoid negative feelings. 

Internet Addiction The internet can change the brain. Yes, literally. Those who spend 11 or more hours on the web a day can experience a rewiring of their brain. Internet friends, communities, and activities are great to a point. This impairment effects real life relationships and disrupt day-to-day living. 

Gambling Addiction Also called compulsive gambling, a person with pathological gambling cannot resist the impulse to gamble. The thought of gambling becomes so overwhelming and intrusive that the only relief is to engage in gambling.

Video Gaming Addiction For some, playing a game is anything but. This disorder is not a healthy fun gaming hobby but an addiction that negatively impacts the activities of life.

Food Addiction Often linked to depression, food addiction or binge eating disorder includes symptoms of eating to ease emotions and feeling guilty after overdoing it on food while alone.

Exercise Addiction Yes, exercise is good for you but not when you do it too much. Exercise addiction makes getting exercise irresistible.  

Plastic Surgery Addiction Fueled by body dysmorphic disorder, plastic surgery addicts have a propensity to change their body by sifting through doctors to find the one that will give them another risky procedure. People with this disorder are preoccupied with their appearance and believe that they are ugly or deformed.

Risky Behavior Addiction Maybe you’ve heard of them “adrenalin junkies”? Many thrill seekers share the same symptoms as those struggling with substance abuse. The thrills flood the brain with the same chemicals released by addictive drugs. Like chasing the high of 

Impulse Control Disorders

Sure when you think of impulse control (or lack thereof) it would seem a natural aspect of addiction, and it is. Impulse control is also a concern with other mental health diagnoses including bulimia, substance abuse and paraphilias. However there are specific conditions that are charactertized by the inability to control urges leading to the development of significant difficulties on a day-to-day basis and can lead lead to the harm of oneself or others. These conditions include:

Kleptomania is a condition in which individuals are unable to resist the urge to steal things that do not belong to them.

Pyromania is a condition in which an individual has a fascination with fire and is unable to resist setting things on fire. These individuals experience pleasurable feelings while engaging in fire-setting behaviors.

Intermittent explosive disorder includes highly aggressive behaviors and emotional reactions that are usually out of proportion to the situation at hand.

Trichotillomania refers to a disorder in which a person experiences irresistible impulsive urges to pull out their hair. They may pull hair from their scalp or other areas of the body. Not everyone who has this disorder finds the act of pulling out hair to be pain-free. However, even for people who find it to be unpleasant, the urge to do it is so intense that it overrides concerns for pain. This disorder was also recently recategorized and is now considered an obsessive-compulsive disorder.

Seeing a Mental Health Professional

If you become concerned addiction, it’s best to seek the support of a mental health professional- such as a social worker, counselor, psychologist or psychiatrist. When you see someone professionally trained in mental health care, they can help you understand the difficulties you’re experiencing. 

Sure just the thought of seeking mental healthcare can create more cravings. You may think they will make you talk about your past. Or that you won’t connect with them to feel comfortable to talk about anything. Maybe you’re afraid to cry in front of anyone let alone a stranger. Worse- you think they’ll put you in a hospital, rehab or institution.

Please know I don’t bring this up to elicit fear but to say- those who work in the mental health field are trained to work with you at your own pace. You don’t have to talk about anything you don’t want to. Ever. The idea is to create a safe space for you to feel comfortable to connect with someone who can help you understand your symptoms and learn to manage them. Therapist are legally bound to uphold privacy and confidentiality. That means they can only repeat what you’ve said to them if they are concerned about your safety or the safety of others. Anything else you tell a therapist, they cannot repeat to anyone else without your consent. You literally have to sign paperwork stating they can talk to others about what you’ve shared with them.

Keep in mind- Untreated substance abuse disorders can be harmful to your health and even fatal. If you think you or your loved one may have a substance use disorder or addiction, see a doctor or therapist to determine the best course of treatment.

When to seek emergency treatment

Here are the signs and symptoms would warrant a trip to the emergency room immediately:

  • changes in consciousness
  • trouble breathing
  • seizures or convulsions
  • signs of a possible heart attack, such as chest pain or pressure
  • any other troublesome physical or psychological reaction to use of the drug

If anything listed is cause for concern, call 911 or go to your local emergency room immediately.

About Laura Geftman, LCSW

Laura Geftman, LCSW

Laura Geftman, LCSW is the Founder of The Calm, Cool & Collected and a practicing therapist. Beyond all things cannabis and mental health, Laura is passionate about developing greater understanding for kindness and acceptance. In her free time, Laura can be found on her yoga mat, in a kayak or singing karaoke.

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