Scope of the Issue
While behavioral addictions are well accepted as serious mental and behavioral health problems, this historically was not the case. Mental health and even substance abuse specialists were slow to recognize the addictive properties in these behaviors for several reasons. First, the behaviors, such as shopping, were often engaged in routinely with no signs of addiction in most people. The activities themselves are usually ordinary, everyday, and common. There is nothing inherently addictive about them.
Second, some behavioral addictions that are not as ordinary (for example, pornography) occur privately, often hidden from public view. Performed in secret, people who are addicted are unseen and unchallenged. Others simply were unaware of the problem. Third, there was a general lack of awareness that such activities could become truly addicting in the same way that alcohol, cocaine, or prescription pain or anti-anxiety medications could become addicting. Among specialists, occasional disagreement still exists about whether behavioral addictions are true addictions.
With increased recognition of the underlying characteristics of behavioral addiction has come more accurate reporting and intervention. Physicians and other health care providers, educational and workplace personnel, friends, and families are now more likely to express concern and acknowledge a serious problem. While varying sources estimate the prevalence of behavioral addictions differently, most addiction specialists conservatively assume that one in ten families has a behaviorally addicted family member. Some specialists believe the prevalence is as high as one family in three.
Families and Causes
It is established that chemical addictions run in families. That is, having one family member addicted to chemicals increases the likelihood, fourfold, that a first-order relative—a parent or sibling—will develop a chemical addiction at some time in his or her life. Behavioral addictions also run in families, though it is unclear just how much more likely it is that a second family member will develop a behavioral addiction when a first-order relation is addicted to a specific behavior.
The actual connections between one behaviorally addicted family member and a similar addiction in another family member are complex and far from fully delineated. Similarly, how particular family climates promote (or discourage) behavioral addiction is also far from being fully understood. Still, the existence of connections is indisputable.
The first, and most fundamental, connection is family-shared biology and genetics. The response in the brain’s pleasure centers tends to be similar in genetically related persons. The enjoyment the video-gaming addict gets will be similar among his or her family members even if the particular source of enjoyment (such as addictive catalog shopping rather than video gaming) is different. The intensity of the reward and its recurrent allure will be similar. However, family genes do not cause addiction.
As many as three-quarters of families with a behaviorally addicted family member do not have a second addicted member. The genetic contribution lies in the degree of likelihood that each family member shares for developing addiction, not that they will develop the addiction. The strength of the tendency to become addicted is largely shared though the outcomes (being addicted to gambling as a primary force in one’s life or merely enjoying gambling as a pastime) are not necessarily the same. One is not “doomed” to addiction if a sibling or parent has become addicted.
A second connection lies in what family members are exposed to and learn to imitate. A straightforward example would be how children learn to copy their parents. If a single mother has a relational addiction in which she serially and incessantly dates men regardless of the psychological health of these relationships, her children will gradually learn that their value and sense of safety, security, and meaning is dependent on being in a relationship. Though it could take years for the addictive properties of this behavior to develop in her children, the chances that they eventually will are multiplied.
The woman’s children see and experience the emotional anxiety and panic that their mother feels when she lacks an active, current dating relationship. Even if they do not have the language to describe what their mother is doing, they notice their mother’s pattern and learn how to ensure they are part of a relationship—any relationship. Even if the children come to understand the self-destructive pattern their mother is enduring (and putting her children through), they learn that having a relationship, even a bad one, prevents feelings of insecurity and insignificance that they believe are sure to come if they are not in a relationship. Their addictive pattern of incessant serial dating thus begins.
Families and Continuation
Though behavioral addictions are pathological, maladaptive, and harmful to the addicted persons and their families, the addictions persist because the families’ way of functioning, how it achieves or fails to achieve what it sets out to do, has accommodated the addictive disease. As much as the family may want the addiction to stop and as much suffering as the addicted member causes, the family responds as a unit (or system, in the jargon of family therapy) in ways that end up supporting the addictive behaviors. Thus, the behaviors continue.
While this dynamic seems contrary to the well-being of the family and its members, it demonstrates the powerful emotional need within families to hold together for their survival—that no members can be lost. Families achieve this through maintaining a psychic balance, what social psychology describes as homeostasis: the drive within a family to keep itself going, regardless of the existence of harmful and hurtful family patterns (such as abuse, neglect, and addiction).
As the family realizes there is a problematic behavior (for example, one member’s addiction to food) it responds initially with efforts to correct the problem. Usually, however, families cannot control a member’s addictive behaviors. As the family experiences repetitive failures, its emotional life becomes threatened, and though members do not consciously and explicitly coordinate their response, they react to the addict in ways that dysfunctionally balances the emotional energy within the family. Members become preoccupied with the addict’s food consumption, where he or she is getting the food, where it is hidden, and how much is consumed, for example. This preoccupation involves everyone in the family with the well-intentioned, but unsuccessful, goal of getting the addict to eat normally.
Often, the addiction, known to all, is spoken openly by no one. It becomes this family’s “public secret.” As a secret, it cannot be effectively addressed. The addict reacts, in turn, to the heightened concern and scrutiny, and because the addiction must be fed, he or she reacts against the family’s efforts to help.
These reactions take a variety of predictable forms: angry denial of the problem, in which family members are intimidated and told to mind their own business; avoidance of family encounters and generally being less visible, often in the guise of being too busy to participate in family activities, like meals, and spending large blocks of time at work, school, or in one’s room; and helpless proclamations of guilt and shame while vowing to get help or promising to try harder.
This setting involves many negative emotions, including blame, that surface and resurface. Questions are asked by the addict and by family members: Who really cares? Who is really selfish? Who really understands the addict? Who among us will take a stand? The emotional disconnection within the family grows.
Families and Treatment
Just as families are typically central to the successful treatment of chemical and substance abuse, they are usually central to successful treatment of behavioral addiction. First, open acknowledgement of the problem—that it has reached the stage of addiction—allows the addiction to be treated.
In the early stages of treatment, or recovery, families are often confronted by the behaviorally addicted member’s denial that there is a problem, that the problem is as bad as members say, that the addict can control it, or that the behavior is anyone else’s business. Addicted video gamers, for example, will likely argue the benefits to their many hours of compulsive playing: It relieves stress for them. They enjoy it. They have friends online who play as much as they do and they enjoy their companionship. They are not bothering anyone else.
In such a case, family members must be supportive but honest in confronting both the addict and themselves, addressing how they have unintentionally enabled the addiction to continue. Family members need to recognize and openly declare what they used to do that allowed the addiction to continue and that they will no longer support the behavior. Members too should seek help, because it is inherently difficult to disengage from a loved one in trouble. Family members should assume a position of full support for helping the addict get help and of zero support for anything the addict does that does not promote recovery.
Bibliography
American Academy of Child and Adolescent Psychiatry. “Facts for Families.” Washington, DC: AACAP, 2011. Print.
Bradshaw, John. On the Family: A New Way of Creating Solid Self-Esteem. Deerfield Beach, FL: Health Communications, 1996. Print.
"Family Behavior Therapy." National Institute on Drug Abuse. NIH, Dec. 2012. Web. 29 Oct. 2015.
Hayes, Steven, and Michael Levin. Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions. Oakland, CA: New Harbinger, 2010. Print.
Sadock, B. J., and V. A. Sadock, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. Philadelphia: Lippincott, 2000. Print.
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