How does group therapy for behavioral addictions work?
All support groups help a person addicted to a harmful behavior to become aware of the problem, find solace in the company of other people with similar issues, and develop new ways of coping with stress. Behavioral addictions are destructive patterns of behavior that mimic substance abuse. They begin when a person experiences pleasure in association with a behavior and then later engages in that behavior to reduce stress.
Eventually, through frequent and ritualized indulgence, the behavior becomes part of the person’s daily routine. A person addicted to behaviors such as gambling, eating, sex, video games, exercise, shopping, or work or affection from another person (codependency) has a strong urge to engage in the behavior to experience relief and euphoria, despite persistent negative consequences.
Whether caused by substances or undesirable behaviors, all addictions have three things in common: physical and mental cravings, a habit, and denial of both craving and habit. Denial is a key factor with behavioral addictions, and it must be overcome if the person is to recover. Group therapy is successful in such cases because sitting in a room and listening to others describe situations and feelings that one has experienced in painful isolation tends to turn denial into identification. People who have recovered from the same affliction can also offer compassion, which is needed to offset feelings of self-loathing in the addict.
Evidence suggests that behavioral addictions involve the same brain mechanisms as substance addictions, although more research is needed to clarify and confirm this. For now, it is clear that behavioral addictions present problems with relationships similar to substance abuse by undermining trust and by putting pressure on family members to compensate for difficulties caused by the addiction.
Unlike treatment for most types of substance abuse, behavioral addiction treatment does not require a detoxification period. A person with a behavioral addiction can stop doing it suddenly without experiencing physical withdrawal symptoms. Psychological withdrawal symptoms are common, however, and include feeling restless or anxious and having a strong desire to engage in the harmful behavior.
Pathological gambling (PG) is the only behavioral addiction included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). PG is classified as an impulse control disorder, in which the “essential feature is the failure to resist an impulse, drive or temptation to perform an act that is harmful to the person or to others.” It has been proposed that PG be renamed gambling disorder and moved to a new category, addiction and related disorders.
PG is a serious problem not only for the addict but also for the addict’s family and for society at large. The disorder produces financial insecurity, family dysfunction, domestic abuse, legal problems, employment difficulties, psychological distress, and higher rates of suicide. The problem is likely to become more prevalent, as state governments derive significant revenue from and thus promote gambling-related activities, such as lotteries. Also, Internet gambling increases access and anonymity.
Gamblers Anonymous (GA) was founded in Los Angeles in 1957 by two men who focused on fostering a character change within themselves in order to stop gambling. This fellowship of men and women has since grown to thousands of groups in the United States, Australia, Brazil, Israel, Japan, Kenya, Korea, the United Kingdom, and Spain. GA’s website offers a questionnaire to help people determine if they need the program.
Family members of compulsive gamblers can attend Gam-Anon, another twelve-step program, founded in 1958. Through Gam-Anon, members come to understand their problem and learn how to give emotional support to the troubled person without enabling him or her in the illness. Children can attend Gam-A-Teen, part of the Gam-Anon program.
The idea for Overeaters Anonymous (OA) came to a woman who attended a GA meeting in 1958 and “heard her story,” though she related the speaker’s turmoil to her eating compulsion instead of a gambling problem. Not until 1960, though, did she find another person willing to recover from the addiction. As of 2015, OA offers recovery from compulsive eating through a worldwide fellowship of sixty-five hundred groups in seventy-five countries.
The organization’s website includes a fifteen-item questionnaire to help people determine if they have an eating problem. Compulsive eating is a threefold illness, affecting physical condition, mental state, and the spirit. In the mental dimension, a compulsive eater is not “eating down” feelings but is expressing an inner hunger that leads to a loss of spiritual values.
Co-Dependents Anonymous, which celebrated its twenty-fifth anniversary in 2011, is a fellowship of men and women whose common purpose is to develop healthy relationships. Rather than a questionnaire, its website offers a list of patterns and characteristics of codependence, in five categories.
Under the category of denial, for example, co-dependent behaviors include minimizing one’s feelings or expressing negativity in passive-aggressive ways. Low-self-esteem behavior patterns include difficulty making decisions and constantly seeking recognition. Compliance patterns emerge in compromising one’s integrity to avoid rejection or anger and being hypervigilant of other people’s feelings. Control patterns include freely offering advice and direction to others without being asked and needing to be needed. Avoidance patterns show up in pulling people close and then pushing them away.
Sex and Love Addicts Anonymous, or SLAA, offers help to anyone who has a sex addiction, love addiction, or both, and who wants to recover from that addiction. The fellowship was founded in 1976 by an Alcoholics Anonymous member who was serially unfaithful to his wife. SLAA recognizes that an obsessive-compulsive pattern exists when relationships or sexual activities become destructive to one’s career, family, and self-esteem. Advances in computer technology have made it easier for people to access sex-related websites with great anonymity, leading to a problem called Internet-enabled sexual behavior, which affects family relationships, work productivity, and academic success.
Internet addiction is a behavioral problem affecting a growing number of people who use the web, according to the American Psychiatric Association. People who lose track of time while using the Internet become more socially isolated, depressed, and challenged by family discord, divorce, academic failure, financial failure, and job loss.
In the United States, one-on-one cognitive-behavioral therapy (CBT) has been shown to reduce the amount of time a person spends online. A study in Shanghai found that group therapy using CBT techniques, which emphasize that thoughts precede actions, was successful in treating teenagers addicted to the Internet.
Hecht Orzack, Maressa, et al. “An Ongoing Study of Group Treatment for Men Involved in Problematic Internet-Enabled Sexual Behavior.” Cyberpsychology and Behavior 9.3 (2006). Print.
Jiménez-Murcia, Susana, et al. “Cognitive-Behavioral Group Treatment for Pathological Gambling: Analysis of Effectiveness and Predictors of Therapy Outcome.” Psychotherapy Research 17.5 (2007). Print.
Ladouceur, R., et al. “Group Therapy for Pathological Gamblers: A Cognitive Approach.” Behavior Research and Therapy 41.5 (2003): 587–96. Print.