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Coping mechanisms as behavioral addictions

January 26, 2015
by Robert L. Smedley, LICDC-CS, LSW
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The opening chapter on substance-related and addictive disorders in the DSM–5 states in the second paragraph that a variety of behaviors not related to drugs activate reward systems similar to those activated by drugs of abuse, producing some behavioral symptoms that appear comparable to those produced by substance abuse disorders. The behaviors that are mentioned include gambling, sex, exercise and shopping.1

We should more closely examine that statement, with a special emphasis on understanding how those behaviors that we refer to as coping mechanisms are an active dynamic of all addiction, chemical or non-chemical.

There are two behavioral reward systems. Positive reinforcement is often used to reward a behavior. Life can provide these rewards. The reward can be a cookie from a parent for doing a chore, it can be some form of recognition, or it can be the satisfaction that comes with a job well done. The behavior is associated with the cue that fires the neurochemical reward, with the result that the behavior continues long after the reward is discontinued.

Life isn’t all pleasure, however; it is also filled with danger and pain. As we all experience pain, we also all develop methods of dealing with discomfort. These methods, or coping mechanisms, vary in magnitude relative to the amount of pain.

Coping mechanisms produce rewards by relieving pain. Coping is a means to relieve pain or discomfort by either eliminating it or replacing it with something more comfortable. Scratching an itch is an easy-to-understand example of this. The itch is a form of discomfort, and scratching it produces a good sensation—until the scratching produces a sore. Boredom is one of the most significant discomforts in our world, and we have developed countless activities for relieving it. It is not uncommon to experience a compulsion to find something to do when bored, regardless of how risky it may be, if it produces relief. The relief is the reward. This is a negative reinforcer.

When a coping behavior is re-enacted for the same result, it becomes learned. When it is repeated out of memory or without conscious thought, we can say it has become habituated. Locking the car door is an example of this habituation. We get out of the car, lock it and walk away without really thinking about it. The car “at risk” is the discomfort, locking it is the behavior, and safety is the reward.

The coping behavior meets our need for a reward (feeling of relief). So why is this subject a matter of concern for professionals in the addictions field?

Destructive patterns

Substance abuse therapists often take referrals from other systems of care in addition to treating those who seek help for addiction themselves. This can involve working extensively with juvenile justice, children's services, adult corrections, employment services, public schools, business, health services and mental health services. In my own career, I have noticed destructive behavior patterns with individuals referred by these systems that go well beyond substance abuse. In fact, many of the individuals referred do not use drugs, even though their pathway to self-destruction has made it seem that way.

I have always found these self-destructive behavior patterns to be coping mechanisms. The consequences of these behavior patterns are just as harmful to the affected individuals and their loved ones as drug use, and just as difficult to change.

Whether the behavior is sleeping too much, hanging out with questionable friends, engaging in violence, spending all day looking for sex, or engaging in excessive Internet and television use, these individuals have the same struggles as individuals addicted to chemicals. Memory-linked reminders cue these addicts to the relief rewards, they experience cravings, and they repeatedly fail to change, even when these behaviors are clearly leading to self-destruction. Scratching the itch feels good, but it produces a sore.

In the case of violence or gambling as a coping mechanism, this logic is easily accepted. Interestingly, the same logic also may apply to mental illness. Laurie Ahern wrote in an article for the National Empowerment Center that mental illness is a coping mechanism.2 She cites mania, depression, obsessive-compulsive disorder and agoraphobia among issues that are probable responses to trauma, but also understandable as coping mechanisms. She makes a strong case for these being learned behaviors.

Role of the workforce

The trials of working in the addiction field are well-known and generally revolve around the lack of funding and status within healthcare. This is troublesome in that the field has so much to offer to the healthcare industry and to the community in addition to treating substance use disorders.

The battle to achieve adequate public and private reimbursement for services hasn’t changed for 40 years. Yet there is no question that the systems noted in this article offer financial opportunity for addiction specialists beyond treating alcohol and drug abuse.

A recent challenge in the addiction field has been attracting and retaining an adequate workforce. We have a lot of talent retiring, and too few young people showing interest in the field. Rather than retrench, there is an opportunity to push addictions forward by developing the research needed to substantiate the treatment of other addictive behaviors. Coping mechanisms are a rich resource toward which to advance the field with new product lines.

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Great article. However, I still view most process addictions, like sex, food, shopping, as an OCD, and I think that's a more appropriate lens to view and treat them. If you don't believe that you can teach moderation drinking to a severe alcoholic, than how can you successfully treat a food addict to eat in a healthy way? Having a sex addict or food addict learn to eat and have sex in a healthy manner flys in the face of what we are taught about addiction. If it doesn't hold true for all of the addictions, then it's not the same disease/disorder. You are essentially teaching someone to control their addiction, and that wouldn't work for the majority of SUD patients. It never clicked for me, with the exception of maybe gambling. It's more like an obsessive disorder or compulsive behavior than an addiction, and I think if we started viewing it and treating as such, we'd make more progress and help more people. If you believe you can't teach use moderation to drug addicts but you can to sex addicts, how is it the same disease in the brain? Because they're not addictions like drug addictions. This is just my working theory, and I may change it as I continue to learn.

Those who say Alcoholics cannot recover to consume responsibly, in moderation and on occasion are incorrect. I am retired after 22 years in the United States Marine Corps. After being Medevac'd from Iraq in the Battle of Fallujah in 2004, I was mourning the loss of fellow Marines and dealing with post traumatic stress. I started drinking more and more until my sons carrying heavy filled recycle containers with my favorite beer bottle to the curb each week. I would drink 4-6 beer after work each night just to "relax" then on weekends I would sit on the back porch or inside my garage depending on the season and go through cases of beer. I began to put on weight from all the calories I was drinking in beer which began to impact my physical abilities especially after recovering from injuries. My drinking led to trouble on the job as a senior Marine. I ended up getting a dui and other legal trouble. By this point I had been drinking, every day, for over three years. Towards the end and before my DUI I was drinking at lunch during the day, leaving work early to come home and drink, and getting absolutely intoxicated every weekend. After the DUI, I made a choice after realizing that my behavior was going to lead to my death if I didn't change my behavior. I was also a single father after a divorce from my wife of 21 years. My teenage son stayed with me and he was depending on me now alone. (My divorce was not from the addiction, but the fault was with the negative behavior of my wife towards me and the children) I, without AA or some other outside intervention sobered up and quit drinking because I chose to. After my retirement, Dui and divorce, I moved cross country and was staying with family that didn't drink, After six months my two teen sons and I moved into our own place. I was able to keep a six pack of beer in the fridge for guests. I would drink a glass of wine on occasion at while going out to eat or a beer or two at a ball game. It has now been 4 years since I chose to change my behavior, and in the last four years I haven't been intoxicated one time. I can't recall the last alcoholic beverage I had even as it's been months since I have had even one drink. I didn't exchange addictions or start some other negative habit in order to quit drinking. I honestly used a year or so to re-evaluate my life and re-discover my faith. So, I don't believe I am the exception to the rule, and with the right guidance and therapy, I believe that any addiction can be conquered.

Very interesting comment, you have me thinking now. It seems that there is still so much that we do not fully understand about process addictions, and substance addictions for that matter. What is exciting is that it is being explored, and answers are being sought. I have always believed that each person with an addiction should be viewed separately and their unique set of circumstances taken into consideration. There are so many factors that need to be looked at, and taken into consideration with each individual person. You mentioned that you viewed process addictions such as sex, food, and shopping as an OCD. That may very well be true. But what if a person continues to engage in the activity despite the negative consequences as seen with substance addiction? Could it be an addiction for some and an OCD for others? I’m just not sure that it is the same for everyone. I’m just thinking out loud. I think it is interesting to hear how others view this. Thanks for sharing.

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