When a behaviour becomes an addiction

What is a behavioural addiction? It’s not at all easy to define. Is someone addicted if they play for money at a casino every week, or spend six hours a day on the Playstation, or love nothing more than buying clothes online? A common feature of behavioural addictions is that things which used to be everyday activities suddenly have absolute priority. The sufferer’s life increasingly revolves around the addiction: they neglect their friends, family and job. Their behaviour becomes obsessive and they need more and more of the same. Sufferers can’t stop, even if their bank account was emptied long ago.

Behavioural addictions are not substance-related – in other words, unlike addiction to alcohol or tobacco, they are not associated with a psychoactive substance but with an activity. Another difference between substance-related and behavioural addictions is that some behavioural addictions are stigmatised less. Work can be addictive, for example, but is often not viewed by society as a behavioural addiction. 

On the other hand, there are many common features. The behavioural patterns of sufferers are similar, and comparable biochemical processes take place in their brains. The reasons why an addiction develops are also often comparable. Behavioural addictions help some people to suppress unpleasant feelings – fear or stress, for example. And only a minority of those affected seek help.

Behavioural addictions are becoming an increasingly important component of the addiction problem in Switzerland. The Federal Office of Public Health is currently focussing on the problematic use of gambling, video games, cybersex and social media. These addictions are very prevalent and they are thought to have considerable addictive potential. Yet the particular challenge of careful differentiation when diagnosing an addiction remains. It is also necessary to avoid reaching an incorrect diagnosis too fast in situations in which people passionately pursue an activity or live a certain behaviour.

Behavioural addictions are not an isolated phenomenon. Many people with behavioural addictions have accompanying psychiatric problems such as impaired sleep, depression or personality disorders. But other correlations have also been observed. People addicted to online gaming often get too little physical exercise and have a poor diet. Some gambling addicts have problems with alcohol, cannabis or smoking. The relationship between the phenomena is unclear – whether an alcohol problem causes a gambling addiction or vice versa. 

The figures state the following about equity of opportunity: People with a lower level of education are at greater risk for behavioural addictions. Almost twice as many people in the high-risk online gamer’s category have a lower level of education. 

Gender also plays a role. It is assumed that, on the whole, men and women are equally likely to be affected by behavioural addictions. Yet women tend more to spend an excessive amount of time with social media, while men are more likely to spend an excessive amount of time gaming online. However, men are more likely than women to seek therapy. A young woman’s excessive use of social media, for example, often remains hidden and is perceived by her parents as being less serious. 

The FOPH believes it has a role to play in three main areas relating to behavioural addictions: research, monitoring and coordination of preventive measures.

The purpose of basic research is to expand knowledge about behavioural addictions. To this end, the FOPH has launched a study designed to provide an overview and orientation. For example, the question of the point at which a person’s behaviour becomes an addiction is the subject of discussion. The study is intended to identify measurement scales that can be used to classify behaviour as problematic or pathological. It will also seek to organise and define the large number of terms used to describe behavioural addictions. Is there such a thing as an online addiction or problematic Internet use, or is the Internet simply another medium in which to pursue behavioural addictions? 

The globally recognised WHO classification system for medical diagnoses International Statistical Classification of Diseases and Related Health Problems (ICD) provides initial guidance on terms and concepts and on the severity of behavioural addictions. From 2022, this publication will use the terms “gambling disorder” (involving money) and, for the first time, “gaming disorder” (video games) to describe separate clinical pictures. Most other behavioural addictions have not been identified by ICD diagnoses to date. That is why it is so important to establish clear concepts and measurement scales.

The aim of monitoring is to observe the prevalence and development of behavioural addictions over an extended period of time. Are behavioural addictions increasing? How many people are demonstrating problematic gambling behaviour? The addiction and NCD monitoring system operated by the FOPH (MonAM) provides facts and figures for some behavioural addictions and facilitates observation over time.

The FOPH coordinates activities in conjunction with partners working in the field of addiction, among them the addiction associations, the new “Federal Commission for Issues relating to Addiction and the Prevention of Non-communicable Diseases” and the cantonal addiction officers. Coordination with partners plays an important role in the addiction strategy. An exchange with these partners enables the FOPH to quickly integrate new findings into further research activities. Furthermore, the Parliament has mandated the FOPH to observe the development of problematic Internet use in Switzerland. The FOPH is being supported in this task by the Expert Group on Online Addiction. The German-speaking professional association “Fachverband Sucht” and the French-speaking “Groupement romand d’études des addictions” (GREA) coordinate the exchange between the group’s members on behalf of the FOPH. The experts agree in their recently published summary report on online addiction that people don’t have an “online addiction” but rather are addicted in the Internet. The Internet is a means of satisfying their addiction. This is an important finding that, for example, will affect the way we record behavioural addictions in the statistics. 

And it shows that more knowledge about behavioural addictions is important to be able to distinguish even more clearly between passion and addiction in the future and to offer counselling and therapy to people with an addiction.