Can someone be addicted to both a substance and a behavior at the same time?

Yes. Co-occurring substance use disorders and behavioral addictions are common and well-documented. Both activate the brain’s reward system, and having one addiction increases the neurological vulnerability to developing another.

How does trauma contribute to the development of process addiction?

Trauma, particularly early childhood trauma and unresolved adverse experiences, is one of the most significant risk factors for developing any addiction. Compulsive behaviors often begin as coping mechanisms for the emotional pain, hypervigilance, or emotional numbness that follows traumatic experiences.

Are eating disorders considered process addictions?

This is an area of ongoing clinical debate. Binge eating disorder, bulimia nervosa, and other disordered eating patterns share many of the hallmarks of behavioral addiction, including compulsive behavior, loss of control, continued engagement despite negative consequences, and use as a coping mechanism for difficult emotions. The American Psychiatric Association classifies eating disorders separately from addiction disorders in the DSM-5, but many clinicians and researchers recognize significant neurological and behavioral overlap. Treatment for eating disorders typically draws heavily from the same evidence-based approaches used for other process addictions.

How long does process addiction treatment typically last?

The duration of treatment varies significantly based on the type and severity of the behavioral addiction, the presence of co-occurring mental health conditions, the person’s support network, and their progress in therapy. A partial hospitalization program may last several weeks, while intensive outpatient treatment typically spans several months. Ongoing outpatient therapy and participation in support groups are often recommended well beyond the formal treatment program to maintain accountability, continue developing healthy coping mechanisms, and reduce the risk of relapse. Recovery is a long-term journey rather than a time-limited event.

What role do family members play in recovering from a process addiction?

Family members play a significant and often underestimated role in the recovery process. Behavioral addictions frequently cause hidden damage to relationships, finances, and trust that needs to be explicitly addressed as part of treatment. Family therapy helps family members understand the neurological basis of addiction, identify patterns in the family system that may have contributed to or sustained the addiction, and develop healthy communication strategies that support recovery without enabling compulsive behavior. Family members also need their own support, particularly if they have been significantly affected by the behavioral consequences of a loved one’s addiction.

The difference between process addiction and substance addiction

Author: Emily Rowe, LCSW, Clinical Director

Medical Reviewer: Kendra Krieg Psych NP, NPI

Process addiction vs substance addiction is a comparison that comes up frequently in clinical settings, and understanding the distinction matters because it shapes how both conditions are diagnosed and treated. A substance addiction involves compulsive use of a chemical, whether alcohol, drugs, or prescription medications, to the point where the body becomes physically dependent. A process addiction, also called a behavioral addiction, involves compulsive engagement in a behavior, such as gambling, shopping, sex, or internet use, that activates the brain’s reward system in the same way substances do. Both are recognized mental health conditions.

Understanding process addiction and substance addiction

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychological Association, formally recognizes substance use disorders and gambling disorder as addictive disorders. The International Classification of Diseases (ICD-11) has expanded this framework further, adding gaming disorder to the recognized list.

While further research is ongoing about where the full range of behavioral addictions fits within formal diagnostic criteria, the clinical picture is increasingly clear. Compulsive behaviors like gambling, food addiction, sex addiction, and shopping addiction activate the brain’s reward center, release dopamine, and create cycles of craving, tolerance, and withdrawal that closely mirror what happens with substance use.

What we treat at Lanier Recovery Center includes both substance use disorders and behavioral addictions, because both cause real suffering and both require structured, compassionate professional care. Process addiction therapy and treatment is available for clients struggling with compulsive behaviors that are disrupting their work, romantic relationships, family life, or physical health.

Many people struggling with addiction also face co-occurring mental health conditions like depression and anxiety that drive compulsive behavior and make recovery more complex without integrated care.

What is process addiction?

A process addiction is a compulsive pattern of behavior that a person continues engaging in despite knowing it causes negative consequences. Unlike substance addiction, no chemical is ingested. Instead, the brain becomes addicted to the neurochemical response produced by the behavior itself.

Common process addictions include:

Gambling addiction. One of the most widely recognized behavioral addictions, gambling addiction hijacks the brain’s reward system through the unpredictability of wins and losses.
Internet addiction and gaming addiction. The constant stimulation, social rewards, and achievement systems built into online environments create powerful dopamine loops.
Sex addiction. Compulsive sexual behavior is one of the most stigmatized process addictions, which is part of why people struggling with it often wait longer to seek help.
Shopping addiction. Compulsive buying provides a brief sense of euphoria followed by regret and financial consequences.
Food addiction and binge eating disorder. Binge eating disorder and other forms of food addiction involve compulsive eating driven by emotional rather than physical hunger.
Work addiction. While socially praised, compulsive overworking follows the same neurological pattern as other behavioral addictions and causes significant damage to physical health and relationships over time.

What all of these called behavioral addictions share is the same core mechanism. The behavior triggers a dopamine release that temporarily relieves anxiety, depression, or emotional distress. Over time, the brain adapts by requiring more of the behavior to produce the same effect, and the person develops increasing tolerance. When they try to stop, they experience psychological withdrawal symptoms including intense anxiety, depression, irritability, and cravings.

What is substance addiction?

Substance addiction, formally called a substance use disorder, occurs when a person compulsively uses alcohol, drugs, or other substances to the point where stopping causes physical withdrawal symptoms. The body has become chemically dependent on the substance to maintain basic neurological functioning.

Physical withdrawal symptoms associated with substance use disorders include:

Severe tremors, sweating, and rapid heart rate with alcohol or benzodiazepine withdrawal.
Nausea, vomiting, muscle aches, and intense cravings with opioid withdrawal.
Extreme fatigue, depression, and prolonged sleep with stimulant withdrawal.
In severe cases, seizures and life-threatening cardiovascular instability.

These physical symptoms are a key clinical distinction between substance addiction and most process addictions. Stopping a substance can be medically dangerous without supervision. Stopping a behavioral addiction typically produces primarily psychological withdrawal rather than physical medical emergencies.

How behavioral addiction affects the brain

Understanding process addiction vs substance addiction is key to understanding your addiction recovery process.

Understanding how behavioral addiction works in the brain helps explain why people struggling with process addictions can’t simply stop through willpower. The brain processes the reward from a compulsive behavior the same way it processes the reward from a drug.

When a person engages in a behavior like gambling or binge eating, the brain releases dopamine in the reward center. This dopamine release signals to the brain that the behavior is important and should be repeated.

With repeated exposure, the brain begins to downregulate dopamine receptor sensitivity, meaning more of the behavior is needed to produce the same feeling of relief or pleasure. At baseline, the person begins to feel emotionally flat, anxious, or depressed without the behavior, which drives continued compulsive engagement simply to feel normal.

This is why addiction of any kind is classified as a brain-based disorder in the DSM-5 and not a character flaw. Environmental factors like stress, trauma, isolation, and access to addictive behavior all influence how quickly and severely this neurological pattern develops. Genetics also plays a significant role. Research suggests that genetics account for approximately 40 to 60% of a person’s vulnerability to developing addictions.

Healthy coping mechanisms and life skills in recovery

Learning to identify and tolerate difficult emotions without immediately seeking relief through a compulsive behavior.
Building a support network of trusted people, including family members, peers in recovery, and clinical professionals.
Developing life skills around financial management, time management, and communication that were disrupted by the addiction.
Practicing mindfulness techniques to increase awareness of triggers and create space between the urge to engage and the action itself.
Using support groups to avoid triggers, process setbacks, and maintain accountability within a community of people who understand the recovery journey.
Addressing the root causes of the addiction through individual and family therapy rather than only managing the symptoms.

Co-occurring disorders and mental health

One of the most important things to understand about both process addiction and substance addiction is how frequently they co-occur with other mental health disorders. Depression, anxiety, eating disorders, and trauma-related conditions often either precede addiction as contributing factors or develop alongside it as consequences.

Co-occurring disorders require integrated treatment, not sequential treatment. Treating the addiction without addressing the underlying mental health conditions leaves the root causes unresolved, significantly increasing the risk of relapse. This is why dual diagnosis treatment Atlanta produces consistently better outcomes than treating each condition in isolation.

Getting help at Lanier Recovery Center

Lanier Recovery Center’s treatment programs include multiple levels of outpatient care so clients receive the right amount of support at each stage of recovery.

Our partial hospitalization program, PHP Atlanta, provides intensive daily clinical programming for clients who need consistent structure and oversight while living at home. As clients stabilize, our intensive outpatient program, IOP Atlanta, offers a more flexible schedule that allows clients to balance treatment with work, family, and daily responsibilities.

Therapies used in treatment

Evidence-based therapy is the primary engine of recovery from both process addiction and substance addiction. Cognitive behavioral therapy Atlanta (CBT) helps clients identify the thought patterns, emotional triggers, and environmental factors driving compulsive behaviors and develop healthier responses.

Dialectical behavior therapy, offered through our DBT therapy Atlanta program, teaches distress tolerance, emotional regulation, and mindfulness skills that are especially valuable for people using addiction to cope with overwhelming emotional distress.

Individual therapy Atlanta provides a private, one-on-one space to explore personal history, trauma, and the root causes underlying compulsive behavior.

Group therapy Atlanta builds peer connection and accountability and allows clients to develop healthy social skills alongside others who understand the recovery journey.

Family therapy Atlanta helps rebuild trust, improve communication, and equip family members with the tools to support recovery without enabling addictive patterns.

Substances and behavioral conditions we treat

Lanier Recovery Center treats a range of substance use disorders and behavioral addictions through individualized, evidence-based outpatient care. Our process addiction therapy and treatment program addresses gambling addiction, sex addiction, food addiction, internet addiction, and other common behavioral addictions.

For clients whose struggles involve both behavioral addiction and substance use, we address both as part of a comprehensive, coordinated treatment plan. Our alcohol treatment Atlanta and opiate addiction treatment programs are available for clients managing substance use alongside or independently of behavioral addiction.

Addressing process addiction with professional guidance

Whether you’re struggling with a behavioral addiction, a substance use disorder, or both, your pain is valid, and help is available. Both forms of addiction hijack the brain’s reward system, both respond to evidence-based treatment, and both deserve the same level of clinical seriousness and compassion.

Alcohol and drug rehab Atlanta GA at Lanier Recovery Center provides outpatient addiction and mental health treatment built around individualized, evidence-based care. Our compassionate admissions team can help you get started. Contact us, visit our Google page, or call (470) 470-5697 today.

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Frequently asked questions

Get answers to commonly asked questions.

Can someone be addicted to both a substance and a behavior at the same time?
Yes. Co-occurring substance use disorders and behavioral addictions are common and well-documented. Both activate the brain’s reward system, and having one addiction increases the neurological vulnerability to developing another.
How does trauma contribute to the development of process addiction?
Trauma, particularly early childhood trauma and unresolved adverse experiences, is one of the most significant risk factors for developing any addiction. Compulsive behaviors often begin as coping mechanisms for the emotional pain, hypervigilance, or emotional numbness that follows traumatic experiences.
Are eating disorders considered process addictions?
This is an area of ongoing clinical debate. Binge eating disorder, bulimia nervosa, and other disordered eating patterns share many of the hallmarks of behavioral addiction, including compulsive behavior, loss of control, continued engagement despite negative consequences, and use as a coping mechanism for difficult emotions. The American Psychiatric Association classifies eating disorders separately from addiction disorders in the DSM-5, but many clinicians and researchers recognize significant neurological and behavioral overlap. Treatment for eating disorders typically draws heavily from the same evidence-based approaches used for other process addictions.
How long does process addiction treatment typically last?
The duration of treatment varies significantly based on the type and severity of the behavioral addiction, the presence of co-occurring mental health conditions, the person’s support network, and their progress in therapy. A partial hospitalization program may last several weeks, while intensive outpatient treatment typically spans several months. Ongoing outpatient therapy and participation in support groups are often recommended well beyond the formal treatment program to maintain accountability, continue developing healthy coping mechanisms, and reduce the risk of relapse. Recovery is a long-term journey rather than a time-limited event.
What role do family members play in recovering from a process addiction?
Family members play a significant and often underestimated role in the recovery process. Behavioral addictions frequently cause hidden damage to relationships, finances, and trust that needs to be explicitly addressed as part of treatment. Family therapy helps family members understand the neurological basis of addiction, identify patterns in the family system that may have contributed to or sustained the addiction, and develop healthy communication strategies that support recovery without enabling compulsive behavior. Family members also need their own support, particularly if they have been significantly affected by the behavioral consequences of a loved one’s addiction.

Sources

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
American Psychiatric Association. [PDF] Substance-Related and Addictive Disorders. American Psychiatric Association.
National Institute on Drug Abuse. Medications for Opioid Use Disorder. National Institute on Drug Abuse.
Substance Abuse and Mental Health Services Administration. Mental Health and Substance Use Co-Occurring Disorders. Substance Abuse and Mental Health Services Administration.
National Institute on Drug Abuse. (2020, July 6). Drug misuse and addiction.