Recovering from a behavioral addiction

The multi-causal origin of behavioral addictions and the different areas and aspects they affect require an intervention of the problem from a comprehensive and integrative perspective , considering the biological, psychological and social aspects.

Intervention with adolescents, who are undergoing rapid brain development and significant changes (identity, relationships, personality, etc.), requires consideration of the potential fluctuations that may occur during the intervention, both due to the adolescent's own maturation process and the changes that our intervention may bring about. Therefore, treatment with adolescents must be a comprehensive, dynamic, flexible, ongoing, and individualized process.

Typically, adolescents arrive at treatment resources under duress, primarily at the behest of their parents; they do not seek help themselves, have little awareness of their illness, a low perception of the risks associated with addictive behavior, and little motivation to change. To gradually facilitate their understanding of the disorder and its severity, we can initially begin by adapting to the adolescent's needs and goals. To achieve these goals, it is important to establish a strong therapeutic relationship and alliance with the adolescent and their family, utilizing various techniques, particularly motivational strategies.

In some cases, behavioral addiction is a maladaptive coping strategy to avoid resolving limitations or shortcomings in oneself or problematic or traumatic life situations.

It's important to keep in mind that, often, addictive behavior is just the tip of the iceberg ; it's what's perceived as the problem, the symptom, but it's actually overshadowing other underlying issues that need addressing. In some cases, behavioral addiction is a maladaptive coping strategy used to avoid confronting personal limitations or shortcomings, or problematic or traumatic life situations.

Therefore, although the focus of treatment is the addictive behavior, it is also necessary to address all the related issues, problems, or pathologies that contribute to the origin or maintenance of the behavior. The goal is to tackle the problem holistically , considering all the factors involved in its onset, progression, and improvement, with the ultimate aim of improving functioning in all areas of daily life , thus promoting good mental health and emotional well-being for adolescents.

The therapeutic goal for behavioral addictions (with the exception of pathological gambling), unlike substance addictions where the goal is abstinence, is relearning and acquiring an adaptive pattern of behaviors . We are talking about behaviors (screen use, sex, work, shopping, etc.) that, in themselves, are not toxic and for which it is not adaptive to stop performing them; rather, they should be established as healthy habits.

The goal is relearning and acquiring an adaptive pattern of behaviors, which should be able to be established as healthy habits.

Assessment and diagnosis

Proper diagnosis and treatment require a detailed psychopathological evaluation of the person, analyzing aspects such as:

• The addictive pattern
• The meaning of addictive behavior.
• Risk and protective factors
• Motivation for change.
• The personal and family psychopathological history.
• Personality.
• The social environment.
• School performance.
• Interference in different vital areas.
• The relevant factors in its acquisition and maintenance.
• The presence of other mental disorders.
• The presence of significant stressful or traumatic situations in their life (sexual abuse, grief or significant losses, domestic violence, abandonment or breakups, illness, separation of parents, physical or psychological abuse, bullying, migration processes, etc.)

Based on the biopsychosocial assessment, an individualized intervention plan should be developed, which will be agreed upon with the adolescent and their family.

Treatment

Regardless of the diagnosis of behavioral addiction, if the problematic behavior exhibited by the adolescent is causing distress and affecting different areas of their life, it is essential to intervene to prevent the situation from worsening.

There is no clear scientific evidence regarding the best treatments. Integrative psychotherapeutic models allow the use of techniques from different models, depending on the individual's profile and the objectives at each stage of the process, taking into account risk factors and comorbidity. These models tend to combine cognitive-behavioral therapy, motivational strategies, emotion regulation strategies, and family therapy strategies. They can also be combined with psychopharmacological treatment for associated symptoms (anxiety, depression, attention deficit hyperactivity disorder, etc.).

It is essential to work with the family (or legal guardians), addressing both the impact that addictive behavior has on the family and family dynamics.

The treatment is aimed at:

• Connect with the teenager.
• Reduce risk factors and enhance protective factors related to behavioral addiction.
• Identify the motivations behind addictive behavior.
• To assess and adjust the perception of the risk of addictive behavior, to become aware of the invasion of these behaviors into daily life and the difficulty in self-control.
• To motivate towards a re-education of behavior in a more adaptive and healthy way.
• Working on relapse prevention, identifying situations that may cause discomfort and may be at risk for addictive behavior, and acquiring appropriate alternative responses to cope with them.
• To restore normalcy to those areas of life that have been affected.
• Look for healthy and normalized leisure alternatives.
• To improve coexistence and relationships in different contexts (family, school, social).
• Addressing emotional problems, associated psychopathology, and family dysfunctions.  

In cases of dual diagnosis (substance use disorder and mental disorder), the most effective treatment option is an integrated approach that identifies, assesses, and treats both disorders. Dual diagnosis cases are highly complex, have a poorer prognosis, and require more flexible, intensive, and long-term treatments.

It is essential to work with the family (or legal guardians) both as the focus of the intervention and as a therapeutic agent, addressing the impact of addictive behavior on the family and the family dynamics that influence its development. This includes fostering positive parenting that promotes healthy, protective, and stable emotional bonds, enabling the establishment of healthy family relationships.

It is also necessary to work with the adolescents' immediate educational and social environment , with the aim of promoting or restoring their personal development in these areas, allowing them to feel integrated into their community environment.