Addiction can exist without physical dependence:
“Complicating matters, physical dependence is not necessary for the notion of addiction to apply. For example, upon stopping, pathological gamblers who do not use alcohol or other psychoactive drugs often reveal physical symptoms that appear to be very similar to either narcotics, stimulant, or polysubstance withdrawal” (Shaffer, 1997).
The main process addictions are pathological gambling, eating disorder and sex addiction.
These are termed process addictions because they are behavioural, in that they do not involve attachment to a substance. They are also activities that constitute an integral part of life, and so cannot, on the whole, be abstained from.
Thus, “If addiction can exist both with and without physical dependence, we may consider the objects of addiction to be those things which reliably and robustly shift subjective experience” (Shaffer, 1997).
Though not always involving a substance, process addictions share four common areas with substance dependence:
- Obsession
- Compulsion
- Impaired control
- Damage to functioning
They are also often co-morbid with substance abuse/dependence, and will often be the primary diagnosis.