Just ran across a great article in the New Scientist online journal. It talks about current research being done on the “soft addictions” (addiction to behaviors, such as gambling or sex, as opposed to chemicals). It’s a great article, and I’m going to quote it at length here, and offer some of my own commentary.
Several studies of the brain and behaviour back the idea that there’s very little biological difference between what goes on in the head of a gambling addict and that of a crack addict. A growing number of researchers believe that the same processes lie behind all addictions, behavioural or chemical, whether it’s gambling or shopping, computer gaming, love, work, exercise, pornography, eating or sex. “They have more in common than different,” says Sabine GrÃ¼sser-Sinopoli, who runs a clinic and research lab for behavioural addictions at the CharitÃ© Medical University in Berlin, Germany. “Addiction is all the same.”
That’s a controversial claim. There’s a common perception that overindulgence in certain behaviours is all down to individual choice. If you are overeating, oversexed, gambling away your earnings or spending all your time online, you are more likely to be considered morally abhorrent than the victim of a disease. Calling these problems “addictions” has triggered debates about whether our society or our biology is to blame, and whether people that fall foul of a behavioural obsession should be offered help and treatment rather than punishment.
Whether you consider them true addictions or not, finding ways to attack these problem behaviours is becoming ever more urgent. More and more people are going to clinics asking for help to control the need to shop, have sex or gamble, because their behaviour is ruining their lives, says GrÃ¼sser-Sinopoli. Technological advances, especially the rise in popularity of the internet, are increasing the opportunities we have to engage in potentially addictive behaviours. The Center for Online Addiction, an educational and treatment group founded just over a decade ago by psychologist and internet addiction specialist Kimberly Young, now of St Bonaventure University in New York, estimates that as much as 5 to 10 per cent of the US population is addicted to some kind of internet-based activity, be it gaming, gambling, or using chatrooms and email.
It’s mystifying to me why at this point the author doesn’t include pornography in this list. If he or she did – and if Kimberly Young was factoring it into her research – I’m sure the numbers would be much, much higher. Later in the article, we read:
The debate about whether behaviour can be considered a true addiction is not an entirely new one. In 1975, psychologist Stanton Peele wrote a book called Love and Addiction, which argued that all kinds of drug and non-drug experiences, including love, could be described as addictions. At the time, this was a term only really used to describe heroin abuse, he says. But look at how we talk about a lost love, and how similar to drug withdrawal it sounds: we are unable to think of anything else or to get out of bed, we’re crying and physically in pain. “There really is no way to differentiate the behaviour of gambling, a love affair or pursuing a drug,” he says.
While we all think we know what is meant by the term addiction, surprisingly there is still no scientific consensus about how to define substance addictions, let alone behavioural ones. Some medical definitions consider addiction a disease, while others consider it hijacking the normal “reward” signals in the brain (see Diagram). Some textbook definitions include the ingestion of a substance as an essential part of the definition, which would rule out behavioural addictions entirely. Even now, the current edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, the official manual of psychiatric illness, talks of dependence and abuse rather than addiction even with drugs, and it lists pathological gambling among conditions such as Tourette’s, as an impulse control disorder.
My understanding is that the question of whether or not to include sex addiction as an identifiable psychological disorder in the DSM-IV is a highly controversial and political one. If sex addiction was a diagnosable disorder, insurance companies would be required to pay for its treatment, and every person charged with a sexual harrassment or a sex crime would use this disorder as part of their defense.
There are, however, plenty of researchers who now support a broader definition of addiction that includes behavioural addictions. Griffiths is leading the charge for including extreme obsessive behaviours as addictions. He has been studying pathological gamblers and people with other behavioural problems for 20 years, and the work has led him to a new definition for addiction. He says there are a set of key features common to crack, heroin, alcohol and nicotine addiction that describe all addictions and equally apply to many excessive behaviours.
1. The pursuit of the addiction (ie. gambling, sex, or a drug) dominates peoples’ lives
One of those features is that addiction dominates people’s lives, he says, leading to cravings and a complete preoccupation with a habit. This can apply to a behaviour other than substance abuse. “If a person is addicted, first they have to conduct this behaviour, ahead of all other behaviours: ahead of eating, drinking or sleeping,” says GrÃ¼sser-Sinopoli. “They are not doing it because they like it, they are doing it because they have to.”
2. The development of tolerance
Another feature in Griffiths’s broader definition is tolerance – a well-established feature of drug habits – meaning that as time goes on, a greater dose is needed for the same high. It’s a feature that’s starting to be documented in behaviours too, says Griffiths. He measured the heart rate of gamblers, for example, finding that slot machine players all experience a quickening of the pulse as they play – the sign of a rush, rather like a drugs high. In new or less experienced players, the rate remains high for the duration of play, but in regular gamblers, the rise is only transient. To maintain the effect, they have to gamble faster, longer and take greater risks.
One of the most disturbing and defining features of addiction is withdrawal. Griffiths says that addicted gamblers who are unable to engage in their habit feel similar symptoms, such as excessive moodiness, irritability, nausea, stomach cramps, headaches and sweats. “These are real effects,” he says. “Gamblers have withdrawal symptoms like drug addicts.” GrÃ¼sser-Sinopoli has seen patients with anxiety, depression, and physical symptoms such as sweating and hallucinations, triggered by withdrawal from shopping and gambling.
The evidence that behavioural addictions are very similar to chemical ones is mounting from brain studies too. According to addiction specialist Eric Nestler of the University of Texas Southwestern Medical Center in Dallas, drug addictions and “natural” addictions seem to involve shared pathways in the brain. “Take a person with sex addiction, or a pathological gambler: their brains all show abnormal responses – the same reactions to drugs of abuse,” he says.
All pleasurable stimuli, natural and unnatural, act on the same “reward” circuitry in the brain. When we find something desirable, the brain chemical dopamine is released in the brain. Drugs of abuse all cause dopamine release, triggering a desire to keep taking them. Pleasurable behaviours are rewarding too and also release dopamine. The fact that behaviours and drugs of abuse converge on the same brain circuit is not enough to prove they can both be addictive, but there are more specific changes that do seem to be characteristic of addiction.
For example, new research has shown that higher than normal dopamine levels are associated with some behavioural compulsions (see “Addiction by stealth”). There are also signs that, just as recovering drug addicts may have abnormally strong memories of drug paraphernalia and drug-taking locations that can trigger irresistible cravings, so obsessive computer gamers may have abnormal memories too.
And so do sex addicts! Most sex addicts can recall with vivid detail their first sexual experiences and exposure to pornography.
GrÃ¼sser-Sinopoli and her colleague Ralf Thalemann found that gamers or gamblers experienced cravings, triggered by images from their favourite games, that were comparable to the responses of drug addicts. They had heightened physiological and EEG brain responses to the images, indicating that they were more pleasing and motivationally relevant than they were to inexperienced players. An addict’s brain learns to respond much more dramatically to previously innocuous scenes, says GrÃ¼sser-Sinopoli.
They have conducted the same tests in cannabis, heroin and alcohol addicts, casino employees, abstinent gamblers and people undergoing methadone and naltrexone treatment. They found that this EEG response shows up in all addicts, but not in people who are exposed to the same surroundings yet remain unaddicted, such as casino employees. “People may deny they have a craving, but when we expose them to these cues the system is still active,” she says.
Nestler and his colleagues have recently discovered another physical marker of addiction. In chronic drug users there seems to be a distinctive rise in production of a gene regulator called delta Fos B in a part of the reward circuit called the nucleus accumbens. It shows up in the brains of rodents that compulsively consume drugs or alcohol, and although it is hard to test behavioural addictions such as gambling in a mouse, it has also shown up in animals that are allowed to have sex more often than a control group.
One thing that this focus on behavioural addictions highlights is that we all have the potential to be addicts, says Jim Orford of the University of Birmingham, UK, author of a report on behavioural addictions for the UK Office of Science and Technology. “Almost any of us can become behavioural addicts, given the right exposure, the right timing and so on,” he says. “But there are multiple causes: our personalities, genetics – it’s not simple.” Why some people develop addictions while others can safely dip into these activities with no ill effects is still unknown.
One thing Orford is certain of is that these behavioural addictions will only increase over the next few years. Not everyone will try an illegal drug or hit a casino, but most of us use computers, and many more people are playing computer games or gambling online than ever before. We need to be ready to treat people with these new addictions.
The key here will be addressing underlying emotional problems, says GrÃ¼sser-Sinopoli. She has conducted surveys in schools that show children are more likely to turn to computer games when they are unhappy. Since we can’t keep people away from computers or shops for the rest of their lives, learning how to cope with stress will be key to stemming the huge rise in behavioural addictions, GrÃ¼sser-Sinopoli says.