The Addiction Habit
Do we really need rehab centers for people who spend too much time shopping or using the Internet?
Like a compulsive crack user desperately sucking on a broken pipe, we can't get enough of addiction. We got hooked on the concept a few centuries back, originally to describe the compulsive intake of alcohol and, later, the excessive use of drugs like heroin and cocaine. Now it seems like we're using it every chance we can get—applying the concept to any behavior that seems troublesome or ill-advised. Take overuse of technology, for example: Over the summer, a flurry of media reports touted the services of the RESTART clinic in Washington state—apparently the first "Internet addiction" recovery center in the United States. For $15,000, you can enroll in a 45-day course designed to rid you of a dangerous or unhealthy fascination with, say, the online role-playing game World of Warcraft. So-called Internet addiction is just one of many new behavioral addictions to break into the mainstream: there's also shopping addiction, sex addiction, eating addiction, love addiction, and others.
This creeping medicalization of everyday life means that almost any problem of excess can now be portrayed as an individual falling foul of a major mental illness. While drug addiction is a serious concern and a well-researched condition, many of the new behavioral addictions lack even the most basic foundations of scientific reliability. In light of Tiger Woods' extramarital trysts, "sex addiction" has been widely touted by the global media despite the fact it lacks official recognition and scientific support. Perhaps the most widely publicized of these new diagnoses, Internet addiction, is flawed even on its own terms: A 2009 study published in the journal CyberPsychology and Behavior revealed that it has been classified in numerous, inconsistent ways in published research. Most studies of the "disorder" rely on self-selecting samples of college computer users and are otherwise subject to significant bias.
Despite the scientific implausibility of the same disease—addiction—underlying both damaging heroin use and overenthusiasm for World of Warcraft, the concept has run wild in the popular imagination. Our enthusiasm for labeling new forms of addictions seems to have arisen from a perfect storm of pop medicine, pseudo-neuroscience, and misplaced sympathy for the miserable.
You might assume that we've always known about addiction, but it's a relatively recent idea—and one that has almost always been championed by people with a political and moral agenda. The modern concept was invented in the 18th century by physician Benjamin Rush, who, with his fellow temperance campaigners, promoted it as an explanation for, and warning against, the dangers of the demon drink. In this early formulation, the booze itself caused a "disease of the will."
Later, the theory of "degeneracy" became popular among medical men with the assumption that mental illness could be explained by an inherited tendency to be mentally defective and socially disadvantaged. The devastating effects of alcohol on supposedly inferior native people led colony psychiatrists in the 19th century to conclude that the two conditions—drunkenness and degeneracy—went hand in hand. Slowly the concept of addiction began to shift from poisonous drugs to a biological weakness among certain people. Addicts were to be pitied but not blamed. "Degeneration," along with eugenics, died a long-overdue death in the 1950s, but the idea that addiction is a vulnerability that exists before someone has even taken his first hit lives on. It seems to have reached its pinnacle in 2004, when a report from the World Health Organization called substance dependence "as much a disorder of the brain as any other neurological or psychiatric illness."
This reframing of addiction carries its own risks. We know that describing a problem solely from a medical perspective changes how we understand it, which may explain why addiction has become such a popular label for human troubles. Recent work by psychologist Meredith Young and colleagues at McMaster University in Canada has shown that if we replace a common name for an illness with a medical term—pharyngitis for sore throat, e.g.—people tend to perceive the illness as being more serious. Several other studies have found that when mental disorders are described solely in biological terms, those with the diagnosis are perceived as having less control over their actions. This approach aims to be sympathetic to sufferers—but it may come at the cost of portraying the miserable as slaves to their damaged brains.
The idea that all these behavioral problems can be reduced to brain chemistry is also linked to a vacuous piece of pseudo-neuroscience. According to many popular discussions of the topic, dopamine equals addiction. That fallacy is often touted by mental health professionals as a substantive explanation when it is nothing of the sort. The popular myth goes something like this: Dopamine levels increase when we do something pleasurable, and this is what causes the addiction. When anyone wants to convince you that something should really count as an addiction, they'll quote the fact that it "raises dopamine levels."
The myth does have some basis in fact: We know that dopamine is involved in pleasure and desire, and that drug addiction causes long-term changes to the dopamine system that likely weaken our impulse control and draw our attention to reminders of drugs and drug-taking. There are subtle but important differences between these two statements, though. The former refers to an instant reaction to any pleasurable activity, while the latter indicates a possibly permanent change in how the brain reacts to the world owing to the use of substances which artificially alter it. There's no direct one-to-one relationship between dopamine and addiction, and knowing that this particular brain chemical is released during an activity predicts nothing about how problematic the activity might be. As the dopamine system starts working when we encounter anything pleasurable, the popular myth would suggest everything we like could be addictive: reading books, scratching an itch, building model steamships out of matchsticks, whatever floats your boat. A recent article on extended and unresolved grieving for the New York Times cited a study on how dopamine is released when affected people looked at a picture of their late family member, suggesting that even thoughts of the deceased could be addictive.
The fact that the dopamine fallacy is used to prop up our dubious assumptions rather than test them can be seen in how some pleasurable, repetitive, and likely dopamine-fueled behaviors are never described as an addiction. A study by psychologists Kirk Wakefield and Daniel Wann found that while most sports fans are well-adjusted, others are preoccupied with their fandom, excessively motivated to follow their team, and abusive in response to outcomes on the field. What's more, sports fandom has a clear and well-researched link to violence, social disorder, and alcohol abuse. But despite the fact that following a sports team could have serious personal and social consequences, and seems to fulfill all the criteria for a diagnosis of behavioral addiction, it is never considered as such. Being a fan of an online computer game, however, can get you placed in an expensive private clinic for "addiction therapy."
Currently, we are concerned about young people using the Internet, eating too much, spending irresponsibly, and being promiscuous, and these worries are being expressed in the language of addiction. The medical terminology helps us to believe we're avoiding moralization or blame, and popular science has given us a sound bite of pseudo-neurology to support our prejudices. For these problems, addiction is little more than a fig leaf for a realistic understanding that would address why people return to unhelpful ways of coping with isolation, stress, and depression. Instead, we prefer to rely on a trite and unhelpful catch-all label that prevents people from getting appropriate help for their difficulties. We need to break the addiction habit, before it breaks us.
Vaughan Bell is a clinical and neuropsychologist at the Universidad de Antioquia, Colombia, and King's College London.
Photograph of Tiger Woods by William West/AFP/Getty Images.