INDIANA UNIVERSITY, BLOOMINGTON

ADDICTIVE BEHAVIORS

Adapted from Engs, R.C. Alcohol and Other Drugs: Self Responsibility, Tichenor Publishing Company, Bloomington, IN, 1987. (c) Copyright Ruth C. Engs, Bloomington, IN, 1996

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THE ADDICTIVE PROCESS AND ADDICTIVE BEHAVIORS

According to W.R. Miller, in The Addictive Behaviors, an individual can become addicted, dependent, or compulsively obsessed with any activity, substance, object, or behavior that gives him/her pleasure. Several researchers imply that there is a similarity between physical addiction to various chemicals, such as alcohol and heroin, and psychological dependence involved in such activities as compulsive gambling, sex, work, running, or eating disorders. The reason for this is that these behavior activities may produce beta-endorphins in the brain, which makes the person feel "high." These and other reports suggest that if a person continues to engage in the activity to achieve this feeling of well-being and euphoria, he/she may get into an addictive cycle. In so doing, he/she becomes physically addicted to his/her own brain chemicals, thus leading to continuation of the behavior even though it may have negative health or social consequences.

Most physical addictions to substances such as alcohol, heroin, or barbiturates also have a psychological component. For example, an alcoholic who has not used alcohol for years may still crave a drink. Thus these researchers feel that we need to look at both physical and psychological dependencies upon a variety of substances, activities, and behaviors as an addictive process and as addictive behaviors. They suggest that all of these behaviors have a host of commonalities that make them more similar to than different from each other and that they should not be divided into separate diseases, categories, or problems.

Common Characteristics Among Addictive Behaviors

There are many common characteristics among the various addictive behaviors, as suggested by Miller, Levison, Hatterer, and others. First of all, the individual becomes obsessed (constantly thinks of) the object, activity, or substance and will seek it out, often to the detriment of work or interpersonal relationships. The person will compulsively engage in the activity, that is, do the activity over and over even if he/she does not want to. Upon cessation of the activity, withdrawal symptoms of irritability, craving, and restlessness will often occur. The person does not appear to have control as to when, how long, or how much he or she will continue the behavior (loss of control). He/she often denies problems resulting from his/her engagement in the behavior, even though others can see the negative effects. Individuals with addictive behaviors usually have low self esteem and feel anxious if the do not have control over their environment.

There is a lack of consensus as to the etiology (cause), prevention, and treatment of disorders. A United States government publication, Theories on Drug Abuse: Selected Contemporary Perspectives, came up with no less than forty-three theories of chemical addiction and at least fifteen methods of treatment!

As an example of this confusion, many people consider addictive behaviors such as gambling and alcoholism as "diseases," but others consider them to be behaviors learned in response to the complex interplay between heredity and environmental factors. Some reserchers argue that, unlike most common diseases such as tuberculosis, which has a definite cause (a microbe) and a definite treatment model to which everyone agrees, there is no conclusive etiology or definite treatment method to which everyone agrees for most of the addictive behaviors. This lack of agreement causes problems with prevention and treatment approaches for the addictive behaviors. Other professionals debate whether total abstinence or controlled use of a substance (such as alochol) or activity (such as gambling) is desirable, or whether or not a substitute chemical (such as methadone for heroin) or activity is a desired treatment method. In the area of addiction to food or exercise, of course, very few individuals advocate total abstinence as a solution.

Though the etiology of addictive behaviors and treatment modalities are numerous, various types of therapy can help the individual with an addictive behavior.

EATING DISORDERS

There are several types of eating disorders common in North America. Some individuals overeat to the point of obesity, others consume large amounts of food and then prevent its assimilation by vomiting or using laxatives, and still others starve themselves so as to be thin. All of these are considered to be addictive behaviors with no clear etiology.

Anorexia Nervosa

In the addictive behavior called anorexia nervosa, a person begins to believe that he/she is too fat, even if he/she is of normal weight for his/her age and height. The individual feels that he/she must constantly diet and starve him/herself to be thin and beautiful. Once the person starts dieting, he/she finds it difficult to stop. Anorexics spend great emotional energy thinking of ways to avoid food and to cover up their lack of eating. They may wear bulky clothing, throw food away when no one is looking, and frequently exercise in the middle of the night to burn up calories.

Due to lack of eating and extreme diets, anorexics are extensively malnourished and exhibit signs and symptoms of starvation. Symptoms of anorexia include cessation of menstruation, extreme thinness, edema (swelling in various parts of the body from electrolyte imbalance), thinning or falling hair, tooth decay, and dry skin from dehydration. Even with these symptoms they continue to compulsively lose weight to the point of emaciation and sometimes death. Along with losing weight, they are often obsessed with obtaining extremely low body fat composition. Even when they have lost weight to the point of emaciation, they view themselves as being fat. Anorexics have even been hospitalized and have died, stubbornly maintaining that they were still too fat!

Most anorexics tend to be females from white upper-middle-class families. They tend to be high achievers and to be compulsive in other aspects of their life such as schoolwork. As an example, they become extremely depressed if they do poorly on an exam. They have low self esteem, usually deny they have a problem, and are often depressed.

During the past fifty years, being beautiful in North America has meant being thin. The mass media has emphasized youth along with thinness as the accepted prerequisites for happiness and social desirability. This has resulted in an increase in compulsive dieting and eating disorders. Yates et al. feel that a cause of anorexia is that the individual believes he/she is out of control over life. In order to gain some measure of control, achieve social desirability, and overcome fear of personal ineffectiveness, the person stops eating. Another theory proposed by Yates et al. is that emaciated anorexics have elevated brain levels of endorphins, which may be associated with the elevated mood many anorexics report, a feeling that could serve as a potent reinforcer of the destructive behavior. Anorexia may also be related to a malfunctioning hypothalamus, which controls the release of morphine-like endorphins in response to stress, according to this research group.

Bulimia

The person who overeats or binges on food and then prevents absorption by purging (laxatives, vomiting, water pills, enemas) is considered to have bulimia. In this obsessive behavior the person feels driven to consume food as well as to purge him/herself of it to prevent gaining weight. It is often associated with anorexia. Bulimia can occur with individuals who are of normal weight or even overweight. The bulimic person often plans and organizes the consumption of a large amount of food. The planning is often ritualistic and secretive. So great an amount of time and energy is spent thinking of food that it often interferes with an individual's ability to function.

This behavior is usually cyclic in nature, with the person binging due to lonelines, depression, or boredom and then purging due to feelings of guilt about binging. Symptoms of bulimia include tooth decay, dehydration, constipation, weakness, lightheadedness, low blood potassium, cardiac arrhythmias, kidney damage, swelling of salivary glands, and irritated esophagus. The blood chemical imbalance can lead to heart attack. The individual is usually secretive about the behavior and may make numerous trips to the bathroom as the result of laxative abuse or desire to vomit.

Like anorexics, bulimics tend to be white upper-middle-class females. They are often involved with cheerleading, performing arts, or gymnastics. They tend to have low self esteem and rely on the opinions of others to validate their self worth.

The cause of bulimia is not known, but various theories, including emotional stress, need for relief from anger and depression, and pre-occupation with body size, have been suggested. As with anorexia, bulimia may be related to a malfunctioning hypothalamus or a need to be in control of one's environment.

Compulsive Eating

As in any other addictive behavior, the compulsive eater is obsessed with the object of the compulsion, namely food. The person has a compulsive urge or craving to eat and will often eat when not hungry. The individual will often binge in secret, away from others, and will lose control over how much food he/she eats. For example, a compulsive eater may consume a whole box of cookies when he/she intended to have only one. This often occurs when the person is feeling lonely, angry, insecure, depressed, anxious, or bored. As with other addictive behaviors, the individual will deny that he/she has overindulged. When asked, the person may claim that he/she only ate "a couple of pieces of chicken" when two chickens were actually consumed.

Compulsive overeating usually results in obesity. However, according to Hooker and Convisser, the "compulsive eater is not necessarily identifiable by her body size because many women who eat compulsively also are compulsive dieters." There is a difference between being overweight and being obese. Overweight is weighing more than one should for his or her body structure, height, and sex. It is possible to be overweight and still be in good health. Weight lifters and others who do muscle-producing exercise are often overweight but have a very low proportion of body fat. Individuals who are obese, however, are more than 30 percent over their ideal weight and have a high body fat content.

Obesity can lead to serious health problems. Excessive body fat is associated with diabetes, hypertension, and heart disease. It is also linked to varicose veins, problems in pregnancy, digestive disorders, arthritis, and respiratory disorders.

The compulsive eater is usually female. She has low self image, a preoccupation with body size, feels a lack of control over her environment, feels depressed, and tends to turn anger inward. Overeating is a way to alleviate boredom, stifle negative emotional feelings, calm down, relax, and feel comforted.

Though most obesity is considered to result from overeating due to psychological causes, some people are thought to have a physiological basis for their problem. One theory, the setpoint theory, suggests that people are born with different natural setpoints for a particular body weight In response to weight changes, metabolic or physical reactions occur to maintain the weight at which the body is "set." This may in turn cause the person to eat more to maintain his/her set weight. If the person has a high setpoint, he/she will tend to be overweight or obese.

The fat cell theory posits that adipose tissue (fat cells) can affect body weight by increasing either in number or size. It is thought that in childhood a greater number of fat cells than normal are produced because of overfeeding. In dieting, the fat cells become smaller but are not eliminated. The person appears to be of average weight. However, when the person does not diet but eats a normal amount of food, the many fat cells enlarge, thus causing him/her to again become overweight.

Other research appears to indicate that the hunger and appetite control centers in the brain may be the same as the amphetamine-binding site in the hypothalamus. Many more binding sites seem to be available when the person is hungry than when the person is not hungry. Eating food or taking stimulants such as amphetamines decreases appetite and causes a heightened sense of well-being. Perhaps in obese individuals, when large quantities of food are ingested, a feeling of well-being similar to that produced by stimulants occurs. If the person is feeling lonely or depressed, eating may help him/her feel better.

It has also been found that eating patterns of obese individuals are different from those of normal-weight persons. Obese people often eat more rapidly and take larger and more frequent bites than normal-weight individuals. They also appear to expend less physical energy than average-weight persons due to lack of exercise and slow movement in daily routine. However, as with the other addictive behaviors, a simple etiology of compulsive eating is not clear.

GAMBLING

When a gambler behaves mindlessly and irresponsibly, losing money, depriving the family, and harming the community, he/she is often treated as a criminal, rejected, or punished by friends and society alike. During the 1970s the attitude towards the compulsive gambler as a weak-willed person or criminal began to change. Pathological or compulsive gambling began to be viewed as an addictive behavior. The compulsive gambler loses control over the behavior, denies that he/she has a problem, is easily depressed, and has a low self image.

Gambling addicts tend to be males from middle- to upper-middle-class backgrounds. They are often articulate, have a higher than average IQ, are energetic, industrious, competitive, and desire independence. They often have a family history of alcoholism, depression, or compulsive gambling. About one third of them have parents with the same problem. In most cases they were introduced to gambling by family members when they were young.

Surprisingly, compulsive gamblers rarely have a history of antisocial behavior, either as children or adolescents. They tend to perform well at school and work. While still in their teens many experienced a "big win," either at a race track, casino, or lottery, of such proportions that it made a lasting impression on them. They often return to the track, casino, or even the stock market with the expectation of winning big again.

There are three stages that the compulsive gambler goes through. In the early or winning phase, the dependency on gambling develops as the individual begins to bet more frequently and tends to win as his/her knowledge of gambling odds and risks is developed. During this stage, the person still "controls" the behavior and can stop gambling. Rarely does the individual borrow money, since winnings are usually enough to support continued gambling. This phase may continue for months to years and typically ends with a substantially big win.

During the next phase, the losing phase, the individual begins to gamble alone instead of with friends and begins to bet large amounts of money. Around this time, because the individual is gambling more, he/she begins to lose. Out of frustration, the individual begins to bet more money and take more chances. As his/her winnings are quickly depleted, the person begins to draw upon other resources in order to "get even." This is often money that has been earned, saved, or invested. If the person continues to lose, he/she feels a sense of urgency to win back what has been lost and eventually may borrow money. The individual then tries to cover up and may lie about his/her gambling, which alienates both family and friends. When friends or family do lend money to help the person get out of debt, it usually is quickly lost.

During the last or desperation phase, the person disregards creditors, family, and friends and begins to take even further risks. He/she may engage in illegal loans, thefts, or other crimes. The person often loses family and job. Depression is common, and suicide attempts are frequent.

The cause of compulsive gambling is not known. Most gamblers talk about the "thrill" or "high" they get while gambling, and it is speculated that, as in other addictive behaviors, perhaps beta-endorphines are produced in the brain, which causes the individual to repeat the behavior to obtain the pleasant feeling. It is interesting to note that during treatment, compulsive gamblers undergo withdrawal symptoms similar to symptoms of persons addicted to depressant drugs: headaches, abdominal pain, diarrhea, cold sweats, tremor, and nightmares.

OTHER ADDICTIVE BEHAVIORS

There are a variety of other activities, behaviors, or even hobbies upon which some individuals can become psychologically dependent. Some of these activities may not be as life threatening as chemical addictions or eating disorders, but they can have profound negative effects on the individual and society. The reason why some people compulsively engage in a behavior, while others can engage in the same activity without becoming psychologically dependent upon it, is not known. In general, any behavior that is compulsively done by a person to the extent that it causes physical, social, or psychological problems to the individual, his/her family, or society would be considered to be an addictive behavior for that individual.

WORK

Our society rewards hard work. It is the basis of the Protestant work ethic, which was brought to North America by our immigrant ancestors. Work hard, play hard, save your money, and anything in the world can be yours is the basis of this philosophy. Society implies that the person who spends much time at the office or studying, if it brings more money, job promotion, or better grades, is "being productive." In fact, many individuals who have spent most of their time working have made extremely positive contributions to society and have often changed history because of their dedication.

On the other hand, if the "work" becomes an obsession to the extent that family, friends, other interests, or hobbies become unimportant and ignored, the person is then thought to be a workaholic or work addict. Complete devotion to work, to the exclusion of close relationships,often leads to family problems and divorce. It can lead to loneliness in old age, when the person realizes that all of his or her accomplishments really "do not mean much, were not rewarded properly, and who will care anyway a 100 years from now what I did or did not do."

Workaholics who become "absent parents" can cause psychological problems in their children. For example, if a father promises his child that they will go to the basketball game on Saturday and, when that day arrives, tells the child that he will not be able to take the child because of a business emergency, the child may lose faith in the father, especially if the behavior occurs frequently.

The work addict often has low self esteem, feels inadequate, has a compulsion to set goals and meet them, and feels anxious and distraught when he or she is not "doing something." Workaholics find it difficult to relax and just "do nothing." When "relaxing" they often feel guilty because they are not being productive and will spend their free time becoming more and more anxious because they are doing nothing until they are back at work again.

Computers

Over the past few years, with the increase in home computers and computer games, computer addicts or "hackers" have begun to emerge. According to Ingbert, these compulsive computer interactors tend to be young high-school or college-age males. They are generally highly intelligent and good at problem solving and mathematics. Even though they often are above average in intelligence, many flunk out of school, repeatedly lose jobs, lose contact with friends, and become alienated from their families. Compulsive computer interactors have been known to spend hours at the console without eating, bathing, or sleeping. When deprived of the computer, they go through withdrawal symptoms of irritability and anxiety.

The primary lure of the computer for the computer addict is that the person can have complete control over it. It does what it is told and is always predictable in its behavior or action. The person can create a world of his/her own, with its own set of rules and behaviors. Likewise, the machine will never exert peer pressure or express anger or insults or talk back. This is often a comfort to a young adult who is confused about sex roles, parental expectations, career choices, and the development of intimacy with another person. Though the cause of compulsive computer interaction among young people is not known, the hackers do have similar psychological characteristics to individuals with other addictive behaviors. They tend to have low self image and to feel insecure and out of control over their environment. In addition, they have poor interpersonal skills.

Exercise

In our society, since the days of the ancient Greeks, athletes have been admired, especially the ones who have gone above normal performance limits of the human body. However, excessive participation in various physical activities has overtones of addictive behavior. Runners who run over 100 miles a week with unhealed stress fractures or other painful and serious injuries, and who become depressed when they cannot exercise, are now beginning to be considered addicts.

Extreme commitment to athletics, like extreme commitment to work, has had a time-honored place in our society. But that extreme commitment has been shown in some cases to be self destructive and harmful to the individual. According to Yates et al., anorexia and compulsive marathon running are now seen as having similar etiologies. These authors imply that runners, like anorexics, tend to be introverted, compliant, self effacing, unable to express anger, and have low self esteem. They commit themselves to extreme exercise in order to establish identity. Like anorexics, compulsive runners tend to be high achievers from affluent families. The obsession with the activity usually begins at a time of heightened stress. The elevated mood change or "high" experienced by long distance runners is thought to serve as a reinforcer for the behavior. They may become addicted to this "high" in order to feel worthwhile.

Love and Relationships

According to Peele and Brodsky, an individual can become obsessed with another person to the point that other areas of his/her life are neglected. The person focuses all of his/her attention and energy on the "love object," to the exclusion of friends, family, and other life commitments. Even when the person knows intellectually that the obsession is causing harm, even thinking about breaking up the relationship will bring on an anxiety attack. When the relationship is finally terminated, by either party, withdrawal symptoms of sleep and eating disorders, shaking, confusion, weeping, and feelings of failure, depression, and hopelessness occur.

There are two basic form of love addiction. In the first type, the relationship is often one sided, with the object of the person's love not even interested in, or aware of, the obsessed person's infatuation. The love is based upon imagination and not upon a relationship. An example of this would be someone "madly in love with the guy with the dark hair who sits in the front row of English class," to whom the person "in love" rarely speaks. Individuals with one-sided addictions sometime have "attachment hunger," according to Halpern. They feel inner emptiness, incompleteness, insecurity, and anxiety if they do not have a relationship. Some of these individuals enjoy the "chase." However, if the loved one finally becomes interested in them, they quickly lose interest. This type of person is addicted to the challenge of making an unloving person love them. These individuals will often go from one relationship to another and often never find anyone who is "just right" for them.

Sometimes two people are addicted to each other. These individuals seldom interact with others and tend to be possessive of each other and jealous of their lover's interactions with other people. They are motivated by their own need for security and not by an appreciation of each other's personal qualities. Addicted lovers will see each other more and more in order to maintain a secure state, often completely rejecting other people. When they are apart, they "long" for each other. Neither feels that he or she is a whole person without the other. Even if their constant contact degenerates into conflict, fights, and problems, they feel that they cannot separate.

According to Halpern, some characteristics of love addiction occur with all relationships. However, if the relationship begins to be destructive, with constant mental or physical abuse by one or both partners, and neither person can break it off, then it is addictive. In our society it is often common for friends and relatives to urge a couple to "keep trying to make it work." However, when nothing has changed over a period of time, or the people involved do not express a desire to change and/or get psychological help, it is time to give up the relationship before severe psychological or physical damage occurs.

The cause of love addiction is not known, but, as in the other addictive behaviors, the person usually has low self image, feels insecure, is frequently depressed, and undergoes "withdrawal symptoms" when deprived of the object of his/her obsession.

Groups

Throughout history, social movements have been started by individuals who were extremely committed to their causes. However, some individuals may become so involved with various religious sects, cults, or political or social action groups - or even a self help group - as to become addicted to them. When a religious sect such as the "Jonestown" group has an influence over individuals to the point where they will commit mass suicide, a compulsive state is thought to have occurred.

As with the other addictive behaviors, the group- or cause-dependent person often has low self esteem, feels insecure, is anxious, and is looking for "something" to give meaning to his/her life. Individuals are considered to be addicted to a group or cause if they constantly talk about their beliefs to everyone they meet, feel that the group's philosophy is the "only true way," and believe that everyone else is wrong, immoral, or "condemned" if they do not believe as they do. Compulsive "groupers" often feel guilty if they are not attending gatherings or working for the cause almost every day. They sometimes begin to spend less time with their families, jobs or recreation and have been known to lose their employment because of their intense involvement with "the cause." If they cannot be with their group, they often feel depressed, anxious, and irritable.

Eric Hoffer, in his book The True Believer, describes similar characteristics in individuals with commitments to a variety of political, environmental, religious, and social movements. However, like work and athletic commitment, this type of dedication has often been rewarded in our society and has produced both positive and negative social effects over the centuries on a worldwide basis.

On the whole, any activity that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially has become an addictive behavior.