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Video: Addicted to Facebook, chocolate or shopping?

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    >>> this morning on "today's health" soft addictions. what are they? they are not drug-related but if you can't stop shopping , going on facebook or eating chocolate you may have a soft addiction. they are featured in woman's day magazine. gail saltz is a "today" contributor. good morning.

    >> good morning, al.

    >> what's the difference between addiction and compulsive behavior ?

    >> with a true addiction you expect tolerance. like you get used to it and you need more of whatever it is to feel the same way and you expect withdrawal. so the feeling that if you can't do the thing you feel terrible. with a true addiction like alcohol, tobacco, drugs, when you stop doing it you feel physical withdrawal. nauseous, sweaty and you have a tremor and so on. with things we call soft addictions or compulsive behavior you may not feel good but you don't have physical withdrawal. it's just something you want to keep doing and it's emotionally driven as opposed to being physically driven.

    >> so it not a biological or a genetic component?

    >> there is often a biological or genetic component though we are talking about compulsive behaviors. it tends to run in families and even if it's not it can be brought on by other things. maybe you are doing this behavior because you're depressed or anxious and you are trying to fend off the feelings. it can be in the environment. say your mom was a big shopper and she handled everything by going out and shopping. that could affect you and you could grow up to be a compulsive shopper .

    >> when you talk about these addictive behaviors.

    >> yes.

    >> you talk about something that can be detrimental in life. do soft addictions have this same component?

    >> absolutely. that's the thing. even though i'm not calling it a drug or alcohol kind of addiction, they can really destroy your functioning in life. they destroy relationships. if you're shopping like crazy and you can't afford it and your spouse is upset, this can ruin a marriage. it can financially ruin you. it can ruin your work environment if you're doing whatever it is at work and not working.

    >> there are questions you should ask yourself.

    >> yes.

    >> the first question is, are you planning and really preoccupied about planning to do the behavior?

    >> exactly. it's not just how often you're doing it but are you thinking about it all the time? if it's about exercise, when can i go to the gym, how long can i spend in the gym, what will i do? same thing about shopping. any of these behaviors you think about it a lot.

    >> if the behavior impacts other parts of your life, that's a problem as well.

    >> absolutely. this is the primary one. is this affecting your relationships, your work, your finances.

    >> and then are you secretive about the behavior.

    >> another biggie. do you find you shop and then kind of leave the bags in the trunk so your spouse won't notice when you bring them are in? are you going under ground because you know you have a problem?

    >> and then you have tried to quit and you have to ask yourself have i tried to quit and i can't.

    >> either you can't or you did quit but it was for a relatively short period of time and you started. sometimes people fool themselves and say, well, i can quit, i quit before. but you went right back to it.

    >> how do you break it?

    >> first off you have to admit you have a problem. no behavior changes until you admit you have a problem. that's a big feature of it.

    >> what's driving the behavior?

    >> is this mood-generated? do you feel crummy when you don't do it? does it run in the family? you have to look at what's driving it so you can stop it.

    >> in the case of overeating they say, look, walk away for ten minutes and come back.

    >> exactly. shake up the behavior. compulsions are repetitive and thrive on a pattern. if you pull back and say, instead of checking my e-mail every hour on the hour, i'm going to shake it up and do ten minutes one day, two hours the next. break the pattern and just do it differently. instead of eating sweets all the time, go for the apple. in the gym instead of the routine, break it up and do it differently. that throws off the compulsion. but if this is affecting your life and you have tried things and they are not working you probably need professional help. kcome pull sieve behavior can be difficult to get over. think about seeing somebody. some people respond to therapy. some people respond to medication. so it's something you want to think about because it can be very damaging in your life.

    >> dr. gail saltz, good stuff to think about.

updated 1/3/2012 1:38:34 PM ET 2012-01-03T18:38:34

Almost every day I hear a friend—or a patient—talk about being “addicted” to something: chocolate, exercise, email, a TV show. Are these really addictions? No—not if you follow the classic definition of addiction—but they’re still potentially problematic.

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Let me explain: Addiction, by definition, means being psychologically and physically dependent on something. If you’re addicted to alcohol, tobacco or drugs, for example, you’ll experience withdrawal symptoms like a rise in blood pressure, nausea, sweating and tremors if you stop taking it. That’s because these substances change body and brain chemistry.

Nowadays, many people also use the term “addiction” to refer to a “need” to repeat a behavior such as gambling, eating, having sex, exercising, working, shopping or surfing the Internet. These things are technically compulsions, not addictions. If a compulsive gambler doesn’t get to the casino, he might feel uncomfortable, but he’s not going to get the shakes.

Of course, a compulsion can be quite serious—just imagine a gambler who finds himself in significant debt or someone who keeps having affairs despite the toll that it’s taking on her marriage. The important question isn’t whether something really is an “addiction,” but whether or not it’s having a destructive impact on your life. If you’re simply a zealous fan of Glee, it’s probably not destructive (unless you’re so obsessed that you’re missing your best friend’s wedding to watch the show). But plenty of compulsive eaters and shoppers can wreak havoc on their health, relationships or financial security.

One of my patients, Kate (names have been changed to protect privacy), often spoke of her intractable shoe addiction. An outgoing woman in her mid- 40s, she revealed that she had many more shoes than she could use or afford— and yet she found it nearly impossible to pass up a pair that caught her eye. When she was stressed out, she bought shoes. When she felt sad, she bought shoes.

If Kate forced herself not to buy shoes for a week or two, she did not get physically ill. But she was rarely able to resist shoe shopping for much longer than that, even though she had racked up so much debt that her family was in danger of losing their house and her husband was thinking of leaving her.

Another patient, a 33-year-old woman named Meg, came to me as a “last resort” before getting gastric bypass surgery. A compulsive eater, she had been secretly eating entire bags of candies, cookies and chips for years. She frequently ate until she felt sick. As soon as she finished cramming in the food, she was immediately overcome with guilt. She knew that overeating was slowly killing her, but she couldn’t stop.

What causes compulsions?
A number of different factors—biological and environmental—can play a role. First of all, we think there is a genetic component, since compulsive behaviors seem to recur in families. Meg, for example, mentioned that her 15-year-old son was playing video games day and night, and his grades, friendships and sleep habits were suffering—all signs that he was developing a compulsion, too. An imbalance of chemicals in the brain called neurotransmitters may also be to blame. And you can also be genetically predisposed to having this imbalance.

Compulsions also often go hand in hand with anxiety and depression. The excitement of gambling, the comfort of eating, the high of the purchase all temporarily drown out feelings of sadness and worry. But of course as soon as the moment is over, that bad feeling returns, and so does the urge to repeat the soothing behavior.

For more help

Experts also think that in some cases, compulsive behaviors trigger the same neurological pathways and pleasure centers in the brain as drugs do, hence the feeling of a “high” when you perform them. Unfortunately, the more you activate those pathways, the stronger they become, making it extremely difficult to quit. Your environment makes a difference, too. If you saw your mother relieving tension by repeating a behavior (like cleaning, shopping or eating), you might do the same.

Of course, there’s nothing wrong with occasionally (or even regularly) enjoying many of these behaviors. So how do you know when it’s crossed the line? Ask yourself these questions:

1. Are you preoccupied with planning and doing the behavior?For example, are you having trouble concentrating on and/or are behind at work because you’re spending time shopping online and/or taking long lunch breaks to shop?

2. Is the behavior negatively affecting one or more areas of your life?Are you fighting with your husband over debt you have from shopping?

3. Are you secretive about the behavior most of the time? Do you keep the shopping bags in the car and sneak them inside later?

4. Have you tried your best to stop the behavior but couldn’t (or stopped for a bit only to restart)?

If you answered yes to any of these questions, you may be struggling with a compulsive behavior and need some help. Though seeing a psychotherapist is likely your best bet, there are some things you can try on your own:

Start by admitting that you have a problem
You can’t address quitting until you’re honest with yourself. In this same vein, it can be very helpful to tell someone else (like a spouse or close friend) that you think you have a problem. This makes it more concrete and easier to deal with. And it makes you more accountable for taking steps to change it.

Think about what’s driving the behavior
Understanding the reasons and emotions behind your behavior will help you focus on working through those issues. Are you hitting the gym night and day to avoid looking heavy as you age? Are you constantly surfing the Internet because you’re feeling depressed and lonely and want to be distracted by something?

Try to interrupt or at least postpone the behavior
If you find yourself going to check Facebook yet again, try to hold back for one hour. You don’t have to postpone it longer and longer each time. It’s better to be erratic about it, so the next time delay by 2 hours, then 10 minutes, then a full day. This helps you feel some control over the behavior; the point is to remind yourself that you’re in charge, not your compulsive behavior.

Change the way you do it
If you can’t stop eating sweets every day, try having an apple or granola bar every time you want that candy bar. (You’re still eating, but you’re eating something else.) Do your exercise routine out of order. This can help shake up the ritualistic nature of compulsive behavior—which is part of why we keep going back to it; it becomes a habit.

For some compulsions (like gambling or eating candy), you may find that it’s best to stop doing it completely because even a little bit of it will throw you back into a pattern.

Finally, if you feel you need more help, consider seeing a therapist. A combination of psychotherapy— to understand the roots of the behavior— and cognitive-behavioral therapy—to give you tools to change the actual behavior—is often what works best. In Kate’s case, we were able to work through her shoe-shopping compulsion by focusing on her underlying depressed mood. She still struggles from time to time, but she has greatly benefited from individual as well as group therapy sessions (not dissimilar to AA).

Sometimes, medication can also help. If a compulsive behavior is serious and doesn’t get better with talk therapy, a psychiatrist may prescribe an antidepressant. These drugs affect levels of serotonin and norepinephrine—two brain chemicals that have been linked to compulsive behavior as well as the anxiety and depression that may accompany it.

Gail Saltz, MD , a psychiatrist and psychoanalyst, is a clinical associate professor of psychiatry at New York Presbyterian Hospital, a TODAY show contributor and author of Becoming Real and Anatomy of a Secret Life

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