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.
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.
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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