A Challenge to the Behavioral Addiction Concept

While I do believe that behaviors in excess can be called addictions, I must consider the counterpoint that doing this can actually worsen the chances of improving health.

When observing a new phenomenon, say Internet Gaming Disorder, it is recommended to follow a theory, a systematic set of concepts that explain the relationships between variables. Or plainly, it is a model of reality. That means it’s a simplification, but it may be useful. People monitor their high blood pressure because they perceive that taking action will prevent a stroke in the future. Smokers have different stages in their propensity to quit. People are more likely to take drugs if they see others doing it. A theory is required to have been validated by numerous studies with robust results (Do we see the same sort of result when doing the experiment again?) This can get extremely complicated with human behavior. In addiction, we risk labeling every behavior as an addiction if not approached carefully.

Let’s try an example. Let’s use blogging in place of gambling in the DSM-V (the manual for diagnosing various mental illnesses by practitioners). Do you sometimes need to blog more to get the same amount of excitement? Do you get restless or irritable if you don’t blog enough? Do you have persistent and intrusive thoughts about blogging? Do you worry about the number of likes and comments you will get? Do you obsessively check your metrics and compare your performance with others (Guilty as charged!)? Clearly, few people would believe that there’s such a thing as blogging addiction. But if you fit enough of the criteria, it would be classified as an addiction. Researchers do the same labeling with work, exercise, shopping, sex, gaming, tanning, dancing, and a whole plethora of other activities. That is not to say there can’t be serious harms if these behaviors occur in excess, but if applied broadly enough, you would say that everyone in the world has addictions. Is this a useful statement?

Part of the problem is that substance addiction criteria are transplanted into behavioral addiction criteria. Can there be tolerance and withdrawal with excessive Internet use? Yes. Can you see changes in the brain with excessive Internet use? Yes. But is it the same as addiction? The answer to this question is important because in using the wrong approach, we may inadvertently harm people. For example, we risk creating a moral panic and then start infringing on the freedoms of others.

What if there’s something else driving these behaviors? Social anxiety forces people to be shut-ins and they cope by surfing the web at all hours. Some people may perceive that they’re going nowhere in life and gamble to stave off feelings of inadequacy. Depression symptoms are ameliorated by binge eating, but get mislabeled as a binge eating disorder. People can spend years getting the wrong medications, and without addressing the root cause, they relapse. And even worse, a lot of these medications can have severe side effects if taken long enough, such as weight gain, addiction, seizures, loss of sexual function.

Clearly, much more needs to be understood.

Summary: If we’re not careful, we can start calling all normal behaviors addictions. This has implications for treatment.

 

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