Addiction or Compulsion?
Several behavioral problems that are closely related to drug and alcohol addiction are viewed as addictions themselves. As we continue to formulate a comprehensive definition of what addiction is, these disorders provide salient examples of why we cannot look to the pharmacological properties of drugs alone as the cause of addiction.

The three most commonly seen conditions that resemble alcohol and drug addiction are pathological gambling, sexual addiction, and eating disorders. Since each of these is characterized by loss of control of the behavior and continued involvement in it despite negative consequences, we view them as addictions.

The cost to society of these three problems is enormous.

A 1993 estimate placed the amount of money spent on legal gambling at over $300 billion a year. Sexual addiction leads to broken families, AIDS and its medical costs, sexual crimes, and millions spent on pornography. Eating disorders can lead to diabetes, hypertension, and heart disease and even result in sudden death. Millions of dollars are spent each year on weight loss gimmicks. Each of these disorders is also linked to an increased risk of depression and suicide. And the hidden costs - loss of productivity, of well-being, and of self-actualization - can never be measured.

A common misconception is that these behaviors are a manifestation of obsessive-compulsive disorder, since we often describe them as compulsive. Those with obsessive-compulsive disorder have thoughts and urges that seem to come from nowhere and are experienced as odd and anxiety-provoking. These are called obsessions, and usually lead to ritualized behaviors (compulsions) that temporarily reduce the anxiety associated with the thoughts and urges. A person may be obsessed with the danger of contamination and compulsively wash to reduce the risk of being infected. The compulsion results in a relief of anxiety and is intended to avoid the harm predicted by the obsessive thought. In pathological gambling, sex addiction, and eating disorders, the problem lies in the repetitive impulse to engage in a behavior with the goal of obtaining pleasure despite possible harmful consequences. It is compulsive in the general sense of the word, but the goal of the behavior is different from what it is in obsessive-compulsive disorder.

These disorders also highlight the behavioral and conditioning aspects of addiction. Behavioral psychologists describe the slot machine as the perfect instrument for illustrating conditioning with variable reinforcement. In this model, the subject engages in a behavior that is known to lead to a reward, but the reward comes at unpredictable intervals.

Trainers who want to strongly implant a specific behavioral response in an animal will reward that behavior at intervals rather than every time the animal performs the behavior.

As a result, the animal will perform the behavior repeatedly even without a reward. This type of conditioning contributes to gambling addiction. It may be most potent in addiction to video poker games. Gambling counselors have referred to video poker as the crack cocaine of gambling addiction.

Research shows that these disorders also involve activity of the pleasure center of the brain, the ventral tegmentum and medial forebrain bundle. Addiction to alcohol and drugs involves stimulation of this area of the brain by a source outside the body - the drug which is ingested. In behavioral addictions, stimulation of this area of the brain comes from changes in brain chemistry that occur as a result of the addictive behavior. Gambling is thought to stimulate this area through the adrenergic system, sexual addiction through the complex orgasmic response, and eating disorders through the serotoninergic system. In each case, the animal model of repetitive self-stimulation applies.

Elizabeth Connell Henderson, M.D.

 

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information