A number of other behaviors and kinds of substance use are commonly referred to as addictions. These include excessive time spent on computer games, the Internet, TV sports, and golf, compulsive shopping, and “workaholism.” Some people believe that sugar and chocolate have specific addictive qualities and are the cause of compulsive overeating.

If we go back to the basic definition of addiction - that it involves loss of control over the use of a substance (or the practice of a behavior) and the inability to stop despite negative consequences - then we can consider at least some of these perhaps to have the characteristics of addiction.

Recent studies of compulsive computer users identify characteristics including preoccupation with use of the machine, restlessness when one is not using it, a continuation of use despite physical consequences such as carpal tunnel syndrome or eye strain, and neglect of job and family responsibilities.

Some of those studied had addiction to drugs and alcohol and were abstinent at the time when the computer use became a problem. Some computer use, such as chat room participation and Internet pornography, overlaps with sexual addiction. A number of users were preoccupied with computer games, which may have the same reinforcing qualities found in slot machines or video poker, although without the anticipation of monetary gain.

Compulsive shopping has also been characterized as an addiction since it involves financial consequences and loss of control. Compulsive shoppers are usually women, and some are also addicted to drugs and alcohol. They consciously use shopping as a mood-altering activity, believing that buying something will make them feel better and being disappointed when it doesn’t work.

There is some overlap between compulsive shopping and eating disorders. From a dynamic standpoint, the aim of the behavior is similar - satisfaction of a vague emotional neediness. This is followed by the subconscious realization that purchasing items at a store is only a symbolic substitute and does not satisfy the emotional need. It is believed that, for those with eating disorders, this cycle represents an unconscious attempt to re-create the frustrating relationship with early caregivers.

Excessive shopping is sometimes seen during the manic or hypomanic phases of bipolar disorder. In this situation the behavior is a reflection of impaired judgment and grandiosity and is not the same as compulsive shopping. Kleptomania, or compulsive shoplifting, is classified as a disorder of impulse control. In a general sense it could be considered an addiction, but it’s viewed by clinicians as a reflection of a deeper disturbance in personality functioning that goes beyond the dynamics of addiction.

Hoarding is a symptom of obsessive-compulsive disorder that may involve excessive shopping. The term refers to a person’s inability to throw away items of little value, which may include old newspapers and magazines, rubber bands, jars, junk mail, and worn-out clothing. Sometimes items of little apparent value are purchased in large quantities and saved, often in their original bags. People who have experienced poverty and deprivation often appear to be pathological hoarders, but the difference lies in the approach to cleaning up the mess that ensues. For those who suffer from pathological hoarding, throwing out or giving things away causes intense anxiety, whereas people from poor backgrounds are able to make rational decisions about what goes or stays.

We often refer to preoccupation with such activities as watching TV sports, following soap operas, playing golf, talking on the phone, reading romance or mystery novels, collecting dolls, and going to garage sales as addictions. People may engage in these practices to excess in order to cope with emotional stress and to gain satisfaction. What seems like an addiction to a family member - for example, to a “golf widow” - may actually constitute behavior that reflects some problem the person is having, with the marital relationship or otherwise. Defining and then treating these behaviors as “addictions” may miss the point entirely.

On the other hand, engaging excessively in a particular behavior is often seen in people who have addiction and are currently abstinent. What has happened is that the addict has begun to use a specific behavior to cope with uncomfortable feelings, rather than continuing to learn to identify and resolve these feelings in an effective manner. This is often an early symptom of relapse. I frequently see “workaholism” in addicts who later relapse. They throw themselves into work as a way of coping with the stress of recovery and to recoup the financial losses associated with the addiction.

Continued growth stops and the addict begins to lose sight of the principles of recovery. The person in recovery turns into a “dry drunk,” and many eventually “wet it down” by relapsing because they are not experiencing the contentment and satisfaction that comes with true recovery. Such behavior problems occurring in recovering people should not be seen as a new addiction but as a reason for returning to work on the original one.

The chocolate question is an interesting one. Chocolate contains a compound that may have psychoactive qualities.

Informal studies have suggested that when we eat chocolate,

we feel as though we are in love - hence the custom of giving chocolate for Valentine’s Day. Addicts in recovery love chocolate. (There is a scene in the movie Clean and Sober that always gets a laugh when it’s shown at a treatment center.

One of the characters is on pass from a treatment center and spends his time sitting on the side of his bed eating mounds of Hershey’s Kisses.) Some compulsive overeaters report specific cravings for chocolate. However there is little evidence that a chocolate “addiction” occurs if we apply the criterion that addiction must cause significant impairment in functioning or emotional distress.

The belief that sugar is addicting to compulsive overeaters has a large following, especially among compulsive overeaters in recovery, but there is little scientific evidence to support such a notion. I believe that this phenomenon is due to the difficulty compulsive overeaters have in identifying what abstinence means for them and what the addiction really is.

Targeting sugar as the culprit provides a concrete solution.

Abstaining from eating - as opposed to abstaining from drinking alcohol or using drugs - is obviously not the solution. Neither is dieting, since many compulsive overeaters are also compulsive dieters. The obesity that results from compulsive overeating is a secondary effect and not the primary problem, but the social discomfort and damage to self-esteem that obesity causes makes losing weight a priority. Abstinence from compulsive overeating really involves using food only for nutritional sustenance and not as a way of altering mood, but this does not always result in the desired weight loss.

Strict abstinence from any food that contains refined sugar, which includes most breads, pastas, condiments, and processed foods, is sometimes recommended at Overeaters Anonymous meetings. Members who swear off sugar sometimes report “withdrawal” symptoms, such as headaches, lethargy, and irritability, early on. And following this type of regimen does result in weight loss. Sugar Busters is a popular diet book based on the concept that intake of refined sugar leads to impaired metabolism and subsequent obesity.

What we do know is that intake of refined sugar causes sharp increases in circulating levels of insulin. That is because refined sugar is quickly absorbed and blood sugar levels rise quickly. One of the functions of insulin is to regulate blood sugar levels by causing glucose to be converted to fat and then stored. But the pancreas often “overshoots” because of the sharp rise in blood sugar, and this leads to a rebound effect resulting in a sharp drop in blood sugar that motivates the person to eat again. If the person becomes obese, fat cells enlarge and become more resistant to the effects of insulin. As a result, the pancreas produces even more insulin, which promotes more fat storage and a greater rebound when refined sugar is eaten. The effect is more pronounced in people who are genetically predisposed to adult-onset diabetes mellitus.

Complex carbohydrates break down more slowly than refined sugar and therefore do not cause sharp increases in circulating insulin levels. The ups and downs of blood sugar do not occur, so that the motivation to overeat decreases.

Compulsive overeaters who abstain from refined carbohydrates may feel an increased sense of control over their food intake, but the psychological dynamics of the eating disorder still need to be addressed.

Since this complex metabolic effect occurs only as a result of the overeating and subsequent obesity, I can’t agree with its being characterized as addiction to sugar. The eating disorder arises from the difficulty a compulsive overeater has in self-regulation and self-soothing and from the mood-altering effects of food intake on the emotional centers of the brain. Any food, not just refined sugar, can have this effect.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information