Behavioural and Substance Addiction

'Society is said to 'produce' addictive patterns of behavior and, in the contemporary US it seems that any behavior may become 'pathologized' as an addiction (Sedgwick, 1993).'

If the word addiction is not used selectively, it can encompass any activity. Spending too much time with your friends to the point of ignoring your work, jeopardising family relationships, or even inflicting damage to society by hanging around in 'gangs' may be considered behavioural addiction as it meets the criteria of the most commonly used definition of addiction as a:

Addiction is a term which until recently was limited to repeated and continues use of drugs such as cocaine and heroin. Recently however experts are regarding behaviours such as eating (or lack of it), shopping, exercising, gambling, working, as addiction. This may be because studies on addiction have increased our understanding of how it works and they seem to suggest that behavioural addiction has more commonalities than differences with substance addiction. In a qualitative study of alcoholics and pathological gamblers it was found that gamblers where just as much attached to gambling as drinkers to drinking (Jim Orford, Victoria Morison, Marcia Somers). Although the authors acknowledge that alcoholics were sampled from an agency for alcohol treatment while the gamblers were recruited through newspaper advertising, the study does not lack the support of numerous other studies which show common patterns between substance addicts and individuals addicted to behavioural activities.

In 1985 Marlatt & Gordon found almost identical patterns of relapses in different addictions. Donegan et al. (1983) noted many psychological commonalities such as acting as a reinforcer, tolerance, euphoria etc. Research has shown that neuroadaptation occurs in pathological gamblers hence resembling the effects of chemicals in the brain (Wray and Dickerson, 1981; cited in Shaffer, 1999). Smith (1981) supports the view of addiction as a disease as he suggests that it explains why so many of those who become addicted to one substance also become addicted to another dissimilar substance or activity. Istvan and Matarazzo (1984) explored the possibilities that these substances are 'linked by reciprocal activation mechanisms' and that they may be linked by their 'pharmacologically antagonistic... effects'. The 'addiction disease' theory, is supported by many experts from the biological perspective who consider pathological gambling and other behavioural addictions, such as eating, as habituation or hijacking of the reward system, typicalised by a high and finding comfort from, say, seeing the lights of a fruit machine or taking heroin.

There are a vast number of addiction theories however, ranging from fields such as biology, psychology and neuroscience. One way of understanding addiction, its similarities and differences, may be through the conditional theory developed by Pavlov. The main focus of this theory is the cue-conditioning response to addiction which might explain the high percentage of relapse amongst addicts. In a study of rats by Kelly, Schlitz and Laundry (2005), it was found that conditional stimuli activates common neuromolecular substrates linked to past experience with drugs or rewarding food. In another study, remarkable similarities were found between condition gene activation due to exposure to food or drug related cues. The authors suggest that addiction induces neuroadaptation in brain circuits which normally serve for memory and learning to motivate silent stimuli. These finding might be explained from an evolutionary perspective also as animals and humans in prehistoric times needed to require information about the reward value of stimuli in order to survive. The effective performance of such task may depend on the ability of associating the environment with the internal representation of the environmental context. It may therefore be suggested that the context in which addiction occurs is an important factor in determining the commonalities of different types of addiction. It is well known that most of the Vietnamese veterans did not continue to abuse drug substances once they returned home. Such anecdotal evidence is supported by many studies which have shown that the cue-conditioning theory holds true for pathological gamblers as well as substance addicts. One of these studies is that of Shaffer, LaBrie, and LaPlante (2004) in which it was found that the rates of pathological gamblers were positively correlated with the index of gambling exposure. A more striking resemblance to the Vietnamese veterans might be the findings of Garn and his co-workers (1979). They suggested that similarities in weight level of people who live together is a result of similar eating habits and energy expenditure. They found that the longer parents and their children live together, the more they resemble each other in weight levels. In contrast, the longer parents and children live separately, the less pronounced such similarities become until they approach 0 at the extremes of separation (Garn, LaVelle, and Pilkington 1984).

However, although behavioural and drug addiction has many psychological, environmental and genetic similarities, it seems that they do have some differences. Schachter (1971, 1977, 1978; Schachter and Rodin 1974) has proposed that obesity is due to an inbred tendency, while smoking is due to an acquired constraint in order to avoid withdrawal symptoms. There may be key differences in the pharmacology of nicotine and alcohol addiction (Ashton & Stepney, 1982; Gilbert, 1979; Myers, 1978; Pomerleau & Pomerleau, 1984). Differences in goals also exist, in some cases aiming at abstinence while others at moderation as suggested by Lichtenstein.

Nonetheless, the above mentioned studies and numerous other studies clearly suggests a striking resemblances between drug addiction and behavioural addiction. Research has shown that gambling addicts suffer as much cravings and withdrawal symptoms as do individuals addicted to substances. It has been suggested that the consequences of the addiction is equally devastating for drug addicts and pathological gamblers as some studies suggest that pathological gamblers have a high rate of suicide. The similarities between behavioural and drug addiction may be due to the way we have evolved, as in prehistoric times the reward pathway played a pivotal role in the race for survival, a pathway which now seems to be adapted to devastating behaviours such as self-harm through substance abuse, overeating, excessive shopping.

It may be argued however that drug addiction has more devastating effects biologically and psychologically as, for example, excessive use of marijuana has consequences for the working memory and may lead to the development of paranoia, while excessive cocaine use may lead to hallucinations and even schizophrenia, all of which might not be true for an individual who is addicted to shopping or sex. Notwithstanding these limited differences, research has shown that the same brain circuits are activated in behavioural and drug addiction. They both are characterised by an inability to control oneself from taking a substance or doing the activity, withdrawal symptoms when not doing so, cravings. As behavioural and drug addiction seem to be so similar to each other, perhaps it wont be long until a universal theory of addiction which encompasses behavioural and drug addiction is developed.

Sponsored by: