The Heart of Addiction

How psychology drives addictive behavior.

The Myth of “Addictiveness”

In addiction, things are often not what they seem.

How common it is for people to say that things are "addictive"! Scratch lottery tickets, pornographic videos, foods, even exercising have all been said to be addictive. But none of them is. In fact, "addictiveness" of any object or activity is a myth. Perhaps surprisingly, that's true even if the object is a drug.

The notion of "addictiveness" is that objects or activities can magnetically draw people to overuse them. But once you appreciate that addiction is a psychological process within people, as I've described in this blog (and in my book The Heart of Addiction), it becomes clear that the idea of "addictiveness" is precisely backward. A case example of this (from my book) was a man who addictively sought prostitutes. It was important to him that they have certain physical characteristics: they had to be big and strong. When he was with them he required that they play out a fantasy in which they took on a submissive role. In treatment we learned that he had been bullied by larger and stronger sisters as a child. This made his addictive act clear. It was a displaced way to reverse the helplessness he had suffered as a child, while also expressing his rage about having been placed in that role. For this man, no other activity would have been as suitable (attractive) to express and (temporarily) resolve the helpless rage with which he struggled. Consequently, this action became a repetitive, compelled behavior. That is, it became an addiction. Neither the prostitutes nor the activity he performed with them were "addictive."

The same reasoning applies to every other focus of addictive behavior. Scratch tickets, for example, are thought by some to be more "addictive" than weekly drawing lottery tickets because they are more popular. But their high sales aren't due to any inherent quality of the ticket. They are popular because they are more attractive for the purpose of gambling addiction. People suffering with compulsive gambling have an urgent drive to win, often because winning provides a temporary reversal of helpless feelings of not being a "winner," or being cheated out of winning in one way or another. Since scratch tickets offer the possibility of getting that win instantly, they are attractive to express the purpose of the addiction. But the tickets do not cause compulsive gambling: they are not "addictive."

I said the myth of "addictiveness" also applies to drugs. Yet, how can that be when certain drugs are, of course, well-known to be physically addictive?

Physical addiction, the capacity of some drugs to induce biological tolerance with withdrawal symptoms when the drug is removed, is quite real, and may be medically dangerous. But it is only a minor factor in the nature of addiction. Even when physical tolerance develops in the course of excessive drug use, it is never the cause of the addiction. It is never the drug's "addictiveness" that draws people to it. This is why people often return to addictive drug use years after their last dose, long after they were last physically dependent. They return because their drug of choice serves the purpose of their addiction, not because of the drug's capacity to induce physical tolerance. Of course, cravings following discontinuance of drugs can make it hard to stop drug use. But that is the least of the problems in addiction. Almost all people with drug addictions have stopped for long enough to end their physical addiction, yet they return to their drugs later. Cravings cannot create or maintain an addiction in a person who does not have a psychological basis for the addiction.

Another way to look at this is to consider whether people can be turned into drug addicts by physically addicting them - which should be possible if drugs are "addictive" in any sense beyond physical tolerance. But this isn't what happens. People become physically addicted all the time to medically prescribed drugs without ever becoming drug addicts. And, as I mentioned in an earlier post, we know from a classic study that soldiers with physical addiction to heroin could not be turned into heroin addicts. Once they were detoxified, 90% of them never used heroin again. A final example is cigarette smokers. When the surgeon general started placing warnings on cigarette packs in the early 1980's millions of people stopped smoking, even though they had a physical addiction to nicotine. The bottom line is that drugs are just like lottery tickets or food or any other object of addiction: they become the focus of addictions not because they are physically addictive, but because they are attractive for the purpose of a particular person's addiction.

This raises one more question. What makes some things more attractive than others as addictive objects? Drugs are a good example here. Since the purpose of addictive behavior is to reverse feelings of overwhelming helplessness, it is not surprising that drugs are a common focus of addiction. They are almost perfect for this job because they allow people to alter their mental state, by their own intentional control. Being able to do this can restore a sense of control over one's life just when a person feels that his control or power has been lost or taken away.

But it turns out that many other activities besides drugs can work just as well for this purpose. Buying lottery tickets, eating, or playing a game online can all serve to reverse feelings of helplessness. What any one person finds attractive may be quite different from another person, which is why addiction may take on so many different forms on the surface. This also explains why people can shift their addictive focus and therefore appear to have a "new" addiction. A different object or activity has become more suitable for the expression of the emotional drive behind that person's addiction.

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Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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