Issue Date: September 28, 2003
Are you addicted?
Even if it's not drugs or alcohol, the brain response may be the same.
Those who know me from my radio show, "Loveline", or from my appearances on television may not realize that in my day-to-day life I'm an internist. I have found a passion for treating what I see as the central disease of our time: addiction. I've worked in and around the disease for 16 years, the last 12 of them as medical director of a Pasadena, Calif., psychiatric hospital's chemical dependency unit.
"Addiction is the manifestation of everything that's sick about our culture."
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Few people have ever set foot in the world I live in every day, or considered what it's like to care for these very sick people. I recently wrote a memoir chronicling my experiences -- "Cracked: Putting Broken Lives Together Again" (ReganBooks, $24.95). Here, I answer questions I often get about addiction:
Why is this an important story to tell?
Addiction is a pre-eminent health issue, diminishing the happiness and well-being of an astonishing 30% of American families.
Addiction also is a powerful metaphor -- the manifestation of everything that's disturbed and sick about our culture. Addicts are often the products of abusive, chaotic family systems. They are delivered into an adolescence where the solutions they are offered for their inability to feel good are actually part of the problem: more forms of arousal. It's sex and drugs and Nike's "Just do it." Anything you want, you go get it.
Are behaviors such as compulsive soap-opera watching or PlayStation use considered addictions?
No. I'm confronted daily with the devastating, often deadly toll of addiction, so it bothers me when the term is used loosely to describe behaviors like those. Addiction is a brain disease with a genetic basis. It's a disruption of the reward mechanism in the brain, which is the part responsible for creating drives. When those drives are powerful enough, it becomes nearly impossible to screen or contain them.
Can you become addicted to things other than drugs and alcohol?
Yes, but they need to be arousing enough to activate that reward system. Classic examples are things like sex, gambling, eating and shopping, all of which provide the same intensity of gratification that drugs and alcohol do.
Do compulsions lead to addictions or vice versa?
Not necessarily. But I do find that behavioral addictions are much more common in people whose reward apparatus already has been altered by substances. For example, compulsive gambling and alcoholism often go hand in hand.
Are compulsions and addictions treated the same way?
Not exactly. Both may respond to counseling and/or medication, but addicts generally require more comprehensive, longer-term care.
Compulsives tend to be troubled by their behavior and look for solutions. And they're usually able to stop when serious consequences come to bear, such as losing their home because of excessive shopping. Addicts, on the other hand, deny their problem and get progressively worse over time. Ultimately, addicts don't stop their behavior despite negative consequences because they are literally incapable of doing so.
Can you be addicted to positive behaviors, such as giving gifts and charitable work?
I believe the answer is no. To be truly addictive, a behavior has to be thrilling enough to activate the brain's reward system. Not many altruistic behaviors are truly thrilling. When I see the depth of my patients' despair, I sometimes think it just might be time to invent some that are.
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