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The Addictive Process and Addictive Behaviors

 

According to W.R. Miller, in The Addictive Behaviors, an individual can become addicted, dependent, or compulsively obsessed with any activity, substance, object, or behavior that gives him/her pleasure.

Several researchers imply that there is a similarity between physical addiction to various chemicals, such as alcohol and heroin, and psychological dependence involved in such activities as compulsive gambling, sex, work, running, or eating disorders.

The reason for this is that these behavior activities may produce beta-endorphins in the brain, which makes the person feel "high."

These and other reports suggest that if a person continues to engage in the activity to achieve this feeling of well-being and euphoria, he/she may get into an addictive cycle.

In so doing, he/she becomes physically addicted to his/her own brain chemicals, thus leading to continuation of the behavior even though it may have negative health or social consequences.

Most physical addictions to substances such as alcohol, heroin, or barbiturates also have a psychological component.

For example, an alcoholic who has not used alcohol for years may still crave a drink. Thus these researchers feel that we need to look at both physical and psychological dependencies upon a variety of substances, activities, and behaviors as an addictive process and as addictive behaviors.

They suggest that all of these behaviors have a host of commonalities that make them more similar to than different from each other and that they should not be divided into separate diseases, categories, or problems.

Common Characteristics Among Addictive Behaviors

There are many common characteristics among the various addictive behaviors, as suggested by Miller, Levison, Hatterer, and others.

First of all, the individual becomes obsessed (constantly thinks of) the object, activity, or substance and will seek it out, often to the detriment of work or interpersonal relationships.

The person will compulsively engage in the activity, that is, do the activity over and over even if he/she does not want to.

Upon cessation of the activity, withdrawal symptoms of irritability, craving, and restlessness will often occur.

The person does not appear to have control as to when, how long, or how much he or she will continue the behavior (loss of control).

He/she often denies problems resulting from his/her engagement in the behavior, even though others can see the negative effects.

Individuals with addictive behaviors usually have low self esteem and feel anxious if the do not have control over their environment.

There is a lack of consensus as to the etiology (cause), prevention, and treatment of disorders. A United States government publication, Theories on Drug Abuse: Selected Contemporary Perspectives, came up with no less than forty-three theories of chemical addiction and at least fifteen methods of treatment!

As an example of this confusion, many people consider addictive behaviors such as gambling and alcoholism as "diseases," but others consider them to be behaviors learned in response to the complex interplay between heredity and environmental factors.

Some reserchers argue that, unlike most common diseases such as tuberculosis, which has a definite cause (a microbe) and a definite treatment model to which everyone agrees, there is no conclusive etiology or definite treatment method to which everyone agrees for most of the addictive behaviors.

This lack of agreement causes problems with prevention and treatment approaches for the addictive behaviors.

Other professionals debate whether total abstinence or controlled use of a substance (such as alochol) or activity (such as gambling) is desirable, or whether or not a substitute chemical (such as methadone for heroin) or activity is a desired treatment method.

In the area of addiction to food or exercise, of course, very few individuals advocate total abstinence as a solution.

Though the etiology of addictive behaviors and treatment modalities are numerous, various types of therapy can help the individual with an addictive behavior.

EATING DISORDERS

There are several types of eating disorders common in North America. Some individuals overeat to the point of obesity, others consume large amounts of food and then prevent its assimilation by vomiting or using laxatives, and still others starve themselves so as to be thin.

All of these are considered to be addictive behaviors with no clear etiology.

Anorexia Nervosa

In the addictive behavior called anorexia nervosa, a person begins to believe that he/she is too fat, even if he/she is of normal weight for his/her age and height.

The individual feels that he/she must constantly diet and starve him/herself to be thin and beautiful. Once the person starts dieting, he/she finds it difficult to stop. Anorexics spend great emotional energy thinking of ways to avoid food and to cover up their lack of eating.

They may wear bulky clothing, throw food away when no one is looking, and frequently exercise in the middle of the night to burn up calories.

Due to lack of eating and extreme diets, anorexics are extensively malnourished and exhibit signs and symptoms of starvation. Symptoms of anorexia include cessation of menstruation, extreme thinness, edema (swelling in various parts of the body from electrolyte imbalance), thinning or falling hair, tooth decay, and dry skin from dehydration.

Even with these symptoms they continue to compulsively lose weight to the point of emaciation and sometimes death. Along with losing weight, they are often obsessed with obtaining extremely low body fat composition.

Even when they have lost weight to the point of emaciation, they view themselves as being fat. Anorexics have even been hospitalized and have died, stubbornly maintaining that they were still too fat!

Most anorexics tend to be females from white upper-middle-class families. They tend to be high achievers and to be compulsive in other aspects of their life such as schoolwork.

As an example, they become extremely depressed if they do poorly on an exam. They have low self esteem, usually deny they have a problem, and are often depressed.

During the past fifty years, being beautiful in North America has meant being thin. The mass media has emphasized youth along with thinness as the accepted prerequisites for happiness and social desirability.

This has resulted in an increase in compulsive dieting and eating disorders. Yates et al. feel that a cause of anorexia is that the individual believes he/she is out of control over life.

In order to gain some measure of control, achieve social desirability, and overcome fear of personal ineffectiveness, the person stops eating. Another theory proposed by Yates et al. is that emaciated anorexics have elevated brain levels of endorphins, which may be associated with the elevated mood many anorexics report, a feeling that could serve as a potent reinforcer of the destructive behavior.

Anorexia may also be related to a malfunctioning hypothalamus, which controls the release of morphine-like endorphins in response to stress, according to this research group.

Bulimia

The person who overeats or binges on food and then prevents absorption by purging (laxatives, vomiting, water pills, enemas) is considered to have bulimia.

In this obsessive behavior the person feels driven to consume food as well as to purge him/herself of it to prevent gaining weight. It is often associated with anorexia. Bulimia can occur with individuals who are of normal weight or even overweight.

The bulimic person often plans and organizes the consumption of a large amount of food. The planning is often ritualistic and secretive. So great an amount of time and energy is spent thinking of food that it often interferes with an individual's ability to function.

This behavior is usually cyclic in nature, with the person binging due to lonelines, depression, or boredom and then purging due to feelings of guilt about binging.

Symptoms of bulimia include tooth decay, dehydration, constipation, weakness, lightheadedness, low blood potassium, cardiac arrhythmias, kidney damage, swelling of salivary glands, and irritated esophagus.

The blood chemical imbalance can lead to heart attack. The individual is usually secretive about the behavior and may make numerous trips to the bathroom as the result of laxative abuse or desire to vomit.

Like anorexics, bulimics tend to be white upper-middle-class females. They are often involved with cheerleading, performing arts, or gymnastics. They tend to have low self esteem and rely on the opinions of others to validate their self worth.

The cause of bulimia is not known, but various theories, including emotional stress, need for relief from anger and depression, and pre-occupation with body size, have been suggested. As with anorexia, bulimia may be related to a malfunctioning hypothalamus or a need to be in control of one's environment.

Compulsive Eating

As in any other addictive behavior, the compulsive eater is obsessed with the object of the compulsion, namely food.

The person has a compulsive urge or craving to eat and will often eat when not hungry. The individual will often binge in secret, away from others, and will lose control over how much food he/she eats.

For example, a compulsive eater may consume a whole box of cookies when he/she intended to have only one. This often occurs when the person is feeling lonely, angry, insecure, depressed, anxious, or bored.

As with other addictive behaviors, the individual will deny that he/she has overindulged. When asked, the person may claim that he/she only ate "a couple of pieces of chicken" when two chickens were actually consumed.

Compulsive overeating usually results in obesity. However, according to Hooker and Convisser, the "compulsive eater is not necessarily identifiable by her body size because many women who eat compulsively also are compulsive dieters."

There is a difference between being overweight and being obese. Overweight is weighing more than one should for his or her body structure, height, and sex. It is possible to be overweight and still be in good health.

Weight lifters and others who do muscle-producing exercise are often overweight but have a very low proportion of body fat. Individuals who are obese, however, are more than 30 percent over their ideal weight and have a high body fat content.

Obesity can lead to serious health problems. Excessive body fat is associated with diabetes, hypertension, and heart disease. It is also linked to varicose veins, problems in pregnancy, digestive disorders, arthritis, and respiratory disorders.

The compulsive eater is usually female. She has low self image, a preoccupation with body size, feels a lack of control over her environment, feels depressed, and tends to turn anger inward. Overeating is a way to alleviate boredom, stifle negative emotional feelings, calm down, relax, and feel comforted.

Though most obesity is considered to result from overeating due to psychological causes, some people are thought to have a physiological basis for their problem. One theory, the setpoint theory, suggests that people are born with different natural setpoints for a particular body weight In response to weight changes, metabolic or physical reactions occur to maintain the weight at which the body is "set."

This may in turn cause the person to eat more to maintain his/her set weight. If the person has a high setpoint, he/she will tend to be overweight or obese.

The fat cell theory posits that adipose tissue (fat cells) can affect body weight by increasing either in number or size. It is thought that in childhood a greater number of fat cells than normal are produced because of overfeeding. In dieting, the fat cells become smaller but are not eliminated.

The person appears to be of average weight. However, when the person does not diet but eats a normal amount of food, the many fat cells enlarge, thus causing him/her to again become overweight.

Other research appears to indicate that the hunger and appetite control centers in the brain may be the same as the amphetamine-binding site in the hypothalamus. Many more binding sites seem to be available when the person is hungry than when the person is not hungry.

Eating food or taking stimulants such as amphetamines decreases appetite and causes a heightened sense of well-being. Perhaps in obese individuals, when large quantities of food are ingested, a feeling of well-being similar to that produced by stimulants occurs. If the person is feeling lonely or depressed, eating may help him/her feel better.

It has also been found that eating patterns of obese individuals are different from those of normal-weight persons. Obese people often eat more rapidly and take larger and more frequent bites than normal-weight individuals.

They also appear to expend less physical energy than average-weight persons due to lack of exercise and slow movement in daily routine.

However, as with the other addictive behaviors, a simple etiology of compulsive eating is not clear.