Addiction to sugar, salt, hamburgers, video games, television, sex, work, the Internet, shopping… day after day the media talk about how many things that we could simply call intense hobbies are ‘addictions’ comparable to excessive use of drugs or alcohol.
The American Psychiatric Association is much more restrictive in its use of the term. “Substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite the harmful consequences that it entails. People with SUDs have an intense focus on the use of certain substances, such as alcohol, tobacco, or illegal drugs, to the point where the person’s ability to function in daily life is impaired. People continue to use the substance even when they know it is causing or will cause problems. The most serious SUDs are sometimes called addictions.”
This definition, much more focused on the physiology of our nervous system, would exclude non-chemical addictions because, again according to this association, those who suffer from this disorder “may have distorted thoughts and behaviors. Changes in the structure and function of the brain cause people to have intense desires to consume, changes in personality, abnormal movements and other behaviors. Brain imaging studies show changes in areas of the brain that are related to judgment, decision-making, learning, memory, and behavioral control.” The changes that the brain undergoes, and that are detectable and measurable, can also last long beyond the moment in which the effects of the substance disappear, the intoxication, the sensation for which, precisely, it is consumed.
withdrawal syndrome
But, also, the substance continues to be consumed as a way to avoid withdrawal syndrome, which is a violent reaction of the body to the lack of the addictive substance. As researchers Mohit Gupta, Srinivasa B. Gokarakonda and Fibi N. Attia of the US National Center for Biotechnology Information explain, the human body seeks homeostasis, that is, an active process to maintain the stable conditions necessary for survival. When an addictive substance is administered, the body adapts to surviving on it, resulting in tolerance to the substance that requires ever-increasing doses to obtain the desired effects. In the case of alcohol, for example, it interacts with neurotransmitters and neuroreceptors that affect the chemical balance and induce the sensation of pleasure and the motivation to continue consumption.
If the supply of the substance is suddenly interrupted, especially when a relevant tolerance has been developed, the balance achieved with the habit is upset and reactions occur that can range from mild to violent. In the case of alcohol, again, withdrawal can produce hyperactivity, rapid breathing, increased temperature, sweating, tremors and, in about a quarter of cases, hallucinations, the so-called ‘delirium tremens’. Barbiturate and benzodiazepine withdrawal is mild, but can lead to seizures, psychotic symptoms, and muscle breakdown, while opioid withdrawal can include nausea, sneezing, diarrhea, vomiting, and feelings of panic, but is not usually life-threatening. Finally, withdrawal from cocaine, amphetamines, and other central nervous system stimulants is also not life-threatening, but is characterized by profound depression that can last for several weeks, along with drowsiness and restlessness.
Behaviors that are called addictions but that do not present physiological alterations and therefore do not produce withdrawal syndrome have been addressed in the well-known ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM-5) under a new category of ‘behavioral addictions’ to which, at the moment, only gambling addiction belongs. In this case, it is observed that pathological gambling has some similarities with disorders related to the use of addictive substances, and these similarities can help to understand and treat pathological gambling. Other behaviors, such as obsessive Internet gambling, are considered situations that still require further investigation, which is applicable to all other activities that are popularly considered ‘addictions’.
Addictions or hobbies?
The great debate about non-chemical addictions is, above all, whether the person who suffers from them, who plays video games, who watches many series on television, who apparently buys compulsively, are really incapable of controlling themselves or are taking the drug freely. decision to indulge in those behaviors and the idea that they do not control their behavior is a fiction. Behavioral addictions cause, like those related to substances that affect the nervous system, a sensation of pleasure and reward, but they do not have the elements of tolerance and alteration of neurochemistry that substances have.
Beyond the DSM-5, it should be noted that many clinics, institutions and organizations dedicated to treating these behaviors tend to treat them as if they were indistinguishable from substance addictions, offering people who feel unable to control a certain behavior, and to their families, hope to recover a greater social, psychological and family balance in their lives. Whether or not they are the same as chemical addictions is ultimately irrelevant in the face of evidence that certain therapeutic approaches seem to be really effective in controlling such behaviors.
However, even the largest studies indicate that the relationship of behavioral addictions with psychiatric disorders or with substance dependence still lacks solid, extensive and representative investigations that offer rigorous conclusions.
In the meantime, we should be cautious when talking about addiction to what we like, be it chocolate, cycling, movies or raising Belgian Shepherd puppies. On the one hand, perhaps we are exaggerating what is simply a natural human proclivity to derive pleasure from certain activities and, on the other, we would be minimizing the seriousness of substance dependencies, which are one of the great health problems of our world in the twentieth century. XXI.