Hooked on a Feeling: The Dangers of Behavioral Addictions

PHOTO: Behavioral addictions, sometimes called process addictions, are difficult to measure and present a boatload of diagnostic challenges.
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Anne* was 34 years old when she thought she'd found her soul mate. Never mind that she was already married with three kids at home.

This new guy -- actually, her former high school English teacher -- made her laugh; he exhilarated her; he got her. A schoolteacher herself, Anne started skipping out of work early to meet him. "It was incredible, exciting, and miserable all at once," she says. Just like falling in love. Except this wasn't quite love.

Fueled by a soon-insatiable hunger for the high that comes with a new romance, Anne began jumping from affair to affair. Yahoo! Personals was, literally, her gateway to satisfaction in her small, conservative Arkansas town. She had standards, of course: Her boyfriends, as she thought of them, couldn't be married (even though she was), and she responded only to suitors who were highly educated (she was a teacher, after all). Eventually, she was sneaking out while her husband slept. She bought secret cell phones and hid them all over the house, in her car, under her bra.

"It got crazier and crazier," she says. "I needed more and more."

The urgency was, she guessed, similar to what crystal-meth addicts must feel.

She wasn't far off. The driving forces behind compulsions like Anne's are surprisingly similar to, and can be just as detrimental as, what makes an alcoholic crave booze or a drug addict jones for a score. But whereas drinks or pills are easily measurable, behaviors are not. And thanks to a culture obsessed with obsessions, behavioral dependencies--to things such as gambling, stealing, shopping, exercise, sex, and, yes, love -- can balloon from common indiscretions into destructive threats before women realize they're in trouble.

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Downplaying the Detriment

Anne's story may seem sensational, but cases like hers are increasingly documented, and countless people are now addicted to compulsive behaviors. So prevalent is gambling addiction, for instance, that it is included in the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders, or DSM. (Substance addictions are a big problem as well: More than 23 million Americans are addicted to drugs or alcohol, according to the Substance Abuse and Mental Health Services Administration, and more people than ever are hooked on prescription painkillers.)

Sneakier than their substance counterparts, behavioral addictions--sometimes called process addictions at treatment centers--are difficult to measure and present a boatload of diagnostic challenges. For years, addiction doctors wouldn't acknowledge them as legitimate--after all, who doesn't love food or sex? A woman who works out every day could be mentally ill or enviably fit; Anne's love addiction stemmed from a serious compulsion, yet wives who cheat on their husbands aren't always addicts. The now-accepted difference between a habit and a dependency lies in this definition of addiction: Continued compulsive use of a mind-altering substance or behavior with negative life consequences. In English: If your behavior harms you or others and you still can't stop, you could be dealing with a serious sickness.

The problem is, it's hard to reflect on whether your tendencies are dangerous when everybody everywhere seems to be addicted to something--or at least that's what they say. "I'm so addicted to these cookies," friends confide to each other, or these jeans, these spinning classes, that dating show. Search the hashtag #addict on Twitter and discover a world of habits and cravings, real and exaggerated: People confess addictions to shoes, diet soda, Forever 21, nail biting, and (naturally) Twitter.

Even life-altering dependencies are now regarded in a more casual way. In the cultural ground zero of Hollywood, for example, addictions, once shameful and scandalous, are almost completely out of the closet. Celebs speak openly about needing rehab, and their relapses somehow seem less shocking. The entertainment industry has been quick to adapt. See: Gwyneth Paltrow's upcoming Thanks for Sharing, a movie about sex addicts in a 12-step program. It's a comedy.

"We're living in a time when addiction can be said without shame... and that's a good thing," says Anna David, executive editor of The Fix, a website dedicated to addiction and recovery. The increased acceptance might help some addicts seek treatment without fear of judgment, says David. But it also has the potential to have a far less helpful effect, according to neuropsychiatrist Dr. Timothy Fong, codirector of the UCLA Gambling Studies Program. With addiction so glamorized and addiction-talk so common, it can be hard for many addicts to see their problem as a problem . . . before it's far-gone.

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*Names and identifying details have been changed.

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Addiction Mechanics

In other words, seemingly harmless addiction-speak can give true addicts blanket permission to act out their obsessive impulses under the cover of normalcy, says Fong. Take, for example, one of his recent patients, a woman who started stealing small items from big-box stores three or four times a week because it was the only thing that calmed her down. She didn't want to do it, but she had to, she told him. Even so, says Fong, "she never thought of it as an addiction. She thought of it as bad behavior."

Therein lies the crux: While addiction memes on Twitter may be frothy hyperbole, addiction in real life is a life-altering misery--one that almost always starts in the brain. It's hard to fathom, but many nonsubstance addictions affect the brain in almost exactly the same way as a drug or alcohol dependency, says psychologist David Shurtleff, Ph.D., acting deputy director of the National Institute on Drug Abuse (NIDA). MRI scans have shown that snorting cocaine and snarfing a fast-food hamburger light up the same pleasure center in the brain.

"The hamburger is highly pleasurable," explains Shurtleff. "Some people might find it so pleasurable that they will overeat to the point of bingeing. They want more and more and more, because their compulsive craving for it has overcome their ability to stop."

While all addictions share certain brain biology, who gets hooked and who doesn't is an infinitely complex matter. The focus of addicts' obsessions has to do with how they were raised, and the habits and substances they were exposed to early in life. Studies also point to inherited genes associated with behaviors that lead to addictions in general, which may be why so many addicts are tempted by more than one substance or behavior, or seem to transfer their compulsions (e.g., an alcoholic who stops drinking only to become an exercise fanatic). But the biggest insight into addiction mechanics--one Anne might have benefited from knowing before she lost her job, marriage, house, and kids--has to do with gender.

Women at Risk

When it comes to substance abuse, nearly twice as many men as women have chemical dependencies to illicit drugs or alcohol. Women may be likelier to abuse prescription drugs, simply because they're more often prescribed habit-forming meds, says Johanna O'Flaherty, Ph.D., a vice president at the Betty Ford Center.

Behavioral addictions are another story. Women might be at higher risk for so-called mall disorders--shopping, binge eating, stealing--in part because of old-school social norms, says Fong. Good girls don't drink, but they might steal a lipstick once in a while. What's more, on the Internet, all kinds of behavioral addictions can thrive in private. Once typically male obsessions--like sex, pornography, and gambling--now seem to be affecting females. At his UCLA center, for instance, Fong says he sees many, many women seeking help for gambling compulsions. (And a number of men who can't control their online shopping.)

Among those women is Lucy. Ten years ago, in her forties, she felt crushed by the strain of caring for her dying mother. "I was avoiding my issues," she says, but she did find an emotional outlet--at the casinos near her parents' Southern California home. Though her family once went to Vegas every Christmas, gambling had never fazed Lucy. But now that the casino was in her backyard, she couldn't seem to stay away. Soon, she was telling herself she'd stop by for an hour or two at the end of the day; she would wind up staying all night.

Still, she was functional, she says. She owned a condo and had enough money to live. "I was in denial," she says. "When you're in that state, you're not thinking clearly." At one point, she tried Gamblers Anonymous but she couldn't relate; the rooms were full of guys.

It took the death of her mother--and an inheritance--to sound the alarm. "If I gamble away this money my mom worked so hard to save, I don't know how I'll live with myself," she remembers thinking. She called Fong and went through intensive therapy. She hasn't stepped foot in a casino since.

Lucy's story nods to the fact that therapy could be even more effective if it treated men and women differently. Here's why: "There are changes in the chemistry of the brain that happen more rapidly in females," says neuroscientist Jill B. Becker, Ph.D., of the University of Michigan. Even though women typically tiptoe into addictions, and start with smaller doses than men do, they become hooked faster. And menstrual cycle hormone swings can also aggravate things by altering brain chemistry so that addictions form more powerful holds.

The promising news is that this research has dramatic implications for treatment. NIDA is supporting research to develop vaccines for nicotine and cocaine addictions, among others, says Shurtleff. In her lab, Becker is searching for similar gender-specific fixes. And therapy has caught up with the latest science: Understanding that females become addicted for different reasons than men do, are drawn to different substances and behaviors, and recover differently, addiction centers are designing specialized, single-sex support groups. All of which gives women a better chance of fighting their addictive demons.

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--Additional reporting by Caitlin Carlson

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