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.
--Additional reporting by Caitlin Carlson
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