Addictions and Compulsions
An addiction—a persistent need to consume a substance or commit an act—is distinct from a compulsion, which is an overwhelming and irresistible impulse to act. Usually, a compulsive act is preceded by obsessive, intrusive thoughts that compel the person to act, whereas an addiction is more of a habit that is not necessarily accompanied by obsessive thinking. An individual experiencing either addiction or compulsions may find it helpful to speak to a mental health professional.
Compulsive behaviors include chronic gambling, substance abuse, sexual addictions, unrestrained shopping and spending, hoarding, excessive exercising, Internet gaming, eating issues, and other behaviors. Any compulsive behavior can become an addiction when the act is no longer able to be controlled and impairs a person’s ability to function socially, academically, and professionally. The distinction between “addiction” and “compulsion” can sometimes become unclear, as a person might think frequently about the object of the addiction, and it may become near-compulsive to pursue the addictive behavior.
Determining whether a habitual behavior has become problematic begins with evaluating the benefits associated with the activity and the feelings and beliefs surrounding it. The distinction between a passionate hobby and a compulsive behavior may be difficult to discern. For example, is running 10 miles every day—rain, shine, or snowstorm—an addiction, or is it good athletic discipline? Is a monthly trip to Vegas to play the slots a gambling problem, or just an escape from daily life? Addiction or compulsivity may be indicated when the behavior results in feelings of distress, guilt, or shame or when abstaining from the behavior provokes anxiety or proves to be impossible.
Symptoms that suggest a compulsive behavior has become problematic include:
- Interpersonal and professional relationship problems
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- Concealment of the behavior
- Denial of a problem
- Inability to stop the behavior
- Alternating feelings of anxiety, confusion, shame, or elation that revolve around the behavior
- Withdrawal from or a lack of enjoyment in other activities
- Desire only for the company of others who pursue the activity or, to an opposite extreme, the urge to conduct the activity only in isolation
- Fear surrounding the potential repercussions associated with discontinuing the activity
Typically, addictions or compulsions develop as a result of an underlying psychological issue, such as depression. Engaging in an act of addictive behavior can temporarily relieve stress or anxiety for several minutes to several days. Compulsive behaviors often trigger the same neurological pathways that specific substances stimulate in the brain of someone with drug addiction, and this cycle of reward can make the activity that much more attractive and addictive.
People with severe mental health conditions, such as bipolar, may experience poor impulse control that can make it difficult or impossible to resist compulsive urges. In addition, a rare side effect associated with dopamine agonist medications—which treat conditions such as ADHD and Parkinson’s—can produce extreme compulsive behaviors, even in people who had no such inclinations previously.
"Addiction, a merciless, emotionally destructive illness, is a family disease or problem, and it can be easy to underestimate the sometimes covert, but painful, "ripple effects" of addictive behaviors that lead to hurt, anger, isolation, depression, and despair," said Darren Haber, MA, MFT, a California therapist who specializes in the treatment of addictions and compulsions.
Family members of an individual experiencing an addiction can develop high levels of stress, especially when daily routines are interrupted by that individual's unusual, uncharacteristic, or potentially threatening behavior. Children living in a family affected by addiction may find it difficult to cope with the anxiety, stress, or emotional overwhelm that may result from the chaos and stress in homes affected by a family member's addiction or compulsions. Addiction that continues to go untreated may have a traumatizing effect on both children and adults, leading to developmental concerns, difficulty regulating emotions, and relationship difficulties among family members or partners.
"I cannot stress highly enough the importance of each family member getting support."Adults who grew up with a family member who experienced addiction may have a higher likelihood of experiencing depression, anxiety, relationship issues, or learned helplessness. They may also be more likely to develop an addiction themselves, have difficulties with self-regulation, engage in high-risk behavior, or reenact a dangerous or dysfunctional cycle from childhood with their own partners and children.
Parents who experience addiction may come to increasingly rely on their children, placing the child in a parental role, which often has an effect on development and can cause difficulties in relationships later in that child's life. Individuals experiencing an addiction may also isolate themselves from their families due to guilt, a fear of censure, or denial, among other reasons. This isolation can make family interactions and relationships difficult and may also forestall treatment of the problem.
"I cannot stress highly enough the importance of each family member getting support," Haber said, encouraging all family members affected by a parent, child, or sibling's addiction to seek help. "Even if it seems they have the problem, [treatment] is the smart, safe thing to do for yourself. It also sets a good example for your loved one, who may be attracted to the positive changes—including loving but healthy boundaries—he or she sees in you."
Compulsive behaviors and addictions may provide a person with a sense of power, euphoria, confidence, validation, or other feelings that may otherwise be lacking in their lives. Psychotherapy is designed to help people identify uncomfortable feelings and sources of distress in order to change and grow. People who struggle with compulsivity and addiction are unlikely to conquer those behaviors unless they work to address the underlying causes of their addictive and/or compulsive behaviors, such as trauma, stress, past abuse, and others.
Working with a therapist is one of the most effective treatments for managing compulsive behaviors and addictions, and there are many types of therapy suited to addressing behaviors that a person may want to change. A person is likely to achieve the most benefit from consulting with a therapist who is qualified to address the particular area of addiction or compulsion experienced, as well as the underlying cause of the issue. For example, a person who uses drugs to dull the intensity of posttraumatic stress may benefit from treatment for PTSD as well as drug addiction, but resolving the PTSD may also help significantly with treatment for the addiction. Self-help, support groups, and 12-step programs may also facilitate recovery from addiction and compulsivity.
- Internet addiction: Morgan, 22, is a college student. He spends several hours on the Internet each night, sometimes staying awake until sunrise, which generally causes him to experience difficulty functioning in class the next day. He has friends at school but finds he is isolating himself from them and becoming absorbed in the virtual world of the web. Morgan obsessively plays games and engages in chats, and he does little else with his free time. His social life and grades suffer, but he cannot seem to stop. He reports feeling like he is in a daze and says he is bored and anxious when he is not on the computer. Therapy reveals ambivalence about his major and the ensuing career it implies, as well as homesickness, social anxiety, and perhaps some chemical issues that tend toward depression. At the suggestion of his therapist, Morgan begins to involve friends in computer activities, watching movies with them and playing games in a group. This leads to extended social activities, and Morgan’s confidence improves. Career counseling steers him toward a more fulfilling path, and a few family sessions with his mother and brother uncover old grief that, once resolved, allows a better mood to prevail and socializing to become enjoyable again.
- Therapy for sex addiction: Daisy, 30, is disturbed by her own promiscuity, which has resulted in an unwanted pregnancy that she chose to terminate, as well as the contraction of sexually transmitted diseases, which were treated and remitted. Daisy is ashamed of her behavior but continues to meet new partners several times a week and engage in what she calls “totally meaningless sex.” Daisy does not know why she is driven to this behavior. In therapy, feelings of inadequacy, rooted in the experience of being criticized, abused, and eventually estranged from her parents, are discovered. Daisy realizes she is unsure of her own worth, and after several months discovers healthier ways of building self-esteem, such as rock climbing and excelling at her job. Eventually, she begins dating and after experiencing true intimacy, she is able to abstain from compulsive sexual encounters.
- Brandes, H. (2010, Dec 29). Shopping 'til they drop: Compulsive spending poses danger of addiction. Journal Record. Retrieved from http://search.proquest.com/docview/822335078?accountid=1229
- Compulsive Gambling. (2014). Mayo Clinic. Retrieved from http://www.mayoclinic.org/dotorg/diseases-conditions/compulsive-gambling/basics/definition/con-20023242?footprints=mine
- Dayton, T. (n.d.). The Set Up : Living with Addiction. Retrieved from http://www.nacoa.org/pdfs/The Set Up for Social Work Curriculum.pdf
- Fong, Timothy. (2006, November). Understanding and Managing Compulsive Sexual Behaviors. Psychiatry 3(11). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945841
Kaufman, E. (2005). Impact of Substance Abuse on Families. In Substance abuse treatment and family therapy. Rockville, MD: U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration.
Last updated: 03-08-2016
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