Addictions & Compulsions

Overview of Addictions & Compulsions: Compulsive behavior is not limited to substance abuse. Chronic gambling, sexual addictions, internet addiction, and a myriad of other, less widely known habitual behaviors are more common than one might suspect.

A compulsion is any behavior a person wishes not to carry out, but is unable to stop due to feelings of great anxiety and distress, which arise when the person abstains from the compulsive behavior. Usually, the word “compulsion” indicates the presence of obsessive thoughts, which lead to the compulsive behavior, whereas an addiction is more of a habit, not necessarily accompanied by obsessive thinking. Still, given how often an addict thinks about whatever he or she is addicted to, the line between “addiction” and “compulsion” may be somewhat unclear, even arbitrary.

Some relatively common addictions include:

• internet

• gambling

• food (especially sweets)

• coffee

• nicotine

• television

• new romantic/intimate relationships

• exercise

• sex

• masturbation

• pornography

The boundary between a passionate hobby and a compulsion or addiction may not be clear. Is running ten miles every day, rain, shine, or snowstorm, an addiction, or is it good athletic discipline? Is a monthly trip to Vegas a gambling problem, or just a fun escape from the daily grind? What about binging on ice cream, even when you know you shouldn’t?

A professional can help one determine whether behavior is compulsive. Possible questions and indicators might be

• Can you stop?

• What happens if you abstain from this behavior for a day, a week, a month?

• What are the benefits of this habit?

• What are the problems, if any, that it causes?

• Do you do this behavior with others, alone, or both?

• What else do you like to do?

• How do you feel about this habit?

• What are the thoughts and beliefs that are associated with this behavior?

If stopping is very distressing, or impossible; if the problems outweigh the benefits; if you have few other pleasures in life or have stopped participating in social activities; if you only do this alone, or always with the same people, who seem to be harmed by their participation; if you feel anxiety, confusion, shame, or alternating ecstasy and pain around this behavior; if you feel you must continue this behavior, or that you must stop, else some terrible feeling or experience will occur – this may be not a hobby, but an addiction.

The Medical Model and Addictions & Compulsions: As with addictions, causes, treatments, and theoretical models vary widely and are the subject of some controversy. Is addiction a disease, a choice, an unconscious result of childhood experiences, a biological tendency, an obsolete coping skill, or something else? Certainly, therapy has made progress in that we no longer view addiction as a moral failing. A bio-psycho-social-model, which looks at many different causes and treatments, is the preferred approach today.

Case Examples of Therapy for Addictions & Compulsions:

Morgan, 22, is a college student. He spends several hours on the internet each night, sometimes staying awake until sunrise and having trouble functioning in class the next day. He has friends at school, but finds himself isolating from them and becoming absorbed in the virtual world of the web. He does not look at porn, but plays games, chats, and 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 towards 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 becomes enjoyable as it once was.

Daisy, 30, is disturbed by her own promiscuity, which has resulted in an unwanted pregnancy ended by abortion, 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 by, abused by, 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 proving herself to herself, such as rock climbing and excelling at her job. Eventually, she begins dating and after experiencing true intimacy is able to abstain from compulsive sexual encounters.

Therapy for Addictions & Compulsions: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of addictions and compulsions. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for addictions other or any other issue, it is helpful to familiarize oneself with these elements.

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Addictions & Compulsions Article Summaries