Wine, Women and Song: Can Experiences/Behaviors Be Addictions?

An old saying, often dubiously attributed to Martin Luther, warns: "Who loves not wine, women and song/remains a fool his whole life long." The phrase has hedonistic implications (which is why I find the Luther attribution puzzling) and its modern equivalent is "sex, drugs and rock-and-roll." Whether it really was Luther who said it, or whether it was Johann Heinrich Voss, as Bartlett's Familiar Quotations has it, the hendiatris is an old one.

Even if Bartlett made it up himself, it would still date to at least 1855. That means that for a long, long time, people have lumped substances, sex and music into the same category of mood-altering temptations. Reflecting on this fact made me wonder, is there a difference between addiction to mind-altering substances and mind-altering behaviors or experiences?

Behavioral versus Substance Addiction

The scientific community has been studying this question for years, with no real consensus emerging. In order to address the topic at all, we have to establish a working definition of addiction. Understanding and definition of the term "addiction" has changed over the centuries. According to the American National Institute on Drug Abuse, a drug addiction is "a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences." The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not use the term addiction in reference to exogenous substances at all. Rather, the DSM describes "substance use disorder." However, the most recent DSM includes a category for "behavioral addiction," which for now includes only gambling, but leaves the door open for more behaviors, such as sex and Internet use, to be listed as behavioral addictions in the future.

[caption id="attachment_2281" align="aligncenter" width="385" caption=""Dopamine and serotonin pathways" by NIH - http://www.drugabuse.gov/pubs/teaching/largegifs/slide-2.gif. Licensed under Public domain via Wikimedia Commons."][/caption]

Drugs produce changes in the human brain. But, we now know, so does sex, love, food, Twitter and music. So what is the difference between a gambling addiction and a heroin addiction? Many mental health researchers and professionals claim that the process of craving and reward is essentially the same in both. Another camp claims that although substances and behaviors affect brain changes, the changes differ and the addictions (or disorders, if you prefer) are fundamentally different.

Substance and Behavioral Addictions May Overlap

I've never been addicted to either gambling or heroin. But that doesn't mean I could do either of those things recreationally and without becoming addicted. I have been addicted to alcohol, and I'm pretty darn sure other mind-altering substances would be a problem for me too. When I couldn't access my drug of choice, alcohol, I would take something else, usually cough syrup, because I wanted to feel different. My existence became about escape. I have trouble picturing myself as a gambling or shopping addict, but the truth is, there's very little I would put past me. After all, as a straight-laced, high school valedictorian, I never predicted my alcoholism either.

Looking back, however, I recognize I always had what I would call an addictive nature. In high school I had an eating disorder and when I started drinking in college it was like switching from one negative obsession and compulsion focus to another. In fact, there is a strong correlation between eating disorders and substance abuse.

Much of the diagnostic criteria for substance addiction and behavioral addiction is similar. Personally, my experience with a behavioral disorder was quite different from my experience with a substance disorder. But then again, my struggle with alcohol was quite different from my struggle with nicotine, both addictive substances. Ultimately, I don't know what to make of the opinions surrounding behavioral or process addictions and substance addictions. Does the nature of the addiction (or if you prefer, obsession and compulsion) matter, or is it one's relationship to an activity or substance that determines whether or not it is an addiction? If you've had different types of addiction problems, how were they different and how were they the same to you? I'm looking forward to hearing your opinions and experiences.

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