What Is Addiction
By definition, addiction is a process of compulsively engaging in rewarding stimuli despite adverse effects. That is, repeatedly doing things that feel good despite the costs and damage caused to other areas of a person’s life, and being unable to stop or control this behaviour.
In this sense all addictions look fairly similar, whether it's an addiction to alcohol, drugs, sex, shopping, gambling or gaming. A person who is addicted will compulsively and repetitively engage in their addiction in ways that become increasingly destructive over time. Addictions are often referred to as being 'progressive', which means that most of the time, an addicted person will engage in the addiction more and more the longer they remain addicted. Over time, an alcoholic will drink greater quantities and more often, a gambling addict will gamble more often and spend more when they do, and a gaming addict will spend more time gaming. In addition, the effects of addiction tend to worsen over time. In the case of gaming addiction, at first a person may only play games when they have free time. As they become addicted, they might start giving up other things that they enjoy in their life, or neglecting minor tasks like housework or homework. If the addiction continues, they may increasingly give up more and more important parts of their life and neglect commitments including work, study, relationships and financial obligations.
Alongside neglecting and losing interest in other parts of their life, over time an addicted person will often tend to become more protective around their addiction. That is, they will tend to try and prevent other things from interrupting or taking away their addiction. For some people, this can come across as irritability or aggression if their addiction is interrupted. For others, they may be more inclined to avoid conflict and try and find ways to continue their addiction where other people don't see it or are less likely to interfere by isolating themselves and cutting off contact with others.
In the case of gaming addiction this means that as a person becomes addicted you would expect to see some of the following signs and symptoms:
- they plays for increasingly greater periods of time
- they become unable to control how often or how much they engage in gaming
- they become preoccupied with games even when not playing - they may talk about them, read or watch videos about them, think about them and even dream about them
- they may become irritable, depressed or anxious when they are not able to play games or if their gaming is interrupted
- they start to lose interest in other hobbies, activites or relationships in their life
- they start to hide or deceive others about their gaming
- they begin to use gaming to avoid negative moods or feelings
- their gaming starts to negatively impact other areas of their life including relationships, work or study, finances, friendships, or physical health and hygiene
Essentially, when somebody becomes addicted to something, that thing takes priority over everything else with all the follow-on effects that could be expected from that becoming the number one priority.
History has given us numerous ways of understanding addiction:
- as a moral failing or a lack of willpower
- as an inevitable consequence of using drugs
- as a progressive and lifelong disease
- as a consequence of genetics and biology
- as a result of altered neurotransmitter functioning in the reward circuits of the brain
- as a means of self-medicating.
Each of these ideas has held sway to varying degrees and continues to do so in public and professional discourse about addiction, but each of these explanations is at best an incomplete metaphor. These explanations provide a simple picture that makes it easier for us to grasp what we are dealing with, and which at times have proved valuable in terms of shifting public policy and treatment methodologies. At the same time, they obscure as much as they reveal, and have often led to ‘one-size-fits-all’ approaches to addiction treatment that do not acknowledge the complexity of the concept.
In reality, there is no simple or short-hand way to explain addiction as there are multiple factors that affect susceptibility to addiction, that contribute to the formation of addiction and that perpetuate the problem. One way to understand addiction is to look at two cycles or patterns of behaviour which operate in parallel – a positive reinforcement cycle and a negative reinforcement cycle.
In early addiction, the positive reinforcement cycle shown below tends to dominate and be the main reason for a person to continue engaging in the addictive behaviour.
Positive Reinforcement Cycle
There is a period of anticipation and excitement that occurs before a person engages in the addictive behaviour. This is followed by engagement in the activity itself, which leads to a positive emotional state – feeling great. This engagement is often characterised by excessive use of the substance or activity, and is sometimes referred to as ‘binging’. The effects of this good feeling wear off over time, and the person returns to a normal emotional state which is then followed by another period of anticipation, sometimes referred to as ‘craving’. As a person uses a particular drug or engages in a particular addictive activity over a long period of time, this also alters the way in which the brain processes and experiences reward – the positive feelings that tell us to continue doing something. Over time, the brain becomes accustomed to a persistent level of stimulus, and this becomes the ‘new normal’. As a consequence, levels of stimulus that are below this new normal now feel less rewarding, and greater stimulus is required to achieve the same level of rewarding experience. This is commonly conceptualised as ‘tolerance’ when it comes to addictive drugs, and is part of the reason why people who develop addictions tend to increase their using or addictive behaviours over time, as their brain no longer creates a positive reaction to lower levels of using or engagement. This goes beyond just the addictive behaviour itself, and at this stage a person with an addiction will experience all activities as less enjoyable and less rewarding than they did prior to the addiction.
Alongside this positive reinforcement cycle is a negative reinforcement cycle as shown below.
Negative Reinforcement Cycle
As a person develops an addiction to a substance or behaviour, increasingly the negative reinforcement cycle drives their behaviour. At this stage, people with addictions experience little or no enjoyment from using their substance or activity of choice, but experience strong negative feelings and symptoms if they stop engaging in the behaviour. A person at this stage when not using experiences dysphoria (low or negative moods), heightened stress symptoms and symptoms of anxiety. When used over prolonged periods, all drugs of abuse increase stress in the brain. This is part of what creates negative states when not using. When a person with an addiction then engages in their addiction, their stress levels and negative moods are brought back to what in a non-addicted person would be a ‘normal’ level. However, this does not last as the effects of the substance or behaviour wear off and a dysphoric and anxious state returns. This is part of the reason why people with addictions can often become irritable, anxious or even overtly angry or hostile when their access to their addiction is prevented.
In addiction, these two cycles operate simultaneously. That is, the addicted person begins to experience pleasure only when they are engaging in the addictive behaviour, and they begin to experience persistent stress and anxiety when not engaged in the behaviour. This obviously creates a very strong motivation to continue the behaviour. The interrelation of these two cycles is shown below.
The Dual Cycles of Addiction
A third system in the brain that is affected in addiction are the parts of the brain responsible for executive function – that is, the ability to make complex decisions. This is still a fairly new area of research but there is sufficient evidence to show that our capacity to make decisions is affected in the long term by addiction, particularly when presented with reminders of our addictions. The effect of this is that once in addiction, people are less able to adequately weigh up the pros and cons of their decisions such as continuing to use or seeking help, and this may contribute to prolonging the addiction.
We now know that addiction affects three areas of the brain among others – the parts of our brain responsible for creating positive feelings and ‘reward’, the parts of our brain responsible for experiences of stress and anxiety, and the parts of our brain responsible for complex decision making. In this way, addiction can be understood as a disorder of reward, a disorder of stress, and a disorder of executive function or decision making. However, these are just the processes that occur once a person has developed an addiction. Developing that addiction in the first place is often a combination of biological and genetic susceptibility, environmental factors and circumstance.
First of all, there is some evidence that there is a genetic component to addiction, although there is no identified ‘gene’ for addiction and there probably will never be one. Instead, genetic factors likely contribute in the form of multiple different susceptibilities that can occur. For example, because addiction cycles are perpetuated through a desensitization of the reward systems in the brain and an over-activation of stress systems in the brain, a person who already had a desensitized reward system or an over-active stress system might be more prone to addiction.
Similarly, environmental factors and early life experience are well known to have lasting effects on the reward and stress systems in our brain. Trauma in particular can lead to the brain’s stress systems becoming over-active which could place someone at risk of developing addiction, and the same effects have been seen in children who have experienced neglect.
Then there are the psychological factors that cause people to turn to addictive behaviours. When someone is experiencing bullying at school, or financial difficulties at home, it’s not surprising that people will turn to whatever they can find to alleviate the negative feelings and stresses that this creates. If the circumstances that caused someone to engage in a rewarding behaviour only last for a short time, then the person will usually stop the behaviour once the stressful situation has gone. However, in cases where a stressful situations persists for a prolonged period it may be that an addictive cycle has begun by the time that the situation changes. Similarly, the longer a person engages in a behaviour as a way to regulate their mood or to cope with overwhelming situations, the less they develop other ways of regulating and coping in that situation, and so it can become more difficult to stop the addictive behaviour.
It is in these precipitating factors that the differences between different addictions are perhaps most apparent. Once a person has developed an addiction, the cycles of addiction appears to be relatively consistent across both substance and behavioural addictions, and early research seems to indicate that many of the neurobiological changes are similar as well. However, the reasons why a person might develop a gaming addiction as opposed to a gambling, drug or sex addiction have a lot more to do with the psychological function that the addiction serves in its early days. Partly this is due to availability – for many people, if they do not have access to drugs of abuse it is unlikely that they will seek them out. At the same time, different drugs and different addictive behaviours do provide subjectively different experiences and meet different psychological needs and this is certainly true of gaming addiction.
The most important factor however, without which an addiction cannot form, is repetitive engagement in using a substance or behaviour. That is to say, you cannot become an alcoholic unless you drink regularly, and you cannot develop a gaming addiction unless you play games regularly. Sometimes, this repetitive engagement in a behaviour can be enough on its own to create an addiction due to the neurobiological changes it creates. More often than not though a person will not become addicted unless other risk factors , such as those described above, are present as well.
The diagram below shows the various risk factors that can influence the development of addiction, and as you can see, the more factors a person has the more at risk they are for developing an addiction. Unfortunately, many of these risk factors may be unknown (such as biological susceptibility) or difficult to see from an outside perspective (internal psychological stresses, historical traumas).
When Is It Addiction?
Because there is no simple way to test the functioning of the reward and stress systems in a person’s brain, there is no simple way to say whether someone’s behaviour constitutes an addiction or not. Instead, from a practical perspective addiction can best be understood and separated from more healthy engagement in a behaviour by understanding the function of the behaviour, the impacts of the behaviour, and the level of control over the behaviour.
The function of a behaviour refers to the purpose that the behaviour serves. With gaming, does a person play games because it’s enjoyable and engaging, because it’s a way to relax after work, because it’s a way to not have to think about difficulties in their marriage, because it’s the only time they experience a sense of potency and control, or for one of a number of other reasons. When we can understand the function of a behaviour and what purpose it serves, then we can start to understand the meaning it has within the context of a person’s life and whether it could constitute an addiction.
Alongside the function of a behaviour, we need to look at the impact of that behaviour. The impact of a behaviour is the way in which it affects a person. In the case of gaming, does it make the person playing feel more relaxed and less anxious after playing, or do they feel more irritable and depressed after gaming? Does their gaming affect their sleeping, eating, exercising or commitments to other activities such as work or study? Does the gaming affect their relationships, either in terms of how other people in their life feel about their gaming or in terms of how they feel about and relate to other people? The impacts of a behaviour influence whether the person sees the behaviour as a problem (though that doesn’t mean they are necessarily willing to acknowledge it as a problem). Sometimes behaviours cause problems for other people in a person’s life, but not for the person themselves (see the “Their Problem or Yours” section of this website).
Lastly, the level of control that a person experiences over a behaviour is significant in determining whether it could be considered an addiction. In short, does the person ever find themselves engaging in the behaviour when they don’t intend to, for longer or more intensively than they intended to, and do they experience difficulty in stopping the behaviour if needed for some other reason. When a person starts to feel that they cannot control their engagement in a behaviour, they are said to be compulsively engaging in that behaviour.
Taken together, these three factors can indicate the presence of addiction. If the function of a behaviour is primarily to avoid or manage overwhelming situations or emotional states, and the behaviour has significant negative impacts on a person’s life, and the person compulsively engages in the behaviour, then that behaviour could be considered an addiction.
Treatment For Addiction
Although there are biological treatments that aid with certain addictions such as suboxone for opiate and alcohol addictions, most addiction treatments follow similar principles. This usually involves some form of ‘talk therapy’ or group skills-training which to be effective must address the parallel cycles of addiction described previously. That is, a person with an addiction must find ways to rebalance the reward systems in their brain by engaging in positive non-addictive behaviours that provide satisfaction. At the same time, they must reduce activation of the stress systems in their brain by finding new ways to regulate and tolerate anxiety and the negative emotional states that arise when not engaging in the addictive behaviour. Effective therapy or skills training will assist a person with an addiction to identify and engage in these new behaviours. This is often done by identifying the circumstances and ‘triggers’ that are unique to each person that lead to addictive behaviour and collaboratively identifying other ways to respond to these triggers.
For example, many gaming addicts find that it is only when gaming that they experience a sense of being valued and needed by other people, and so when they have experiences in their lives when they feel devalued or unwanted, they may return to gaming. Successful treatment would involve helping a person tolerate the feeling of being devalued when it occurred, and to explore other ways to find a sense of purpose and being needed that did not involve gaming.
While treatment of various sorts can be helpful to many people, the reality is that many people who recover from addiction do so without any form of outside help. The largest study ever conducted into alcoholism by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) surveyed 43,000 Americans and found that “twenty years after the onset of alcohol dependence, three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.” More importantly with regards to treatment, the study found that “About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and Alcoholics Anonymous. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment.” This is not to say that treatment does not have its place as it can often speed up recovery, and for some people who have tried to overcome their addictions on their own treatment may be invaluable. At the same time, many people can and do overcome addictions with the support of friends, family members and online communities.