Strung Out

Heroin be the death of me

Heroin, it's my wife and it's my life

Because a mainer to my vein

Leads to a center in my head

And then I'm better off than dead

The Velvet Underground

"An orgasm is nature's pale imitation of heroin."

Unattributed (if anyone knows source let me know)

Psychology Today blogger Stanton Peele, Ph.D. has a post proposing, according to him, the seven most addictive "substances," from cocaine (least) to, believe it or not, love (most). I won't quibble with his ranking per se, but since many people ask whether one can be addicted to such things as shopping, food, the Internet, and sex, it brought to mind how we go about defining addictions.

The problem is that the very concept of addiction is controversial and philosophically problematic, touching on great questions of free will, emotion, and even spirituality. Most of this is beyond the scope of this post (and, it must be said, beyond the scope of this amateur philosopher), but it seems safe to say that addictions are never entirely chosen nor entirely determined. They always hover somewhere in between, and it's hard to get one's mind around that (sort of like the uncertainty principle of quantum mechanics on a psychological level, perhaps). It is simple-minded to claim that willpower is absolute, but with addictions there is always room for choice ("Do I stop by the liquor store on the way home? Just two won't hurt.").

When we say that someone has a "conventional" addiction to something like nicotine or alcohol, we mean that the direct neurobiological effects of the substance are, if not removing, at least significantly impairing a person's capacity to avoid the substance. If a person stopped smoking three days ago and , feeling intense craving, gives in and takes a smoke, do we say that he was absolutely compelled (against his will) to do this? Well, no, but we think he has diminished volition--because of biological withdrawal effects--as compared to someone, say, who takes a smoke after being abstinent for a year.

We have a great deal of evidence now, from neuroimaging and other sources, that substances of abuse powerfully affect brain pathways. The conundrum is: how do we get form there to inferences about free will? After all, it is pretty likely that, say, flying into a rage is accompanied by certain neurobiological changes as well. If someone looks at me the wrong way and I take him down (I have not, generally, been known to do this), what keeps me from saying that "my brain made me do it?"

There would seem to be two answers to this, one biological and one sociological. Biologically, the question is how specific and how intense the neurochemical changes are as compared to what one might think of as a "normal" pleasurable experience (such as a walk on the beach, an enjoyable concert, or even sex). The more specific and prominent these changes are, the greater reduction in free will we might expect.

The sociological answer would seem to be that society, over time, develops, one hopes, a more refined consensus about what can reasonably be expected from individual behavior. It is reasonable to expect people not to fly into a murderous rage; it is not reasonable to expect all people at all times to be able to stop smoking at will without biological and other cessation strategies that may reduce hindrances to their free will.

Which brings us to the questionable "addictions" to sex, the Internet, and even food. The problem is that these activities just may not override the brain's volitional system in the same way that nicotine, etc. do. After all, just as a thought experiment, suppose that I enjoy reading books; I may even read them, at times, to cope with life's slings and arrows. In fact, I enjoy reading books so much that if I were prevented from reading them for a day or two, I could deal with it, but if it went on for much longer I would start to miss them, would become mentally restless, and would overall feel less happy. Would I be in "withdrawal" from a book "addiction?"

Similarly, if a materialistic person suffers a major financial hit, is he in withdrawal from a money "addiction," or if a "workaholic" is obliged to reduce his hours, does he suffer from "work withdrawal?" We may jokingly say yes, but we shouldn't really mean it.

To return to my example, what if I felt compelled to read so much that I neglected family and work responsibilities? (Note to wife if reading this post: please do not comment here). And after all, inasmuch as reading is pleasurable for me, it is probably associated with release of endorphins and other neurobiological changes at some level. The problem is that these changes are not above and beyond the evolutionary normal pathways that dictate our values and how we choose to attend to them. I would be overindulging in reading not because of an addiction, but because I was repeatedly choosing to do so (as emotional distraction or whatever).

There may be interesting gray areas. One might think sex would be one--after all, sex is arguably, in a purely biological sense if nothing else, one of the most focused, intense, and "rewarding" experiences we are naturally equipped to have. But the operative word here is "naturally," as nothing is evolutionarily normal if not sex. For eons societies have expected individuals to govern their sexual impulses without appeal to anything like a sex addiction clinic.

A true gray area could conceivably be video games and other virtual experiences. As these grow in intensity and engagement, perhaps they could stimulate the brain's reward systems in a way that may be beyond the evolutionary pale, such that cyberdetox would be necessary. Ars Psychiatrica does make for compelling reading, I know, but generally speaking the Internet doesn't appear yet to have reached that point.

None of this is to say that overindulgences in food, sex, or the Internet aren't problems; they certainly can be. But the issue, which may well be amenable to psychotherapy or other means of amelioration, is the individual's basic system of emotional self-regulation, not an "addiction."