Compulsive behavior can arise in several ways.
You’ll hear that a group of people have an “addictive personality” and sometimes hear that they’re neurotic, dishonest, and selfish. Actually, all kinds of people fall into patterns that could qualify as an addiction.
Mark Griffiths, a British psychologist who studies behavioral addictions, points to a social cause. We live in an addictive society in which many people can get into trouble, for different reasons. Griffiths and colleagues examined the data from 83 large-scale studies on eleven potentially addictive behaviors — smoking tobacco, drinking alcohol, taking illicit drugs, eating, gambling, internet use, love, sex, exercise, work, and shopping. They concluded that over a year, nearly half of American adults may have a behavioral addiction. Depending on how we define a behavioral addiction, that number ranged from 15 to 61 percent.
It doesn’t make sense to say that half of a population has a particular kind of personality. So maybe the problem is the definition of an addiction? To consider someone addicted to an activity, Griffiths looks for “overriding preoccupation” and conflict with other activities and relationships. In an analogy to substance addiction, he looks for “withdrawal symptoms when you can’t do it, an increase in the behavior over time (tolerance), and use of the behavior to alter mood state.” You may feel out of control and crave the behavior. Other addiction specialists specify that a behavior qualifies as an addiction only if you do it despite significant negative consequences.
Are some traits more common in people who get hooked? Yes, but they may not be the ones you suspect. Also, those traits don’t doom you (or your child).
Alcoholics Anonymous and psychiatrists historically considered addiction a form of antisocial personality disorder or “character” disorder. No research ever backed up the idea. In fact, no one trait is characteristic of all addicted people. You’ll hear that “addicts lie.” But in fact, reports Maia Szalavitz, author of “Unbroken Brain: A Revolutionary New Way of Understanding Addiction,” only 18 percent of addicts tend to be manipulative and dishonest; that’s a higher than normal rate but not a description of most addicted people. “The whole range of human character can be found among people with addictions, despite the cruel stereotypes that are typically presented,” she says.
The confusion may have to do with the ways addiction changes people. Addictions interfere with other obligations and end up hurting you and the people around you; by definition, they promote selfish behavior. But a person with an addiction may have unselfish instincts and large areas or times in their lives notable for generosity and thoughtfulness.
The best reason to search for addiction-related personality traits is to help teens. Szalavitz argues that it is possible to tell in childhood who is at most risk: the kids at the extremes. High intelligence, for example, is associated with higher rates of illegal drug use. Being especially impulsive, bold, and thirsty for sensation — the boy who craves motorcycle rides — contributes. Sad, anxious, inhibited children can come as adults to rely on drugs to feel better. They can also become rigidly locked into habits. Some people swing between impulsivity and fear. The underlying issue, she says, is a failure to master the skill of emotional “self-regulation.” Yet as adults unhappy people are no more likely to be addicts.
The “addictive personality” explanation arose in part to explain the fact that many people have more than one compulsive behavior in their lifetime, or at one time. We all know workaholics who drink too much coffee. We know gamblers who are alcoholics. People who give up an addiction speak of a “void” that they may fill with another excessive or potentially excessive activity. But “addictive personality disorder” has never been a recognized diagnosis among professionals.
It may be most useful to say that in a world in which many people develop substance and behavioral addictions, some people are more at risk. You might make an analogy to obesity, which also runs in families. Eating badly and a sedentary lifestyle will bring it on. Some people are better able to resist. But given that a third of Americans are obese, it’s unreasonable to say that they have a “fat” personality. People can reach the same destination by many paths — especially when too many roads lead to Rome.
If you’re worried about your own behavior, the first step might be to confess to the people in your life you believe will support you. The remedy is to stop doing “it,” whatever “it” is, and figure out what you need to make that happen. Twelve-step groups provide accountability; you’ll have a “sponsor.” You might need to build in alternative pleasures and distractions: take on a new interesting project. You might keep a record of the times you feel most tempted and the times you succumb. A popular book first published in 1990, “Willpower's Not Enough: Recovering from Addictions of Every Kind,” is a starting-point. Just don’t accept the idea that you’re doomed by your personality to behave in any particular way. It’s always up to you.
If you’re worried about a loved one, again don’t assume the worst. The sooner you both get help, the better. In the end, you can help your loved one best by examining the ways you can change your own behavior — and following through. Consistent changes on your end will rock the waters and you will know you did your best.
July 12, 2016
Christopher Nystuen, MD, MBA