In 2008, a research paper published by a psychology professor and two undergraduate students at Muhlenberg College in Allentown, Pa., found that 10% of Harry Potter fans surveyed reported showing characteristics of addiction after the final book in the popular series was released.
Looking back now, clinical psychologist David J. Ley, PhD, has a pop culture reference of his own to convey his feelings about the study.
“It was an example,” Ley says, “that the addiction model has jumped the shark.”
The phrase, a nod to the sitcom “Happy Days,” is an expression for the moment when a concept has reached its peak and begins losing its cache. Ley is one of several clinicians interviewed by Addiction Professional who laments that the term “addiction” has lost meaning in large part because it is used so loosely in everyday conversation.
“I’ve even made that mistake myself sometimes when I say I’m a chocolate addict,” says David Mee-Lee, MD, senior vice president for The Change Companies and a board-certified psychiatrist. “I’m not really a chocolate addict, where I would give up family, friends and work to ‘do chocolate.’ That’s when addiction takes over a person’s life. There is a danger in saying I’m a shopping addict or a running addict or a chocolate addict.”
The way the treatment field defines and applies the term "addiction" has significant implications for patients, from the way they are perceived to the type of treatment they receive to the amount of coverage their insurer will provide.
Providers are divided even on what an addiction is. The American Society of Addiction Medicine (ASAM) defines it, in part, as “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” (See the complete ASAM short definition of addiction on the next page.)
“It’s important that all the disorders that we call addiction actually have neuroscience research that supports that addiction is occurring in the brain,” says Stefanie Carnes, PhD, CSAT-S, president of the International Institute for Trauma and Addiction Professionals. “As long as we have the research evidence to really identify that these brain changes are occurring, I think the addiction label is appropriate. I think it’s appropriate for substance use disorders, I think it’s appropriate for behavioral addictions that we know follow this same pattern from a neuroscience perspective.”
Among the issues around addiction that providers are split on: Do multiple addictions exist, or is addiction in itself a disease with various manifestations? Mee-Lee, who also serves as chief editor for the ASAM Criteria, a set of guidelines for the placement, continued stay and transfer/discharge of patients with addictions and co-occurring disorders, says in his view, the disease is addiction, but that it manifests itself in whole-person ways. Providers not subscribing to this philosophy—opioid overdose treatment centers offering smoking areas, for example—can create challenges for those in recovery.
“If somebody uses while in treatment, many outpatient programs will tell a person to come back tomorrow when they are stable or sober, or they won’t let them into group. You would never do that if somebody had depression and showed up suicidal. You wouldn’t say, ‘come back tomorrow when you’re not suicidal,’ ” he says. “Inpatient facilities and many residential programs have zero tolerance that if somebody uses, they discharge them. You would never have somebody who has cutting behavior, or gets psychotic, manic or suicidal that if they get suicidal and try to hurt themselves, you would discharge them or ban them from treatment.
"Even in the addiction field, we say addiction is a disease and then treat it as willful misconduct and say things like, ‘we can’t have people who use stay in the program because it will trigger other people.’ I say what better place to be triggered, where there’s somebody to help you rather than be triggered on your own?”
The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes one behavioral addiction: gambling.
Studies on brain activity in relation to hypersexual activity, or compulsive sexual behavior (CSB), however, have found the following in comparison to non-CSB test subjects:
- Greater prefrontal activity to sexual cues, but less brain activity to normal stimuli
- Enhanced attentional bias
- Dysfunctional Hypothalamus-Pituitary-Adrenal (HPA) axis and altered brain stress circuits
- Epigenetic changes on genes central to the human stress response
- Higher levels of Tumor Necrosis Factor, a marker of inflammation
Each of the above findings are consistent with the brain activity observed in those diagnosed with substance use disorder.
Carnes argues that with research showing brain changes around hypersexual activity similar to those triggered by gambling, the addiction model is appropriate for sexual behavior as well. Not having such a diagnosis for hypersexual activity has had critical implications for research in the field, she says.