Dear Therapist:

What qualifies something as an addiction? My brother plays video games all day. Does that make him an addict? My mother shops all day. Is she addicted to shopping? It seems like the word addiction gets thrown around a lot these days but when is it really a true thing and when is it just an excuse for continuing behavior that you don't want to stop? I get that cigarettes, alcohol and the like are considered addicting but are we to extend that now to anything 

Response:

One of the great advantages of the proliferation of mental health treatment throughout most of our society is the ability that people now have to identify problems and begin treatment before the problem gets out of hand. One of the downsides, however, is that laypeople are constantly “diagnosing” themselves and others with one disorder or another. Sometimes these “diagnoses” are accurate, but they are often based on misconceptions and misunderstandings. 

The term “addiction” has become a byword for behaviors identified (by anyone) as excessive. We tend to apply this term to just about anything that we view as maladaptive. Officially, the only non-substance related behavior included as an “addictive disorder” is gambling. This is largely due to evidence of biological and experiential similarities between gambling and substance use. There appears to be insufficient evidence to assume that other repetitive behaviors share these similarities. 

We all have aspects of mental disorders. Who among us has never felt anxious, depressive, obsessive, unfocused, or distracted? In order for a disorder to be diagnosed, specific criteria must be fulfilled. One of the general concepts is that fulfillment of these criteria points to a problem that significantly affects the person’s ability to properly function. Although many repetitive actions may include aspects of addiction, they may also include aspects of other disorders, like depressive and anxiety disorders, OCD, and ADHD. This doesn’t necessarily mean that the person has any or all of these types of disorders. Even if not, however, this may mean that the person has a problem that should be addressed. If someone meets only one or two criteria from each of a few disorders (and therefore has no official diagnosis), they may be in worse shape than someone who fulfills all the criteria for only one disorder.

The question isn’t what qualifies as an addiction, but rather what qualifies as a problem. We can, however, refer to some of the characteristics of addiction in order to respond to your question. From our perspectives as observers, the most obvious aspect of addiction is the repetitive action. Addiction, however, is largely characterized by the compulsion and not simply by the action per se. An intense emotional craving for the behavior—along with continuation despite detrimental effect—distinguish addiction from non-addictive behavior. There is typically a loss of control and preoccupation with the behavior. Similarly, any action that is continuously repeated due to an emotional need regardless of negative consequences can be viewed as troubling. Even if this does not constitute an official addiction or other disorder, it should be addressed 

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317