You are here: MEDICA Portal. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2010. April 2010: Addiction. Neurology.
“The Affected Person Experiences a Dopamine Shower“
People adiccted to a behavior lose
control of their actions; © SXC
MEDICA.de: Mr. Müller, in the case of alcohol and drugs, we get addicted to a substance. How can you become addicted to a behavior?
Kai Müller: First of all: You cannot become addicted to every type of behavior. For example, there isn’t an addiction to drinking excessive amounts of mineral water. There also isn’t an accurately defined catalog which lists behavioral patterns which could lead to addiction. However, we already know several behavioral patterns that have the potential and new ones are constantly being added, like for example addiction to the Internet. The characteristic that all of these behaviors share is excitement. Take gambling for example. Poker, Internet games, Roulette or slot machines all can make you become addicted: Lights are blinking, it rings and rattles and you have to push buttons quickly, it’s interactive. By comparison, only very few people become addicted to filling out a lottery ticket, since audio-visual and interactive stimuli are missing.
MEDICA.de: What behavioral addiction is the most common one?
Müller: It is difficult to compare, since a diagnosis is not easy. However, you can say this: Gambling- and video game addictions are more common, and work- and sexual addiction is not as rare either. Sport addiction is more exotic by comparison and so is addiction to shopping.
MEDICA.de: Why is a diagnosis so difficult?
Müller: In the case of drugs you can say clearly: As long as somebody is using the drug, this person is addicted to them. In the case of behavioral addictions this is different. Here the question is: At what point do you become a victim of your own automated behavior? If a person ruins themselves by catering regularly to their shopping addiction and cannot stop themselves, it is entering the area of addiction. In addition, it is a question of psychological strain the afflicted person is experiencing, because he or she is regularly losing control. Even a filthy rich person who isn’t hurt by the money spent, can suffer over it, because the affected gets a feeling of: “I did not have control over myself.“
MEDICA.de: What is happening in your brain during the urge for this excessive behavior?
Müller: In a neurobiological sense the same associated mechanisms like the ones in substance abuse are set in motion. The brain’s reward system is sensitized. The neurotransmitter Dopamine, commonly also known as the “Happiness-hormone“, is being released. The affected person is essentially experiencing a “Dopamine-shower” whenever pursuing the behavior he or she is addicted to. The longer the addiction lasts, the stronger the reward effect gets during the addictive activity and the weaker it gets with other hobbies that used to be fun – until in the end only the addictive behavior will deliver a feeling of happiness.
MEDICA.de: If we know those processes so well and are able to describe them, why is only gambling officially diagnosed as an addiction?
Müller: Indeed that is a little puzzling. Perhaps, because gambling addiction has been researched the most. Scientists have contributed empirical studies on the subject for the past 30 years. Naturally this is an important criteria for experts, who determine disease classifications and therefore a diagnosis.
MEDICA.de: Why is it like this? Work addiction has already been mentioned in the 80s in studies. Is nobody interested in this anymore?
Müller: I don’t think so. I think many researchers have become tired, because it is so difficult to determine a diagnosis. As a researcher, you would like to have something concrete, which in the end can be clearly specified and objectified.
MEDICA.de: Does this mean, research on behavioral addiction is standing still?
Müller: No. At the moment, there is a lot of research in the areas of Internet-and video game addiction. However, this is still a very new topic.
MEDICA.de: Are behaviorally addicted people without an official diagnosis being left alone? Health insurance companies don’t recognize their disease as such.
Müller: Basically this is true. However, in practice it is often handled by naming accompanying disorders, which often exist, as the reason for medical treatment – a depressive mood, anxiety disorder or the like. You can render an account for services through them. Even so, there remain some disadvantages: For most people it’s an unaffordable luxury to get treated exclusively and therefore more intensively for their behavioral addiction. Points of contact where one can seek help are few and far between. As an afflicted person, you have to search for yourself and won’t necessarily find something suitable located nearby.
MEDICA.de: How do you work clinically with behavioral addicts? Abstinence like in the case of alcohol addicts probably doesn’t work with behavioral addictions. After all, you need to go to work, go shopping and go on the Internet every once in a while.
Müller: Just like in the case of substance abusers, you have to focus the attention on the person as a whole. With an alcoholic it also isn’t enough to just do a detox, the patient also needs to work on his mind. Otherwise he is quickly going to fall into relapse. That’s exactly what you need to ask a behavioral addict: What is the source of the addiction? If somebody got addicted to the Internet, because they have a poor social network, you have to strengthen their social skills. If the reason was a poor way of coping with stress, then a training on how to handle stress can help. If the problem that triggered the addiction is eliminated, the risk of relapse in everyday life is small.
MEDICA.de: Can affected people hope that in the future there might be diagnoses for behavioral addictions available other than gambling addiction, so it becomes easier to apply for therapeutic treatment?
Müller: At present, things look great. At least there hopefully soon will be a category of diseases in the International Classification of Diseases ICD, which would encompass physical and psychological dependencies. So far, there is no such category – for behavioral dependencies only the somewhat unkind main category “Impulse control disorders“ exists. A whole array of uncontrollable behavioral patterns are included, all the way down to obsessive hair pulling. The American Diagnostic and Statistical Manual of Mental Disorders (DSM), which often serves as the guideline for corresponding passages in the ICD, is currently being revised. A research group demands that the category which thus far only encompassed physical dependencies , will get a more general title - for example “Addictive illnesses“. This would be an entry way for all psychological dependencies.
The interview was conducted by Anke Barth and translated by Elena O'Meara