Ever wondered where the line between indulgence stops and dependence starts?

There are many theories about what addiction is and what causes it.  In the broadest sense, addiction can be defined as a craving for a substance or experience that starts off pleasurable but becomes compulsive and the major focus of a person’s life. Or it has begun to harm a person or others physically, mentally, or socially.  A user comes to depend on the substance or behaviour to make them feel all right. I say all right because there’s a perception that people fall into addiction because the substance or behaviour are sources of pleasure; but if you really listen to a person struggling with addiction, the ratio of pleasure to distress that they experience is minimal.

In terms of what causes it, some believe addiction is a failure of morality or a weakness in people who refuse to take responsibility for their behaviour. Politicians say it’s a self-control problem or a breakdown of family values, sociologists cite poverty, teachers blame ignorance, psychologists consider personality traits and temperament to be at the root of addictive personalities. Cognitive-behaviour theorists will tell you it’s a conditioned response, the biologically oriented say it’s all in the genes and heredity whilst anthropologists believe that it’s culturally determined. It’s a complex issue and there’s probably an element of all those factors involved. I come from a lineage of addiction, and in my experience, people compulsively misuse substances or indulge in risk taking behaviour as a reaction to being emotionally stressed. New research by brain, mind and behaviour specialists suggests that far from the notion that addicts are weak willed or morally redundant, addiction may be a fundamentally human condition. We may all be predisposed to addiction to one extent or another. An analogy would be genetics loads the gun, psychology aims it and our environment pulls the trigger.

There’s a fascinating and unspoken hierarchy of addiction. We tend to consider some addictions as serious and to ignore others, or worse, actively encourage them because they are socially acceptable or they don’t fit our conceptual model of what addiction is. Alcohol addiction is somehow seen as fundamentally worse and more difficult to manage than sugar or caffeine, but try coming off sugar and caffeine cold turkey and see what happens. Although not as life threatening as chemical addictions or eating disorders there are a variety of other activities which can have profoundly negative effects on the individual. Our culture tells us working is productive and therefore good. We work hard so a night out gambling with friends is simply a bit of fun. We shop because we’re worth it and of course no-one can ever have enough sex. Interestingly, research has shown that symptoms of anxiety, paranoia, insomnia, and palpitations are not the preserve of withdrawal from hard drugs but are also experienced by people withdrawing from shopping, sex, gambling and internet addictions.

Here are 10 of the leading contenders with the most scientific evidence for being addictive, along with some important questions we should all ask ourselves from time to time. By determining the impact, or consequences of our behaviour we can begin to determine whether we have an issue and take steps to address it.  One of the key shifts is realising it’s not a case of using willpower to force yourself to avoid the substance or behaviour, but to understand and pre-empt triggers and calm yourself so that engaging in the substance or behaviour has less urgency.

1. Smoking: Talk to any smoker and you’ll hear how irritated they are about how unfashionable it is becoming. But in World War II, soldiers were issued cigarettes in their rations to help them concentrate. Scientists didn’t research the consequences of Nicotine until the 1960’s because it was considered socially acceptable.

Is it a problem? Nicotine causes a profound influence on brain physiology compelling some smokers to light up every twenty minutes. Numerous studies have found that smokers have 30% less vitamin C than non-smokers. Vitamin C is crucial for growth and repair of tissues in all parts of your body including blood vessels, skin, tendons, ligaments, cartilage, bones and teeth and wound healing. It’s also an antioxidant; a nutrient which blocks some of the damage caused by free radicals and may play a role in managing aging, cancer, heart disease, and arthritis. Individuals exposed to smoke need extra vitamin C daily. 

Tip: Your diet should include daily servings of vegetables and fruits such as broccoli, spinach, strawberries and oranges–all excellent sources of vitamin C. Other important nutrients for smokers include vitamin E, which is found in nuts and oils, and folic acid, which is abundant in orange juice, beets and dark leafy greens.

2. Alcohol: Alcohol is a causal factor in more than 60 medical conditions, including: mouth, throat, liver, stomach and breast cancers; high blood pressure, cirrhosis of the liver; and depression. Harmful use of alcohol results in the death of 2.5 million people annually, causes illness and injury to millions more, and increasingly affects younger generations and drinkers in developing countries.

Is it a problem? Do you drink heavily when you are disappointed, under pressure or have had a quarrel with someone? Can you handle more alcohol now than when you first started to drink? Have you ever been unable to remember part of the previous evening, even though your friends say you didn’t pass out? Do you sometimes feel uncomfortable if alcohol is not available? For a more comprehensive test https://ncadd.org/learn-about-alcohol/alcohol-abuse-self-test

Tip: Excess alcohol intake can lead to nutritional deficiencies because heavy drinkers sometimes replace food with alcohol or skip meals altogether. Over the long-term, the negative effects of alcohol, combined with the body’s decreased ability to digest and absorb nutrients, can lead to a state of malnourishment. While a healthy diet may help improve general health and eliminate cravings, it is not a substitute for medical advice or treatment from a health-care professional. Eliminate sugar and junk foods; avoid soft drinks and snacks with a high salt content that put additional stress on the body. Reduce fat intake and increase protein, vegetables and other complex carbohydrates. Switch to decaffeinated products as caffeine frequently causes agitation, which may lead to a desire for alcohol to counteract the edgy feelings. Eat healthy meals and nutritious snacks regularly throughout the day to keep blood sugar levels stable to ward off cravings. When the body is dehydrated, it may crave more alcohol to correct the imbalance. Vitamin B and C deficiencies are also common in heavy drinkers. Consider taking vitamin supplements to replace the nutrients depleted by excess alcohol consumption.

3. Eating disorders: There are several types of eating disorders all of which are considered to be addictive behaviours with no clear aetiology.

Anorexia nervosa: a person believes they are overweight, even if they are of normal weight for their age and height. Due to lack of eating and extreme diets, anorexics are extensively malnourished and exhibit signs and symptoms of starvation including cessation of menstruation, extreme thinness, oedema – swelling in various parts of the body from electrolyte imbalance, thinning hair, tooth decay and dry skin from dehydration.

Is it a problem: Do you feel you should be constantly dieting or hungry to keep yourself thin /attractive? Have you ever found it difficult to stop dieting? Do you; avoid specific foods, stick to the same foods, avoid social situations with food or preparing food for other people without eating yourself. Do you spend a disproportionate amount of time thinking about food and body weight, recipes, food channels, and food shopping and  find it difficult to define whether you are hungry or eat a balanced meal?

Tip: Nutritional therapy will not get to the root of the issue but can support recovery. Research suggests a combined deficiency of zinc, magnesium and essential fatty acids plays a role. A nutritional therapist specialising in eating disorders should be part of a programme that includes emotional and behavioural counselling.

Bulimia: The person who overeats or binges on food and then purges using laxatives, vomiting, water pills or enemas, is considered to have bulimia. This behaviour is usually cyclical, with the person binging due to loneliness, depression, or boredom and then purging due to feelings of guilt about binging. Symptoms of bulimia include tooth decay, dehydration, constipation, weakness, light-headedness, low blood potassium, kidney damage, swelling of salivary glands, and irritated oesophagus.

Is it a problem? Are you driven to consume food and purge to prevent gaining weight? Have you ever planned / organised the consumption of a large amount of food, secretively? Do you spend a great deal of time and energy thinking about food or has it ever interfered with your ability to function? Do you make numerous trips to the bathroom as the result of laxative abuse or a desire to vomit?

Tip: Nutritional therapy will not get to the root of the issue but can support recovery. Research suggests that when levels of the brain chemical serotonin rise, hunger decreases. People who engage in binge eating may have a different response to changes in serotonin levels. Standard antidepressant drugs are often used to alter serotonin levels in an attempt to moderate binge eating behaviour. However, it might be possible to achieve similar results with tryptophan and related supplements. A nutritional therapist specialising in eating disorders should be part of a programme that includes emotional and behavioural counselling.

Compulsive Eating: the compulsive eater will have a compulsive urge or craving to eat and will often eat when not hungry. The individual may often binge in secret, and will lose control over how much food they eat. It’s assumed that compulsive overeating always results in obesity. However, many people who eat compulsively also are compulsive dieters. Obesity is a complex condition, with a lack of consensus surrounding its aetiology. Some researchers consider it to be due to psychological causes, others believe there’s a physiological basis for the problem. The condition can lead to serious health problems. Excessive body fat is associated with diabetes, high blood pressure and heart disease. It is also linked to varicose veins, fertility and pregnancy problems, digestive disorders, arthritis, and respiratory disorders.

Is it a problem? Do you over eat to alleviate boredom, stifle negative emotional feelings, calm down, relax, or feel comforted?

Tip: Nutritional therapy can support weight loss, but should be part of a programme that includes emotional and behavioural counselling.

4. Exercise: In our society, athletes are admired, especially those who have risen above normal performance limits of the human body. However, excessive participation in various physical activities has overtones of addictive behaviour.

Is it a problem? Running over 100 miles a week, exercising with unhealed stress fractures or other painful and serious injuries, or if you become depressed when you cannot exercise may be signs of self-destructive and harmful behaviour. Interestingly anorexia and compulsive marathon running are now seen as having similar aetiologies; becoming addicted to the high may play a role in establishing identity.

Tip: Like anorexics, compulsive exercisers tend to be high achievers, the elevated mood change or ‘high’ experienced by long periods of exercise is thought to serve as a reinforcer for the behaviour. Often obsession with the activity begins at a time of heightened stress. If you suspect this might be you, start reducing the time you spend exercising by 5 minutes and alter your routines so you run a different route. You can still challenge yourself; just make sure the challenges are about something other than pushing yourself to the limit.

5. Work: Our society rewards hard work with status, financial rewards, a sense of identity and a sense of purpose. Work hard, play hard, save your money and the world can be yours is the basis of this philosophy. However, complete devotion to work, to the exclusion of close relationships, often leads to family problems and loneliness in old age.

Is it a problem? Do you feel compelled to set goals and meet them, and feel anxious and distraught when you are not doing something? Do you find it difficult to relax or feel anxious or guilty because you are not being productive?

Tip: Ask yourself, are you being rewarded adequately for your time and efforts and will anyone care what you achieved at work in 100 years from now? It’s not about being unproductive; it’s about finding balance and being productive in other ways. Find something you love and divert some of your energies into it. It will widen your horizons and could change your life.

6. Computers / Internet / Mobile devices: Following the increase in mobile devices and computer games, we are now starting to witness individuals addicted to technology. People with technology addiction tend to be young, highly intelligent and excel at problem solving and mathematics. Technology addicts often report the attraction to technology is the sense of complete control and predictability. Sufferers often have similar psychological characteristics to individuals with other addictive behaviours.

Is it a problem? Do you lose track of time and find you’ve spent hours at the console without eating, bathing, or sleeping? When deprived of your computer / mobile do you feel irritable and anxious? Do you feel guilty about the amount of time you spend online or often find your partner or family nagging you about the time wasted? Do you frequently suffer from dry eyes, aches or sleep disturbances?

Tip: Set reasonable goals around usage and stick to them. Take frequent breaks, at least 5 minutes each hour, and do another activity. Alter your routine to break your usage patterns. If you spend evenings on the Internet, start limiting your use to mornings. Nutritionally, there are a variety of nutrients that have been implicated in poor impulse control, including iron, omega-3 fats and B vitamins; all required for methylation – a key biochemical process that’s essential for the proper function of almost all of your body’s systems. A nutritional therapist can help assess your individual nutrient status and requirements.

7. Pain killers: Opioid addiction is a chronic condition that results from changes in the brain in susceptible people. Prescription drugs alter the circuits responsible for mood and reward behaviour. Long-term prescription drug abuse affects virtually every system in the body. Symptoms of opioid withdrawal include: craving for drugs, diarrhoea, enlarged pupils, abdominal pain, chills and goose bumps, nausea and vomiting, body aches agitation and severe negative moods. For someone with an established substance addiction these symptoms don’t reflect the pain of opioid withdrawal. The syndrome is intensely unpleasant and people will do almost anything to avoid it. Escaping the cycle of detox and relapse is generally a long-term process and requires much more than willpower.

Is it a problem?  Has your usage increased, are you increasing your dose? Do you experience changes in energy, mood, and concentration? Have you withdrawn from family and friends? Do you spend time trying to obtain painkillers or prescriptions for pain medication? Have your personal hygiene, sleeping or eating habits changed? Do normal sights, sounds and emotions feel overly stimulating? Or do you constantly have a cough, runny nose  and red, glassy eyes? Do you call in sick to work more often, neglect household chores and bills or regularly forget events that have taken place / suffer blackouts?

Tip: If you suspect you may be dependent on over the counter or prescription drugs contact your GP who can discuss treatment with you.

8. Compulsive Spending / Shopping:Compulsive buying is common in our culture, and the behaviour is often not seen as a problem but it can be as difficult to stop as any other compulsion or addiction. Our culture condones and even encourages materialism; we are taught that buying the latest fashions and gadgets is the key to happiness and success and greater social acceptance. We even have a term to justify shopping purely for immediate personal gratification – retail therapy. Like disordered eating and other compulsions, the impulse to buy stems from an emotional need, although unsurprisingly the need is rarely fulfilled by the act. Compulsive buying is often used to regulate emotions, to allow a person to alleviate or avoid negative feelings or enhance and prolong positive emotions. Some experts identify compulsive buying as an obsessive-compulsive tendency, whilst others see it as an impulse control problem because of the short-term gratification and dismissal of long-term consequences associated with the behaviour. Compulsive spending has been linked to depression, although you could argue that the psychological distress resulting from overspending could lead to depression. 

Is it a problem? Do you experience an overwhelming and irresistible urge to buy that persists despite the consequences? Does buying an item provide temporary relief, but leave you feeling remorseful or disappointed once the purchase is made? Do you have difficulty making decisions and frequently spend far more time shopping than you intend? Have you experienced financial difficulty, debt, and personal distress or relationship conflicts due to your spending?

Tip:  Cognitive Behavioural Therapy can help people gain greater emotional awareness and healthy emotion regulation strategies. The focus should be to explore the useful sides and destructive sides of compulsive shopping to help a person discover how the behaviour serves them. Financial counselling can also help, whilst relationship counselling can help families who are impacted by overspending. Nutritionally, there are a variety of nutrients that have been implicated in poor impulse control, including iron, omega-3 fats and B vitamins; all required for methylation – a key biochemical process that’s essential for the proper function of almost all of your body’s systems.

9. Gambling: Pathological or compulsive gambling is increasingly being treated as an addictive behaviour. Most gamblers talk about the thrill or high they get whilst gambling, so it is speculated that, as in other addictive behaviours, it’s the beta-endorphins produced in the brain which causes the individual to repeat the behaviour. It’s interesting that during treatment, compulsive gamblers undergo withdrawal symptoms similar to symptoms of those addicted to drugs including headaches, abdominal pain, diarrhoea, cold sweats, tremor, and nightmares.

Is it a problem? Do you lose control over the  frequency of your gambling or the amount you gamble? Do you deny you have a problem? Are you easily depressed? 

Tip: If you think you have a problem contact Gamblers Anonymous. Therapies that focus on substance misuse often also treat gambling problems, e.g. Cognitive Behavioural Therapy.  A nutritional therapist specialising in addictions can help review your diet and individual nutrient status, particularly those that have been implicated in poor impulse control, including iron, omega-3 fats and B vitamins; all required for methylation.

10. Sex: As a concept sex addiction is still difficult to discuss and often subject to ridicule. We live in a highly sexualised culture that teaches us we are never getting enough. However, some experts believe sex is more addictive than drugs, more destructive than alcohol and more misunderstood than other addictions. Sex addiction isn’t as simple as promiscuity, it’s an intimacy disorder. People who are addicted to sex may be afraid or unfamiliar with intimacy, so they substitute sex for real human closeness.

Is it a problem? Sexuality is something that should make you feel good about yourself; do you keep secrets about your sexual behaviour or romantic fantasies from those important to you? Do you lead a double life?  Have your desires driven you to have sex in places or with people you would not normally choose? Do you need greater variety, increased frequency, or more extreme sexual activities to achieve the same level of excitement or relief? Does your use of pornography occupy large amounts of time and/or jeopardise your significant relationships or employment? Does your pursuit of sex or sexual fantasy conflict with your moral standards? If you’re engaging in risky or compulsive sexual behaviour you may have lost control of your sexuality. Check out https://saa-recovery.org/IsSAAForYou/SelfAssessment/ for more questions.

Tip: See your GP for further help and advice. Cognitive Behavioural Therapy (CBT) is often used to treat sex addiction. Sex and Love Addicts Anonymous follows a twelve-step model similar to that of Alcoholics Anonymous http://www.slaauk.org/

Shani Shaker BA (hons), dipION, mBANT, CNHC, is a registered nutritional therapist with a focus on regenerative and functional nutrition, disordered eating, addiction and mental health. Based in London her services include one-to-one coaching, group classes and Skype sessions. Contact her at [email protected]

Disclaimer: 

While a healthy diet may help improve general health and eliminate cravings, it is not a substitute for medical advice or treatment from a health-care professional. If you suspect you are dependent on a substance, speak to your GP for advice on treatment options. The information provided is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Supplementation should only be temporary. If you’re eating a nutrient-rich diet, extra supplementation should only last for a month or two, just long enough to resolve the deficiency.