Addiction: Psychological Perspective

Dr. Karen Binder-Brynes replies:

A:Over the years as a psychologist, I have treated countless patients who have suffered from one form or another of “addiction.” Whether it was the woman whose whole body was marked with needle marks from her secret heroin addiction, the young girl addicted to binging and purging or the good-looking athlete, wasting hours of his days with video porn...all suffered terribly from something that has most likely plagued humankind from the beginning of time – addictive behavior.

Addiction, in my view, has two basic elements. These include the tolerance and withdrawal phenomenon. Tolerance basically means that over time, more and more of the addictive behavior or substance is needed to achieve the desired effect. Withdrawal essentially means that the individual has a very painful physical and/or emotional reaction when the substance or behavior is ceased. Addiction is probably one of the most costly and serious problems facing our culture today. If each of us stops to reflect, we can probably all come up with at least one negative addiction we have or have had in our lives that has caused pain and suffering.

There is much controversy in the medical and psychology worlds in terms of what the exact nature of addiction is. I tend to gravitate toward a multi-leveled, biopsychosocial model as a theorem for explaining addiction. Although historically addictions were usually regarded in terms of psychoactive substances, such as drugs, that when ingested caused chemical alterations in the brain, the current thinking has broadened to include other compulsive behaviors such as pathological gambling, shopping, eating, etc. In our current lives, even “working” can be addictive. In fact, so commonplace are addictions, that we have adopted the terminology “oholic” for many behaviors, e.g., alcoholic, shopaholic, workaholic and so on.

Without getting too technical, it is now accepted that the human brain, like many animal brains, is organized to prefer one outcome over another. In essence, “all sentient beings have developed in such a manner, through natural selection, that pleasurable sensations serve as their habitual guides” (Darwin, 1958:89). Basically what this means is that most addictions can be traced to an activation of the brain’s pleasure and reward systems. What I am saying is that humans and other animals will seek to find pleasure and for the most part, avoid pain at all costs. This makes intuitive sense as well as being a biological reality. Now the question becomes whether or not one’s individual will can ignore, overcome or avoid the temptations of those habits, which ultimately turn from pleasurable and rewarding to destructive and often life-shattering addictions.

Why some people become more prone to addictions than others is a matter of great debate. The arguments range from a strict “disease” model suggesting a biochemistry of addiction, perhaps with genetic basis, to a “choice” model (Szasz, 1973) suggesting that the addict is a person who chooses a taboo substance or behavior to a low-risk lifestyle. Regardless of the causes, addictions can be costly and cause tremendous suffering for not only the “enslaved” person but for their families, friends and society in general. If you or someone you know is addicted to substances or destructive behaviors, it is never too late to get treatment. Denial and shame are often deterrents to seeking assistance. Never lose hope that you or a loved one can get help and beat an addiction. People can make miraculous recoveries from the powerful grip of addiction. I have seen it!

Dr. Karen Binder-Brynes

Dr. Karen Binder-Brynes is a leading psychologist with a private practice in New York City for the past 15 years. See her website, drkarennyc.com, for more information.