When it comes to addictions, something strange is happening. On one hand, government figures suggest that the cases of addiction to drugs such as heroin, cocaine and alcohol are either shrinking or have flatlined.
But on the other, it seems that addictions to drugs are being swapped for a plague of ruinous lifestyle habits. These include cravings for social media, gambling, sex — and eating junk food, with some claiming their food 'addiction' is responsible for their weight gain.
What's more, we hear the term 'addiction' used widely in casual conversation. People talk of being 'addicted' to Instagram, coffee or biscuits, self-diagnosing their behaviour. Some fear this overuse is problematic for people with genuine addictions and say the definition is important and not to be used lightly.
Fear about real addiction to social media is one of the most high-profile concerns — indeed, Britain's biggest private rehab provider, UK Addiction Treatment Centres (UKAT), says it has seen demand more than double in the past five years for treatment for social-media 'addiction'.
A spokeswoman said: "Evidence increasingly suggests that social media dependency can lead to symptoms typically associated with substance-use disorders, such as poor mental health, lack of self-control and negatively impacted relationships."
In the past year, UKAT treated more than 70 people who had referred themselves for rehab for addictions relating to online behaviour — including using the internet or engaging in social media.
Meanwhile, regulators warn that social media companies are deliberately designing their products to grab our attention and keep it, using an armoury of stimuli and rewards such as instant offers, positive likes and constant notifications of the 'next exciting thing'.
The theory is that social media giants try to configure their platforms to stimulate the reward centres in our brains to trigger the release of feel-good chemicals such as dopamine, to keep us engaged and coming back for more.
For example, in a 2010 study in the journal Frontiers in Behavioral Neuroscience, cognitive neuroscientists showed that the types of rewarding stimuli seen on social-media platforms — such as likes and smiles from others — activate the dopamine reward pathways in our brains.
So concerned are European regulators that, at the end of August, the EU imposed new rules, called the Digital Services Act, to force big online platforms to open up their computer programs to scrutiny, in the hope of stopping them from using hidden lures that could turn vulnerable youngsters into lifelong social media addicts.
These so-called 'behavioural addictions' — as opposed to substance addictions — are not new.
Gambling was the first behavioural addiction to be medically recognised, including by the NHS. But the trend towards increasing numbers — and types — of these behavioural 'addictions' is raising eyebrows over the potential for over-diagnosis, as some people seem to be redefining the way in which we use the term 'addiction' (more on that later).
The proliferation of the internet has facilitated many people's addictions — not least an obsession with pornography: UKAT says it has seen more than a 130 per cent increase in patients self-referring with porn addiction since 2017, with numbers exceeding 300 last year. It also reports rises in addictions to sex and love.
None of these is medically recognised as an illness. Yet several UK private clinics now offer to 'diagnose' and 'treat' sex addictions.
The Cheshire-based private Delamere rehab centre, for example, says "sex addiction or compulsive sexual behaviour disorder is a recognised mental health disorder whereby a person takes sexual activity to the extreme and it overpowers everything in their life".
It says that "treatment for both sex and love addiction — defined as a problem when an individual becomes obsessed with the subconscious release of pleasure hormones — involves cognitive behavioural therapies to challenge and change the beliefs and mindset that accompany these disorders".
Again, this isn't recognised by the NHS.
But another category of behavioural addiction is garnering experts' interest — that is, the 'addiction' to junk foods.
The charity Public Health Collaboration (PHC) — which promotes improved population health in the UK — announced in February that it estimates that 20 per cent of people are addicted to ultra-processed foods. The charity is campaigning for food addiction to be a recognised condition so that people can get clinical help to quit cravings.
We certainly has an unhealthy eating epidemic.
Latest NHS figures suggest that nearly two-thirds of over-18s in the UK are either overweight or obese. But is this because of an addiction?
Dr Jen Unwin, a clinical psychologist, speaking on behalf of PHC, said: "We believe that the addictive eating of these foods underlies, in part, the current epidemics of obesity, diabetes and mental ill health."
Scientists have known since the 1990s how eating foods high in sugar and fat can be a seductively compelling pleasure.
In 1995, Adam Drewnowski, director of the human nutrition programme at the University of Michigan, scanned people's brains while they ate sweet snacks such as biscuits.
He reported in The American Journal of Clinical Nutrition that the ultraprocessed treats appear to act on the same reward centres in the brain that respond to addictive drugs.
Indeed, research suggests that when someone scoffs something sweet or fatty, their brain then rewards itself with the release of heroin-like chemicals called endogenous opioids. This suggests that snacks such as sweet biscuits act on the same pleasure centres that respond to addictive drugs.
Nevertheless, mainstream medicine does not yet class overindulgence in ultraprocessed foods as an addiction.
On its website, the NHS describes such eating problems, even at their worst, as 'disorders' rather than addictions.
Some experts disagree and say they should be recognised as a genuine addiction and treated accordingly.
"Make no mistake, addiction to food is real," says Ian Hamilton, an associate professor in addiction at the University of York.
He argues that products high in salt, sugar and fat 'overactivate' our brain's natural reward-system response to eating food, and that this response can be so strong as to create addictions similar to drug addiction.
Nevertheless, ultra-processed foods clearly do not have the chemically addictive powers of classic drugs of addiction, such as heroin — otherwise we would all become ultra-processed food addicts after sampling the products only a very few times.
Instead, it seems more likely that overeating ultra-processed foods is effectively a behavioural addiction, if it is a clinical addiction at all.
The controversy here ultimately centres on the definition of an 'addiction' — and how it differs to 'dependency'.
Becoming emotionally dependent on a behavioural problem such as overeating or gambling may, of course, seriously harm a person's health, relationships and lifestyle.
Yet that emotional dependency often does not cross the clinical borderline into a 'classic' mental and physical addiction.
Even so, some leading authorities argue that behavioural addictions can effectively be the same as drug addictions.
Bruce Alexander, an emeritus professor of psychology at Simon Fraser University in Canada and one of the world's foremost experts in addiction, believes that addiction can be driven by our environments and circumstances.
Back in the late 1970s, in experiments known as Rat Park, he found that lab rodents living solitary lives in cages, with the option of drinking either plain or drugged water, easily became addicted to heroin.
However, when he put rats in toy-filled enclosures with other rats for company, they weren't interested in the heroin. Professor Alexander concluded that, as with the rats, life circumstances may drive people to adopt addictive habits.
For socially isolated and despairing people, behaviours such as overindulging on junk food can be just as addictive as drugs, he says.
"I think the basic mechanism for how addiction to hedonistic (behavioural) habits arise is essentially the same as the basic mechanism for how some of our most dreaded drug addictions arise," he adds.
Not everyone agrees, though. Mark Griffiths, a distinguished professor of behavioural addiction at Nottingham Trent University, has been studying this field for 38 years.
He was the first to explore internet addiction, back in 1995, and subsequently has published papers on addictions to gambling, video games, sex and social media.
Professor Griffiths explains that substance addictions and behavioural dependencies such as overusing social media are different in fundamental aspects. For example, people can have multiple substance addictions, but they only ever display one behavioural addiction at a time, he said.
What's more, Professor Griffiths is highly sceptical of the idea that large numbers of us are actually 'addicted' to their problematic behaviours — and believes that many experts overuse the term 'addiction'.
"My basic position is that it is theoretically possible to become addicted to anything if it can stimulate our reward systems —but the chances are remote," he says.
"The number of people who fulfil my addiction criteria for behaviours — including to social media and food — are few and far between."
Professor Griffiths sees a crucial difference between being excessively enthusiastic about a lifestyle habit and being clinically addicted to it: "A healthy excessive enthusiasm adds to life, whereas an addiction seriously takes away from it."
Thus, he argues, just because a habit is intrusive or socially harmful it most probably is not addiction.
"We have lots of habitual behaviours that creep into other areas of our lives — you may be checking social media while at work or just ignoring people around you in social situations," he says.
"But that's not addiction. A true addiction totally takes over people's lives and gets in the way of family life, jobs and normal behaviour. Most people have healthy enthusiasms. They may, for example, spend inordinate amounts of their time playing games — but they may just love playing games a lot, rather than being clinically addicted."
He argues that the number of people with behavioural addictions is vastly exaggerated.
"You get these reports of 50 per cent of people being addicted to something, or 30 per cent of people being addicted to smartphones. That's ludicrous. Plus these surveys are based on people's own self-reported opinions," he says.
In everyday language we bandy the word 'addiction' very loosely — sincerely, saying things such as, 'I'm addicted to this new TV series'. Such attitudes can make analysis based on people's self-reporting of their behavioural addictions unreliably exaggerated.
Professors Griffiths's research shows, for example, that of 7,000 teenagers, only 4 per cent are actually at risk of social- media addiction — whereas online surveys frequently put the figure as high as 50 per cent.
He is keen to point out: "I'm not belittling this. Even a small part of a percentage is still a significant number of people, particularly when you factor in the family and loved ones around them who can be affected."
Does any of this matter?
This turns on the question of whether behavioural 'addictions' can be treated. Again, experts disagree. The most commonly used approach in the UK is cognitive behavioural therapy (CBT), a talking therapy which focuses on identifying addicts' triggers and compulsive patterns, and then encouraging them to make lifestyle changes that foster healthy behaviour.
However, as Professor Griffiths points out: "Relapses are common in all addictions — including behavioural addictions."
This suggests that deep underlying factors such as genes, upbringing and personality play a significant role.
Meanwhile, Professor Alexander argues that, rather than changing people's behaviour, we have to change our culture — because this is a driver of addictive behaviours.
"We have to reinvent society with an eye on ensuring we have sufficient healthy connections with each other, so that people can grow up and be content enough so they don't need to find substitutes in addictions," he says.
Clearly, that's a tall order.
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