CHAPTER 14

Out-of-Control Actions

Addicts continue to make bad choices, even when it's damaging their life and health

PART 1 Whose Behavior Goes Off the Rails?

Addiction is part genetic, part behavioral, and part social. Someone who has a family history of addiction, and is then exposed to friends who use addictive substances has a higher chance of becoming addicted than someone in a different set of circumstances. Researchers have identified some genetic markers for addiction and thrill-seeking, which are big clues to an addict's profile. READ MORE

Studies of identical twins, who have shared genetic profiles, finds that heredity is a significant factor in the development of addictions. However, a person's exposure to addictive substances, socioeconomic status, mental health and cultural traditions all play a part in determining whether an addiction could take hold. As researchers delve into the exploration of genes' role in addictive behaviors, some exciting connections have already been discovered. In one study, alcohol-dependent patients who had the same variant in a certain receptor gene, Asp40, were much less likely to relapse after treatment than those with a different variant, Asn40. And the so-called thrill-seeking gene, a dopamine receptor gene called DA-D4, has been linked to individuals' likelihood of trying risky behaviors. Other studies have proven that our chances of becoming addicted are partially determined by genes' influence on the numbers and kinds of receptors in our brains, the speed at which we can metabolize drugs and alcohol, and responses to medications.

But biology is not destiny—or at least, it's not the sole predictor of our destiny. “We all have appetites and cravings,” says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University. “People differ in the target of their desires based on how much they expect positive beneficial effects from their whiskey, cigarette, or Creamsicle, and how much they expect negative outcomes. How well we regulate our appetites is based on age, strategies we've learned to control our automatic responses, the environment and culture we're in, the strength of our arousal when that substance is around, other individual risk factors, the acute and long-term effects of those behaviors, and genetics, too. Sometimes our cravings are related to one another—alcohol and drug abuse are not isolated disorders. Sometimes they're part of a spectrum of disinhibitory disorders.” LESS

PART 2 Gambling, Overspending and Other Compulsive Behavior

Substances that alter an addict's experience of the world give him pleasure, so he keeps coming back. But are obsessive gambling, overspending, internet use, and other actions true addictions? They are if we continue the behavior, even after it takes over our life and destroys our relationships. READ MORE

The American Psychiatric Association identifies certain levels of gambling as “pathological,” or addiction-like. Gamblers fit a profile of needing to gamble for larger and larger amounts of money to feel excitement from gambling, and feeling helpless to stop even after losing large sums of money.

Others spend too much time on the Internet, or cannot control their impulse to have sex. In the absence of substance addictions, which harm our health, behavioral compulsions rob us of our time, perhaps our money, and our feelings of control. However, that loss of control has consequences. A large study in China found that teens who obsessively surfed the Internet were more likely to develop depressive symptoms.

“Not all substances that interest us (for instance, salty foods) are addictive,” says Michael Stein, M.D. “Neither are compulsive actions. We don't have physical withdrawal symptoms when we stop. Whether we give in to or control our impulses can be simply thought of as being based on our ability to inhibit ourselves, to redirect our attention or goals, and our motivation to do so.” Significantly, however, the same people who experience behavioral compulsions also abuse substances. Research is accumulating on all of these behaviors to find out more about their genetic underpinnings, so that behavioral experts can treat them more successfully. LESS

PART 3 How to Break the Cycle

Talking the Talk

What is OCD?

When your lack of moderation does no physical harm, it's best to seek help from a behavioral expert who has experience with the activity that's out of control in your life. How will the expert help you? By trying to understand how your actions became problematic in the first place, and helping you find more constructive actions to replace them. READ MORE

If you decide to speak to a behavioral specialist about an out-of-control behavior, be prepared to give your family history of substance-abuse, obsessive-compulsive disorder and any other mental health and behavioral issues in your family background. Before you embark on a plan to break your habit, a professional will make sure that you don't have any substance-abuse issues, which frequently go hand-in-hand with compulsive behavior. Find a specialist who will work with you to incorporate positive new activities and habits that will take the place of your time-wasting obsession. The goal is to take control of your life again and spend your time on activities that are satisfying and productive. LESS