Most people today think of drugs or alcohol when they hear the term addiction. They may also use other similar popular terminology such as substance abuse or chemical dependency. However, as our understanding has grown, it has enabled us to broaden our vision of what addiction means. We may know that the drugs of abuse and addiction are not necessarily illegal ones, like heroin, cocaine, or methamphetamine. Someone can be addicted to legal prescription medications such as the pain medications to which Rush Limbaugh has recently admitted an addiction. In addition, people may be addicted to other chemicals or substances that we ingest, such as the nicotine in cigarettes or the caffeine or sugar in our foods.

We have also come to recognize that people may become addicted not just to chemicals or substances but also to certain behaviors. Foremost among these recognized activities are gambling and certain patterns of eating or relating to food. Popular terminology, such as workaholic and sex addict, reveals other behaviors that have become recognized as addictive. We also have terms such as shopaholic and chocoholic that reveal our appreciation for a broadened perspective on behaviors, actions, and activities that people engage in addictively. While some of these expressions are often used in a whimsical way, there is often painful reality that is expressed in these terms. Expanding our focus to a wider range of behaviors, we see other patterns that have been largely accepted as being engaged in addictively as well.

From the legacy of Alcoholics Anonymous, we have recognized that the sober partners of alcoholics may behave in certain ways that are themselves considered addictive. It is now understood that they were a part of, not just apart from, their partner's drinking pattern and addiction. The style and nature of their relating with the alcoholic in their lives is intimately connected with the drinking. In fact, it is often shocking to discover that sometimes the sober partner consciously or unconsciously sabotages and undermines the drinker's efforts to get sober.

From these awarenesses, the term co-alcoholic was derived to indicate the interconnectedness and interdependency between the alcoholic and the sober partner in the pattern and perpetuation of the drinking. The realization grew that not only was the alcoholic dependent on drinking but that the sober partner may also be dependent, though their dependency was on the continuation of the alcoholic's drinking and on the roles and styles of relating that existed between the two people under those conditions. Accordingly, it has come to be recognized that the relationship was actually a triangular one. It consisted not only of two people but also of the relationship that each person had with the other and with alcohol.

The co-alcoholic partner would therefore enable their partner's drinking by covering up for them, making excuses for them, and denying or minimizing the negative consequences of the drinking. Such negative repercussions might include embarrassing moments at the public exposure of the drinking, hurt feelings or damaged relationships with other people that resulted from something said or done while under the influence of alcohol. This may even include damage to person or property that occurred because someone was drinking. In these ways, the co-alcoholic was helping or enabling their partner to continue to drink rather than helping them to stop drinking by forcing them to be accountable for their behavior.

Alanon was founded for and about the needs of these partners. CODA (Co-Dependents Anonymous) was later founded in the further recognition that these patterns of dependent relating existed not only between a drinker and a non-drinker but also may exist between non-drinkers. In such situations, one person's abusive behavior becomes the stand in for the alcohol in the triangular co-dependent relationship. While someone might complain about their partner's mistreatment or neglect of them, if that person did not confront the issue openly and directly, set boundaries and consequences of actions, and act on those consequences, they are enabling and perpetuating that behavior.

From this standpoint, some people came to see that they were engaging in addictive relationships. It was in this context that love addiction was conceptualized. Some people are unable to leave relationships that are unhappy and even self-destructive. Robin Norwood, in her popular book Women Who Love Too Much, helped to give this new perspective a broad acceptance and helped people to discover that the crux of the matter was not about love but rather about dependency.

If we look at the components of addiction or dependence, we can see how the characteristics occur in a variety of behaviors and styles of relating. As stated in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), "the essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior" (p.176). The compulsive component refers to the felt need or driving urge to engage in the behavior. It is this sense of "have to" that propels us to do something that may be illogical or against our better judgment.

Often we may rationalize or make excuses that enable us to do things that we know we should not do and which are against our best interests. This is the kind of thinking that occurs when we spend money we can not afford and explain it away "because it was on sale," "because it was the last one," or "because it was just perfect." We may turn off our thinking and "do it anyway." Or we may twist our thinking to allow us to do what we want to but shouldn't. This type of rationalization allows us to have many slivers of pie or broken pieces of cookies that cumulatively are much more than we know we should have if we don't want to gain weight.

The tolerance aspect refers to the need for increasingly more of the substance/behavior in order to reach the desired effect. We see this with alcohol when someone "can really hold their liquor" because they now need five drinks to reach the level of intoxication they were previously able to reach with one drink. This type of behavior may be seen in a style of love addiction in which the person becomes increasingly clinging or needy and has increasingly more difficulty being alone or tolerating any separateness. In those circumstances, the person may be thought of as having an attachment addiction. Conversely, someone who finds relationships frightening might withdraw from personal interactions and either maintain only superficial relationships or isolate themselves to minimize interactions with others, eventually becoming addicted to seclusion. They may act this way because they have previously been hurt and are afraid that they will be disappointed again.

The withdrawal component refers to the uncomfortable, distressed, or painful feelings that arise when someone does not partake of the addicted substance or behavior. The symptoms of withdrawal may be physiological (change in heart rate, respiration, perspiration, blood pressure) as well as psychological (increased fear, anxiety, panic, agitation, irritability, and decreased cognitive functioning such as memory, attention, concentration, and problem solving).

The withdrawal usually begins when the need-satisfying capacity of the substance or behavior has ceased or has dropped below a certain level. However, the psychological component of the addiction triad is so strong that the mere thought or fear of being without may trigger withdrawal symptoms even when the desired substance or behavior is present and in ample supply. Behaviorally, this may occur when someone who cannot stand being alone begins to anticipate that someone will leave him or her even though the person is right there and is being caring and attentive.

When we consider the basis of any of the addiction-based substances or behaviors, we must understand that underlying the viability of that substance or action is its facility to induce a feeling of pleasure or its capacity to remove a feeling of pain. The pleasure principle states that we avoid those circumstances that induce pain or discomfort and we pursue those circumstances that provide pleasure. Sometimes, the pleasure is merely the absence of pain.

This concept of the pain-avoiding and pleasure-seeking foundation of the addiction is important to understand when we broaden our outlook to examine how various behaviors may be utilized in addictive ways. In this context, many common activities may become addictions for some people. The deciding factor is to what extent that behavior or activity is engaged in and relied upon as a means of avoiding pain or discomfort. The critical issue is not the activity itself but the way in which we relate to it and the function which it serves for us.

We all enjoy diversions, such as watching TV, going to movies, reading a book, exercising, playing sports, or gardening. But we may turn to these activities as a way of avoiding painful thoughts or feelings. We may engage in them compulsively. We may do them in such a way that they overshadow and interfere with other aspects of our life. We may feel distressed when we are not able to do them. In these instances, these behaviors operate like an addiction. They have taken on a self-medicating function in our life. They have moved from being an amusement, diversion, or distraction to becoming dependence, something on which we rely in order to enable us to feel safe and sound.

From this perspective, we can understand how various activities, behaviors, or styles of relationship may be understood to serve as pain avoiding, self-medicating, and addictive. For some people, sex may no longer be a result of emotional expression or erotic arousal, but rather it may be a means of creating excitement and arousal to counter feelings of anxiety, aloneness, and depression. Shopping or buying things may no longer be a way of obtaining things that one needs, but rather it may be a way of making someone feel good so they can offset feelings of inadequacy, insecurity, and worthlessness. Exercising may no longer be a way of staying fit and healthy, but it may become a vehicle to purge a previous eating binge or it may be a way to relentlessly pursue an idealized body image that counters one's sense of weakness, vulnerability, and deficiency. Even such behaviors as self-mutilation may be seen as addictions when understood from their self-medicating functions.

In addition to specific behaviors, we can also understand patterns of relating as having addictive functions. We noted above how co-dependency may exist as a certain style of relationship and how co-dependency may exist with any other style of behaving as well. The interrelationship between styles of relating does not only involve extremes of behavior, however. It may also be seen in complimentary patterns of interacting involving any one style and its counterpart, such as that between leader and follower, dominant and submissive, superior and inferior, or responsible and frivolous. In any relationship, where there is a lack of flexibility in roles or in styles of relating, where either party is rigidly attached to enacting only certain roles or behaving in certain circumscribed ways, there may be an element of addiction.

If we can expand our scope of vision to operate from this broadened conception of addiction that includes anything we do compulsively or any pattern of relating that we engage in for the purpose of relieving pain or discomfort, we might be able to understand our behavior more fully. We may then be more able to change those behaviors or patterns by becoming aware that we are dealing with addictions.

Dr. Shubs is a psychotherapist in practice in Beverly Hills. He is a member of the Independent Psychotherapy Network.

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