Everybody has a vice. For me, it is chocolate, coffee and exercise. I am one of those people who feels grumpy and tired if they don’t have their cup of coffee in the morning, do my daily bike ride to work, or have my 3 o’clock chocolate snack. This made me wonder how liking or enjoying something moves into dependence and addiction. It also made me wonder if there is such a thing as chocolate or exercise addiction.
What is addiction?
There is some controversy as to whether the term addiction should be replaced with the term dependence, or whether these are actually two different disorders. According to the DSM-V (Psychiatric Diagnostic and Statistical Manual, version 5) committee, dependence can be/has been used to describe a medication or chemical that the body has adapted to and is tolerated, but does not result in, and is different to, compulsive, uncontrolled ‘drug’-seeking behavior as for substance that results in addiction. This had led to criteria being described for addiction and dependence, and has been expanded to include non-substance and behavioral addiction. Now the proposed ‘umbrella’ term is substance use disorder.
So, can chocolate, coffee or exercise ‘use’ be considered a disorder?
According to the DSM-V, caffeine cannot be considered a substance use disorder. Although it is acknowledged that caffeine does induce withdrawal symptoms in ‘users’, it does not cause significant clinical and psychological behavioural changes, or result in increased uncontrolled drug-seeking behaviour. The withdrawal effects of caffeine are due to altered neurotransmitters and their receptors in the brain, arising from the neural stimulating effect of caffeine, although mild. Despite this, caffeine does cause immediate cognitive effects in humans and animals, as well as affecting the glucose balance and lowering the risk of Type 2 diabetes (in animal models).
It is now being recommended in the DSM-V as a substance that requires further clinical investigation. This means is that they want to determine the long-term effects of caffeine consumption on behaviour and psychology.
Ahh chocolate. Sweet, sweet chocolate. Who doesn’t get the 3 pm craving for a chocolate bar? My niece once told my sister that she needed to go to the shops and when my sister asked her why, my niece responded with “because you need to buy chocolate mum. I need chocolate.”
So is it addictive? At the heart of it is dopamine reward. Eating foods like chocolate induces a surge of dopamine, which is a neurotransmitter that controls the brain’s reward and pleasure centres. Thus a cognitive pattern can be set in place, where the mind associates eating chocolate with pleasurable feelings. There is now evidence that the dopamine reward trigger can induce an excess of other neurotransmitters leading to over-consumption.
While not a true addiction (i.e. it does not induce withdrawal), the dependence on the reward from eating chocolate is real.
Furthermore, there is now evidence that there is both a genetic and environmental component to the overconsumption or ‘compulsion’ eating behaviours. What this means is that genetic makeup can also play a role in the response to the conditioning to desire and eat chocolate daily.
Exercise also falls under the ‘rewarding behaviour’ umbrella. It is characterised as a behavioural addiction that is defined as performing increasing amounts of exercise, preferentially placing exercise above other priorities, ignoring injuries, and negative emotional/behavioural responses if unable to exercise. While some have reported that exercise addiction increases the more ‘professional’ the athlete is, others report that is has a strong association with narcissistic behaviour. Again, this leads more towards the reward and pleasure centres of the brain rather than dependence, if based on the DSM-V definition of dependence.
A final thought
The take home message from this is that addiction/dependence can be a chemical alteration resulting in drug-seeking behaviour, a conditioning due to the reward centres of the brain or an interplay between environment and genetics. And therefore caffeine, chocolate and exercise can be considered addictive but not ‘substances of dependence’.
However, one thing is clear.
Any behaviour or substance that drives the user to continually seek the ‘drug’, resulting in increased risk-taking, altered priorities or severe psychological damage, it can be considered a dominating and potentially harmful ‘drug’.
If this post has caused any emotional distress or raised issues, please consider contacting Lifeline (https://www.lifeline.org.au/Home); Counselling UK (http://www.counselling-directory.org.uk) ; Counselling Services in France (English and French speaking; http://www.counsellinginfrance.com) or in the US you can go to http://www.findtreatment.samhsa.gov/.
A final, final note!
For those who want more information on the neurobiology of addiction, there is this comprehensive review: Noël X, Brevers D, Bechara A. A neurocognitive approach to understanding the neurobiology of addiction. Current opinion in neurobiology. 2013;23(4):632-638. doi:10.1016/j.conb.2013.01.018.
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