Habit or Addiction—Who Decides?

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Habit or Addiction—Who Decides?

By Jeanene Swanson 10/14/14

Most of what we call addictions these days are simply behaviors that get reinforced and lead to adverse consequences.

Image: 
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Many of us have what we would consider bad habits—smoking, unhealthy diet, not enough exercise. But, what happens when these bad habits begin to affect our health?

A 2004 JAMA article reported that the leading causes of death in 2000, according to CDC mortality data, were tobacco use, poor diet and physical inactivity, and alcohol consumption. In other words, over 35 percent of all deaths could have been avoided if people had changed their behavior.

Controversy remains over whether so-called behavioral addictions are actually true addiction disorders—in fact, the DSM only officially recognizes gambling.

“Why can’t people just quit when faced with these types of consequences?” says Dr. Deni Carise, Deputy Chief Clinical Officer of the CRC Health Group, Chief Clinical Advisor at Sierra Tucson treatment facility, and an adjunct clinical professor at the University of Pennsylvania. “If someone wants to shed a few pounds—do they have a bad eating habit or is it genetics? What if they hear from their physician that they are at high risk for potentially lethal disorders if they keep eating? Keep smoking? Many of us wonder why some folks don’t change their behavior when their 'bad habits' begin to impact their health."

In recent years, behavioral addictions—otherwise known as process addictions—have come to the fore. Treatment facilities now specialize in sex, gambling, and Internet addiction, to name a few, and a 12-step recovery group exists for just about anything—Sex Addicts Anonymous, Gamblers Anonymous, and Online Gamers Anonymous only begin to scratch the surface. However, controversy remains over whether so-called behavioral addictions are actually true addiction disorders—in fact, the DSM only officially recognizes gambling. Are all the rest simply bad habits? And, how can people break these habits before they lead to negative health consequences, or worse, addiction?

Habit or addiction?

We all have habits—deeply ingrained behaviors that are hard to change, especially in the face of new goals. A habit is specifically defined as “an association that builds up between a stimulus—cue, [or] context—and a response—any sort of behavioral reaction, though usually one learned to get a goal,” Dr. Kyle Smith, an assistant professor of psychological and brain sciences at Dartmouth College, says. “It works like a reflex.” Neuroscientists believe habits form in an area of the brain called the basal ganglia, a key area of which is the dorsal striatum.

Habits serve us; we depend on them for our survival. Once the cue-behavior-reward is learned and put down as habit in our neural circuitry, we can move on and do other more important things. And, according to behavioral psychologists Dr. Wendy Wood and Dr. David T. Neal, that’s precisely why they’re so hard to break.

Habits are not dependent on our goals, although goals can initially inform habits. While goals are flexible and ever-changing, habits remain fixed. So, even if a habit is no longer serving us, it’s programmed to stick. “Slow-learning, conservative memory systems, as exemplified in habits, appear to confer functional benefit for learning systems,” Wood and Neal write in a scientific paper published in the journal Psychological Review in 2007. “By reflecting the recurring features of an organism’s past experiences, such systems shield existing knowledge against potential disruption from being overwritten or unduly distorted by new experience.” 

Habits are not addictions, but bad habits share traits of addictive behaviors and bad habits can become addictions. How are habits different from addictions?

Addiction involves more than the traditional cue-behavior-reward circuit. “It probably does involve habits in the formal sense—drug-taking rituals are a good example,” Smith says. “But it also involves extremely high levels of craving and motivation, a great deal of behavioral flexibility, and a lack of impulse control.” Addiction, then, involves the basal ganglia, but also affects the prefrontal cortex—an area associated with self-control—and deeper-rooted limbic systems—one being the mesolimbic dopamine circuitry, which increases motivation levels for the drug of choice.

Driving forces

Conditioned behavior—think Pavlov’s dogs—is hard to break. Habits can be broken and then come back at the sound or scent of something that originally cued it, for instance. While all learning essentially involves reinforcement, and the brain deciding what is worthwhile to engage in a second, or third, or millionth time, process addictions like gambling—or even texting while driving—are based on intermittent reinforcement learning.

In this type of learning, sometimes called variable ratio reinforcement, you never know what you’re going to get—and it keeps you coming back for more. In a classic experiment dating back to the 1970s, scientists found that “you could easily produce behavior that effectively is dysfunctional in an animal by manipulating schedules of reinforcement,” Dr. James Claiborn, a clinical psychologist and author of the book, The Habit Change Workbook, says. The study found that pigeons pecked at a higher rate on a key when it produced intermittent reinforcement rather than regular reward. “If you look at this behavior and then watch someone playing a slot machine, it is difficult to see any difference,” Claiborn says.

While initially habitual behavior can be goal-directed, “it is more accurate to say any behavior which persists is being reinforced,” Claiborn says. “The schedule of reinforcement and other factors determine the pattern of engaging in the habit. This is just as true of behaviors now commonly called addictions, including overeating, excess sexual behavior, prolonged game playing or Internet use, gambling, etc.”

Hard to break

We think of habits as things we do on “autopilot”—and hence, easy to do without giving much thought to them. However, recent research is beginning to show that habitual behavior is not so autopilot after all. MIT’s Dr. Ann Graybiel, an award-winning scientist at the McGovern Institute of Brain Research, is a leading figure in the quest to learn how disorders rooted in the basal ganglia—as diverse as Parkinson’s disease, Huntington’s disease, as well as neuropsychiatric disorders and addictive states—develop.

Graybiel’s experiments in rodent models looking at which brain pathways are activated in the formation of habits have suggested a link between the basal ganglia and the neocortex—part of the executive control area of the brain. In a series of experiments on rats conditioned to navigate a maze seeking a reward, she found that after a habit is formed, the dorsal striatum (in the basal ganglia) is only engaged at the start and finish of the behavior—they call this “chunking” and it is similar to how memories are formed and stored. Essentially, the habit areas of the brain are “on” only at the start and finish of habitual behavior. However, even though the striatum turned to autopilot mode during the actual habitual activity, Graybiel’s team also discovered that by optogenetically (using light) stimulating another region of the brain located in the neocortex, they could interrupt a habit or even prevent it from forming.

“Even if we are not conscious of monitoring our habitual behaviors—after all, that is a large part of their value to us—we have circuits that actively keep track of them on a moment-to-moment basis,” she writes in a recent article for Scientific American magazine co-authored with Dartmouth’s Smith.

How to change?

Habits haven’t yet hijacked the circuits that influence addiction—memories, emotions, and impaired decision-making are not yet inextricably linked to the substance or behavior. So maybe, like Graybiel believes, we can intervene at the right moment to prevent them from forming?

“Most of what we call addictions these days are simply behaviors that get reinforced and lead to adverse consequences for the individual but do not represent any special process that is not active in everyone every day,” Claiborn says. “If we want to change behaviors, then we want to look at these same principles of learning and what we know about behavior change and modify controlling variables including reinforcement schedules.”

In their paper, Wood and Neal suggest the two most effective ways to change habits are to either willfully inhibit the habit once it’s been cued, or, avoid the cues that lead to habitual behavior. The first can be difficult, and studies have shown that the ability to exert self-control over one area (i.e., resisting that jelly donut) is diminished if you’ve already had to focus on a task that requires self-control (i.e., working out).

Wood and Neal admit that neither way is sustainable in the long-term for most people, and possibly the most effective way to change a habit would be to pair either inhibition or avoidance with “learning and performing a new, desired response.” Others have proposed that changing contexts helps—moving house or changing jobs could become opportunities for changing habits.

“Research on the neuroscience of addiction has shown that behavioral addictions arise from the same neural adaptations as drug addictions,” Carise says. “But, even if we did not have this new research, when any behavior begins to have negative consequences—when people lose their jobs, their health, their families because of any detrimental activity that they do not feel in control to stop—we should be prepared to help them and to provide treatment we know can work. No one should be kept from living the life of their dreams because of an addiction, even if we still call it a bad habit.”

Jeanene Swanson is a regular contributor to The Fix. She last wrote about the science of nicotine addictionerasing your traumas and alcoholism and genetics.

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