When it comes to addictions, something strange is happening in Britain. On the plus side, government figures suggest that the cases of addiction to drugs such as heroin, cocaine and alcohol are either shrinking or have flatlined.
But it seems that the nation is increasingly swapping addictions to drugs 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 told Good Health: ‘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.’
It seems the nation is increasingly swapping addictions to drugs for a plague of ruinous lifestyle habits. These include cravings for social media, gambling, sex — and eating junk food
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 feelgood 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 this month, the EU is imposing 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).
Fear about real addiction to social media is one of the most high-profile concerns (File image)
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 Brits, 10 million people, are addicted to ultraprocessed foods. The charity is campaigning for food addiction to be a recognised condition so that people can get clinical help to quit cravings.
Under the microscope
Broadcaster and writer Gyles Brandreth, 75, answers your health quiz
CAN YOU RUN UP THE STAIRS?
I have to. I had a wake-up call in Ireland not long ago when someone shouted across the street: ‘Hi, Joe!’ They clearly thought I was the American President, who’d just been there. Ever since, I’ve been running up and downstairs — and without holding the bannister.
These days I can’t afford to put on weight at all. I’m known for my colourful jumpers, all knitted 40 years ago and I still have to get into them. It’s why I follow a low-carb diet which outlaws bread, rice, potatoes and pasta. I’m a pescatarian. I gave up alcohol 25 years ago. I weigh around 12 st [he’s 5 ft 10 in].
I’m a cakeaholic. Show me a slice of Victoria sponge and I’m your man.
POP ANY PILLS?
My wife, Michele, puts out four vitamins each morning at breakfast. I’ve never asked what they’re for.
ANY FAMILY AILMENTS?
My father was a heavy smoker and died of cancer at 71. I’ve never smoked, but two of my sisters did and also succumbed to cancer at 61 and 84. My mother lived to 96, as did the Queen. I’m using them as role models.
COPE WELL WITH PAIN?
Not terribly well. I yelped like a baby when I broke my arm last year. I was in Scotland walking down a road and, for no very good reason, I tripped over. My wife called an ambulance. I was given gas and air — heaven!
HAD ANYTHING REMOVED?
Only my appendix when I was 11. I wanted to get out of playing rugby so pretended to have stomach pains, which resulted in me being whipped into hospital and having it removed.
TRIED ALTERNATIVE REMEDIES?
Yes. My great-great-great-grandfather made a fortune in Victorian times by marketing something called Brandreth’s Pills; vegetable pills sold around the world. Want a baby? Take a Brandreth pill. Don’t want a baby? Take a Brandreth pill. They cured everything. I have some of them [they’re still available in parts of the Middle East] which I occasionally swallow.
WHAT KEEPS YOU AWAKE AT NIGHT?
Nothing, but I do often wake up at 5am. To get back to sleep, I count my blessings: my wife, my cat, my children, my grandchildren — though I’m usually asleep before I reach the young ones.
It used to be a fear of flying, but then someone pointed out to me that I’d been flying since 1955. He asked me how many accidents I’d been involved in. When I told him none, he said that my phobia was, therefore, irrational.
LIKE TO LIVE FOR EVER?
Oh, yes, because there’s still so much to be done — and so much to be said.
Gyles’s one-man show, Can’t Stop Talking!, is at the Edinburgh Fringe until August 27, and on tour from September 1 to January 17.
Britain 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, told Good Health: ‘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, ultraprocessed foods clearly do not have the chemically addictive powers of classic drugs of addiction, such as heroin — otherwise we would all become ultraprocessed food addicts after sampling the products only a very few times.
Instead, it seems more likely that overeating ultraprocessed 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 told Good Health.
What’s more, Professor Griffiths is highly sceptical of the idea that large numbers of Britons 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.
‘The number of people who fulfil my addiction criteria for behaviours — including to social media and food — are few and far between,’ he adds.
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 in the UK 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’ 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.
How medicating might make addiction worse
Rather than using psychological behavioural therapies such as CBT to tackle our behavioural addictions, a new set of drugs may provide a solution.
The crucial role that our brain chemistry plays in driving addictive behaviour has been highlighted by warnings of serious problems caused by a common antipsychotic drug to treat mental illnesses.
In March, Professor Henrietta Bowden-Jones, of the National Centre for Gaming Disorders, warned how she had seen growing numbers of patients at her clinic who had become gambling addicts after being prescribed aripiprazole for schizophrenia. Although behavioural addictions are a known side-effect of the drug, she says that patients were not warned by doctors prescribing it, and that mental health teams are failing to monitor these patients for emerging addictions.
Rather than using psychological behavioural therapies such as CBT to tackle our behavioural addictions, a new set of drugs may provide a solution (File image)
This is despite the mental health charity Mind warning that aripiprazole can also cause people to eat or shop excessively, or become abnormally sex-obsessed.
How can aripiprazole have such effects? The answer seems to lie in dopamine, a brain chemical associated with reward and pleasure. Numerous studies show that when we are exposed to a stimulus that is rewarding, our brains respond by releasing dopamine that gives us feelings of pleasure and makes us remember the experience and want to repeat it.
When this feedback loop of stimulus and pleasure becomes extreme, we may get addicted to the stimulus. According to DrugBank Online, a project funded by the Canadian Institutes of Health Research, aripiprazole seems to work by regulating dopamine in the brains of people with mental illnesses.
In people with low dopamine, it increases levels of the chemical in the brain. But it seems that in some people it may increase dopamine excessively.
Similar addiction risks are seen with dopamine-boosting drugs prescribed to patients with Parkinson’s disease.
Professor Bowden-Jones says: ‘We have been aware for years of Parkinson’s medication’s ability to trigger gambling problems in patients who have never gambled. I have met many people who have experienced this very difficult side-effect.’
Conversely drugs that block dopamine help tackle addictive behaviour. This is being seen with dopamine-blocking drug naltrexone. ‘We use it at our NHS clinics if gambling patients do not respond well enough to psychological therapy,’ says Professor Bowden-Jones.
This is an ‘off-licence’ use of the drug, which in the UK is licensed only to manage opiate dependency. She adds: ‘For some of our patients, the effect is literally night and day. They go from gambling all day every day to not being interested in it.’
The NHS says that serious but rare side-effects of naltrexone include depression, attempted suicide and hallucinations.