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Addiction is a growing problem in the modern West. But how we treat it depends heavily on how we understand it, and how we understand it depends, in turn, on how we understand ourselves. In the first of an occasional series of articles on science and religion in the modern world, Theos’ Senior Fellow Nick Spencer looks at our addiction to addiction. 27/09/2019
Our definition of addiction is growing. Once upon a time, we were addicted only to substances: alcohol, drugs, nicotine. Now, and increasingly, behaviours are judged to be addictive.
Since 1980, when the Diagnostic and Statistical Manual of Mental Disorders first classified gambling as a disorder, the idea that people could be addicted – in a formal, medical sense – to a pattern of behaviour has grown. In May this year, the World Health Organisation included gaming disorder in its International Classification of Diseases for the first time. The NHS runs a gambling clinic and has plans to open a gaming one.
There are sex addiction clinics aplenty in the US (Harvey Weinstein famously checked himself into one when the wave of sex and rape allegations broke over him). Compulsive sexual behaviour is, in fact, classified only as an ‘impulse control disorder’, rather than formally a behavioural addiction. However, ‘sex/ porn addiction’ is a widely–used term and many think it is a matter of time before sufficient evidence is gathered and it is ‘upgraded’, so to speak.
In a similar way, the substances in food are not generally considered to be addictive. However, according to the NHS, “researchers argue that… it would be more useful to talk of a behavioural addiction to the process of eating and the ‘reward’ associated with it.” In other words, when it comes to food it is the behaviour rather than the substance that is addictive.
Reactions to this tend to be pungent. In one corner there are those who chorus, “About time!” They welcome the recognition of such behaviours as medical disorders, and of addicts as patients or victims rather than as spineless or immoral wrongdoers. They tend to brush over Harvey Weinstein. In the other corner are those who roll their eyes and chorus ‘What next?’ They wonder whether humans can be credited with any moral agency any more, or at least agency for which they can be blamed. They tend not to know what addiction is like from the inside.
This is more than a little local difficulty. In fact, the stakes are surprisingly high, because we’re playing not only for the right understanding and treatment of addicts, but for a pretty fundamental understanding of human nature. And in doing so, we touch on a number of themes in Theos’ growing work on science and religion.
There is, it should be emphasised, a clear, consistent, reasoned, and well–evidenced (neuro)scientific case for the classification of certain behaviours as addictive. Serious scientific analysis of addiction began in 1960s and 70s, but it was only with the development of PET (positron emission tomography) scans in ‘90s that a more detailed understanding of what is going on in the brain during addiction emerged. The details are highly complex and technical (and way beyond my capacity) and scientific opinions on the topic vary. However, the basics mechanisms – involving the neurotransmitter dopamine and the gene transcription factor DeltaFosB – are well–established.
There is more. The neuroscientific analysis can go further than addiction and provide a physiological explanation of habits and even character. In the words of one recent article on the subject in New Scientist:
“the prefrontal cortex, where decisions are made, is far quieter in the brains of people who are addicted than in those who aren’t. This suggests that their brain function had changed as a result of drug use…”
There is clear overlap in the dopamine surge in the brains of those addicted to substances and those addicted to the behaviour. Drugs may have a more powerful effect, but the difference is one of level not kind. In short, the medicalisation and pathologization of certain behaviours is not speculative. It’s serious, well–evidenced and coherent.
Does this mean that gambling, gaming and porn are, therefore, medical problems? And if them, why not other behaviours? After all, a different New Scientist article from 2017, reported how the craving, euphoria, dependence, and misery of “intense romance” could be understood (if not yet classified) as following the pattern of a classic addiction, and speculated that “people struggling with love addiction may one day benefit from other types of drugs.” Indeed, that is more or less what scientists managed to do with prairie voles, monogamous critters whose tendency to form strong pair bonds was disrupted by the manipulation of the hormone vasopressin, causing the normally faithful males to stop defending their mates, and spend more time with other females. (I will pause here to let this simultaneously cute, bizarre, amusing, and tragic image rest with you a moment). If not voles, why not us?
The answer is indeed why not. You could, I imagine, develop a coherent narrative of addiction through the language and logic of dopamine, DeltaFosB, vasopressin, and the like, in much the same way as Enlightenment savants imagined a coherent picture of the universe, past, present and future, in the language and logic of Newtonian mechanics.
Yet, coherent as it may be, it would still be inadequate, because it leaves out things that are real and relevant to the subject of addiction, and in doing so, offers only a partial narrative, one that, crucially, has tools inadequate for the problem.
“Leaves out things” requires clarification. The medical understanding of behavioural addiction doesn’t omit things in the sense of ignoring patterns or data that it can’t explain, any more than a physical atlas might leave out an awkwardly shaped island or mountain range. It does, however, leave out questions of agency, morality, will power, relational networks, repentance, humility, forgiveness, and the like, about which it has nothing to say – in much the same way that a physical atlas says nothing about ethnic groupings, language borders, religious demographics, resources, etc. It’s not that agency or morality are any less real than ethnicity or languages. They’re simply not captured by the language of neuroscience (/ physical geography).
To insist that human behaviour is only a matter of dopamine, vasopressin, oxytocin and other hormones that have gained fame of late is effectively to dismantle the human. Indeed, it is to explain human behaviour at precisely the cost of losing the human, who we are and what we do dissolved into a network of genes and neurotransmitters.
In a similar way, to believe that human behaviour is only a matter of agency, will, morality and so forth is to spiritualise or Platonise us, disembedding humans from the gross materialism of reality in favour of pure quintessence. It is (again) to explain human behaviour at the cost of losing the human, only this time at the other end of the scale. If one error flattens us, the other evaporates us.
Where does this leave our attitude to behavioural addiction? That depends if we can move away from either/or – neuroscience or agency; vasopressin or moral willpower; etc. – and expand our mind to encompass both/and.
In a worldview dominated by neuroscience, PET scans and genetic manipulation, everything looks like a hormone or a genetic problem. Thus, the only legitimate response to addiction becomes hormone or gene therapy. Conversely, in one dominated by agency, responsibility and morality, the only response is one of counselling, exhortation, correction, and the like. Yet neither seems adequate. ‘Pull yourself together and exercise some will power’ is as problematic a response to addiction as ‘take this pill and you’ll no longer feel a thing’.
If we take both/ and seriously however, we will recognise that sometimes ills demands pills, and many times they do not. There will be examples of addiction that are so severe or intense that a medical intervention is necessary, if only to stabilise the person and gain time and energy for a more personal intervention.
Where we draw the line will be highly debatable but my sense is that our default option should be the ‘human’ level of agency and morality, and that we should reach for the medical one only as a last resort. And the reason for this offers a nice contortion on the oft–mouthed New Atheist soundbite, “science works.”
It is, I think, highly instructive that Professor George Vaillant’s analysis of the uniquely long–running longitudinal Grant study of the adult development of Harvard students from the class of 1939–44, in parallel with the Glueck study of a matching cohort drawn from Boston inner–city ‘underclass’, reported that when viewed beyond a five–year window, almost all health interventions and short–term talking remedies such as cognitive behaviour therapy had only short–term limited effects, or indeed none at all. The studies’ cases were about more than addiction, but are nonetheless instructive. Medical interventions of this nature worked but often only temporarily. In contrast, Vaillant observed, the two factors that did make a long–term difference were interventions on improving relationships and those that reach into the spiritual side of people’s lives, Vaillant citing the global success of Alcoholics Anonymous 12–step process as the classic example of the latter.
In other words, for all that behaviour addiction, as much as substance addiction, is undoubtedly a neurochemical reality, and one that is susceptible to neurochemical responses, a long–term solution is most likely to be found in recognising and treating it as a human problem with recognisably human solutions. Relational healing and spiritual meaning make the biggest difference. Or, put another way, religion works.
Nick is Senior Fellow at Theos. He is the author of a number of books and reports, most recently The Political Samaritan: how power hijacked a parable (Bloomsbury, 2017), The Evolution of the West (SPCK, 2016) and Atheists: The Origin of the Species (Bloomsbury, 2014).
Posted 27 September 2019
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Theos researches and investigates the intersection of religion, politics and society in the contemporary world.