When you think about addiction, what images does it bring to mind? Negative, overt, unhappy-ending sort of images? Loss-of-everything images? Think you know an addict when you see one? Life’s a mess, face is a mess, no job, no friends or loved ones left to help out – maybe even homeless, helpless, and shameless…
The truth is, addiction has many faces; it impacts people of every gender, ethnicity, size, and socioeconomic status – and addiction manifests itself in many ways: drugs and alcohol, gambling and sex, shopping, working, food, and even exercise.
In some ways, addictions can go undetected, made light of, or even celebrated. Consider the work-a-holic dad who is accommodated by his wife and children because of the money he earns for the family, the high prestige his job brings, or both; the relationship addict who lunges from one intense, dramatic relationship to the next, only to laugh about her pain and poor choices over drinks with her friends, or make fun of herself for “always choosing the wrong guy.” And what about addicts who are respected, rewarded, and even revered for their compulsions?
One of the most insidious labels society ascribes to people struggling with addiction is “high-functioning”, a misconception Sarah Allen Benton discussed at length in her book, Understanding the High Functioning Alcoholic.1 Often used as an excuse for unhealthy behaviors, the label ‘high-functioning’ obscures the emotional, developmental, and relational consequences of addiction: interpersonal isolation, guilt, shame, dissolution of relationships, and distortion of rational thinking. Sometimes, addictive behavior has even been described as “healthy” when it results in financial, occupational, or appearance-related rewards.
And high-functioning addicts of all types are much more common than people realize. Recent research examined the prevalence of 11 unique addictions over a 12-month period.2 These addictions included both substances, like drugs and alcohol, and “processes”, like gambling, shopping/spending, and exercise, among others. The authors of the research concluded that approximately 47 percent of the U.S. population shows signs of an addictive disorder in a one-year period.
Based on these findings, addiction is so prevalent in American society that it can be described as common. These addictions occur along a spectrum, ranging from what could be considered catastrophic and life threatening, to invisible, productive, and even “healthy.”
Some solutions for addiction, specifically substance addiction, are well known: Detox, rehab, counseling, 12-step programs. Another often-used solution is to trade up one addiction for another. Many alcoholics in early recovery joke that they traded in their pints and fifths for Ben and Jerry’s. Cocaine addicts in recovery feel they could not survive without lots of coffee and plenty of energy drinks, and many, many in early recovery would identify participation in AA, NA, and other 12-step programs as a substitute addiction for their drug of choice. In fact, 12-step programs were recently described as substitute addictions for people recovering from drug or alcohol dependence.3
A variety of behaviors and activities can used to substitute one addiction for another. Most notably is the transfer of addiction from food to drug or alcohol use. A growing body of research demonstrates a strong correlation between gastric bypass surgery and subsequent development of an alcohol use disorder (King et al., 2012; Svensson, et al., 2013).4,5
Currently referred to as substitute addiction, cross-dependence, or addiction transfer, these interchangeable terms refer to the phenomenon of swapping out one addictive behavior for another.6 The transfer of addiction emerges from a concerted effort to abstain from his or her substance or behavior “of choice.” Once an addict abstains from this substance or behavior, cravings and urges to cover up the thoughts and feelings that emerge can be overwhelming. In an effort to avoid the substance or behavior of choice, an alternative may easily be identified, which removes (or temporarily weakens) the negative consequences of abstaining from the drug of choice. This transfer is often met with social approval, leading it to be labeled, “healthy,” or at the very least, “better than” the previous addictive behavior.
Take exercise, for example, which could be viewed as a “healthy” trade-in for other addictive behaviors. Exercise and the pursuit of fitness can become a craving or compulsion when a person continues to engage in excessive exercise despite adverse consequences like injury, overtraining, and fatigue.7 Although working out may seem like a great substitute behavior to drug or alcohol use, obsession with exercise comes with its own risks.
Exercise dependence includes classic symptoms of addiction, like tolerance, withdrawal, and relapse, and can have negative effects on social and occupational functioning.8
Exercise addiction can often be accompanied by an eating disorder, but is a unique and separate condition.9 A common misconception is that exercise addiction is a “healthy addiction.” In truth, an exercise addict may choose working out over spending time with friends and family and may continue to exercise when she is exhausted or over trained. Although this person may appear healthy and “high-functioning,” she is most likely obsessed, drained, and not present for her own life.
Maintain Balance in Your Life
Ultimately, only you can determine whether or not your use of a habit, behavior, or substance is healthy or not. Remember that a “balanced” life isn’t stagnant – it requires flexibility, growth, and constant adjustment. Forming healthy habits and sampling new experiences is fabulous. Allowing those same habits to become the number one priority prevents you from living a full, balanced life.
If reading this article causes you to question your use of a substance, or a process (like exercise), it’s helpful to examine the pros and cons. Make a simple list, inserting your substance or process “of choice” in the blank space:
Pros: “What do I get out of ____?”
Cons: “What do I miss out on, or sacrifice, because of ____?”
Ask yourself these questions,
- “Does _____ add to, or take away from the quality of my life?”
- “Does _____ have a positive or a negative impact on my relationships?”
- “What percentage of my thoughts and mental energy is devoted to planning for, enjoying, thinking about, or avoiding _____ ?”
- “Name five alternative coping skills or enjoyable activities to _____ ?”
- “What would happen if I abstained from _____ for a period of time?”
If your answers to some of these questions concern you, talk to a friend. If you’re still worried, check in with a counselor, nutritionist, personal trainer, or other professional who has expertise in the behavior or substance that you are worried about. Don’t carry the burden alone! Talking out loud about your internal struggle can help you to determine what might be the next best step.
If you’re recovering from an addiction of some kind, brava! It’s common to shift your thoughts and focus from your previous addiction to something new – maybe something you perceive as less dangerous, harmless, or even “healthy.” Keep in mind that addiction isn’t just about what you’re using, but how. Being a “high-functioning” addict doesn’t make it OK to be an addict. My favorite explanation of addiction perfectly underlines the core feature of addiction:
Every addiction arises from an unconscious refusal to face and move through your own pain. Every addiction starts with pain and ends with pain. Whatever the substance you are addicted to – alcohol, food, legal or illegal drugs, or a person – you are using something or somebody to cover up your pain. — Eckhart Tolle
Do you use a substance or a process to cover up pain? Does it keep you from getting all that you want out of life? If so, check it out, even if it feels benign or provokes anxiety. We all have go-to behaviors: ways to unwind, disconnect, escape. Unhealthy coping skills cause unwanted side effects, and can get in the way of your goals, your relationships, and your happiness. Healthy coping enables you to deal with your thoughts and feelings and get back to the business of your life!
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- Benton, S.A. (2009). Understanding the High Functioning Alcoholic. Praeger Publishers, Westport, CT.
- Sussman, S., Lisha, N., and Griffiths, M. (2011). Prevalence of the Addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
- Sussman, S., Reynaud, M., Aubin, H.J., and Leventhal, AM. (2011). Drug addiction, love, and the higher power. Evaluation and the Health Professions, 307, 362-70.
- King, W.C., Chen, J.Y., Mitchell, J.E., et. Al. (2012). Prevalence of alcohol use disorders before and after bariatric surgery. JAMA, 23, 2516-2525.
- Svensoon, P.A., et al., (2013). Alcohol consumption and alcohol problems after bariatric surgery in the Sweedish obese subjects study. Obesity, 21, 2444-2451.
- Sussman, S. and Black, D.S. (2008). Substitute addiction: a concern for researchers and practitioners. Journal of Drug Education, 38, 167-180.
- Griffiths, M.D. (1997). Exercise addiction: a case study. Addiction Research, 5, 161-168.
- Berczik, K. et al., (2012). Exercise Addiction: Symptoms, diagnosis, epidemiology and etiology. Substance Use and Misuse, 47, 403-417.
- Lichtenstein, M.B., et. Al. (2014). Exercise Addiction: A study of eating disorder symptoms, quality of life, personality traits and attachment styles. Psychiatry Research, 215, 410-416.
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