Dossier: Strong mind

When does a habit become an addiction?

Addiction tends to creep up on us gradually – for a long time, we fool ourselves into believing we can stop at any time. Caroline Zeller, clinical psychologist and addiction therapist, explains why it’s so hard to stop and how you can break the dependency for good.

Text: Irène Schäppi / Caroline Zeller; photo: XXX

Ms Zeller, how do we define addiction?

Definitions and medical diagnoses of substance abuse and addictions are fluid and reflect their time. They can differ, for example, in terms of criteria, causes and explanatory approaches. Today, the World Health Organisation’s ICD-10 and DSM-5 international classification of disease systems define what is meant by a dependency in a professional context.

One criterion is if a person uses an addictive substance as a strategy for emotional compensation in critical life situations. Over time, this gives rise to a psychological and physical dependency and consumption increases. Another typical sign of addiction is that addictive substances such as alcohol, tobacco and illegal drugs are increasingly mixed.

With behavioural dependency, the person affected performs an activity longer and more intensely than actually intended. Or they lose control and can no longer stop. And, as a result, they start to neglect their social contacts and professional commitments. 

What is the difference between behavioural and substance-related addiction?

Behavioural addictions are not related to substances but to the behaviour or the feeling experienced by acting out the behaviour. These include an addiction to sex, shopping or the internet, for example. Usually, dependence and addictive behaviour are understood more as substance-related addictions, for example to nicotine, illegal drugs or alcohol.

And that’s why behavioural addictions are not listed as separate disorders in the above ICD-10 diagnostic system. Instead, behavioural addictions are listed there as abnormal habit and impulse control disorder. But things are changing, with gambling addiction being included in the new ICD-11 catalogue as a separate illness for the first time.

How addictions start

There are a wide range of triggers reaching from genetic and neurobiological factors through to environmental and psychological aspects. For example: how has a person learned to handle emotions through their family and upbringing? What is their story? Or perhaps their family has a genetic predisposition to addiction?

Genetic studies confirm that addiction may be hereditary, but it isn’t written in stone. For example, some children from families with a history of addiction don’t fall prey to addictions themselves. And the neurobiological factors can also be explained by the happiness messenger dopamine, which makes addicts increasingly dependent. 

But ultimately, it’s a person’s self-efficacy or resilience that determines whether or not they slip into addiction: What do I believe I can do? What do I want to achieve? What is my standing? How do I handle critical life events? Do I have the emotional resources required to deal with them? The initial decision to take an addictive substance is usually up to the individual.

What’s the best way to treat addiction?

There are many options – it depends which one works best for you. You may benefit from support during withdrawal, an inpatient withdrawal programme, outpatient therapy or a self-help group.

However, it’s important to have regular counselling over a longer period of time so you have the support in place to get help again quickly if you relapse. Talking to a person you trust about negative emotional experiences often helps to change perspective and identify solutions.

Can you ever be cured of an addiction?

You can certainly feel healthy again. However, the WHO doesn’t include a definition for recovery; the diagnosis of “addiction” is retained for life. Once an addiction memory is activated, addictive thoughts can be pushed into the background through counselling and therapy, but relapse is still possible at any time – even decades later. 

How can friends and family help?

We encourage friends, family and even colleagues not to sweep the topic under the table, but to use “I sentences” to explain how they’ve seen the addiction affecting the person. Tell them that you still value their friendship and support them. There’s little point in reproaches and recrimination. But loved ones also have to protect themselves against falling into co-dependency. Friends and family can also go for counselling. 

If communication lines are no longer open, a clean break may be necessary. You have to be consistent and can’t give in after only a short time – and that can be difficult when it’s someone you’re close to. Helper syndrome doesn’t help addicts. A person in a downward spiral often has to hit rock bottom before they can be helped. They have to want to recover from their addiction themselves.

The interviewee

Caroline Zeller is a health and clinical psychologist and addiction therapist in Garmisch-Partenkirchen. As part of her work, she also supports people with addictions.