The case for compulsive shopping as an addiction.
Kate sits at her computer at 1:15am clicking through jewelry websites searching for and finding objects she finds inspiring and beautiful, and relieving the tension from managing family conflicts on her own all day. She often finds herself distracted, counting the minutes until the kids go to bed so she can get online. Her spending has caused ruin to her family and reassessment of financial plans, inability to make mortgage payments and a forced change of housing. Her teenagers have lost respect for her and consider her powerless as a parent. Still, the stolen moments during the day or night looking through deep, rich colors, interesting shapes and combinations are irresistible and she ends up buying more. When she becomes immersed in colors, textures, designs and possibilities, she can't stop herself.
Kent glances at his Ashley Madison smartphone app (an online dating and social network service marketed primarily to married people) and then quickly wishes he hadn't. It is a quick, automatic habit to tap the icon on his phone. Before he can consciously stop himself he is already tempted with easily accessible possibilities. He now knows there are three interested and available sex partners within a few blocks of the office he currently sits in. A brief lunch break is all it would take to meet one of them. He has promised not to do this sort of thing again and is at the brink of divorce over it, but temptation is speaking louder now. It would be so easy, a much-needed thrill on an otherwise joyless day. And who would have to find out?
Tim can hear his elevated heart rate slamming in his ears. Just one more bet and he could win everything back. He figures he is due for a win, especially after all the losing. Although his calculations have been off before, he has a good feeling about this next hand. Wouldn't it be great to come back home with a wallet full of winnings this time? It would validate everything he has been working towards. It's his turn. This is his day. It just has to be.
BEHAVIORAL ADDICTIONS AND ADDICTIVE DRUGS HAVE SIMILAR EFFECTS ON DOPAMINE REWARD AREAS
The brain does not distinguish between dopamine (DA) release due to drugs or experiences (real or imagined). Any pleasurable experience is associated with increased DA release in the nucleus accumbens (NAcc) and ventral tegmental area (VTA). If a drug or experience is hyperstimulating and repeated exposures occur there is risk of neuroadaptation, a down regulation of the DA receptors to maintain a homeostatic level of neurotransmission in the presence of too much DA release. Neuroadaptation can be long-lasting and is a hallmark of addiction. Some behaviors, for some people, can act like hyperstimulating drugs, leading to the same increased release of DA in reward pathways and to neuroadaptation.
One concern with categorizing compulsive shopping as an addiction is that there is no clear limit on the number or variety of behaviors that might qualify as potentially addictive. This could result in an impractically long enumeration of potential addictions, or it would necessitate a more comprehensive broadening of the definition of addiction. Changing the definition of addiction to a general underlying syndrome without emphasizing specific behaviors or substances has been suggested by Shaffer and colleagues (2004). Another solution is to define and describe only the most frequently occurring behavioral addictions and to heighten awareness of factors that increase the likelihood for any behavior to become addictive.
Compulsive shopping occurs in 6% of the general population, which is a greater point prevalence than has been observed with generalized anxiety disorder (GAD) or depression (APA 2000). Compulsive shopping affects men and women equally, with devastating consequences for those who fall victim to it (Koran et al. 2006). Considering its prevalence, serious life consequences and the similarities of problem shopping behavior to addictions it seems important to define and describe shopping addiction to help in its identification and treatment.
Key factors in what makes something addictive are hyperstimulation of DA reward pathways, experienced frequently enough to trigger lasting changes in DA reward pathway functioning. After this neuroadaptation an addict's craving is greater and ability to intervene in addiction-driven behaviors is impaired.
After neuroadaptation, even though a larger than usual amount of dopamine is released into the synapse during a hyperstimulating event, there are fewer receptor binding opportunities. The net DA transmission rate is decreased. Behaviorally, a person who is addicted to a drug or behavior craves an even greater or more frequent exposure to it to feel good or even just to avoid feeling bad. This neuroadaptation can be long lasting, resulting in reward deficiency syndrome, a constant state of withdrawal or deprivation during which the person is nonresponsive to everyday activities that would normally bring a moderate level of pleasure. When the hyperstimulating event is temporarily unavailable or discontinued, the addicted person feels depressed, plagued with withdrawal symptoms and obsessed with obtaining another exposure. People with behavioral addictions also go to extreme means to get further exposures, including deception, self-neglect, legal violations and role failure, a clinical picture very similar to drug addiction.
Drugs of abuse clearly hyperstimulate the DA reward areas more than traditional everyday experiences. Cocaine's intensely pleasurable subjective experience, described as being "like an orgasm without sex," has been associated with a 300% increase in dopamine release (Rawson et al. 2000). Crystal meth elicits 1200% the rate of normal dopamine release. An enjoyable everyday behavior such as eating good food creates an increased DA release of only 50%, and sex creates an increase of only 100% (Rawson et al. 2000).
However, in recent years there has been a growing body of evidence showing that some behaviors, in some people, can be hyperstimulating enough to create addiction-like behaviors and brain changes. Sex, gaming, shopping and gambling are a few such addictive behaviors that have drawn media, clinical and research attention.
Brain imaging studies of compulsive gambling, which was originally thought to be a disorder of impulse control but is now being considered for recatagorization as an addiction in the upcoming DSM-V (APA 2010), show evidence of the same reward physiology hyperactivation as addictive drugs. During gambling experiences or in anticipation of them "monetary reward in a gambling experiment produces brain activation very similar to that observed in a cocaine addict receiving an infusion of cocaine" (Breiter et al. 2001). Behavioral symptoms are also similar, including anticipatory salivation, sweating and profound euphoria "like skydiving." Substance addiction and gambling addiction have a very high comorbidity rate, up to 64% in some studies, (Black & Moyer 1998; Crockford & el-Guebaly 1998) corroborating the idea that gambling addiction and substance addiction have overlapping behavioral and neurophysiological effects.
Running, for a small percentage of people who establish a dedicated habit, has also been described as an addictive behavior such that the runner becomes dependent on endogenous opioid peptide release associated with increasingly rigorous running experiences. Animal and human studies of running show euphoria after strenuous running, need to increase the distance or effort to continue the feeling of well being, an increased tolerance to pain medications and withdrawal symptoms including depression, irritability or anxiety if running is prevented or when naloxone is administered (Kanarek et al. 2009). Although the direct action of endogenous opioid release associated with running is on a non-dopamine pathway, it also indirectly causes hyperstimulation of DA in the VTA and NAcc via a reduction in activity of DA-inhibiting GABA neurons. This is the case with nicotine as well (Luo et al. 2011; Britt & McGehee 2008).
FACTORS ASSOCIATED WITH ADDICTIVE BEHAVIORS
Factors which increase the likelihood of a behavior becoming addictive include: (1) a hyperstimulating experience (or an experience that was hyperstimulating during initial exposures); (2) easy accessibility or a high likelihood of frequent engagement; and (3) vulnerability to addiction, which can be genetically present or can be created by neuroadaptation or reward deficiency syndrome.
How Does Shopping Become as Hyperstimulating as an Addictive Drug?
Coca-Cola took the cocaine out of their formula in 1903, but marketing research is finding more sophisticated ways to make advertising, product experience and packaging work on the reward circuitry of consumer brains as if the drug was still involved.
Neuromarketing is the use of scientific brain research to potentiate the effectiveness of product marketing. This research uses fMRI brain imaging, EEG, skin moisture levels, heart rate, breathing patterns, eye movement and pupil dilation among other scientific measures. Marketing firms have spent 6.8 billion dollars in research (leading to 117 billion in advertising) (Wells 2003) learning to maximize the influence that branding, packaging, product placement and ad content can have on shopper decisions to buy. Many neuromarketing studies bypass the conscious adult rational decision-making brain functions to maximize excitement, emotional attachment, brand attachment, reward pathway activation, medial prefrontal identification and oxytocin stimulation, influencing impulsive buying decisions in ways individuals are not aware of or informed about (Robischon 2010). Companies such as Google, CBS, Disney, Frito-Lay, A&E television and some political campaigns (Robischon 2010) have used neuromarketing to investigate consumer reactions to their brands (Singer 2010) and then restructure advertising strategy.
A few examples of scientifically informed marketing include incorporating the color red (think of the coke can) resulting in attributions of intelligence and power to owning a product or to sales people (Elliot & Aarts 2011). "Sneaker radio", a muzak-like soundtrack designed for use in athletic shoe stores, is designed to slow a shopper's pace through the store and increase impulsive purchases. Studies using fMRI scans can identify which ad strategies trigger the consumer to strongly desire a product, saying they are "itching to buy" (Thompson 2003). Bypassing interaction with the cortex and maximizing stimulation of emotional and reward areas can create hyperstimulating and difficult to resist marketing and can sabotage avulnerable shopper's intentions and efforts to resist buying.
Other ways shopping can become hyperstimulating is by ascribing an exaggerated sense of importance to buying products, or to the process of shopping. For some, shopping has essential importance as the only source of praise (from sales people), excitement, or accomplishment (finding a deal, creating a look, searching for the best sweater). Finding an amazing sale, searching for flattering clothes or adding books or technology to your collection can be a crucial external source of identity and validation for some people, just like a job, car or grades. A shopping addict may come to depend on external sources like these, with their confidence and life satisfaction fluctuating along with buying opportunities. Some suggest that the process of shopping can function as a reenactment of the original attachment bond in an attempt to repair childhood experience of insecure attachment (Muensterberger 1994). If so, shopping addiction may be a pattern difficult to break.
Behaviors may not reach the intense level of DA hyperstimulation that drugs do when each separate exposure is compared. However, because addictive behaviors are more easily accessible and more frequently engaged in than drug use (more exposures per day or week), the net effect of many more frequent exposures can make an addictive behavior hyperstimulating enough to have similar behavioral and physiological consequences as drugs.
Consider the example of nicotine, which has been shown in some studies to be as addictive as heroin, but clearly has a weaker reward stimulation per exposure. Frequency is the key difference. A heroin addict does not use every day. However a smoker may have ten or more uses per day. More exposures means more pairings of use and mild hyperstimulation, more encoding of the positive associations with smoking in memory, more consistent hyperstimulation of DA reward areas and more ease in increasing use. Due to its ease of availability, someone who tries smoking is more likely to become addicted than someone who tries heroin (Hilts 2009).
Shopping has increased dramatically in availability. Shoppers no longer have to escape work or home to get to a store. Twenty-four hour online shopping and personal media devices make it available anywhere, just a few finger-taps away. A shopper can browse or purposefully seek target items during many stolen moments each day, from almost any location, or for extended amounts of time whenever a break may occur. Impulses to buy can be acted on immediately, without the protective time delay there used to be. And the steps to completing a purchase have become shortened, with credit card numbers already saved and one-click purchasing options additionally catering to impulsivity.
Brain Changes Associated with Reward Deficiency Syndrome Make It Harder to Stop the Behavior
Long-standing addictions trigger changes not only in DA reward physiology but also to its cortical connections, thereby impairing self-regulation. Although the addicted person and their surrounding family or support people are still ultimately responsible for choosing interventions to stop problematic behavior, changes in the addict's brain physiology can make it harder to do this himself. Actions "preferred" (valued at higher importance) by hyperstimulated striatal neurons are more likely to occur despite the addict's conscious insight (Lau & Glimcher 2008; Hikosaka et al. 2008; Hikosaka, Nakamura & Nakahara 2006). This means that when desires become addictions they can have an overriding command over behavior and decision making, which is difficult to interrupt even in the presence of insight or higher goals. Addicted brains also show less age-related expansion of white matter, reflecting a loss of learning capacity and difficulty making new choices, further inhibiting an addict's control over impulsive reward seeking behaviors (Goldstein & Volkow 2002). People who find themselves in the trap of addiction, whether to a drug or a behavior like shopping, need to be able to access effective interventions and support in order to stop the problematic behavior and prevent relapses.
Evidence suggests that shopping, similarly to other addictive behaviors, for approximately 6% of men and women, can share many physiological and behavioral characteristics of addiction.
Compulsive shopping is a prevalent problem involving hyperstimulation, sometimes unintentional and repeated overindulgence despite negative consequences, deception and self neglect. Given the high prevalence of the problem and its strong similarities to other addictions, it would be clinically helpful to define and describe shopping as a potentially addictive behavior. Breaking a shopping addiction habit can be a complicated task involving more than just insight and will power. Identification of the addiction is a necessary first step in successfully helping addicts towards recovery. Awareness of how the physiological components of addiction can complicate efforts to stop the behavior is helpful in terms of avoiding self-blame for failed attempts to stop, predicting high-risk relapse situations and encouraging acceptance of social support and help with treatment. It can also help in structuring a tailored treatment plan that is more likely to work.
American Psychiatric Association (APA). 2010. DSM-5: The Future of Psychiatric Diagnosis. Available at www.DSM5.org
American Psychiatric Association (APA). 2000. Diagnostic and Statistical Manual of Mental Disorders. Fourth Ed., Text Rev. Washington, DC: APA.
Black, D. & Moyer, T. 1998. Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior. Psychiatric Services 49: 1434-39.
Breiter, H.; Aharon, I.; Kahneman, D.; Dale, A. & Shizgal, P. 2001. Functional imaging of neural responses to expectancy and experience of monetary gains and losses. Neuron 30 (2): 619-39.
Britt, J. & McGehee, D. 2008. Presynaptic opioid and nicotinic receptor modulation of dopamine overflow in the nucleus accumbens. Journal of Neuroscience 28 (7): 1672-81.
Crockford, D. & el-Guebaly, N. 1998. Psychiatric comorbidity in pathological gambling: A critical review. Canadian Journal of Psychiatry 43: 43-50.
Elliot, A. & Aarts, H. 2011. Perception of the color red enhances the force and velocity of motor output. Emotion 11 (2): 445-49.
Goldstein, R. & Volkow, N. 2002. Drug addiction and its underlying neurobiological basis: Neuroimaging evidence for the involvement of the frontal cortex. American Journal of Psychiatry 159 (10): 1642-52.
Hilts, P. 1994. Is nicotine addictive? It depends on whose criteria you use. New York Times. Aug. 2. Available at http://www.nytimes.com/ 1994/08/02/science/is-nicotine-addictive-it-depen ...
Hikosaka, O.; Nakamura, K. & Nakahara, H. 2006. Basal ganglia orient eyes to reward. Journal of Neurophysiology 95: 567-84.
Hikosaka, O.; Bromberg-Martin, E.; Hong, S. & Matsumoto, M. 2008. New insights on the subcortical representation of reward. Current Opinion in Neurobiology April 18 (2): 203-08.
Kanarek, R.; D'Anci, K.; Jurdak, N. & Foulds Mathes, W. 2009. Running and addiction: Precipitated withdrawal in a rat model of activity-based anorexia. Behavioral Neuroscience 123 (4): 905-12.
Koran, L.; Faber, R.; Aboujaoude, E.; Large, M. & Serpe, R. 2006. Estimated prevalence of compulsive buying behavior in the United States. American Journal of Psychiatry 163 (10): 1670-72.
Lau, B. & Glimcher, P. 2008. Value representations in the primate striatum during matching behavior. Neuron 58: 451-63.
Luo, A.; Tahsili-Fahadan, P.; Wise, R.; Lupica, C. & Aston-Jones, G. 2011. Linking context with reward: A functional circuit from hippocampal CA3 to ventral tegmental area. Science July: 353-57.
Muensterberger, W. 1994. Collecting: An Unruly Passion. San Diego, Harcourt Brace & Co.
Rawson, R.A.; McCann, M.J.; Hasson, A. & Ling, W. 2000. Addiction pharmacotherapy 2000: New options and new challenges. Journal of Psychoactive Drugs 32: 371-78.
Robischon, N. 2010. Neuromarketing the 2010 elections: Scoring campaign ads. Fast Company. Nov 5. Available at http://www. fastcompany.com/1700207/campaign-ads-and-neuromarketing
Shaffer, H.; LaPlante, D.; LaBrie, R.; Kidman, R.; Donato, A. & Stanton, M. 2004. Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry 12: 367-74.
Singer, N. 2010. Making ads that whisper to the brain. New York Times November 14: BU4.
Thompson, C. 2003. There's a sucker born in every medial prefrontal cortex. New York Times Magazine. October 26: 54-65.
Wells, M. 2003. In search of the buy button. Forbes. September: 62-70.
Heidi Hartston, Ph.D. (a)
(a) Psychologist, private practice, Oakland, CA.
Please address correspondence to Heidi Hartston, Ph.D., 5278 College Avenue, Oakland, CA, 94618; email: email@example.com
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|Publication:||Journal of Psychoactive Drugs|
|Date:||Mar 1, 2012|
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