Historically characterised as a male problem, in reality, addiction crosses the gender line. Women make up almost half of New Zealanders seeking telephone counselling for problem gambling; up to 40 per cent of Alcoholics Anonymous participants are female; and we remain significant among the numbers of people on prescription treatments like methadone for drug addiction, and high users of prescription drugs such as Valium.
Female addictions are also on the rise - women comprise the majority of binge eaters and email/Facebook addicts. And that image of online gamers as tracky dak-clad, pizza-scoffing blokes? Delete. Women aged 25 to 34 outnumber game-playing men - the difference is that we're playing things like Tetris and puzzle games more often than console shoot-'em-ups. Of course, some women can pull the plug after five minutes while others end up bleary-eyed and dreaming of polygons, which raises the question: what makes something an addiction?
"People can go out shopping to help manage feeling a bit shitty, and that doesn't mean they've actually got a disorder," says Dr Dan Lubman, associate professor in addiction psychiatry at the University of Melbourne. "But what we're talking about is people who do that to such an extent that it's interfering with other important activities like work, personal life, managing finances - and they start really struggling to control their behaviour."
This is how an addiction to overeating affected Lynn*, and alcoholism affected Elizabeth*. Read on for their real stories and to get the lowdown on the science of addiction.
Status: Lynn Thomas is avoiding the kitchen at all costs
Last updated: 4 minutes ago
Work: web producer
Born: 1982
TO: Women's Health
FROM: Lynn
Subject: Hunger has nothing to do with it
When I'm in an eating slump, I don't eat to feed my body. Food becomes an obsession. Paying attention to whether I'm still hungry goes out the window. It becomes a race to finish food, a bag of chips or pizza in one sitting. Opening a box and "just having one" is impossible. So when I'm not going through a period of compulsive eating, I know better than to buy the box in the first place.
THE REWARD
So, let's get back to basics: how does addiction work in the brain? Well, there are many theories explaining it all, and interestingly they all include two key components: reward, and impulse control. The first part of the puzzle concerns pleasure. Researchers believe addicts have an error in the part of the brain that's triggered by natural rewards. We're hard-wired to get natural highs from food, water, sex and nurturing, which motivates us to seek them to ensure our survival.
"What we know is that drugs are abused because they hijack the brain's reward system, and activate it more powerfully than other more natural rewards," Dr Lubman says. The user experiences a greater surge of the feel-good chemical dopamine within the brain's reward system from the drug than she would from, say, an apple. Not rocket science. But as a consequence, the brain seeks balance by toning down its response to natural rewards even further. For instance, the brain makes kissing less pleasurable to make up for the heavy hit it gets from the needle, smoke or sound of the pokie machine.
Scientists are finding increasing evidence that food can work the same way as drugs and alcohol. Research has linked binge eating to the same kinds of impairments in the brain that drug addicts and alcoholics experience, making people crave food the way others crave nicotine or cocaine. "Bulimia shares a lot with other addictions," says Dr Rachel Marsh, an assistant professor in clinical psychology at Columbia University, US. "It's possible that someone with bulimia continues to eat when full because food is not as rewarding to them as it should be."
Last updated: 7 years ago
Work: owner, recruitment company
Born: 1973
TO: Women's Health
FROM: Elizabeth
Subject: I lost control
Initially I drank wine. I thought that if I bought an expensive half-bottle, that was OK. But once I'd drunk the half-bottle, I'd buy a big cask of wine and continue to drink. When wine wasn't enough, I swapped to straight top-shelf scotch or brandy. I started off drinking on weekends only, then I became a daily drinker. I could go a couple of weeks without drinking but would always return to it.
THE IMPULSE
The other crucial focus of addiction research is impulse control - weighing pros and cons. The frontal cortex is the area of the brain that helps you decide if what you want in the present (that whole chocolate cake, perhaps) is in line with what you want in the long run (to feel good in the buff and avoid heart disease), and if you should act on impulse. Professor Douglas Sellman, head of the New Zealand National Addiction Centre, says addictive behaviour is marked by compulsion, where the person starts to do things they don't want to do due to their interaction with a substance or behaviour. Research has shown this part of the addicted brain is impaired. "[Addicts] find it much more difficult to inhibit their responses," Dr Lubman explains. "And on tasks where we look at short-term versus long-term gains, they're much more keen on getting rewards immediately than waiting." In a study by Dr Marsh and her team, the same held true for bulimic women - they responded more impulsively. And the women with severe bulimia showed the least amount of self-regulatory brain activity.
"There's been increasing [amounts of] research showing similar changes in the brain in problem gamblers," Dr Lubman says. "We haven't done any brain studies examining whether people who develop problems with shopping or whatever are actually similar to people who are drug-addicted, but my gut feeling would be that some of those changes are also occurring in [their brains]."
TO: Women's Health
FROM: Lynn
Subject: Triggers
My "all or nothing" mentality prompts my compulsive eating. I label foods as "good" or "bad". If I have just one "bad" item during the day, I'll take it as an opportunity to eat more crap later that evening since I've already blown the day.
It feels like a little gremlin in my head controls me. Even if I haven't been thinking I want to order pizza, if my flatmate says she's staying at her boyfriend's place, the first thing I think is, Oh, what crap should I stuff into my face tonight now I'll have the apartment to myself?
"The jury's out on the notion of an "addictive personality", although people with a parent or sibling who has experienced alcohol dependency could be at a 10 to 15 per cent greater risk of the same, says Sellman. Most experts agree that addicts tend to be impulsive, glass-half-empty types, with inclinations toward risk-seeking.
THE X/Y FACTOR
Whether men and women get hooked differently is a question researchers only started asking a decade or so ago. Dr Nora Volkow, director of the US National Institute on Drug Abuse, says there are gender differences, pointing to research on how the menstrual cycle and female hormones change the way drugs act in our bodies. For example, a study in Nicotine & Tobacco Research showed women were more vulnerable to nicotine cravings during the latter part of their menstrual cycle when progesterone and oestrogen are released. Another study, by researchers at the University of Heidelberg in Germany, found although men generally drink more alcohol, women may develop alcohol dependence and adverse health consequences more readily. One suggested reason is that women have less alcohol dehydrogenase, the stomach enzyme that breaks down ethanol in alcohol, than men.
TO: Women's Health
FROM: Lynn
Subject: Wanting to be thinner makes me eat more.
Thanks to the towering piles of my mum and sister's women's magazines, I've been aware of dieting, exercise and skinny models since I was five. I was a tall girl and a little bigger than anyone in my class. At nine, I'd tell myself I couldn't eat anything for a day. I'd be starving by lunchtime, come home from school ravenous and raid the pantry.
Now, feeling fat and unattractive drives the bingeing. It should make me want to sprint from lollies. But for some reason, I end up thinking, Well, I'm ugly anyway, why shouldn't I eat this? Feeling lonely and depressed does it too - often late at night. Maybe because I'm tired and I don't have the mental strength to realise what I'm doing, think about it and stop.
UNDER PRESSURE
It's no news that peer pressure is linked to addiction - whether it's coming from TV or a friend persuading you to stay for "just one more". "There are a lot of peer pressures that are gender specific," says Dr Mary Jeanne Kreek, a long-time addiction researcher at Rockefeller University in the US. For instance, experts say that, based on size, females should drink less alcohol. However Sellman believes women in New Zealand are narrowing the gap in areas like alcohol dependency because of a desire to "keep up with men".
Clinical psychologist Dr Louise Nadeau, director of the University of Montreal's institute on addiction, calls shopping and weight obsession "the female addictions". The yummy-mummy trend has pushed many healthy-weight women on a compulsive quest for unhealthy thinness. A study published last year in PLoS One showed anorexia, bulimia and binge eating are all on the rise in women in their 30s and 40s.
"Ageing bodies are increasingly less acceptable in their natural form," says Dr Rachel Calogero, a psychologist at the UK's University of Kent studying compulsive exercise. "There is an extreme amount of pressure to look young, and thinness is associated with a more youthful appearance." Some women yield to that pressure by eating, by exercising or by shopping. Of course, a new Workshop dress - or three - can make you feel good without meaning you have a problem. "When you feel guilty or ashamed about buying stuff or you've tried to stop but haven't been able to, that's the dividing line," says Dr April Benson, author of To Shop or Not to Shop (amazon.com).
Unfortunately, there are plenty of Kiwis who can identify. According to the New Zealand Insolvency and Trustee Service, 1400 women declared bankruptcy in 2006/07 - up from 1250 in 2004/05. And there was a marked rise in the number of women aged between 20 and 30 years old being declared insolvent. "[Shopaholism] is an attempt to control something external because of some internal lack of control," says Nancy Ridgway, a marketing professor at the University of Richmond, US. "It's a way of trying to feel better about yourself." As are most addictions.
TO: Women's Health
FROM: Elizabeth
Subject: When it all fell apart
While I was married and under the watchful eye of my husband, my alcoholism lay dormant. When I left him, I lived alone. My career was going well, so I had a big ego - and exceptionally low self-esteem. My addiction kicked in. What started out as social drinking became drinking at night alone. Most of my friends didn't realise the extent of my problem, but my drinking ruined at least two relationships.
SOCIAL STANDING
The strength of a woman's social network seems crucial in her vulnerability to addiction. Dr Kimberly Young, director of the US Center for Internet Addiction Recovery, agrees that, among her patients, "low self-esteem, few social relationships, poor social relationships, poor anger management are commonalities".
The internet's become a refuge, making over-consumption, over-sharing and instant gratification commonplace. New addictions are being coined. Psychologist David Smallwood, an addictions expert at the UK's Priory Clinic, recently spoke out about Facebook "friendship addiction", which fuels insecurity, and feelings of rejection and inadequacy - particularly for females, as a lot of our self-worth stems from relationships with others.
TO: Women's Health
FROM: Elizabeth
Subject: I drank for relief
I'd always suffered from severe anxiety. From an early age I felt different. Alcohol alleviated a lot of it. However, the shame and the guilt about what I'd done the night before was horrendous. If I felt pressure at work I'd drink during the day - I'd go to the pub at lunch or disguise wine in a coffee mug.
IN THE DUMPS
Experts concur that stress, anxiety and depression are among the causes of addictions. "People who are lonely, or anxious, or those who have simply had bad lives to start with - all of these [things] make you more vulnerable to the process of addiction," explains Sellman. Studies have shown that those who report high levels of psychological distress are more likely to smoke. One thing that underpins addiction is dysphoria, or being unhappy, Dr Lubman says. "Feeling really crappy drives a lot of behaviours that, in the short term, can help manage emotions over things that stimulate the reward system, like using drugs, gambling, exercise."
TO: Women's Health
FROM: Elizabeth
Subject: Where drinking led me
My last drink was memorable. After a fight with my then partner, I went to a bar alone, fell off a bar stool, had my bag stolen, went from nightclub to nightclub, fell down an escalator and was escorted into a taxi at 5.30am. (This was a work night and I was due in to work at 8am.) I arrived home with no key so I smashed a garden ornament through a window. I crawled through broken glass and woke up bleeding to the telephone ringing. It was my business partner wondering why I wasn't at work. At that moment I contemplated suicide or, my last chance, going back to AA.
THE DAMAGE DONE
The consequences of long-term alcoholism and drug addiction are well known: depression, increased risk for several cancers, cirrhosis of the liver, dementia, and relationship, work and financial troubles, among others. What about the "new", "female" addictions? "Compulsive buyers may lose relationships, get into financial trouble, become what I call 'emotionally bankrupt'," Ridgway says. "I think this is the worst outcome of all - being disgusted with your behaviour but unable to stop it."GET BACK ON TRACK
While treatments for different kinds of addiction vary, the most successful strategies all seem to involve some combo of cognitive-behavioural therapy and support groups. Groups like AA (alcoholics-anonymous. org. nz), Overeaters Anonymous (oa.org) and Debtors Anonymous (debtorsanonymous.org) all operate 12-step support programmes in New Zealand.If you've got a problem, you can get a GP's referral to a psychiatrist, who can determine if prescription treatment is needed. The Addictions Treatment Directory (addictionshelp.org.nz) has addiction experts and 0800 numbers to call for assistance. Also, the New Zealand Psychological Society (psychology.org.nz) has a "Find a Psychologist" tool to help you find a specialist.
TO: Women's Health
FROM: Elizabeth
Subject: Doing something about the problem
I initially went to AA 10 years ago and thought it wasn't for me. I couldn't accept that I was an alcoholic. I then went after another two years and stayed for six months.
I'm now in my seventh year of sobriety. It was tough to begin with. I felt insane when I got to AA, yet I could relate to other alcoholics. I got a sponsor and she nurtured me and loved me when I couldn't love myself. I replaced drinking with meetings and over time things got better. When I craved a drink, I called another alcoholic, went to a meeting or read some literature.
It gets easier over time. Today, I have a great life and the freedom not to drink. As an addict I was self-obsessed. Now I help others achieve sobriety. I visit prisons and detox units and sponsor other alcoholics. I'm a better boss, daughter, sister, auntie. I've bought out my business partner and been successful in an economic downturn. Sobriety has taught me to turn every negative into a positive and believe that nothing in life happens by mistake.
TO: Women's Health
FROM: Lynn
Subject: Finding the right help
I've seen a therapist and nutritionist, but they didn't help. No one's told me how to be aware of my food intake without being so obsessed with it that I go nuts. I have to have conversations with myself that list reasons why I shouldn't buy that stupid chocolate cake. It's so hard.
Going to yoga and meditating helps SO much. Maybe it's because it teaches me to honour my body and notice how it feels. Maybe it's because the breathing induces a calm from deep in my brain and being.
Lately, I've also tried to give myself a break. I'm hard on myself, and I think that's been triggering the behaviour. I'd like to join a program targeted to binge eaters. I think getting help from people who understand this problem is what I need.
DO YOU HAVE A PROBLEM WITH THAT?
Addiction comes in many forms. Wondering if your "habit" might be something more serious? Answer the questions below, adapted from the DSM-IV Criteria for Dependence and the CAGE model for Addiction Diagnosis. Insert your drug/habit/problem into the blanks. If you answer "Yes" more than three times, you may want to consider seeking professional help.
- Does it annoy you when friends and family ask you about ___________?
Have you lied about ___________ to them?
Do you _________ when you feel down, guilty, anxious or depressed?
Do you feel you need more and more _______________ to be satisfied?
Have you tried to cut down on __________?
Did you feel restless or irritable as a result of cutting down on ___________?
Did you end up going back to __________?
Have you felt guilty about the time or money you've spent on ________?
Do you lose track of time when you're _______?
Have you ever __________ instead of tending to your family or career?
NEW AGE CURES
Next time your vice starts calling your name too loudly, consider these options before giving in:
- My Stop Smoking Coach with Allen Carr for Nintendo DS. A true product of the noughties, stop-smoking guru Allen Carr's advice is now accessible as a Nintendo game. Now that's nifty.
Hang with some horsies: Seriously. Equine Assisted Psychotherapy (EAP) - a collaborative effort between a licensed therapist, a patient and a, um, horse - has been used for years as therapy for substance abusers. EAP exploits the bond and interaction between human and horse to hold a mirror up to the patient. The horse is used to identify underlying behaviour - fear, impatience, anger - and then as a tool for changing that.
Work it out: Think exercise has nothing on your pangs for a quick ciggie? Think again, then make a beeline for your yoga mat. Just five minutes of moderate exercise can help smokers resist their cravings, say researchers from the UK's University of Exeter.
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