This week I want to talk about an interesting question: What, exactly, is the difference between a bad habit and an addiction? Elizabeth wrote in with this question a few months ago. Then I was talking recently to a friend who was concerned that she was playing too much solitaire. She pledged to cut down, because it was, in her words, out of control and addictive. She played it all day, on weekends, and even when she tucked her daughter into bed.

She asked me what the difference is between a habit and an addiction, and I told her it came down to this: is it a pattern of behavior that’s causing clinically significant impairment or distress?

Addiction According to the The Diagnostic and Statistical Manual of Mental Disorders

The DSM-5 (that’s The Diagnostic and Statistical Manual of Mental Disorders) has 11 criteria for addiction:

1. Are you doing it or using it more than you intend to?
2. Do you have repeated attempts to cut back or stop doing it?
3. Do you spend excessive time with it?
4. Do you have a craving or strong desire for it?
5. Is there a failure to fulfill roles; that is, is it keeping you from being the person (such as a parent, friend, spouse, or worker) you need to be?
6. Is it causing social or interpersonal problems?
7. Are you reducing time spent or giving up other activities that you enjoy?
8. Are you using it in ways that are hazardous?
9. Are you using despite physical or psychological problems that were caused or made worse by the behavior?
10. Do you need to do it more and more to get the same effects?
11. Do you feel bad effects if you stop?

You don’t need to have all these criteria. For a mild case, you just need two or three, while four or five is moderate, and six or more is severe. But you also need this lynchpin symptom: it needs to be causing clinically significant impairment or distress. In my friend’s case, it’s causing her distress.

Is Everyone Addicted to Something?

It irks me when I hear someone say that everyone’s addicted to something. That’s just not true. Most people are not addicted to anything. Nothing has taken over their life enough to have these criteria apply.

Take a heavy smoker, for example. We might think that a two-pack-a-day smoker is addicted to nicotine. But are they? If they’re not bothered by it and don’t have health issues because of smoking, I’d argue that they have a bad habit, not an addiction. Because it’s only when you have clinically significant distress or impairment that it’s addiction.

You might argue that some of the criteria would still apply even if they don’t have impairment or distress. We might say from the outside that they’re just in denial. But I love the approach of many programs that say addiction is for the person to decide.

The Difference Between Addiction and Habits

For me, as a recovering addict, I break addiction down to one word: suffering.

Am I suffering over this? If so, it’s an addiction. If not, it’s more likely to be a bad habit. But some would argue that if a person isn’t suffering, they’re just in denial.

For example, let’s look at someone who is using heroin and living in an abandoned building. They haven’t seen their family in years for whom they used to have a deep love and abiding devotion, their clothes are dirty, and they smell.

If you ask them, they may say they’re fine. From the outside, we’d say this person has an addiction. When considering whether there’s clinically significant impairment or distress, impairment may be present but not distress. Maybe they’re too high all the time to notice the distress.

So I think in the extreme, like in this case, we can diagnose addiction from the outside. But as a recovering addict, I prefer a world where we leave it to the individual to diagnose themselves. And I’d suggest that for any bad habits you have, ask yourself if you are suffering. Do you wish you would stop doing this? I think my friend has reached that point. She can tell. And I believe you can, too.