Well, hey there, it's Dr. Susan Peirce Thompson, and this week I want to address a really interesting question. What is exactly the difference between a bad habit and an addiction? Elizabeth wrote in this question a few months ago, and I was planning to answer it on this vlog this morning, and then I happened to pick up the phone a friend called and she started talking about how she was pledging to not play solitaire today, that it was getting out of control, it was addictive, and she was going to try to not play for one day. Then she started describing her distress about it. She started talking about how she was playing it all day on her day off, over the weekend, even though she felt like it wasn't the most restorative way to spend her time, she was playing it sometimes when she tucks her daughter in at bed at night. She was playing it during her breaks at work. She was playing it all the time, and it was getting out of hand, she felt. I said, "That's so interesting that you're bringing this up because I'm just about to shoot a video, a blog about what's the difference between a habit, a bad habit, and an addiction." She said, "Well, what's the difference?" I said, "Essentially it comes down to this. Is it a pattern of behavior that's producing clinically significant impairment or distress?"
According to the DSM-5, there's 11 criteria that you can look at that'll help to give you a sense of that. Number one is, are you doing it or using it more than you intend to? It sounds like in her case it is definitely getting out of control like that. Number two, do you have a persistent desire or perhaps repeated, unsuccessful attempts to stop doing it, to cut down, to control it, to moderate it, and do keep failing at that, or you keep wanting to, and you're not even trying, but you have the persistent desire? It sounds like in her case that's absolutely the case. Number three is excessive time spent doing it. Probably also the case for her. Then number four, a craving or a strong desire to do it to use. Number five is failure to fulfill roles. Is it keeping you from being the mother, the worker, the partner that you want and need to be in life? Is it keeping you from fulfilling those role obligations? Number six, and I do have a little sticky note here where I don't have these memorized at all, but number six is, is it causing social or interpersonal problems? For example, do you have a partner that's harping on you that it's problematic, friends who are abandoning your friendship because of it, etc.? And then, are you reducing the time you spend or just entirely giving up activities that you really typically enjoy, but you're abandoning them so that you can use or do this thing? Are you engaging in use in ways that are truly hazardous or dangerous? In her case, if she was playing solitaire on her phone while driving repeatedly, maybe she'd already gotten into a car accident over it and she was still doing it, that's hazardous use. And then are you continuing to use despite some sort of physical or psychological problem that was caused by the behavior and or is made worse by the behavior? Let's imagine that she's got some sort of carpal tunnel or tendonitis happening in her wrists or her hands, and she's still playing this game, and the tendonitis is exacerbated or made worse by the use, then that would satisfy that criteria. And then, tolerance, are you needing to do it more and more to get the same effect? Then withdrawal if you stop, do you feel terrible effects from stopping? Headache, nausea, fatigue, distress, shakes, that kind of thing.
You don't have to have all 11 of these. As a matter of fact, to have a mild substance use disorder, you only have to have two of them, and you can translate this into a behavioral disorder pretty easily. Two or three is mild, four or five is moderate, and six or more is severe. But you also have to have this linchpin criterion, clinically significant pattern of impairment or distress. In her case, it's bothering her a lot, and she woke up on a Monday morning not thinking about work, but about solitaire and how she needed to stop doing it.
It's so interesting when you look at addiction through this lens, it really irks me when people say everyone's addicted to something, I think, "Oh no, my friend, oh no, my friend. It is not the case that everybody's addicted to something." As a matter of fact, most people at this moment are not addicted to anything. There's nothing that's taken over their life so much that these criteria would apply. Now, let's even take a heavy smoker. We might all think at this point, and thank goodness for the public information and awareness campaigns that happened all through the 80s and 90s, we might all think that someone who's smoking two packs a day by definition is addicted to nicotine. I would say, "Are they?" If you look at these criteria, if they're not bothered by it and they don't at the moment have any lung cancer or any issues, I might argue that they have smoking a bad habit of smoking, they have a bad habit. It's really where clinically significant distress or impairment comes into the mix that you start to have an addiction where you're trying to cut back and failing. Now, you could argue, well, the two pack a day smoker is spending too much time doing it, and it's probably causing social issues whether they realize it or not. There's all kinds of maybe scenarios or people they're not hanging out with or places they're not going because they know they can't smoke, so they're not going, that's time spent and social activities given up and so forth. You might from the outside, look down the list and say, I can see 3, 4, 5 things that apply to them. Therefore, they have a mild addiction or a moderate addiction. Maybe. But if they don't feel or claim any clinically significant impairment or distress, if they're like, this isn't bothering me. I'm not hurting anybody. This isn't bothering me. Leave me alone. I'm just smoking my cigarettes and I'm fine. We might from the outside say, well, you're in denial. You do have an addiction, but you're just in denial about it. I don't know. I guess now we're getting into splitting hairs, but I love the approach of a lot of modern 12-step programs and different diagnostic approaches that basically say, addiction is for the person to decide. It's up to each one of us to decide, what have I got here? Is this a bad habit or is this an addiction?
For me, as a recovering addict who has claimed addiction in all kinds of domains, lots of them, I would say I break addiction down to one word and it's diagnostic, and that one word is suffering. Am I suffering over this? Am I suffering? If I'm suffering, it's an addiction. If I'm not suffering, I would say it's more likely to be a bad habit. It might be that someone else from the outside would say, "Well, it's an addiction, and you're in denial. You should be suffering." Okay. I don't know that we'll ever answer that one definitively. I think that we can paint a picture in an extreme where we would from the outside, say, no matter whether the person is suffering or not, it's an addiction. Let me think of an example. Okay, well, let's take someone who's using heroin and they're in a shooting gallery. I mean, they're literally living in an abandoned building and they smell, they haven't showered and they don't remember when months, and they've got some kind of online thing that gets them money. So, they do have money coming into their account, something that maybe they set up a long time ago that still produces recurring revenue. They have money coming in and they're just living to buy heroin, but they feel like they're fine. Their clothes are dirty. They have family they used to care about. They haven't been in touch with them in over a decade. They have children they used to love dearly. They haven't watched them grow up ever since the heroin took over their life, and they're living in this shooting gallery. If you ask them, they'll say, "I'm fine." If you try to give them this test of addiction criteria, they'll refuse to take it. We might from the outside say, "This person has an addiction, whether they claim it or not." Now, clinically significant impairment or distress impairment can be there whether they have distress or not. So, that person may not claim any suffering and in fact, having smoked quite a bit of opium, which is not heroin, but is pretty darn similar, I could say, I could see why they're not suffering. Okay, so maybe they're not suffering, they're on dope, and they're feeling no pain, okay? But there's clinically significant impairment there. Their functioning is impaired to the extreme.
I think in the extreme, we maybe could diagnose addiction from the outside, but as a recovering addict, I really prefer a world in which we leave it to each individual to diagnose themselves. I would suggest to you, for every bad habit that you've got, really take a look at, are you suffering? Do you really, really wish? Is it grating on your soul? Do you really, really wish that you would stop doing this? I think my friend this morning reached that point with the solitaire. I could hear it in her voice. There was a heaviness, and there was a trepidation and a fear about trying to spend one day without playing solitaire and thinking about tomorrow was too much. She had to keep it in the day. I think the solitaire was causing suffering. It's an interesting question I think that each of us has to decide for themselves. Thanks for letting me share my thoughts on what the difference is between a bad habit and an addiction. That's the weekly vlog. I'm Susan Peirce Thompson. I'll see you next week.
