Who's an Addict?

In fact, according to the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association's bible of mental health, no one is actually "addicted" to anything. People who overuse drugs and alcohol have "substance-related disorders," and the only so-called behavioral addiction in the book is "pathological gambling." The word "addiction" never appears.


That's an embarrassing oversight, says Norman Rosenthal, a professor of psychiatry at Georgetown University who has extensive experience with so-called behavioral addictions. "This isn't just an academic matter of classification, it's a matter of allowing patients
to have the full benefits of everything we've learned over the past 80 years about alcoholism and drug addiction. If we aren't willing to entertain the possibility that we're dealing here with addiction, we're depriving people who are in desperate need."


Whether they use the word "addiction" or not, there is one point scientists seem to agree on: It would be extremely valuable to identify the biological cues that indicate when a behavior becomes pathological, so that it can be treated with psychological or pharmacological approaches. Researchers often refer to this as the hunt for "the switch," the sign that something has gone from healthy or recreational to obsessive. Finding it, however, will take some time, because animal tests can't be used to monitor human behavior like habitual shopping or an addiction to cybersex. And human brain imaging studies tend to be lengthy and are only now beginning to uncover the scantiest evidence for how obsessive and compulsive behaviors as well as addictions work.


"We don't know what that switch is," says Breiter, still working on his son's statue. "We're starting to localize which brain regions mediate different aspects of addiction, but we have quite a way to go. But I think in the next six to 10 years, we will have very strong, compelling data as to what's going on." Especially if scientists like Breiter keep working nights and holidays.