by Judson Brewer
Hate to tell you this, but you’re addicted to something. When you read the word addicted, your first thoughts might be of alcohol, heroin, opioids, or other illicit drugs. You might also think that addiction is something that happens to other people. A friend, family member, or coworker who really struggled (or is still struggling) might pop into your head as your brain quickly compares their situation to yours. In fact, I wouldn’t be surprised if you said out loud, “No way, I’m not an addict. I just have a few pesky habits that keep sticking around.”
I can guess that’s your first reaction, because that’s exactly what I thought for the longest time. I’m just a normal guy who grew up in the center of normal—Indiana. My mom made sure I ate my vegetables, got an education, and stayed away from drugs. I clearly took her lessons to heart—perhaps even too much?— because here I am, in my forties, and I’m a vegetarian with too many graduate degrees (MD and PhD). Everything a boy could do to make his mom proud. Yet I didn’t know the first thing about addiction.
In fact, it wasn’t until I was in my psychiatry residency training at Yale that I really learned about addiction. I saw patients addicted to meth, cocaine, heroin, alcohol, cigarettes . . . you name it. Many of them were addicted to multiple substances at the same time, and many had been in and out of rehab. In most cases, these were ordinary, intelligent people who knew all too well the costs of their addiction on their health, their relationships, the people around them— heck, on their lives in general—and yet they could not get back in control. It was often as baffling as it was sad.
Seeing what my patients were going through brought to life the otherwise dry definition of addiction: “continued use despite adverse consequences.” Addiction isn’t limited to the use of chemicals such as nicotine, alcohol, and heroin. Continued use despite adverse consequences goes way beyond cocaine or cigarettes or any of the really bad things I had avoided. That definition— and let’s hear it once again, in case we’re in any doubt: “continued use despite adverse consequences”—well, that could mean continued use of anything.
This thought brought me up short. While I was treating patients who had ruined their lives with use of the big bad stuff, I also had some nagging questions in my head: “What if the root of addiction isn’t in the substances themselves, but in a deeper place? What really causes addiction?” Could anxiety be a habit, or even an addiction? In other words, how obvious are the adverse consequences of anxiety?
Can we get addicted to worrying? On the surface, it seems that anxiety helps us get things done. It seems that worrying helps us protect our children from harm. But does the science back this up?
The joke among psychological researchers is that when we conduct research, we are in fact conducting “me-search.” We study our own quirks, foibles, and pathology (conscious or unconscious) in order to gain a way into the wider subject. So I looked inward; and I also started asking friends and coworkers about their habits. Long story short: I found addiction everywhere. And this is what it looked like: Continued shopping despite adverse consequences. Continued pining away for that special someone despite adverse consequences. Continued computer gaming despite adverse consequences. Continued eating despite adverse consequences. Continued daydreaming despite adverse consequences. Continued social media checking despite adverse consequences. Continued worrying despite adverse consequences (yes, as you’ll see, worry does have significant adverse consequences). Addiction isn’t limited to the so-called hard drugs and addictive substances. It is everywhere. Is this new, or had we missed something?
The answer: this is old and new. Let’s start with the new.
The rate of change in our world over the last twenty years far outstrips all the changes in the previous two hundred years. Our brains and bodies haven’t kept up, and it’s killing us.
Let’s use where I grew up—Indianapolis, Indiana, the middle of the Midwest, the center of normal— as an example. Back in the 1800s, if I lived on a farm on the prairie and I had a hankering for a new pair of shoes, I’d need to hitch my horse to my wagon, ride into town, talk to the person at the general store about what shoes I wanted (and what size), go back home, wait a couple of weeks for the order to go out to the cobbler and for them to be made, hitch my horse back up to my wagon, go back into town, and (assuming I had the money to pay for the shoes) buy the darn shoes. Now? I can be zipping along in my car, find myself stuck in traffic, and in a fit of frustration, click on an ad that I saw in my email (yes, targeted to me because Google knows I like to buy shoes), and as if by magic, one to two days later (thanks to Amazon Prime), a pair of perfectly fitting shoes shows up on my doorstep.
You don’t need to be an addiction psychiatrist to see that the two-minute, two-click fix is more likely to get you to keep buying shoes than the two-month experience.
In the name of convenience and efficiency, the modern world is increasingly designed to create addictive experiences. This holds true for things (like shoes, food, etc.) and behaviors (like watching TV, checking social media, or playing video games). It can even be true for thoughts, like politics, romance, or the need to keep up with the latest news: dating apps and news feeds are increasingly engineered to have itch-inducing features and headlines designed to be “clickbait.” Instead of time-honored news agencies delivering a newspaper to your door once a day, letting you decide what to read, modern media conglomerates and start-ups decide what information to deliver to you and when. They can track your every search and click, which give them feedback on which articles have click-worthy stickiness that gets you to scratch that itch. Based on this feedback, they can write more clicky and sticky articles, rather than simply delivering the news. Notice how today more headlines are phrased as questions or partial answers than ten years ago.
On top of this, because almost everything is readily available at a moment’s notice through our TVs, laptops, and smartphones, companies can take advantage of any weak moment (boredom, frustration, anger, loneliness, hunger) by offering a simple emotional fix (buy these shoes, eat this food, check this news feed). And these addiction get reified and solidified into habits, so that they don’t feel like addictions—they just feel like who we are.
How did we get here?
To answer this question, we need to go back a lot further in time than Little House on the Prairie. We need to go back to when our brains evolved the ability to learn.
Remember, our brains have old and new components. The new parts facilitate thinking, creativity, decision-making, and so on. But these newer sections are layered on top of the older parts of our brain—parts that evolved to help us survive. One example that I gave in chapter 2 was the fight/flight/freeze instinct. Another feature of the “old brain” that I briefly touched on previously is what’s known as the reward-based learning system. Reward-based learning is based on positive and negative reinforcement. Put simply, you want to do more of the things that feel good (positively reinforcing) and less of thethings that feel bad (negatively reinforcing). This ability is so important and evolved so far back that scientists can see it at play in sea slugs—as I mentioned earlier, organisms with only twenty thousand neurons in their entire nervous system (a discovery so big Eric Kandel won the Nobel Prize for it). Imagine that: just twenty thousand neurons. That’s a creature similar to a car stripped down to only the essential elements needed to make it go (and stop).
Back in cave-person days, reward-based learning was exceedingly helpful. Since food was hard to come by, our hairy ancestors might come across some food and their stodgy little brains would grunt, “Calories . . . survival!” Cave person tasted the food—yummy—and presto! Cave person survived. When cave person got some sugar or fat, his or her brain not only connected nutrients with survival but also released a chemical called dopamine, a neurotransmitter essential for learning to pair places with behaviors. Dopamine acted like a primeval whiteboard, upon which was written: “Remember what you are eating and where you found it.” Cave person laid down a context-dependent memory and learned over time to repeat the process. See food, eat food. Survive. Also, feel good. Repeat. Trigger/cue, behavior, reward.
Fast-forward to last night. You weren’t feeling so great— you had a bad day at work; your partner said something hurtful; or you recalled the moment your father left your mother for somebody else— and you remembered that Lindt Excellence Extra Creamy Milk Chocolate Bar on the door of your refrigerator. These days, finding food isn’t as hard as it was for the cave person, so food has a different role in the (over-) developed world at least. Our modern brains say, Hey, you can use this dopamine thing for more than remembering where food is. In fact, the next time you feel bad, you can try eating something good, and you’ll feel better! We thank our brains for that great idea and quickly learn that if we eat chocolate or ice cream when we’re mad or sad, we feel better. This is the exact same learning process that cave person went through, but now the trigger is different: Instead of a hunger signal coming from our stomach, an emotional signal— feeling sad/mad/hurt/lonely— triggers our urge to eat.
Recall back to when you were a teenager. Remember those rebel kids outside of school smoking? You really wanted to be that cool, so you start smoking. The Marlboro man wasn’t a dork, and this was no accident. See cool. Smoke to be cool. Feel good. Repeat. Trigger, behavior, reward. And each time you perform the behavior, you reinforce this brain pathway.
Before you know it—because it’s not really a conscious occurrence—the way you deal with an emotion or to assuage stressors becomes a habit.
This is a crucial moment, so please read this slowly: With the same brain mechanisms as that unnamed cave person, we modern geniuses have gone from learning to survive to literally killing ourselves with these habits. And it’s gotten exponentially worse in the last twenty years. Obesity and smoking are among the leading preventable causes of morbidity and mortality in the world. Undeterred by modern medicine, anxiety disorders top the charts as the most predominant psychiatric conditions.
On top of this, people spend most of their time online getting little dopamine hits from clicking on this or that, or liking this or that, or being liked for this or that. Each of these habits and conditions are created by our old brain trying to help us survive in a new world.
And it’s not working so well.
I’m not just talking about stress or overeating or shopping or unhealthy relationships or too much time online or that general anxiety we all seem to face all the time. If you ever get caught up in a worry habit loop, you know what I mean:
Trigger: Thought or emotion
Result/reward: Avoidance, overplanning, etc.
Here, a thought or emotion triggers your brain to start worrying. This results in avoiding the negative thought or emotion, which feels more rewarding than the original thought or emotion.
Our brains evolved to help us survive. When we were hungry cavepeople, we used reward-based learning to help us remember where to find food. Now this learning process can be leveraged to trigger cravings and evoke emotions . . . and create habits, compulsive behavior, and addictions.
Companies have understood this for quite a while now.
The food industry spends billions of dollars finding just the right amount of salt, sugar, and crunch to make foods irresistible. Social media companies spend thousands of hours tweaking their algorithms to make sure you are triggered by the perfect photos, videos, and posts to keep you scrolling for hours (while looking at their advertising partners). News outlets optimize their headlines for clickbait. Online retailers design their websites with hooks like “other customers like you also purchased . . .” to keep you searching until you buy. It’s everywhere, and it’s only going to get more intense and bigger.
And it’s worse than you realize: there are additional “addiction maximizers” in play in the modern world.
First, the most crave-ogenic (that is to say, meant to make you crave) type of reinforcement learning is called intermittent reinforcement. When an animal is given a reward that isn’t on a regular schedule or one that seems random (intermittent), the dopamine neurons in the brain perk up more than usual. Think of a time when someone surprised you with a gift or party. I bet you can remember it, right? That’s because unexpected rewards fire off dopamine in your brain at a much higher rate than expected ones.
Casinos provide one example of how this works in the commercial world. They have dialed intermittent reinforcement in so well that they have a formula/algorithm that has the slot machines “hit” just enough times to get people to keep playing, even though on average everyone loses money (the casino’s “winning” formula).
Here’s another: Silicon Valley. It turns out that intermittent reinforcement extends to anything that alerts you to something new. Remember, this is our old brain, using the only tricks that it has to try to survive in today’s fast-paced and hyperconnected world. That part of the brain, though, doesn’t know the difference between a saber-toothed tiger and a late-night email from your boss. So any kind of alert—from the ancient “You’ve got mail” of aol.com to a buzz in your pocket for a new like on your social media post—triggers a response in your old brain. Your email, Twitter, Facebook, Instagram, Snapchat, WhatsApp, Trulia 3-bedroom, 21⁄2-bath apartment with granite countertops search filter— anything that claims to help you stay connected is designed for maximum addiction, in part because they don’t bing, beep, tweet, email, or chirp at regular intervals.
The second everyday addiction maximizer in the modern world is immediate availability. Buying those shoes back in the 1800s was a lot of work, and that was a good thing. If I had a hankering for new shoes to celebrate the end of the Civil War, I couldn’t just impulsively order them, knowing that they’d show up at my barn the next day. And because the process was arduous and time-consuming and slow and, crucially, not immediate, I had to think hard about the costs and benefits. Were the shoes I already had really worn out, or would they work for a little while longer?
Time is critical for allowing all of that excitement to wash over us (oh, new shoes, how fun!), and importantly, go away. Time gives us, well, time to sober up, so that the sweet juiciness of the moment can fade into the reality of the need.
In the modern world, however, you can take care of any need or desire almost instantly. Stressed out? No problem. Cupcakes are right around the corner. Bored? Check out the latest posts on Instagram. Anxious? Watch cute puppy videos on YouTube. “Need” a new pair of shoes (as in see someone with a cute pair of shoes that you have to have)? Just hop on Amazon.
Hate to also tell you this, but . . . your smartphone is nothing more than an advertising billboard in your pocket. What’s more, you pay for it to advertise to you constantly.
By combining the reward-based learning built into our old brain with intermittent reinforcement and immediate availability, we’ve created a dangerous formula for modern-day habits and addictions that goes well beyond what we typically think of as substance abuse.
I’m not laying this out just to scare you. I want you to understand how your mind works and how much of the modern world is de signed to create addictive behaviors and capitalize on them. In order to successfully work with your mind, you have to first know how your mind works. Once you understand how your mind works, you can begin to work with it. It’s that simple. Now you know how your mind forms habits. And with this understanding, you are ready to take the next step: mapping your mind.
Ready for the first reflection?
Anxiety is a bit trickier than most habits. To manage anxiety, you need a bottom-up approach, so let’s start with something simple. What are my top three habits and everyday addictions? What bad habits and unwanted behaviors do I keep doing, despite adverse consequences?
Excerpted from UNWINDING ANXIETY by arrangement with Avery Books, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright © 2021, Dr. Judson Brewer