The Difference Between an Addiction and a Compulsion

While people may use the words “addiction” and “compulsion” interchangeably, they are different. Addiction creates a sense of pleasure in the brain and removes discomfort from cravings. Compulsions involve an overwhelming urge to do something but does not create satiation in the brain’s reward circuitry.

Unfortunately, the misuse of addiction vs. compulsion creates confusion, especially for people experiencing these conditions. It also creates confusion for professionals trying to help people progress through treatment.

At a Glance

While addition and compulsion share some commonalities, they mean different things. Compulsions play a part in addiction, but these are different from the compulsive behaviors that people engage in as part of OCD.

If you are experiencing compulsions or an addiction, talking to your doctor or mental health professional is an essential first step. By getting an accurate diagnosis, a health professional can recommend appropriate treatments that can help.

Compulsion vs Addiction: Key Differences

Compulsion

Compulsion is a narrow term that describes the intense urge to do something, which can sometimes lead to a behavior.

Compulsions refer to repetitive behaviors that people feel compelled to engage in due to obsessions. These obsessions create a sense of anxiety, so people engage in compulsions to relieve those feelings of distress.

Examples of compulsions that a person might experience include excessive hand washing, counting, or checking locks.

Compulsions are also a symptom of obsessive-compulsive disorder (OCD). Someone with OCD may have a compulsion to engage in a behavior like washing their hands, tying their shoes, or checking the stove as a way of trying to alleviate anxiety.

Compulsions in OCD are often directly related to obsessions, which are repeated thoughts that generate distress.

Addiction

Addiction is a broad term that describes how someone becomes dependent on a particular substance or behavior. When people have an addiction, they experience an intense and uncontrollable craving for a substance or activity. Consuming that substance or engaging in that behavior produces rewarding feelings of pleasure.

The American Society of Addiction Medicine (ASAM) defines addiction as a chronic disease that involves compulsively using substances or engaging in behaviors that continue despite harmful consequences.

Addictions are defined by the lack of control over behavior, an excessive preoccupation with the substance and behavior, and continuing to engage with it despite experiencing negative consequences.

Compulsions do play a role in the addiction process. As an addiction develops, it often will involve a feeling of compulsion to take an addictive substance, such as alcohol or heroin, or to carry out an addictive behavior, such as gambling or sex.

OCD Symptoms

  • Obsessions
  • Unwanted thoughts and images
  • Avoidance of triggers
  • Compulsions
  • Rituals to control obsessive thoughts
Addiction Symptoms

  • Intense urges for the substance
  • Using more to get the same effect
  • Inability to stop in spite of negative consequences
  • Withdrawal symptoms

Relief vs. Pleasure

A major distinction between addiction and compulsion is the way they are perceived.

People with OCD may feel a sense of relief when taking part in compulsive behavior, but they don’t feel pleasure; someone with an addiction, however, does experience pleasure through their behavior, at least at the onset.

Compulsions Are Associated With Relief

For someone with OCD, compulsions develop as a way to mitigate the anxiety or fear that their obsessions are causing. Someone with an obsession with contamination, for example, may develop compulsions that involve excessive washing and cleaning.

Compulsions often cause emotional distress when they’re carried out, even if they do offer some temporary relief.

Addictions Are Associated With Pleasure

In the case of addiction, the desire to use the substance or engage in the behavior involves an expectation that it will be pleasurable. This expectation of pleasure is so strong that someone with an addiction will continue their behavior even despite the negative consequences it can cause, like:

  • Financial problems
  • Health issues and physical discomfort
  • Social disapproval
  • Legal consequences
  • Decreased self-esteem

For people with addictions, there often comes a point where they don’t really enjoy the addictive behavior. Instead, they are just seeking relief from the urge to engage in it. This is compounded by the experience of withdrawal that often happens when they stop taking the substance or engaging in the behavior.

Although this can resemble the way someone with OCD engages in compulsions because the pleasure is gone, the original motivation to engage in the behavior was to feel good.

Reality vs. Denial

Another major distinction between an addiction and a compulsion has to do with awareness and acceptance of reality.

Awareness in Compulsions

Someone with OCD may often be aware that their obsessions are not realistic or that their compulsions are excessive or illogical. They may even feel disturbed by their thoughts and their need to carry out a compulsive behavior, yet they do it anyway to relieve their distress.

Denial in Addiction

In contrast, people with addictions often have memory and cognitive impairment and lack this same level of insight. They may not recognize the negative consequences their addiction is causing. This is known as denial, and it’s a core component of the addictive process in the brain.

It can be difficult for someone with an addiction to realize that their substance use or behavior is causing problems in their life, and recognizing this fact is a very important step toward recovery.

Distressing Thoughts vs. External Cues

Compulsions and addictions also differ in terms of the triggers that lead to a behavior. Generally speaking, compulsions in OCD are related to internal stimuli (specifically, distressing thoughts), whereas addictions are more likely to be triggered by external cues related to the substance or behavior.

Obsessions or intrusive thoughts often trigger compulsions in OCD. Such thoughts generate distress, which then leads to compulsive behavior.

In addiction, behaviors can be triggered by a variety of causes. Emotional states, stress, environmental cues, or exposure to substance/behavior-related stimuli can often lead to the behavior.

 

Treatment for Compulsions vs. Addictions

Addiction and OCD can both cause major disruptions in your life. However, both conditions are treatable, and seeking professional help is important. The treatments for compulsions vs. addictions are distinct, so it is essential to distinguish between the two and get an accurate diagnosis.

Treatment for Compulsions

Treatment for OCD may involve a combination of medication and therapy:

  • Medications can include antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), and your doctor may augment these with an antipsychotic.
  • Therapy for OCD is generally a form of cognitive behavioral therapy (CBT), which involves learning to recognize and change your thought patterns. Exposure therapy is often helpful for people with OCD, as it helps you learn how to tolerate anxiety-inducing objects or thoughts without performing a compulsion.

Exposure and response prevention (EPR) is a mainstay of OCD treatment. It is a specific type of exposure therapy that involves exposing the individual to their fears while they the urge to engage in a compulsion.

Treatment for Addiction

Treatment for addiction can vary based on what you are addicted to. If your addiction involves a substance, your doctor may prescribe medication to help you detox safely and deal with symptoms of withdrawal.

Your doctor may also prescribe medication to address the neurochemistry associated with pleasure in the brain.

For example, Suboxone or Subutex is a medication that blocks the sense of pleasure induced by opiates. Your doctor may prescribe this medication to block compulsions related to cravings for alcohol and opiates, as well as for behavioral addictions.

Therapy is also an important component of addiction treatment. This may include individual or group counseling, as well as a stay in a residential treatment facility.

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