All addictions turn from pleasure to dependency

The state can only deal with our myriad compulsive behaviours by first recognising their common basis

Anthony Giddens
Tuesday October 16, 2007
The Guardian

Two important reports came out this weekend. One says obesity will cost the UK £45bn a year by 2050 if current trends are not reversed. Another shows the number of people admitted to hospital with drink-related problems has risen by 30% since 2002. Overeating, undereating, binge drinking and alcoholism, smoking, dependence on tranquillisers or antidepressants, excessive gambling and hard-drug use: what do they have in common? In his report as chair of the Tories' Social Justice Policy Group, Iain Duncan Smith, says they are the result of our "broken society". That isn't convincing, however. Most are worsened by poverty, but addictions spread much further. Affluence is not a protection against them and may, in some cases, make people more vulnerable.

Addictive behaviour always starts with pleasure. That may be the result of substances such as alcohol, cigarettes or other drugs, or it may be people saying "you look good" when you've lost weight, a win on a poker machine, or the feeling of relief from anxiety or pain. Pleasure turns into addiction when the high becomes a necessity. In other words, what is originally satisfying turns into a dependency and can take the form of a deteriorating cycle.

Addiction is compulsive behaviour. When an initially pleasurable experience becomes a fix, individuals have lost control of their behaviour. To regain the intensity of the initial high, they have to have a higher dose, or more frequently repeated doses. Anorexia is just as much a form of addiction - a compulsive cycle into which the individual becomes locked - as overeating.

I first became interested in addiction when looking one day at two Sunday newspaper magazines. I put them side by side. The first featured a starving girl, caught up in a famine in Africa. The second had on its cover a starving teenager, in the US. Save for the fact that one was black and the other white, they looked almost identical. The African girl was starving because of lack of food; the American was starving to death in a society where food is available in abundance, and her appearance was the result of a deteriorating compulsive cycle. The outcome was the same, but the dynamics of the two were plainly very different.

Why is compulsive behaviour so common in modern society? It seems to be linked to lifestyle choice. We are freer now than 40 years ago to decide how to live our lives. Greater autonomy means the chance of more freedom. The other side of that freedom, however, is the risk of addiction. The rise of eating disorders coincided with the advent of supermarket development in the 1960s. Food became available without regard to season and in great variety, even to those with few resources.

The fact that substance addiction may have a physiological dimension might lead us to suppose that it should be separated from other compulsive behaviours. But that would be a false approach: all addictions have a common basis in compulsive repetition - habits that are hard to break because of their emotional content. The politics of addiction is a relatively unexplored area but has become hugely consequential. How should government approach it? The government apparently has no generic policy framework for reducing addiction but deals with each area separately.

Such an approach can to some extent involve a generalisation of existing policy orientations. For instance, regulation of the food industry has to be stepped up - a process that is still in its early stages. Governments can try to persuade people to eat more healthily, but a great deal can be done to improve the quality of available foods, above all in the fast food industry. Pressure is increasing on food producers, but it needs to be much greater; and in supermarkets even small things such as changing store layouts can make a big difference to impulse buying of sweets and alcohol.

However, there is a need for involvement in areas governments normally avoid. Addictive behaviour is bound up with identity and the emotions. The theorist of happiness Professor Richard Layard has been successful in persuading the government to fund an extension of counselling for depression. But addictive behaviour, which in any case overlaps with depression, has more serious consequences for society.

There are some principles to establish. One is to spend money on treatment when addictions are first formed; the other is to orient policy towards self-esteem. Addiction almost always goes with a loss of self-confidence. Therapists such as Susie Orbach have long insisted that developing emotional literacy should be the foundation of most areas of social policy. I agree. Whenever individuals' behaviour is controlled by habits that they should control, we are at the fulcrum of the relationship between domination and freedom. Government has been reluctant to intrude, but now it must.

· Anthony Giddens is a Labour peer and a former director of the London School of Economics.