I Read Medical Journals So You Don't Have To

Here are some recent studies....

I feel like I owe you a column. Sadly, my own love life refuses to be an entertaining bad example, so I turned to the scientific literature for a topic. When I wrote Love Addict: Sex, Romance and Other Dangerous Drugs in 2011, love addiction was considered by most professionals as something a few weirdos in the 12-step community made up in order to, I don’t know, give away bad coffee in church basements? Sell poker chips with a triangle logo on them at cost? In 2023, though, love addiction is a perfectly serious area of psychiatric study. There are tons of research papers I can share with you, and will.

Problem is, most of them kinda suck.

Here, for example, is a piece in PsyPost, a journal covering the latest in psychology and neuroscience. It’s titled New Psychology Research Indicates Love Addiction and Sex Addiction Are Related but Distinct Phenomena - and goes on to prove nothing of the sort. Turns out, the basis of the work is a study of 329 subjects, 310 of them women, all Italian. Oh, and all of them were in relationships of six months or more.

If you’re reading this blog, I’m guessing did a spit-take on that “in relationships of six months or more.” I’m not saying sex and love addicts are never in medium-to-long-term relationships. I’m just saying that this study was peering at the skinniest end of the addiction bell curve. These folks are outliers. The kind of love addiction I am familiar with puts you on the floor in fetal position when a “relationship” of six days goes kaput. Fantasy love affairs — where only one person is aware that said love affair exists — can go on for years, of course, but that’s a whole ‘nother issue.

I also don’t believe that a women currently in a relationship is a great barometer of active sex addiction. If she were a practicing sex addict, odds are she would have been kicked out of the house within six weeks. This was just not a good sample on which to base any conclusions about the relationship of sex addiction to love addiction.

One thing I did like about the PsyPost article, though, is the way it compared sex and love addiction to substance and other behavioral addictions. It talks about the Components Model of Addiction, which holds that love addiction is characterized by six discrete dimensions:

1. Salience: The person’s love interest is the most important thing in their life, and they think about it all the time.

2. Tolerance: They need to spend more and more time with or thinking about the person they love to get the same satisfaction.

3. Mood modification: Being with or thinking about the person they love makes them feel better when they’re upset or stressed.

4. Relapse: They find it hard to stop spending time with or thinking about the person they love, even if they try to.

5. Withdrawal: When they’re not with the person they love, they feel physical or emotional symptoms like frustration, anxiety, and nausea.

6. Conflict: Their love interest interferes with other parts of their life, like work, school, or friendships.

Here is a scholarly deep dive on the Component Model from the National Institutes for Health. Think of it as a “unified theory of addiction.” These six factors — salience, tolerance, mood modification, relapse, withdrawal and conflict — can be applied to addictions ranging from smoking to screentime; you just have to tweak the descriptions. “Salience: When you’re eating breakfast, you’re thinking about what you’re going to have for lunch.” “Tolerance: You find yourself spending more and more time doomscrolling, even though you don’t mean to.” “Withdrawal: Without a cigarette, you feel like someone peeled your skin off.” “Conflict: You gambled away your kid’s college fund and now she won’t speak to you.”

The other cool thing about the NIH piece is that it endorses what’s called the Transdiagnostic Treatment approach. Here’s a long piece on that from the National Library of Medicine .

“Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions including etiology, course, and neurobiology. Yet, the treatment of behavioral and substance use addictions tends to be separated,” the abstract says, and argues that it would be more effective — and cheaper, and less of a strain on already limited psychology resources — to treat them all similarly. The article actually says, and this is something I did not expect to read in an NIH research paper, that the medical community would learn a lot by going to the meetings with the bad coffee and the poker chips:

“There exists a multitude of 12-step programs for distinct addictive behaviors such as alcohol (Alcoholics Anonymous), cocaine (Cocaine Anonymous), gambling (Gamblers Anonymous), sex (Sexaholics Anonymous), and eating (Overeaters Anonymous). 12-step programs largely operate independently and are disorder-specific, emphasizing each groups' need to embrace “singularity of purpose.” …However, regardless of which 12-step program an individual attends, the principles of the program and the 12-steps remain very similar. Implicitly then, the treatment of addictions may closely resemble a transdiagnostic approach in practice.”

Do I think most of these studies are restating the obvious in their diagnoses, and reinventing the wheel in their treatment models? Yes, yes I do. But we need the studies to validate the existence of something you and I both know damn well exists, so that they’ll teach the diagnosis in medical school and cover the treatment with insurance. So bring on the Italian girls, if that’s what it takes. And send them to a meeting.