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Are We Compulsively Chasing Rainbows? Rethinking Addiction




The drug overdose crisis is a call to action for all of us, but to solve it, we need to make sure we are asking the right questions. In our latest perspective piece, a collaboration between our team and the labs of Serge Ahmed at the University of Bordeaux and Nicholas Gilpin at LSU Health New Orleans, we challenge a common assumption in the field: the idea that addiction is defined almost exclusively by "compulsive" behavior.


The Question: Is "Compulsion" Everything?

In both clinical and research settings, addiction is often defined by continued drug use despite harmful consequences, like health problems or legal trouble. In the lab, we often test this by seeing if an animal will still seek a drug even if it receives a mild electric shock. But is this "persistence" truly the same thing as a "compulsion"? We wanted to explore whether the field's heavy focus on this one specific behavior is causing us to miss the bigger picture of what addiction really is.


The Study: A Reality Check on Research Methods

We analyzed how the term "compulsion" is being used (and misused) in modern neuroscience. We looked at the gap between the human experience—where compulsion is a internal feeling of "having to" do something even when you don't want to—and laboratory models that simplify it down to just "using drugs despite punishment". We also examined several biological factors, such as individual pain tolerance, that can make an animal appear compulsive when they are actually just less sensitive to the punishment being used in the experiment.


Key Findings: Addiction is a Spectrum, Not a Single Behavior

We identified several critical points that suggest we need a broader approach:

  • Persistence is NOT Compulsion: Using a drug despite a negative consequence can happen for many reasons, such as a lack of sensitivity to pain or a simple choice, rather than a lost sense of control.


  • History Matters: The brain mechanisms that drive drug use in someone who just started are very different from those in someone with a chronic, long-term history of use.


  • The "Silver Bullet" Trap: Addiction is a highly diverse "spectrum disorder". Not everyone with a substance use disorder acts compulsively, and focusing only on that behavior ignores the many other factors, like withdrawal, habit, and emotional distress, that keep people trapped.


Why It Matters

If we equate addiction only with compulsion, we risk leaving behind a huge group of people who are using drugs excessively and harmfully but don't fit that narrow definition. These individuals still need and deserve treatment. By embracing the true "heterogeneity" or diversity of addiction, we can move away from chasing a single "silver bullet" cure and instead develop a variety of treatments that help people reduce harmful consumption and improve their lives, regardless of how their addiction manifests.


Full Reference: George O, Ahmed SH, Gilpin NW. Are we compulsively chasing rainbows? Neuropsychopharmacology. 2022;47(12):2013-2015.



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