Habits or addictions? COVID-19 changed the game.
If the reasonable person on the street was asked to define “a habit,” they might shrug their shoulders and be at a loss for words. According to Laura Araujo, cofounder of the Mindfulness, Activation, Purpose, and Surrender (MAPS) Institute, habits are nonverbal, automatic behaviors associated with the prefrontal cortex that take on average 66 days to become ingrained. Habits are not necessarily associated with higher cognition, in contrast to routines, which are planned sequences of behavior.1
Contemplating how our daily habits and routines have been impacted by COVID-19 has become national pastime, if not consciously then at least subconsciously. Especially now that we are undecided about whether the pandemic is over, many of us are left wondering what exactly our new behavioral patterns should be.
It can become quite overwhelming to think about this. A 2020 survey of 8000 adults conducted in the greater Tokyo area showed that 33 % of male respondents and 34% of female respondents experienced an increase in sedentary activities since the onset of the pandemic, while, conversely, 17% and 18% of men and women respectively reported a decline in daily physical exertion along with self-reported changes in health status.2
Cognitive therapists have spent considerable effort constructing models for habits and routines. Habits are triggered by various types of cues and are known to become automatic over time. While routines are volitionally created, they too can become automatic given sufficient impetus. And habits, as well as routines, can swing the pendulum from adaptive to off-putting, thoughtful to reckless.3 Henceforth, the focus will be on adaptive habits and routines.
Several of my associates have remarked on the need to rebuild socialization stamina, rusty from months of lockdown and somewhat analogous to the professional athlete in re-training. For Miriam Lavine, LCSW, director of a community mental health program, the opposite has actually been true. “Before the pandemic,” reflects Ms Lavine, “I may have taken collegial gatherings for granted. But now, where there is an event, I find that socializing and reestablishing with others is anything but tiring, and I am aware of how normal and pleasant it all seems.”
Some routines have been unaffected by COVID-19, as illustrated by this story.
At the close of a prepandemic session, “Ms Young,” lamented on her boyfriend’s habit of watching sports over the weekend. She reported an impending feeling of exclusion on Friday evenings as she anticipated competition with the ESPN channel, and yet was afraid to speak up as the relationship was still brand new. When asked whether she believed a compromise was possible, given hers and her boyfriend’s mutually hectic weekday schedules, Ms Young responded, “Honestly, I doubt it, doctor. We are dealing with something powerful here. Let’s discuss this again. Thanks so much.”
Ms Young described her partner’s intense devotion to TV sports—the major leagues, professional golf, and the Stanley cup playoffs—in a good-natured manner. While “sports addiction,” never entered the dialogue, I could not help but reflect on the term based on some of my own experience.
According to Nora D. Volkow, MD, Director of the National Institute on Drug Abuse (NIDA) and renowned researcher on the neural mechanisms of substance abuse, while terms like “addicted” and “obsessed” permeate our everyday conversation as part of a compelling narrative, the risk for the public is a misperception of just how serious clinical addiction can be.
Dr Volkow further explains that, “The challenge in sorting out routines from true compulsions is that in both cases we are dealing with normal and pleasurable aspects of life, such as eating or making a purchase.”
“Plus,” adds Dr Volkow, “behaviors do not necessarily set up as powerful brain circuits as do drugs which hijack the reward pathways in the ventral area of the brain’s prefrontal cortex. The key distinction is whether the person can no longer control that particular behavior such that it becomes deleterious.” (Table)
To a certain extent, the concept of a behavior veering into “addictive” carries some degree of elusiveness. How do everyday routines blithely transform into compulsions and what are the risk factors? How does the wellness routine of yoga practice, for instance, turn into something nightmarish, a question I once posed to a certified yoga instructor? Her response was incredibly straightforward. “I do not think yoga is addictive if you do not have an addictive personality.”
In the DSM-5, the only recognized behavioral addiction under nonsubstance-related disorders is gambling.4 Yet, we find that shopping, eating, intimacy, video gaming, and posting on social media can all be grouped under the umbrella of behavioral addictions when taken to the extreme.5,6 There is also excessive body building, sometimes accompanied by the use of anabolic steroids and disordered eating, due to the condition of bigorexia, a belief that one’s muscle mass is inadequate.7
Since the start of the pandemic, the newspaper for me has become central towhat I view as an adaptive routine. Some might argue that reading the newspaper is obsolete, given all the available news feeds on smart phones. However, I duly admit that holding a daily paper with coffee in hand, is a comforting ritual. Scanning the front section for international news, then the second section for pandemic metrics, followed by all the cultural happenings allows a connection to the greater world despite its problems and upheavals.
You may ask yourselfwhat has changed in your own lifestyle during the pandemic? Take a glance within. I would invite you to honor all of those daily routines that promote strength and purpose, that maintain an internal sense of structure. This process can also be applied when treating patients experiencing any degree of stress. The key is to avoid harsh self-appraisals and over-analysis, particularly during this continued time of uncertainty. In closing, I would remind the reader that adaptive routines are necessary and never compulsive if conducted with intention and balance.
Acknowledgements: The author would like the thank the following individuals: Yi Zhou, MLIS, and the library staff of Morristown Medical Center; Nora D. Volkow, MD; Miriam Lavine, LCSW; and Mr Jon W Green, esq.
Dr Sofairis a board-certified psychiatrist affiliated with CarePoint Health and Atlantic Health System in New Jersey.
1. Araujo L. Understanding the difference between routine and habit and why it’s critical to our functionality. May 7, 2021. Accessed July 26, 2022. https://themapsinstitute.com/understanding-the-difference-between-routine-and-habit-and-why-its-critical-to-our-functionality/
2. Suka M, Yamauchi T, Yanagisawa H. Changes in health status, workload, and lifestyle after starting the Covid-19 pandemic: a web-based survey of Japanese men and women. Environ Health Prev Med. 2021;26(1):37.
3. Le Cunff A-L. Habits, routines, rituals. Accessed July 26, 2022. https://nesslabs.com/habits-routines-rituals
4. Gambling disorder under non-substance-related disorders. Desk Reference to yhe Diagnostic Criteria From DSM-5. American Psychiatric Publishing; 2013:282-283.
5. Kar A, Adikey A, Wells J, Kablinger A. Obsessive-compulsive disorder driven by aspects of ritual addiction: a case report and review of the literature. Psychopharmacol Bull. 2021;51(2):65-68.
6. Luigjes J, Lorenzetti V, de Haan S, et al. Defining compulsive behavior. Neuropsychol Rev. 2019;29(1):4-13.
7. Martyniak E, Wyszomirska J, Krzystanek M, et al. Can’t get enough. Addiction to physical exercises: phenomenon, diagnostic criteria, etiology, therapy and research challenges. Psychiatr Pol. 2021;55(6):1357-1372.