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 don't 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.

Compulsion vs Addiction: Key Differences

In order to understand the meaning of the two terms, it is essential to look at the common features that they share as well as their key differences.

Compulsion

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

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. 

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.

Relief vs. Pleasure

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

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.

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.

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.

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.

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.

For example, naltrexone 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.