- Compulsions are repetitive behaviors that are driven by strong emotions or urges but not necessarily driven by a physical addiction. Many compulsive behaviors, like those seen in OCD, are driven by fear, and a desire to feel safer
- Those who have an addiction will often pursue it for the pleasurable chemical effects of dopamine, serotonin, and endorphins in the brain that substance abuse causes, and indeed the pleasure that comes from abusing substances and behaviors play a part in developing an addiction
- Treatment for addiction varies depending on the substance or behavior but most inpatient and outpatient rehab centers will use some form of medication and therapy combination
The terms addiction and compulsion are commonly and incorrectly used interchangeably. This misconception that these words mean the same thing can cause confusion for both people struggling with these conditions and those who are trying to diagnose and provide treatment for them.
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What is the difference between addiction and compulsion?
The term addiction is used in a broad sense to describe the process by which someone becomes dependent on a substance (heroin, alcohol, meth, etc.) or behavior (gambling, sex, social media). People can be predisposed to addictions because of their genes, biology, or psychological make-up. When a person stops using a substance they are addicted to, they often experience significant withdrawals because their brain and body have become dependent.
Compulsions are repetitive behaviors that are driven by strong emotions or urges but not necessarily driven by a physical addiction. Many compulsive behaviors, like those seen in obsessive-compulsive disorder (OCD), are driven by fear, and a desire to feel safer and are recognized as mental health disorders. Compulsion often plays a role in the addiction process and can be hard to distinguish from dependence when the compulsive behavior is towards a harmful substance or activity.
Unlike dependence, compulsions can manifest as normal activities like repeated hand washing, checking the stove is off or turning light switches on and off. This is a symptom of obsessive-compulsive disorder (OCD) and the compulsions are a result of distressing obsessions that cause acute anxiety until the compulsion is met. People with addiction continue to use a drug or repeat a behavior because they have developed a dependence, while people with compulsive disorders are acting on impulses, emotions, or urges not related to addiction.
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Relief or pleasure?
As with the terms compulsion and addiction being misused, people often wrongly attribute relief and pleasure as the same motivator. Those who have an addiction will often pursue it for the pleasurable chemical effects of dopamine, serotonin, and endorphins in the brain that substance abuse causes, and indeed the pleasure that comes from abusing substances and behaviors play a part in developing an addiction. Someone with OCD does not feel pleasure from indulging in compulsive behavior but they will often have a sense of relief once the action has been carried out.
For people suffering from OCD, obsessions cause feelings of acute anxiety and fear that can only be mitigated by completing the compulsive behavior. For example, someone with OCD may become obsessed with a terrible thing happening to them or a loved one if a specific action isn’t carried out exactly. This compulsive need to calm the obsessive fear can be emotionally distressing when carried out, and often not pleasurable in the slightest, but carries a small and temporary relief.
Pleasure over relief is often the main driver in substance and behavioral abuse, and the desire for the pleasurable stimulus is greatly heightened in addicts. This desire for pleasure is what drives substance abusers to seek out drugs or alcohol in spite of the negative effects it is having on their lives. These negative impacts are what lead to a diagnosis of addiction.
There does come a point when someone's addiction becomes severe that the pleasure gained from abusing substances and behavior fades away. This is when relief as a motivator for addiction becomes more prominent. Some will abuse to avoid the often painful withdrawal symptoms from not having drugs or relieve intense cravings. However, as pleasure was the original reason to abuse the substance or behavior, it is not considered the same as the relief felt by those with OCD.
People will also often confuse compulsion with the vage term "addictive personality". Find out more about addictive personality and what it means here.
Another key distinction between addiction and compulsion is the awareness and acceptance of their reality. Those with OCD will often be aware of the unrealistic nature of their obsessions and that their compulsions are illogical.  they may often find carrying out their compulsions distressing or disturbing due to the irrational behavior involved but will need to do it to feel relief.
For addicts, avoiding the reality that their addictions are having negative consequences on their lives in order to continue abusing a substance or behavior is part of the process.  This denial of reality often prevents the addict from seeing that they have a problem at all, and it can take a moment of clarity or strength of will to see sense and get treatment.
Treatment for compulsion and addiction
Both addiction and OCD are conditions that can cause disruption and pain in life and can be extremely difficult to cope with on one’s own. Fortunately, both are treatable and seeking medical advice and help can make a huge difference to a person's life.
OCD is often treated with a combination of medication, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) as well as antipsychotics, and therapies such as cognitive-behavioral therapy (CBT) to recognize and adapt thought patterns around compulsive behavior.
Treatment for addiction varies depending on the substance or behavior but most inpatient and outpatient rehab centers will use some form of medication and therapy combination. Medication will often be used to ease the painful, dangerous and uncomfortable withdrawal symptoms that arise during detox from substance abuse (such as opioids or benzodiazepines) as well as part of long-term recovery programs. Therapy may also include CBT as well as other therapies and group support.
Addictions and compulsive behaviors have many overlapping symptoms and features but are driven by different types of urges. Problem drug and alcohol use can cause dependence on a substance, while compulsive behaviors tend to be driven by strong urges and emotions.