Can running be an addiction?

I am a runner. I am also a scientist who studies addiction. For a long time I have wondered: can running be an addiction?

When most people think of exercise they think positively of an activity  that increases their health and longevity. When most people think of an  addiction they think negatively of an activity that is harmful and  damaging. Is it possible that something that is healthy (exercise) can  also be something that is harmful and damaging?

Let’s start with the basics: how does the American Psychological Association define “addiction”? Well, the DSM (the diagnostic bible) defines “abuse” and “dependence” as follows (bold/underlined mine):

Abuse

Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as  manifested by one (or more) of the following, occurring within a 12-month  period:

1. Recurrent substance use resulting in a failure to fulfill  major role obligations at work, school, or home (such as repeated  absences or poor work performance related to substance use;  substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is  physically hazardous (such as driving an automobile or operating a machine  when impaired by substance use)
3. Recurrent substance-related legal problems (such as  arrests for substance related disorderly conduct)
4. Continued substance use despite having persistent or  recurrent social or interpersonal problems caused or exacerbated by the  effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Dependence

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time  in the same 12-month period:

1. Tolerance, as defined by either of the following: (a) A need  for markedly increased amounts of the substance to achieve  intoxication or the desired effect or (b) Markedly diminished effect with  continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following: (a)  The characteristic withdrawal syndrome for the substance or (b) The  same (or closely related) substance is taken to relieve or avoid  withdrawal symptoms.
3. The substance is often taken in larger amounts or over a  longer period than intended.
4. There is a persistent desire or unsuccessful efforts to  cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of  having a persistent physical or psychological problem that is likely to  have been caused or exacerbated by the substance (for example, current  cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made  worse by alcohol consumption).

I am fortunate to have lots of friends in the endurance community but sometimes their behaviors make me question whether their hobby may be more of an addiction. Here are a few stories of people that I know:

• One woman ran a marathon on a broken femur.
• One man’s boss told him that he couldn’t take leave to run the Boston marathon. The man, who had run hundreds of marathons, including Boston many times, lost his job when he ran the race.
• One couple ran a minimum of one marathon a weekend instead of spending time with their teenage children or forming social relationships in their community.
• One triathlete went into a race with an injured leg. He exacerbated his injury to the point where he finished the race, posting on Facebook that “I’ll be on [sic] a wheel chair for a bit but well worth  it!”

I am sure that many people would view these examples as extreme and can see how they could fit into the rubric of addiction outlined above. But let’s take a step back from these more extreme examples. As endurance athletes, we pride ourselves on the discipline and sacrifice needed to achieve a goal. In order to complete in an ultramarathon or an Ironman event there will likely be social outings that will be missed, we need to push through pain and discomfort to reach our training goals, and there are disagreements with people who don’t understand why we would punish our bodies to be endurance athletes. But where do we draw the line? When I, as a clinician, think of addiction, I think: is this person impaired in their daily functioning? And this is where it gets a bit tricky.

Once I was assessing someone for alcohol dependence and they reported that they didn’t need to spend a lot of time obtaining alcohol because they brewed their own and that they were never late for work because they set up a work schedule that allowed them to sleep in late to avoid hangover. Technically, this person wasn’t impaired, but it was only because they had built their life around supporting their alcohol use. I view that as impairment. I see areas of similarity with athletes I know. I know athletes who plan family vacations around races, turn significant others and children into runners (or romantically pair up with people who are already runners) and when they can’t run because of an injury exercise compulsively in other ways (e.g. swimming, elliptical). Maybe it’s not impairing, per se, but are these aspects of a healthy habit?

And let’s look at this from yet another perspective. Recently the WSJ had an interesting article about the exercise widow: the experience of women left to care for house and family alone because their spouses are spending their time exercising to extremes. This is a difficult topic because which came first: the chicken or the egg? It is possible that these women’s relationships were negatively impacted by extreme exercise, and it is also possible that extreme exercise was the chosen mechanism for coping with a deteriorating marriage. However, I’m not sure it matters which came first. The key element is that there is a marriage in danger and no one is doing anything to try to repair it.

I’m not here to knock exercise. In fact, I think that the average person could benefit from moving more. However, from my perspective there are some individuals who use exercise as an outlet in a way that becomes extreme, unhealthy, and mimics many aspects of addiction. Chrissie Wellington recently claimed that she was addicted to exercise but that exercise can be okay in moderation. I won’t speak for others but I can speak for my own experience. I love exercise and I love running. I also love my boyfriend, friends, helping others and being healthy. There is nothing that would make it ok for me to run on a broken leg (save being chased by a bear), quit my job for a hobby, or land myself in a wheelchair to finish a race. The purpose of my running is to be healthy and to make myself a better human, partner and friend. People can exercise without it being a problem, just as people can drink socially without becoming addicted. However, I think in the running community there is an absence of awareness about just how far we push and how much some people lose- or are willing to risk- for a hobby.

What do you think- can running be an addiction?