When Exercise Becomes Addiction

Michael J. Miletic, M.D.

I recently heard a podcast from the MIT Director of neuroscience. She had a profound statement. Our brain is the most uncharted part of the universe. To me, the brain and mind are endlessly fascinating, because we are only at the beginning of discovering it’s hidden secrets.

One area of intense interest in neuroscience is addiction. Addiction is very complex. It has biological, psychological, behavioral, and neuroscience roots, as well as roots in trauma and development. Defined classically, it is a chronic relapsing condition characterized by compulsive seeking out of a substance or activity, despite its harmful consequences. It strongly involves the dopamine reward circuit in the brain. Specifically, the mesolimbic dopamine system. It is responsible for reward and motivation. As I spoke recently about in Scott McNally’s podcast and at the annual SWIS conference, it is a relatively simple loop beginning in an area in the mid brain, called the VTA or tegmentum. The circuit loops into the NA or accumbens, and when activated has a positive feedback, responsible for the chronic seeking of intense and additional rewards. Dopamine is also released preferentially into the synapse. However, we cannot just hack a dopamine system, because so many other neurotransmitters and circuits are involved. For example, glutamate is an excitatory neurotransmitter that contributes to the seeking behavior. Serotonin is a neurotransmitter that modulates the activity of dopamine. Endogenous opioids are also involved in reward and reinforcement. These all interplay together, and must be accounted for in treating addiction.

Addiction becomes even more complex when applied to exercise training and working out. When does something so good for you, become harmful?

We know of the unlimited benefits of exercise to our body, but only recently are we seeing profound benefits to our brain too. A meta-analysis recently published lines up with others that have said that exercise is the most effective anti-depressant known. Exercise has powerful effects on depression and anxiety but also on other conditions, including OCD, PTSD, and more.

Many of my patients come to me with anxiety or depression. Most have stopped exercising, or even moving as much, due to the lack of motivation. However, it is impossible to sit still waiting for motivation to appear or for depression and anxiety to go away before we return to the gym, walking, and in some cases even getting out of bed.  We must first force ourselves to go to that gym, to move, to get active, even when we least feel like it. Movement and exertion creates motivation by increasing dopamine release,. It is not the other way around. The more we are inactive, the more reduction in energy and motivation we will experience. We must commit to the action and the activity, not wait to feel motivated. So, for the brain, the more the better… Up to a point.

When does exercise become addictive?

I have three criteria that I use. They all involve withdrawal.

1. Are you withdrawing from other important aspects of your life? From friends, significant others, work, social relationships, other interests and hobbies? Are you becoming more isolated from all of the ways that you used to connect with the world?

2. Do you suffer from withdrawal from the gym or from your training? Do you become irritable and anxious or even panic if you cannot work out, if even for a good reason like a vacation or a holiday? I am reminded of a patient who felt conflicted about being present for the birth of his firstborn child. Even though, in the back of his mind, he knew it was irrational, he was concerned about missing his workout that day and days to follow .

3. Withdrawal from self-care. Do you prioritize the need to exercise over your own health? If so, you are entering dangerous territory. Are you neglecting rest periods, body signals of intense fatigue, or being run down? Are you including off days, and deloading in your training? Are you maintaining your sleep and nutrition? It does you no good to wake up at 3 o’clock in the morning in order to work out for two hours before work, if you are left exhausted and rundown.

The question of addiction and exercise becomes even more complex when we look at trauma. Many health practitioners state the following: “the goal of exercise should only be for physical and mental wellbeing“. Beyond simple “wellbeing”,  I often work with people who are driven to exercise to deal with traumatic feelings and emotions, having developed exercise as an adaptation to their pain. Without being able to move, train, to compete, etc. many patients describe first an increase in tension, then stress, then irritability, then, even feeling overwhelmed with a feeling of “going crazy“.

In fact, I have never worked with, or met a top athlete, or even a special forces retired soldier without a history of significant childhood trauma. Often, these people are forced to train to their limits, and sometimes beyond. That training becomes etched in their minds as being necessary to survive. So, exercise in training can be both an adaptation [something necessary] and compulsive, and possibly harmful at the same time. There is a fascinating interplay between trauma, exercise, and performance, which I have posted about in the past, and we’ll continue to dig into it in coming weeks.