People talk about being addicted to coffee and work; people can feel hooked on almost anything. In a rich, complex world, people develop genuine addiction to all sorts of weird things.

In day to day life, people throw around the word “addiction” a lot. People talk about being addicted to coffee, their work, their phone, to Facebook, to sugar, and all manner of other things. Obviously, the vast majority of these aren’t real addictions, but it reflects that people can feel hooked on almost anything, be it a drug (which may or may not include sugar depending on your point of view), a device, an activity, or anything else that gives a sense of reward. Conversely, the rules for addiction as presented in the various system reference documents are specific for ingestible substances. The classic d20 SRD presents addiction rules under the heading of “sanity” and provides adequate if simplistic rules. The Pathfinder SRD gives somewhat richer and more complex mechanics but still pretty much restricts itself to substances that a character might sniff, snort, smoke, or swallow. There’s nothing wrong with this limitation, as it keeps the game simple and the rules playable, but we (and our characters) live in a rich, complex world where people do develop genuine addiction to all sorts of weird things.

The concept of “addiction” is itself not always understood. Anybody living in the Western world would have a hard time cutting sugar out of their diet and would crave it from time to time, and the majority of young adults these days can get a little twitchy and anxious if they don’t have access to their computer or texting device of choice, but that doesn’t mean they’re addicted. In medical terms, a person suffers from an addiction (or “use disorder”) if the their use of something somehow interferes with their life of causes harm, or under some circumstances, if they want to stop and can’t seem to. A drug, substance, or activity might cause harm in a lot of different ways; a heavy drinker might lose a job because they can’t get to work in the mornings after drinking or might lose a liver due to alcohol’s toxic effects, whereas someone who measures their coffee intake in pots instead of cups might suffer heart palpitations while using but debilitating headaches when they try to stop. Anybody who smokes marijuana every day for a year can expect to develop anxiety when they stop, but withdrawal alone doesn’t necessarily mean that they were addicted. It’s possible to become addicted to things that don’t enter your body, though; gambling addiction is a recognized problem in health care, and although it’s probably quite rare, there is good-quality data, mostly out of Asia,  on people developing full-blown addictions to surfing the Internet or playing World of Warcraft. Such people may want to stop but can’t, and their use reaches the point where they lose jobs, relationships, and even their health because of pathological playing. There is data on people becoming addicted to Facebook and other social media, but interestingly, there’s some early evidence suggesting that Facebook is less addictive than various other forms of Internet use. Essentially, anything that gives someone a rush or trigger’s the brain’s reward system could theoretically be addictive to someone whose biology or personality makes them vulnerable, although for many things the potential is infinitesimally small.

It’s also possible for a person’s perception of their use to be unrealistic, making them think they have an addiction when they don’t. In my residency training, I was involved in the care of six people who came to my office saying that they suffered from sex addiction. While there is good research on sex addiction and it probably is a real problem for some people, all of the patients that I’ve personally met were deeply religious individuals who had been raised in sub-cultures where sex is a deeply shameful thing, and their sexual behaviours and interests were equal to or less than what’s generally considered the Western norm, but they felt it was excessive and unhealthy. What this illustrates is that much of a person’s experience of addiction is dependent on their own point of view and what their society is telling them.

A fantasy setting presents a number of additional that a character might become dependent on. For example:

Magic: Spellcasting is an inherently activating experience. At low levels, a young character finds themselves bending the fundamental forces of the universe to their will. At higher levels, a character can level mountains, warp reality, and stop time. It’s difficult to imagine that anyone could be a spellcaster without getting a rush of dopamine in their brains when they cast spells. The more a person casts a spell, the less exciting and the more mundane it no doubt becomes, but what happens to people who start to crave the rush of power that comes from casting a new spell? Characters who develop an addiction to magic probably don’t suffer withdrawal symptoms, but they may feel an insatiable need to seek out new spells, always trying to recapture the rush they felt the first time they flew or polymorphed or cured a disease. Characters may feel jittery and anxious if they don’t cast a spell every few hours, and might get into trouble impulsively casting in social situations where they really shouldn’t.

Negative Energy: Unlike the real world, “energy” is actually a sort of substance in many campaign settings, however metaphysical a substance it may be. It’s easy for me to imagine how a character could get hooked on the feeling of positive or negative energy flowing through them. Exposure to negative energy may not sound like fun, but become can develop a desire for almost any sensation, and given the love that some people have for extreme sports or horror movies, it’s not impossible that some adrenaline junkie might develop a pathological desire to be affected by fear or rage spells.

Positive Energy: Despite being an innately feel-good experience, it might be harder to imagine someone getting addicted to positive energy, because being the target of a remove disease spell or similar magic might cure any addiction it risks causing. Still, a character might develop a dependence on the feeling of healing magic, a harmless habit for an adventurer but a prohibitively costly habit to feed for a merchant, artisan, or commoner. Such a character might bankrupt themselves if local clerics heal them every time they ask, or be turned away from local temples for being a nuisance, or even start self-mutilating or faking illnesses to justify getting their next fix.

All of this might up some new game mechanics. For example, the Pathfinder campaign setting has a spell called imbue addiction, which does exactly what it sounds like. The spell as written requires a sample of some drug or addictive substance as a material component, but could it possibly be used to cause a gambling or magic addiction? Perhaps it could, but only if cast by someone using a metamagic feat such as Eschew Materials.

Addiction is a complex phenomenon not easily captured by game mechanics. Some drugs have little to no apparent addiction potential, even though they might cause unpleasant withdrawal, while other drugs can addict a person with a single dose and kill them during a come-down. Many more things than just substances have the potential to be genuinely addictive, and almost anything has the potential to be merely habit forming, and all of it can make for a nifty story-hook or a tool to shake up a game. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on July 12, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system.