With the popularity of reality TV shows, many personal and family struggles have become the fodder for discussion. Television shows which highlight the plight of hoarders is just one example of this phenomenon. The interest has also brought on questions such as what is the difference between a person who compulsively hoards things and the person who is addicted to drugs or alcohol. Compulsion is defined by mental health providers as a strong desire to behave in a certain manner. In the case of hoarders, there is an intense desire to acquire. By engaging in the behavior (hoarding) the person is attempting to either lower anxiety or to avoid anxiety. For hoarders, they wish to avoid the anxiety that getting rid of stuff would produce. Addiction is defined as a biologically and neurologically grounded condition that is associated with an oft-repeated behavior regardless of the negative consequences that engaging in the behavior brings. Substance addiction involves a physiological dependence and to suddenly stop using the substance would cause a physiological withdrawal. Experts comparing compulsion and addiction point to the different regions of the brain affected by the behaviors. Hoarding appears to be connected to a dysregulation in the frontolimbic region of the brain while addiction is associated with changes in the prefrontal cortex and the amygdala. One could argue that both conditions are similar in that they bear a neurological footprint. Another point of comparison between hoarding and addiction looks at the reward system which drives the behaviors. For addicts (whether to substances like drugs or behaviors like gambling/pornography) there is a reward “high” each time the substance is used or the person engages in the behavior. Over time, the body develops a tolerance for one level of use/engagement and more of the substance or stronger doses of the behavior are required in order to experience the same degree of satisfaction. With hoarding, the person may experience the reward “high” at the moment they acquire some object be it a statue, clothing item or even a newspaper. However, the problem is actually deeply rooted in the person’s avoidance of negative emotions that would be experienced with discarding the acquisition. Both hoarding and addiction often appear in conjunction with other mental health conditions. Hoarding is most frequently connected to obsessive compulsive disorder. Nearly all experts agree that more research needs to be done in the area of mental health comorbidity. So while hoarding can look very much like addiction there are a couple of key differences. The first difference being that there is no physiological dependence involved in hoarding. While the person may feel intense anxiety about discarding possessions, they will not have a biologically based response. Secondly, addiction is reinforced positively through substance use while hoarding is reinforced negatively by avoidance. The differences are not great, but they do exist.