Phenomenology and treatment of behavioural addictions

Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 05/2013; 58(5):252-9.
Source: PubMed


Behavioural addictions are characterized by an inability to resist an urge or drive resulting in actions that are harmful to oneself or others. Behavioural addictions share characteristics with substance and alcohol abuse, and in areas such as natural history, phenomenology, and adverse consequences. Behavioural addictions include pathological gambling, kleptomania, pyromania, compulsive buying, compulsive sexual behaviour, Internet addiction, and binge eating disorder. Few studies have examined the efficacy of pharmacological and psychological treatment for the various behavioural addictions, and therefore, currently, no treatment recommendations can be made.

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    • "Nevertheless, there is a sum of different terms used in the scientific literature when referring to an overuse of the Internet, such as Internet addiction (Young, 1998b, 2004; Hansen, 2002; Chou et al., 2005; Widyanto and Griffiths, 2006; Young et al., 2011), compulsive Internet use (Meerkerk et al., 2006, 2009, 2010), Internet-related addictive behavior (Brenner, 1997), Internet-related problems (Widyanto et al., 2008), problematic Internet use (Caplan, 2002), and pathological Internet use (Davis, 2001). We prefer the term Internet addiction, since we see some important parallels between Internet addiction and other so-called behavioral addictions (e.g., Grant et al., 2013) and substance dependency (see also Griffiths, 2005; Meerkerk et al., 2009), which we will summarize in Sections “Neuropsychological Correlates of Internet Addiction” and “Neuroimaging Correlates of Internet Addiction.” "
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    ABSTRACT: Most people use the Internet as a functional tool to perform their personal goals in everyday-life such as making airline or hotel reservations. However, some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior. Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency. The neuropsychological and neuroimaging results have important clinical impact, as one therapy goal should enhance control over the Internet use by modifying specific cognitions and Internet use expectancies.
    Frontiers in Human Neuroscience 05/2014; 8:375. DOI:10.3389/fnhum.2014.00375 · 2.99 Impact Factor
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    ABSTRACT: Recent emerging functional magnetic resonance imaging (fMRI) studies have identified many brain regions in which gambling cues or rewards elicit activation and may shed light upon the ongoing disputes regarding the diagnostic and neuroscientific issues of gambling disorder (GD). However, no studies to date have systemically reviewed fMRI studies of GD to analyze the brain areas activated by gambling-related cues and examine whether these areas were differentially activated between cases and healthy controls (HC). This study reviewed 62 candidate articles and ultimately selected 13 qualified voxel-wise whole brain analysis studies to perform a comprehensive series of meta-analyses using the effect size-signed differential mapping approach. Compared with HC, GD patients showed significant activation in right lentiform nucleus and left middle occipital gyrus. The increased activities in the lentiform nucleus compared to HC were also found in both GD subgroups that had, or had not, excluded substance use disorder comorbidity. In addition, the South Oaks Gambling Screen scores were associated with hyperactivity in right lentiform nucleus and bilateral parahippocampus, but negatively related to right middle frontal gyrus. These results suggest dysfunction within the frontostriatal cortical pathway in GD, which could contribute to our understanding of the categories and definition of GD and provide evidence for the reclassification of GD as a behavioral addiction in the DSM-5.
    Behavioural Brain Research 09/2014; 275. DOI:10.1016/j.bbr.2014.08.057 · 3.03 Impact Factor
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    ABSTRACT: Internet addiction (IA) has become a serious mental health condition in many countries. To better understand the clinical implications of IA, this study tested statistically a new theoretical model illustrating underlying cognitive mechanisms contributing to development and maintenance of the disorder. The model differentiates between a generalized Internet addiction (GIA) and specific forms. This study tested the model on GIA on a population of general Internet users. The findings from 1019 users show that the hypothesized structural equation model explained 63.5% of the variance of GIA symptoms, as measured by the short version of the Internet Addiction Test. Using psychological and personality testing, the results show that a person's specific cognitions (poor coping and cognitive expectations) increased the risk for GIA. These two factors mediated the symptoms of GIA if other risk factors were present such as depression, social anxiety, low self-esteem, low self-efficacy, and high stress vulnerability to name a few areas that were measured in the study. The model shows that individuals with high coping skills and no expectancies that the Internet can be used to increase positive or reduce negative mood are less likely to engage in problematic Internet use, even when other personality or psychological vulnerabilities are present. The implications for treatment include a clear cognitive component to the development of GIA and the need to assess a patient's coping style and cognitions and improve faulty thinking to reduce symptoms and engage in recovery.
    Frontiers in Psychology 11/2014; 5:1256. DOI:10.3389/fpsyg.2014.01256 · 2.80 Impact Factor
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