Addiction: Non-Substance

Question 1

While it is difficult to define which repetitive behaviours are actual addictions, what are some indicators that make the distinction easier?

Answer 1

When the repetitive (and persistent) behaviours result in significant harm or distress (to oneself or to others) that causes functional impairment.

Question 2

What year was the concept of Non-Chemical addictions highlighted? And what happened?

Answer 2

1990 with the publication of a prominent text. Afterwards there was a rapid escalation in behaviours being labelled as ‘behavioural addictions.’

Question 3

What is the most empirically supported and recognised non-substance behavioural addiction? When was it first identified as a problem in society? When was it first identified as a clinical problem?

Answer 3

Gambling. It was identified as a serious problem as far back as 4000 BC, and since then has gone through phases of being reported on.
From 1970 - 1980 there arose the concept of ‘pathological gambling’ as a psychiatric disorder, and it was included in the DSM-3 as an Impulse Control Disorder: Not Elsewhere Classified.

Question 4

What was the main criteria for the DSM-3 classification of an Impulse Control Disorder: Not Elsewhere Classified?

Answer 4

‘Repeated behaviour that led to significant impairment and distress in the individual.’

Question 5

What were the changes made in the DSM-5 concerning Non-Substance Addictive Disorders?

Answer 5

The DSM-5 created a new category called Substance-Related and Addictive Disorders, with Gambling Disorder included as the only diagnosable Behavioural Addictive Disorder.

Question 6

Why was Gambling Disorder classified in the DSM-5 as an Addictive Disorder?

Answer 6

Gambling Disorder was included as an Addictive Disorder for two reasons:

1. Scientifically it is viewed as an addiction.
2. Politically it was important for Gambling Disorder to be seen as an Addictive Disorder so it can be covered by medicare.

Question 7

From the DSM-3/DSM-4 to the DSM-5, what was gambling reclassified as?

Answer 7

It was classified previously as pathological gambling, and now it is known as Gambling Disorder.

Question 8

Although Gambling Disorder is the only Behavioural Disorder included in the Substance-Related and Addictive Disorders chapter of the DSM-5, what other disorder was mentioned? And for what three reasons was it mentioned?

Answer 8

Internet Gaming Disorder - (conditions for further study).
It was included because:
1. IGD has similarities to substance abuse disorders.
2. Has significant public health implications.
3. Internet gaming was recognised by the Chinese Government as a disorder and pushed heavily for it to be included in the ICD-10 (which it has been).

Question 9

What are the 9 criterion (A) in the DSM-5 for Non-Substance Addictive Disorders? (they are based on gambling but are sometimes extrapolated to other disorders).

Answer 9

Criterion A (four or more):

1. Preoccupation (psychological dependance).
2. Increased amount gambled (tolerance).
3. Irritability/restlessness on cessation (withdrawal).
4. Escape from stress (negative reinforcement & motivation).
5. Chasing losses (erroneous & distorted cognitions).
6. Lying.
7. Repeated failure to cease (impaired control).
8. Risking significant relationships.
9. Bailout.

Question 10

For the criterion (A) of non-substance addictive disorders, what are they a mixture of?

Answer 10

Symptoms and consequences of symptoms.

Question 11

There is now a confusion in the relevant literature relating to a certain word. What is the word, and what are the two ways it can be confused?

Answer 11

‘Gaming’. Can refer to gambling activities (sometimes on the internet) or video and arcade games.

Question 12

The important question that people get confused about is: can we be addicted to the internet? What is the answer?

Answer 12

No, the internet is a virtual communication network, you cannot be addicted to it any more than you can to a telephone. What people become addicted to is the object of desire that the internet allows access to (pornography, eSports, videos, web surfing).

Question 13

There is a wide range of behavioural addictions. What are the 6 most commonly identified?

Answer 13

1. Gambling Disorder (DSM-5).
2. Sex addiction.
3. Compulsive shopping.
4. Internet addiction.
5. Internet gaming disorder.
6. Kleptomania.

Question 14

There is a wide range of behavioural addictions. What are 7 that are LESS commonly identified?

Answer 14

1. Exercise addiction.
2. Eating addiction.
3. Love addiction.
4. Work addiction.
5. Social networking addiction.
6. Smart phone addiction.
7. Tanning addiction.

Question 15

What is a confirmatory three-step approach to identifying and thus pathologising a behaviour as an addiction?

Answer 15

1. Anecdotal observations that consider the behaviour as addictive.
2. Screening instrument is used.
3. Identifying risk factors that play a role in the development and maintenance of the addiction (biological, psychological, social).

Question 16

What are some problems with the confirmatory three-step approach to identifying and thus pathologising a behaviour as an addiction? What does this model ignore?

Answer 16

It does not extrapolate to all behaviours or problems (like taking the criteria from one cancer and trying to apply it to another).
The model ignores:
1. functional impairment of the behaviour.
2. the stability of the behaviour (is it a passing fad? a behaviour that is transient and context specific?).

Question 17

From a diagnostic view, what is the operational definition of gambling?

Answer 17

Gambling involves risking an item of value based on the outcome of events that are determined by chance, all for personal gain.

Question 18

Two main types of gambling have been identified, they involve lying on a dimension of severity. What are they?

Answer 18

Problem Gambling: sub-threshold but people nevertheless experience personal or social harm.
Pathological Gambling/Gambling Disorder: Meet the criteria in the DSM.

Question 19

What do people INITIALLY gamble?

Answer 19

The excitement of uncertainty mingled with hope & the fun .

Question 20

Why do people persist in gambling despite adverse consequences?

Answer 20

• Hope to recoup losses (chasing).
• Emotional escape (trauma sufferers).
• Satisfy emotional needs (narcissism, ego).
• Manage dysfunctional affective states (depression, anxiety, trying to dissociate).

Question 21

How prevalent is gambling and disordered gambling?

What about the prevalence in adolescent groups?

Answer 21

Gambling: 60-85% of general population, this means we know that the majority of adults gamble responsibly.
Pathological gambling: around 1%.

Question 22

The prevalence of gambling comes and goes depending on the era. What is the gambling climate like today?

Answer 22

Today it is very acceptable and there is widespread access to gambling programs, particularly on the internet and smartphone applications.

Question 23

What is the percentage of pathological gamblers among the patrons in hotels, clubs and pubs were the gaming machines are?

Answer 23

15-25% are pathological gamblers.

Question 24

What is one of the tricks free online gambling games will do to try and convince you to play for money?

Answer 24

They will create a free game where the odds are stacked in the favour of the participant. This gives them enough confidence to start playing with money, however, in the paid versions the odds are moved back to the operator. You are guaranteed to lose if you play.

Question 25

Rates of gambling are much higher among younger people. What happens as they get older?

Answer 25

The majority will cease to gamble after experiencing a harm, but a portion will continue to gamble into adulthood.

Question 26

What is one issue concerning internet gambling games (aside from the accessibility)?

Answer 26

The normalisation of gambling.

Question 27

Internet Gaming Disorder is classified as a potential psychiatric disorder. What is some of the contention surrounding the legitimacy of the disorder?

Answer 27

Gaming industries say that the game is popular and the child being immersed in it is not necessarily a bad thing, it is the parents who have a problem. If the child spent as much time being isolated due to reading would the parent criticise that behaviour?
However, IGD is associated with significant problems like: RSI, eye strain, back problems, not eating for long periods of time. Also, impairment in cognition, psycho-social relationships, & daily life.

Question 28

What is the prevalence of Internet Gaming Disorder among adolescents? What about in Asian countries?

Answer 28

Between 0.8-26.7%

In Asian countries, it is above 10%.

Question 29

If an internet game as gambling-like features what is it at risk of producing?

Answer 29

Gambling-like features in a game can be a gateway to more problematic gambling.

Question 30

Out of 1,287 Australian high school students, how many regularly played simulated games last year?
How many played a simulated game at least once?

Answer 30

• 13% played regularly.

- 32% played at least once.

Question 31

Out of 561 Australian adolescents, how many played social casino games? And how many played a practice casino game?

Answer 31

• 23%.

- 22%.

Question 32

Many online games, that sometimes require money, are designed to create an addiction and take the money of players. What is one example?

Answer 32

Many games (such as candy crush) do a ‘break in play’ right at the height of the game to create a craving. Often there is an option to wait, or to pay money to immediately continue.

Question 33

What are some features of internet games that contribute to problems?

Answer 33

• they are very accessible on multiple platforms.
• attract people with psychological issues and potentially exacerbate them: depression, social anxiety, ADD, impulsivity.
• Anonymity and the capacity to play unsupervised.
• Any age can play.
• Multiple pay options (around 260 ways to pay).

Question 34

In the past, there was one single causative model. From that, multiple treatments have risen, what are they? (5)

Answer 34

1. Psychodynamic (addiction or gambling is a form of psychic self-punishment for unresolved complexes).
2. Behavioural (around 1973 report about a problem gambler who stole money, he was lobotomised. Other types of therapies have been used - relaxation, aversive, stimulus control).
3. Cognitive-Behavioural (arose from the recognition of erroneous beliefs).
4. Addictions model.
5. Biological model (looking at biology and neurochemistry as the underlying core of addiction).

Question 35

There are two main components in the Cognitive Behavioural model of gambling addiction. What are they and what do they involve?

Answer 35

1. Cognitive component: erroneous beliefs about gambling are maintained and reinforced through biased interpretations of gambling outcomes.
2. Behavioural component:
   the learning of maladaptive behaviour caused by early experiences and reinforcement schedules.

Question 36

In the Cognitive Behavioural model of gambling, the cognitive component intervenes by focusing on identifying and correcting cognitive distortions, what are the 6 main distortions?

Answer 36

1. Illusions of control (believe they have personal skills and overestimate their ability to win).
2. Gambler’s fallacy (a misunderstanding of probability, believing that if you have a run of bad luck on a machine, you will eventually get a big win. This is false, as each game has the same 50/50 odds).
3. Biased evaluation (if I win it is because of my skill, if I loose it is because of external factors).
4. Mutual independence (again, not understanding that games are independent of one another).
5. Probabilities (not understanding the probability you will loose over time).
6. Illusory correlations (superstitions, wearing a certain thing to try and guarantee a win).

Question 37

The Behavioural component of the Cognitive Behavioural model of Gambling involves conditioning, why is this important?

Answer 37

Because conditioning occurs when you have a big win and you want to win more. If in your initial exposures to gambling you have big win, that is exciting and reinforces the idea that gambling is an easy way to make money.
It activates neuro-cognitive and psychophysiological processes.

Question 38

Certain areas of the brain are activated during a big win in gambling, what neurotransmitter increases and how does this effect the person?

Answer 38

Dopamine increases after a big win, this reduces executive functioning so people are more likely to make poor decisions.

Question 39

What assumption was the Pathways Model of Pathological Gambling developed on?

Answer 39

That pathological gamblers are not a homogenous population, they may have common phenomenological elements but they have different aetiological factors.

Question 40

Why were gamblers viewed as a homogenous group before the introduction of the Pathways Model of Pathological Gambling?

Answer 40

Because even though each person may have different aetiological factors, when they present clinically all gamblers can appear somewhat the same.

Question 41

The Pathways Model of Pathological Gambling is premised on the fact that pathological gamblers are not a homogenous population, what three defining factors support/are supported by this idea?

Answer 41

1. Common phenomenology.
2. Different aetiological factors.
3. Differ in treatment requirements.

Question 42

In the Pathways Model of Pathological Gambling, what are the three pathways to pathological gambling?

Answer 42

• Pathway 1: symptoms are caused by GAMBLING (first big win conditions the problem).
• Pathway 2: the previous presence of psychological disturbances, poor coping skills contribute to gambling.
• Pathway 3: deficits in reward and impulse pathways.

Question 43

In the Pathways Model of Pathological Gambling, what do the three pathways have in common?

Answer 43

Initial arousal/excitement and the development of cognitive schemas surrounding the gambling behaviour.

Question 44

In the Pathways Model of Pathological Gambling, what is Pathway 1 characterised by?

Answer 44

It is driven by the motivation to keep winning and the absence of psychopathology.

Question 45

In the Pathways Model of Pathological Gambling, what is Pathway 2 characterised by?

Answer 45

Person is psychologically vulnerable, might have a background of psychopathology/trauma/poor coping strategies.
Uses gambling as an emotional escape, not about winning.

Question 46

In the Pathways Model of Pathological Gambling, what is Pathway 3 characterised by?

Answer 46

There are deficits in certain neurotransmitters that push the person to being more impulsive. This person is likely to have other problem behaviours (criminality, substance abuse, impaired relationships).