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Drugs and behavior > Behavioral addictions > Flashcards

Behavioral addictions Flashcards

1
Q

Core features of behavioral and drug addictions

A

Similarities between behavioral addictions and substance use disorders

  • repetitive or compulsive engagement in a behavior despite adverse consequences
  • diminished control over the problematic behavior
  • an appetitive urge or craving state prior to engagement in the problematic behavior
  • hedonic quality during the performance of the problematic behavior
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2
Q

Behavioral addiction

A
  • gambling diroders
  • sexual addiction
  • eating disorder
  • impulse control disorder
  • compulsive buying
  • internet addiction
  • exercise addiction
  • online gaming disorder
  • compulsive hoarding
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3
Q

Gambling disorder

A

excessive/problematic/pathological gambling

  • GD costs an estimated 6 billion $/ year.

Individually:

  • average debt of male gamblers: 55-90.000 dollars
  • Average debt of female gamblers: 15 dollars
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4
Q

Gambling disorders (DSM-5 diagnostic criteria)

A

A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as individuated by the individual exhibiting four of the following in a 12-month period:
1. need to gamble with increasing amount of money in order to achieve the desired excitement
2- restless or irritable when attempting to cut down or stop gambling
3. making repeated unsuccessful effort to control, but back, or stop gambling
4. often preoccupied with gambling
5. often gambling when feeling distressed
6. after loosing money gambling, often returning another day to get even
7. Lies to conceal the extent of involvement with gambling
8. jeopardizin or losing a significant relationship, job or educational or career opportunity because of gambling
9. relying on others to provide money to relieve desperate financial situations caused by gambling

B. The gambling behavior is not better explained by a manic episode

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5
Q

Stages of GD

A
  1. Winning (3-5 years - tolerance, losing control, feeling of victory and omnipotence)
  2. loosing (longer than 5 years - major setback, narcissistic crisis, borrowing money, lies and deception)
  3. desperation (out of control lying, gambling to cover pain, anger and blame, financial difficulties, illegal activities, loosing partner/family)
  4. hopelessness (completely losing all hope, giving up, depression, suicide, jail - last stage for many gamblers)
  5. Recovery
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6
Q

Structural and situational factors

A
  • physical availability
  • availability in time
  • rapidity of feedback
  • possibility to bet again
  • rapidity of getting the money
  • illusion of control
  • visual and auditory effects
  • atmosphere of the venue
  • anonymity
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7
Q

Prevalence of GD in the USA

A

Gambling diroder (GD)

  • adults: 1.6 - 3.9%
  • adolescents: 3.2-8.4%

Problem gambling
- adults: 3.5-5%

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8
Q

Risk factors of GD

A
  • younger age
  • male (woman start later but have more rapid course)
  • race: hispanic, African Americans, native Americans have more problems than caucasians
  • lower level of education
  • lower level of income
  • staff of casiones (closeness to any casino)
  • prisoners
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9
Q

Comorbidity

A

people suffered in any mental disorder: 6-12%

people suffered in substance use disorder: 9.33%

Among GD people: 
- Alcohol, drug problem: 35-73%
 Mood disorders: 33-78%
 ADHD: 20%
 OCD: 1-20%
 Personality disorders: 25-87%
 Impulse control disorders: 18-43% 
 Suicide: 13-20%
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10
Q

Negative consequences

A
  • somatic complaints (gastrointestinal problems, high blood pressure)
  • psychological problems (anxiety, depressive mood)
  • family issues (problems in communication, intimacy, confidence; divorce, physical abuse)
  • at work (lower efficacy, absence, job loss)
  • legal issues
  • financial consequences
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11
Q

Etiology of GD (biological factors)

A
  • comorbid psychiatric disorder
  • family aggregation (GD in family)
  • Twin studies: GD, alcoholism and antisocial personality disorder
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12
Q

Reward deficiency syndrome

A

Blum et al, 2000

Abnormalities in the dopaminergic system: lower level functioning of the midbrain dopaminergic system, lack of D2 dopamin receptors -> reward deficiency syndrome
- impulsive, risk taking behavior

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13
Q

Neuro-cognitive approach (GD)

A
  • deficit in self-regulation processes
  • deficit in high level cognitive processes
  • behavioral inhibition
  • cognitive flexibility
  • time perception
  • planning processes
  • -> dysfunction in prefrontal cortex
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14
Q

Psychological factors (GD)

A
  • trauma
  • low self-worth and feeling unwanted, unneeded or rjected
  • psychoanalytical approach (repression of aggression)
  • behavioral approach: learnt maladaptive behavior, money and excitement are positive reinforcements
  • cognitive approach: distorted cognitive processes: illusion of control, explanations why cannot win.
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15
Q

Therapy (GD)

A

Pharmacotherapy

  • SSRI
  • opiate antagnosist (naltrexone)
  • mood stabilizers (lithium)
  • dependent on the comorbid disorder
    > anxiety disorder: SSRI
    > impulsive control disorder: naltrexone
    > mood disorders: ms
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16
Q

Psychotherapy (GD)

A
  • psychoanalytic approach: correction of low level of self-worth and narcissistic problems
  • cognitive behavioral therapy: correction of unrealistic and dysfunctional beliefs, developing problem solving behaviors, developing social skills, relapse prevention

family therapy

17
Q

Internet addiction

A

1995: Goldberg > symptom list for internet addiction disorder

First definition in 1998: Young - Internet addiction - similar to pathological gambling (impulse control disordeR)

18
Q

Symptoms of internet addiction (Young)

A
  1. preoccupation with the Internet (thoughts about previous online activity or anticipation of the next online session)
  2. Use of the internet in increasing amounts of time in order to achieve satisfaction
  3. Repeated, unsuccessful effort to control, cut back or stop Internet use
  4. Feelings of restlessness, moodiness, depression or irritability when attempting to cut down use of the internet
  5. Online longer than originally intendended
  6. Jeopardized or risked loss of significant relationships, job, educational or career opportunities because of internet use
  7. Lies to family members, therapists or others to conceal the extent of involvement with the internet
  8. Use of the internet is a way to escape from problems or to relieve a dysphoric mood
19
Q

Some characteristics of addictive internet users

A
  • loneliness, lack of social interactions
  • problems in adaption to social conventions
  • dominance of abstract thinking
  • avoidance of face to face communications
  • need for change in self identity
20
Q

Etiology - personality (internet addiction)

A
  • depression
  • loneliness
  • anxiety
  • impulsivity
  • low self control
  • low self esteem

problematic family relations (dysfunctional relationship, divorce, neglect)

21
Q

Etiology - motivations (internet addiction)

A
  • escape (from reality and problems)
  • coping (stress, aggression)
  • fantasy (new identities, new experiences)
  • skill development (coordination, concentration etc.)
  • competition (with others, being successful in something)
  • recreation
  • social factors
22
Q

Etiology - biology (internet addiction)

A

Internet use may also lead specifically to dopamine release in one of the reward structures of the brain.

dysfunction in dopaminergic system as in other addictive disorders.

same structures of the brain involved as in other chemical or behavioral addictions and impulse control disorders.

23
Q

Exercise addiction

A

Regular physical exercise contributed to the maintenance of health.

is it just a positive addiction? physical injury and negligence of everyday responsibilities (work and family life)

24
Q

Griffiths 6 component model of exercise addiction (EA)

A
  1. salience: exercise is the most important activity in life and dominates thinking, feeling, behavior
  2. Mood modification: exercise as a coping strategy
  3. Tolerance: increasing amount of exercise are required to achieve the former effects
  4. Withdrawal symptoms: unpleasant feeling states/physical effects when exercised is discontinued or reduced
  5. Conflict: interpersonal conflict, conflicts with other activities, intrapsychic conflict
  6. Relapse
25
Q

Primary vs. secondary EA

A

Primary EA

  • a form of behavioral addiction
  • exaggerated exercise is a primary problem
  • motivation for overexercising: avoiding something negative (escape from stress)
  • the exercise is the objective

Secondary EA

  • co-occurs with another psychological dysfunction, typically with eating disorders (anorexia nervosa or bulimia nervosa)
  • excessive exercise is used for weight loss (objective)
26
Q

EA similarities with anorexia

A
  • importance of eating is overrated
  • perfectionism
  • denial of exhaustion
  • good tolerance of unpleasant bodily sensation and pain
  • inhibition of anger
  • depressive tendencies
27
Q

Etiology - physiology (EA)

A

oldest and most popular: “runners high hypothesis”

  • intense feeling of euphoria after intensive running
  • increased peripheral beta-endorphin activity
  • but other activities (listening to music) cause similar euphoric states…

“arousal regulation hypothesis”

  • regular exercise –> lower basal heart rate and lower sympathetic activity at rest - and, in parallel, lowers levels of arousal.
  • experienced as lethargic or energy-lacking states –> obvious way to increase the arousal level is via exercise
28
Q

“arousal regulation hypothesis”

A
  • regular exercise –> lower basal heart rate and lower sympathetic activity at rest - and, in parallel, lowers levels of arousal.
  • experienced as lethargic or energy-lacking states –> obvious way to increase the arousal level is via exercise
29
Q

“runners high hypothesis”

A
  • intense feeling of euphoria after intensive running
  • increased peripheral beta-endorphin activity
  • but other activities (listening to music) cause similar euphoric states…
30
Q

“thermogenic regulation hypothesis”

A
  • intense physical activity increases body temperature –> trigger a relaxing state, reduces anxiety
  • positive reinforcers or motivational incentives exercise –> turn to exercise whenever they experience anxiety
31
Q

“catecholamine hypothesis”

A
  • brain catecholaminergic activity is altered through exercise
  • central catecholamine levels -> regulating mood and affect
  • unclear: the peripheral changes in catecholamine levels have an effect on brain catecholamine levels or vice versa
32
Q

Etiology - psychology (EA)

A

AFFECT REGULATION HYPOTHESIS

  • exercise has dual effect on mood: increases positive affect and decreases negative affect (guilt, irritability, anxiety) associated with missed exercise
  • the longer the interval between two exercise session, the experience of negative affect becomes more likely -> tolerance

COGNITIVE APPRAISAL HYPOTHESIS

  • using exercise as a means of coping with stress -> learning to depend on exercise at times of stress
  • person uses rationalization to explain the exaggerated amount of exercise.

Low self-esteem, perfectionism, anxiety, OCD.

Drugs and behavior (18 decks)

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