Behavioural addictions

Question 1

Key questions and concerns

Answer 1

• Is it appropriate to classify excessive engagement in non-substance behaviours as addictions?
• Are we pathologizing everyday behaviours?
• Rapid escalation of normal everyday behaviours being labelled as ‘addictions’.
• Simply maladaptive coping or emotional dysregulation?
• Are behavioural and drug addictions the same thing ?

Question 2

Behavioural addiction - definition

Answer 2

Repetitive, persistent behaviour which results in signficant harm or distress and causes functional impairment

Question 3

Core symptoms of addiction - Components model (Griffiths, 2005)

Answer 3

1. Salience
2. Mood modification
3. Tolerance
4. Withdrawal
5. Conflict
6. Relapse

Sussman and sussman (2011): all forms of addiction share five elements
1. Appetitive effects
2. Preoccupation with the behaviour
3. Temporary satiation
4. Loss of control
5. Negative consequences associated with the behavior

Compulsivity and cue sensitivity - incentive sensitisation theory

Opposing affective cycles , increasingly worsening withdrawal & tolerance.

Question 4

What is not an addiction? (Kardefelt Winther et al. 2017)

Answer 4

It is not considered a disorder if:
1. The behaviour is better explained by an underlying disorder (e.g., a depressive disorder or impulse control disorder)
2. The functional impairment results from an activity, although potentially harmful, is the consequence of wilful choice.
3. The behaviour can be characterised as period of prolonged intensive involvement that detracts time and focus from other aspects of life, but does not lead to significant functional impairment or distress
4. The behaviour is the result of a coping strategy.

Across the Classification systems (DSM, ICD etc), the two consistent features which define an addiction include:
- Social occupational problems
- Impaired control

Question 5

Similarities and differences between Behavioural and drug addictions

Answer 5

Similarities
- Similar, but not identifcal symptomatology
- Similar neurobiological effects and risk factors (D2 receptors, frontal matter structure and perfusion)
- Evidence of heritability (impulsivity)
- Phenomenology
- Treatment options

Differences
- Absence of exogenous substance with psychoactive effects
- Absence of damaging biological effects
- Withdrawal and tolerance less relevant

Question 6

Recognising new behavioural addictions - the confirmatory approach and the inductive, exploratory approach

Answer 6

Confirmatory approach
Premise: Behavioural addictions should be classified according to the criteria for substance abuse disorders
Three step process in practice:
1. Anecdotal observations consider behaviour a priori as addictive
2. Screening instrument developed (often derived from criteria defining another disorder - substance/gambling disorder)
3. Explore associations with risk factors known to play a role in development/maintenance of substance abuse /gambling disorders (impulsivity, sensation seeking, attentional biases)

• We must consider each proposed pattern of addictive behaviour individually
  Confirmatory approach fails to fully investigate purported “addictions” by ignoring:
• Stability of dynsfunctional behaviors
• Functinal impairment
• SUD symptoms aren’t all applicable/diagnostic.

Inductive, exploratory approach
- “Bottom up”
- Gathering information about the patient’s behavior and symptoms to identify patterns and develop hypotheses about the underlying causes of the addiction.
- often used when the patient’s symptoms are not well-defined or when there is no clear evidence of substance abuse.
- more flexible and open-ended method that can be used to diagnose a wide range of behavioral and drug addictions.

Question 7

Pros and cons of labelling disordered behavioural patterns as “behavioural addictions”

Answer 7

Pros:
- Prompts development of treatments
- Greater research focus?
- Recognition/validation of true conditions that people suffer from

Cons:
- Dilute significant of the term addiction
- Category becomes too internally heterogenous (is addiction the right term?)
- Pathologizes normal behaviour ?
- Wasted time + resources

Question 8

Addiction case studies: substance (1) and behavioural (2)

Answer 8

Substance: caffeine (components model)

Salience: no
Mood modification: not sure
Tolerance: yes
Withdrawal: yes
Conflict: no
Relapse: not sure
Impaired control: no

Behavioural: extreme sports

Salience: yes
Mood modification: yes
Tolerance: yes
Withdrawal: not sure
Conflict: no
Relapse: probably not
Impaired control: no, they are calculated risks and decisions when engaged in these behaviours

Implications:
- Clinical significance important
- Can addictions be positive in nature (caffeine)?
- This is still debated

Take home message:
Addiction is complex and messy, difficult to determine how we can identify or define whether somethin is an addiction