Introduction to Behavioural Addictions Flashcards
How were behavioural addictions classified in the DSM-IV?
Under “impulse control disorders”
- separate from substance use disorders (despite similar underlying pathology)
What was the essential feature of behavioural addictions described in the DSM-IV-TR (2000)?
“failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others”
How does Billieux and colleagues (2019) define a behavioural addiction?
“repeated behaviour leading to significant harm or distress”
- “not reduced by the person and persists over a significant period of time”
- “harm or distress is of a functionally impairing nature”
-> focus on person’s actions
Which disorder is currently the only non-substance related disorder classified as an addiction?
Gambling disorder (behavioural addiction) - in DSM-V and ICD-11
What is the state of substance use disorders and behavioural addictions in current classifications?
> SUDs have long been accepted, classified, treated and studied
> Behavioural addictions are the relative ‘new kid on the block’
What do behavioural addictions share with substance use disorders?
Common underlying pathology:
- shared diagnostic criteria
- vulnerability markers
- high co-morbidity with SUD
- genetic vulnerability
- similarities at neurobiological level
- neurocognitive deficits
Which elements of diagnostic criteria do substance use disorders and behavioural addictions share?
> Tolerance
> Withdrawal
> Loss of control
> Negative consequences
> Preoccupation
How does the preoccupation vary between substance use disorders and behavioural addictions?
> Gambling disorders:
- focus on cognitive component
> Substance use:
- focus on time spent obtaining, using or recovering
What are the common vulnerability markers identified between Alcohol and Drug Use Disorders, and Gambling Disorders?
- Young age
- Male sex
- Low socio-economic level
- Unpaired marital status
What is the common genetic vulnerability of substance use disorders and behavioural addictions?
> Individual genetic makeup -> risk in development
> Heritable risk is non-specific across substances
> Shared genetic variance between SUD-GD
- linked to presence of TaqA1 allele of D2 receptor polymorphism
> Multifinality
- expressions are variable, even though there’s high overlap of etiological substrates
- environment shapes expression of behaviours
Why is the heritability risk in substance use disorders non-specific across substances
Likely due to broad constructs (e.g. impulsivity) which serve as risk factors for both SUD and GD
Which elements of structural and functional neurobiology do substance use disorders and behavioural addictions share?
> Mesocorticolimbic dopamine pathway
- modulates reward value of addictive substances and behaviours
> Striatal regions
- reduced dopamine activity mediate reward threshold
- > increases tolerance
> Insula
- development of urges and craving
> Prefrontal cortex (PFC)
- inhibition, decision-making
How does the mesocorticolimbic dopamine pathway modulate the reward value of addictive substances and behaviours?
Arguably, by regulating D2 receptors
AND magnitude of dopamine release -> subjective hedonic response
Which neurocognitive deficits do substance use disorders and behavioural addictions share?
- Decision-making
- Inhibitory control
- Mental flexibility
What does the current evidence suggest on the neurocognitive deficits in substance use disorders and behavioural addictions?
Multimodal evidence for preexisting inhibitory control deficits shared across addictive disorders
- Premorbid impulsive deficits in larger population of individuals with addictions
- Trait impulsivity tends to be elevated in gambling disorder and SUD
