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
How is tolerance characterised in substance use disorders?
> Less reward from same stimulus
-> tolerance to hedonic effects
- > Increased consumption to achieve same high
- refers to volume or strength (e.g. beer to vodka) of consumption
How is tolerance characterised in gambling?
> Greater engagement needed to achieve same high
- increased volume of bets, or stake size
- can come through shifts in gambling form
> Increased reward potential, and loss potential
How is tolerance in gambling recognised in the DSM?
Person “needs to gamble with increasing amounts of money in order to achieve the desired excitement”
How can the withdrawal symptoms be characterised in substance use disorders and behavioural addictions?
> Psychological
- anxiety
- depression
- insomnia
- poor concentration
> Physical
- headaches
- sweating
- chest tightness
- palpitations
- muscle tension
- nausea
How is the loss of control characterised in substance use disorders and behavioural addictions?
> Using more of the substance than intended
- e.g. “chasing loses” phenomenon in gambling (DSM)
> Using substance longer than intended
- e.g. “entering the machine zone”
> Not being able to keep track of the quantity of the substance has been used
What are the shared negative consequences in substance use disorders and gambling?
> Mental health problems
> Physical health problems
> Breakdown of relationships
> Homelessness
> Crime
How does the negative consequences on the relationships vary between substance use disorders and behavioural addictions?
Mechanisms through which the behaviour is damaging the relationship can be subtly different between SUD and BD
- even though negative consequences can be consistent
> Behavioural addictions, especially gambling:
- often, the lies and deceit are more damaging to the relationships than the behaviour itself
What is the danger of applying the addiction models to everyday behaviour?
Creates potential for almost any behaviour to be classified as an addiction
-> over pathologisation of everyday behaviour
What characterises the new criteria specific to behavioural addictions?
Focus on cognitive, emotional and social implications in addition to the neurobiological and neurocognitive underpinnings
-> clinical research needs to keep pace
