Beyond Substance Employ: Understanding Behavioral Addictions

For decades, addiction has been largely associated with substances like alcohol, nicotine, and opioids. However, a growing body of research and evolving diagnostic criteria are expanding our understanding of addiction to include behaviors. Whereas not all intense habits qualify as addictions, certain compulsive behaviors can disrupt a person’s life to a clinically significant degree, leading to recognition as behavioral addictions. This article explores the current understanding of behavioral addictions, focusing on gambling disorder, gaming disorder, and emerging research into other potentially addictive behaviors.

What Defines an Addiction?

Defining addiction is crucial for accurate diagnosis and treatment. According to Dr. Nathan Carroll, a board-certified psychiatrist, an addiction is characterized by a behavior that becomes “so all-encompassing and so obsessive that you get functional impairment across multiple domains — socially, occupationally, educationally.”

Behavioral addiction researcher Mark Griffiths identified six key criteria that help define addiction, applicable to both substance and behavioral addictions:

• Salience: The behavior becomes the most important activity in a person’s life.
• Mood modification: The person uses the behavior to change how they feel.
• Tolerance: Increasing amounts of the activity are needed to achieve the same effect.
• Withdrawal: Stopping the behavior triggers negative psychological or physical symptoms.
• Conflict: The behavior harms relationships, operate or education.
• Relapse: The person repeatedly returns to the behavior after trying to stop.

Griffiths notes that meeting all six criteria is necessary for a behavior to be classified as a true addiction.

Gambling Disorder: A Recognized Behavioral Addiction

Gambling disorder is currently the only formally recognized behavioral addiction in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). A diagnosis requires exhibiting at least four of the following within a year:

• Frequent thoughts about gambling (such as reliving past gambling or planning future gambling)
• Require to gamble with increasing amounts to achieve the desired excitement
• Repeated unsuccessful efforts to control, cut back on, or stop gambling
• Restlessness or irritability when trying to cut down or stop gambling
• Gambling when trying to escape from problems or negative mood or stress
• After losing an item of value by gambling, feeling the need to continue to get even (“chasing” one’s losses)
• Often gambling when feeling distressed
• After losing money gambling, often returning to get even
• Lying to hide the extent of gambling involvement
• Losing important opportunities due to gambling
• Relying on others to help with money problems caused by gambling

Gambling activates the brain’s reward system similarly to drugs, providing a neurochemical basis for its classification as an addiction.

Gaming Disorder: On the Verge of Recognition

Internet gaming disorder has been a subject of ongoing research and debate. While included in the DSM-5 as a condition requiring further study, it is poised for full recognition in the upcoming DSM-6. The growing body of research supports its classification as a behavioral addiction.

Other Potential Behavioral Addictions

Researchers are investigating other compulsive behaviors for potential classification as addictions, including compulsive shopping, excessive exercise, workaholism, social media use, and even mukbang (obsessive viewing of eating videos).

A recent study suggested that compulsive shopping may qualify as a behavioral addiction, with compulsive buyers scoring higher on measures linked to addictive behaviors, such as distress and using shopping for emotional gratification.

The Risks and Benefits of Expanding the Definition of Addiction

Expanding the list of recognized behavioral addictions has both potential benefits and risks. One concern is the potential to pathologize normal behavior. However, classifying more behaviors as addictions can provide a useful framework for clinicians to distinguish between healthy engagement and pathological behavior, and help individuals recognize problematic patterns.

Looking Ahead

The understanding of behavioral addictions is continually evolving. As research progresses and diagnostic criteria become more refined, we can expect to see further clarification and potentially the inclusion of additional behaviors in future editions of the DSM. Recognizing these conditions is a crucial step toward providing effective treatment and support for individuals struggling with compulsive behaviors.