The Classification of Substance and Behavioural Addictions: A Preliminary Investigation (original) (raw)
Related papers
Journal of Affective Disorders, 2010
Current "official" nosology (e.g. DSM IV) is largely limited to physical manifestations of addiction that can be objectively observed and are suited to the maintaining of an "atheoretical" perspective. However, addicted subjects display additional psychiatric symptoms that affect their well-being and social functioning and, in accordance with DSM IV, are typically relegated to the domain of psychiatric "comorbidity." We contend that the relationship of these psychiatric symptoms with addiction is very close, as demonstrated by the high frequency of association observed. We further assert that substance use may modify pre-existing psychic structures such as temperament and related subthreshold conditions and lead to addiction as a specific mental disorder, inclusive also of symptoms pertaining to mood/anxiety, or impulsecontrol dimensions. The present contribution addresses the weaknesses of the current DSMbased nosology of addiction-related mental comorbidity. We highlight the overlap of the biological substrates and the neurophysiology of addictive processes and psychiatric symptoms associated with addiction, and propose the inclusion of specific mood, anxiety, and impulsecontrol dimensions in the psychopathology of addictive processes. We postulate that addiction reaches beyond the mere result of drug-elicited effects on the brain and cannot be peremptorily equated only with the use of drugs despite the adverse consequences produced. We infer that mood, anxiety and impulse-control dysregulation is at the very core of both the origins and clinical manifestations of addiction and should be incorporated into the nosology of the same, emphasising how addiction is a relapsing chronic condition in which psychiatric manifestations play a crucial role. To conclude, addictionology cannot be severed from its psychopathological connotations, in view of the undeniable presence of symptoms, of their manifest contribution to the way addicted patients feel and behave, and to the role they play in maintaining the continued use of substances.
Introduction to Behavioral Addictions
American Journal of Drug and Alcohol Abuse, 2010
Background-Several behaviors, besides psychoactive substance ingestion, produce short-term reward that may engender persistent behavior despite knowledge of adverse consequences, i.e., diminished control over the behavior. These disorders have historically been conceptualized in several ways. One view posits these disorders as lying along an impulsive-compulsive spectrum, with some classified as impulse control disorders. An alternate, but not mutually exclusive, conceptualization considers the disorders as non-substance or "behavioral" addictions.
The word "addiction" has too many meanings. This is partly because it contains a fundamental ambiguity. For centuries, "addiction" referred to the state of being "given over" or intensely involved with any activity. The ambiguity lay in the value attached to this state; addiction could be either tragic or enviable, or somewhere in between. As well, a second meaning emerged in the 19th century, and now coexists with the earlier one. The new meaning is more restrictive than the traditional one in three ways; it links addiction to harmful involvements with drugs that produce withdrawal symptoms or tolerance.
There is now a growing movement that views a number of behaviours as potentially addictive including many that do not involve the ingestion of a drug (such as gambling, sex, exercise, videogame playing and Internet use). This paper argues that all addictions consist of a number of distinct common components (salience, mood modification, tolerance, withdrawal, conflict and relapse). The paper argues that addictions are a part of a biopsychosocial process and evidence is growing that excessive behaviours of all types do seem to have many commonalities. It is argued that an eclectic approach to the studying of addictive behaviour appears to be the most pragmatic way forward in the field. Such commonalities may have implications not only for treatment of such behaviours but also for how the general public perceive such behaviours.