Addiction Series copied from Psychology Today
Types of Addiction (Reviewed by Psychology Today Staff)
Addiction is a condition marked by behavior that is difficult to control and continues despite adverse consequences. The behavior stimulates reward centers of the brain, and the intensely pleasurable effects create a progressively compelling incentive to repeat the activity, often displacing everyday behaviors to the point of disrupting relationships, livelihood, health, and other pillars of normal life.
A number of psychoactive substances have addictive potential, and while they differ pharmacologically one from another, what they have in common is direct activation of the brain’s reward system. Changes in the reward pathways of the brain they induce set the stage for intense cravings at the same time they weaken pathways involved in the ability to control behavior.
There was a time when addiction was thought to be a property residing within substances themselves—morphine, heroin, alcohol, and other psychoactive agents. Eventually it was understood that aspects of both the person (including the larger environment a person dwells in) and the substance contribute to the possibility of addiction. But over recent decades, science has offered a compelling case to include under the addiction umbrella not only substances but behaviors, prime among them excessive gambling. Evidence indicates that gambling behaviors can directly activate brain reward systems in similar ways as drugs of abuse and produce behavioral effects similar to those seen in substance use disorders.
With publication of the Diagnostic and Statical Manual of Mental Disorders, Edition 5 (DSM-5) in 2013, the American Psychiatric Association formally revised the definition of addiction to include compulsive gambling, creating a new category of behavioral addictions. The criteria for diagnosis parallel those for substance use disorders. Much debate rages about including other behaviors taken to problematic extremes—video gaming, internet use, porn use, to name a few. According to DSM-5, the research on behavioral conditions other than gambling is less clear. What is clear is that technology is reshaping modern life in ways that create the potential for addiction-like disruption by numerous activities.
What qualifies as an addiction? By itself, repeated use of a psychoactive substance or gambling is not an addiction—unless use is beyond the person’s ability to control, even when wanting to cut down use, and impairing functioning at school, work, or home. Another marker of addiction and criterion for diagnosis is that the person spends a great deal of time involved with the substance/behavior—obtaining it, using it, or recovering from its effects.
In addition, craving the substance/activity occurs and can be intense, to the point where the person is not able to think of anything else, especially in places where the substance/activity was obtained or used in the past. What also signifies addiction is risk attached to use of the substance/behavior —whether using in hazardous situations or developing physical or psychological problems as a result of use.
Other common signifiers of addiction are the development of tolerance—marked either by need for increased amounts of the substance to have an effect or diminished effect of the same amount of drug—and withdrawal, the experience of physical and psychological distress for a period after abruptly stopping the drug.
How are all addictions alike? The common denominator of all addictions is compulsion. Behavioral and substance addictions arise from the same brain processes. The brain becomes less capable of controlling itself. All addictions act directly on the reward center of the brain to create the intense burst of pleasure known as a “high,” which involves an outpouring of the neurotransmitter dopamine. Addictions of all types are a shortcut to the sense of reward, which is normally obtained by working hard toward and eventually achieving some type of goal.
In addiction, nerve pathways of attention and motivation change in ways that cause a person to preferentially notice, desire, and seek the psychoactive substance or behavior. Activity in the brain’s decision-making center weakens, so that what started as a choice becomes a compulsion. In addition, those addicted generally lose the capacity to respond to life’s normal rewards.
Are all addictions treated the same? The aim of all addiction treatment is to return a person to health, restore their ability to control their own behavior, and rebuild the life that was interrupted. That typically starts with removing access to the substance or activity, which ushers in a period of acute physical and psychological distress—withdrawal—that can last days or weeks. Withdrawal from most addictions is accompanied by extreme discomfort, but with some substances (especially severe, long-term alcohol addiction) withdrawal can be life-threatening and requires medical supervision.
Once withdrawal subsides, real treatment begins. That's when individuals must address the underlying vulnerabilities that made the substance or activity so appealing. There is no one way to do that. Some people make use of clinical services ranging from individual or group psychotherapy to residential care at a “rehab” facility. Others prefer the support of peers and join self-help groups like Alcoholics Anonymous. Many do it on their own. However it is accomplished, recovery must address a person’s emotional state, the nature and quality of their relationships, their stress reactivity, coping skills, their education and job skills.
In short, all addiction treatment aims to help people find healthy new ways for handling life’s difficulties and rebuild the life that was derailed by addiction. Overcoming addition usually entails finding meaningful goals to pursue, to provide the brain with rewards more naturally. Over time—usually months—successful treatment reverses the changes in brain circuitry that make substance use hard to control.
Substance Addictions The sine qua non of all types of addiction is a cluster of behavioral, cognitive, and physiologic changes that enable people to continue use of a substance despite the development of problems stemming from that use. In addition, addictions bypass normal processes of reward to directly stimulate an outpouring of dopamine in the brain; the resulting rush of pleasure, known as a high, powerfully motivates people to repeat the behavior. Intoxication is marked by altered perception and altered consciousness, and often by physical changes as well, such as altered speech and poor coordination.
The DSM-5 distinguishes nine distinct substance use disorders, differing by type of substance involved. How long intoxication lasts, the specific signs of use, and other particulars depend on many factors, including individual biology, but most of all they vary according to which pharmacologic category the addictive substance belongs to. Substance addictions are sometimes collectively referred to as chemical addiction, to distinguish them from behavioral addiction, but many find that a confusing term.
Alcohol Use Disorder By far, alcohol is the world’s most ubiquitous intoxicant, and it has been used in virtually every culture since Neolithic times. It is also the most common substance subject to addiction. Much evidence suggests that beer stirred civilization, and agriculture got its start in order to produce grain for beer. A social lubricant and releaser of inhibitions, alcohol plays a key role in most of life’s celebrations. It is, pharmacologically speaking, a central nervous system depressant, with sedative and anxiety-dissolving effects. The vast majority of people have experienced one or more instances of alcohol intoxication.
The line between social drinking and alcohol abuse is not always clear. One clear sign of a problem is drinking that starts well before social events or even early in the day. Another is concealing drinking from family and friends. Considering the wide use of alcohol, only a small proportion of people are unable to control their consumption of it. According to the 2019 National Survey on Drug Use and Health, 14.5 million Americans—9 million men, 5.5 million women—have an alcohol use disorder. Alcohol intoxication accounts for nearly 20 percent of all hospital emergency room visits and nearly 30 percent of all driving fatalities. Cultural attitudes toward drinking play a major role in alcoholism, and the condition is less prevalent in societies where drinking is integrated into everyday life, such as in Mediterranean countries.
The peak age of onset of alcohol use disorder is late teens to mid-20s, especially among those with conduct disorder and antisocial behavior. In 90 percent of cases, alcohol use disorder develops before age 40. Alcohol use disorder is associated not only with a significantly increased risk of accidents but of violence and suicide as well.
Research shows that people may drink alcohol to regulate their emotions. Alcohol tends to improve people’s mood, and some come to rely on it as a way of regulating uncomfortable negative emotional states, such as anger and anxiety. Alcohol use is reinforced through its effects on mood. Recovery from alcohol use disorder typically involves learning new, adaptive ways of coping with negative affect, a cornerstone of most psychotherapies.
Psychotherapies such a cognitive behavioral therapy also focus on reducing shame, a powerful negative emotion that can undermine recovery of those suffering from addiction. Heavy alcohol use has effects on many organ systems of the body, especially the digestive system, the cardiovascular system, and the nervous system. It causes stomach ulcers and liver damage, raises the risk of heart disease, impairs nerve conduction leading to muscle weakness and numbness in limbs, and erodes memory.
While alcohol use poses dangers, so does sudden stopping or reduction after heavy use, leading to alcohol withdrawal symptoms, marked by a rebound in nervous system activation. Anxiety, irritability, and mood instability are prominent reactions, along with physical shakiness or tremors. In a small percentage of cases—less than 10 percent—alcohol withdrawal can lead to delirium or seizures, which is why withdrawal is best managed with medical supervision.
Fewer than 7.5 percent of those with alcohol use disorder receive any treatment for their condition. The vast majority of people choose to curtail drinking on their own. While some recovery programs, notably the Alcoholics Anonymous peer-support network, demand complete abstinence and maintain that recovery is possible only through abstinence, research also validates moderation of drinking as a path of recovery. Many other recovery programs, such as TK, focus on reducing alcohol consumption to manageable levels rather than abstaining completely.
People with AUD are more likely to seek care from a primary care physician for an alcohol-related medical problem rather than specifically for drinking too much alcohol.
What is considered alcoholism, or alcohol use disorder? As with other addictions, the key feature of alcohol use disorder, commonly known as alcoholism, is the inability to reliably control drinking. The DSM-5 describes 12 diagnostic signs and symptoms of alcohol-related impairment:
• Using alcohol more frequently or in higher amounts than intended • Being unable to stop drinking or control alcohol intake despite attempts to do so • Devoting significant amounts of time getting alcohol, drinking, and recovering from its effects • Experiencing strong urges to drink (cravings) • Failing to fulfill obligations at work, home, or school due to alcohol use • Continuing to drink even after experiencing social or relationship problems resulting from alcohol use. • Giving up or reducing the amount of time spent at work or school or on social and recreational activities that a person once enjoyed due to alcohol use. • Drinking when it is physically dangerous to do so (such as while driving or operating machinery) • Drinking despite the development of physical or psychological problems related to alcohol use • Experiencing tolerance—the need for increasing amounts of alcohol to achieve desired effects or the loss of effects of a continued amount of alcohol • Experiencing withdrawal symptoms when trying to stop or cut back on drinking.
The presence of 2 to 3 symptoms indicates a mild substance use disorder. Moderate disorder involves the presence of 4 to 5 signs. Six or more symptoms is considered diagnostic of severe alcohol use disorder.
How many drinks a day does it take to be an alcoholic? The National Institute on Alcohol Abuse and Alcoholism cites two patterns of drinking that can lead to the risk of alcohol use disorder—binge drinking and heavy alcohol use.
• Heavy alcohol use is consumption of more than 4 drinks on any day or more than 14 drinks per week for men, and more than 3 drinks on any day or more than 7 drinks per week for women.
• Binge drinking is consumption of more than 5 drinks in 2 hours for men, 4 drinks for women—or any pattern of drinking resulting in a blood alcohol concentration (BAC of 0.08 g/dl or above. Binge drinking is twice as common among men as among women, and most common among those with household incomes above $75,000. While binge drinking is a risk factor for alcoholism, and a contributor to accidents and emergency room visits—for car crashes, falls, burns, and alcohol poisoning—most people who binge drink do not have an alcohol use disorder.
According to the 2019 U.S. National Survey on Drug Use and Health, 29.6 percent of adults ages 18 to 22 reported binge drinking in the past month— 33.0 percent of full-time college students and 27.7 of non-college agemates. The same survey counted 7.0 percent of adults as heavy users of alcohol in the past month, including 8.2 percent of full-time college students and 6.4 percent of other non-college peers.
Binge-drinking is intensifying. The NIAAA describes an emerging trend of “high-intensity drinking.” It involves consuming alcohol at two or more times the gender-specific binge drinking threshold. Such drinking exponentially increases the likelihood of an emergency room visit.
Cannabis Use Disorder Marijuana and other cannabinoid agents are the most widely used illicit psychoactive substances in the United States. They are most popular with teens aged 12 to 17. As of early 2021, the recreational use of cannabis (called marijuana, weed, pot, hashish) is legal in 14 states and use has been decriminalized in 16 others. The drug is most commonly smoked, and concentrations of the active agent can vary from 1 percent to 15 percent—and is rising. According to the DSM-5, those who regularly use cannabis often report using it to cope with mood, sleep, pain, or other physiological or psychological problems.
According to the 2020 U.S. National Survey on Drug Use and Health, cannabis use disorder is the fastest-growing substance use disorder among all age groups. The National Institute on Drug Abuse reports that 30 percent of those who use marijuana may have some degree of marijuana use disorder, and those who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults. Like other psychoactive substances that are subject to abuse, cannabis can create all the general features of a substance use disorder, including withdrawal effects when stopped.
THC, or tetrahydrocannabinol, the active ingredient in marijuana, acts on the brain to heighten the experience of novelty. Cannabis makes everything so interesting. The world sparkles. The “high” that smoking marijuana induces—physical relaxation, emotional calming, increased appetite, vivid sensations, ease of falling asleep—can last for four hours; when ingested, it can create a high for up to eight hours.
Prominent among the behavioral effects of marijuana use is reduction in pain, but the drug also reduces motivation and alters memory. There is some evidence that the earlier marijuana use is started, the more it negatively affects motivation. Although marijuana use has been linked to such psychiatric conditions as anxiety and depression, the evidence is contradictory. What data do show is that early, heavy, and frequent use of marijuana creates a risk for psychosis.
Hallucinogen Use Disorder Hallucinogens are enjoying a new round of interest in mental health research as well as in underground and mainstream culture, and they appear to have a significant future in psychology. In trials at many major medical centers, a number of hallucinogens—administered in combination with intensive psychotherapy—are proving unusually promising for treatment of resistant conditions, notably post-traumatic stress disorder, alcoholism and other addictions, and intractable depression. In addition, they are under study for treatment of cancer-related existential distress. There is evidence that, when used therapeutically, hallucinogens can stimulate growth of nerve cells in the brain and help people reorganize a sense of self.
The classic hallucinogen is lysergic acid diethylamine—popularly known as LSD—a potent mood- and perception-altering chemical. Psilocybin, commonly called magic mushroom, creates feelings of euphoria and can stimulate the sensation of religious experience. Decades ago it was under study for treatment of alcoholism, as it is again today. Another common hallucinogen is DMT, or dimethyltryptamine, also called Dimitri or “the spirit molecule,” a nod to its long history in religious rituals. Ketamine, a medically used anesthetic that produces dissociative states and has long been popular illicitly as club drug “Special K,” has now found serious use as relief from treatment-resistant depression and, in combination with intense psychotherapy, in the treatment of post-traumatic stress disorder.
Hallucinogens produce visual distortions. They do not produce perceptions of things that are not actually present; rather, they distort the ability of the brain in representing objects that are present. Some people also experience a distortion of their sense of time and sense of self. But hallucinogens have a dark side and can induce panic, paranoia, and even delusional psychotic states that persist beyond acute intoxication. The hallucinations associated with hallucinogens tend to be vividly visual, versus the auditory hallucinations typical of schizophrenia.
One of the distinguishing features of addiction to hallucinogens is the absence of withdrawal symptoms when use is abruptly stopped. Another feature of hallucinogens is a continual evolution in the way they are used outside of sanctioned use. Many are popular “club drugs.” One of the newest iterations of addictive agents is the combination of ketamine with cocaine, “the new speedball,” according to the 2020 National Survey on Drug Use and Health; on the street it is known as C.K. or Calvin Klein.
Between 2017 and 2020, the national drug survey recorded a 56 percent increase in the use of LSD. The rise is most pronounced among people who are college-educated, those aged 26 to 34—and especially among those age 50 and older.
Opioid Use Disorder Heroin, morphine, prescription painkillers such as oxycodone, and the far more powerful synthetic painkiller fentanyl all belong to the class of drugs known as opioids. Opioid intoxication is characterized by intense euphoria and well-being, and addiction to opioid drugs increased rapidly in the United States during the 1990s, paralleling a sharp rise in the prescription of pharmaceuticals for the treatment of pain. Diversion of prescription drugs fueled what has become known as “the opioid crisis” in the U.S. One of its most distinctive features is a changed face of drug addiction to include all ages, all socioeconomic classes and, especially, women.
The expense of maintaining an addiction to prescription drugs paved the way for a wave of addiction to heroin—cheap, illegal, and easier to obtain “on the street,” albeit with the added risk of infection because it’s injected as well as great variability of dosage. Deaths due to accidental heroin overdose rose nearly 300 percent between 2002 and 2013. Since 2016, the availability of illicitly manufactured fentanyl has compounded the number of drug-overdose deaths, even as the epidemic of opioid addiction has begun to wane, due to changes in postoperative prescribing patterns long sought by public health officials.
Opioid addiction, like other addictions, arises when the substance user cannot control use and, as a result of use, problems arise in fulfilling obligations or maintaining relationships. Daily activities are typically planned around getting and administering opioids. Most people with opioid use disorder develop high levels of tolerance and experience withdrawal when stopping use.
• Consulting physicians from multiple practices for prescriptions • Calling one’s physician’s office to be seen immediately because “the pain is much worse” • Frequently calling a physician’s office to request early refills because “I needed to take some extra ones” • Making frequent emergency room visits for prescriptions • Missing appointments and obligations because of pain • Hoarding opioids.
Withdrawal from opioids has been likened to a bad case of the flu, with whole-body discomfort, abdominal pain , and nausea and diarrhea lasting several days. Such symptoms frequently drive those trying to quit back to use. That is one reason why those quitting opioid use are frequently advised to seek medical supervision for doing so.
Stimulant Use Disorder The potent central nervous system stimulants cocaine and methamphetamine—cocaine in urban areas, methamphetamine in rural areas—are now eclipsing heroin and prescription opioids as substances of abuse. Both classes of substances are associated with feelings of euphoria and well-being, but cocaine and the amphetamines bring with them perceived increased powers of thought, strength, and accomplishment—even to the point of aggressive and promiscuous behavior.
For many people, stimulant use begins as a means to control weight or gain a performance edge in school, work, or sports. They are often widely available in school settings as “study drugs,” often prescribed for the treatment of attention-deficit/hyperactivity disorder. Researchers report that addiction to stimulants can develop rapidly—sometimes within a week— especially when the drugs are injected intravenously or smoked.
Chronic heavy users of stimulants often experience anxiety, sometimes to the point of panic, as well as temporary paranoid delusional states that can last for weeks or months. The psychotic states induced by cocaine do not necessarily involve impaired abstract reasoning or thinking, unlike those associated with schizophrenia, and the delusions are more likely paranoid than floridly bizarre.
People who abuse stimulants typically experience significant energy shifts in the course of a day. Methamphetamine is particularly linked to increased sex drive and performance. Whether the short-lasting effects of cocaine or the longer-lasting effects of amphetamines, the stimulant high eventually ends with a crash into fatigue, excessive sleeping and eating, and depression, a dynamic driving long binges of stimulant use that are hard to stop.
Extreme fatigue and depression mark withdrawal when those who are addicted to stimulants abruptly stop use. Even after many weeks of abstaining they commonly unable to experience pleasure. Over time, that capacity returns.
Tobacco Use Disorder Tobacco use disorder arises from addiction to nicotine, whether exposure occurs through the smoke of conventional cigarettes, the vapor of e-cigarettes, or chewing tobacco. Tobacco use is a major public health problem in the U.S. and sustained smoking is a leading cause of lung disease, heart disease, an array of other chronic health conditions and premature death.
Tobacco use and nicotine addiction most often begin in adolescence. Surveys shows that nearly 90 percent of adult smokers started before age 18. Although rates of cigarette use have been declining over the past few decades—less among nonurban youth than among urban teens— exposure to nicotine through “vaping” has been rapidly increasing among adolescents; e-cigarettes are currently the most commonly used tobacco product by adolescents in the U.S.
Nicotine is rapidly absorbed into the bloodstream and stimulates the adrenal glands to release adrenaline (epinephrine), which activates the central nervous system. It also acts on the brain’s reward system to release dopamine—briefly stabilizing mood and providing a short-lived but powerful incentive to repeat the experience. Other chemicals present in tobacco may magnify the effect of tobacco on the brain.
The neurostimulating effects of cigarette smoke have made tobacco use particularly prevalent among psychiatric populations. Youth with psychiatric disorders are thought to be particularly vulnerable to developing tobacco use disorder. According to one major report, 41 percent of people affected by mental illness are habitual smokers. New research suggests, however, that quitting smoking may actually improve mental health—and stopping smoking has the equivalent benefit of antidepressant treatment of anxiety and depression. And while the discomfort of nicotine withdrawal lasts weeks, the mental health benefits of smoking cessation are enduring.
Vaping Vaping is inhaling the aerosolized vapor created by puffing on an electronic cigarette or other device. E-cigarettes heat up cartridges filled with a liquid containing nicotine (typically as much as in a pack of cigarettes), various flavorings, and many unknown chemicals, and they have been in use, especially among teens, since 2014. Sometimes marijuana is added to the “vape juice.” According to a recent report from the U.S. Centers for Disease Control, 4.47 million middle and high school students used a vaping device in 2020, a decrease from the year earlier.
Nevertheless, vaping poses the risk of nicotine addiction as well as all the life-shortening hazards of smoking tobacco. Vaping can prove even more addictive than smoking regular cigarettes because it is possible to purchase cartridges with an extra-high concentration of nicotine. The use of flavorings in e-cigarettes is designed to make them especially appealing to young people. According to the National Institute on Drug Abuse, many teens who partake of vaping are not even aware that the e-cigarettes contain anything more than flavoring.
Like the nicotine in conventional cigarettes, the nicotine in vapor is absorbed into the bloodstream, only more readily so. It stimulates the adrenal glands to release the hormone adrenaline, a central nervous system stimulant that speeds up heart rate and breathing and raises blood pressure. Like other addictive agents, nicotine also activates the reward circuits of the brain to release dopamine, and the resulting pleasurable sensations motivate repeated use.
In addition to the risk of nicotine addiction, vaping is associated with direct damage to lung tissue. As of January 2020, the CDC had confirmed 60 deaths as a result of lung injury from vaping. In most cases, the damage was linked to the presence of compounds associated with marijuana use. E-cigarettes are sometimes marketed as devices to aid in stopping smoking, but they are not approved for that use. Studies show that vaping actually raises the risk of cigarette smoking in the future.
Non-Substance-Related Addictive Disorders In 2013, with the publication of the fifth edition of its influential Diagnostic and Statistical Manual of Mental Disorders, edition five, or DSM-5, the American Psychiatric Association formally recognized that, much like certain psychoactive substances, certain activities can be subject to addiction. Gambling disorder became the first—and so far, only—behavior singled out for addictive potential.
But other behaviors—video game use, pornography use, sexual activity, smartphone use—are hotly debated both in households around the world, popular culture, and medical circles. The idea that gambling and other behaviors can turn into addictions is relatively new, and many professionals, policymakers, and researchers take issue with it. Some see it as opening the door to pathologizing everyday passions and pleasures.
The true problem is that technology is conferring the capacity for addiction on many activities that would never before have lent themselves to significant abuse. Many behavioral addictions occur predominantly online, and one major reason for the advent of behavioral addictions is changing technology: The rapid adoption of internet-connected smartphones, starting in 2007, has placed and continues to place, quite literally at everyone’s fingertips, pleasurable activities that once were available only in special settings and required special efforts to access. Technology has not only eliminated all barriers to their availability but added many incentives to engage in them and stay engaged—making them deceptively attractive diversions from effortful life and the need to manage stress, boredom, and other unpleasant if inevitable feeling states.
Behavioral addiction—sometimes also called process addiction—is a still-evolving domain of human behavior, and the definitive chapter on behavioral addiction is nowhere near complete. New apps constantly elaborate new ways to snare people’s attention and hold it—because financial incentives reward app creators significantly for doing so.
Ongoing research is tracking many of the behaviors of concern and may shed more definitive light on the potential for addiction. No matter which activities are formally added to the list of addictions, the core characteristics are the same as in other addictions—an overwhelming urge to repeatedly engage in an activity despite negative consequences.
Gambling Disorder As the DSM-5 states, “gambling involves risking something of value in the hopes of obtaining something of greater value,” and across many cultures many activities are subject to gambling for pleasure. While most people partake with impunity, some people get caught up in “chasing” their losses—trying to recover lost money—and their gambling activities intrude on and impair functioning in other life demands. Most people who develop an addiction to gambling do so over a period of time in which they gradually increase both the frequency and amount of wagering. “The essential feature of gambling disorder is persistent and recurrent maladaptive gambling behavior that disrupts personal, family, and/or vocational pursuits,” the DSM-5 explains.
Many people are at risk of developing problems as a result of gambling—incurring big losses, for example— but there is a significant distinction between problem gambling vs. gambling addiction. While both can create significant financial problems, addiction can occur only when the activity is regularly available, because it relies on frequency of rewards. Since 2018, sports betting is legal in the U.S., earns more than a billion dollars annually for its sponsors, and is growing exponentially, as real and fantasy leagues join the market. Gambling earned U.S. casinos $ 43.61 billion in 2019. But that only scratches the surface—there’s horse-racing, bingo, and just about any other human activity or event probability to stake a bet on.
Further, the COVID-19 pandemic had a major effect on the gambling industry worldwide. With the forced closure of gambling casinos and sports events, the entire market has migrated from offline to online. Sources differ but an estimated 1 to 3 million Americans are believed to have some degree of gambling addiction; Nevada and Mississippi rank as the two “most gambling-addicted states.” The effects of the pandemic on gambling addiction has yet to be tallied.
As with substance addictions, gambling can be the subject of craving. Further, the addiction can be invisible, conducted privately on a handheld device. The ubiquity of smartphones may magnify difficulty overcoming the disorder, with every phone serving as an environmental trigger to craving. Curtailing or stopping gambling can lead to symptoms of withdrawal, notably restlessness and irritability.
Studies of the psychology of gambling show that gamblers commonly hold many superstitions and myths about the activity. For example, many believe they can devise a system to win—even though gambling is a completely random event. Breaking down the fallacies that gamblers subscribe to may help in overcoming their addiction.
Video Gaming Although not recognized by the DSM-5, video gaming disorder is recognized by the World Health Organization, in its International Classification of Diseases, and the entry includes all the criteria of addiction. But there is much controversy on the subject. When does video gaming become a disorder? Is there a difference between video gaming disorder and video game addiction? Is the distinguishing feature progressive loss of control over the behavior, as with classic addictions, to the e point of neglect of other obligations and consequent harm?
Video games have become a virtual rite of passage among children and adolescents in many parts of the world. According to the DSM-5, “internet gaming disorder,” which it classifies as a condition warranting further study, is most prevalent in Asian countries and in male adolescents aged 12 to 20. Many parents can attest to the difficulty of pulling a child away from a game to go on a family outing or even as far as the dinner table. Colloquial use of the term addiction is common for such situations, but most researchers look at the activity in the broader context of a person’s life and specifically the function it serves—internally and externally.
People engage in video games for many positive reasons—they provide recreation, they have become social hubs—especially the massive multiplayer online games such as Minecraft, with hundreds of millions of players—and playing even sharpens many skills. The DSM-5 acknowledges that team aspects may be a key motivation for playing. Many experts believe that video gaming becomes an addiction only when the original motivation for pleasure dissolves and a person feels compelled to continue amid mounting negative consequences, such as to schoolwork.
Much of the concern over video gaming relates to the effects on still-developing brains of an activity with so many pings and booms, visual displays, and levels of advancement serving as built-in short-term rewards and reinforcers: Do they have a long-term effect in overriding all possibility of self-control or delay or even prevent its full development? The answers are not in.
Other concerns focus on social development, especially during adolescence, normally a period of rapid development of social skills but for many a socially challenging time of life. Some researchers find that video gaming is most problematic among males with social phobia, and treating the underlying condition through psychotherapy is necessary for resolving the problem, whether it rises to the definition of addiction or not.
Internet/Cellphone Addiction No technology was ever adopted more quickly than the mobile phone, around the turn of the millennium. Starting in 2007,with the general introduction of the smartphone, mobile technology opened worlds of connection—to everyone and everything—requiring minimal effort. No one would argue that extraordinary good has come of it—boundary-less social connection, research and collaboration in virtually every field of human endeavor, education, entertainment, extension of life-saving medical advances to remote corners of the world, and much more. But as philosopher Paul Virilio observed, when you invent the ship, you also invent the shipwreck.
The effects of unlimited internet connectivity on mental health are still being tallied. A much-discussed concern is the possibility of addiction to or problematic use of one feature or another of the internet among people of all ages, but especially among the young, whose as-yet-undeveloped capacities for self-control, it is thought, could render them especially vulnerable to developmental disruption.
Researchers debate whether the internet is simply a portal to content-specific addictions—such as video gaming, gambling, or porn—or can be addictive in its own right. Exhibit A of its own capacity for problems might be social networking, which can take place only online. Sites such as Facebook, Twitter, Instagram, and TikTok are major channels of communication and social belonging for millions. People spend hours a day on them—sharing information, opinions, and photos, and commenting on all of them.
Many tech observers contend that such sites invite and, through programming features delivering a steady stream of small rewards, even encourage overuse if not frank addiction. “The [inter]net teaches us to need it,” MIT psychologist Sherry Turkle observes in her highly regarded book, Alone Together: Why We Expect More from Technology and Less from Each Other. In capitalizing on our social nature, it can also undermine it.
Much research documents that overuse of social media can be bad for mental health. It invites social comparison—often with negative effects on self-esteem for women, giving rise to anxiety and depression, even teen suicide. New studies regularly link excessive Facebook use to depression. Ironically the overuse of social media is also associated with loneliness.
Public health advocates recommend regular “digital detox.” Too, internet connectivity has widely documented negative effects on social life. People often use their devices at inappropriate times and places, annoying many others. The devices, even when not in active use but just in eyeshot, can sabotage intimate encounters between romantic partners, leading many to feel alienation.
The social media problem, observers believe, results from a profound mismatch between our evolutionary heritage and our newest tools. We are wired for face-to-face contact, not remote communication, which becomes subtly disruptive. Hungering for real connection, we get the pale substitute of digital connection, which removes many natural constrains on mental disorder and weakens psychological resources.
While almost everyone with a digital device at some time wrangles with how much attention to accord it, no one know syet exactly what constitutes digital device overuse, although many researchers and clinicians are trying to develop ways to measure it. The most sobering observation might be that of tech industry insiders who have formed a Center for Humane Technology. They argue that addiction is the purpose, a built-in feature, of social media platforms, and not simply a bug. It remains an open question.
Signs of potentially problematic internet use include:
• Frequently spending more time online than you want or intend • Feeling guilty about frequent internet use • Thinking about using your device when it’s not possible to do so • Turning to internet use when you’re in a bad mood or upset • Losing interest in non-internet activities • Having conflicts with others about internet use • Maintaining levels of internet use even when they are causing problems • Hiding the true extent of internet use from others.
If you or a family member is having trouble regulating internet use, it would be wise to seek help. It’s worth mentioning to your healthcare provider. Psychotherapy for internet overuse is widely available in most communities. Alternatively, you can search out whether mutual support groups exist in your community for those wishing to cut down usage.
Porn Addiction/Sex Addiction One of the most common complaints that clinicians hear is “I think my husband is a porn addict” or its corollary, “I think he’s a sex addict.” On the basis of porn viewing, many men identify themselves as porn addicts or sex addicts. Although “porn addiction” and “sex addiction” are used in common parlance, are they in fact addictive disorders? Neither is a recognized condition in the DSM-5, but the World Health Organization does include “compulsive sexual behavior disorder” in the International Classification of Diseases. Clinicians report that pornography use is the major concern of patients so diagnosed.
Statistics indicate that porn use is normative male behavior. More than 90 percent of men report using pornography with some regularity. Two of the top 10 websites in the world are devoted exclusively to pornography. Just those two combined garner more than 6.5 billion visitors a month.
Research suggests that porn addiction is more a perceived problem than an actual disorder. It arises from the fact that accessing erotic imagery online is often done in secret, it typically leads to sexual arousal and masturbation, and it is generally proscribed by religion. The combination gives rise to feelings of shame in men and their partners, who then see the activity as proof of perversion.
Significantly, researchers find that what is commonly labeled “porn addiction” does not reflect a critical feature of addictive activity—lack of control over the behavior. There is no correlation whatsoever between frequency of porn use and a person’s sense of self-control. Men are just as likely to designate themselves porn-addicted if they view porn once or twice in six months as they are if they view it daily.
If the label “porn addiction” or “sex addiction” is indicative of anything at all, many sex researchers believe, it’s symptomatic of a general lack of understanding of human sexuality. What brain science suggests about sex is that men and women differ significantly in their erotic imagination, regardless of what they say turns them on—and every couples counselor can attest to the resulting failure of even committed couples to engage in frank sexual conversation about their private sexual fantasies and desires. In other words, “porn addiction” and “sex addiction” are often pseudoscientific misnomers for men’s reluctance to freely voice their sexual preferences and feeling ashamed about them.
In a recent public statement, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) tackled the misleading “sex addiction" label. The organization declared that there is not sufficient empirical evidence to support the classification of sex addiction or porn addiction as mental health disorders, although there are therapists who offer therapy for it. AASECT went on to point out that neither the training nor treatment methods applied to such so-called addictions reflect accurate human sexuality knowledge.
Why, then, do people persist in believing there is such a thing as “sex addiction”? Many clinicians observe that the label “sex addicted” is often leveled at one partner by the other when what really exists is a troubling discrepancy in sexual desire between them. Or it may be misapplied when either partner’s sexual interests clash with religious or spiritual beliefs.
Next in the Series: Addiction and the Brain
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SOURCE: Addiction | Psychology Today (Clickable Link)