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Behavioral addiction is a form of
addiction Addiction is a biopsychosocial The biopsychosocial model is an interdisciplinary model that looks at the interconnection between biology Biology is the natural science that studies life and living organisms, including their anatomy ...

addiction
that involves a
compulsion Compulsion may refer to: * Compulsive behavior, a psychological condition in which a person does a behavior compulsively, having an overwhelming feeling that they must do so. * Obsessive–compulsive disorder, a mental disorder characterized by in ...
to engage in a rewarding non-
substance Substance may refer to: * Substance (Jainism), a term in Jain ontology to denote the base or owner of attributes * Chemical substance, a material with a definite chemical composition * Matter, anything that has mass and takes up space * Substance th ...
-related behavior – sometimes called a ''natural reward'' – despite any negative consequences to the person's physical, mental, social or financial well-being. Addiction canonically refers to substance abuse; however, the term's connotation has been expanded to include behaviors that may lead to a reward (e.g., gambling, eating, or shopping) since the 1990s. A gene transcription factor known as
ΔFosB Protein fosB, also known as FosB and G0/G1 switch regulatory protein 3 (G0S3), is a protein that in humans is encoded by the FBJ murine osteosarcoma viral oncogene homolog B (''FOSB'') gene. The FOS gene family consists of four members: C-Fos, FO ...

ΔFosB
has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations in the
reward system The reward system (the mesocorticolimbic circuit) is a group of neural structures responsible for incentive salience An incentive is something that motivates or drives one to do something or behave in a certain way. There are two types of ince ...
.


Psychiatric and medical classifications

Diagnostic models do not currently include the criteria necessary to identify behaviors as addictions in a clinical setting. Behavioral addictions have been proposed as a new class in
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomy (general), taxonomic and diagnostic tool published by the Am ...
, but the only category included is gambling addiction. Internet gaming addiction is included in the appendix as a condition for further study. Behavioral addictions, which are sometimes referred to as impulse control disorders, are increasingly recognized as treatable forms of addiction. The type of excessive behaviors identified as being addictive include
gambling Gambling (also known as betting) is the wagering something of Value (economics), value ("the stakes") on an Event (probability theory), event with an uncertain outcome with the intent of winning something else of value. Gambling thus requires ...
,
food Food is any substance consumed to provide Nutrient, nutritional support for an organism. Food is usually of plant, animal or Fungus, fungal origin, and contains essential nutrients, such as carbohydrates, fats, protein (nutrient), proteins, vi ...
,
chocolate Chocolate is a food product made from roasted and ground cacao pods, that is available as a liquid, solid or paste, on its own or as a flavoring agent Flavor, or flavour, is the perceptual Perception (from the Latin Latin ...
,
sexual intercourse Sexual intercourse (or coitus or copulation) is a sexual activity Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality Human sexuality is the w ...
, use of
pornography Pornography (often shortened to porn) is the portrayal of Human sexual activity, sexual subject matter for the exclusive purpose of sexual arousal.
, use of
computers A computer is a machine that can be programmed to Execution (computing), carry out sequences of arithmetic or logical operations automatically. Modern computers can perform generic sets of operations known as Computer program, programs. These p ...
, playing
video games#REDIRECT Video game#REDIRECT Video game A video game is an electronic game that involves interaction with a user interface or input device such as a joystick, game controller, controller, computer keyboard, keyboard, or motion sensing device ...

video games
, use of the
internet The Internet (or internet) is the global system of interconnected computer networks that uses the Internet protocol suite (TCP/IP) to communicate between networks and devices. It is a ''internetworking, network of networks'' that consist ...
and other digital media,
exercise Exercise is any bodily activity that enhances or maintains physical fitness Physical fitness is a state of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value ...
, and
shopping Shopping is an activity in which a customer browses the available goods or services presented by one or more retailers with the potential intent to purchase a suitable selection of them. A typology of shopper types Typology is the study of ty ...
. Researching addiction to food, for example, a 2009 Scripps Research Institute study found evidence that the same molecular mechanisms correlated with human drug addiction also exist in compulsive overeating in obese rats. The dopamine D2 receptor studied is associated with vulnerability to drug addiction in humans. It was found downregulated in obese rats exposed to a high fat diet, and further reductions of the receptor increased compulsive eating. The D2 receptor responds to dopamine, a central neurotransmitter released in anticipation of rewarding, satiating experiences such as those involving food, sex or psychoactive drugs. In August 2011, the
American Society of Addiction Medicine The American Society of Addiction Medicine (ASAM), founded in 1954, is a professional medical society representing over 6,000 physicians, clinicians and associated professionals in the field of addiction medicine. ASAM is dedicated to increasing ...
(ASAM) issued a public statement defining all addiction in terms of brain changes. "Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry." The following excerpts are taken from the organization's FAQs:
The new ASAM definition makes a departure from equating addiction with just
substance dependence Substance dependence, also known as drug dependence, is a biopsychological situation where-by an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance, because of an adaptive state that has develo ...
, by describing how addiction is also related to behaviors that are rewarding. This is the first time that ASAM has taken an official position that addiction is not solely "substance dependence." This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system. Food and sexual behaviors and gambling behaviors can be associated with the "pathological pursuit of rewards" described in this new definition of addiction.
We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or 'enough.' In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors. So, anyone who has addiction is vulnerable to food and sex addiction.
Since ASAM released its statement, and shortly before its release, additional new studies have come out on Internet addiction. They reveal the same fundamental brain changes seen in other addicts of drugs. Another 2011 study found that the risk of Internet addiction in men was about three times more than women. Researchers noted,
Internet addiction is a psychosocial disorder and its characteristics are as follows: tolerance,
withdrawal symptoms Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may ...
, affective disorders, and problems in social relations. Internet usage creates psychological, social, school and/or work difficulties in a person's life. Eighteen percent of study participants were considered to be pathological Internet users, whose excessive use of the Internet was causing academic, social, and interpersonal problems. Excessive Internet use may create a heightened level of psychological arousal, resulting in little sleep, failure to eat for long periods, and limited physical activity, possibly leading to the user experiencing physical and mental health problems such as depression, OCD, low family relationships and anxiety.


Treatment

Behavioral addiction is a treatable condition. Treatment options include
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
and psychopharmacotherapy (i.e., medications) or a combination of both.
Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (e.g ...
(CBT) is the most common form of psychotherapy used in treating behavioral addictions; it focuses on identifying patterns that trigger
compulsive behavior Compulsive behavior is defined as performing an action persistently and repetitively without it necessarily leading to an actual reward or pleasure. Compulsive behaviors could be an attempt to make obsessions go away. The act is usually a small, ...
and making lifestyle changes to promote healthier behaviors. Because cognitive behavioral therapy is considered a short term therapy, the number of sessions for treatment normally ranges from five to twenty. During the session, therapists will lead patients through the topics of identifying the issue, becoming aware of one's thoughts surrounding the issue, identifying any negative or false thinking, and reshaping said negative and false thinking. While CBT does not cure behavioral addiction, it does help with coping with the condition in a healthy way. Currently, there are no medications approved for treatment of behavioral addictions in general, but some medications used for treatment of drug addiction may also be beneficial with specific behavioral addictions. Any unrelated psychiatric disorders should be kept under control, and differentiated from the contributing factors that cause the addiction.


Research

A recent narrative review (2017) reviewed the existing literature for studies reporting associations between behavioural addictions (pathological gambling, problematic internet use, problematic online gaming, compulsive sexual behaviour disorder, compulsive buying and exercise addiction) and psychiatric disorders. Overall, there is solid evidence for associations between behavioural addictions and
mood disorder Mood disorder, also known as mood affective disorders, is a group of conditions where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Statistical Manual of Mental Disorders The ...
,
anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such fe ...
as well as
substance use disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as ...
s. Associations between
ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, or excessive activity and impulsivity, which are otherwise not Developmental psychology, appropriate for a person's age. Some indivi ...

ADHD
may be specific to problematic internet use and problematic online gaming. The authors also conclude that most of current research on the association between behavioural addictions and psychiatric disorders has several limitations: they are mostly cross-sectional, are not from representative samples, and are often based on small samples, among others. Especially more longitudinal studies are needed to establish the direction of causation, i.e. whether behavioural addictions are a cause or a consequence of psychiatric disorders. Another growing area is social media addiction. Psychology researchers surveyed 253 undergraduate students at the University of Albany and found that not only is social media (particularly Facebook) itself potentially addictive, those who use it may also be at greater risk for substance abuse.


Biomolecular mechanisms

ΔFosB Protein fosB, also known as FosB and G0/G1 switch regulatory protein 3 (G0S3), is a protein that in humans is encoded by the FBJ murine osteosarcoma viral oncogene homolog B (''FOSB'') gene. The FOS gene family consists of four members: C-Fos, FO ...

ΔFosB
, a
gene transcription Transcription is the process of copying a segment of DNA into RNA. The segments of DNA transcribed into RNA molecules that can encode protein Proteins are large s and s that comprise one or more long chains of . Proteins perform a vast a ...
factor, has been identified as playing a critical role in the development of addictive states in both behavioral addictions and drug addictions. Overexpression of ΔFosB in the
nucleus accumbens The nucleus accumbens (NAc or NAcc; also known as the accumbens nucleus, or formerly as the ''nucleus accumbens septi'', Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin w ...

nucleus accumbens
is
necessary and sufficient In logic Logic (from Ancient Greek, Greek: grc, wikt:λογική, λογική, label=none, lit=possessed of reason, intellectual, dialectical, argumentative, translit=logikḗ)Also related to (''logos''), "word, thought, idea, argument, ac ...
for many of the seen in drug addiction; it has been implicated in addictions to
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
,
cannabinoid Cannabinoids () are compounds found in Cannabis (drug), cannabis. The most notable cannabinoid is the phytocannabinoid tetrahydrocannabinol (THC) (Delta9-THC or Delta8-THC), the primary psychoactive drug, psychoactive compound in cannabis. Cannabid ...
s,
cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a tropane alkaloid and stimulant drug obtained primarily from the leaves of two coca species native to South America, ''Erythroxylum coca'' and ''Erythroxylu ...

cocaine
,
nicotine Nicotine is a naturally produced alkaloid Alkaloids are a class of basic BASIC (Beginners' All-purpose Symbolic Instruction Code) is a family of general-purpose, high-level programming language In computer science Computer sci ...

nicotine
, phenylcyclidine, and
substituted amphetamines Substituted amphetamines are a class of compounds based upon the amphetamine structure; it includes all derivative (chemistry), derivative compounds which are formed by replacing, or substitution reaction, substituting, one or more hydrogen ato ...
as well as addictions to natural rewards such as sex, exercise, and food. A recent study also demonstrated a
cross-sensitization Sensitization is a non-associative learning Learning is the process of acquiring new understanding Understanding is a psychological process related to concepts, such as a person, situation, or message whereby one is able to make sense of th ...
between drug reward (amphetamine) and a natural reward (sex) that was mediated by ΔFosB. Besides increased ΔFosB expression in the nucleus accumbens, there are many other correlations in the neurobiology of behavioral addictions with drug addictions. One of the most important discoveries of addictions has been the drug based reinforcement and, even more important, reward based learning processes. Several structures of the brain are important in the conditioning process of behavioral addiction; these subcortical structures form the brain regions known as the
reward system The reward system (the mesocorticolimbic circuit) is a group of neural structures responsible for incentive salience An incentive is something that motivates or drives one to do something or behave in a certain way. There are two types of ince ...
. One of the major areas of study is the
amygdala The amygdala (; plural: amygdalae or amygdalas; also '; Latin from Greek language, Greek, , ', 'almond', 'tonsil') is one of two almond-shaped clusters of nucleus (neuroanatomy), nuclei located deep and lateral and medial, medially within the ...

amygdala
, a brain structure which involves emotional significance and associated learning. Research shows that dopaminergic projections from the
ventral tegmental area The ventral tegmental area (VTA) (tegmentum is Latin for ''covering''), also known as the ventral tegmental area of Tsai, or simply ventral tegmentum, is a group of neurons located close to the midline In typography, the mean line is the imagina ...

ventral tegmental area
facilitate a motivational or learned association to a specific behavior. Dopamine neurons take a role in the learning and sustaining of many acquired behaviors. Research specific to Parkinson's disease has led to identifying the intracellular signaling pathways that underlie the immediate actions of dopamine. The most common mechanism of dopamine is to create addictive properties along with certain behaviors. There are three stages to the dopamine reward system: bursts of dopamine, triggering of behavior, and further impact to the behavior. Once electronically signaled, possibly through the behavior, dopamine neurons let out a ‘burst-fire’ of elements to stimulate areas along fast transmitting pathways. The behavior response then perpetuates the striated neurons to further send stimuli. The fast firing of dopamine neurons can be monitored over time by evaluating the amount of extracellular concentrations of dopamine through micro dialysis and brain imaging. This monitoring can lead to a model in which one can see the multiplicity of triggering over a period of time. Once the behavior is triggered, it is hard to work away from the dopamine reward system. Behaviors like gambling have been linked to the new found idea of the brain's capacity to anticipate rewards. The reward system can be triggered by early detectors of the behavior, and trigger dopamine neurons to begin stimulating behaviors. But in some cases, it can lead to many issues due to error, or reward-prediction errors. These errors can act as teaching signals to create a complex behavior task over time.


See also

* Addictive behavior *
Addictive personalityAn addictive personality refers to a hypothesized set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction ...
* *
Habit A habit (or wont as a humorous and formal term) is a routine of behavior Behavior (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of t ...

Habit


Notes


References


External links

* * Technical review of biomolecular-neurobehavioral research {{DEFAULTSORT:Behavioral Addiction Addiction Psychiatric diagnosis