Behavioral Addictions: Conceptual, Clinical, Assessment, and Treatment Approaches

265 Pages·2022·3.848 MB·English

by  Halley M. Pontes

Studies in Neuroscience, Psychology and
Behavioral Economics
Halley M. Pontes   Editor
Behavioral
Addictions
Conceptual, Clinical, Assessment, and
Treatment Approaches
Studies in Neuroscience, Psychology
and Behavioral Economics
SeriesEditors
MartinReuter,RheinischeFriedrich-Wilhelms-UniversitätBonn,Bonn,Germany
ChristianMontag,InstitutfürPsychologieundPädagogik,UniversitätUlm,Ulm,
Germany
This interdisciplinary book series addresses research findings and methods in the
intersectionofthefieldsofneuroscience,psychologyandbehavioraleconomics.At
the core of the series is the biological basis of human decision making, including
aspectsofaneconomic,cognitive,affectiveandmotivationalnature.Contributions
from fundamental and applied sciences are equally represented and cover a broad
range of scientific work, reaching from mathematical modeling to scholarly intro-
ductions into new research disciplines and related methodologies and technolo-
gies (e.g. genetics, psychophysiology, brain imaging, computational neuroscience,
animalmodeling).Thebookseriespresentsempiricalandmethodologicalscientific
innovations bridging the gap from brain to behavior. It includes research works in
neuroeconomics and neuro-information systems (e.g. human-machine interaction)
aswellassocial,cognitiveandaffectiveneuroscience,whichaimatenhancingthe
understandingofhumandecisionmaking.
Moreinformationaboutthisseriesathttps://link.springer.com/bookseries/11218
Halley M. Pontes
Editor
Behavioral Addictions
Conceptual, Clinical, Assessment,
and Treatment Approaches
Editor
HalleyM.Pontes
DepartmentofOrganizationalPsychology
Birkbeck,UniversityofLondon
London,UK
ISSN 2196-6605 ISSN 2196-6613 (electronic)
StudiesinNeuroscience,PsychologyandBehavioralEconomics
ISBN 978-3-031-04771-8 ISBN 978-3-031-04772-5 (eBook)
https://doi.org/10.1007/978-3-031-04772-5
©SpringerNatureSwitzerlandAG2022
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Series Editor’s Foreword
Thestudyofbehavioraladdictionspresentsasanimportanttopicinthebehavioraland
psychologicalsciences.Inparticular,addictivebehaviorswithinthecyberspacehas
becomeamajorfocusofresearchforscientistsaroundtheglobe.Withmorethan65%
oftheworldbeingconnectedtotheinternetandtherapidriseofsmartphoneandsocial
mediause,itisnotsurprisingthatscientistsareactivelyseekingtobetterunderstand
howtheoveruseofdiverseonlinecontentcanbebestcharacterized.Addictiveuse
of the internet has now been studied for over two decades and the question how
(over-)useofdifferentonlinecontentimpactsontothepsycheofinternetusersisstill
growinginimportanceinaworldthatisbecomingincreasinglydigital.
This excellent book—edited by a highly recognized researcher investigating
bothInternetUseDisorders(IUD)andinparticulardisorderedgaming,Dr.Halley
Pontes—providesinterestedscientists,psychologystudents,andmentalhealthprac-
titionersalikewithathoroughoverviewontherapidlyevolvingfieldofbehavioral
addictions.Thebookincludestenuniquechaptersthatnotonlyfocusononlineaddic-
tivebehaviors,butalsoaddictivebehaviors,whichhappentoappearinthe“offline”
world.Itislikelythatthedistinctionbetweenonlineandofflinebehaviorswillnotbe
ofrelevanceinthenearfuture,whenhumanmankindnavigatesthroughacompletely
connectedworld,hencethe‘InternetofThings’.
The present book starts with two chapters providing the reader with insights
regarding two officially recognized additive behaviors (Chaps. 1 and 2): Both
Gambling Disorder (6C50) and Gaming Disorder (6C51) are included in the 11th
InternationalClassificationofDiseases(ICD-11),andinparticular,theinclusionof
GamingDisordermarkedanimportantpointinthestudyofonlineaddictivebehav-
iors.SixyearsaftertheinclusionofInternetGamingDisorderinthe5thDiagnostic
andStatisticalManualofMentalDisorders(DSM-5)asatentativediagnosisin2013,
theWorldHealthOrganizationdecidedtoincludeGamingDisorderasabonafide
addictivedisorderinthelatestrevisionoftheICD,stirringupaheateddebateamong
scientistsdiscussingifthisdiagnosiscametooearly.Itneedstobementionedthat
not only the Gaming Disorder diagnosis itself is still a matter of ongoing debate
amongscientists,butalsothenatureofexcessiveonlinebehavioringeneral.Please
v
vi SeriesEditor’sForeword
notethatintheICD-11,bothdisorderedgamingbehaviorintheonline(6C51.0)and
offline(6C51.1)contextarementioned.
Is excessive gaming, shopping, or social media use behavior (to name a few
examples)mostappropriatelycharacterizedwithinanaddictionframework?Here,
weseethatsomescientistscometotheconclusionthataddictivebehaviorssuchas
‘socialmediaaddictionmightnotexist’(Chap.3)andthatsomespeakinthecontext
ofaddictivebehaviorsofcopingstrategies(i.e.,self-medication)todealwithnegative
affect.Thisallsaidandgoingbeyondtheaddictiondebate,itappearsthatadverse
consequencescanbealikelyoutcomeofone’sownexcessive(online)behavior,for
instancewhenapersonbeingaddictedtoacertainactivityfacesjoblossorbreakup
ofaromanticrelationship.Here,itisalsooflargeinteresttobetterunderstandwhat
canbeunderstoodfromumbrellatermssuchas‘smartphoneaddiction’or‘Internet
addiction’(seeChaps.4and5).Itisalsopointedtowardthefactthatmanyresearchers
at least at the moment prefer to speak of problematic smartphone/Internet use or
smartphone/Internetusedisorders.
Theaforementionedaddictiondebateisnotonlyregardingthefieldofexcessive
online use, but also areas and topics such as Love Addiction (Chap. 6) and Sex
Addiction(Chap.7).Interestingly,SexAddictionhasbeenincludedascompulsive
sexualbehaviordisorderintheICD-11(6C72).Butasonecanseefromthetermi-
nology, it has been included as an impulse control disorder in the ICD, although
the diagnostic criteria rather mirror an addiction (the symptoms are very close
to Gambling Disorder/Gaming Disorder). Finally, the book ends with three chap-
ters providing state-of-the-art overviews on Exercise Addiction (Chap. 8), Work
Addiction(Chap.9),andShoppingAddiction(Chap.10).
While the present book gives a timely and rigorous overview on new research
publishedinthedifferentareasofaddictivebehaviors,itbecomesapparentthatmany
questions are still unanswered to fully grasp the nature of behavioral addictions.
In this context, I also mention the importance to not over-pathologizing everyday
lifebehaviorsandtonotstigmatizepersons,whoactuallydonothaveabehavioral
addictionproblem.Therefore,thescientificcommunityneedstotakearigorouslook
atbothempiricalfindingsandclinicalevidencesheddinglightonthetopicsdiscussed
inthisbook.Insofar,stillmuchworkliesaheadforthoseconductingresearchinthe
fieldofbehavioraladdictions.
Personally, I believe that of most relevance to judge if a certain excessive
behavior is ‘problematic’ or not is the experience of functional impairments that
maybeobservedinapersonduetotheirexcessivebehavior.Inotherwords,itisof
importancetoseethatacriticalthresholdoffunctionalimpairmentisreachedand
whetherthisisduetoaperson’sexcessivebehaviororanotherunderlyingcondition
asonlythenwemightspeakofdisorderedoraddictivebehavior.
Attheendofthiswork,Imentionthatthisbookhasbeenwrittenbywell-known
scholarsintheirrespectivefieldsandthegratitudegoesoutbothtotheEditorand
SeriesEditor’sForeword vii
theauthorsofeachchapterforhavingputthisbooktogether.Theireffortsaremuch
appreciated.
Ulm,Germany ChristianMontag
3July2022
Preface
Thisbookrepresentsoneofmybestattemptsatunderstandingthenatureof(non-
substance)addictions.Ihavebeeninterestedinthestudyofbehavioralofaddiction
foroveradecadenow,andIcanconfidentlysaythatstudyingaddictivebehaviors
andaddictionhastrulybeenthemostfascinatingandimportantaspectofmylifeas
apsychologist,scientist,andeducator.
OftenwhenIintroducemyselftomypsychologystudentsinthefirstlectureof
theyear,Itellthemthatasapsychologist,Ihavetwolifequestionsthatexplainand
capturereallywellwhyIdowhatIdoinmywork.ForthepurposesofthisPreface,
Iwillonlyfocusonthefirstquestion:Whydowedosomethingtoomuch,toapoint
wherewedisregardeverythingelse?Hopefullyafterreadingthisbook,youwillsee
thatthisquestionclearlyliesatitsheartasitcanbeseenasthemaindrivingforce
behindit.
Addiction as a scientific notion and social phenomenon has been extensively
debatedoverthelastdecades.Initially,scientistsbelievedthataddictionswouldonly
emergeinresponsetothecontinueduseofpsychoactivesubstances.Nevertheless,
this limited understanding started to radically change around the 1980s with the
formalmedicalrecognitionandintroductionof‘pathologicalgambling’asapsychi-
atricdisorderinthethirdrevisionoftheDiagnosticandStatisticalManualofMental
Disorders(DSM-III)bytheAmericanPsychiatricAssociation.
Personally, I believe this marked a significant milestone within psychiatry and
psychology, leading to the revolution and modernization of the concept of addic-
tion. This is because if we can accept that one behavior that does not involve the
useofapsychoactivesubstance(i.e.,gambling)canbecomeanaddiction,thenlogi-
callyspeaking,whatwouldprecludeotherpotentiallyproblematicbehaviorstoshare
the same fate, provided that there is sufficient empirical evidence supporting this
recognition?
Infact,thisgradualshiftfrom‘addictionasbeingexclusivelyrelatedtosubstance
use’to‘addictionasalsoincludingbehavioralphenomenanotinvolvingsubstance
use’hasarguablyledtomanyimportantscientificdevelopments.Inmyview,thefirst
onerelatestotheofficialdefinitionofaddictioninthisdayandage.TheAmerican
SocietyofAddictionMedicine(ASAM)hasrecentlyredefinedaddictionasfollows:
ix
x Preface
[…] a treatable, chronic medical disease involving complex interactions among brain
circuits,genetics,theenvironment,andanindividual’slifeexperiences.Peoplewithaddic-
tion use substances or engage in behaviors that become compulsive and often continue
despiteharmfulconsequences.Preventioneffortsandtreatmentapproachesforaddiction
aregenerallyassuccessfulasthoseforotherchronicdiseases(seehttps://www.asam.org/
quality-care/definition-of-addiction,accessedonMarch14,2022).
Fundamentally,whatweseetodayisthataddictionisunderstoodfromdifferent
standpoints (see the seminal work by West, 20011), with the field having clearly
moved beyond the mere use and abuse of substance and its nefarious effects on
people’s lives. The current scientific view on addiction has been further cemented
with the publication of the DSM-5, where ‘pathological gambling’ (now known
as Gambling Disorder) has been reclassified and added to the ‘non-substance-
relateddisorders’and‘InternetGamingDisorder’madeanappearanceasatentative
disorder—lateronin2019beingfullyrecognizedasabonafideaddictivedisorder
and the second behavioral addiction; see Pontes and Griffiths (2020)2 for a brief
overview.
Perhaps the second key scientific development stemming from such a concep-
tualshiftisrelatedtotheexponentialgrowthinprominenceandlegitimacyofthis
field.AccordingtoarecentstudybySixto-Costoyaandcolleagues(2022),3research
onbehavioraladdictionhasgreatlyincreasedoverthelast25years,withscientific
productioninthefielddoublingupeveryfiveyearsfrom1995to2019.Thescientific
growthinbehavioraladdictionresearchwasmostlyobservedwithinthesubfieldsof
Gambling Disorder (33.83%), information and technology communication-related
disorders (31.73%), Gaming Disorder (11.69%), Food Addiction (3.81%), Shop-
pingAddiction (7.39%),Sports Addiction (3%),and Sex Addiction (3.56%).This
growth in prominence and legitimacy as a field of research has also been continu-
ouslysupportedovertheyearsbymajoracademicjournalsplayingasignificantrole
inpromotingbehavioraladdictionresearch,suchastheJournalofBehavioralAddic-
tions(ISSN:20625871),Addiction(ISSN:09652140),AddictiveBehaviors(ISSN:
03064603), Addictive Behaviors Reports (ISSN: 23528532), and Psychology of
AddictiveBehaviors(ISSN:0893164X).Additionally,behavioraladdictionexperts
fromallovertheworldgathereveryyearatmajoreventssuchastheannualInter-
national Conference on Behavioral Addictions and the Lisbon Addictions confer-
ence. Indeed, the field of behavioral addiction has grown so much that experts
have come together to create theInternational Society for the Study of Behavioral
Addictions(ISSBA)(http://issba.elte.hu),whichisasocietyfocusingonthestudyof
1West,R.(2001).Theoriesofaddiction.Addiction,96(1),3–13.https://doi.org/10.1046/j.1360-
0443.2001.96131.x.
2Pontes,H.M.,&Griffiths,M.D.(2020).Aneweraforgamingdisorderresearch:Timetoshift
fromconsensustoconsistency.AddictiveBehaviors,103,106059.https://doi.org/10.1016/j.addbeh.
2019.106059.
3Sixto-Costoya,A.,Castelló-Cogollos,L.,Aleixandre-Benavent,R.,&Valderrama-Zurián,J.C.
(2021).Globalscientificproductionregardingbehavioraladdictions:Ananalysisoftheliterature
from1995to2019.AddictiveBehaviorsReports,14,100371.https://doi.org/10.1016/j.abrep.2021.
100371.