DIAGNOSTIC APPROACH TO BEHAVIORAL OR "NON-SUBSTANCE" ADDICTIONS

Abstract

Until recently, non-substance related behavioral addictions were not categorized in diagnostic manuals of mental disorders. Addictive states are characterized by changed reinforcement contingencies, anhedonia, diminished capacity to experience pleasures due to reduced sensitivity to endogenous brain dopamine, and increased sensitivity to internal and external triggering factors. An underlying biological mechanism for urge-driven disorders may involve the pre-frontal cortex, nucleus accumbens, the ventral tegmental area, amygdala and hippocampus, which are considered to play a critical role in the characteristic behavioral impairments of addictive disorders. Recent literature implicates serotonergic, dopaminergic, noradrenergic, and opioidergic neurotransmitter systems in the pathophysiology of behavioral addictions. A reduction in the sensitivity of the brain reward system and hyperactivity towards addiction-associated stimuli was demonstrated in addiction disorders. Due to the lack of a diagnostic guide, different psychometric instruments were used to assess behavioral addictions, including pathological gambling, compulsive buying, internet addiction, video/computer game addiction, sexual addiction, and excessive tanning. Psychosocial interventions encourage the abstinence by lifestyle changes, and reinforce healthy behaviors via motivational enhancement and cognitive behavioral therapies. Pharmacologically, there are no medications currently approved for the treatment of behavioral addictions, but naltrexone, topiramate, and N-acerylcysteine have some promising effects.