Other Addictions

The Debate

Questions about whether compulsive behaviors should be defined as addictions center on several points. One rationale against the idea comes from the fact that many of the behaviors already have their own diagnostic label or are embedded within other diagnoses. Pathological gambling, eating disorders, and impulse control disorders, for example, are diagnoses presently in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), and are grouped separately from substance use disorders.

Another aspect of the debate on whether these repetitive behavioral problems are addictions or not is framed by one's underlying theory. Social learning model theorists, for example, focus on the cessation of "bad behavior," whereas neurobiologists focus specifically on changes within the brain from alcohol and other drug (AOD) use. Those who subscribe to the medical model of addictions question if the physiological symptoms of tolerance and withdrawal in behavioral compulsions are similar enough to chemical addictions to warrant the term addiction.

As researchers discover more variation in the tolerance and withdrawal factors of differing drugs, this argument becomes less defining. Not all drugs, for example, have both the quality of physiological cravings and withdrawal. And for some drugs, tolerance is not a factor, but the recurrent use of such substances is determined to be an addiction due to the harmful personal, social, legal, and vocational consequences. This variation and other research and practice aspects challenge the need for separation of substance and behavioral addictions.

Research into the brain's reward system, for example, indicates more similarity than difference between AOD and compulsive behavior reactions. It appears that biochemistry and brain activity may be impacted in much the same way whether the repetitive object is a substance or a behavior. The brain experiences a positive reward from the use or behavior and, in both cases, neurological adaptation occurs. Such adaptation adds to the decreasing ability to abstain or resist the object of desire. A purist viewpoint with only medical definitions of tolerance and withdrawal becomes less useful as more is discovered about the brain's reaction to any addictive behavior.

Other points that support the perspective that substance and behavioral problems are very similar come from the treatment rather than the diagnostic world. Because individuals with compulsive disorders often face similar emotional and cognitive concerns, efforts such as Twelve-Step recovery groups and relapse prevention activities have been adopted for behavioral [Page 664]addictions. The effectiveness of these cross-over treatments has led to the development of new strategies, protocols, and best practices.

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