Addiction is defined as a disorder characterized by persistent use of drugs (including alcohol) despite knowing their potential harm and adverse effects. For a behavior to be addictive, it must be both rewarding and reinforcing. However, anything can be addictive, depending on the nature of a person, their emotional needs, and psychological state. An addicting behavior can be sex, shopping, smoking, social media, gaming, binge eating to psychic tendencies like self-injury (cutting), torturing others, multiple cosmetic surgeries, and many more.
Addictive behavior is comparatively a new idea. Presently, gambling disorder and gaming disorder are the two officially recognized behavioral addiction disorders. As per WHO, 350 million gamblers are displaying problematic patterns each year. In the past 12-month, the prevalence of gambling varies from 0.1%~5.8%. Similarly, the prevalence of “gaming disorder” varies in populations from 1.3 to 9.9%. Internet addictive behavior is also common among adolescents in Asian countries. Hong Kong has the highest number of adolescents reporting excessive daily internet use (68%).
Causes - Addictive Behavior and Ongoing Clinical TrialsThere is usually no single cause responsible for the development of the addiction disorder. Often, a combination of any of the following may be the pushing factor:
- Genetic predisposition to the development of an addiction disorder.
- Family background: Sometimes, growing up in a home where other family members regularly engage in a certain behavior may contribute to a person’s development of behavioral addiction.
- Living in or growing up in an environment that is permissive of the behavior: Drinking alcohol, smoking, etc may be culturally permitted in certain societies.
- Trauma that alters brain function.
- Acute issues of stress due to which a person may develop the behavior as a coping mechanism.
When Should You Worry?One should consider consulting a doctor if there is the development of tolerance, withdrawal symptoms, and mental instability in a person due to overindulgence in certain activities. For example:
- Marked impairment in personal, family, social, educational, occupational, or other important areas of functioning due to the behavior.
- Psychological distress for a significant minority of video game players such as depression, OCD, anxiety, etc.
- Excessive indulgence to an extent that the amount of time they spend on an activity affects their other daily activities.
- Any changes in their physical or psychological health and social functioning that could be attributed to their pattern of gaming behavior.
- Problems in social relations.
- Alteration in eating habits and limited physical activity to the level affecting their fitness.
Some of the growing addictive behaviors are:
- pathological gambling
- problematic internet use
- problematic online gaming
- compulsive sexual behavior or porn addiction
- compulsive buying behavior
- work addiction
- tattoo addiction
- love addiction
- exercise addiction
- social media addiction.
Diagnosing Addictive BehaviorThe diagnosis is clinical and is based on the following red flag sign:
- The majority of time is lost while involving, thinking about, or arranging to engage in the behavior.
- The person has become dependent on that behavior as a way to cope with their emotions.
- They continue doing those activities despite knowing physical and/or mental harm.
- They are having trouble stopping themselves from doing those activities despite wanting to stop.
- They have started to neglect their work, school, or family to engage in the behavior more often.
- Experiencing symptoms of withdrawal i.e. depression, suffocation, restlessness, irritability, etc when trying to discontinue those actions.
- Telling lies and hiding the extent of the problem from their friends, family, and loved ones.
Treatment - Addictive Behavior and Ongoing Clinical TrialsTreatment options for addictive behavior include psychotherapy and medications or a combination of both.
- Cognitive-behavioral therapy (CBT): It is the most common form of psychotherapy used in treating behavioral addictions. We first identify the patterns that trigger compulsive behavior then make lifestyle changes to promote healthier behaviors. Several sessions of CBT may be required for complete treatment. The therapists will help the patients by identifying the issue, becoming aware of one's thoughts surrounding the issue, identifying any negative or false thinking, and reshaping the negative and false thinking.
- One-on-one or couples counseling and personal therapy: During counseling, the patients discuss the acute issues that may be triggering the urge to engage in the behavior with the trained health care professional. They also discuss childhood and other past events that may have contributed to its development. This can empower the person to take responsibility for behaviors and institute new, healthier coping mechanisms.
- Family therapy: The family also suffers a lot in cases of psychiatric illness. The relationships at home are negatively impacted. This can lead to feelings of broken trust and resentment. Hence all these issues must be addressed therapeutically if the family wishes to continue and thrive in recovery.
- Group therapy and self-help groups: It is helpful to connect with others who also struggle with behavioral addictions or those who have recovered from a similar illness. It can help the person not to feel lonely or anxious due to disorder and increase the support network that is necessary for long-term healing.
- Currently, no medications are approved for the treatment of behavioral addictions. Some medications used for the treatment of drug addiction may also be beneficial with specific behavioral addictions. Any other existing psychiatric disorders should be kept under control, and differentiated from the contributing factors that cause the addiction.
Ongoing Clinical Trials for Addictive Behavior
- Journaling and Addiction Recovery: Piloting "Positive Peer Journaling" (PPJ) This study is done to test the effectiveness of journaling intervention and its feasibility and acceptability in patients having addictive behavior. It encourages making a daily journal for the past 24-hour review and upcoming 24-hour planning. This helps to improve subjective wellbeing in recovery and reduces relapse. It has several column headings under which individuals make bullet-pointed lists such as "recovery," "work/school," "spirituality," "home and household," and "health" that helps patients to control and plan their daily living.
- Just-In-Time Adaptive Interventions for Addictive Behaviors: In this study, the researchers want to know about the effectiveness of an app that gives people the right advice at the right time as per their need.
- An Addiction-Based Mobile Health Weight Loss Intervention With Coaching: It is a new and creative approach to address childhood obesity. A pilot study was done using an addiction model-based mobile health weight-loss intervention in adolescents. It showed that the app intervention reduced BMI to a greater extent than youth participating in an in-clinic multidisciplinary weight management intervention. Hence it appeared to be a cost-effective, labor-efficient method for adolescent weight management.
- Electronic Cigarettes as a Harm Reduction Strategy in Individuals With Substance Use Disorder: E-cigarettes are electronic nicotine delivery devices. These are battery-powered devices that deliver vaporized nicotine when inhaled. Due to increased media attention, marketing, and promotion, the use of e-cigarettes has increased dramatically. Studies have shown that a large proportion of those using e-cigarettes were able to reduce the number of cigarettes they are smoking or were able to quit smoking.
Addictive behaviors. (2021). Retrieved from https://www.who.int/health-topics/addictive-behaviours#tab=tab_3
Grant, Jon: Impulse Control Disorders: A Clinician's Guide to Understanding and Treating Behavioral Addictions
Mak KK, Lai CM, Watanabe H, Kim DI, Bahar N, Ramos M, Young KS, Ho RC, Aum NR, Cheng C. Epidemiology of internet behaviors and addiction among adolescents in six Asian countries. Cyberpsychol Behav Soc Netw. 2014 Nov;17(11):720-8. doi: 10.1089/cyber.2014.0139. PMID: 25405785.