Non-Substance-Related Disorders: Behavioral Addictions

Non-substance-related disorders, also called behavioral addictions, involve compulsive engagement in rewarding behaviors despite negative consequences. The DSM-5 currently recognizes only Gambling Disorder as a diagnosable behavioral addiction, but others are under research.

1. Gambling Disorder (DSM-5 Recognized)

DSM-5 Criteria (≥4 symptoms within 12 months)

  • Preoccupation: Constant thoughts about gambling.
  • Tolerance: Needs to gamble with more money for excitement.
  • Withdrawal: Restlessness/irritability when trying to stop.
  • Failed Attempts to Quit: Repeated unsuccessful efforts to cut back.
  • Lies About Gambling: Hides losses or debts.
  • Risked Relationships/Job: Due to gambling.
  • “Chasing Losses”: Keeps gambling to win back money.

Treatment:

  • CBT (identify triggers, manage urges).
  • Medications: Naltrexone (reduces cravings).
  • Support Groups: Gamblers Anonymous (GA).

2. Internet Gaming Disorder (DSM-5 “Condition for Further Study”)

Proposed Symptoms (≥5 within 12 months)

  • Preoccupation with gaming.
  • Withdrawal symptoms (irritability, sadness when not playing).
  • Loss of interest in other activities.
  • Deceptive behavior about gaming time.
  • Continued use despite problems.

Treatment:

  • Behavioral therapy (set limits, alternative activities).
  • Family interventions (parental controls, structured schedules).

3. Other Potential Behavioral Addictions (Not Officially in DSM-5)

A. Compulsive Sexual Behavior (“Sex Addiction”)

  • Symptoms: Uncontrollable urges, risky sexual behaviors, distress.
  • Treatment: CBT, support groups (e.g., Sex Addicts Anonymous).

B. Shopping Addiction (Compulsive Buying Disorder)

  • Symptoms: Excessive spending, financial ruin, guilt.
  • Treatment: Financial counseling, CBT.

C. Exercise Addiction

  • Symptoms: Obsessive workouts despite injuries/social harm.
  • Treatment: Balance training, therapy for body image issues.

D. Social Media Addiction

  • Symptoms: Excessive use, anxiety when offline, neglect of real-life relationships.
  • Treatment: Digital detox, mindfulness practices.

Shared Risk Factors for Behavioral Addictions

  • Genetic predisposition (similar to substance addictions).
  • Mental health disorders (depression, ADHD, OCD).
  • Dopamine dysregulation (reward system hijacking).

Treatment Approaches for Behavioral Addictions

  1. Cognitive Behavioral Therapy (CBT):
    • Identify triggers, develop coping strategies.
  2. Medications (if applicable):
    • SSRIs (for OCD-like symptoms), naltrexone (for gambling/sex addiction).
  3. Support Groups:
    • Gamblers Anonymous (GA), Sex Addicts Anonymous (SAA).
  4. Mindfulness & Stress Management:
    • Yoga, meditation to reduce impulsive urges.

When to Seek Help

✔ Loss of control over the behavior.
✔ Financial, social, or health problems due to the behavior.
✔ Failed attempts to quit despite consequences.

Warning Signs in Teens:

  • Dropping grades due to gaming/social media.
  • Stealing money for gambling/shopping.