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Non-Drug Addictions

We have discussed some of the most common and severe addictions: those involving alcohol, cocaine, and tobacco. Opioids, depressants, hallucinogens, and marijuana were discussed in Chapter 3 (States of Consciousness) although not in the context of addiction..

We will move on to a different category: non-drug addictions. Gambling, for example, is a "pure addiction" according to experts. It has all the classic signs (McCown and Chamberlain, 2000).

What a "classic signs" of addiction in gambling?

The gambler is compulsive and would rather lose than not gamble at all. Some even go through withdrawal symptoms when they are broke and cannot gamble.

Gambling follows a predictable pattern. Often there is a "big win" early in life that starts the addiction.

From then on, the gambler is hooked on "the chase" and plays as much for the high emotional stakes as the high financial stakes. Tolerance sets in. The addict wagers in larger and larger amounts, trying to re-capture the thrill of earlier days.

Gamblers naturally downplay the resem­blance between their addiction and classic drug addictions. However, the dangers from pathological gambling are great. Wright (2012) wrote:

There is only so much heroin, cocaine or vodka you can consume before you end up in a hospital or a morgue. Gambling is subject to no such constraints.

"The amount of financial devastation you can wreak plays a big role in this," says Keith Whyte, the NCPG Executive Director. "You can bet $50,000 in a single hand, every minute."

Suicide rates among gambling addicts are staggeringly high. The National Council on Problem Gambling (NCPG) has estimated that one in five problem gamblers attempt to kill themselves, about twice the rate of other addictions.

The incidence of pathological gambling in the U.S. increased after some states legalized forms of gambling to increase revenue. Bernard P. Horn, political director of the National Coalition Against Legalized Gambling, wrote in 2014:

In Iowa, the legalization of casinos more than tripled the addiction dilemma. A study released in July, 1995, found that 5.4% of the state's adults (roughly 110, 000 residents) are lifetime pathological or problem gamblers. Before riverboats came to the state, 1.7% of Iowans fell into this category.

In Louisiana, four years after the state legalized casinos and slots, a study found that seven percent of adults had become addicted to gambling. In Minnesota, as 16 Indian casinos opened across the state, the number of Gamblers Anonymous groups shot up for one to 49. (Horn, 2014)

What happened in states where gambling was partly legalized?

In older versions of the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association) pathological gambling was listed as an "impulse disorder" rather than an addiction. That changed in 2013 with DSM-5.

In the new DSM-5, gambling addiction was categorized as a psychiatric disorder under the Substance-Related and Addictive Disorders category. The change was "reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse and produce some behavioral symptoms that appear comparable to those produced by the substance abuse disorders." (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013).

The DRD2 gene, which influences dopamine metabolism and is found in many people with serious addictions, apparently makes pathological gambling more likely (Comings et al., 1996). The researchers found that "63.8% of those in the upper half of the Pathological Gambling Score (more severe) carried the D2A1 allele." They added:

These results suggest that genetic variants at the DRD2 gene play a role in pathological gambling, and support the concept that variants of this gene are a risk factor for impulsive and addictive behaviours." (Comings et al., 1996)

What is evidence for a genetic influence on gambling?

In 1972, The National Council on Problem Gambling (NCPG) was established. A journal for the study of gambling addiction, The Journal of Gambling Behavior, started in 1985.

Gambling, as a supposedly pure addiction lacking the drug component, but with a partly genetic basis and documented harm to addicts, can serve as a template for evaluating other non-drug addictions. Many have been proposed.

For a time, television addiction was a proposed as a disorder. However, it does not have the classic symptoms of addiction shown with drug addictions and gambling.

Also, television viewing has actually dropped among young people, so no pandemic is likely. Unlike with gambling, people do not lose their life savings watching TV.

Internet addiction started receiving attention in the late 1990s, as the web became popular. Some college students spent all their time in chat rooms (the early version of instant messaging) even if it meant missing homework assignments.

Psychologists Kandell and Kimberly Young of the University of Pitts­burghat Bradford proposed that internet addiction was like any other addiction. It became a problem if it started to cause misery or interfere with other parts of life.

"Some of these people even forget to eat," Kimberly Young commented (Murray, 1996). Young offered a checklist of symptoms similar to alcoholism checklists, to determine if enjoyment of being online has turned into a harmful addiction:

When does internet addiction become a problem?

Not everybody agrees that internet addiction is a useful concept. Shaffer, Hall, and Vander Bilt (2000) argued that defining computer addiction as a psychiatric disorder was premature and "excessive computer use may be symptomatic of other, more primary disorders." They did, however, urge further investigation.

Eating can itself take on the characteristics of an addiction. Morbidly obese people commonly confess that, for them, eating is like a drug experience.

It provides comfort when they are feeling down. It stimulates an emotional high that blots out other concerns. They feel compelled to indulge their appetites even when they know it is harmful to their health and will shorten their lives.

Sex addiction has been described as a major problem for some people. A book published in Victorian era England, My Secret Life, went on for 11 volumes about the author's single-minded pursuit of sex.

The anonymous author, who called himself Walter, was compelled to have "many different women all the time." Yet he did not find happiness in his obsession.

"The need for variety...is itself monoto­nous," he wrote. Walter showed all the typical signs of sex addiction: compulsive sexuality that dominated his life, remorse, attempted abstinence, and bargaining with God during his numerous unsuccessful attempts to reduce the power of the addiction.

What characteristics define a sex addict?

Patrick Carnes, in a book titled Out of the Shadows (1983), described similar case histories of sex addicts in more recent times. Carnes wrote that sex addicts commonly suffer from delusions: false beliefs based on projecting their own attitudes onto others. They interpret other people's behavior as a "sexual come-on" signal when the opposite is true.

What sort of delusion is common among sex addicts?

Carnes gave this example:

Late one evening, Del pulled up next to a young woman at a stoplight. He had always had the fantasy of picking up a woman on a street. He looked at her and she smiled at him. Del became very excited. They drove side by side for several blocks.

She returned his stares at each stop sign. Soon she pulled ahead of him, turned off the road, and pulled to a stop. He followed and pulled up behind her. She waved towards him and pulled out again. Del thought she wanted him to follow.

Del's mind raced ahead to where she could be leading him... His mind filled with fantasies, he pulled up behind her when she stopped. As he was opening his door, she leaped out of her car and dashed into the building. Surprised, he looked up to see that he was not in front of the restaurant. Rather, she had stopped at the police station three blocks away.

Horrified, Del got back in his car and raced home. While driving, he was in shock at how out of touch with reality he was. She had not been encouraging him to follow her but was in fact frightened. He, on the other hand, was so caught up in his fantasy he failed to notice that she was parking at a police station. (Carnes, 1983, pp. 2-3)

During President Bill Clinton's brush with impeachment in 1998, Carnes testified that Clinton fit the description of a sex addict. Clinton apparently engaged in compulsive sexual behavior repeatedly during adulthood, despite knowing it could jeopardize his marriage, family, and career. Like many addicts, he got into trouble after several attempts to quit his self-destructive behavior.

As with internet addiction, many experts have doubts whether sex addiction is "real" or fits the pattern of other addictions. Hypersexual Disorder was considered for DSM-5 but removed from the final draft.

Why do experts raise doubts about the sexual addiction concept?

Reid (2015) summarized the arguments against the concept of sex addiction. Reid was the principle investigator of a group considering Hypersexual Disorder for inclusion in DSM-5, but he cautioned that "pathologizing" a phenomenon has many implications for the health care system and should not be done without good cause.

In the case of sexual addiction, there is no demonstration of an underlying biological dysfunction. There is no data showing that hypersexual behavior diverges from what might be considered normal, using the variety of measures available to scientists: brain imaging, molecular genetics, and so forth. Reid wrote:

Colleagues at Yale, Columbia University, and I...drew comparisons between the vast amounts of data reported in the scientific literature on gambling disorders (which is included for the first time in DSM-5...) compared to the paucity of data gathered in support of hyper­sexual disorder.

Simply put, despite claims to the contrary, there is not enough research to say that hypersexual behavior (or what's commonly known as "sex addiction") is a psychiatric disorder. (Reid, 2015)

Reid allowed that sexual addiction could be harmful to individuals. It could also co-occur with other mental disorders. He agreed that mental health professionals should "find ways to alleviate the suffering and distress encountered by those experiencing hypersexual behavior."

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References:

American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association.

Carnes, P. (1983). Out of the shadows: Understanding sexual addiction. Minneapolis, MN: CompCare Publications.

Comings, D. E., Rosenthal, R. J., Lesieur, H. R., Rugle, L. J., Muhleman, D., Chiu, C., Dietz, G., & Gade, R. (1996) A study of the dopamine D2 receptor gene in pathological gambling. Pharmacogenetics, 6, 223-234.

Horn, B. (2014) Gambling facts and stats. PBS Frontline. Retrieved from: http://www.pbs.org/wgbh/pages/frontline/shows/gamble/procon/horn.html

McCown, W.G. & Chamberlain, L.L (2000) Best Possible Odds: Contemporary Treatment Strategies for Gambling Disorders. New York: Wiley.

Murray, B. (1996, June) Is Your Computer Use Out of Control? APA Monitor. Retrieved from: http://www.apa.org/monitor/june96/onlinec.html [no longer available]

Reid, R. C. (2015, April 29) Is sex addiction a real disorder? Pro Talk. Retrieved from: http://www.rehabs.com/pro-talk-articles/is-sex-addiction-really-a-disorder/ .

Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (2000) Computer addiction: A critical consideration. American Journal of Orthopsychiatry, 70, 162-168.

Wright, C. (2012, September 13) You bet your life. Salon. Retrieved from: http://www.salon.com/2012/09/13/you_bet_your_life/

Young, K. S (1998) "Dr. Kimberly S. Young - The Center for On-Line Addiction (COLA) - Research, Counseling, and Consultation about Internet Behavior." Retrieved from: http://netaddiction.com


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