BY Dr. Soheir H. ElGhonemyAssistant Professor of Psychiatry- Ain Shams University MD in Psychiatry and Addiction Arab Board in PsychiatryMember of International Society of Addiction Medicine (ISAM
Objectives: Distinguish addiction from habits, and identify the signs of addiction. Discuss the addictive process; The new gate way for chemical addiction. Describe types of process addictions, including gambling, work, exercise, sexual, and Internet addictions, as well as codependence. Evaluate treatment and recovery options for addicts.
Habit versus Addiction Addiction is continued involvement with a substance or an activity despite ongoing negative consequences. Habit is repeated behavior in which the repetition may be unconscious. Compulsion is present if considerable discomfort is experienced if the behavior is not performed. The mental health community considers process addiction a treatable medical condition, Many people view it as moral condition and believe addiction is no more than habit; they feel behaviors such as smoking, gambling, and biting your nails are self-selected.
InternetFood Shopping AddictionWork Gambling Exercise Sex
Addictive BehaviorsProcess addictions are behaviors known to beaddictive because they are mood altering.Termed a “Process” addiction because it is atype of behaviour (a process) that the person isinvolved with, not a substance.Substance-related phenomena; tolerance,withdrawal, greater quantity or intensity thanintended, time spent (preparing, engaging…etc),loss of other life domains, continued despitehazardous consequences.
Common and Problematic Processaddictions: Compulsive gambling Compulsive overeating Compulsive shopping and borrowing Work addiction Exercise addiction; Addictive exercisers- Muscle dysmorphia Internet addiction Sexual addiction Multiple addictions; as many as 60 % of people in treatment have problems with more than one addiction.
Definition: There is no formal DSM-IV definition “…is physical activity that is extreme in frequency and duration, relatively resistant to change, and often accompanied by an irresistible impulse to exercise even when injury, fatigue, or other personal demons persist.
Criteria for Exercise Dependence:1. Tolerance: need for increased amounts of exercise to achieve desired effect; diminished effect with continued use of same amount of exercise2. Withdrawal: characteristic withdrawal symptoms for exercise (e.g., anxiety, fatigue) or exercise is taken to relieve or avoid symptoms3. Intention Effect: exercise is often taken in larger amounts or over a longer period than was intended4. Lack of Control: a persistent desire or unsuccessful effort to cut down or control exercise
5. Time: a great deal of time is spent in activities necessary to obtain exercise (e.g., physical activity vacations)6. Reduction in Other Activities: social, occupational, or recreational activities are given up or reduced because of exercise7. Continuance: exercise is continued despite knowledge of having a persisting/recurriing physical or psychological problem that is likely to have been caused or exacerbated by the exercise (e.g., continued running despite injury). (Hausenblas and Downs, 2002)
Signs of Exercise Dependence It interferes with daily activities and relationships. You believe that bad things will happen if you don‟t work out. You develop a perfectionist attitude toward exercise and your body. You ignore the signs of illness, injury or fatigue and work out despite them. You set unattainable goals (miles run, hours worked out, percentage of body fat, etc.) You ignore friendships or satisfying hobbies in order to exercise.
Consequences Psychological Physical Anxiety Damaged tendons, ligaments, bones, Depression cartilage, and joints Worthlessness Loss of muscle mass Insomnia Ammhenorea (females) Social - Osteoperosis Eating Disorders Neglect relationships Gastro-intestinal blood Social withdrawal loss and anemia Myocardial infarction and death.
Compulsive Overeating Bulimia Nervosa and Binge Eating Disorder Most people feeling control over eating habits; eating when you are hungry and stopping when you are satisfied. Compulsive overeating usually in the form of bingeing or excessive snacking
Binge Eating, in a discrete period of time an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances A sense of lack of control over eating during the episode People describe feeling that they cannot stop eating or control what or how much they are eating
Bulimia Nervosa Recurrent episodes of binge eating. Recurrent inappropriate compensatory behavior in order to prevent weight gain Purge subtype: self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications Non-purge subtype: fasting; or excessive exercise Occur on average, at least twice (once) a week for 3 months. Stems from a negative perception body shape and weight.
Binge Eating Disorder Recurrent episodes of binge eating. Marked distress regarding binge eating. The binge eating occurs, on average, at least 2 days a week for 6 months. The binge eating is not associated with the regular use of inappropriate compensatory behaviors.
Causes of Compulsive Overeating Socio-cultural issues: Body image Fast Food Society Diet craze Interpersonal issues: Emotional eating Susceptibility to addiction Self-Regulation Issues
Compulsive Overeating More food/binges for satiety (tolerance) Depressed mood, guilt, shame and irritation (withdrawal) Binge is defined as excessive (excessive intake) Loss of control of bingeing Social withdrawal, lie about and hide eating activities, steal and hoard food ( behavioral changes) Extreme dieting attempts, obesity, psychological distress (continue despite consequences)
Laboratory findings; binge eating, like addictions, might involve the endogenous opioid systems and the mesocortical dopamine system. Low levels of dopamine D2 receptors have been reported in individuals with compulsive disorders, including both drug addiction and compulsive overeating Eating disorders and substance-use disorders co-occur at higher than expected rates, particularly among individuals who binge eat (elevated rates of eating disorders are reported by individuals with substance-use disorders) Compulsive overeating may occur to compensate for reduced activation of reward circuits which are modulated by dopamine. (Volkow & Wise, 2005)
Internet Addiction Time-consuming, incontrollable, or distressing internet use which results in social occupational, or financial difficulties. The internet became commercially available only 20 years ago in the early 1990s. According to the International Telecommunications Union, as of 2009, almost a quarter (~22%) of the world‟s population uses the internet. Since the internet is so young, relative to other drugs, internet addiction is a fairly new disorder and has only recently been considered a major treat to society due to its addictive nature.
Types of Internet Addiction Addiction to online video games (role playing games) Online gambling Cybersex Chat rooms FACEBOOK
Almost half of Facebooks users visit itevery day. And some of its users spend aninordinate amount of time on Facebook,allowing the hours to while away unnoticed,the chores to go uncompleted, and evengoing so far as to ignore family and friendsin the actual world.
Signs of a Facebook addiction: You wake up and the first thing you do is "check Facebook". And its the last thing you do at night. Nothing else thrills you or you feel "empty" without Facebook. All you want to do is spend time on Facebook, even to the exclusion of getting work done that needs to be done, or meeting family obligations. Youre not able to go for more than a day without using Facebook. If forced to do so, you find yourself suffering from Facebook "withdrawal" symptoms, such as finding nothing else interesting, trying to find ways to get back to Facebook even if it means using a computer that is either out of bounds, or difficult to get to, or you find yourself intensely worried about missing out on Facebook updates.
Even if youre not on Facebook constantly (indicating you need a reality check), checking it many times during the day is a sign of compulsive behavior. Spending more than an hour on Facebook a day will easily cut into all the other obligations you have in life and may cause social dysfunction problems. Your real life isnt going so well and Facebook presents a fantasy escape life where everything seems neat, happy, and easy – all things that are the opposite of your everyday life. Adequate sleep ceases to be important to you. Instead, youre prepared to stay up way too late just to be able to accommodate your Facebook neediness. You have tons of friends on Facebook but you still feel very lonely.
Possible Causes/Risk Factors ofInternet Addiction Quality of Family and Social Life Problems with Partner/Friends Addictive personality Loneliness Social phobiasUnlike drugs of abuse, the internet is usually a vital tool for everyday life, thus People tend to rationalize their excessive use of theinternet
Problem Gambling Gambling behavior which causes disruptions in any major area of life: psychological, physical, social or vocational.” Other names: compulsive gambling, pathological gambling
Diagnostic Criteria Must apply to five or more of the following: Gambling preoccupation Increasing amount of money gambled Lack of success in halting gambling habits Uses gambling as an escape Lies to family members or significant other At risk of losing career or education Lost relationships of close friends/family to gambling Bailout - Needs financial assistance from others
Sexual Addiction Sexually related compulsive behavior that interfere with normal living and cause severe distress. Individuals learn to relay on sex to relieve pain and stress Three levels: 1. Compulsive masturbation, pornography and multiple sexual partners . 2. Exhibitionism , voyeurism 3. Sexual acts that are abusive to others.
Spending Addiction Chronic repetitive purchasing that becomes a primary response to negative events or feelings. The “purchase on credit” mentality. Common feelings: depression, anxiety, frustration and low self esteem. Financial problems, shoplifting, bad check writing are the possible consequences.
The recently posted first draft of DSM-5 has suggested awhole new category of mental disorders called the“Behavioral Addictions.” The category would begin life inDSM-5 nested alongside the substance addictions and itwould start with just one disorder (gambling). None ofthe other “behavioral addictions” suggested for DSM-5would gain official status as a stand alone diagnosis. ifsuspected presence, this could be diagnosed as“Behavioral Addiction Not Otherwise Specified” and thusreceive the dignity of an official DSM code.
Behavioral Addiction Treatments Neuropsychological Assessment. Cognitive behavioral therapy (CBT): teaches patients how to recognize triggers and learn healthier coping strategies. Group Therapy that gives patients an opportunity to learn from each other and develop a support network during their behavioral addiction treatment Spiritual Therapy that uses yoga, creative visualization, breathing exercises, and other holistic therapies to bring calm and centeredness to the patient‟s life
If a person shops till she dropsbecause this is fun, it should not be called „addiction‟ no matter how much trouble it causes.”