Addictions

Technology Addiction

±Technology addiction (TA), a term encompassing technological use comprehensively, is an advancing phenomenon that continues to affect society through individuals' heavy reliance on euphoria-producing technological devices. °To better understand technology addiction, it is important to examine its biological, psychological, and sociological components. In other words, utilization of the biopsychosocial model may help us gain a better awareness of the addictive properties of technology. www.netaddictionrecovery.com and www.netaddictionanon.org understanding this phenomenon as the use of a device defines technology addiction rather than the addictive tendencies of the pleasure-seeking behavior for each specific subset, such as smartphone or Internet addiction.

Gambling Addictions

DSM-IV-TR (2000) Classified as an impulse control disorder No levels; only specified between pathological gambling versus social and professional gambling To be diagnosed, needed to meet five of the criteria (over unspecified amount of time) Diagnostic Criteria A, defined as persistent and recurrent "maladaptive" gambling behavior Diagnostic Criteria A has 10 parts DSM-5 (2013) Classified as a nonsubstance addictive disorder Severity in three levels: mild, moderate, and severe To be diagnosed, need to meet four or more of the criteria in a 12-month period Diagnostic Criteria A, defined as persistent and recurrent "problematic" gambling behav-ior leading to clinically significant impairment or distress Diagnostic Criteria A has nine parts: removed the illegal criteria (i.e., "forger, fraud, theft, or embezzlement") of DSM-IV-TR

Gambling Addictions

±$154 billio ±Professional and Amateur Sports Protection Act, also known as the Bradley Act ±To reflect the research that demonstrates similarities between the reward systems activated by both substance use disorders and behaviors related to gambling, DSM-5 now designates gambling as a disorder under the Non-Substance-Related Disorders section of Substance-Related and Addictive Disorders (APA, 2013)—the first of the process addictions to be so designated. •In the United States, consumer spending on legalized gambling was approximately $154 billion in 2016 •On May 14, 2018, the U.S. Supreme Court made a ruling that may lead to continued changes with legalized gambling in our country. The justices, in a 6-3 vote, struck down the 1992 Professional and Amateur Sports Protection Act, also known as the Bradley Act (Totenberg, Domonoske, Dwyer, & Montanaro, 2018). This decades-old act made sports betting illegal, except in four states in which it had already been legalized. It is unknown what the full impact of this decision will be, although it is sure to impact our world as addictions counselors. •To reflect the research that demonstrates similarities between the reward systems activated by both substance use disorders and behaviors related to gambling, DSM-5 now designates gam-bling as a disorder under the Non-Substance-Related Disorders section of Substance-Related and Addictive Disorders (APA, 2013)—the first of the process addictions to be so designated.

Food Addiction and Disordered Eating

±Bulimia nervosa is typified by a compulsive cycle of binge eating and then purging. An indi-vidual with bulimia eats a large amount of food in a short period of time and then gets rid of the food and calories through vomiting, laxative abuse, or excessive exercise. Some of the symptoms of bulimia include repeated cycles of bingeing and purging, frequent dieting, extreme concern with body weight and shape, and feeling out of control during a binge, as well as eating beyond the point of fullness. Impulse control can be a problem for those with bulimia and lack of control may also extend to risky behaviors such as shoplifting, sexual adventurousness, and alcohol and other drug abuse (ANAD, 2014). ±Binge-eating disorder is a recognized disorder in DSM-5 (APA, 2013) and is differentiated from bulimia nervosa in that there are episodes of uncontrollable, impulsive bingeing but there is no purging. An individual with binge-eating disorder engages in random fasting and diets and feels extreme shame and self-hatred after bingeing. Individuals with binge-eating disorder tend to eat rapidly and secretly and be depressed and obese. Other eating disorders include a combination of symptoms from anorexia, bulimia, purging, night eating, and binge-eating disorders and the symptoms, if severe enough, can be considered a clinical disorder (APA, 2013).

Compulsive Buying

±Compulsive shopping, uncontrolled buying, addictive buying, addictive consumption, shopaholism, and spendaholism are all names for compulsive buying ±Compulsive buying (CB) has been described as a condition caused by chronic failures at self-regulation that becomes self-reinforcing over time, as persons move through antecedent, internal/external trigger, buying, and post purchase phases ± CB has been defined as consistent, repetitive purchasing that becomes the first response ±to negative or stressful life events or feelings. Compulsive buyers try to fill the meaninglessness, unhappiness, and void in their lives by purchasing items to relieve these negative feelings.

Food Addiction and Disordered Eating

±Experts who claim that eating disorders (including anorexia, bulimia, and binge eating) are addictions argue that individuals suffering with these disorders often share common traits with those addicted to alcohol or drugs, such as obsession, compulsion, denial, tolerance, withdrawal symptoms, and cravings ± Anorexia nervosa is typified by compulsive self-starvation and excessive weight loss. Some of the symptoms can include refusal to maintain a normal body weight for height, body type, age, and activity level; intense fear of weight gain; loss of menstrual periods; continuing to feel "fat" despite extreme weight loss; and extreme obsessive concern with body weight and shape (NEDA, 2014). ANAD (2014) states that symptoms of anorexia nervosa include weighing 15% below what is expected for age and height. ±An individual with anorexia nervosa may have a low tolerance for change and new situations, may fear growing up and taking charge of his or her own life, and be overly dependent on parents and family. Dieting may represent avoidance of and ineffective attempts at coping with the demands of new stages of life (ANAD, 2014). ±

Work Addiction

±First coined the term work-aholism more than 25 years ago, and since then many researchers define workaholism differently. ±Seybold and Salamone (1994) describe workaholism as an excessive commitment to work that results in the neglect of important aspects of life. "In the narrowest sense, workaholism is an addiction to action; but the action takes many forms . . . the type of action may vary, but the process is the same: You leave yourself" (Fassel, 1990, p. 4). ±Chamberlain and Zhang (2009) describe work addiction as a dependence on work despite adverse consequences, with their research focusing on areas of increased somatic complaints, psychological symptoms, and poor self-acceptance •Additionally, the oftentimes secretive nature of the addiction, as well as the societal acceptance and even reward of workaholism, limits the availability of accurate data. •Research adds complications from perfectionism, which is often tied closely to workaholism (Stoeber, Davis, & Townley, 2013). Sussman (2013) points out that the number of hours worked weekly may be one important indicator of workaholism if the hours worked exceeds 50 hours per week.

Sexual Addiction

±Love/relationship addiction is not the same ±Sexaholics Anonymous (SA) defines a sexaholic as someone who is addicted to lust. The sexaholic can no longer determine what is right or wrong, has lost control, lost the power of choice, and is not free to stop sexual behavior despite adverse consequences, such as threats of job or family loss (SA, 2010). ±Common characteristics of male and female sexaholics include marked isolation, prevalent guilt, marked depression, and a deep feeling of emptiness. ±Typical behaviors of a sexaholic include compulsively fantasizing about sexual desires; remaining in harmful codependent relationships; engaging in compulsive masturbation; obsessive and compulsive use of pornography, including on the Internet; repeatedly engaging in promiscuous sexual relationships; conducting adulterous affairs; and compulsively pursuing exhibitionism or sexually abusive relationships, regardless of legal, career, or family consequences •Experts in the field of addictions did not really start talking about sex addiction until the early 1980s, when Patrick Carnes introduced the idea that sexual behavior, rather than a drug, could be addicting •The incidence of sexual addiction is on the rise because of increased affordability, easy access to sexual materials, and anonymity of the Internet •

Gambling Addiction: Risk

±Risk ±Signs: secretiveness and excessive time with phone calls and Internet access, unaccounted time away from work or home, unexplained preoccupation, increased debt and worry over finances, extravagant expenditures, and increased alcohol, drug consumption or both. ±Other disorders, such as substance use, depressive anxiety, and personality disorders, are often present in comorbidity with gambling disorders, which is to be taken into consideration during treatment Gambling involves an aspect of risk to get something greater in return, such as the euphoria often referenced by recovering gamblers (APA, 2013). Signs of gambling addiction can include "secretiveness and excessive time with phone calls and Internet access, unaccounted time away from work or home, unexplained preoccupation, increased debt and worry over finances, extravagant expenditures, and increased alcohol, drug consumption or both" (Buck & Sales, 2000, p. 5). Other disorders, such as substance use, depressive anxiety, and personality disorders, are often present in comorbidity with gambling disorders, which is to be taken into consideration during treatment

Work Addiction

±The primary characteristics of workaholics include "multiple addictions, denial, self-esteem problems, external referenting, inability to relax, and obsessiveness" (Fassel, 1990, p. 27), as well as out-of-control behavior and an escape from personal issues or relationship intimacy (Buck & Sales, 2000; Sussman, 2013). ±These characteristics can be the result of a need to control one's life, an overly competitive drive to succeed, being raised by a workaholic parent or role model, and low self-esteem or self-image (Buck & Sales, 2000). In Table 3.2, the stages of work addiction are examined utilizing a biopsychosocial approach depicting the progressive nature of addiction. ±Workaholics do things in excess. They keep a frenetic pace and do not feel satisfied with themselves unless they are always doing something. As a result, workaholics tend to have more than one addiction, perhaps as many as 20% (Sussman et al., 2011). Often, they smoke, drink, or do drugs as a way to cope with stress. They may have strict eating and exercise regimens in order to have enough energy to sustain such a fast-paced lifestyle. ±Treatment considerations may need to stress family counseling, self-talk, and reviewing with clients their individual reinforcement patterns

Internet Gaming Disorder

±Three main types of player motivations and 10 subcategories: ±(1) achievement (advancement, mechanics, competition), (2) social (socializing, relationship, teamwork), and (3) immersion (discovery, role-playing, customization, and escapism). ±Each of these main motivators and additional sub motivator categories would be interesting areas for counselors to explore with clients presenting with Internet gaming difficulties. There is debate in the field as to whether compulsive online gaming will eventually be formally acknowledged as a process addiction. Researchers suggest that appropriate diagnostic criteria for the disorder may be similar to those used to identify pathological gambling

Process Addictions

±it is important to stress the following as we begin our examination of process addictions: ±(1) that understanding the addictive elements in compulsive and obsessive patterns and the associated negative consequences is critical and ±(2) that assessing the loss of the ability to abstain from harmful processes, or behaviors, is often thought of as one of the hallmarks of addiction, including tolerance and withdrawal patterns, if any. Furthermore, it is critical for the counselor to distinguish a process addiction from other types of behavior that may lead to nega-tive consequences, for example, displaying undesirable social behavior. •A person struggling with an addiction, whether it be process or substance, is engaging in behaviors marked by obsession, compulsion, and significant life (career, relationship, health) impairment. • It is important to note that frequently addiction to one substance or process is accompanied or replaced by addiction to another substance or process (e.g., a female with an eating disorder is also struggling with substance use disorder; a male recovering from a sexual addiction develops a gambling addiction). Comorbidity, or multiple addictions occurring at once, is quite common whether a person is suffering from a substance or a process addiction