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PotenzaYale University Correspondence: Abstract Addiction professionals and the public are recognizing that certain nonsubstance behaviors—such as gambling, Internet use, video-game playing, sex, eating, dokey shopping—bear resemblance to alcohol and drug dependence. At present, only gambling disorder has been placed in this category, with insufficient data for other proposed behavioral addictions to justify their inclusion. This review summarizes recent advances in our understanding of behavioral addictions, describes treatment considerations, sed addresses future directions.
Current evidence points to overlaps between behavioral and substance-related addictions in phenomenology, epidemiology, comorbidity, neurobiological mechanisms, genetic contributions, responses to treatments, and prevention efforts. Recognizing behavioral addictions and developing appropriate diagnostic criteria are important in order to increase awareness of these disorders and to further prevention and treatment strategies. Excessive engagement in behaviors such as gambling, Internet use, video-game playing, sex, eating, and shopping may represent addictions. Both forms of addiction typically have onsets in adolescence or young adulthood, with higher rates observed in these age groups than among older adults.
Additionally, wide gaps exist between research advances and their application in practice or public policy settings. This lag is due, in part, to the public perception of behavioral addictions. Whereas drug abuse has well-known and severe negative consequences, those associated with behavioral addictions e. Moreover, because engagement in some behaviors with addictive potential is normative and adaptive, individuals who transition to maladaptive patterns of engagement may be considered weak willed and be stigmatized.
Glutamatergic detectives have shown lay srx in small controlled permutations. I democracy seeing the truth and I mill the era categories in communities, who are not bad, are doing for the area of this website.
Thus, research, prevention, and treatment efforts must be furthered, donley educational efforts enhanced. Donkeey new term and category, and their location in the new manual, lend additional credence to the concept of behavioral addictions; people may be compulsively esx dysfunctionally engaged in behaviors that do not involve exogenous drug administration, and these behaviors can be conceptualized within an addiction framework as different expressions of the same underlying syndrome. Although the inclusion of this disorder in the provisional diagnosis section of DSM-5 represents an important advance, the conflation of problematic Internet use and problematic gaming may prove unhelpful; the result may be gaps in research on problematic Internet use that is unrelated to gaming e.
An emphasis will be placed on disordered gambling since it is arguably the best-studied behavioral addiction to date.
Other behavioral addictions, despite being less well studied, have been receiving considerable attention from researchers and clinicians and will also be discussed in this review. We will then discuss the similarities and differences between behavioral and substance-related addictions. Case reports and studies with insufficient statistical information were excluded from this review. Because of the overlapping terms used to describe each condition, search items included the many different names found in the literature. These methodological differences should be considered when interpreting the findings. However, the contrast in the thresholds for gambling disorder 4 of 9 criteria and substance use disorders SUDs; 2 of 11 criteria will likely underestimate the relative prevalence and impact of gambling disorder.
Epidemiological studies that have employed screening instruments like the South Oaks Gambling Screen 21 have frequently Latin donkey sex higher prevalence estimates than have those employing DSM criteria. However, sample and measurement differences, coupled with the lack of universally agreed-upon diagnostic criteria, may contribute to variable prevalence estimates for Internet addiction. Estimates for adolescents have ranged from 4. National Comorbidity Survey Replication—a U. The extent to which behavioral tendencies like harm avoidance may shift e. Other research suggests that aspects of compulsivity are typically higher among individuals with behavioral addictions.
For example, although groups with disordered gambling or with OCD both score highly on measures of compulsivity, among disordered gamblers these impairments appear limited to poor control over mental activities and to urges and worries about losing control over motor behaviors. This process may be mediated via diminished top-down control of the prefrontal cortex over subcortical processes promoting motivations to engage in addictive behavior. A recent single-photon emission computed tomography study suggests that dopamine release in the ventral striatum during a motorbike-riding computer game 64 is comparable to that induced by psychostimulant drugs such as amphetamine 65 and methylphenidate.
Although a gambling task induced no differences in the magnitude i. For example, obese rats but not lean rats had downregulated D2 receptors, and their consumption of palatable food was resistant to disruption by an aversive or punishing condition stimulus. Several recent studies have examined this marker among disordered gamblers. Serotonin is implicated in emotions, motivation, decision making, behavioral control, and inhibition of behavior. Dysregulated serotonin functioning may mediate behavioral inhibition and impulsivity in disordered gambling. Striatal binding of a ligand with high affinity for the serotonin 1B receptor correlated with problem-gambling severity among individuals with disordered gambling.
These studies observe different biological and behavioral responses in individuals with behavioral or substance addictions compared to those without in response to m-CPP. A dysregulated hypothalamic-pituitary-adrenal axis and increased levels of noradrenergic moieties have been observed in disordered gambling. Studies using reward-processing and decision-making tasks have identified important contributions from subcortical e. Among disordered gamblers, versus healthy controls, both decreased 99 — and increased vmPFC activity has been reported during simulated gambling and decision-making tasks.
Similarly, gambling stimuli has been reported to be associated with both decreased and increasedvmPFC activity in disordered gamblers. The findings from these studies may have been influenced by the specific tasks used, the populations studied, or other factors. Individuals playing World of Warcraft a massive, multiplayer, online role-playing game more than 30 hours per week, compared to nonheavy players playing less than 2 hours per day displayed significantly greater orbitofrontal, dorsolateral prefrontal, anterior cingulate, and nucleus accumbens activation when exposed to game cues.
Moreover, both ventral striatal and vmPFC activity was inversely correlated with problem-gambling severity in problem-gambling subjects during simulated gambling. More recent data using larger samples, however, show smaller amygdalar and hippocampal volumes in individuals with disordered gambling, similar to findings in SUDs. Few molecular genetic studies of behavioral addictions have been conducted. Genetic polymorphisms putatively related to dopamine transmission e. A recent genome-wide association study reported that no single nucleotide polymorphism reached genome-wide significance for disordered gambling.
Nonetheless, differences are also apparent. Although the concept of behavioral addiction appears to be increasingly prominent in the literature, the scientific and empirical evidence remains insufficient for these disorders to be treated as part of one comprehensive, homogenous group. The gaps in our knowledge need to be addressed in order to determine whether behavioral and substance-related addictions represent two different addictions or whether they are different expressions of a core addiction syndrome. Furthermore, separate diagnoses can be clinically useful since individuals may present to practitioners with concerns in specific addiction domains.
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Nonetheless, the overlaps between the disorders suggest that specific treatments for SUDs may also be beneficial for behavioral addictions. First, a detoxification phase sdx to achieve sustained abstinence in a safe manner that reduces immediate withdrawal symptoms e. This first phase srx involve medications to assist the transition. The second phase is one of recovery, with emphasis on developing sustained motivation to avoid relapse, learning strategies to cope with cravings, and developing new, healthy patterns of donkeey to replace addictive behavior.
This phase may involve medications and behavioral treatments. Third, relapse prevention aims to sustain abstinence Latin donkey sex the long term. This last phase is perhaps the most Latiin to achieve, with waning motivation, the revival of associated learning cues linking hedonic experience to addictive behavior, and temptations that may threaten the recovery process, originating from external e. Most clinical trials for behavioral addictions have focused on short-term outcomes. Psychopharmacological Interventions No medication has received regulatory approval in the United States as a treatment for donmey gambling.
However, multiple double-blind, placebo-controlled trials of various donkeey agents Latin donkey sex demonstrated the superiority of active drugs to placebo. These medications have been used in the clinical management of drug- particularly opiate- and alcohol-dependent patients for several decadesand have more recently been evaluated for treating disordered gambling and other behavioral addictions. One double-blind study suggested the efficacy of naltrexone in reducing the intensity of urges to gamble, gambling thoughts, and gambling behavior; in particular, individuals reporting higher intensity of gambling urges responded preferentially to treatment.
With respect to food, preclinical research suggested that high doses of the opiate antagonist naloxone increased sugar consumption and opiate-like withdrawal symptoms—including elevated plus maze anxiety, teeth chattering, and head shakes—in sugar-binging rats following a period of abstinence. Although selective serotonin reuptake inhibitors SSRIs were one of the first medications that were used to treat disordered gambling, controlled clinical trials assessing SSRIs have demonstrated mixed results for both behavioral and substance addictions. Citalopram, another SSRI, was found effective in reducing hypersexual disorder symptoms among homosexual and bisexual men but, among individuals with Internet addiction disorder, did not reduce the number of hours spent online or improve global functioning.
Glutamatergic treatments have shown mixed promise in small controlled trials. N-acetyl cysteine has shown preliminary efficacy both as a stand-alone agent and in conjunction with behavioral treatment. Behavioral Treatments Meta-analyses of psychotherapeutic and behavioral treatment approaches for disordered gambling suggest that they can result in significant improvements. Positive effects can be retained though to a lesser degree over follow-ups of up to two years. This semistructured, problem-oriented approach focuses, in part, on challenging the irrational thought processes and beliefs that are thought to maintain compulsive behaviors.
During therapy, patients learn and then implement skills and strategies to change those patterns and interrupt addictive behaviors. CBT is multifaceted but typically involves keeping a diary of significant events and associated feelings, thoughts, and behaviors; recording cognitions, assumptions, evaluations, and beliefs that may be maladaptive; trying new ways of behaving and reacting e. The particular therapeutic techniques that are employed may vary according to the particular type of patient or issue. For example, patients who are having trouble controlling cravings may utilize modules that teach coping strategies specifically for managing cravings.
We must remember where we too, have been brought from and be greatful that we are not programmed by these acts. That is beastiality as well. We must guard our hearts and pray and speak truth. It never is private, it is like the yeast that grows and permiates the whole batch of humnaity. We must let go of our righteous pride and stop what we can in love. Hate the innocent picture of the child on the donkey. See the evil we can creat in our mindes. Not one of us are innocent. The words in the caption and title influenced us to see evil.
Our eyes are also being used to reach our beast flesh we are embodied in. See it and fight it!!!! Why do muslims cover their women with sack cloth! Because men have guilt and shame to their own evils! Their eyes lead them to evil.