691 Ch 3 Process Addictions
Process newer research using sophisticated brain imaging techniques
addictions in the continues to add compelling evidence that the brain reward and
brain``inhibitory systems of those with a process addiction resemble brains
of those with an ingestive addiction
DSM-5gambling was the only disorder included in the revised section on
addictive disorders in DSM-5 (APA, 2013). While gambling disorder
has been included in DSM since 1980, DSM-5 marks the first time it
has been included in the newly titled Substance-Related and
Addictive Disorders chapter
Clinical examination of process addictions: (1) that understanding the
significance 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.
an individual experiences euphoria while compulsively and
obsessively discussing sexual practices in social settings, even after
an ongoing pattern of adverse consequences related to this behavior
(e.g., arguments with spouse/partner or disciplinary action by an
employer), then the counselor would be advised to evaluate further
for an addictive pattern.
Gambling 67% of adults within the state had engaged in one or more
Addictiongambling activity within the past year, and of those, approximately 5%
reported problem gambling symptoms that could benefit from
addiction counseling services
person “needs to gamble with increasing amounts of money in
order to achieve the desired excitement; lies to conceal the extent of
involvement with gambling; and relies on others to provide money to
relieve desperate financial situations”
related to neuroadaptation, or tolerance, and withdrawal
symptoms
a 12-month gambling addiction prevalence of 2%
half a million Americans that are struggling with problematic
gambling
“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”
Comorbidity-substance use, depressive anxiety, and personality
disorders
Technology
addiction
Internet Gaming
Disorder
Research conducted by the Centers for Disease Control and
Prevention (CDC; 2011) found that 31% of adult drivers age 18–64
were reading or sending text or email messages while driving within 30
days
participants identified enmeshment of the functionality of
technology, which means the device itself is not the object of the use;
rather, it is the seeking behavior
If clients respond “yes” to at least one of the questions on the
TECH screening instrument, it indicates a positive finding and
counselors can start a discussion with the client about that person’s
patterns of technology use
ReSTART was the first known treatment center to exist in the
United States specializing in technology addiction treatment
www.netaddictionrecovery.com and www.netaddictionanon.org
Currently, DSM-5 includes Internet gaming disorder as a condition
for further study
“Internet gaming has been reportedly defined as an ‘addiction’ by
the Chinese government, and a treatment system has been set up”
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).
escapism and desire for advancement are the most likely
motivators to suggest problematic engagement
MORE intervention or a support group control condition- The
MORE group participants reported a significant reduction in the
number of proposed DSM-5 (APA, 2013) criteria for Internet gaming
disorder, a reduction in reported craving symptoms, and a reduction
in maladaptive cognitions, which were all maintained at a 3-month
follow-up; Future counselors may want to consider specialized
training in TeleMental Health if there is interest and a future demand
via this medium.
Work Addiction
Sexual Addiction
Parkinson
Disease and Impulse
Control
paraphilic
disorders
3% of U.S. adults (Sussman et al., 2011). An estimated 20–25%
of sexual addicts are women (Carnes, 2011). Additionally, a range of
20–40% of sex addicts are thought to be struggling with another
addiction, such as alcoholism
exaholics Anonymous (SA) defines a sexaholic as someone who
is addicted to lust. - 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
marked isolation, prevalent guilt, marked depression, and a deep
feeling of emptiness.
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 .
Cybersex “Internet-related sexually oriented chat rooms, message
boards, and pornography”
Comorbidity- chemical dependency, eating disorders, work
addiction, compulsive buying, or compulsive gambling; depression,
anxiety, personality disorder, relationship issues, or bipolar disorder
“sexually addicted men are nearly 50% less likely to relate to their
partners in a secure manner than nonaddicted men . . . ”
Persons suffering from PD may experience tremors, joint
stiffness, and a decline in the executive functioning of the brain. ;
Dopamine receptor agonists, a type of drug used to treat PD, is
associated with compulsive gambling, sex, eating, and shopping
There are, however, DSM-5 diagnoses (and DSM-5 estimated
prevalence) for sexual disorders, also known as paraphilic disorders,
that can involve compulsivity, obsessions, and harm to others such as
voyeurism (concerning perhaps 12% of males and 4% of females),
pedophilia (estimated to involve 3–5% of men and a smaller number
of women), sexual sadism (estimated range of perhaps 2–30% of
individuals), sexual masochism (involving an unknown number of
people), and exhibitionism (affecting possibly 2–4% of men) (APA,
2013).
A briefer screening tool, PATHOS, developed by Patrick Carnes
and associates, utilizes six items and may be an important way for
both the counselor and the client to begin to assess for sexual
addiction
cognitive-behavioral therapy; however, additional biological
approaches, such as hormonal therapy involving antiandrogens or
certain libido-inhibiting antidepressants, may also be used
dependence on work despite adverse consequences, with their
research focusing on areas of increased somatic complaints,
psychological symptoms, and poor self-acceptance. 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.
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
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
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
A compounding problem of workaholism is that our fast-paced,
performance-driven society readily supports, encourages, and
rewards it (Fassel, 1990). In fact, many people are self-proclaimed
workaholics.
The irony is that the workaholic’s perfectionist tendencies and
inability to delegate tasks to others can reduce efficiency and
flexibility and decrease progress in the workplace
costs include workers’ compensation for stress, burnout, hiring
and retraining new employees, and legal fees when companies get
sued by employees for stress-related illnesses
First, they truly find enjoyment and satisfaction in their work.
Second, they have an uncontrollable desire to work, even if they do
not enjoy the task. Third, they receive a euphoric high from
accumulating the rewards of their hard work. Eventually, their desire
to receive these accolades, the workaholic’s euphoria, interferes with
their life
workaholism negatively affects physical health, psychological
well-being, and self-acceptance; mirrored in children
These researchers noted that in both samples, high workaholism
scores were significant predictors of heightened work–family conflict;
higher drive scores, or ambition-driven behaviors, led to lower job
satisfaction findings, and less enjoyment of leisure
marital conflict, dysfunction within the family, and strained social
relationships
Brief screening of behaviors described by Sussman (2013) such
as frequent hurrying and rushing, overcontrolling, perfectionism, work
bingeing, work-related exhaustion, hyperfocus on work leading to
poor concentration and recall, compulsive checking on work, and poor
self-care
higher incidences of hypercritical, inefficient, negative, and
overcontrolling behaviors or increased complaints by supervisees
occur
Compulsive
buying
6% of the U.S population - self selected samples
Compulsive shopping, uncontrolled buying, addictive buying,
addictive consumption, shopaholism, and spendaholism
). 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
Debtors Anonymous (2014)
In clinical samples, women make up the majority of subjects, yet
experts report a 1:1 male-to-female ratio
s try to fill the meaninglessness, unhappiness, and void in their
Bulimia nervosa
Food Addiction
and Disordered
Eating
Anorexia nervosa
lives by purchasing items to relieve these negative feelings. CB takes
a toll on the individual, family, and society, and it can lead to
“overspending, indebtedness, and bankruptcy”
Comorbidity- kleptomania ; impulsivity and acquiring behaviors on
several measures, but minimal hoarding, bipolar, or obsessive-
compulsive disorder-related behaviors
Psychosocial, cognitive behavioral, and pharmacotherapy
treatment
onsumer-driven society fueled by powerful messages urging
buyers to spend. These messages tell us that buying things will
enhance our self-esteem, make us happy, and increase social status.
Strategies such as teaching individuals how to resist powerful
marketing messages and examine the social forces at work
obsession, compulsion, denial, tolerance, withdrawal symptoms,
and cravings
certain foods may promote a loss of control and continued use
despite negative consequences- sugar releases opioids and
dopamine in the brain, causing neurochemical changes and
suggesting possible addictive qualities
The roles of hormones and genes that may be related to whether
a person is likely to develop addictive eating patterns are also being
investigated
Overeaters Anonymous, Food Addicts in Recovery Anonymous,
Anorexics Anonymous, and Bulimics Anonymous
eating disorders are complex, involving long-term psychological,
behavioral, emotional, interpersonal, familial, biological, spiritual, and
social factor
preoccupied with food, appearance, and weight, they also often
struggle with issues of control, acceptance, and self-esteem
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;
weighing 15% below what is expected for age and height
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 family
Dieting may represent avoidance of and ineffective attempts at
coping with the demands of new stages of life
is typified by a compulsive cycle of binge eating and then purging.
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
Binge-eating
disorder
those with bulimia and lack of control may also extend to risky
behaviors such as shoplifting, sexual adventurousness, and alcohol
and other drug abuse
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.
