Mechanisms and treatment of behavioral addictions with special emphasis on internet and food addictions.

BACKGROUND:

The extent to which excessive engagement in non-substance-related behaviors may constitute addictions has been debated. The recent classification of gambling disorder together with substance-use disorders in DSM-5 was based on similarities between the disorders and lends additional credence to the concept of non-substance or behavioral addictions.

METHODS:

Data will be presented from studies into the biological underpinnings of substance-use and non-substance-use disorders involving excessive patterns of gambling, eating, Internet use, sex and other behaviors. Data from randomized clinical trials will be presented.

RESULTS:

Gambling disorder is arguably the best studied of the behavioral addictions to date. Data indicate multiple similarities, as well as differences, between gambling disorder and substance-use disorders. Considerable debate exists as to whether obesity of other eating-related disorders might be best considered within an addiction framework, with data suggesting particular similarities between gambling, substance-use and binge-eating disorders. Although less data exist for excessive engagement in other behaviors (Internet use, sex), emerging data suggest similarities with substance-use disorders. Given biological similarities, a question arises as to whether behavioral and pharmacological treatments efficacious in the treatment of substance addictions might prove helpful in the treatment of behavioral addictions, with data providing support for cognitive-behavioral therapies and opioidergic and glutamatergic agents.

CONCLUSIONS:

An improved understanding of the biological factors underlying behavioral addictions is developing, and this understanding should lead to the greater availability of validated therapies.

© The Author 2014. Medical Council on Alcohol and Oxford University Press. All rights reserved.