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Episode 54
Donald Black, MD, gives a masterclass lecture on behavioral addictions and Renee Kohanski talks about what normal is.
Show Notes
By Jacquiline Posada, MD.
- Gambling disorder (previously pathological gambling) is widespread, though not commonly assessed
- Patients may not volunteer information related to gambling unless asked, so questions about gambling should be included in routine questioning
- Assessment should include questions about legal and illegal gambling
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- Explore extent: Ask about the level of financial burden; impact on home life, such as marital problems and divorce; legal complications like bankruptcy. Finally, ask about suicide risk related to gambling
- Treatment: There is strong data for SSRI medications and naltrexone for urges
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- Therapy is more efficacious, such as CBT therapy and Gamblers Anonymous
- In certain states, such as Iowa, a person can ask for "self-exclusion," which is essentially banning oneself from a casino or lottery. Also, participation in gambling results in arrest
Behavioral addictions: Behavior that is out of control and has qualities and consequences similar to drug and alcohol addiction
- Examples include gambling disorder, compulsive buying, compulsive sexual behaviors (hypersexuality), and Internet addiction
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- Gambling disorder is similar enough to substance addictions that it is included in the DSM-5 in the "substance-related and addictive disorder"
- Addiction neurocircuitry active in these behavioral addictions: Dopamine driven in the nucleus accumbens
- Compulsive shopping: primarily a female disorder, onset in late 20s, with shopping and spending that are chronic and problematic
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- CBT programs developed to target compulsive shopping, studies about medications for this disorder are mixed
- Compulsive sexual behavior: Primarily a male disorder affecting 5% of the population; onset late teens, early 20s. The addiction will combine conventional sexual behaviors taken to extremes often combined with an addiction to pornography
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- This disorder will often overlap with an Internet addiction
- No evidence-based treatments exist, though CBT-driven models and 12-step programs exist
- SSRI or TCA antidepressants may be helpful in dampening sex drive
- Internet addiction has developed in our technologically enabled world; most psychiatrists have encountered this addiction.
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- Most data come from Asia, where children are exposed to technology at an even earlier age than in the U.S.
- China has developed residential treatment programs involving individual and group therapies.
References
