Academic journal article New Zealand Journal of Psychology

The Classification of Substance and Behavioural Addictions: A Preliminary Investigation

Academic journal article New Zealand Journal of Psychology

The Classification of Substance and Behavioural Addictions: A Preliminary Investigation

Article excerpt

The term addiction has been used to refer to impaired control over substance use for several centuries (Potenza, 2006) however, more recently there has been a shift toward using this term in the context of non-substance use related disorders, such as pathological gambling (PG). This stems from the observation that core components of addictive behaviour can be observed in a variety of behaviours which are not related to substance use such as PG, compulsive sex, shopping, and computer use (Griffiths, 2000; Potenza, 2009). These core components include preoccupation with the behaviour, craving or appetitive urge to engage in the behaviour, diminished control over the compulsion to engage in the behaviour, repeated unsuccessful attempts to cut down or stop the behaviour, tolerance, withdrawal symptoms and continued engagement in the behaviour despite ongoing legal, social and health consequences (Grant, Potenza, Weinstein & Gorelick, 2010; Griffiths, 2000; Potenza, 2009; Wareham & Potenza, 2010). In fact, it has been suggested that these disorders could be best described as 'behavioural addictions' (Holden, 2001; Petry, 2006). However, whether these 'behavioural addictions' should fall under diagnostic criteria for addictions, compulsive disorders or impulse control disorders is still being debated (Potenza, 2009).

The proposed changes to diagnostic criteria in the upcoming Diagnostic and Statistical Manual of Mental Disorders 5th Edition include the renaming of the 'Substance-Related Disorders' category to 'Substance Use and Addictive Disorders' to incorporate substance use disorders (SUDS) and non-substance addictions (specifically Gambling Disorder; APA, 2011; Petry, 2010). PG has been identified as a psychiatric disorder in its own right since 1980, and is included within the current DSM (DSM-IV TR; APA, 2000) as an Impulse Control Disorder. The recommendation to re-classify this disorder has been made as a result of the increasing body of literature which reveals a high degree of similarity between SUDS and PG in relation to diagnostic criteria, co-morbidities, biological bases and treatment.

With regard to diagnosis, five of the DSM-IV TR (APA, 2000) diagnostic criteria for PG are based on SUDS criteria (i.e., interference in life functioning, tolerance, withdrawal, repeated unsuccessful attempts to quit & preoccupation with the drug / gambling: Petry, 2006; Potenza, 2006). There are high rates of co-morbidity between the two disorders, for example, lifetime prevalence rates of PG in SUDS populations are estimated at 14% (Shaffer, Hall & Van der Bilt, 1999), with point prevalence rates between 10-13% (Cunningham-Williams, Cottler, Compton, Spitznagel, & Ben-Abdallah, 2000; Langenbucher, Bavly, Labouvie, Sanjuan, & Martin, 2001) compared to general population rates of 0.4-2% (Petry, Stinson, & Grant, 2005). In PG, 70% present with alcohol use disorders and 30% with disorders involving another drug (Petry et al., 2005). In addition, co-occurring mood and anxiety disorders are a common characteristic of SUDS in community and inpatient populations (Adamson, Todd, Sellman, Huriwai, & Porter, 2006; Burns & Teeson, 2002; Goodwin, Fergusson, & Horwood, 2004; Merikangas, Mehta, & Molnar et al., 1998) and PGs (Crockford & el-Guebaly, 1998; el-Guebaly et al., 2006; Kessler et al., 2008).

Epidemiological studies suggest that 26-37% of those with alcohol dependence also had a lifetime history of mood disorder (with depression being the most common), whereas 32-37% met lifetime criteria for an anxiety disorder (Jane-Llopis & Matytsina, 2006; Merikangas et al., 1998; Robins & Regier, 1991). Similarly, in PGs, epidemiological studies report a lifetime prevalence of over 50% for mood disorders and 40% for anxiety disorders (Kessler et al., 2008). Both are highly prevalent in those seeking treatment for PG (el-Guebaly et al., 2006; Kim, Grant, Eckert, Faris & Hartman, 2006) with up to 75% meeting criteria for a major depressive disorder and high rates of anxiety disorders (Crockford & el-Guebaly, 1998). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.