Behavioral Addictions:Behavioral Addictions:Are they Are they ReallyReally

Addictions?Addictions?

Thomas E. Legere, Ph.D.Thomas E. Legere, Ph.D.

How do we Decide?How do we Decide?

Old School: DSMOld School: DSM

We Need a We Need a NEWNEW Model! Model!

From From THREETHREE Sources… Sources…

Source #1: Source #1:

The DSMThe DSM

Source #2: Source #2: What Those Who What Those Who Suffer From the Suffer From the

Disease SayDisease Say

Source #3:Source #3:

NeurobiologyNeurobiology

Three Three TYPESTYPES of Addictions of Addictions

I. I. HARDHARD Addictions: Addictions: Alcohol & DrugsAlcohol & Drugs

II. II. SOFTSOFT Addictions: Addictions: Nicotine & CaffeineNicotine & Caffeine

III. III. BEHAVIORALBEHAVIORAL AddictionsAddictions

Three Three LevelsLevels of of

Addiction:Addiction:

• • MildMild

• • ModerateModerate

• • SevereSevere

Soft Addictions:Soft Addictions:““Soft” for a ReasonSoft” for a Reason

Proposed Proposed Behavioral Addictions:Behavioral Addictions:

• • SexSex• • LoveLove• • GamblingGambling• • ExerciseExercise• • EatingEating

What Makes them What Makes them “Real” “Real”

Addictions Addictions (or (or notnot)?)?

Need Need CommonCommon Criteria Criteria for for

HardHard Addictions & Addictions & BehavioralBehavioral Addictions Addictions

Honestly: Honestly: The DSM is Not The DSM is Not

Buying BehavioralBuying BehavioralAddictionsAddictions

DSM: DSM:

• • Compulsive DisordersCompulsive Disorders

• • Pathological BehaviorPathological Behavior

• • Eating DisordersEating Disorders

Twelve Integrated Twelve Integrated CriteriaCriteria

(DSM, Experience,(DSM, Experience,Neurobiology)Neurobiology)

1. 1. “Pleasure Pathway”“Pleasure Pathway”In the BrainIn the Brain

2. 2. Same BrainSame BrainChemicals InvolvedChemicals Involved

• • DopamineDopamine • • GabaGaba• • Serotonin Serotonin • • GlutamateGlutamate• • EndorphinsEndorphins • • CortisoneCortisone• • Norepinephrine Norepinephrine • • CorticotrophinCorticotrophin• • EpinephrineEpinephrine • • HistamineHistamine• • EnkephalinsEnkephalins • • AnandamideAnandamide• • AcetylcholineAcetylcholine

3. 3. ToleranceTolerance

4. 4. Use to “Intoxication”:Use to “Intoxication”:““I Can’t Stop!”I Can’t Stop!”

5. 5. Obsessive DimensionObsessive Dimension

6. 6. DenialDenial

7. 7. Continued Use Continued Use DespiteDespite

Adverse ConsequencesAdverse Consequences

8. 8. Progressive Progressive Escalation Escalation

of “Intake” and of “Intake” and ProblemsProblems

9. 9. Repeated Attempts Repeated Attempts To Control UseTo Control Use

10. 10. WithdrawalWithdrawal

11. 11. IncurableIncurable(Only Remission)(Only Remission)

12. 12. Effectiveness ofEffectiveness of12 Step Program12 Step Program