Author(s): Dr. Sai Mithra Kamineni*, Dr. Maithri Kolluri and Dr. Kota Suresh Kumar
The term“behavioural addiction” has been used to refer to a range of excessive behaviours, such as gambling, video game playing, eating disorders, sports and physical exercise, media use, sex addiction, pathological working, and compulsive criminal behaviour.
Although behavioural addictions do not involve a chemical intoxicant or substance the core neuronal pathways of the behavioral addictions are similar to those of chemical or substance addiction.
The absence of physical signs of withdrawal, absence of substance, clear-cut classification, and less availability of literature on these addictions carries with it the difficulties in diagnosis and management. The digital surge during Covid and accompanying disruption of mental health services during this period have significantly increased the risk of developing behavioral addictions.
Cell Phone, Internet, Online Shopping, Social Media Addictions Cell phones provide individuals unlimited access to information and to connect with others all around the world in a way otherwise thought to be impossible. With the unparalleled dominance of cell phones involving every aspect of life, dependence on it has become inevitable in the Covid era, affecting social, educational occupational, and cultural functioning. But when this dependence becomes problematic and significantly impairs the functionality then it can be labelled as cell phone addiction. With the whole of the world under the thumb of the internet and a false sense of control over it, the prevalence of addictions related to smartphone are on the constant rise.
The cell phone addiction branched out into multiple addictions based on the vulnerability of the person using it. Internet addiction, social media addiction, online shopping, gaming have not been included in the current diagnostic classifications. These behavior addictions have a major psychological impact on people of all age groups, especially the unguarded adolescents in their formative years. It is the need of the hour to tackle these addictions for prevention and effective management of the psychological wellbeing.
Gambling disorder is defined as gambling that disrupts or damages personal, family, or recreational pursuits. Just like substance use, gambling too exists on a spectrum or continuum of escalating severity (ranging from social or non-problem gambling, through problem gambling, to gambling addiction or gambling disorder) and can have multiple adverse consequences. Adult problem gambling over the last 12 months ranged from 0.5 - 3% with three to four times as many people reporting sub-clinical problems and harm. Gambling in India, just as it is in the rest of the world, is a common and socially acceptable leisure activity. Simply put, gambling involves wagering something of value (usually money) on a game or event whose outcome is unpredictable and determined by chance. Examples of popular gambling activities include lottery, slot machines, sports betting, card games, scratch cards, internet gambling, casino games, bingo, and private betting. Online pornography use, also known as Internet pornography use or cybersex, maybe one of those Internet-specific behaviors with a risk for addiction. It corresponds to the use of the internet to engage in various gratifying sexual activities. Continued use in this fashion sometimes leads to financial, legal, occupational, and relationship trouble or personal problems, with diverse negative consequences. Feelings of loss of control and persistent use despite these adverse results constitute“online sexual compulsivity” or Problematic Online Pornography Use. A study reports that 58% of men view pornography weekly and 87% at least monthly; while the prevalence of pornography addiction ranges from 4.5-9.8%. Overall, pornography consumption increases over years, more among males particularly young adults, and decreases with age.
The assessment of behavioural addictions is of importance for counteracting an inflationary use of the concept of behavioral addiction and for distinguishing pathological behaviour from normal excessive behaviour. Scales like South Oaks Gambling Screen (SOGS) and the National Opinion Research Center DSM Screen for Gambling Problems (NODS) were being widely accepted. In addition, many other scales like the Problematic Internet Use questionnaire, Video game addiction scale, Exercise addiction inventory were being used. Due to a lack of statistical validation, most of the instruments had their limitations. Especially in certain areas, there are only a few valid and reliable instruments available to assess excessive rewarding behaviour. The strengthof instruments relies in their ability to deliver extensive and essential information for the diagnostic and therapeutic process. Standardized classification of mental disorders should classify excessive behaviour meeting criteria of addiction as addiction disorder and operationalize them according to diagnosis. This will establish an accurate diagnosis and facilitate the effective treatment of individuals.
The prevalence of behavioral addiction disorders has increased in tandem with the rise in technology-facilitated by the Covid pandemic ushering a need for better classification, diagnosis, and management. People with behavioral addictions may not suffer the same physical risks to their health that people with drug addiction experience. But, leaving a behavioral disorder untreated can cause immense suffering for the person addicted and their family. With its similarities and differences with substance addiction, various pharmacological and nonpharmacological treatment modalities are being tried. The management of behavior addiction should be a holistic approach with a broader view focussing on multiple problematic areas following the biopsychosocial model of the disease.
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