Behavioral Addictions?

For the majority of time that addiction treatment has been available in the United States, the focus has been on the destructive misuse of alcohol &/or other chemical substances. However such “behavioral addictions” as gambling, compulsive sexual behavior, and an increasing variety of internet-related pursuits have gained increasing amounts of attention, as unchecked involvement has led to negative outcomes that have impaired quality-of-life and crippled level-of-functioning for many. And yet, if every behavior that human beings find pleasurable is automatically considered an ‘addiction,’ such a designation loses meaning, and severe and distressing examples of behavioral addiction are put at risk of being minimized or invalidated. We live at a time when people who love chocolate speak of being “chocoholics” and others describe themselves as “overdosing on NetFlix” or addicted to their iPhones. How then can it be made reliably possible to clinically describe behaviors that have actually crossed a self-destructive line into what may be meaningfully understood as an addictive disorder?

Thankfully, such a tool has been made available to us, compliments of Celilie Schou Andreassen and her colleagues from the Department of Clinical Psychology at the University of Bergen in Norway. Known as the “Bergen Scale,” the various adaptations of this framework evaluate the addictive nature of patterned behaviors according to 6 well-established, core elements of addiction – Salience, Tolerance, Mood modification, Relapse, Withdrawal, and Conflict. Salience speaks to the primacy of focus and priority that addiction becomes in the lifestyle of the addicted. Tolerance describes the progressive nature of addiction, requiring increasingly larger doses over time to achieve the sought-after payoff. Mood modification captures a major driver of addictive behavior, namely, to change or enhance an emotional state to one more desired by the addicted. Relapse speaks to the loss of volitional control over quitting or limiting addictive behavior, while Withdrawal describes the discomfort of the neurochemical recalibration experienced when the addicted reduces or terminates using. Lastly, Conflict captures the many tensions that arise between prioritized addictive behavior, and honoring other valued areas of health and functioning. The Bergen Scale has been applied to the study of social media addiction, shopping addiction, and Facebook addiction among others, resulting in a valid and reliable framework for identifying behavioral addictions, and for informing their effective treatment.

Given what we know about the so-called “science-to-services gap” as pertaining to research-based treatments being implemented, it is not surprising to learn that grass-roots, mutual-help addiction recovery fellowships have become well-established in advance of more recent scientific findings about behavioral addiction. Gamblers Anonymous has been around since 1957, Overeaters Anonymous since 1960, Debtors Anonymous since 1968, Sex Addicts Anonymous since 1977, Co-Dependents Anonymous since 1986, and On-Line Gamers Anonymous since 2002. As the associated recognition of addictive disorders focused on the behaviors of gambling, eating, spending, sex, relationships, working and online gaming continue to grow, we can expect increasingly effective treatment to also continue to evolve, for the betterment of those whose behaviors have truly crossed Bergen-Scale lines into addictive disorders.