Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views Seyyed Salman Alavi, Masoud Ferdosi1, Fereshte Jannatifard2, Mehdi Eslami3, Hamed Alaghemandan4, Mehrdad Setare5 Master of Science in Psychology, Management and ABSTRACT Medical Informatics Faculty of Isfahan University of Medical Sciences, 1Assistant Professor, Health Introduction: Behavioral science experts believe that all entities Service Management, HMERC, Isfahan Unuversity capable of stimulating a person can be addictive; and whenever of Medical Sciences, 2Bachelor of Hygiene, Organization of education, Isfahan, 3Psychiatrist, a habit changes into an obligation, it can be considered as an Shohadaye Lenjan Hospital, 4Hazrate Zahra addiction. Researchers also believe that there are a number of Hospital, Isfahan, 5Legal Medicine of Isfahan,Iran similarities as well as some differences between drug addiction and behavioral addiction diagnostic symptoms. The purpose of this Correspondence to: study is to consider different approaches in this field. Brief Communication Dr. Hamed Alaghemandan, Department of Internal Medicine, Hazrate Methods: This is a descriptive research using content analysis Zahra hospital, Isfahan University of method. First, differences and similarities of various perspectives Medical Sciences, Isfahan, Iran. on addiction and addiction behavior in different substances were E-mail: [email protected] obtained, thereafter, the data was coded and categorized, subjects were discussed and major issues were extracted. Date of Submission: May 8, 2011 Results: Behavioral addiction such as internet addiction is similar Date of Acceptance: Oct 04, 2011 to drug addiction except that in the former, the individual is not addicted to a substance but the behavior or the feeling brought How to cite this article: Alavi SS, Ferdosi M, Jannatifard about by the relevant action. In addition, the physical signs of drug F, Eslami M, Alaghemandan H, Setare M. Behavioral addiction versus substance addiction: Correspondence addiction, are absent in behavioral addiction. Others have stated of psychiatric and psychological views. Int J Prev Med that behaviorally addicted individuals have certain symptoms and 2012;4:290-4. will undergo the same consequences brought about by addiction to alcohol and drugs as well as other obsessive behaviors. Conclusion: Similar to substance abuse prevention, programs aimed at addicted individuals and specialized training can educate Archiveadolescents about ofthe warning SID signs of online addiction, in order to assist the early detection of this disorder. For prevention of behavioral addiction (such as internet addiction) authorities, cultural institutions and parents should monitor the use of internet and teach to the adolescent and children, the useful and appropriate methods of internet use. Keywords: Addiction, addictive behavior, prevention INTRODUCTION The concept of addiction is not easy to define and the usage of the term addiction has been considered as controversial;[2] 290 International Journal of Preventive Medicine, Vol 3, Nowww.SID.ir 4, April 2012 www.mui.ac.ir Alavi, et al: Behavioral and substance addiction however, central to its definition is the dependence this study was to review the major approaches on a substance or activity.[1] expressed in this field. Until recently, “non‑substance related behavioral addiction” was listed in neither of the METHODS two internationally used diagnostic manuals of This is a descriptive study and content analysis. mental disorders, i.e. DSM‑IV‑TR (Diagnostic First, differences and similarities of different and Statistical Manual of Mental Disorders) perspectives in the field of addiction as well as [1] and ICD‑10 (International Classification of behavioral symptoms of addiction to various Disease).[3] Contrary to the commonly held belief substances was obtained from scientific literature that holds addiction to be a particular kind of (1990‑2009). Thereafter, the obtained data was dependence on drugs and chemical substances coded and categorized and subjects were discussed such alcohol, nicotine and heroin, behavior science and major issues were extracted. experts believe that any source which is capable of stimulating an individual, could become addictive. Findings The change of behaviors such as gambling, drug Researchers concluded that there are similarities abuse, computer gaming or chatting and internet and differences between diagnostic symptoms of browsing from habits into obligatory behavior, can drug addiction and behavioral addiction. [4] be considered as the development of addiction. Behavioral addictions such as gambling, The idea that true addictions can exist even in overeating, television compulsion, and internet the absence of psychotropic drugs (behavioral addiction are similar to drug addiction addictions) was popularized by Peele.[4] According except that the individual is not addicted to a to Peele, addicted individuals are dependent on a substance, but he/she is addicted to the behavior particular set of experiences, of which the reactions or the feeling experienced by acting out the to a specific chemical substance is only one example. behavior. Goodman’s[17] and Griffiths’[18] criteria Building on Peele’s notion, some authors for behavioral addictions are presented below have developed the idea that addiction does not [Tables 1 and 2). necessarily have to involve the abuse of a chemical Based on the views of Peel and Griffiths (1988) intoxicant or substance.[5,6] behavior addiction like drug addiction includes the For example, the term ‘‘addiction’’ has been following components: used to refer to a range of excessive behaviors, However, the physical signs of drug addiction such as gambling,7 video game playing,[8,9] eating are absent in behavioral addiction.[19] One of the disorders,10 sports and physical exercise,[11] media precursors of behavioral addiction is the presence use,[12,13] sex addiction, pathological working,[14] of psychopathologies such as depression, substance and compulsive criminal behavior. Although such dependence or withdrawal, and social anxiety as behavioral addictions do not involve a chemical well as a lack of social support[20] intoxicant or substance, a group of researchers Based on Davis model, Urzack believed that have posed that some core indicators of behavioral people who suffer from behavioral addictions, addiction are similar Archiveto those of chemical or were of tired, depressed, SID lonely, bashful, shy, and substance addiction.[15] At present, researchers usually have other types of addiction.[21] Young emphasize that in order to make a diagnosis of (1998) stated that individuals with behavioral behavioral addiction, functional impairments must addiction have certain symptoms and will undergo be present at work, in social relationships, or in the same consequences as those with alcohol and other social situations.[16] drug addiction and other obsessive behaviors.[22] A number of experts believe that behavioral From a neurobiological point of view, addictions can be passive (e.g. television) or active behavioral addictions that only indirectly affect the (e.g. computer games), and usually contain inducing neurotransmitter systems of the brain, can serve and reinforcing features which may contribute to as reinforcers comparable to pharmacological the promotion of addictive tendencies.[16] substances that directly affect these systems (e.g., Considering the importance of prior literature dopaminergic system).[23,24] Indeed, recent findings on behavioral addiction, the primary aim of support the assumption of common mechanisms International Journal of Preventive Medicine, Vol 3, No 4, April 2012 www.SID.ir291 www.mui.ac.ir Alavi, et al: Behavioral and substance addiction Table 1: Diagnostic criteria for behavioral addictions Table 2: Diagnostic criteria for behavioral addiction Goodman (1990) Griffiths (1996) A. Recurrent failure to resist impulses to engage in a 1. Salience: specified behavior. When the particular activity becomes the most B. Increasing sense of tension immediately prior to important activity in people’s lives and dominates their initiating the behavior. thinking (preoccupations and cognitive distortions), C. Pleasure or relief at the time of engaging in the feelings (cravings) and behavior (deterioration of behavior. socialized behavior). D. A feeling of lack of control while engaging in the 2. Mood modification: behavior. A consequence (such as an arousing “buzz” or “high” E. At least five of the following nine criteria: or a feeling of escape) of engaging in the particular 1. Frequent preoccupation with the behavior or with activity; can be seen as a coping strategy. activity that is preparatory to the behavior. 3. Tolerance: 2. Frequent engaging in the behavior to a greater Increasing amounts of the particular activity are extent or over a longer period than intended. required to achieve satisfaction. 4. Withdrawal 3. Repeated efforts to reduce, control or stop the symptoms: behavior. Unpleasant feeling states (such as moodiness or 4. A great deal of time spent in activities necessary irritability) and/or physical effects (such as “the for the behavior, engaging in the behavior, or shakes”). recovering from its effects. 5. Conflict: 5. Frequent engaging in the behavior when Interpersonal conflicts between addicts and those expected to fulfill occupational, academic, around them or intrapsychic conflict within the addicted domestic or social obligations.