Advance Praise for The Behavioral Addictions “Kudos to Ascher and Levounis for recognizing that addiction is a disease de- fined symptomatically by the discomfort experienced by an individual in the absence of a particular substrate, and for further recognizing that the substrate may be more than simply a substance that can produce physiologic depen- dence. The substrate can include emotional states, activities, and pastimes. The addict, to enter recovery, must remain abstinent not merely from dependence- inducing substances, but from all activities that, for that individual, generate a response that ultimately stifles interpersonal relating and intimacy. The editors and their chapter authors recognize this and have taken on the topic in a com- pelling and constructive manner that will assist the field in moving forward.” Stuart Gitlow, M.D., M.P.H., M.B.A., President, American Society of Addiction Medicine, Chevy Chase, Maryland “This book raises awareness and fosters understanding of the clinical presenta- tions and approaches to treatment of a new frontier of non-substance addic- tions, many of which have been engendered by the proliferation and popularization of new technologies. It is a must-have resource for psychiatrists and other behavioral health practitioners.” Annelle B. Primm, M.D., M.P.H., Deputy Medical Director, American Psychi- atric Association, Arlington, Virginia This page intentionally left blank The Behavioral Addictions This page intentionally left blank The Behavioral Addictions Edited by Michael S. Ascher, M.D. Petros Levounis, M.D., M.A. Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we rec- ommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Publishing (APP) represent the findings, con- clusions, and views of the individual authors and do not necessarily represent the poli- cies and opinions of APP or the American Psychiatric Association. If you would like to buy between 25 and 99 copies of this or any other American Psychi- atric Publishing title, you are eligible for a 20% discount; please contact Customer Ser- vice at [email protected] or 800–368–5777. If you wish to buy 100 or more copies of the same title, please e-mail us at [email protected] for a price quote. Copyright © 2015 American Psychiatric Association ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 18 17 16 15 14 5 4 3 2 1 First Edition Typeset in Minion Pro and Trade Gothic LT American Psychiatric Publishing A Division of American Psychiatric Association 1000 Wilson Boulevard Arlington, VA 22209–3901 www.appi.org Library of Congress Cataloging-in-Publication Data Behavioral addictions (Ascher) The behavioral addictions / edited by Michael S. Ascher, Petros Levounis.—First edi- tion. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58562-485-0 (pbk. : alk. paper) I. Ascher, Michael S., 1980– , editor. II. Levounis, Petros, editor. III. American Psychi- atric Association, issuing body. IV. Title. [DNLM: 1. Behavior, Addictive—therapy. WM 176] RC552.R44 616.86—dc23 2014035470 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Contributors . .vii Preface . xi Video Guide . xv Part I. Introduction 1 Helping People Behave Themselves: Identifying and Treating Behavioral Addictions . 3 Marc N. Potenza, M.D., Ph.D. 2 Forensic Implications of Behavioral Addictions. 9 Robert L. Sadoff, M.D. Eric Y. Drogin, J.D., Ph.D., ABPP Samson Gurmu, M.D. Part II. The Behavioral Addictions 3 Problematic Exercise: A Case of Alien Feet. .29 Elias Dakwar, M.D. 4 Food Addiction: Sugar High. .43 Jessica A. Gold, M.D., M.S. Kimberly A. Teitelbaum, ARNP Mark S. Gold, M.D. 5 Gambling Disorder . .53 Carla J. Rash, Ph.D. Nancy M. Petry, Ph.D. 6 Internet Gaming Disorder: Virtual or Real? . 67 Tolga Taneli, M.D. Yu-Heng Guo, M.D. Sabina Mushtaq, M.D. 7 Internet Addiction: The Case of Henry, the “Reluctant Hermit” . 81 Sean X. Luo, M.D., Ph.D. Timothy K. Brennan, M.D. Justine Wittenauer, M.D. 8 Texting and E-mail Problem Use. 101 Tauheed Zaman, M.D. Daniel Lache, M.D. 9 Kleptomania: To Steal or Not to Steal— That Is the Question . 113 Erin Zerbo, M.D. Emily Deringer, M.D. 10 Sex Addiction: The Fire Down Below . 137 Lisa J. Cohen, Ph.D. 11 Love Addiction: What’s Love Got to Do With It?. 153 Alexis Briggie, Ph.D. Clifford Briggie, Psy.D., LADC, LCSW 12 Shopping Addiction: If the Shoe Fits, Buy It in Every Color!. 175 Najeeb Hussain, M.D. Nicole Guanci, M.D. Mahreen Raza, M.D. Dmitry Ostrovsky, B.A. 13 Tanning Addiction: When Orange Is the New Bronze . 187 Petros Levounis, M.D., M.A. Omar Mohamed, B.A. Carolyn J. Heckman, Ph.D. 14 Work Addiction: Taking Care of Business. 199 Michael S. Ascher, M.D. Jonathan Avery, M.D. Yael Holoshitz, M.D. Index . 209 Contributors Michael S. Ascher, M.D. Clinical Associate in Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania Jonathan Avery, M.D. Assistant Professor of Psychiatry, Weill Cornell Medical College, New York, New York Timothy K. Brennan, M.D. Associate Director, Fellowship in Addiction Medicine, The Addiction Institute of New York; Clinical Instructor of Pediatrics, Weill Cornell Medical College, New York, New York Alexis Briggie, Ph.D. Staff Psychologist, Center for Motivation and Change, New York, New York Clifford Briggie, Psy.D., LADC, LCSW Senior Clinician and On-Site Behavioral Health Director, Community Health Center, Meriden, Connecticut Lisa J. Cohen, Ph.D. Professor of Psychiatry, Department of Psychiatry, Mount Sinai Beth Israel, New York, New York Elias Dakwar, M.D. Assistant Professor, Department of Psychiatry, Columbia University, New York, New York Emily Deringer, M.D. Addiction Fellow, Department of Psychiatry, New York University School of Medicine, New York, New York Eric Y. Drogin, J.D., Ph.D., ABPP Clinical Instructor, Department of Psychiatry, Harvard Medical School; Mem- ber, Program in Psychiatry and the Law, Beth Israel Deaconess Medical Center, Boston, Massachusetts vii viii The Behavioral Addictions Jessica A. Gold, M.D., M.S. Psychiatry Resident, Stanford University School of Medicine, Palo Alto, Cali- fornia Mark S. Gold, M.D. Psychiatry Chairman, Dizney Eminent Scholar, and UF Alumni Distinguished Professor, University of Florida, College of Medicine, Gainesville, Florida Nicole Guanci, M.D. Chief Resident, Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey Yu-Heng Guo, M.D. Chief Resident of Psychiatry, Department of Psychiatry, Hospital of the Univer- sity of Pennsylvania; Philadelphia VA Medical Center, Philadelphia, Pennsylvania Samson Gurmu, M.D. Director, Women’s Unit, Ann Klein Forensic Center, Division of Mental Health Services, West Trenton, New Jersey Carolyn J. Heckman, Ph.D. Associate Professor, Cancer Prevention and Control Program, Fox Chase Can- cer Center, Philadelphia, Pennsylvania Yael Holoshitz, M.D. Clinical Fellow in Public Psychiatry, New York State Psychiatric Institute/New York Presbyterian-Columbia University Medical Center, New York, New York Najeeb Hussain, M.D. Assistant Professor, Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey Daniel Lache, M.D. Addictions Fellow, Philadelphia VA Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Petros Levounis, M.D., M.A. Chair, Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey; Chief of Service, University Hospital, Newark, New Jersey Sean X. Luo, M.D., Ph.D. Leon Levy Fellow in Translational Neuroscience, Department of Psychiatry, Co- lumbia University ; The Ne w York State Psychiat ric Institute, Ne w York, New York Contributors ix Omar Mohamed, B.A. Medical Student, Rutgers New Jersey Medical School, Newark, New Jersey Sabina Mushtaq, M.D. Assistant Professor, Director, and Training Director, Division of Child and Ad- olescent Psychiatry, Department of Psychiatry, Rutgers New Jersey Medical School, New Brunswick, New Jersey Dmitry Ostrovsky, B.A. Senior Medical Student, Rutgers New Jersey Medical School, Newark, New Jersey Nancy M. Petry, Ph.D. Professor, University of Connecticut Health Center, Calhoun Cardiology Cen- ter—Behavioral Health, Farmington, Connecticut Marc N. Potenza, M.D., Ph.D. Director, Yale Center of Excellence in Gambling Research, Director, Women and Addictions Core of Women's Health Research at Yale, and Professor of Psy- chiatry, Child Study and Neurobiology, Yale University School of Medicine, New Haven, Connecticut Carla J. Rash, Ph.D. Assistant Professor, University of Connecticut Health Center, Calhoun Cardi- ology Center—Behavioral Health, Farmington, Connecticut Mahreen Raza, M.D. Chief Resident, Department of Psychiatry, Rutgers New Jersey