Abstract
Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions including etiology, course, and neurobiology. Yet, the treatment of behavioral and substance use addictions tends to be separated. However, we argue that a more effective and efficient treatment approach is to conceptualize behavioral and substance use addictions as different expressions of a common underlying disorder and, in treatment, to address the underlying mechanisms common to both. To this end, the article presents a developing transdiagnostic treatment model of addictions that targets underlying similarities between behavioral and substance use addictions, called the component model of addiction treatment (CMAT). The CMAT is transdiagnostic in that it can be used in the treatment of both behavioral and substance use addictions. It is pragmatic in that it targets component vulnerabilities, which are enduring, yet malleable, individual psychological, cognitive, and neurobiological characteristics that are common to all addictive disorders and have been demonstrated to be modifiable. A working model of CMAT is presented, including proposed component vulnerabilities: lack of motivation, urgency, maladaptive expectancies, deficits in self-control, deficits in social support, and compulsivity, as well as their potential intervention possibilities. Future directions and potential implications of the CMAT are discussed.
Highlights
Component Model of Addiction TreatmentInternet gaming disorder (i.e., video game addiction) is currently listed in section Unified Theories of Addictive Disorders of the DSM-5 Emerging Measures and Models as a potential psychiatric disorder pending further empirical investigation
Reviewed by: Daniel Luke King, University of Adelaide, Australia Rodrigo Marín-Navarrete, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico Mateusz Kazimierz Gola, University of California, San Diego, United States and Polish Academy of Sciences, Poland
Sauer-Zavala et al [47] recently distinguished among three broad categories, all of which have empirical support for their efficacy. The first of these are universally applied therapeutic principles. Treatments such as psychodynamic and cognitive behavioral therapy (CBT) models are transdiagnostic in the sense that they are designed to be applied to a variety of presenting conditions
Summary
Internet gaming disorder (i.e., video game addiction) is currently listed in section Unified Theories of Addictive Disorders of the DSM-5 Emerging Measures and Models as a potential psychiatric disorder pending further empirical investigation. To gambling and internet gaming, empirical research has examined other compulsive behaviors which have been postulated as behavioral addictions. Dysregulation in underlying neurobiology such as the dopamine reward system has been found in problematic engagement with gambling [16], video games [17], and shopping [18], and both behavioral and substance addictions share similar executive functioning deficits as demonstrated by deficits in decision making and difficulties in delaying rewards [2]. What is known is that engaging in both behavioral and substance addictions results in the activation of the dopamine reward system, with continued engagement being associated with structural and functional changes [2] In these ways, behavioral addictions closely mimic the hallmark characteristics of substance use disorders [35]
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