Features of Gambling Disorder and Internet Gaming Disorder in the spectrum of addictive disorders

Abstract

It might be hard to imagine that a leisure activity could turn to suffering and mental disorder in need of treatment. Nevertheless, emergent behavioral addictions (BAs) such as gambling disorder (GD) and Internet use disorders (e.g., Internet gaming disorder [IGD) have become common treatment-seeking motives in dedicated facilities and a flourishing field for research. These recent entities and their similarities to substance use disorders (SUDs) have raised debate in the scientific community and among clinicians. A major resulting revolution is that the addictive spectrum has recently been enlarged to include addictions that do not require the intake of a psychoactive substance. This inclusion has sparked debate on addiction determinism and whether neurobiological processes could be involved in repetitive exposure to a substance, as well as in cognitions and behaviors. A core clinical addiction syndrome can be extracted by comparing recent diagnostic criteria for SUDs in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) with those for the two considered BAs: GD and IGD. Clinical, psychological, and neurobiological differences and similarities between BAs and SUDs are reviewed and discussed in the present work. Critical links are made between these scientific findings and recent DSM-5 criteria. A full picture of the magnitude of BAs remains imprecise because of several methodological limitations, a lack of standardized screening tools being the major obstacle. We present a recent study (Appendix 4) that we conducted to test the factorial structure of the most commonly used screening tool in which we made some psychometric enhancement proposals. We also presented the relevance of this screening tool for online GD and IGD. The research complexity (financial, ethical, and technical, as well as access to targeted samples) of this field is illustrated by the paper on IGD (Appendix 1). Our results nevertheless contribute to a better understanding of this disorder. High prevalence rates of IGD were found among gamers, and the impact of IGD on social functioning, health, and emotional states was self-reported in a representative adult gamer population. Withdrawal and tolerance symptoms in gaming activity were also self-reported, lending an additional link to SUDs. Neuro-functional and cognitive processes involved in GD have been reviewed (Appendix 2) to offer a better understanding of the development and evolution of GD from a neural, environmental, behavioral, and psychological perspective. Such a perspective will have therapeutic applications in the treatment of patients with these disorders, in consideration of the interconnection between biology, psyche, and behavior. The interactive relationship between clinical practice and research is vital to bring light to the phenomenological understanding of mental disorders. This is also the case for GD and IGD, with a need for a multivariate outlook that leads to a rich, multidimensional, comprehensive definition. To improve the early detection of and intervention in BAs and to reduce the impact of treatment delay on patients and their environment, preclinical efforts are a promising field of action in which to invest. A willingness and readiness of primary care to be part of this effort for GD is discussed in the present work (Appendix 3), with some interesting perspectives such as tailored information and training. The treatment strategy most commonly used in BAs is psychotherapy. Nevertheless, pharmacological approaches should be explored to alleviate suffering in patients who have BA or related disorders. We hereby present an overview of effective and promising drugs tested in clinical trials (Appendix 5) in order to help clinicians choose therapeutic options and to help researchers explore promising avenues of investigation. The field of BAs offers numerous and promising perspectives in development and research. We present some of our blueprints on the conceptualization and recognition of BAs (i.e., GD and IGD), vulnerability factor identification, detection and diagnosis, and care response. The application of a public health framework to BAs is a challenging step in order to fill the gap between individual support and a national and global strategy of harm reduction and care management. It needs to integrate many more parameters than those of a health system, as it must deal with contextual factors (e.g., law, economics, and culture)