Treatment Of Addictive Behaviors Research Articles

Behavioral Addiction Treatment Centers in the Hospitals of Türkiye: A Web-Based Research.

This study investigates the current landscape of behavioral addiction treatment in Türkiye hospitals, considering both inpatient and outpatient approaches. The analysis involved examining the websites of 1393 hospitals across Türkiye based on various criteria. The review of the websites was conducted between June and September 2023. The findings reveal that out of these hospitals, comprising 822 public and 571 private institutions, only 51 provide treatment for behavioral addictions. Behavioral addiction treatments are available in 23 of the 81 provinces in Türkiye, and 24 out of the 51 hospitals offering treatment for behavioral addictions are located in İstanbul (47.1%), while three (5.9%) are located in Ankara. Among these 51 hospitals, 22 are public, and 29 are private. The primary focus of treatment revolves around internet and gambling addiction. Upon analyzing the patient groups served, it was observed that 49% (n = 25) of the hospitals specialize in treating adult patients, while 29.4% (n = 15) cater to pediatric patients. While the websites of 11 hospitals contain information about the behavioral addiction treatments offered, they lack any information on the patient groups to which they cater. The predominant treatment modalities include psychotherapy (25.49%), followed by psychopharmacotherapy (19.61%) and cognitive-behavioral therapy (17.65%). In conclusion, the treatment of behavioral addictions, such as those related to the internet, gaming, and shopping, are offered in hospitals across various regions and age groups. Considering that only 3.7% of hospitals in Türkiye treat behavioral addictions, this type of treatment is not widespread.

A historical perspective on clonidine as an alpha-2A receptor agonist in the treatment of addictive behaviors: Focus on opioid dependence.

Clonidine operates through agonism at the alpha-2A receptor, a specific subtype of the alpha-2-adrenergic receptor located predominantly in the prefrontal cortex. By inhibiting the release of norepinephrine, which is responsible for withdrawal symptoms, clonidine effectively addresses withdrawal-related conditions such as anxiety, hypertension, and tachycardia. The groundbreaking work by Gold et al. demonstrated clonidine's ability to counteract the effects of locus coeruleus stimulation, reshaping the understanding of opioid withdrawal within the field. In the 1980s, the efficacy of clonidine in facilitating the transition to long-acting injectable naltrexone was confirmed for individuals motivated to overcome opioid use disorders (OUDs), including physicians and executives. Despite challenges with compliance, naltrexone offers sustained blockade of opioid receptors, reducing the risk of overdose, intoxication, and relapse in motivated patients in recovery. The development of clonidine and naltrexone as treatment modalities for OUDs, and potentially other addictions, including behavioral ones, underscores the potential for translating neurobiological advancements from preclinical models (bench) to clinical practice (bedside), ushering in innovative approaches to addiction treatment.

Correction: Treatment of Behavioral Addictions and Substance Use Disorders: a Focus on the Effects of Theta-Burst Stimulation Over the Pre-SMA

Correction: Treatment of Behavioral Addictions and Substance Use Disorders: a Focus on the Effects of Theta-Burst Stimulation Over the Pre-SMA

Linking Striatal Dopaminergic Asymmetry with Personality Traits: Insights from Gambling Disorder.

The role of dopamine in the pathophysiology of gambling disorder (GD) remains incompletely understood, with disparate research findings concerning presynaptic and postsynaptic structures and dopaminergic synthesis. The aim of this study was to investigate potential correlations between striatal dopamine transporter (DAT) lateralization and asymmetry index, as assessed by 123I-FP-CIT SPECT, and temperamental traits, as measured by Cloninger's Temperament and Character Inventory (TCI), in GD subjects. Significant associations were found between DAT binding asymmetries in the caudate and putamen and the temperamental dimensions of harm avoidance and novelty seeking. Specifically, high noveltyseeking scores correlated with increased DAT binding in the left caudate relative to the right, whereas higher harm avoidance scores corresponded to increased DAT binding in the right putamen relative to the left. These observations potentially imply that the asymmetry in DAT expression in the basal ganglia could be an outcome of hemispheric asymmetry in emotional processing and behavioural guidance. In summary, our study provides evidence supporting the relationship between DAT asymmetries, temperamental dimensions and GD. Future investigations could be directed towards examining postsynaptic receptors to gain a more comprehensive understanding of dopamine's influence within the basal ganglia circuit in disordered gambling. If confirmed in larger cohorts, these findings could have substantial implications for the tailoring of individualized neuromodulation therapies in the treatment of behavioural addictions.

Treatment of Behavioral Addictions and Substance Use Disorders: a Focus on the Effects of Theta-Burst Stimulation Over the Pre-SMA

AbstractBehavioral addictions (BA) and substance use disorders (SUDs) share core features, including impaired control and craving, leading to significant personal and societal impacts. Previous research has identified the pre-supplementary motor area (pre-SMA) as a critical node in GD-related neurocircuitry, making it a potential target for interventions also in SUDs. Theta-burst stimulation (TBS) offers a non-invasive method to modulate pre-SMA activity. This study included 58 participants diagnosed with GD or SUDs. They underwent bilateral pre-SMA continuous TBS (cTBS) sessions targeting craving, impulsivity, and addiction severity. Standardized scales and questionnaires were employed to assess the outcomes. cTBS parameters included 20 daily sessions with 80% resting motor threshold (RMT). Both GD and SUD groups exhibited significant reductions in addiction severity and craving following cTBS. Impulsivity decreased significantly in SUD but not in GD. The study’s findings underscore the potential of pre-SMA TBS as an adjunctive treatment for GD and SUDs. The observed improvements in addiction severity and craving emphasize the shared neuronal mechanisms underlying these disorders. However, the nuanced differences, especially in impulsivity, indicate the need for further research to tailor interventions precisely.

Premorbid Personality Traits as Risk Factors for Behavioral Addictions: A Systematic Review of a Vulnerability Hypothesis.

The debate on personality structure and behavioral addictions is an outstanding issue. According to some authors, behavioral addictions could arise from a premorbid personality, while for others, it could result from a pathological use of technological tools. The current study aims to investigate whether, in the latest literature, personality traits have been identified as predictors of behavioral addictions. A literature search was conducted under the PRISMA methodology, considering the most relevant studies of the five-factor model from the past 10 years. Overall, most studies on addiction, personality traits, and personality genetics proved that behavioral addiction may be an epiphenomenon of a pre-existing personality structure, and that it more easily occurs in vulnerable subjects with emotional instability, negative affects, and unsatisfactory relationships with themselves, others, and events. Such neurotic personality structure was common to any addictive behavior, and was the main risk factor for both substance and behavioral addictions. Therefore, in clinical and educational contexts, it becomes crucial to primarily focus on the vulnerability factors, at-risk personality traits, and protective and moderating traits such as extroversion, agreeableness, conscientiousness, and openness to experience; meanwhile, treatment of behavioral addictions is frequently focused on overt pathological behaviors.

Web-based Evidence on the Treatment of Behavioral Addictions in United States Model Treatment Centers.

Behavioral addictions are highly comorbid with substance use disorders, presenting in as many as 54% of service users receiving substance use treatment. Few studies have examined whether treatment centers are attentive to such other addictions, which may undermine treatment. This study examined the mention and treatment of behavioral addictions on United States treatment center websites. The 2021 Newsweek America's Best Addiction Treatment Centers website was utilized to examine the mention and treatment of behavioral addictions in 300 leading treatment centers across 25 states in the United States. Of 289 active websites, only 61 (21.1%) treatment centers mentioned anything about behavioral addictions. The highest prevalence was for gambling (n = 38), sex (n = 22), food/eating (n = 21), and internet gaming (n = 12). A total of 49 treatment centers reported treating those addictions. The most prevalent treatments involved 12-step programming (n = 18), cognitive behavioral therapy (CBT; n = 16), individual counseling (n = 16), and group therapy (n = 15). Little formalized importance via websites was provided regarding the mention or treatment of behavioral addictions at treatment centers. A greater emphasis on concurrent and substitute behavioral addictions is needed to improve the quality of life and lower the possibility of relapse among those persons in addictions treatment.

Analysis of Patient Characteristics in the Inpatient Treatment of Behavioural Addictions: an Exploratory Study

Clinical research on the treatment of behavioral addictions is still scarce. The current study aims to analyze the therapy model for behavioral addictions implemented at the Privatklinik Meiringen, a psychiatric hospital in Switzerland. Patient characteristics over a period of two years were analyzed, documenting abnormalities and changes in their psychological state. A total of 49 individuals between the ages of 18 and 64 were included from the inpatient setting. The patient characteristics were presented with descriptive statistics. Using validated measuring instruments, the psychological state of the patients at the time of admission and discharge was recorded and analyzed. All study participants suffered from psychological comorbidities besides the diagnosis of behavioral addiction. Depression constituted the most common comorbidity, whereas the distribution and incidence of comorbidities varied depending on specific behavioral addiction present in the patient. A clear improvement in psychological distress between the first and the last surveys could be demonstrated. The study provides an exploratory insight into the peculiarities of characteristics of patients suffering from behavioral addiction in an inpatient setting and an overview of their comorbidity spectrum. The retrospective nature of the study prevents an assessment of the effectiveness of the therapy.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

Background and aimsGaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder. MethodsThe sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits. ResultsThe comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness. ConclusionsThe results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions.

Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.

Suicidal behavior in patients with gambling disorder and their response to psychological treatment: The roles of gender and gambling preference

Suicidal ideation and attempts are prevalent among patients with gambling disorder (GD). However, patients with GD and a history of lifetime suicidal events are not a homogeneous group. The main objective of this study was to compare sociodemographic, clinical, personality, and psychopathological features among different profiles of adults with GD with and without a history of suicidal behavior, taking into account two relevant variables: gender and gambling preference. The second aim was to examine how the different profiles of patients with a history of suicidal events responded to cognitive-behavioral therapy (CBT). A total of 1112 treatment-seeking adults who met the criteria for GD were assessed at a hospital specialized unit for the treatment of behavioral addictions. The participants completed self-reported questionnaires to explore GD, personality traits, and psychopathological symptomatology. The lifetime histories of suicidal ideation and attempts, and gambling preferences, were assessed during semi-structured face-to-face clinical interviews. Of the total sample, 229 patients (26.6%) reported suicidal ideation and 74 patients (6.7%), suicide attempts. The likelihood of presenting suicidal ideation was higher for women than men, but no differences were observed based on gambling preference. Regarding suicide attempts, the odds were higher among women with non-strategic forms of gambling. Suicidal ideation and attempts were associated with higher GD severity, a worse psychopathological state and higher self-transcendence levels. In terms of treatment outcomes, neither gambling preference nor past suicidal behavior had an influence on dropouts and relapses. Nevertheless, female gender and a lack of family support constitute two good predictors of a worse treatment outcome.

Mindfulness-Based Relapse Prevention for the Treatment of Gambling Disorder among U.S. Military Veterans: Case Series and Feasibility

Gambling disorder (GD) occurs at higher rates in U.S. veterans than civilians. The present case series describes the application of a manualized mindfulness treatment used with U.S. veterans seeking outpatient treatment for GD at a Department of Veterans Affairs hospital. Mindfulness-Based Relapse Prevention (MBRP) was developed to treat substance use disorders, but its core principles can be readily applied to the treatment of behavioral addictions. However, there has been little empirical evidence demonstrating its successful application for GD, and none demonstrating its successful implementation with U.S. veterans. Three veterans receiving treatment for GD participated in a 9-session adapted MBRP protocol. Following completion of treatment, the veterans reported less frequent engagement in their gambling behavior, fewer cravings, and less intense craving. The veterans also experienced increased self-efficacy in managing urges, less impulsivity and emotion dysregulation, and improved functioning. Preliminary results provide support for a larger treatment trial for veterans seeking treatment for GD.

Addiction as a Coping Response: Hyperkatifeia, Deaths of Despair, and COVID-19.

Addiction as a Coping Response: Hyperkatifeia, Deaths of Despair, and COVID-19.

Validation of a Chinese version of the short form of Metacognitions Questionnaire (MCQ-30)

BackgroundThis study investigated the psychometric properties of a Chinese version of the short form of Metacognitions Questionnaire (MCQ-30), which is an effective tool to assess metacognitive beliefs that have been linked to mental disturbance/disorder. We also tested whether metacognition factors would correlate with Internet gaming disorder (IGD) tendency. MethodsSix hundred and eighty Chinese university students (Mean age=19.72, SD=1.38; 31.9% male) voluntarily completed an anonymous online questionnaire. Using standard translation procedures, the MCQ-30 items were translated from English into Chinese language and then back-translated. Depression, anxiety, and IGD tendency were assessed by validated scales. ResultsConfirmatory factor analysis (CFA) results supported the five-factor structure of the MCQ-30, with satisfactory model fit and good reliability. Criterion-related validity was also supported by significant positive correlations between the five factors and depression/anxiety symptoms. All of the five metacognition factors were also significantly correlated with IGD tendency, with positive beliefs about worry and cognitive confidence being the most salient factor after controlling for gender and age. LimitationsThis study did not examine the test–retest reliability of this scale, and the generalizability of the findings to other age groups remains unclear. ConclusionsThis study showed satisfactory psychometric properties of a Chinese version of the MCQ-30 and is the first to demonstrate a positive association between specific metacognition factors and IGD tendency among Chinese people. The latter finding supports an application of metacognitive therapy to the treatment of behavioral addictions, including IGD.

Dialectical behaviour therapy skills training for the treatment of addictive behaviours among individuals with alcohol use disorder: the effect of emotion regulation and experiential avoidance

ABSTRACT Backgrounds Dialectical behavior therapy skills training (DBT-ST) is an effective treatment for alcohol use disorder (AUD). AUD frequently co-occurs with other addictive behaviors. Objective s: These secondary analyses of prior studies on the effectiveness of a 3-month DBT-ST program for AUD investigated pre- post-treatment changes in the severity of concurrent addictive behaviors. The study hypothesized that emotion regulation and experiential avoidance should be the key therapeutic mechanisms involved in the treatment of addictive behaviors. Methods The research included 186 individuals (110 males; 76 females) with a primary diagnosis of AUD. Mediational models were performed considering shorter PROMIS questionnaire subscales (i.e., gambling, sex, shopping, food binging, and starvation) as dependent variables. The difficulties in emotion regulation scale and acceptance and action questionnaire-II total scores were independent and mediator variables, respectively. Results Clinical variables significantly improved during the treatment, independent of baseline levels. Changes in emotion regulation showed significant total effects on improvements in addictive behaviors. Significant indirect effects of changes in experiential avoidance were detected considering compulsive buying and dysfunctional eating behaviors. Conclusion The DBT-ST was a feasible treatment for several addictive behaviors frequently reported by individuals with AUD. The improvements in emotion regulation and experiential avoidance were relevant therapeutic mechanisms involved in the treatment of these conditions. Future controlled trials and follow-up studies are recommended to support the efficacy of DBT-ST as a stand-alone intervention for the treatment of different classes of addictive behaviors.

Mindful self-regulation of attention is a key protective factor for emotional dysregulation and addictive behaviors among individuals with alcohol use disorder

Individuals with alcohol use disorder (AUD) and other substance use disorders (SUDs) frequently show co-occurrent behavioral addictions (BAs) (i.e., gambling and compulsive sex) and other inflexible behaviors (IBs) (i.e., compulsive buying and dysfunctional eating behaviors). The covariation of these conditions might be explained by a role of emotion dysregulation (ED) and executive dysfunctions. This study aims at investigating whether ED and self-regulation of attention (SRA) could be common processes that underpin BAs and other IBs among individuals with AUD. The study hypothesized that SRA should represent a key protective factor for the relationships between ED and BAs/IBs. The research included 319 treatment-seeking individuals with a primary diagnosis of AUD. Five independent multiple parallel mediational models were tested. Self-report instruments were administered in order to assess ED, BAs and other IBs, which represented independent and dependent variables respectively. SRA was self-report assessed and, it was considered the key mediator variable. The analyses highlighted significant total effects of ED on the severity of BAs and IBs. SRA fully mediated the relationships between ED and BAs/IBs, with exception of gambling. ED and SRA should be considered common dimensions that explain the covariation of BAs and IBs among individuals with AUD. SRA represents an adaptive form of emotion regulation that sustains the engagement in goal-oriented behaviors. Future neuroimaging and longitudinal studies are recommended in order to demonstrate the role of ED and SRA on development, maintenance and treatment of BAs and IBs among individuals with SUDs.

Formación de enfermeras en prevención y tratamiento de conductas adictivas.

El uso y dependencia de sustancias adictivas se relaciona con un amplio conjunto de problemas de salud y de exclusión social, así mismo representan un factor significativo en el incremento de la morbilidad a nivel nacional. En este artículo se presentan los resultados de la revisión y análisis de los planes de estudios correspondientes a la Licenciatura en Enfermería en tres centros de la Universidad Nacional Autónoma de México (UNAM): La ENEO, FESZ y FESI), desde la perspectiva de la formación en prevención y tratamiento de conductas adictivas. Se trata de un estudio descriptivo, evaluativo, transversal, de tipo investigación documental, que analiza la transversalidad de los contenidos sobre la temática de adicciones en los planes y programas de las tres dependencias de la UNAM. Proyecto MP6-20 El análisis comparativo de los planes de estudio permite mostrar que la temática de adicciones, aparece de manera diferencial en los proyectos de formación universitaria de enfermería. Los proyectos curriculares analizados, adolecen de un modelo pedagógico que permita identificar como problema de salud, las conductas adictivas; y en consecuencia se desarrollen estrategias que permitan paulatinamente desarrollar competencias profesionales para la prevención específica, el tratamiento y la reinserción social de las personas con conductas adictivas.

Advancing statistical analysis of ambulatory assessment data in the study of addictive behavior: A primer on three person-oriented techniques

Ambulatory assessment (AA) methodologies have the potential to increase understanding and treatment of addictive behavior in seemingly unprecedented ways, due in part, to their emphasis on intensive repeated assessments of an individual's addictive behavior in context. But, many analytic techniques traditionally applied to AA data - techniques that average across people and time - do not fully leverage this potential. In an effort to take advantage of the individualized, temporal nature of AA data on addictive behavior, the current paper considers three underutilized person-oriented analytic techniques: multilevel modeling, p-technique, and group iterative multiple model estimation. After reviewing prevailing analytic techniques, each person-oriented technique is presented, AA data specifications are mentioned, an example analysis using generated data is provided, and advantages and limitations are discussed; the paper closes with a brief comparison across techniques. Increasing use of person-oriented techniques will substantially enhance inferences that can be drawn from AA data on addictive behavior and has implications for the development of individualized interventions.

Thérapie d’acceptation et d’engagement (ACT) et addiction sexuelle

While referring to the theoretical and practical model of R. Harris (2012), this article proposes the use of acceptance and commitment therapy (ACT) in the treatment of sexual addiction. While dependent behaviors begin and may be maintained by refusal of unpleasant emotional states (that is, addict individuals tend to fight or flee negative emotions by replacing eventually painful or otherwise unpleasant states by behaviors providing pleasure), the ACT framework appears as an ally in treatment of addictive behaviors, in that its goal is a fit between patients’ behaviors and their values (instead avoidance of unpleasant states avoidance). Within a clinical case of a patient suffering from sexual addiction, we show that using ACT helps (i) to decrease the intensity of sexual addiction (as assessed through QMICA-Se in a pre-post design), (ii) to develop psychological flexibility (AAQ-II), and (iii) to decrease anxious and depressive symptoms of the patient (HADS). Moreover, the patient recognizes to feel himself in the here and now, and also to perform activities related to his own values. Acceptance of this limited form of sexuality now allows him to calmly consider the possibility of meeting a new person. ACT thus appears to provide clinical benefits in treatment of sexual addictions.

Pharmacological management of impulsivity and compulsivity

Increasingly patients present themselves to psychiatrists and other care providers with a specific request for treatment of one or more behavioral addictions. From a pathogenic point of view impulsivity and compulsivity are important drivers of these behavioral disorders, and as such may represent a target of pharmacological and broader neurobiological, e.g. Neuro-stimulation, treatment. Although currently treatment as usual has a focus on psychosocial and cognitive behavioral interventions, interest is growing toward the pharmacological interventions. In the presentation a state of the art will be presented regarding the pharmacological treatment of behavioral addictions, with a focus on Gambling Disorder and Gaming Disorder.Disclosure of interestMember Advisory Board Lundbeck - Belgium.Received funding from Belgian LOTTO for research into Cognitive Behavioral Therapy for Gambling Disorder.