Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. Behavioral research has contributed to our understanding of many of the factors involved in drug abuse, including initiation, maintenance, cessation, and relapse. Prior to the s, the general belief held by professionals and lay people was that drug abuse was caused by an underlying psychopathology that could be studied only in humans. Behavioral researchers, however, took advantage of the knowledge gained about the control of appetitive behaviors and developed an animal model of drug abuse.
The ethical issues involved in addiiction engendering violent or aggressive behavior are formidable, and substantial creativity is required to design ethically Behavioral model of addiction and valid models. Researching addiction to foodfor example, a Scripps Research Institute study found evidence that the Oral b rembrandt molecular mechanisms correlated with human drug addiction also exist in compulsive overeating in obese rats. Schedule-induced drug self-administration. Psychopharmacology Berl 4 Individuals who, in the absence of drug use, will Vintage pink plastic wall tiles to Behavioral model of addiction, support a family, seek an education, and engage in other aspects of a productive life style, can become totally involved in drug seeking and drug taking, neglecting all other activities they previously found rewarding. A related construct to deficits in self-control is deficits in executive functioning. Corticosterone in the range of stress-induced levels possesses reinforcing modwl Implications for sensation-seeking behaviors. In addition, there exists a multitude of step programs for distinct addictive behaviors such as alcohol Alcoholics Anonymouscocaine Cocaine Addicfiongambling Gamblers Anonymoussex Sexaholics Anonymousand eating Overeaters Anonymous.
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Behavioral addiction is a treatable condition. They may also suffer losses that seem too great to bear, such as money problemsor relationship ov. Opioids: Facts Parents Need to Know. While gaming, internet, porn, sex, food, and shopping addictions are not officially APA-verified conditions, many experts believe that they should be included in the DSM. Detoxification Alcohol detoxification Behavioral model of addiction detoxification. We all have the brain reward circuitry that makes food and sex rewarding. Need a tool to help people stay drug-free? Internet addiction is a psychosocial disorder and its characteristics are as follows: tolerancewithdrawal symptomsaffective disorders, and problems in social relations. Individuals in CBT learn to identify and correct problematic behaviors by Behavioral model of addiction a range Frat party fucks different skills that can be used to stop drug abuse and to address a range of other problems that often co-occur with it. Journal of Gambling Studies.
Behavioral addiction [note 1] is a form of addiction that involves a compulsion to engage in a rewarding non- substance -related behavior — sometimes called a natural reward   — despite any negative consequences to the person's physical, mental, social or financial well-being.
- Cognitive-Behavioral Therapy CBT was developed as a method to prevent relapse when treating problem drinking, and later it was adapted for cocaine-addicted individuals.
- Behavioral addiction [note 1] is a form of addiction that involves a compulsion to engage in a rewarding non- substance -related behavior — sometimes called a natural reward   — despite any negative consequences to the person's physical, mental, social or financial well-being.
- Behavioral approaches help engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive abuse.
- Most people understand addiction when it comes to a dependence on substances , such as alcohol, nicotine, illicit drugs, or even prescription medications, but they have a hard time with the concept of addictive behaviors.
Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. Behavioral research has contributed to our understanding of many of the factors involved in drug abuse, including initiation, maintenance, cessation, and relapse. Prior to the s, the general belief held by professionals and lay people was that drug abuse was caused by an underlying psychopathology that could be studied only in humans.
Behavioral researchers, however, took advantage of the knowledge gained about the control of appetitive behaviors and developed an animal model of drug abuse. Although early work on drug abuse and drug-taking behaviors assumed that only those animals 1 already physically dependent on opiates could be induced to take them Thompson and Schuster, , it soon became clear that when drugs were made available, drug-naive animals took them readily and to excess.
This chapter highlights some of the major accomplishments in behavioral research including the development of behavioral models and discusses opportunities for future research.
Insights from behavioral research have made major contributions to our understanding of the addictive process, enabling researchers to study the behavior of drug taking separately from its pharmacological sequelae and making it possible to integrate the findings of other research disciplines e.
The terms "animals" and "nonhumans" are used interchangeably throughout this chapter to refer to nonhuman laboratory animals. The major contribution of behavioral research to the study of drug abuse has been the development of the self-administration model and the use of this model to test for abuse liability and to expand our understanding of addiction. This basic model has been augmented by other models based on the principles of learning and conditioning such as drug classification drug discrimination ; the relationship between drug use and variables controlling use behavioral economics ; the nature of transition states in drug abuse initiation, abstinence, withdrawal ; motivational states e.
The drug self-administration model is based on the learning principle that behavior is maintained by its consequences, called reinforcers. Laboratory animals humans and nonhumans will work to receive a range of different drugs administered orally, intramuscularly, intravenously, by smoking, or by insufflation. In this model, the laboratory animal performs some action, such as depressing a lever, to trigger the administration of a drug e.
In general, those drugs e. These results are replicable in virtually every species tested with the model and with different routes of administration.
Such findings brought into question the traditional explanations of the etiology of drug abuse, such as psychopathology or various social deprivations. This model also allows behavioral researchers to control past history and current environmental conditions, thus demonstrating that it is the interaction of the drug's pharmacological effects with past history and current environmental conditions i.
This model points to the importance of a confluence of variables in drug-taking behavior and has broadened the clinician's understanding of the various causal factors that might be involved in drug abuse.
The drug discrimination paradigm is considered a model of the subjective effects of drugs in humans. In this paradigm, research subjects are. For example, a research subject might be trained to press the left lever after a dose of amphetamine and the right lever after a dose of placebo.
After training, research subjects nonhuman or human will respond differentially to drug and placebo, allowing for comparison among drugs and for conclusions about pharmacological and behavioral similarity, depending on the manner in which the trained research subject responds.
Drug dependence has also been modeled in laboratory animals. Dependence is usually accompanied by tolerance and withdrawal; physicians often confuse the presence of a withdrawal syndrome i. Models have been developed in which animals are maintained on specific drugs of abuse e. Manipulations using animal models have provided information about the relationship between repeated drug use and toxicity, as well as the likelihood that the drug will be taken in the future.
In addition to being a useful tool for investigating basic biobehavioral mechanisms underlying drug abuse, the drug self-administration model has provided the foundation for research in many other areas of drug abuse. For example, it has been shown that there is a significant positive correlation between the potencies of cocaine and other stimulants as dopamine reuptake blockers and their ability to maintain self-administration behavior, although the same is not true for norepinephrine and serotonin Ritz et al.
This finding suggests that the action of cocaine at its binding site, which results in dopamine uptake blockade, mediates the effects that contribute to abuse Fischman and Johanson, Neuroscientists have taken advantage of this model to investigate the brain loci mediating the reinforcing and dependence-producing properties of morphine Bozarth and Wise, , the dopaminergic contributions to drug reinforcement, and the brain areas activated by specific drugs Koob and Bloom, ; Cerruti et al.
Geneticists have used this technology to evaluate the heritability of drug abuse e. Research on phencyclidine PCP provides a good example of the way in which behavioral studies provide a body of data for understanding the neural basis of learning and memory, as well as the development of novel medication strategies.
In the early s, the introduction of PCP as a drug of abuse was immediately recognized as different and potentially more devastating than abuse of other hallucinogens. Initial studies evaluated this drug and its analogues in self-administration and drug discrimination paradigms reviewed in Balster and Willetts, PCP became an important research tool for understanding the role of excitatory amino acid neurotransmission initiated by glutamate in the control of a variety of behaviors and in the pathophysiology of neuronal death.
Current work in this area has the potential to lead to novel treatment medication strategies for preventing neurotoxicity following brain trauma. As excitatory amino acid antagonists are developed for therapeutic uses, an important goal will be to avoid the abuse liability the likelihood that a drug will be abused and psychological disturbances produced by PCP; the animal models developed by drug abuse researchers are now being relied on in this area of medications development.
An exciting research development suggests that excitatory amino acids may play an important role in the development of tolerance to and dependence on drugs of abuse such as the opiates, alcohol, and stimulants Balster and Willetts, It is possible that this research will lead to completely novel strategies for the treatment of the addictions. A major concern in the development of new psychotropic medications is to maximize therapeutic efficacy while reducing the risks of abuse and dependence.
In the s, substitutes for morphine were sought that. That research measured physical dependence and focused on the withdrawal syndrome by collecting behavioral and physiological data on both objective and self-reported measures. Work in that area led to the important discovery that physical dependence and abuse liability were not the same and that abuse liability could not be assessed solely on the basis of chemical structure.
The drug self-administration model continues to provide a bioassay for the evaluation of abuse liability. Animal self-administration studies have been used widely to predict the abuse liability of new drugs Brady and Lukas, Self-administration data are frequently a part of the information submitted to the Food and Drug Administration FDA by pharmaceutical companies as part of their applications for approval of psychoactive drugs, including those targeted for psychiatric disorders e.
Those data are used by the FDA and ultimately the Drug Enforcement Administration in their scheduling recommendations. Because the particular schedule in which a drug is placed strongly influences the marketing success of the new compound, the pharmaceutical industry has been a major supporter of behavioral research.
In fact, different preparations of the same medications, with the same active chemical constituent, are often regulated and scheduled differently based on their behavioral effects. For example, nicotine gum is unscheduled and sold over the counter; approval is pending for over-the-counter sale of nicotine patches; however, nicotine nasal spray may be placed in Schedule IV or V.
The drug self-administration model has been of major importance in the search for potentially useful pharmacological interventions to treat drug abusers. Early research, for example, demonstrated the efficacy of immunizing rhesus monkeys with an antigen that caused the formation of antibodies that bound morphine when it was injected intravenously Bonese et al.
Rates of heroin self-administration decreased almost to zero in immunized animals, although the toxicity of the procedure. Under the Controlled Substances Act Public Law , October 27, , a drug with a potential for abuse is placed into one of five schedules, depending on the magnitude of the abuse potential, whether the drug has accepted medical uses, and the extent to which abuse of the drug will lead to physical or psychological dependence.
Other researchers, using monoclonal antibody techniques, recently reported the development of an artificial enzyme that inactivates cocaine by cleaving it into two inactive metabolites Landry et al. This technique is effective in the test tube, but it must now be demonstrated in nonhumans before it proceeds to human trials; researchers are pursuing this work in conjunction with behavioral researchers experienced in drug self-administration research and medications development J.
Woods, University of Michigan, personal communication, Further evidence for the promising nature of immunopharmacotherapy is given in a recent report Carrera et al.
This response was specific to cocaine and was not seen after amphetamine administration. Administration of antagonists or immunization against specific drugs, although clearly potentially important tools in our armamentarium against drug use see discussion on behavioral economics, below , promises no more success than the available opiate antagonist naltrexone 3 for the treatment of heroin addiction.
It is very clear that nonhumans, treated with naltrexone, will show extinction in their opiate responding Koob et al. However, after leaving the structured setting of a residential laboratory individuals relapse to heroin use. Although laboratory studies on naltrexone, with nonhuman and human subjects, demonstrate the utility of the drug self-administration model in the initial assessment of the utility of a new medication, the model does not allow for an evaluation of the contextual social and environmental factors that could ultimately affect drugtaking behavior.
Thus, there is a need for behavioral models that pattern complex behaviors e. Studies focused on compliance are becoming increasingly important because the most efficacious medications are useless if the patient does not take them. Naltrexone acts to block or reverse the effects of mu opioids, such as heroin.
Patients taking naltrexone cannot feel the effects of heroin if they take it; so heroin's positive reinforcing effects are reduced or eliminated IOM, Naltrexone has proven most useful in highly motivated, dependent patients who have a great socioeconomic risk or other risk associated with relapse.
Animal models of self-administration versus human models have several advantages for medications development. For example, drugs that are not approved for use in humans can be evaluated; the effects of new treatment medications on patterns of drug self-administration can be evaluated quantitatively under controlled experimental conditions; social factors such as peer pressure or expectancy do not complicate interpretation of data; and accurate baseline measures of the daily dose and patterns of drug self-administration can be determined before, during, and after administration of the treatment medication.
Additionally, the safety of the medication can be evaluated continually. Thus, the use of animal models for those aspects of medications development is parallel in importance to the earlier reliance on animal models of drug self-administration for evaluation of the abuse liability of new drugs.
To the extent possible, however, these laboratory models should be employed across species to include humans. A major contribution of behavioral research has been an understanding of the ways in which basic principles of learning and conditioning can be used to modify drug-taking behavior.
These principles have been precisely defined so that they can be studied and replicated across conditions and species. For example, research on drug effect expectancies suggests that learned beliefs and attitudes may serve as risk factors for the initiation and use of drugs Brown, Further, epidemiological research has pointed to the importance of social modeling and attitudes as having strong impacts on drug use and abuse.
Research on learning and conditioning has led to successful treatment models for drug abusers, including relapse prevention, community reinforcement, and focused techniques such as extinction training, relaxation training, contingency management, and job skills training.
Two well-studied behavioral interventions are discussed below: contingency management and relapse prevention. Contingency management research is based on the fact that, although drugs are potent reinforcers, there are non-drug reinforcers that can compete with drug use see discussion of behavioral economics, below.
Manipulation of the environment can shift the focus toward or away from drug reinforcers e. In the laboratory, monkeys will choose saccharine over phencyclidine if they are required to work substantially harder for the drug Carroll and Rodefer, Research with humans has shown that experienced cocaine users will choose money or tokens over cocaine when the appropriate quantity and quality of alternative reinforcers are available Foltin and Fischman,.
In addition, direct reinforcement of drug abstinence can be effective in methadone maintenance programs Iguchi et al. Relapse prevention research also combines cognitive and behavioral approaches e. Behavioral analysis of drug abusers has demonstrated that learning and conditioning both classical and operant play an important role in the initiation, maintenance, cessation, and relapse to drug use.
Early work in rats Wikler and Pescor, and in humans O'Brien et al. Thus, even though a previously opiate-dependent person has remained drug free for a prolonged period of time, specific environmental conditions could trigger opiate withdrawal symptoms, which in turn might motivate relapse.
This effect has been modeled in the laboratory, where rhesus monkeys, dependent in the past on morphine, showed clear signs of physical dependence and relapse in the presence of stimuli that in the past signaled opiate withdrawal Goldberg and Schuster, , ; Goldberg et al.
Conditioned opiate withdrawal and craving have also been demonstrated experimentally in humans O'Brien et al. Although Wikler , for example, observed that conditioned withdrawal plays a substantial role in relapse to opiate use, even years after the drug-dependent person has ceased using opiates, the role of conditioned responses in relapse in the nonlaboratory setting is not yet clear.
A variety of behavioral studies have been used to characterize and quantitate the potential deleterious effects of drug administration and withdrawal for both illicit and licit drug use and have been useful in guiding policy development.
For example, while cigarette smoking has long been associated with increased alertness, sustained performance in situations of fatigue, and increased cognitive performance Rusted and Warburton, , dependent individuals experience decreases in performance stemming from nicotine withdrawal. These decrements are reversed rapidly by the re-administration of tobacco or medically approved forms of nicotine such as nicotine gum or patch Henningfield, Characterizing the course and timing of this behavioral degradation has been critical in determining how to manage nicotine-dependent airline pilots.
Since performance decrements do not emerge until approximately. Those findings point the way to research with other drugs of abuse where similar effects may cause a reluctance to stop use. Behavioral research has revealed the complexity of drug use and has shown that the conditions under which drugs are used may be as powerful in motivating drug use as the drug itself.
You can also benefit from seeing a psychiatrist or psychologist, who are skilled in helping people to overcome emotional difficulties and making changes in their lives. Fortunately for those suffering from behavioral addictions, treatments that have been developed to treat substance dependencies have been successfully used to treat behavioral addictions. Topiramate, an anti-convulsant which blocks the AMPA subtype of glutamate receptor among other actions , has shown promise in open-label studies of pathological gambling, compulsive buying, and compulsive skin picking 85 , as well as efficacy in reducing alcohol 86 , cigarette 87 , and cocaine 88 use. How to Know the Symptoms of an Addiction. Diagnostic models do not currently include the criteria necessary to identify behaviors as addictions in a clinical setting.
Behavioral model of addiction. Navigation menu
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. For the first time in history, a behavior, as opposed to a psychoactive substance was classified as an addiction. Specifically, gambling disorder previously called pathological gambling was moved from the Impulse Control Disorders section of the DSM to the Substance Related and Addictive Disorders section.
The re-classification of gambling disorder occurred due to decades of accumulating evidence that gambling disorder shares many commonalities with substance use disorders, which have been well elucidated and summarized in the existing literature 2.
In addition to gambling, internet gaming disorder i. The inclusion of gaming disorder in the DSM-5 and ICD stems from empirical research delineating the similarities between gaming disorder and gambling 4 , as well as substance use disorders 2. The inclusion of the aforementioned behavioral addictions in the manual of psychiatric disorders speaks to the rising relevance of behavioral addictions in both research and treatment in the fields of psychology and psychiatry.
The past several decades have seen a remarkable growth in the research of behavioral addictions 2. Similarly to gambling and internet gaming, empirical research has examined other compulsive behaviors which have been postulated as behavioral addictions.
These behaviors include, but are not limited to: compulsive buying, sex addiction, binge eating, work addiction, exercise addiction, and smartphone addiction 2 , 5 — 8. The overlapping feature common to all behavioral addictions is the failure to resist an impulse or urge, leading to persistent engagement in the behavior e.
However, what is remarkable when examining the relationship between addictive disorders including both behavioral and substance addictions is the similarities rather than the differences. Indeed, there is considerable overlap in etiological e. For instance, behavioral addictions such as gambling and internet gaming disorder, much like substance use disorders, tend to have their onset in late teens or early twenties and follow a variable course of lapses and recoveries 13 , Behavioral and substance addictions also tend to share similar risk factors.
Adverse childhood experience or childhood trauma such as physical and emotional abuse have been linked to increased risk of developing a variety of addictive disorders including addiction to alcohol, gambling, video games, shopping, and sex In addition, 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.
Importantly, the considerable overlap shared across addictive disorders may have potential treatment implications. Specifically, both behavioral and substance addictions share common clinical processes that may be targeted in treatment. For example, impulsivity, the tendency to act rashly without forethought, has been found to be a key characteristic in a wide array of behavioral addictions including gambling 19 , video games 20 , sex 21 , and shopping Compulsivity is present in both behavioral 23 and substance addictions Emotional dysregulation or low distress tolerance has been associated with gambling 25 , compulsive shopping 26 , and binge eating 27 and may increase the severity of the addictive behaviors Lack of social supports and interpersonal conflicts have also been demonstrated to negatively affect the onset and severity of substance use disorders such as alcohol 29 and a variety of behavioral addictions 30 , Although there are similarities between behavioral and substance addictions, there are also important neurological differences.
For instance, whereas the role of neurotransmitters, specifically dopamine, is robustly implicated in substance use disorder, especially stimulants, the role of neurotransmitters is less clear when it comes to behavioral addictions such as gambling Indeed, a recent meta-analysis of 25 studies on reward processing found increased activation in the ventral striatum during reward outcomes for substance use disorders, whereas gambling addiction was associated with decreased activation in the dorsal striatum Neurological differences have also been found in internet gaming disorder.
Compared to alcohol use disorder, internet gaming disorder has been associated with stronger functional connectivity in the left ventromedial prefrontal cortex That said, 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 The similarities among addictive disorders, including behavioral addictions have been noted for decades. Indeed, theoretical models of addictive disorders that view addictions as a common disorder rather than distinct disorders have been proposed as early as in the s The general theory of addictions by Jacobs 36 placed emphasis on two predisposing factors that make an individual at risk for developing an addiction: i chronic hypo or hyperarousal and ii maladaptive schemas of oneself as inferior.
Jacobs 36 argued that coping with negative emotions by engaging in an addictive behavior is a key maintaining factor of addictions. In addition, Jacobs 36 delineated a process model of addictions, which includes three phases: i Phase I, the initial discovery in which one learns that engagement in addictive behaviors can alleviate negative affect, ii Phase II, the phase in which the positive reinforcing effects of the addictive behavior become over-learned and lead to compulsive-like behaviors and are thus resistant to change, and iii Phase III, the phase in which the individual actively avoids experiencing the aversive state that the addictive behavior was alleviating by continuing to engage in the addictive behavior despite the continued harms.
Jacobs 36 argued that the predisposing factors and the three phases are uniform across all addictive behaviors. Orford 37 , 38 , in his excessive appetites model of addictions, emphasized psychological processes that lead to an appetitive behavior such as alcohol use, smoking, gambling, drug use, eating, and sex that may become excessive.
Orford's highlighting of psychological processes was a significant contribution given many theories of addictions focused on the physiological processes that result from ingestion of a psychoactive substance. The focus on psychological processes acknowledges a range of activities that may lead to impairments with excessive engagement.
In other words, this theory provides a conceptual model of addictions that allows for the inclusion of behavioral addictions. The excessive appetites theory of addictions shares overlapping components with the general theory model of addiction, including learning processes in which people associate addictive behavior with alleviation of negative affect i.
The syndrome model of addiction 39 introduced the concept of multiple and interacting biopsychosocial antecedents, manifestations, and consequents of addictive disorders. Shaffer et al. The presence of a syndrome suggests commonalities between different expressions of addictive behaviors, and these commonalities share similar etiologies. The environment, which allows repeated interactions with a specific substance or behavior, determines the specific addiction.
An important contribution of the syndrome model of addiction is the acknowledgment that there are, as well, unique features associated with each specific addictive behavior, despite the underlying syndrome. For example, if a person repeatedly engages in alcohol use, then the manifestation of the addiction syndrome and its consequences will have some characteristics that uniquely reflect problems associated with alcohol such as high blood pressure, liver cirrhosis, and pancreatitis.
Conversely, if one interacts repeatedly with a slot machine, then the manifestation of this syndrome will have some features that uniquely reflect gambling such as chasing losses and financial debt. Internet gaming may lead to sleep disturbances such as insomnia given the significant amount of time an individual can spend playing video games However, the various expressions of addiction will also share common manifestations and sequelae such as psychological distress, the use of addictive behavior to cope with negative affect and impairments in family life, and work life.
The components model of addiction also conceptualizes addictive disorders based on their commonalities According to this model, all addictive behaviors consists of six core components: i salience, which refers to the addictive behavior becoming the most important activity in a person's life and may manifest as pre-occupation or craving; ii mood modification which refers to subjective enhancement such as getting high or alleviating negative affect, in other words, coping; iii tolerance which is the need to increase the frequency, duration, or amount of a particular addictive behavior to get the same effects; iv withdrawal symptoms, which are unpleasant physiological and psychological effects experienced when an addictive behavior is discontinued; v conflict that can be either personal and interpersonal that arise due to continued engagement in addictive behaviors; and vi relapse, which refers to the reversion back to previous levels of engagement when attempting to reduce an addictive behavior.
Griffiths 41 argued that for a behavior or substance to be conceptualized as an addiction, all of the above components need to be demonstrated. The above models are similar in that they each postulate, in one fashion or another, the commonalities between addictions. However, there are also important differences.
The syndrome model of addictions 39 acknowledges that despite the similarities across addictions, there also exists unique manifestations. Orford privileged certain addictions e. Additionally, each model presents strengths and weaknesses. For example, the general theory of addictions 36 was the first to propose a unified theory of addictions. However, the model was based on gambling, and thus was unable to take into account the proliferation of behavioral addictions that exists today.
A strength of the excessive appetites model 38 is expanding the scope of behavioral addictions to include food and sex.
A potential weakness of this model is a minimal focus on physiological processes of addictions. An important contribution and strength of the syndrome model of addictions 39 is introducing the concept of unique manifestations in addictions.
Lastly, a strength of the components model of addictions 41 is providing a model that reduces the similarities of addictions to six core components. However, a potential weakness of such a parsimonious model is the exclusion of other components, which may be important characteristics of both behavioral and substance addictions e. The aforementioned theories have all alluded to the potential treatment implications of viewing addictive behaviors as a common underlying disorder.
Yet, a unified transdiagnostic treatment model for addictive disorders has not emerged. In contrast, the trend over the past number of decades in the development of evidence-based treatments for addictive disorders as well as other mental health disorders has been the development of single diagnosis protocols. Indeed, disorder-specific protocols are readily available for both substance and behavioral addictions 42 , That said, the diversity in treatment programs are likely the result of responding to the needs of clients, whereas the training of clinicians likely impacts the management of different disorders.
Although protocols have not been developed that capitalize on common underlying factors for addictions, clinicians often intuitively target the underlying similarities in the treatment of their clients' addictions, regardless of whether the presenting problem is alcohol, cannabis, gambling, or sex. Indeed, it has been argued that due to increased demand for treatment, the field of addictions treatment has out of necessity, utilized a more holistic approach and has applied a broader focus on examining processes that underlie multiple problem areas Providing support for this supposition, evidenced-based treatments for addictions such as cognitive behavioral therapy CBT for substance use disorders 44 , 45 and motivational enhancement therapies 46 use the same treatment strategies regardless of the specific substance or behaviors.
In addition, there exists a multitude of step programs for distinct addictive behaviors such as alcohol Alcoholics Anonymous , cocaine Cocaine Anonymous , gambling Gamblers Anonymous , sex Sexaholics Anonymous , and eating Overeaters Anonymous. However, regardless of which step program an individual attends, the principles of the program and the steps remain very similar.
Implicitly then, the treatment of addictions may closely resemble a transdiagnostic approach in practice. To summarize, there exists a considerable overlap between behavioral and substance addictions, including in psychological processes that may be targeted in treatment.
In this light, we present a developing transdiagnostic treatment model for addictions that takes advantage of the underlying commonalities that have been shown to be amiable to change across both behavioral and substance use addictions.
The term transdiagnostic treatment is used variably to describe a number of different approaches to providing treatment. Sauer-Zavala et al. The first of these are universally applied therapeutic principles. Treatments such as psychodynamic and CBT models are transdiagnostic in the sense that they are designed to be applied to a variety of presenting conditions.
Included in this category are mindfulness-based interventions and acceptance and commitment therapy ACT The second type of transdiagnostic treatments are modular treatments that provide clinicians with a number of evidence-based treatment strategies that can be applied according to individualized patient needs.
The Harvard University's modular approach to therapy for children with anxiety, depression, or conduct problems MATCH 49 is a well-regarded example. The third type of transdiagnostic treatments are interventions that specifically target shared mechanisms that have been implicated in the etiology or maintenance of a group of disorders.
These models target what are presumed to be core features of groups of disorders, such as avoidance coping related to high neuroticism, which is targeted by the Unified Protocol for transdiagnostic treatment of emotional disorders 50 , and preoccupation with body weight and shape, which is targeted by Fairburn's Enhanced CBT model for eating disorders Emerging research suggests that transdiagnostic treatments lead to superior outcomes when compared to control conditions and treatment as usual.
A meta-analysis of 24 randomized control trials for transdiagnostic treatments for anxiety and depression found medium to large effect sizes in favor of transdiagnostic treatments compared to no treatment control conditions, such as waitlists, and small but significant effect sizes when compared to disorder-specific treatments such as treatment for social anxiety.
It has been argued that a benefit of transdiagnostic treatments is that they treat not only the presenting problem, but can also concurrently treat co-occurring problems For example, transdiagnostic treatments for anxiety disorders have demonstrated modest but significant improvements in symptoms of depression, without explicitly treating the depressive disorder itself This is an immense benefit of transdiagnostic treatments in that co-morbidity is the rule rather than the exception in psychiatric disorders 52 , including addictive disorders