Study Notes on Addictive Disorders and Related Concepts

DSM-5-TR lists gambling disorder as an addictive disorder, alongside the substance use disorders.
- This marks a significant broadening of the concept of addiction, which previously referred only to substance misuse.
- Suggests that addictive behaviors extend beyond substance use.

Definition: Gambling disorder is characterized by persistent and recurrent gambling behavior that leads to various life problems.
Prevalence:
- Estimated prevalence is between 2% to 4% of adults.
- Higher prevalence among teenagers and college students, estimated between 3% to 10% (Domino, 2023; Black, 2020).
Distinction: Gambling disorder is differentiated from social gambling by its addictive nature rather than the time or money spent on gambling.
- Individuals are usually preoccupied with gambling and find it difficult to stop.
- Common behavior includes chasing losses; i.e., gambling more to recover lost money.
Symptoms:
- Continued gambling despite adverse consequences such as financial, social, occupational, educational, and health problems (Macdonald-Gagnon & Potenza, 2022).
- Increased gambling when experiencing distress and a tendency to lie about gambling habits.
- Developing a need to gamble with larger sums of money to achieve the desired excitement.
- Restlessness or irritability when attempting to reduce or stop gambling, resembling tolerance and withdrawal symptoms observed in substance use disorders (APA, 2022).

The rise in gambling disorder is linked to the proliferation of new gambling venues, particularly through online gambling.
Explanations for gambling disorder closely mirror those for substance use disorders (Domino, 2023):
1. Genetic predisposition to develop gambling disorder.
2. Heightened dopamine activity and dysfunction in the brain's reward circuit associated with gambling.
3. Personality traits such as impulsivity and novelty-seeking making individuals more susceptible.
4. Cognitive errors in judgment, including inaccurate expectations and misinterpretations of emotional states.
Limitation: Research on these theories is limited, leaving conclusions tentative.

Leading treatments adapted from substance use disorder treatments include:
- Cognitive-behavioral approaches: Includes relapse-prevention training.
- Biological approaches: Includes the use of opioid antagonists.
- Self-help groups: The Gamblers Anonymous program offers a support network similar to Alcoholics Anonymous, demonstrating a better recovery rate.

Exploding use of the Internet has given rise to Internet use disorder (also termed Internet addiction), which impacts at least 1% of the population (Derevensky et al., 2022).
Symptoms:
- Excessive time spent on various online activities such as texting, gaming, or online shopping.
- Symptoms are comparable to those in substance use disorders and gaming disorder, affecting interests outside of the Internet and leading to withdrawal symptoms when offline (APA, 2022).
Despite popularity, Internet use disorder is not classified as an official disorder in DSM-5-TR.
- DSM workgroup recommends further study of Internet gaming disorder for future inclusion (Müller, Dreier, & Wölfling, 2023).
Note: Reports indicate that 47% of people in the U.S. feel addicted to their smartphones, checking devices about 352 times daily (Howarth, 2024).

The narrative surrounding substance misuse remains similar to past stories — prevalent substance use often leads to significant psychological disorders.
- New psychoactive substances continuously emerge, with periods of public misinformation regarding their safety.
Pandemic Effects:
- During the Covid-19 pandemic, excessive alcohol consumption jumped by 20%, with the largest rise among middle-aged individuals (Hampton, 2022).
- Alcohol-related deaths surged by more than 25% during this period (NIAAA, 2022).
- Projected increases may lead to 8,000 additional alcohol-related deaths by 2040 (Hampton, 2022).
Despite these challenges, there is a growing understanding of how substances affect the brain and body, with ongoing development in treatment methodologies such as self-help and rehabilitation programs.
- Preventive educational initiatives are expanding and starting to yield positive effects.
Interdisciplinary collaboration among researchers and clinicians has emerged, supporting a comprehensive understanding of addiction that encompasses both substance and behavioral categories.

DSM-5-TR's classification of gambling disorder alongside substance use disorders reflects a profound shift in acknowledging how non-substance behaviors can create addiction.
Targeting Internet gaming disorder for future DSM inclusion signals a broader perspective on addictive patterns, potentially leading to innovative and inclusive treatment options.

Define substance use disorders.
Explain how alcohol acts on the brain and body, and describe the dangers of alcohol misuse.
Outline the features and problems relating to the misuse of barbiturates and benzodiazepines.
Compare various opioids (such as opium, heroin, morphine) and the problems associated with each.
List and compare two stimulant drugs, describing their biological actions and problems.
Discuss the effects of hallucinogens, particularly LSD and MDMA.
Describe the effects of marijuana and other cannabis products, noting why marijuana is a greater danger today than in the past.
Explain the special challenges posed by polysubstance use.
Summarize leading explanations and treatments for substance use disorders and evaluate their support.
Justify why gambling disorder is categorized as an addictive disorder in DSM-5-TR along with substance use disorders.