What are non-substance addictions?

A summary of what is known about addictive disorders beyond drugs.

Addictive substances are present everywhere in our society today, from the most anecdotal social situation to movies, television and other media consumption. When we think of addiction, tobacco comes directly to mind.Tobacco kills up to half of the people who use it, 7 million people on Earth die every year directly because of this addictive substance and only 5% of smokers who try to quit on their own are successful.

When nicotine is administered to the body, the brain sends stimulation signals to the adrenal glands (in the kidneys), which release the hormone adrenaline and increase circulating levels of dopamine, a neurotransmitter associated with well-being. Changes in dopaminergic circuitry and substance abuse cause variations in mesolimbic and mesocortical circuitry: in the end, the more a drug is consumed, the more it takes to achieve the same gratification. It is estimated that nicotine is 5 times more addictive than cocaine.

If we are talking about addictions, describing the mechanism of action of tobacco, heroin, cocaine or alcohol is simple: substances enter the organism that stimulate the patient, cause damage in the process and generate resistance and withdrawal syndromes. However, things get more complicated when we focus on non-substance addictions. However, things get more complicated when we focus on non-substance addictions, such as gambling, video games, Internet use and other events.. If you want to know all about it, read on.

What is an addiction?

Addiction, from a clinical point of view, is. a psychosocial disorder characterized by repeated drug use or, alternatively, the performance of certain activities that may be deleterious to the patient and the surrounding environment. for the patient and the surrounding environment. For the mechanism of addiction to take place, the person must have continuous access to the problematic substance/event, since it is exposure to the stimulus that makes tolerance and, therefore, dependence possible.

We are dealing with a series of multifactorial clinical entities that are very difficult to address, since physiological, genetic, epigenetic (activation/inhibition of genes according to the environment), age, environment and many other factors play an essential role in their development. Without going any further, the probability of developing certain addictions if the parents also have them is 60% and up to 90% of addicts have other associated psychiatric problems.

According to the American Psychological Association (APA), humans can become addicted to 10 substances: alcohol, caffeine, cannabis, hallucinogens, inhalants, opiates, sedatives, hypnotics and anxiolytics, stimulants and tobacco. Thus, from lorazepam to relax in a moment of extreme anxiety to heroin, there is no doubt that a person can end up developing dependence on any of these drugs. a person can end up developing dependence on any of these substances if they consume enough of them..

So far, it all seems pretty straightforward. The Diagnostic and Statistical Manual of Mental Disorders (DMS-5), published by the APA in 2013, gives definitions and diagnostic criteria for substance abuse that are very clear and simple to follow. Anyway, what about non-substance addictions?

Non-substance addictions

In the media, more and more often we see fancy names for disorders related to typical activities that we perform in our daily lives. Interaction with the reader is sought and, therefore, the truth is sometimes misrepresented in the pursuit of a click. To define which are the clearest non-substance addictions, anecdotal evidence is not enough.We have to resort to professionals in psychology.

We begin by citing what the APA does not consider as potentially addictive activities. Among them, we find the following: shopping, tarot, dancing, tanning, work, board games, sex or sports. According to the DMS-5, "There is insufficient evidence to establish the diagnostic criteria and disease course descriptions necessary to identify these behaviors as mental disorders."

As you can see, almost nothing that is considered socially addictive today outside of substances has been supported by the scientific community, at least for now. However, there are some examples there are some examples that demonstrate that addiction without substances is possible.

Pathological gambling: a substance-free addiction

Pathological gambling, for example, is a disorder on a par with substance addictions in every sense of the word.It was therefore listed in the DMS-5 in the "Substance-related and addictive disorders" block.

This is not surprising, as studies have shown that brain activation at the moment of receiving a large cash prize is similar to that seen in a cocaine addict receiving a dose. Norepinephrine and dopamine play an essential role in the development of gambling addiction, just like the mechanism that hooks people on tobacco.

As in the case of any other disorder, there must be a diagnostic criterion that can support it.. We obtained the following guidelines for detecting a gambling addict from the American Psychological Association (APA):

• The patient needs to gamble more and more money to reach the expected state of well-being.
• He is anxious, tired and irritated when he tries to quit gambling.
• He has repeatedly tried to control his addiction, but has not succeeded.
• He has frequent thoughts about gambling.
• After losing money on a bet, he convinces himself to gamble again in order to recoup losses.
• Lies to justify/enable addictive behavior.
• Destroys social relationships and job opportunities to continue gambling.
• He relies on his environment to help him solve the problems derived from the addiction.

In order for a person to be diagnosed with this disorder, he or she must exhibit at least 4 of these 8 traits for a period of one year or more. As we are facing a disease, there are standardized criteria that allow its evaluation.

Video games: example of addictions without unproven substances.

On the other side of the coin we find, for example, video games. Although the repeated use of this form of entertainment at the expense of personal well-being and the environment has been recognized by the WHO in its International Classification of Diseases (ICD), the APA has not found sufficient scientific evidence to classify it as a disorder, i.e., the opposite of pathological gambling.

The main controversy lies in the fact that it is not really known whether video game addiction is a disorder in itself or a symptom of another pathology of a psychological nature.. This has prompted much research, information seeking and debate among medical entities, but no clear answer has yet been found. As long as this "disorder" is not included in the diagnostic manuals, it cannot be considered as such.

With these lines we do not mean to say that chronic exercise, compulsive shopping or playing video games 10 hours a day are not examples of non-substance addictions. What we are trying to emphasize is that there is not enough information about these events and, therefore, it is not possible to elucidate them, whether they are isolated clinical entities or part of a larger picture. or part of a larger picture.

For example, compulsive exercise may be a diagnostic criterion for detecting Muscle dysmorphia (vigorexia), but the act itself without context does not indicate a disease on its own. For all these reasons, caution should be exercised in labeling a behavior as addictive.