Process Addictions

1
Process Addictions

• Erik Sanchez
• Elizabeth Tse
• Maleenee Beuhler
• Nishant Munugala

2
Exercise Dependence

• Other names
• Exercise addiction
• Obligatory exercise
• Compulsive athleticism
• Compulsive exercise
• Exercise abuse
• Anorexia athletica

3
Definition

• There is no formal DSM-IV definition
• is physical activity that is extreme in
  frequency and duration, relatively resistant to
  change, and often accompanied by an irresistable
  impulse to exercise even when injury, fatigue, or
  other personal demans persist
• Source University of Florida College of Health
  and Human Performance exercise, Center for
  Exercise Science

4
Criteria for Exercise Dependence

• (1) Tolerance need for increased amounts of
  exercise to achieve desired effect diminished
  effect with continued use of same amount of
  exercise
• (2) Withdrawal characteristic withdrawal
  symptoms for exercise (e.g., anxiety, fatigue) or
  exercise is taken to relieve or avoid symptoms
• (3) Intention Effect exercise is often taken in
  larger amounts or over a longer period than was
  intended
• (4) Lack of Control a persistent desire or
  unsuccessful effort to cut down or control
  exercise
• (5) Time a great deal of time is spent in
  activities necessary to obtain exercise (e.g.,
  physical activity vacations)
• (6) Reduction in Other Activities social,
  occupational, or recreational activities are
  given up or reduced because of exercise
• (7) Continuance exercise is continued despite
  knowledge of having a persisting/recurriing
  physical or psychological problem that is likely
  to have been caused or exacerbated by the
  exercise (e.g., continued running despite
  injury).
• (Hausenblas and Downs, 2002)

5
Signs of Exercise Dependence

• It interferes with daily activities and
  relationships.
• You believe that bad things will happen if you
  dont work out.
• You develop a perfectionist attitude toward
  exercise and your body.
• You ignore the signs of illness, injury or
  fatigue and work out
• despite them.
• You set unattainable goals (miles run, hours
  worked out, percentage of body fat, etc.)
• You ignore friendships or satisfying hobbies in
  order to exercise.
• National Association of Anorexia Nervosa and
  Associated

6
Consequences

• Physical
• Damaged tendons, ligaments, bones, cartilage, and
  joints
• Loss of muscle mass
• Ammhenorea (females) - Osteoperosis
• Eating Disorders
• Gastro-intestinal blood loss and anemia
• Myocardial infarction and death
• Jim Fixx - tolerant to ischemic heart disease

• Psychological
• Anxiety
• Depression
• Worthlessness
• Insomnia
• Social
• Neglect relationships
• Social withdrawal

7
Treatment

• OCD Therapist
• Third wave cognitive-behavioral therapy
• Acceptance and commitment therapy (ACT) for
  treating many disorders including addiction
• Major advocate, Steve Hayes
• Not to fight negative feelings but to accept them
  as part of life
• Mindfulness
• Work toward life values

8
Treatment (continued)

• Cognitive therapy strategy is normally to change
  negative feelings, not accept them
• Multiple studies showed that ACT proved more
  effective than regular cognitive therapy
  including ones on depression (Haynes 2006) and
  psychotics (Haynes 2002)
• Criticized for being too much like a religion
• Tranquilizers
• Medicine
• Tranquilizers
• Antidepressants
• Treament Centers

9
Related Disorders

• Obsessive Compulsive Disorder (OCD)
• Bulimia Nervosa

10
Compulsive Overeating
11
Compulsive Overeating

• Most people feeling control over eating habits,
  meaning eating when you are hungry and stopping
  when you are satisfied.
• Compulsive behavior is defined as acting on an
  internal force that leads one to act against
  their will.
• Compulsive overeating usually in the form of
  bingeing or excessive snacking
• Bulimia Nervosa and Binge Eating Disorder

12
Binge (DSM-IV)

• Eating, in a discrete period of time an amount of
  food that is definitely larger than most people
  would eat in a similar period of time under
  similar circumstances
• A sense of lack of control over eating during the
  episode
• People describe feeling that they cannot stop
  eating or control what or how much they are eating

13
Bulimia Nervosa

• Recurrent episodes of binge eating.
• Recurrent inappropriate compensatory behavior in
  order to prevent weight gain
• Purge subtype self-induced vomiting misuse of
  laxatives, diuretics, enemas, or other
  medications
• Non-purge subtype fasting or excessive exercise
• These behaviors both occur, on average, at least
  twice (once) a week for 3 months.
• Stems from a negative perception body shape and
  weight.

14
Binge Eating Disorder

• Recurrent episodes of binge eating.
• Marked distress regarding binge eating.
• The binge eating occurs, on average, at least 2
  days a week for 6 months.
• The binge eating is not associated with the
  regular use of inappropriate compensatory
  behaviors.

15
Causes of Compulsive Overeating

• Socio-cultural issues
• Body image
• Fast Food Society
• Diet craze
• Interpersonal issues
• Emotional eating
• Susceptibility to addiction
• Self-Regulation Issues

16
Is Compulsive Eating an Addiction?
17
Other Indications of Addiction

• Laboratory findings have provided evidence that
  binge eating, like addictions, might involve the
  endogenous opioid systems (Grigson, 2002 Volkow
  Wise, 2005) and the mesocortical dopamine
  system (Davis, Strachan, Berkson, 2004 Volkow
  Wise, 2005).
• Low levels of dopamine D2 receptors have been
  reported in individuals with compulsive
  disorders, including both drug addiction and
  compulsive overeating
• Eating disorders and substance-use disorders
  co-occur at higher than expected rates,
  particularly among individuals who binge
  eat(elevated rates of eating disorders are
  reported by individuals with substance-use
  disorders)
• It has been postulated that compulsive
  overeating may occur to compensate for reduced
  activation of reward circuits which are modulated
  by dopamine Wang et al. (2001)

18
No Gold Standard

• It is difficult to determine whether binge eating
  is an addiction because no gold standard exists
  by which to judge a behavior as an addiction.
• Ultimately, whether binge eating is considered an
  addiction will depend on the breadth of the
  definition selected.

19
DSM-IV Substance Dependence Criteria

• Binge eating larger amounts than intended
• Persistent desire or unsuccessful efforts to
  control binge eating
• Withdrawal (e.g., restlessness, irritability,
  headaches)
• Great deal of time spent binge eating or
  recovering from the effects

20
Study

• Community women (N79) with a current diagnosis
  of BED
• The substance-dependence module was used to
  assess current substance dependence, with the
  term substance referring to binge eating rather
  than psychoactive drugs.
• Data collected via interviews
• Stephanie E. Cassina and Kristin M. von Ranson,
  a,
• Department of Psychology, University of Calgary,
  2500 University Dr. N.W., Calgary, Alberta,
  Canada T2N 1N4

21
(No Transcript)
22
Results

• 92.4 of participants qualified as addicts
• Participants engaged in a mean of 4.0 eating
  binges/week (SD1.8) and had been binge eating
  for a mean of 14.8 years (SD11.9).
• Eating disorder treatment had been sought by 20
  participants (25.3) from a physician,
  psychiatrist, psychologist, counselor, support
  group, or 12-step program.
• Only 6 participants (7.6) had been formally
  diagnosed with an eating disorder by a
  psychologist or psychiatrist.

23
Current Views Future Implications

• Increasing view that some foods are addictive and
  that eating disorders are a form of addiction is
  widespread among mental health professionals
  (Benton, 2010 von Ranson Cassin, 2007 Wilson,
  Perrin, Rosselli, Striegel-Moore, DeBar,
  Kraemer, 2009).
• More recently, the notion that obesity might be a
  form of addiction has been gaining popularity,
  with the case being made that the study of drug
  addiction may inform our understanding of obesity
  (Volkow Wise, 2005).
• Future approaches considering treating eating
  disorders(Bulimia Nervosa and BED)as an addiction
  may be a key step in finding better treatments

24
Internet Addiction
25
What is Internet Addiction?

• Internet addiction is defined as time-consuming,
  incontrollable, or distressing internet use which
  results in social occupational, or financial
  difficulties.
• 
  (DellOsso et al, 2008)

26
Some Internet Facts

• The internet became commercially available only
  20 years ago in the early 1990s.
• According to the International Telecommunications
  Union, as of 2009, almost a quarter (22) of the
  worlds population uses the internet.
• Since the internet is so young, relative to other
  drugs, internet addiction is a fairly new
  disorder and has only recently been considered a
  major treat to society due to its addictive
  nature.

27
Types of Internet Addiction

• Addiction to online video games (role playing
  games)
• Online gambling
• Cybersex
• Chat rooms

28
Prevalence of Internet Addiction

• In an early survey regarding internet addiction
  it was found that an estimated 6 of internet
  users fit the profile of an internet addict as is
  currently defined by the DSM IV. (Greenfield
  1999)
• Similar research has been done around the world.

29
Prevalence (continued)

• Since there is no standard diagnostic criteria
  there is variability in the estimated number of
  users who are addicted ranging from 6-15.
• It was found that the highest rate of addiction
  was among college students ranging from 13-18.4.
• Adolescents from 12-18 years of age had the
  lowest risk of internet addiction ranging from
  4.6-4.7.

30
Symptoms of Internet Addiction

• Excessive, non-essential use of the internet
  defined by 8-60 hours/week depending on the
  criteria used.
• Loss of sleep.
• Delay of work.
• Disregard for normal drives.
• Seclusion

31
(No Transcript)
32
Possible Causes/Risk Factors of Internet Addiction

• Quality of Family and Social Life
• Problems with Partner/Friends
• Addictive personality
• Loneliness
• Social phobias

33
Consequences of Internet Addiction

• Loss of Spouse/Significant Other/Problems with
  relationships
• Loss of real friends

34
Withdrawal

• Dysphoria
• Depression
• Need of internet
• Loss of interest
• Follows typical addiction cycle

35
Problems with Diagnosis

• Unlike recreation drugs or drugs of abuse, the
  internet is usually a vital tool for every day
  life
• People tend to rationalize their excessive use of
  the internet

36
Prevention of Internet Addiction

• In India, internet use has been restricted to
  daytime hours.
• Various companies have set programs that monitor
  employee internet use such as Spymonkey
• Restrictive use set by parents and school for
  children in grade school (U.S.)

37
Treatment of Internet Addiction

• Many treatments have been employed but since
  internet addiction is such a new phenomenon most
  treatments have yet to be adequately studied
• These treatments include Structured Cognitive
  Behavioral therapy, interventions, abstinence,
  restrictive/controlled use, group therapy, 12
  step recovery programs and medication

38
Medication

• Antidepressant Escitalopram (Lexapro)
• Open label study (n 19)
• This means that people knew what they were taking
  during the first phase
• Then given placebo or the drug in a double blind
  study
• Results peoples usage of the internet dropped
  from an average of 36 hours/week to 16 hours/week

39
Gambling
40
Problem Gambling

• Problem gambling is gambling behavior which
  causes disruptions in any major area of life
  psychological, physical, social or vocational. -
  National Council on Problem Gambling
• Other names compulsive gambling, pathological
  gambling

41
DSM-IV Symptoms of Problem Gambling

• May apply to three or more of the following
  categories
• Tolerance
• Withdrawal
• Larger amounts - After losing money gambling,
  often returns another day to get even-chasing
• Impaired control - neglect of relationships,
  career, preoccupation of gambling
• Time spent
• Continued use despite problems
• From American Psychiatric Association,
  Diagnostic and Statistical Manual of Mental
  Disorders, 4th edition, 1994.

42
(No Transcript)
43
(No Transcript)
44
Diagnostic Criteria

• Must apply to five or more of the following
• Gambling preoccupation
• Increasing amount of money gambled
• Lack of success in halting gambling habits
• Uses gambling as an escape
• Lies to family members or significant other
• At risk of losing career or education
• Lost relationships of close friends/family to
  gambling
• Bailout - Needs financial assistance from others

45
Possible Motivations for Problem Gambling

• Age - teens and older citizens more at risk
• Depression
• Low levels of norepinephrine

46
Norepinephrine

• Believed that lower serotonin would be the reason
  for problem gambling
• Low norepinephrine levels lead to problem
  gambling
• Prone to engaging in high risk activity
• May also be a way for people to stave off
  depression
• Source New York Times, 1989

47
Study

• (Roy et. al., 1988)
• Subject pool of 17 chronic gamblers
• Tested urine to measure levels of norepinephrine
• Results Had significantly lower amounts of
  norepinephrine
• What does this mean?
• Gives strong evidence that people with lower
  levels of norepinephrine are more likely to
  engage in gambling!
• But the study needs to be repeated for more
  validity

48
Gamblers Fallacy

• Assumes the likelihood of winning is higher than
  the likelihood of losing
• Jane "I'll be able to buy that car I always
  wanted soon."
• Bill "Why, did you get a raise?"
• Jane "No. But you know how I've been playing the
  lottery all these years?"
• Bill "Yes, you buy a ticket for every drawing,
  without fail."
• Jane "And I've lost every time."
• Bill "So why do you think you will win this
  time?"
• Jane "Well, after all those losses I'm due for a
  win."

49
Consequences of Problem Gambling

• Financial Debt
• Increase in the likelihood of engaging in
  criminal activity
• Possible suicide

50
Prevalance

• About 0.5 of the US population have experienced
  pathological gambling
• 0.9-2.3 experienced subclinical pathological
  gambling

51
Treatment

• Step-based programs
• Cognitive Behavioral Therapy
• Antidepressants - SSRIs
• Group Therapy

52
References (Exercise)

• http//kidshealth.org/parent/emotions/behavior/com
  pulsive_exercise.html Compulsive Exercise Mary
  L. Gavin, MD Date reviewed October 2010
• D. M. W. De Coverley Veale, Exercise Dependence
  British Journal of Addiction 1987,
• 82, 735-740
• Hollyann E. Jenkins and M. Williams, Ph.D.,
  Clinical Psychologist. Source American
  Psychiatric Association Diagnostic and
  Statistical Manual of Mental Disorders, Fourth
  Edition, Text Revision.
• Washington, DC, American Psychiatric Association,
  2000. http//www.brainphysics.com/exercise-
• addiction.php
• When working out shifts from a healthy habit to
  obsession, Marina Benjamen, Ph.D. http//
  www.anad.org/news/when-working-out-shifts-from-a-h
  ealthy-habit-to-obsession/
• Eating Disorders Review September/October 2010
  Volume 21, Number 5 Adria N. Pearson, Michelle
  Heffner, and Victoria M. Follette. Foreword by
  Steven C. Hayes
• Addiction Rerearch, 1997, Vol. 5 (2) pp.161-168
  EXERCISE ADDICTION A CASE STUDY MARK CRIFFITHS
  http//www.hhp.ufl.edu/apk/ces/affil/exPsy/topics.
  php
• Heather A. Hausenblas and Danielle Symons Downs,
  Exercise Dependence Scale-21 Manual The Third
  Wave of Therapy By John Cloud Monday, Feb. 13,
  2006 Time Magazine

53
References cont.

• Dell'Osso, B., and Et Al. "Escitalopram in the
  Treatment of Impulsive-compulsive Internet Usage
  Disorder an Open-label Trial Followed by a
  Double-blind Discontinuation Phase." Journal of
  Clinical Psychiatry 3rd ser. 69 (2008) 452-56.
  Web. 1 Mar. 2011.
• Young, Kimberly S., and Cristiano Nabuco De.
  Abreu. Internet Addiction a Handbook and Guide
  to Evaluation and Treatment. Hoboken, NJ John
  Wiley Sons, 2011. Print.
• http//www.nytimes.com/1989/10/03/science/biology-
  of-brain-may-hold-key-for-gamblers.html?pagewanted
  printsrcpm
• http//psychcentral.com/archives/gambling04.htm
• http//www.nizkor.org/features/fallacies/gamblers-
  fallacy.html
• Adam, T., and E. Epel. "Stress, Eating and the
  Reward System." Physiology Behavior 91.4
  (2007) 449-58. Print.
• Cassin, S., and K. Vonranson. "Is Binge Eating
  Experienced as an Addiction?" Appetite 49.3
  (2007) 687-90. Print.
• Cota, Daniel. "Cannabinoids, Opioids and Eating
  Behavior The Molecular Face of Hedonism?" Web.
  08 Mar. 2011. lthttp//www.ncbi.nlm.nih.gov/pubmed/
  16364446gt.
• "Eating Disorders, Addictions, and Unconscious
  Fantasy." Web. 08 Mar. 2011. lthttp//www.ncbi.nlm.
  nih.gov/pubmed/7795562gt.
• "Eating Disorders, Obesity and Addiction - Wilson
  - 2010 - European Eating Disorders Review." Wiley
  Online Library. Web. 08 Mar. 2011.
  lthttp//onlinelibrary.wiley.com/doi/10.1002/erv.10
  48/fullgt.