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If Gambling, Games, and Sex Are Addictive, What Is Addiction?

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DSM 5's announcement that the psychiatric diagnostic manual will, for the first time, call something addictive that doesn't involve substance abuse -- gambling -- has opened the floodgates.

It is intriguing to consider how gambling was placed in this category, since there isn't an "addiction" task force for DSM 5, only a substance-related-disorders one. So who decided gambling was the one thing people did, other than to consume drugs and alcohol, that was addictive and how did they decide that?

Charles O'Brien, M.D., a leading "addiction = chronic-brain-disease" proponent and chair of the substance-disorders group, announced the inclusion of gambling because "pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system." Thus it seems O'Brien, rather than the task force of consulting substance abuse specialists, perhaps in league with colleagues at the pinnacle of the "addiction = chronic-brain-disease" movement (like Nora Volkow), spearheaded the adoption of this position.

Where does that leave all the other candidates for inclusion in the addiction category -- leading entries for which are sex and games? For them to be included, will they also have to be "shown" to affect the same "brain and neurological reward system" as drugs and gambling? Is there any powerful experience that does not affect this system? Did O'Brien really scrutinize reams of PET scans of gamblers to find that their reward systems were impacted in the same addictive way as cocaine and alcohol abusers?

I ask because an awful lot of people claim that they are, or have been, addicted to games or to sex. Are they crazy? Didn't we discover gambling was addictive because people gave heartfelt testimony that they were addicted to gambling? Are they right while the people who claim to be addicted to games and sex are just deluded slackers?

A sensible person who is asked, "Are gambling, sex, and games addictive?" will answer, "Anything can be addictive, or not, depending on how engrossed people become in them, and how much they are damaged by it." In other words, it isn't which activities we focus on and call addictive, it is how the person engages in the experience (compulsively, unable to halt or to cut back, in ways that interfere with their functioning and that harm them) that counts.

Think about OCD and its diagnosis. Do we really care what people obsess or behave compulsively around? If a person endlessly organizes shoes, or washes his or her hands repeatedly, or locks and unlocks the door ad infinitum -- the thing they obsess over and behave compulsively towards is not really the matter. It is the pattern of behavior they engage in and its consequences for them.

Same with addiction.

Is this view of addiction "scientific"? It is actually more so than claiming -- without adequate evidence -- that a wide variety of behaviors are all traceable to some posited brain or neurochemical mechanism defined broadly enough to envelop such biologically diverse activity.

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