Sex Both Internet-based and non-Internet-based forms of problematic sexual behaviors warrant clinical consideration and investigation. Acknowledgments Dr Potenza declares no conflicts of interest. Although the genetic and environmental contributions to gambling disorder appear comparable in women and men, 18 , 19 shared environmental factors appear to contribute more to age of gambling onset in women, and genetic factors appear to contribute more in men. Additionally, NAC was administered in a placebo-controlled, double-blind fashion. Key features include interference in major areas of functioning related to gaming ie, videogaming , with persistent and recurrent gaming over a period of at least 12 months that continues despite adverse consequences and in the setting of impaired control over gaming. Internet gaming disorder, currently in the DSM-5 section addressing conditions that may need additional research, will also be considered, as will the concept of Internet addiction. A diffusion tensor imaging study observed similar differences in PG and CD subjects as compared with HC subjects in secondary crossing fibers in corlicostriatal and parieto-occipital tracts, suggestive of similar patterns of poorer white-matter integrity in the addicted groups in tracts previously implicated in connecting brain regions involved in reward processing and addictions. Of particular note is gaming. For example, Gamblers Anonymous, modeled after Alcoholics Anonymous, is available worldwide and has been linked to favorable outcomes, particularly in conjunction with professional treatment.
For example, a cue-induced craving study identified a group PG, CD, and HC by condition gambling, cocaine-related, and sad cues interaction implicating ventral and dorsal mPFC, with the former demonstrating increased activation in the addicted subjects in response to cocaine cues and the latter showing increased activation in a diagnosisand cue-specific manner PG in response to gambling cues; CD, to cocaine cues; and HC, to sad cues. Specifiers those predominantly online and those predominantly offline have been proposed, as has a mutually exclusive category of hazardous gaming meant to capture individuals who engage in types and patterns of gaming that may place them at increased risk for mental or physical health problems but have yet to reach the level of gaming disorder http: Internet use and gaming As the Internet has grown in availability and usage, the degree to which certain behaviors on the Internet might be problematic or addictive has been considered. Additionally, findings of differential [11C]-raclopride binding, particularly in the ventral striatum VS , have been reported in individuals with Parkinson disease PD with and without PG. In this article, I will review the recent history and current status of non-substance or behavioral addictions. NAC has been reported to have a proposed mechanism of action in treating addictions through influences on glutamatergic systems, particularly mGluR2 and mGluR3 receptors. Furthermore, the extent to which co-occurring substance-use disorders may be used to guide selection of therapies for individuals with gambling disorder requires further examination. Such environmental influences may be particularly important for women, whereas in men, larger genetic contributions to the co-occurrence of gambling disorder and alcohol-use disorders have been noted. Some authors have proposed core features of addictions, including continued engagement in a behavior despite adverse consequences, diminished self-control over engagement in a behavior, an appetitive urge or craving state before such engagement, and compulsive engagement. Other constructs eg, cognitive control, risk-reward decision making have been proposed as potential treatment targets in IGD, 95 and fMRI investigations have identified differences in neural correlates of these processes in individuals with and without IGD. For example, given multiple lines of evidence including the absence of differences in GD and HC groups on [11C]-raclopride measures of D2-like receptor availability, a central role for dopamine in the pathophysiology of GD has been questioned. For example, some scholars believe that recognizing IGD as a diagnostic entity has negative implications for individuals who participate in gaming, 88 whereas others believe that having a formal diagnostic entity will help promote public health efforts relating to policies, prevention, and treatment. For example, among individuals with PG, those with a family history of alcoholism were more likely to respond to opioid-receptor antagonists than those without, suggesting that there may be shared biological features across alcohol-use disorders and PG that are effectively targeted by opioid-receptor antagonists. Key features include interference in major areas of functioning related to gaming ie, videogaming , with persistent and recurrent gaming over a period of at least 12 months that continues despite adverse consequences and in the setting of impaired control over gaming. Hypersexual disorder was considered for inclusion in DSM-5 and, despite field testing having been conducted, it was not included. Sex Both Internet-based and non-Internet-based forms of problematic sexual behaviors warrant clinical consideration and investigation. This approach may reflect ongoing debates regarding the most appropriate classification of CSB, as well as the limited amount of data regarding CSB in many domains, including effective treatments and prevalence estimates. A diffusion tensor imaging study observed similar differences in PG and CD subjects as compared with HC subjects in secondary crossing fibers in corlicostriatal and parieto-occipital tracts, suggestive of similar patterns of poorer white-matter integrity in the addicted groups in tracts previously implicated in connecting brain regions involved in reward processing and addictions. Selected abbreviations and acronyms. Additionally, NAC was administered in a placebo-controlled, double-blind fashion. Two articles by Constance Holden published in Science bookend these changes. Nonetheless, with research being conducted worldwide and technological advances leading to more refined understandings of the individual differences related to the development and persistence of and recovery from behavioral addictions, there is reason to remain hopeful that advances toward individualized and more effective care will be made, and also that there will be improved approaches for prevention of, treatment of, and policies concerning behavioral addictions in the future. Conclusion and future directions Although the field of behavioral addictions continues to develop, it is still young, and there are many gaps remaining in what is currently known and in clinical practice. Notably, naltrexone, an opioid-receptor antagonist with indications for alcohol- and opioid-use disorders, has demonstrated superiority over placebo in several randomized clinical trials, as has another opioid-receptor antagonist, nalmefene. A main focus will involve gambling and gambling disorder, given that the latter is currently the sole non-substance addictive disorder described in the main text of the current fifth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM
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