________________________________________________________________________ Behavioral Addictions
to dominate decision-making and lead to addictive behavior patterns. This promotes disadvantageous decision-making for immediate gratification over long-term gains. Gambling or gaming reinforces reward-seeking behaviors, further erod- ing executive-control abilities and perpetuating addictive behaviors [54]. UNIFIED MODELS OF INTERNET-MEDIATED BEHAVIORAL ADDICTIONS Two theoretical models have been developed to describe the underlying mechanisms in the development and maintenance of Internet-mediated addictive behaviors. Both models share common components, are theoretically sound, and have empirically confirmed elements. The Theoretical Model of Internet Gaming Disorder The theoretical model of Internet gaming disorder links decision-making favoring immediate reward despite long- term negative consequences and motivation-seeking (craving) as drives to experience pleasure and/or reduce stress. The third domain is diminished executive control (inhibition and monitoring) over motivation-seeking, consistent with research of executive functioning in individuals with substance use disorders. This model refers to reward-centered models of substance addiction, such as incentive salience theory. Treat- ment interventions are suggested to target specific cognitive and motivational factors [54]. The Interaction of Person-Affect-Cognition-Execution (I-PACE) Model The I-PACE model is a theoretic framework for specific Inter- net-mediated behavioral addictions (e.g., gaming, gambling, pornography/cybersex, buying). According to this model, these addictions are the result of interactions between pre- disposing factors, moderators, and mediators with impaired executive functioning. Conditioned processes (learning and memory) strengthen these associations in the addiction process. Biopsychologic, personality, and affective factors combine and interact to influence an individual’s predisposi- tion for Internet-mediated addictions. Interactions between predisposing affective/cognitive factors and pathologic neuro- psychologic functioning during Internet-mediated addictions are bidirectional [60]. Predisposing biopsychologic factors increase vulnerability to emotional disorders and behavioral addiction. Negative early childhood experiences of trauma, emotional or physical abuse, and/or social isolation are linked to insecure attachment styles, which correlate with Internet-mediated behavioral addictions [61]. Adverse early events increase individual vulnerability to intense stress reactivity, mental disorders, and addictive behaviors in adolescence and adulthood [62; 63]. Predisposing personality factors include high impulsivity, shyness, neuroticism, low self-esteem, conscientiousness, self-directedness, and procrastination. Affective/cognitive responses to environmental stimuli influence the preference of
specific Internet genres. For example, a perceived lack of social support, feelings of isolation, and loneliness are linked to the use (and potential misuse) of Internet genres with prominent communication features (e.g., social networking sites) [64; 65]. Specific Internet-mediated addictions are associated with specific personality profiles, such as greater rates of ADHD and impulsivity. The neural correlates of Internet-mediated addictions reflect a maladaptive interaction between cue-reactivity/craving and reduced prefrontal/executive functioning, also observed in substance addictions. Decisions to reduce craving and increase mood through specific Internet genre use are thought to be the result of increasing dominance of immediate reward and decreasing consideration of longer-term negative impacts [60].
CHILD AND ADOLESCENT VULNERABILITY TO BEHAVIORAL ADDICTION
For many years, experts have expressed concerns over child and adolescent susceptibility to pathologic behavior patterns involving the Internet, video games, and other digital media use. Substantial changes in brain function and structure occur during adolescence into young adulthood. Key developmental characteristics of adolescent brains increase the likelihood of thrill-seeking and risky behaviors associated with substance use and behavioral addictions. Adolescent behavior is marked by intense affective expression and impulsive reactivity. During the transition from childhood to young adulthood, the process of enhanced myelination decreases gray matter and increases white matter. The increase in white matter is mostly uniform, but diminished grey matter (through synaptic pruning) is more selective. Myelination increases the speed of neural signaling and underlies the timing and synchrony of neuronal firing patterns that convey meaning [66]. The PFC region is involved in executive processes important in risk-reward decision-making, but is among the last brain regions to mature. Compared with mature adults, this aspect of brain development renders adolescents more vulnerable to addictions, other risky behaviors, and mental health dis- orders [44]. The brain mechanisms that mediate cognitive control, impulsivity, and sensitivity to reward mature during adolescence and young adulthood, and this is the period when substance use initiation and other problem behaviors most commonly emerge [67]. Immature connections between the PFC, the nucleus accum- bens, and the amygdala are thought to largely influence goal-directed behaviors in adolescents [68; 69]. Reduced prefrontal cognitive control may allow greater influence of affective systems over decision-making and behavior, which increases adolescent vulnerability to social and peer pressure [70]. Addiction can interrupt the normal neurodevelopmental trajectory from adolescence to early adulthood, and addiction
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