________________________________________________________________________ Behavioral Addictions
Interventions promote social communication and bonding in the therapy setting. In the middle phase, patients are taught to identify triggers of dysfunctional Internet use (e.g., emotional states, maladaptive cognitions, daily stress) by keeping diaries. A functional analysis of addictive behavior is done, with the goal of enabling functional computer and Internet use by appropriate problem-solving strategies. Patients establish an in-person social network and build a repertoire of alternative activities. Sessions may include exposition training (i.e., con- fronting and deleting access to critical genre elements, such as the self-created avatar) and skills training (e.g., coping with stress and problems, social skills, building alternative activities) [229]. The last phase is termination and relapse prevention. During this phase, treatment tools are transferred to daily life, including functional computer/Internet use. Relapse preven- tion tools are provided and practiced. The efficacy and stability of outcomes following STICA are under evaluation. Early results indicate that nearly 70% of initially enrolled patients completed the three-month treat- ment, with six-month follow-up showing significant decreases in Internet use, online time, and psychiatric symptomatology [230; 231]. Pharmacologic Interventions Few pharmacotherapy studies have been published in Internet gaming disorder. In one study, adolescents and adults with Internet gaming disorder were randomized to bupropion sustained-release, escitalopram, or a no-treatment control group. After six weeks of therapy, bupropion and escitalopram significantly improved all clinical symptom scores compared with controls. Bupropion led to greater improvements than escitalopram in Internet addiction severity, depression, ADHD, behavioral inhibition and activation, and global func- tioning. Bupropion and escitalopram were effective in reducing Internet gaming disorder symptoms, but bupropion was more effective in improving attention and impulsivity, important in the management of Internet gaming disorder [232]. Eleven patients with Internet gaming disorder received bupro- pion treatment for six weeks. Pretreatment MRI imaging showed higher brain activation in the left occipital cuneus, left dorsolateral PFC, and left parahippocampal gyrus compared with healthy controls. After six weeks of bupropion treatment, craving for Internet gaming and cue-induced brain activity in the dorsolateral PFC decreased from pretreatment in patients with Internet gaming disorder [233]. Atomoxetine and methylphenidate were compared in 86 ado- lescents with Internet gaming disorder and ADHD. After 12 weeks of treatment, both atomoxetine and methylphenidate reduced symptom severity; this reduction correlated with reductions in impulsivity. These results suggest impulsivity may contribute to the development of Internet gaming dis- order [170].
A systematic review found that a wide array of pharmacologic treatments (e.g., bupropion, methylphenidate, SSRIs) may be efficacious for treatment of Internet gaming disorder. Across all the clinical trials included in the review, symptom reductions following the administration of pharmacologic treatments ranged from 15.4% to 51.4% [234]. BINGE EATING DISORDER In the terminology for addictive patterns of eating, “food addiction” is seen as a misnomer that conveys the largely dis- proven concept that certain foods possess inherent properties that promote addictive behavior. More appropriate terms are “eating addiction” or “addictive eating disorder,” because they correctly associate addictive patterns of food consumption with behavior originating from individual predisposition [235]. There is increasing concern that consumption of food with high sugar content may be “addictive” and promote weight gain. Claims that sugar has addictive potential are based on animal studies, but direct human evidence for symptoms of sugar-related substance dependence is lacking [236]. A study evaluated 1,495 university students for potential “food addic- tion” (with DSM-IV substance dependence criteria applied to food) involving high-sugar foods. In this group, 12.6% met food addiction criteria; of these, 5% mainly consumed sugar-laden foods. Overweight/obesity was unrelated to sugary food prefer- ence. “Food addiction” was concluded to result from unique individual characteristics that determined reward response to food and promoted excessive eating [236; 237]. EPIDEMIOLOGY The lifetime prevalence of binge eating disorder in American adults is 0.8%, based on DSM-5-TR criteria [238; 239]. A World Health Organization survey of more than 24,000 adults in 14 mostly upper-middle and high-income countries found lifetime prevalence of binge eating disorder ranging from 0.2% to 4.7%, with the United States second in prevalence only to Brazil [240]. Binge eating disorder is more common in women (3.5%) than men (2%), and in younger and middle-aged adults than those older than 60 years of age [81]. The prevalence is higher in obese than non-obese persons. The lifetime prevalence of binge eating disorder appears slightly lower among Latino and Asian Americans (1.9% and 2.0%, respectively) compared with the general population; the prevalence is similar among Hispanic and non-Hispanic White individuals [239; 241]. While binge eating disorder is found across all weight catego- ries, binge eating is a strong risk factor for obesity, and roughly 25% of those seeking treatment for obesity meet binge eating disorder criteria [242].
53
EliteLearning.com/Social-Work
Powered by FlippingBook