The Behavioral Addictions

Behavioral addictions are one of the most vexing problems facing psychiatry, posing questions about diagnosis and treatment; the use of the diagnoses in courts of law; and the public image of psychiatry. Ascher and Levounis have managed to pack this book with everything we know about each of these questions. At once scholarly and practical, it belongs in the library of every clinician seeing patients with these sometimes devastating disorders. Nada Stotland, M.D., M.P.H., Professor of Psychiatry, Rush University Kudos to Ascher and Levounis for recognizing that addiction is a disease defined symptomatically by the discomfort experienced by an individual in the absence of a particular substrate, and for further recognizing that the substrate may be more than simply a substance that can produce physiologic dependence. The substrate can include emotional states, activities, and pastimes. The addict, to enter recovery, must remain abstinent not merely from dependence-inducing substances, but from all activities which, for that individual, generate a response that ultimately stifles interpersonal relating and intimacy. The editors and their chapter authors recognize this and have taken on the topic in a compelling and constructive manner that will assist the field in moving forward. Stuart Gitlow, M.D., M.P.H., M.B.A., President, American Society of Addiction Medicine

The book provides a pragmatic and engaging guide to help clinicians understand and contextualize conditions that may not be clearly delineated in the DSM-5 diagnostic system. Although not accorded a specific classification, the behaviors addressed in this book share the accepted hallmarks of addiction.

The Behavioral Addictions is the first American Psychiatric Publishing title to explore the diagnosis and treatment of patients who suffer from behavioral addictions, extreme forms of which share specific characteristics with severe forms of substance use disorders. These characteristics include tolerance (the need to use the substance or perform the troublesome behavior at higher doses, or more and more frequently, in order to achieve the same effect); withdrawal (feelings of restlessness, irritability, and discontent following abrupt discontinuation of the substance or the behavior); obsessive thinking and planning that block out anything other than obtaining or engaging in the addictive agent or behavior; and accompanying external consequences in related to finances, health, interpersonal relationships, legal affairs, etc. Although not all behavioral addictions are currently recognized as such by DSM-5, both substances and behaviors can hijack a person's pleasure-and-reward brain circuitry, causing great suffering.

This case-based volume is practical and engaging and offers many features that make it not only informative but also accessible and entertaining:

• Behaviors covered, both those widely recognized and those less commonly accepted, involve exercise, food, gambling, Internet gaming, Internet surfing, kleptomania, love, sex, shopping, work, tanning, and e-mailing/texting.
• Introductory chapters discuss the relationship of behavioral or process addictions to substance use disorders across many spheres, and they provide an overview of the behavioral addictions from neurobiological, theoretical, clinical, and forensic perspectives.
• Gambling disorder is now classified in DSM-5 as a behavioral addiction, lending credence to the construct of behavioral addictions and providing precedent for future consideration of other behavioral addictions, such as those highlighted in the volume.
• Each chapter focuses on a real-life case study of a patient with a behavioral addiction. Videos that accompany the volume demonstrate encounters between a clinician and a patient exhibiting an addiction. This puts material on assessment, treatment, etc. into a real-world context.
• Key points for review and multiple-choice questions are included at the end of each chapter.

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