At the Albatros addictology congress, the status of behavioral addictions vis-à-vis drug-related disorders was discussed again.
Addicted to porn, addicted to online betting, fan of video games… and why not chocolatomaniac, big maniac of sport or gardening. How far does the addiction go? Are we abusing language when we talk about these addictions without substances, when we go beyond the framework of the consumption of pure and hard drugs? The question was at the heart of a presentation at the Albatros congress, a scientific meeting on addictions which ended in Paris last Friday.
It is also at the center of the discussions of the World Health Organization (WHO), which is updating its international classification of diseases (ICD-11) and wishes to include in the list of mental pathologies disorders related to excessive use. games on the Internet. The agency works on behavioral addictions, without products, and confronts all the difficulties of exercise – because if everything is addiction, nothing really is.
Similarities
Gambling addiction (JAH) appeared in 2014 in the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders established by the American Psychiatric Association. “Classifying Pathological Gambling (gambling disorder) as an addiction to substances facilitates diagnosis and treatment”, pleaded on the stage Marc Potenza, who also participates in the working groups of the WHO.
These two forms of addiction – to gambling and to drugs (alcohol, tobacco, cannabis, cocaine, etc.) – share several points in common, he explained in his presentation. The co-occurrence of the two consumptions is frequent, the clinical pathways of the patients are similar: addiction, repeated attempts at weaning, relapses, craving (urgent), lack (craving)…
“Work has shown similarities in risk-taking and the reward system,” continued the researcher. Both patient profiles also show neurobiological similarities; drug treatments for alcoholism have been effective in addiction to HADs, and psycho-behavioral therapies, used in substance-related disorders, work well on compulsive gambling.
Avoid the stigma
The rapprochement therefore does not come out of nowhere, even if it risks exposing the players to a form of stigmatization. “The term pathological gambling can be problematic,” explained Marc Potenza, an addiction psychiatrist at Yale University School of Medicine. The precision of the definition discussed within the WHO also illustrates the complexity of this type of disorder.
“Pathological gambling is manifested by persistent or recurrent behavior characterized by diminished control over gambling, an increasing priority given to gambling over other activities to such an extent that gambling takes over interests and daily tasks. AND by continuing to play despite the occurrence of negative consequences”.
This definition serves as a guideline for the WHO in its classification of the new pathology that is “problematic online gambling” (Internet Gaming Disorder). There too, the points in common with addictions to HDLs and substances are numerous, but still poorly understood.
Common denominator
But is it necessary at all costs to classify, subclass, confine? The scientific controversy is not completely settled, especially since the fields are merging. Should an online video game disorder be treated as an addiction specific to the Internet or specific to video games?
“The games evolve and the creativity of the industrialists is freed from these classifications, thus qualified, during the exchanges, Amandine Luquiens, psychiatrist addictologist at the Paul Brousse hospital. The offer aimed at young people is mixed, the gaming integrates gambling and the gambling is ‘gamified’”.
Finally, a consensus emerges concerning what links all addictions. “It is the collapse of executive control, responsible for our choices and our decisions, the one that allows us not to give in to desires, to lack. Executive control and its fragility would be the lowest common denominator of all scientific theories on addictions”.
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