Substance and Behavioral Addictions

220 Pages·2012·4.34 MB·English

Special Issue
Substance and Behavioral Addictions:
Co-Occurrence and Specificity
2012
Steve Sussman (Ed.)
MDPI
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Table of Contents
Preface
SteveSussman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
AFrameworkfortheSpecificityofAddictions
Steve Sussman, Adam Leventhal, Ricky N. Bluthenthal, Marilyn Freimuth, Myriam Forster
andSusanL.Ames
Int. J.Environ. Res. PublicHealth2011,8,3399-3415;doi:10.3390/ijerph8083399 . . . . 1
Generational Association Studies of Dopaminergic Genes in Reward Deficiency Syn-
drome (RDS) Subjects: Selecting Appropriate Phenotypes for Reward Dependence Be-
haviors
KennethBlum,AmandaL.C.Chen,MarleneOscar-Berman,ThomasJ.H.Chen,JoelLubar,
Nancy White, Judith Lubar, Abdalla Bowirrat, Eric Braverman, John Schoolfield, Roger L.
Waite, Bernard W. Downs, Margaret Madigan, David E. Comings, Caroline Davis, Mal-
lory M. Kerner, Jennifer Knopf, Tomas Palomo, John J. Giordano, Siobhan A. Morse, Frank
Fornari,DebmalyaBarh,JohnFeminoandJohnA.Bailey
Int. J.Environ. Res. PublicHealth2011,8,4425-4459;doi:10.3390/ijerph8124425 . . . . 18
Long-Term Effects of Self-Control on Alcohol Use and Sexual Behavior among Urban
MinorityYoungWomen
Kenneth W. Griffin, Lawrence M. Scheier, Bianca Acevedo, Jerry L. Grenard and Gilbert J.
Botvin
Int. J.Environ. Res. PublicHealth2012,9,1-23;doi:10.3390/ijerph9010001 . . . . . . . . 53
ClarifyingExerciseAddiction: DifferentialDiagnosis,Co-occurringDisorders,andPhases
ofAddiction
MarilynFreimuth,SandyMonizandShariR.Kim
Int. J.Environ. Res. PublicHealth2011,8,4069-4081;doi:10.3390/ijerph8104069 . . . . 76
ExtensiveInternetInvolvement—AddictionorEmergingLifestyle?
KarinHelmerssonBergmark,AndersBergmarkandOlleFindahl
Int. J.Environ. Res. PublicHealth2011,8,4488-4501;doi:10.3390/ijerph8124488 . . . . 89
Concurrent and Predictive Relationships Between Compulsive Internet Use and Sub-
stanceUse: FindingsfromVocationalHighSchoolStudentsinChinaandtheUSA
Ping Sun, Carl Anderson Johnson, Paula Palmer, Thalida E. Arpawong, Jennifer B. Unger,
BinXie,LouiseA.Rohrbach,DonnaSpruijt-MetzandSteveSussman
Int. J.Environ. Res. PublicHealth2012,9,660-673;doi:10.3390/ijerph9030660 . . . . . . 103
OnlineSocialNetworkingandAddiction—AReviewofthePsychologicalLiterature
DariaJ.KussandMarkD.Griffiths
Int. J.Environ. Res. PublicHealth2011,8,3528-3552;doi:10.3390/ijerph8093528 . . . . 117
High Calorie, Low Nutrient Food/Beverage Intake and Video Gaming in Children as
PotentialSignalsforAddictiveBehavior
MaryAnnPentz,DonnaSpruijt-Metz,ChihPingChouandNathanielR.Riggs
Int. J.Environ. Res. PublicHealth2011,8,4406-4424;doi:10.3390/ijerph8124406 . . . . 142
PatternsofandMotivationsforConcurrentUseofVideoGamesandSubstances
GeoffreyL.Ream,LutherC.ElliottandEloiseDunlap
Int. J.Environ. Res. PublicHealth2011,8,3999-4012;doi:10.3390/ijerph8103999 . . . . 161
Playing Video Games While Using or Feeling the Effects of Substances: Associations
withSubstanceUseProblems
GeoffreyL.Ream,LutherC.ElliottandEloiseDunlap
Int. J.Environ. Res. PublicHealth2011,8,3979-3998;doi:10.3390/ijerph8103979 . . . . 175
ConsideringtheDefinitionofAddiction
SteveSussmanandAlanN.Sussman
Int. J.Environ. Res. PublicHealth2011,8,4025-4038;doi:10.3390/ijerph8104025 . . . . 195
I

Preface
Researchers and practitioners have discussed the existence of several types of substance and
behavioral addictions. That is, in general, they have agreed that individuals may fall victim to
maladaptive, repetitive patterns of behavior involving recreational drugs (e.g., tobacco, alcohol,
illicit drugs), other substances (e.g., binge eating), and other behaviors (e.g., gambling, the
internet, shopping, workaholism, exercise addiction, love, or sex), that reflect attempts at
achievement of appetitive physiological outcomes but result eventually in negative outcomes to
self or others. Research over the last two decades suggests that a wide range of substance and
behavioral addictions may serve similar functions. Overall, 12-month prevalence of one or more
of the 11 addictions just listed above among adults in the U.S. has been estimated to be 46%
based on an exhaustive review of the literature [1]. As such, it may be useful to think of the
addictions in terms of problems of lifestyle as well as of a person. Yet, “co-occurrence” of
addictions has been reported among only a minority of sufferers, and is estimated to be
approximately 23% [1]. “Addiction specificity” pertains to a phenomenon in which one pattern
of addiction may be acquired whereas another is not [2]. Differential patterns of addiction may
be a function of such variables as accessibility, intrinsic appetitive effects, differential
socialization, and specific outcome expectations. The present Special Issue examines addiction
co-occurrence and addiction specificity across several addictive behaviors. The goal of the Issue
is to comprehensively describe notable addictive behaviors, and elaborate on what the
associational pathways might be of addiction co-occurrence and specificity.
A total of 11 papers are included. The first paper by Sussman et al. [2] introduces the topic of
the Special Issue and presents a model that might help explain addiction specificity (the “PACE”
model). Pragmatics (e.g., access), attraction (e.g., subjective effects), communication (e.g.,
addictive behavior jargon), and expectation (e.g., number of experiential solutions provided by a
given addictive behavior) variables are described, and examples in the development of different
addictions are derived from this model. The second paper by Blum et al. [3] presents literature
on the Reward Deficiency Syndrome, and how it might apply to various addictions and other
problem behaviors as a nonspecific reward phenotype. Further, these authors present results of a
genotype analysis which indicates extremely high presence of certain gene alleles (e.g., TacA1)
across two families with high prevalence of the phenotype. Their article highlights more an
underlying potential mechanism of addiction co-occurrence which might fall mostly within the
“A” (attraction) facet of the PACE model.
The third paper by Griffin et al. [4] examines the prospective relationships of alcohol use and
sexual behavior among urban minority women from the beginning of high school to young
adulthood, eight years later. Self-control was found to serve as a protective factor of latent class
membership — those who would end up exhibiting low levels on both behaviors, high levels of
alcohol use-low levels of risky sexual behavior, or high levels on both behaviors. This paper
II

highlighted both the operations of addition co-occurrence and specificity and one potential
determinant (lack of self-control; also an “A” variable). The fourth paper by Freimuth et al. [5]
provides one of the first reviews of exercise addiction, how it might develop, and its
developmental specificity (e.g., reliance on exercise for its mood altering effects) and
co-occurrence (e.g., with eating disorders, alcohol use). Treatment implications of exercise
addiction also are discussed.
The next three papers pertain to internet addiction. The fifth paper by Bergmark et al. [6]
provides data from a large Swedish survey on internet use (mean age of sample = 45 years). It is
observed that while face-to-face contact is decreased due to internet use, total number of social
contacts appears to increase. Addiction-type problems pertaining to internet use appear to be a
function of engaging in time intensive activities such as online gaming. Internet addiction may
be best understood as being a modality in which other types of addictions (e.g., gambling, sex)
are expressed. The sixth paper by Sun et al. [7] presents data from Chinese and U.S. adolescents
on the bidirectional one-year prospective relationships between compulsive internet use and drug
use (cigarette smoking and alcohol binge drinking). Each behavior predicted itself over time. In
addition, compulsive internet use positively predicted later smoking or binge drinking among
females but not males, in both countries. The authors speculate that females that take on male
gender roles, possibly through on-line gaming, are at relatively greater risk for drug use
(illustrating both addiction co-occurrence and specificity). The seventh paper by Kuss et al. [8] is
the first review paper on social network sites (SNS) addiction. While SNS are used mainly for
maintenance of offline pre-established social networks, relatively high levels of use are related to
decrease in real life social participation, relationship problems, and academic achievement,
suggestive of addiction. There may be co-occurrence of SNS addiction with drug misuse
and overeating.
The next three papers pertain to playing videogames. The eighth paper by Pentz et al. [9]
examines the relations among high calorie, low nutrient (HCLN) intake and videogaming among
a large sample of initially 9-to-10 year olds over an 18 month period. Male gender, free/reduced
lunch, low perceived physical safety and low inhibitory control predicted both behaviors,
whereas ethnicity and low stress predicted HCLN intake. Possibly, staying indoors (that may
characterize some poor areas), may reflect a “P” (pragmatics) variable conducive to both
behaviors. The ninth and tenth papers, both by Ream, Elliott, and Dunlap [10,11] were drawn
from a nationally-representative survey of U.S. adults who regularly or occasionally played
videogames and had played at least one hour in the past week. These authors found that problem
videogame playing and substance use problems involved the same types of motivations: to pass
time/regulate negative emotion, enhance positive emotion, or balance each type of behavior out
(videogame play versus use of a substance). In their other paper, they found that (controlling for
the shared variance of problem substance use (caffeine, tobacco alcohol, or marijuana) and
problem videogame playing) videogame playing while concurrently feeling the effects of a drug
III

was uniquely associated with problem substance use, but not with problem levels of videogame
playing. That is, it appeared that concurrent activity was fundamentally related to substance use
difficulties but not the converse.
The final paper in this Special Issue, by Sussman and Sussman [12] revisited the definition of
addiction. These authors suggested that cycles of engaging in addictive behaviors to attempt to
satiate an appetitive effect that become associated with preoccupation, loss of control and
negative life consequences, were the criteria that defined addictive behaviors. They also
suggested that there were philosophical concerns regarding the relations of these criteria with
each other and with the concept of addiction. Taken together, it is hoped that these 11 papers
assist in the arduous task of moving the study of addictive behaviors forward through
considering pathways and associations of the many types of behaviors that might encompass, at
least in part, the same types of underlying mechanisms.
Steve Sussman, Ph.D.
Guest Editor
References
1. Sussman, S.; Lisha, N.; Griffiths, M. Prevalence of the Addictions: A Problem of the
Majority or the Minority. Eval. Health Prof. 2011, 34, 3-56.
2. Sussman, S.; Leventhal, A.; Bluthenthal, R.N.; Freimuth, M.; Forster, M.; Ames, S.L. A
Framework for the Specificity of Addictions. Int. J. Environ. Res. Public Health 2011, 8,
3399-3415.
3. Blum, K.; Chen, A.L.C.; Oscar-Berman, M.; Chen, T.J.H.; Lubar, J.; White, N.; Lubar, J.;
Bowirrat, A.; Braverman, E.; Schoolfield, J.; et al. Generational Association Studies of
Dopaminergic Genes in Reward Deficiency Syndrome (RDS) Subjects: Selecting
Appropriate Phenotypes for Reward Dependence Behaviors. Int. J. Environ. Res. Public
Health 2011, 8, 4425-4459.
4. Griffin, K.W.; Scheier, L.M.; Acevedo, B.; Grenard, J.L.; Botvin, G.J. Long-Term Effects
of Self-Control on Alcohol Use and Sexual Behavior among Urban Minority Young
Women. Int. J. Environ. Res. Public Health 2012, 9, 1-23.
5. Freimuth, M.; Moniz, S.; Kim, S.R. Clarifying Exercise Addiction: Differential Diagnosis,
Co-occurring Disorders, and Phases of Addiction. Int. J. Environ. Res. Public Health 2011,
8, 4069-4081.
6. Bergmark, K.H.; Bergmark, A.; Findahl, O. Extensive Internet Involvement—Addiction or
Emerging Lifestyle? Int. J. Environ. Res. Public Health 2011, 8, 4488-4501.
IV

7. Sun, P.; Johnson, C.A.; Palmer, P.; Arpawong, T.E.; Unger, J.B.; Xie, B.; Rohrbach, L.A.;
Spruijt-Metz, D.; Sussman, S. Concurrent and Predictive Relationships Between
Compulsive Internet Use and Substance Use: Findings from Vocational High School
Students in China and the USA. Int. J. Environ. Res. Public Health 2012, 9, 660-673.
8. Kuss, D.J.; Griffiths, M.D. Online Social Networking and Addiction—A Review of the
Psychological Literature. Int. J. Environ. Res. Public Health 2011, 8, 3528-3552.
9. Pentz, M.A.; Spruijt-Metz, D.; Chou, C.P.; Riggs, N.R. High Calorie, Low Nutrient
Food/Beverage Intake and Video Gaming in Children as Potential Signals for Addictive
Behavior. Int. J. Environ. Res. Public Health 2011, 8, 4406-4424.
10. Ream, G.L.; Elliott, L.C.; Dunlap, E. Patterns of and Motivations for Concurrent Use of
Video Games and Substances. Int. J. Environ. Res. Public Health 2011, 8, 3999-4012.
11. Ream, G.L.; Elliott, L.C.; Dunlap, E. Playing Video Games While Using or Feeling the
Effects of Substances: Associations with Substance Use Problems. Int. J. Environ. Res.
Public Health 2011, 8, 3979-3998.
12. Sussman, S.; Sussman, A.N. Considering the Definition of Addiction. Int. J. Environ. Res.
Public Health 2011, 8, 4025-4038.
Reprinted from Int. J. Environ. Res. Public Health. Cite as: Sussman, S.; Leventhal, A.;
Bluthenthal, R.N.; Freimuth, M.; Forster, M.; Ames, S.L. A Framework for the Specificity of
Addictions. Int.J.Environ. Res. PublicHealth2011,8,3399-3415;doi:10.3390/ijerph8083399.
G
Int. J. Environ. Res. Public Health 2011, 8, 3399-3415; doi:10.3390/ijerph8083399
OPEN ACCESS
International Journal of
Environmental Research and
Public Health
ISSN 1660-4601
www.mdpi.com/journal/ijerph
Article
A Framework for the Specificity of Addictions
Steve Sussman 1,*, Adam Leventhal 1, Ricky N. Bluthenthal 1, Marilyn Freimuth 2,
Myriam Forster 1 and Susan L. Ames 3
1 Departments of Preventive Medicine and Psychology, University of Southern California,
California 90032, CA, USA; E-Mails: [email protected] (A.L.);
[email protected] (R.N.B.); [email protected] (M.F.)
2 Clinical Psychology, Fielding Graduate University, Santa Barbara, California 93105, CA,
USA; E-Mail: [email protected]
3 School of Community and Global Health, Claremont Graduate University, Claremont,
California 91711,CA, USA; E-Mail: [email protected]
* Author to whom correspondence should be addressed; E-Mail: [email protected];
Tel.: [phone]; Fax: [phone].
Received: 24 July 2011 / Accepted: 5 August 2011 / Published: 18 August 2011

Abstract: Research over the last two decades suggests that a wide range of substance and
behavioral addictions may serve similar functions. Yet, co-occurrence of addictions has
only been reported among a minority of addicts. “Addiction specificity” pertains to a
phenomenon in which one pattern of addictive behaviors may be acquired whereas another
is not. This paper presents the PACE model as a framework which might help explain
addiction specificity. Pragmatics, attraction, communication, and expectation (PACE)
variables are described, which may help give some direction to future research needs in
this arena.
Keywords: addiction specificity; PACE model
2
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Int. J. Environ. Res. Public Health 2011, 8 3400

1. Introduction: Addiction as a Biopsychosocial Phenomenon Involving a Range of Different
Behaviors
For many years, researchers and practitioners have discussed various seemingly irrational behaviors
that exhibit patterns of self-destruction similar to drug abuse [1-8]. Indeed, the concept of “addiction”
has broadened in scope from referring to only physiologic processes related to drug misuse
(pharmacodynamic tolerance and withdrawal) to a more elaborate biopsychosocial syndrome with
commonalities across several behaviors. An overarching feature of the addictive process includes
compulsively performing a behavior, for example, continuous drug taking, binge eating, gambling or
working [2,4,9-14].
During the “addictive process” [2,4,5] initially one may pursue some course of action for appetitive
effects such as pain reduction, affect enhancement, arousal manipulation, or fantasy. Over repeated
engagement in the behavior, the individual becomes intensely preoccupied with the behavior despite
diminishing appetitive effects [15,16]. Subsequently, the individual, if desiring to control or stop the
behavior, experiences subjective loss control over when the behavior is initiated, how it is manifested,
or when it will stop. Finally, one incurs negative consequences (e.g., social, role, physical, emotional)
while continuing to engage in the self-defeating behavior. Stopping the behavior becomes difficult for
several reasons, including having a lack of awareness of the “stimuli” or triggers that influence the
behavior and the cognitive salience of immediate gratification relative to delayed adverse effects. That
is, the behavior becomes increasingly more automatic and less under one’s control-ability [17-20]. At
this point, the individual also may fear having to cope with day-to-day perceived stress and other life
experiences upon cessation (possibly due to accumulation of addiction-related consequences, or having
to endure “raw” emotional experiences without concurrent self-medication [5]), as well as having to
suffer withdrawal-related phenomena [4,11,14]). Various substance and process/behavioral addictions
appear to be intricately connected in terms of etiology, patterns of behavior, and consequences [12,21].
1.1. Patterns of Addiction Co-Occurrence
While it is not entirely clear what differentiates addictive-prone from non-addictive prone
behaviors [22], Sussman, Lisha and Griffiths [14] identified 11 relatively common behaviors that
appear to have addiction propensity (tobacco use, alcohol use, illicit drug use, binge eating, gambling,
internet use, love, sex, exercise, work, and shopping). That article reported the prevalence and co-
occurrence of these behaviors based on a systematic review of the literature. Data from 83 studies
(each study n equal to or greater than 500 subjects) was presented and supplemented with smaller-scale
data. The authors noted a 23% average co-occurrence among the 11 addictions (with a range from 10%
to 50% overlap among 110 pairs of co-occurrence examined), and determined that approximately 50%
of the U.S. adult population has suffered from signs of some type of addictive behavior over a
12-month period, controlling for co-occurrence. Although there are some methodological limitations
[14], their findings suggest that there is marked variability in the pattern of addiction co-occurrence.
As examples, addictions to cigarettes, alcohol, and illicit drugs are highly associated with each other
and with sex and love addiction, which also are highly associated with each other. In addition,
gambling addiction is strongly associated with cigarette smoking addiction but not as much with illicit