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Hosted by Editor in Chief Lorenzo Norris, MD, Psychcast features mental health care professionals discussing the issues that most affect psychiatry.

Apr 17, 2019

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April 24th, 6 - 7 p.m. EST.
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Episode 54

Donald Black, MD, gives a masterclass lecture on behavioral addictions and Renee Kohanski talks about what normal is. 

Show Notes
By Jacquiline Posada, MD.

  • Gambling disorder (previously pathological gambling) is widespread, though not commonly assessed
  • Patients may not volunteer information related to gambling unless asked, so questions about gambling should be included in routine questioning
  • Assessment should include questions about legal and illegal gambling
    • Explore extent: Ask about the level of financial burden; impact on home life, such as marital problems and divorce; legal complications like bankruptcy. Finally, ask about suicide risk related to gambling 
  • Treatment: There is strong data for SSRI medications and naltrexone for urges
    • Therapy is more efficacious, such as CBT therapy and Gamblers Anonymous 
    • In certain states, such as Iowa, a person can ask for “self-exclusion,” which is essentially banning oneself from a casino or lottery. Also, participation in gambling results in arrest

Behavioral addictions: Behavior that is out of control and has qualities and consequences similar to drug and alcohol addiction

  • Examples include gambling disorder, compulsive buying, compulsive sexual behaviors (hypersexuality), and Internet addiction
    • Gambling disorder is similar enough to substance addictions that it is included in the DSM-5 in the “substance-related and addictive disorder”
    • Addiction neurocircuitry active in these behavioral addictions: Dopamine driven in the nucleus accumbens
  • Compulsive shopping: primarily a female disorder, onset in late 20s, with shopping and spending that are chronic and problematic
    • CBT programs developed to target compulsive shopping, studies about medications for this disorder are mixed
  • Compulsive sexual behavior: Primarily a male disorder affecting 5% of the population; onset late teens, early 20s. The addiction will combine conventional sexual behaviors taken to extremes often combined with an addiction to pornography
    • This disorder will often overlap with an Internet addiction
    • No evidence-based treatments exist, though CBT-driven models and 12-step programs exist
    • SSRI or TCA antidepressants may be helpful in dampening sex drive
  • Internet addiction has developed in our technologically enabled world; most psychiatrists have encountered this addiction.
    •  Most data come from Asia, where children are exposed to technology at an even earlier age than in the U.S.
    • China has developed residential treatment programs involving individual and group therapies.