Behavioral Addictions: Are they Really Addictions? Thomas E. Legere, Ph.D.
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Transcript of Behavioral Addictions: Are they Really Addictions? Thomas E. Legere, Ph.D.
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Behavioral Addictions:Behavioral Addictions:Are they Are they ReallyReally
Addictions?Addictions?
Thomas E. Legere, Ph.D.Thomas E. Legere, Ph.D.
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How do we Decide?How do we Decide?
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Old School: DSMOld School: DSM
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We Need a We Need a NEWNEW Model! Model!
From From THREETHREE Sources… Sources…
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Source #1: Source #1:
The DSMThe DSM
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Source #2: Source #2: What Those Who What Those Who Suffer From the Suffer From the
Disease SayDisease Say
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Source #3:Source #3:
NeurobiologyNeurobiology
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Three Three TYPESTYPES of Addictions of Addictions
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I. I. HARDHARD Addictions: Addictions: Alcohol & DrugsAlcohol & Drugs
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II. II. SOFTSOFT Addictions: Addictions: Nicotine & CaffeineNicotine & Caffeine
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III. III. BEHAVIORALBEHAVIORAL AddictionsAddictions
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Three Three LevelsLevels of of
Addiction:Addiction:
• • MildMild
• • ModerateModerate
• • SevereSevere
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Soft Addictions:Soft Addictions:““Soft” for a ReasonSoft” for a Reason
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Proposed Proposed Behavioral Addictions:Behavioral Addictions:
• • SexSex• • LoveLove• • GamblingGambling• • ExerciseExercise• • EatingEating
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What Makes them What Makes them “Real” “Real”
Addictions Addictions (or (or notnot)?)?
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Need Need CommonCommon Criteria Criteria for for
HardHard Addictions & Addictions & BehavioralBehavioral Addictions Addictions
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Honestly: Honestly: The DSM is Not The DSM is Not
Buying BehavioralBuying BehavioralAddictionsAddictions
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DSM: DSM:
• • Compulsive DisordersCompulsive Disorders
• • Pathological BehaviorPathological Behavior
• • Eating DisordersEating Disorders
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Twelve Integrated Twelve Integrated CriteriaCriteria
(DSM, Experience,(DSM, Experience,Neurobiology)Neurobiology)
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1. 1. “Pleasure Pathway”“Pleasure Pathway”In the BrainIn the Brain
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2. 2. Same BrainSame BrainChemicals InvolvedChemicals Involved
• • DopamineDopamine • • GabaGaba• • Serotonin Serotonin • • GlutamateGlutamate• • EndorphinsEndorphins • • CortisoneCortisone• • Norepinephrine Norepinephrine • • CorticotrophinCorticotrophin• • EpinephrineEpinephrine • • HistamineHistamine• • EnkephalinsEnkephalins • • AnandamideAnandamide• • AcetylcholineAcetylcholine
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3. 3. ToleranceTolerance
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4. 4. Use to “Intoxication”:Use to “Intoxication”:““I Can’t Stop!”I Can’t Stop!”
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5. 5. Obsessive DimensionObsessive Dimension
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6. 6. DenialDenial
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7. 7. Continued Use Continued Use DespiteDespite
Adverse ConsequencesAdverse Consequences
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8. 8. Progressive Progressive Escalation Escalation
of “Intake” and of “Intake” and ProblemsProblems
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9. 9. Repeated Attempts Repeated Attempts To Control UseTo Control Use
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10. 10. WithdrawalWithdrawal
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11. 11. IncurableIncurable(Only Remission)(Only Remission)
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12. 12. Effectiveness ofEffectiveness of12 Step Program12 Step Program