Substance Use Disorder and Behavioral Addiction

Substance use disorder and behavioral addiction are recognized as diagnosable mental health problems by the American Psychiatric Association (APA). People with substance use disorder have isolated symptoms of damaging, non-addictive substance abuse, isolated symptoms of substance addiction or co-occurring symptoms of both abuse and addiction. People with behavioral addictions have brain and behavioral problems similar to those found in people affected by substance addiction; however, these problems arise from involvement in certain pleasurable, non-substance-based activities rather than excessive substance intake. The APA places both substance use disorder and behavioral addiction (which the organization calls addictive disorder) in a category of mental health concerns known as “substance-related and addictive disorders.” While behavioral addictions come in several forms, gambling disorder is the only condition listed by the APA as an addictive disorder. Another behavioral addiction related to Internet use is under review for a possible future listing.

Gambling Disorder

People with gambling disorder have at least four out of nine potential symptoms that indicate a damaging relationship with participation in at least one type of gambling activity. Symptoms of the disorder include having a history of failed attempts to limit or halt gambling involvement, feeling compelled to risk more and more money in order to feel the “rush” of gambling, depending on other people’s financial resources to fund gambling, using gambling to ease or avoid emotional disquiet, feeling stressed or agitated when gambling is not an option, hiding gambling activities from others and remaining mentally fixated with gambling while not actively taking part in gambling. The South Oaks Gambling Screen is one of a number of tests designed to help doctors identify people who gamble in dysfunctional or problematic ways. Individuals with fairly high scores on these tests do not necessarily have diagnosable gambling disorder; however, if they don’t have the disorder, they likely have substantially increased odds of developing it in the future.

How Many People in Substance Treatment?

In the study published in the Journal of Addictive Diseases, researchers from Oklahoma State University, Saint Louis University and Problem Gambling Solutions used an examination of 684 people with substance use disorder to estimate how often such individuals are affected by problematic gambling behaviors while in residential substance treatment. These participants came from 13 residential treatment programs. All of them answered the 16 gambling-related questions found on the South Oaks Gambling Screen.

After reviewing the results of the screening, the researchers concluded that roughly 20 percent of the study participants currently had significant gambling problems or had had such problems at some point in their past. Out of the individuals with a current or past history of gambling problems, only a small minority (15.9 percent) had sought treatment for those problems. In addition, only a small minority of currently or previously affected individuals were enrolled in a residential treatment program for substance use disorder that also tackled their gambling-related issues. Despite these low percentages for both treatment seeking and receipt of treatment, 30 percent of all study participants with current or prior gambling problems believed their gambling behaviors could potentially interfere with their ability to successfully complete their substance programs.

Based on these findings, the study’s authors believe that previous or ongoing gambling issues could derail the treatment outcomes of significant numbers of people receiving residential treatment for substance abuse and/or substance addiction. They also believe that gambling problems arise often enough to merit serious concern from substance program administrators, as well as active efforts to address those problems as part of the larger process of substance recovery.


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