Marc N. Potenza, MD, PhD, on the behavioral addictions of sex, gambling and Internet use
As part of our Addiction Speaker Series, in which leading experts present their latest findings, Marc N. Potenza, MD, PhD, Senior Scientist at Center on Addiction and Professor of Psychiatry, Child Study and Neurobiology at Yale University School of Medicine, discussed his latest research in his talk “Behavioral Addictions: A Current Understanding of Excessive Gambling, Internet Use and Sex.” We interviewed Dr. Potenza to hear more about this interesting area of study.
What are some characteristics that people with different behavioral addictions, such as disordered gambling, Internet use and sex have in common?
While our scientific knowledge is incomplete, data suggest that behavioral addictions share multiple features. These tendencies might be considered core elements of addiction, including: continued engagement in a behavior despite adverse consequences, compulsive engagement, a craving state prior to engagement, and diminished control over engagement in the behavior.
What role does the environment play in behavioral addictions and does it play a larger role than it does in substance addiction?
Genetic and environmental factors seem equally important for both behavioral and substance addictions. Twin studies find that 30 to 70 percent of the factors contributing to substance addictions are environmental in nature, and similar estimates have been reported for gambling disorder.
In what ways are behavioral addictions similar to drug and alcohol addiction?
They share core features and individuals with specific tendencies appear more prone to both substance and behavioral addictions. Some personality or temperament traits like impulsivity and the tendency to make decisions based on immediate rewards, appear common to both substance and behavioral addictions. Shared neurobiological features also appear to exist for substance and behavioral addictions, although our understanding currently is lagging for behavioral addictions as compared to substance addictions.
Why is gambling the only behavioral addiction included in the official psychiatric diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)?
Gambling disorder is the only behavioral addiction to be classified in the section of “Substance-related and addictive disorders” in the DSM-5 because there is a stronger body of research supporting similarities between substance-use and gambling disorders. Data from multiple areas indicate close relationships between substance-use and gambling disorders. As more research is done, it is anticipated that other behavioral addictions will become official psychiatric diagnoses.
What do you find to be most challenging in conducting your research on the behavioral addictions?
There are multiple challenges, but I find these to be the most difficult:
- Recruitment for clinical trials is low because some people are hesitant to consider that they might have an addiction (due to limited insight, shame or other reasons)
- Funding for research and treatment is limited. Some governmental agencies that typically support research do not have specific mechanisms for supporting ongoing research or program evaluation on the behavioral addictions
What do you think could have the greatest impact on reducing the stigma associated with behavioral addiction?
Increasing awareness of the prevalence and impact of behavioral addictions should help reduce the stigma associated with these conditions. A greater understanding of the factors (genetic, neurobiological, environmental, and others) contributing to behavioral addictions would also help to reduce the stigma.
Marc N. Potenza, MD, PhD
Marc N. Potenza is a Senior Scientist at Center on Addiction and
Professor of Psychiatry, Child Study and
Neurobiology at Yale University School of Medicine