Behavioural (non‐chemical) addictions

Abstract ‘Addiction’ denotes repetitive routines that aim to obtain chemicals and, less often, routines without that aim. The latter are behavioural addictions. They include obsessive‐compulsive disorder (OCD), compulsive spending (including gambling), overeating (bulimia), hypersexuality (straight or deviant), and kleptomania. Common across dependence syndromes is: a repeated urge to engage in behaviour known to be counterproductive; mounting tension until it is completed; rapid temporary switching off of the tension by completing the behaviour; gradual return of the urge; syndrome‐specific external and perhaps internal cues for the urge; secondary conditioning of the urge to external and internal cues; similar strategies for relapse prevention by cue exposure and stimulus control. The urge to complete a behaviour and discomfort if prevented from this resemble the craving and the withdrawal (WD) symptoms of substance abusers. Some WD symptoms are common to several addictive syndromes while others may be more specific. Addiction (pull) and compulsion (push) overlap and can occur sequentially or concurrently. Different addictions occur with varying amounts of pleasure at various stages. Prolonged exposure can enduringly reduce the urge and discomfort in OCD, and may help some other addictions. Conditioned cues are important and for lasting efficacy a therapist may need to know their details for each syndrome. There may be some similarities in the early management and prevention of relapse of behavioural and chemical addictions.