Assessing Clients with Addictive Disorders Essay Assignment

Assessing Clients with Addictive Disorders Essay Assignment

Assignment 1- Assessing Clients With Addictive Disorders-WK664N
Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome.Assessing Clients with Addictive Disorders Essay Assignment. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the Levy Family video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction.
Learning Objectives
Students will:
• Assess clients presenting with addictive disorders
• Analyze therapeutic approaches for treating clients with addictive disorders
• Evaluate outcomes for clients with addictive disorders
To prepare:
• Review this week’s Learning Resources and consider the insights they provide.
• Review the Levy Family video Episodes 1 through 5.Assessing Clients with Addictive Disorders Essay Assignment
The Assignment
In a 2- to 3-page paper, address the following Assessing Clients with Addictive Disorders Essay Assignment:
• After watching Episode 1, describe:
o What is Mr. Levy’s perception of the problem?
o What is Mrs. Levy’s perception of the problem?
o What can be some of the implications of the problem on the family as a whole?
• After watching Episode 2, describe:
o What did you think of Mr. Levy’s social worker’s ideas?
o What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?

• After watching Episode 3, discuss the following Assessing Clients with Addictive Disorders Essay Assignment:
o What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?
o What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole? Assessing Clients with Addictive Disorders Essay Assignment
o Inform


ed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.
o Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
• In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.
o Discuss how you would have responded to this revelation.Assessing Clients with Addictive Disorders Essay Assignment
o Describe how this information would inform your therapeutic approach. What would you say/do next?
• In Episode 5, Mr. Levy’s therapist is having issues with his story.
o Imagine that you were providing supervision to this therapist, how would you respond to her concerns?
• Support your approach with evidence-based literature.Assessing Clients with Addictive Disorders Essay Assignment


Levy Family: Episode 1
Levy Family: Episode 1 Program Transcript
FEMALE SPEAKER: You're not dressed? You're going to be late for work.
MALE SPEAKER: I'm not going to work. I'm sick.Assessing Clients with Addictive Disorders Essay Assignment
FEMALE SPEAKER: Of course you're sick. You're hungover. I don't want the
boys to see you like this. Go back to bed.
MALE SPEAKER: See me like what? I told you, I'm sick.
FEMALE SPEAKER: Well, what do you call it when someone is sick almost
every morning, because they drink every night while they sit in the dark watching
MALE SPEAKER: You calling me a drunk?
FEMALE SPEAKER: What do you call it?
MALE SPEAKER: I call it, leave me the hell alone.
FEMALE SPEAKER: Baby, you need to stop this. It's tearing us up. The drinking,
the anger--you're depressed.
MALE SPEAKER: You said, for better or worse.
FEMALE SPEAKER: My vows don't cover this. You were never like this before.
You've changed. I want us back, the way we used to be.
MALE SPEAKER: That way is dead. It died when I went to Iraq.Assessing Clients with Addictive Disorders Essay Assignment
Levy Family: Episode 1 Additional Content Attribution
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
© 2016 Laureate Education, Inc. 1

Levy Family: Episode 2
Levy Family: Episode 2 Program Transcript
FEMALE SPEAKER: I want to thank you for getting me this Levy case. I think it's so interesting. Just can't wait to meet with the client.
MALE SPEAKER: What do you find interesting about it?
FEMALE SPEAKER: Well, he's just 31. Usually the vets I work with are older. If they have PTSD, it's from traumas a long time ago. But Jake, this is all pretty new to him. He just left Iraq a year ago.
You know, I was thinking he'd be perfect for one of those newer treatment options, art therapy, meditation, yoga, something like that.Assessing Clients with Addictive Disorders Essay Assignment
FEMALE SPEAKER: Well, I've been dying to try one of them. I've read a lot of good things. Why? What are you thinking?
MALE SPEAKER: I'm thinking you should really think about it some more. Think about your priorities. It's a good idea to be open-minded about treatment options, but the needs of the client have to come first, not just some treatment that you or I might be interested in.
FEMALE SPEAKER: I mean, I wasn't saying it like that. I always think of my clients first.
MALE SPEAKER: OK. But you mentioned meditation, yoga, art therapy. Have you seen any research or data that measures how effective they are in treatment?
MALE SPEAKER: Neither have I. There may be good research out there, and maybe one or two of the treatments that you mentioned might be really good ideas. I just want to point out that you should meet your client first, meet Jake before you make any decisions about how to address his issues. Make sense?
Levy Family: Episode 2 Additional Content Attribution
© 2016 Laureate Education, Inc. 1
Levy Family: Episode 2Assessing Clients with Addictive Disorders Essay Assignment
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
© 2016 Laureate Education, Inc. 2

Levy Family: Episode 3
Levy Family: Episode 3 Program Transcript
JAKE LEVY: We'd be out on recon in our Humvees, and it would get so hot. We used to put our water bottles in wet socks and hang them right outside the window just so the water would cool off of a bit, and maybe then you could drink it.
Man, it was cramped in there. You'd be drenched, nowhere to breathe. It's like riding around in an oven. And you'd have your helmet on you, 100 pounds of gear and ammo. I swear, sometimes I feel like it's still on me, like it's all still strapped on me.
FEMALE SPEAKER: How many tours did you do in Iraq?Assessing Clients with Addictive Disorders Essay Assignment
JAKE LEVY: Three. After that last recon, I just--There were 26 of us. Five marines in the Humvee I was in. I remember I was wearing my night vision goggles. We passed through a village and everything was green, like I was in a dream or under water.
And then there was a flash, bright light just blinded me. There was this explosion. I can't--I can't-FEMALE
SPEAKER: It's OK, Jake. Take it easy. I understand this is difficult. There's something I;d like to try with you. It's called exposure therapy, and it's a treatment that's used a lot with war veterans, especially those struggling with anxiety and PTSD.
JAKE LEVY: Exposure therapy?
FEMALE SPEAKER: Yes. It's to help someone like yourself to confront your feelings and anxieties about a traumatic situation that you've experienced. Assessing Clients with Addictive Disorders Essay Assignment.It's a-It's meant to help you get more control of your thoughts, to make sense of what's happened, and to not be so afraid of your memories.
JAKE LEVY: Put that in a bottle and I'll buy 10 cases of it.
FEMALE SPEAKER: Well, one part of it is learning to control your breathing. And when you practice that, you can learn to manage your anxiety, to get more control of it, not let it control you, to protect yourself. Do you want to try it?
JAKE LEVY: Right now?
JAKE LEVY: Why not?
© 2016 Laureate Education, Inc. 1
Levy Family: Episode 3Assessing Clients with Addictive Disorders Essay Assignment
FEMALE SPEAKER: OK. Well, I know this sounds crazy, but a lot of people don't breathe properly. And it really comes from bad habits. When they inhale and exhale, all the effort is here in their chest and shoulders. And the problem with that is you get a really short, shallow breath. And that really increases the stress and anxiety in your body.
Instead, a more natural breath should always involve your diaphragm, right here in your abdomen. When you breath in, your belly should expand. And when you breath out, your belly should fall. OK?
JAKE LEVY: OK.Assessing Clients with Addictive Disorders Essay Assignment
FEMALE SPEAKER: So, let's practice. Close your eyes. Now, I want you put one hand on your abdomen and the other across your chest. Good. Good. Now, I just want you to take a few breaths, just like normal. What are you feeling?
JAKE LEVY: I feel my chest moving up and down. But my belly, nothing.
FEMALE SPEAKER: OK. So that's what I was just talking about. That's OK. Let's try this. I want you take a breath. And this time, I only want you to allow your abdomen to expend when you breathe in and to fall when you breathe out.
OK, let's try it. Breathe in. Breathe out. Breathe in. Breathe out.
You feeling better? More relaxed?
FEMALE SPEAKER: And the more you practice it the easier it will become. So when you find that stress and anxiety coming on, just do your breathing. You can keep yourself from getting swept by all those bad thoughts. OK?
JAKE LEVY: Yes. Thank you.Assessing Clients with Addictive Disorders Essay Assignment
FEMALE SPEAKER: So, do you want to try to go back to what you were telling me about before?
JAKE LEVY: I can try. It was night. We were out on recon. It was my third tour in Iraq.
© 2016 Laureate Education, Inc. 2
Levy Family: Episode 3
Levy Family: Episode 3 Additional Content Attribution
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
© 2016 Laureate Education, Inc. 3

Levy Family: Episode 4
Levy Family: Episode 4 Program Transcript
FEMALE SPEAKER: So do you want to try to go back to what you're telling me before?
LEVY: I can try. It was night. We were out on patrol. I remember it was so hot packed in our vehicle.Assessing Clients with Addictive Disorders Essay Assignment. Suddenly there was an explosion. We got tossed into a ditch. And somehow I made it out, and I could see it was the Humvee behind us. It's whole front end was gone. It had hit a roadside bomb. Our vehicle had just driven past it, just mistriggering it. But not them. They didn't make it.
FEMALE SPEAKER: Remember how we practiced. Slow your breathing down. Inhale and exhale from your abdomen.
LEVY: Thank you.
FEMALE SPEAKER: And just take your time. Whenever you are ready.
LEVY: So the bomb went off. I managed to get out. I had my night vision goggles on. And I could see the Humvee, the one that got hit. It's whole front end was gone. And there's this crater in the road. And inside it I could see--I could see Kurt's--our platoon Sergeant, he was lying there everything below his waist was gone, blown off. And he was screaming. Screaming like nothing you'd ever heard.Assessing Clients with Addictive Disorders Essay Assignment
And then he was looking at me. And he was screaming for me to kill him. To stop his suffering. He was yelling, please. Please. And someone tried putting tourniquets on him. But the ground just kept getting darker with his blood. And I was staring into his face.
I had my rifle trained on him. I was going to do it. You know. He was begging me to. I could feel my finger on the trigger. And I kept looking into his face. And then I didn't have to do nothing. Because the screaming had stopped. He'd bled out. Died right there.
And all I could think was I'd let him down. His last request, and I couldn't do it. I couldn't put a bullet in him so he could die fast not slow.
FEMALE SPEAKER: I can see and hear how painful it is for you to relive this story.Assessing Clients with Addictive Disorders Essay Assignment. Thank you for sharing it. Do you think this incident is behind some of the symptoms you've been telling me about?
LEVY: When I go to sleep at night, I close my eyes, and I see Kurt's there staring at me. So I don't sleep too good. That's why I started drinking. It's the only way I
© 2016 Laureate Education, Inc. 1
Levy Family: Episode 4
can forget about that night. So I drink too much. At least that's what my wife yells at me.
We're not doing too well these days. I'm not exactly the life of the party. I left Iraq 10 months ago. But Iraq never left me. I'm afraid it's never going to leave me alone.
Levy Family: Episode 4 Additional Content Attribution
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
© 2016 Laureate Education, Inc. 2

Levy Family: Episode 5
Levy Family: Episode 5 Program Transcript
FEMALE SPEAKER: It was such an intense story. I just kept seeing things the way he did, you know. The weird green of his night-vision goggles, his sergeant screaming for Jake to kill him. I just keep seeing it all in my head.
MALE SPEAKER: Why, do you think?Assessing Clients with Addictive Disorders Essay Assignment
MALE SPEAKER: Why do you think you keep thinking about this story, this particular case?
FEMALE SPEAKER: I don't know, maybe because it's so vivid. You know, I went home last night, turned on the TV to try to get my mind off it. And a commercial for the Marines came on, and there was all over again--the explosion, the screams, the man dying. Such a nightmare to live with, and he's got a baby on they way.
MALE SPEAKER: Could that be it, the baby?
FEMALE SPEAKER: Maybe. That's interesting you say that. I mean, the other vets I work with are older, and they have grown kids. But Jake is different.


I just keep picturing him with a newborn. And I guess it scares me.Assessing Clients with Addictive Disorders Essay Assignment. I wonder if he'll be able to deal with it.
Levy Family: Episode 5 Additional Content Attribution
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
© 2016 Laureate Education, Inc. 1

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

  • Chapter 7, “Motivational Interviewing” (pp. 299–312)
  • Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Assessing Clients with Addictive Disorders Essay Assignment


Note: You will access this text from the Walden Library databases.

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from

Assessing Clients with Addictive Disorders Essay Assignment

Required Media

Laureate Education (Producer). (2013c). Levy family: Episodes 1 [Video file]. Baltimore, MD: Author.


Note: The approximate length of this media piece is 2 minutes.


Laureate Education (Producer). (2013c). Levy family: Episodes 2 [Video file]. Baltimore, MD: Author.


Note: The approximate length of this media piece is 2 minutes.


Laureate Education (Producer). (2013c). Levy family: Episodes 3 [Video file]. Baltimore, MD: Author.


Note: The approximate length of this media piece is 6 minutes.Assessing Clients with Addictive Disorders Essay Assignment


Laureate Education (Producer). (2013c). Levy family: Episodes 4 [Video file]. Baltimore, MD: Author.


Note: The approximate length of this media piece is 5 minutes.


Laureate Education (Producer). (2013c). Levy family: Episodes 5 [Video file]. Baltimore, MD: Author.


Note: The approximate length of this media piece is 2 minutes.


Laureate Education (Producer). (2012c). In their own words [Video file]. Baltimore, MD: Author.


Note: The approximate length of this media piece is 23 minutes.Assessing Clients with Addictive Disorders Essay Assignment


Optional Resources

Dronen, S. O. (2012). New research about Facebook addiction. Retrieved from

Substance Abuse and Mental Health Services Administration. (2005). Substance abuse treatment for adults in the criminal justice system. Treatment Improvement Protocol (TIP) Series 44. Rockville, MD: Author. Retrieved from

Substance Abuse and Mental Health Services Administration. (2007). Problem gambling toolkit. Retrieved from

Substance Abuse and Mental Health Services Administration. (2013). Substance abuse treatment for persons with co-occurring disorders: A treatment improvement protocol. Treatment Improvement Protocol (TIP) Series 42. Rockville, MD: Author. Retrieved from


Diagnostic instruments for behavioural addiction: an overview

Ulrike Albrecht,1 Nina Ellen Kirschner,1 and Sabine M. Grüsser*,1

Author information ► Copyright and License information ► Disclaimer

This article has been cited by other articles in PMC.

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In non-substance-related addiction, the so-called behavioural addiction, no external psychotropic substances are consumed. The psychotropic effect consists of the body’s own biochemical processes induced only by excessive activities. Until recently, knowledge was limited with respect to clinically relevant excessive reward-seeking behaviour, such as pathological gambling, excessive shopping and working which meet diagnostic criteria of dependent behaviour. To date, there is no consistent concept for diagnosis and treatment of excessive reward-seeking behaviour, and its classification is uncertain. Therefore, a clear conceptualization of the so-called behavioural addictions is of great importance. The use of adequate diagnostic instruments is necessary for successful therapeutical implications.Assessing Clients with Addictive Disorders Essay Assignment

This article provides an overview of the current popular diagnostic instruments assessing the different forms of behavioural addiction. Especially in certain areas there are only few valid and reliable instruments available to assess excessive rewarding behaviours that fulfill the criteria of addiction.

Keywords: behavioural addiction, diagnoses, psychometric instruments

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At the end of the 19th century, gambling addiction as a non-substance-related or behavioural addiction was already well-known by experts. In addition to several forms of substance-related addiction, such as alcohol, morphine and cocaine, gambling addiction was described in the literature of that time [1]. Recently, discussion of an adequate nosology and classification of behavioural addiction has been revived.Assessing Clients with Addictive Disorders Essay Assignment

To date, there is no consistent concept for diagnosis and treatment of excessive reward-seeking behaviours, and its classification is uncertain. Therefore, a clear conceptualization of these so-called behavioural addictions is of great importance, and the use of adequate diagnostic instruments is necessary for successful therapeutical implications. Not every excessively conducted behaviour is addictive behaviour. Subjects had to fulfill the criteria of addiction regarding their excessive behaviour for at least twelve months. Only an accurate diagnosis allows the differentiation between addictive behaviour, non-pathological excessive behaviour and excessive behaviour caused by other mental diseases.Assessing Clients with Addictive Disorders Essay Assignment

Until recently, “non-substance related behavioural addiction” was not listed in the two internationally used diagnostic manuals of mental disorders, neither in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) [2] nor in the ICD-10 (International Classification of Mental and Behavioural Disorders) [3]. Since 1980, pathological gambling has been included in the Diagnostic and Statistical Manual of Mental Disorders. Pathological gambling is listed in the category of “disorder of impulse control not elsewhere classified”. It is only possible to categorize these excessive behaviours as “disorders of impulse control”. Therefore, an appropriate classification and a clear diagnosis with respect to the current state of knowledge is required for establishing effective strategies for both the prevention of and interventions for these psychological disorders.Assessing Clients with Addictive Disorders Essay Assignment

From a neurobiological point of view, behavioural strategies that only indirectly affect neurotransmitter systems of the brain, can serve as reinforcers comparable to pharmacological substances that directly affect these systems (e.g., dopaminergic system, [4], [5], [6]). Indeed, recent findings support the assumption of common mechanisms that underlie development and maintenance of both behavioural and substance-related addiction (cf. [7], [8]). This leads to the assumption that excessively conducted behavioural strategies (e.g., excessive shopping/sport, pathological gambling/computer game-playing), which induce a specific reward effect in the body’s own biochemical processes, do have an addictive potential as well.Assessing Clients with Addictive Disorders Essay Assignment. This assumption is also supported by several clinical experiences and scientific investigations. Therefore, several authors have postulated that the criteria of behavioural addiction are comparable with the criteria of substance-related addiction (e.g., [9], [5], [10], [6], [11]). Patients suffering from a behavioural addiction describe addiction-specific phenomena and diagnostic criteria, such as craving to conduct the behaviour excessively, psychological and physical withdrawal symptoms, loss of control, development of tolerance (increased behaviour) to induce and perceive the expected psychotropic effect (e.g., pathological gamblers gamble several slot machines at the same time). In addition, the high comorbidity between behavioural addiction and substance-related addiction suggests comparable etiological mechanisms for their development. All in all, it seems appropriate to categorize excessivly conducted behaviours which lead to suffering as behavioural addictions.Assessing Clients with Addictive Disorders Essay Assignment

In addition, the frequent appearance of comorbidity, such as personality and affective disorders as described for substance-related addiction, is also observed in patients with behavioural addiction, but not in patients with impulsive-compulsive disorders (e.g., [12]). Furthermore, the frequently described impulsivity as a personality feature is not only observed in behavioural addicts, but also in several other psychological disorders (e.g., [13]). Based on recent findings, it does not seem to be sufficient to categorize behavioural addiction as an impulse control disorder because of therapeutical implications and effective methods of intervention [8]. The analogy of clinical characteristics between substance-related and behavioural addiction also favors the classification of behavioural addiction as an addictive behaviour and thus as an impulse control disorder (e.g., [14], [15], [16], [7]). The most evident characteristic of addiction, i.e. continuous substance intake (addictive behaviour) despite negative consequences, which is associated with craving and lack of control, is also dominant in patients with behavioural addiction.Assessing Clients with Addictive Disorders Essay Assignment

Due to the lack of a diagnostic guide, several authors developed psychometric instruments to assess the different forms of behavioural addiction. Using a standardized instrument to assess diagnostic criteria is of great importance for counteracting an inflationary use of the concept of behavioural addiction and for distinguishing pathological behaviour from normal (non-pathological) excessive behaviour.

Published instruments of behavioural addiction consist of newly developed or modified instruments that existed previously and were then refined. Due to the lack of statistical validation, the expressiveness of most of the instruments presented here is limited. Therefore, the presentation of the statistic quality criteria of most of these instruments has yet to be accomplished.Assessing Clients with Addictive Disorders Essay Assignment

Statements on the statistical quality (e.g., validation and reliability) as well as the selectivity are frequently missing. Therefore, an accurate diagnosis is often not possible. The strength of most of the instruments presented here is their ability of delivering extensive and essential information for the diagnostic and therapeutical process. Further studies are necessary for the characterization and appropriate diagnosis of the different forms of behavioural addiction.

In the following, an overview of the most popular and most frequently described diagnostic instruments of behavioural addiction pertaining to several areas (gambling, shopping, sport, working, computer, internet and sex) will be provided.

As a basic premise, considering the still limited practical use of the various assessment tools, validity and reliability data should be at least satisfactory for all of the instruments used in diagnostic assessment of “behavioural addiction”.Assessing Clients with Addictive Disorders Essay Assignment

Most of the presented instruments are predominantly designed to establish a diagnosis. Furthermore, several instruments are also appropriate for assessing therapeutical processes sequentially, such as e.g. the “Gambler's Belief Questionnaire” (GBQ) [17], which assesses gambling-associated cognitions, or the “Yale-Brown Obsessive Compulsive Scale - Shopping Version” (Y-BOCS-SV) [18].

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Assessment of pathological gambling

Excessive gambling is the most commonly described form of behavioural addiction. Therefore, the amount and diversity of existing psychometrics is enormous. Many of the diagnostic instruments for assessing excessive gambling are derived from the existing diagnostic criteria of the classifications of mental disorders (ICD-10 [3]; DSM-IV-TR [2]), in which “pathological gambling” is indeed classified as an impulse control disorder, but operationalized as an addiction. New research results have increasingly led to the integration of further models of development and maintenance of pathological gambling into its diagnostics. Therefore, and due to new empirical evidence from basic psychobiological research, the addiction concept is widely discussed (e.g., [19], [20], [21]; for a review cf. [22], [9]). Furthermore, the significance of irrational beliefs, respectively contortions in the development and maintenance of pathological gambling (e.g., [23], [24]), is widely accepted and considered in its diagnostics. A crucial task regrading the diagnostics of excessive gambling lies in the precise assessment of the different, clinically relevant grades of risky, problematic and pathologic gambling.Assessing Clients with Addictive Disorders Essay Assignment

Below, a few selected, commonly used self-assessment instruments and structured clinical interviews in assessing pathological gambling will be introduced, followed by instruments that assess beliefs and assumptions concerning pathological gambling.

The most commonly used and thoroughly evaluated screening instruments in assessing pathological gambling is the “South Oaks Gambling Screen“ (SOGS) [25], which was developed twenty years ago for use in clinical samples in the context of self-assessment or in clinical interviews. The underlying criteria used by the SOGS are derived from the diagnostic criteria for pathological gambling used by the DSM-III-R (APA) [26]. On a critical note, we would like to point out that changes in the diagnostic criteria (e.g., in DSM-IV [27]) have not been incorporated into the SOGS. Furthermore, it needs to be considered that its application in non-clinical samples leads to a decrease in its accuracy in differentiating between pathological and non-pathological gamblers. The evaluation of its reliability and validity resulted in a good consistency and convergent validity in relation to other instruments used in the assessment of pathological gambling, especially in comparison to the diagnostic criteria of the DSM-IV.Assessing Clients with Addictive Disorders Essay Assignment

The “Canadian Problem Gambling Index“ (CPGI) [28] was developed as a new instrument to assess problematic gambling in the general public. This questionnaire is divided into three sections. The first section is “Gambling Involvement”, which consists of items concerning the frequency of involvement, spending, and duration of involvement in a long list of gambling activities. The second section, “Problem Gambling Assessment”, consists of items which are based on criteria for pathological gambling according to the DSM-IV (APA) [27] and the items of SOGS [25], respectively. The third section, “Correlates of pathological gambling”, was designed to assess gambling-related attitudes, expectancies of winning und cognitive occupation with gambling as well as a family history of problematic gambling. According to the overall score, each respondent can be classified into five categories of gambling behaviour (ranging from non-gambling to problematic gambling). Evaluation so far has indicated satisfactory reliability and validity.Assessing Clients with Addictive Disorders Essay Assignment

Another screening instrument for the assessment of pathological gambling, also referring to DSM-IV criteria (APA) [27], is the “Massachusetts Gambling Screen“ (MAGS) [29]. MAGS assesses biological (tolerance, symptoms of withdrawal), psychological (impulse control disorder, guilt) and social concomitants and accompanying symptoms of pathological gambling by using two subscales, one being based on items from the “Short Michigan Alcoholism Screening Test” (SMAST) [30] and the other on DSM-IV criteria (APA) [27]. MAGS exhibits good validity regarding DSM-IV criteria and a satisfactory consistency.

A simpler and more economical instrument for clinical use is the adaptation of the general “Yale-Brown Obsessive Compulsive Scale“ (Y-BOCS, [31]; cf. "Assessment of Compulsive Buying" below) to pathological gambling (PG-Y-BOCS) [32]. This specific version of the Y-BOCS shows a high concurrent validity with the SOGS and satisfactory psychometric characteristics.Assessing Clients with Addictive Disorders Essay Assignment

The “National Opinion Research Center DSM-IV Screen for Gambling Problems“ (NODS) [33], which is also based on DSM-IV criteria for pathological gambling, contains two scales assessing problematic gambling in one's lifetime and in the last 12 month. Individual classification into non-problematic, problematic and pathological gambling is possible by using the overall score. According to preliminary findings, NODS exhibits a good test/retest reliability as well as reasonable sensitivity and specificity in recognizing pathological gamblers.

A concise self-assessment instrument with high sensitivity and specificity is the “Lie/Bet Questionnaire“ [34], [35]. It consists of only two items: “Have you ever felt the need to bet more and more money?” and “Have you ever had to lie to people important to you about how much you gambled?”.Assessing Clients with Addictive Disorders Essay Assignment

Structured clinical interviews for diagnosing pathological gambling are scarce. Of the few interviews (still in the pilot stage) the “Structured Clinical Interview for Pathological Gambling“ (SCI-PG) [36] is introduced here as an example. The SCI-PG consists of 10 items that assess DSM-IV criteria (APA) [27] for pathological gambling (10 items assessing inclusion and one item assessing exclusion criteria). As for a DSM-IV diagnosis of pathological gambling, subjects have to fulfill five or more items regarding inclusion criteria and one regarding the exclusion criterion (“is not better accounted for by a manic episode”) to be diagnosed with pathological gambling. In clinical samples of pathological gamblers the SCI-PG is highly sensitive, specific and possesses good prognostic validity.

It is well known that cognitive contortions, such as gambling-related cognitions and effect expectancies play an important role in the development and maintenance of pathological gambling (e.g., [23], [24]). These specific cognitive contortions, which are relevant for treatment, are most commonly assessed using self-assessment instruments. Some of them will be introduced below.Assessing Clients with Addictive Disorders Essay Assignment

The “Gambling Attitudes Scale“ (GAS) [37] assesses attitudes (affective, cognitive and behaviour-related aspects) concerning gambling in general and specifically in casinos, horse betting and lottery, which can foster the development of pathological gambling.

Even though extensive evaluations concerning its validity have yet to be performed, internal consistency and test/retest reliability of the GAS scales are good.

The “Gambling Attitude und Belief Survey“ (GABS) [38] assesses cognitive contortions, irrational assumptions and positive attitude towards gambling. In addition, the degree of excitement during gambling is obtained. Gamblers that generate a high overall score, experience gambling as exciting, socially meaningful and focus on luck and winning strategies. The GABS exhibits good internal consistency and high convergent validity with the SOGS.

The “Gambler’s Belief Questionnaire“ (GBQ) [17] assesses cognitive contortions, especially regarding chances of winning (e.g. assumptions on lucky and losing streaks). The GBQ shows high internal consistency, a suitable test/retest reliability and good convergent and concurrent validity, e.g. with the SOGS and the MAGS.

The “Informational Biases Scale“ (IBS) [39] which exhibits good internal consistency, can be administered when estimating specific cognitive contortions in gamblers that mainly use so-called video lotteries. In order to assess the irresistible craving for the addictive agent, which is regarded as a relevant specificity for both maintenance and relapse (e.g., [40], [15]) in gambling addicts the “Gambling Urge Questionnaire“ (GUS) [41] was developed. It can be administered to clinical as well as non-clinical populations. The GUS shows a satisfactory internal consistency and good characteristics of concurrent, predictive and criteria-related validity.

In the manner of the “Situational Confidence Questionnaire-39“ (SCQ-39) [42] the “Gambling Self-Efficacy Questionnaire“ (GESQ) [43] assesses the self-efficacy pertaining to the subjective level of control over the gambling behaviour in varying risk situations. The items of the GESQ describe specific situations corresponding to the eight so-called “high risk situations” (negative and positive emotional state, negative physical state, experiencing urges and temptations, testing control, interpersonal conflict, social pressure and pleasant times with others) [44]. This makes the GESQ especially valuable in relapse prevention. The GESQ shows satisfactory internal consistency und possesses a high test/retest reliability coefficient.

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Assessment of compulsive buying

One of the first instruments aimed at diagnosing excessive buying was the “Compulsive Buying Measurement Scale“ [45]. According to the authors, its items reflect the four dimensions of pathological buying: a tendency to spend, feeling an urge to buy or shop, post-purchase guilt, and family environment. While its evaluation showed a good reliability and validity, it was noticed that high scores also corresponded to heightened anxiety levels and frequent occurrence of comorbid disorders such as bulimia nervosa, depression or alcoholism within the family.

The “Hohenheimer Kaufsuchttest [Hohenheim Shopping Addiction Test]“ [46] is a modified German version of the “Compulsive Buying Measurement Scale“ [45] and hence it differentiates between normal and pathological buyers by the same token. The “Hohenheimer Kaufsuchttest“ exhibits high reliability and construct validity.

A newer screening instrument is the “Erhebung von kompensatorischem und süchtigem Kaufverhalten [Survey on Compensatory and Addictive Shopping Behaviour]” (SKSK) [47]. It is a self-assessment tool to record a potential tendency to and risk for compulsive shopping. The SKSK is also based on the “Compulsive Buying Measurement Scale” [45] and contains 16 items that assess the tendency for uncontrolled, maladaptive and excessive shopping. The instrument is one-dimensional and constitutes a continuum, reaching from inconspicuous and compensatory to compulsive buying. It postulates that compulsive buying is an extreme form of compensatory buying (meaning that the diverted behaviour is a problem-solving tool). The instrument features high reliability and construct validity.

Another screening instrument, the “Compulsive Buying Scale“ [48] was introduced shortly thereafter. Its items were obtained from previous research and reports from affected individuals. The aim was to obtain knowledge of specific feelings, motivations and aspects of behaviour regarding compulsive buying. Scale evaluation revealed that the “Compulsive Buying Scale“ is a valid and reliable instrument.


The structured “Minnesota Impulsive Disorder Interview“ (MIDI) [49] assesses several psychopathological symptom complexes, which, according to the authors, can be considered to reflect impulse control disorders, including cleptomania, trichotillomania, intermittent explosive disorder, pathological gambling, excessive engagement in sex and sports as well as compulsive buying. One part of the MIDI is the compulsive buying screen. It consists of four questions, each leading to five subsections. A subject’s MIDI screen is positive for compulsive buying if all related questions are answered affirmatively. In that case the administration of another 82 items is recommended for a more accurate diagnosis. So far no data regarding its validity and reliability have been published.

In 1996 the “Yale Brown Obsessive-Compulsive Scale” (Y-BOCS) [50], [32] was modified to develop the “Yale-Brown Obsessive Compulsive Scale – Shopping Version“ (Y-BOCS-SV) [18] to assess cognitions and behaviours associated with compulsive buying. This 10-item scale rates time involved, interference, distress, resistance, and degree of control for both cognitions and behaviours. The instrument is designed to measure severity and change during clinical trials. The Y-BOCS-SV shows high internal consistency and good inter-rater reliability.

Christo and colleagues (2003) developed a short form of the “PROMIS Addiction Questionnaire“ (PROMIS) [51], the “Shorter PROMIS Questionnaire“ (SPQ) [52], which like the “PROMIS Addiction Questionnaire“ assesses substance-related addictions as well as several forms of behavioural addiction (work, food, sports, sex and shopping) in an abbreviated approach. An evaluation regarding its psychometric characteristics has yet to be performed.

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Assessment of compulsive exercise

Prequels to diagnostic instruments used to assess exercise addiction were a psychoanalytically oriented interview [53] and the “Commitment to Running Scale“ (CR) [54]. Some authors [55] criticized the underlying concept of the CR by claiming that an “addiction” and a “commitment to physical activity” are two separate constructs. While compulsive exercising is a process forcing individuals to engage in exercise despite any obstacles or to exhibit withdrawal symptoms in case that exercising cannot be conducted ("addicition"), commitment constitutes an engagement in physical activity out of pleasure and expected satisfaction. According to the assumptions that addictions can be classified into positive and negative ones (e.g., excessive running is positive, drugs are negative) [56] the interview by Sachs and Pargman and the CR screening instruments consider compulsive exercise to be a positive addiction. The CR has good to very good reliability and internal consistency. In contrast, the “Negative Addiction Scale“ (NAS) [57] conceptualizes compulsive exercise, especially running, as a negative addiction [56]. Its items focus on the psychological and not the physiological aspects of compulsive running. Due to the lack of any psychometric characteristics, final estimations cannot be made about which score defines an individual as addicted to running.

The “Exercise Beliefs Questionnaire“ [58] assesses individual assumptions regarding exercise based on four factors: “social desirability“, “physical appearance“, “mental and emotional functioning“, and “vulnerability to disease and aging“. It possesses good or satisfactory reliability, respectively.

The “Exercise Dependence Questionnaire“ (EDQ) [59] assesses compulsive exercise as a multidimensional construct. It can be administered in assessing compulsion regarding a variety of sporting activities. The included scales are “interference with social/family/work life“, “positive reward“, “withdrawal symptoms“, “exercise for weight control“, “insight into problem“, “exercise for social reasons“, “exercise for health reasons“, and “stereotyped behaviour“. According to the authors, the EDQ is a reliable and valid instrument.

The “Bodybuilding Dependency Scale“ (BDS) [60] was developed especially to assess compulsive bodybuilding and possesses a satisfactory reliability. The three subscales are: “social dependence“ (individual's need to be in the weightlifting environment), “training dependence“ (individual's compulsion to lift weights) and “mastery dependence“ (individual's need to exert control over his/her training schedule).

The “Exercise Dependence Interview” (EXDI) [61] assesses compulsive exercising as well as eating disorders. The EXDI evaluates excessive engagement in sporting activities in the previous three months, associated thoughts, its effects on and connections to the individual's eating behaviour, self-assessment of exercise dependence and further history data. So far no evaluation of its psychometric characteristics has been performed.

The “Commitment to Exercise Scale“ (CES) [62] covers the pathological aspects of physical activities (e.g., continued exercising despite injuries) as well as compulsory activities (e.g., guilt after skipping exercise). CES exhibits a satisfactory level of reliability.

The “Exercise Dependence Scale“ (EDS) [63] operationalizes compulsive exercise based on the DSM-IV criteria for substance dependence or addiction (APA) [27] and reasonably reliably differentiates between at-risk, dependent and non-dependent athletes as well as between physiological and non-physiological addiction.

The “Exercise Addiction Inventory“ (EAI) [64], [65] is a short screening instrument aimed at identifying compulsive exercise. The EAI assesses the characteristic components of addictive behaviour: salience, mood modification, tolerance, withdrawal symptoms, social conflict and relapse [66]. The EAI features high internal consistency and convergent validity with the EDS.

The “Exercise Orientation Questionnaire“ [67] reliably evaluates attitudes towards exercise as well as related behaviours. It consists of six factors: “self-control“, “orientation to exercise“, “self-loathing“, “weight reduction“, “competition“, and “identity“.

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Assessment of workaholism

Since varying definitions of workaholism exist, its operationalizations also differ. Accordingly, the corresponding checklists and questionnaires have very distinct approaches. Futhermore, very few of these instruments possess the minimally recommended characteristics regarding scale assessment to estimate distinct aspects of behaviour.

In addition, most of these instruments are not based on theory and propose different dimensions. In general, there is a lack in the evaluation of psychometric characteristics and empirical analysis [68], [69]. Mentzel [70] equates workaholism with alcoholism and utilizes Jellinek's diagnostic criteria for alcoholism [71]. Mentzel's instrument is merely a list of items designed to encourage the affected individual to reflect on his/her behaviour (cf. [72]). Accordingly, no psychometric characteristics have been evaluated.

The “Work Attitude Questionnaire“ (WAQ) [73] contains two scales covering the “commitment to work“ and the extent of healthy vs. unhealthy attitudes and behavioural patterns regarding work. According to the authors, workaholism is not derived from the extent of qualitative and quantitative subjective focus on work, but from the attitudes and behaviours regarding mental health. The scale “commitment to work“ assesses attitudes towards work and related behaviour. It was designed to divide interviewees into those with low vs. high commitment to work. The second so-called “health scale” is intended to establish a healthy or an unhealthy attitude towards work. The overall score is obtained by adding the scores of the two scales. WAQ enables discrimination between people who are extremely committed to work and workaholics. A high commitment combined with beneficial attitudes and behaviour concerning health indicates that the interviewee is challenged, stimulated and satisfied by work. In contrast, the combination of high commitment with unhealthy attitudes and patterns of behaviour is characteristic of employees exhibiting emotional, interpersonal and health problems, who are likely to be ineffective in their tasks. Accordingly, the authors distinguish between healthy and unhealthy workaholics. So far, no details about this instrument’s reliability and validity have been published.

The “Workaholism Battery“ (WorkBAT) [74] consists of three scales: “work involvement“, “drive“ as well as “enjoyment of work“. The WorkBat shows satisfactory reliability, adequate internal consistency and reasonable convergent validity with organizational and personal variables. The “WorkBAT-R“ [75] is a revised version of the “Workaholism Battery“ [74]. While its authors identified three underlying factors in their instrument, other authors [74] could only establish the existence of two factors: “fun” (at work), that possesses very good reliability, and “drive” (to work), that appears to have good reliability.

Based on the observation that anankastic personality disorder and workaholism are intertwined diseases, the “Schedule for Non-adaptive Personality Workaholism Scale“ (SNAP-Work) [76] was developed, which accordingly assesses personality-determined maladaptive, compulsive work habits. The SNAP-Work was found to exhibit a high internal consistency and good split half reliability.

Mudrack and Naughton [77] developed an instrument, which estimates the “tendency to engage in non-required work activities” (typically, spending time thinking of ways to perform work better) and “to intrude actively on the work of others” (typically, time and energy spent on taking responsibility for others). It can be adjusted to the specific work situation of the interviewee. The inter-item correlations are satisfactory.

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Assessment of computer addiction

The existing instruments used to assess computer addiction are mostly based on the diagnostic criteria of pathological gambling and substance-related addictions, respectively. Since the symptom complex of computer addiction was initially reported in children and teenagers that excessively played video games, most of the instruments focus on video gaming behaviour in adolescence. Due to the increasing relevance and public discussion of the topic of “excessive computer use in adolescence”, several instruments pertaining to excessive computer gaming have been developed in the past few years. A few of those are introduced here.

Griffith [78] developed a questionnaire of excessive video game-playing in reference to slot machine addiction in adolescence, using the adapted DSM-III-R criteria for pathological gambling (APA) [26]. The behaviour is diagnosed as an addiction, if at least four criteria are met. Scale evaluation has yet to be performed.

The DSM-IV-JV (J = Juvenile, V = Arcarde video game) [79] is a reliable instrument for diagnosing pathological video game use in adolescence. It is based on DSM-IV (APA) [27] criteria for pathological gambling. A diagnosis of pathological computer gaming can be made if at least four of its criteria are met.

The “Problem Video Game Playing Scale“ (PVB) [80] assesses problematic video game playing in adolescence (13 to 18 years) with satisfactory reliability.

In order to assess computer game addiction of children in primary school age, Chiu, Lee and Huang [81] developed the “Game Addiction Scale“, which differentiates between “game addiction“ and “game concern“. No psychometric characteristics have been established yet.

Modifying the “Internet Addicition Test“ for adults [82], the “Computer-Related Addictive Behavior Inventory“ (CRABI) [83] was developed in order to record computer-associated addictive behaviour. The reliability of CRABI is satisfactory.

A comprehensive instrument in assessing computer game behaviour in children is the “Fragebogen zum Computerspielverhalten bei Kindern [Questionnaire of Computer Game Behaviour in Children]" (CSVK) [84]. The CSVK was developed for the German-speaking area in reference to the diagnostic criteria of pathological gambling as well as substance-related addictions according to the international classifications of mental disorders (DSM-IV [2] and ICD-10 [3]). It is a self-assessment tool which enables a diagnosis of “excessive computer gaming” as well as a survey on various related fields such as “family and living”, “leisure time and friends”, “school” and “television consumption”. It also provides information on emotional state, self-esteem, social acceptance and preferred problem-solving techniques. Previous analysis revealed that all seven items of the scale “diagnostic criteria” can be reduced to a single factor and that the instrument exhibits good specificity, internal consistency as well as reasonable reliability. Further evaluation of the CSVK items should involve an analysis regarding their psychological content.

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Assessment of internet addiction

Based on the rising popularity of the internet in all parts of the society during the last decade, a variety of instruments assessing internet addiction were developed. Most of them are based on the DSM-IV criteria for substance-related disorders (APA) [27] . Since, in practice, it is a common experience that computer and internet addiction are difficult to differentiate, adequate diagnostics should involve the consideration of the two symptom complexes and, therefore, the use of instruments assessing both internet and computer addiction as well.

A few select instruments will be introduced below.

Egger and Rauterberg [85] developed an “Online-Internetsucht-Fragebogen” [Online Internet Addiction Questionnaire] based on DSM-IV criteria assessing substance-related diseases (APA) [27]. Its validity and reliability have yet to be established.

Based on the same criteria, another instrument consisting of 32 items for estimating excessive internet use has been developed recently. This instrument, the “Internet-Related Addictive Behavior Inventory“ (IRABI) [86] exhibits a satisfactory level of reliability.

Furthermore, the “Internetsuchtskalen [Internet Addiction Scales]" (ISS) [87], a German instrument designed to obtain information on addiction-immanent features pertaining to internet addiction (e.g. loss of control, withdrawal symptoms, development of tolerance, continued execution of the excessive behaviour despite negative consequences regarding work and performance as well as social relationships) has proven to be both reliable and valid for diagnostics.

Other authors focus on the diagnostic criteria of pathological gambling of the DSM-IV for scale assessment. The “Diagnostic Questionnaire“ (YDQ) [82] - in its revised version - distinguishes between “non-problematic internet use”, “frequent problems related to internet use” as well as “serious problems related to internet use”, employing 20 items. In a psychometric evaluation six valid and reliable factors could be extracted: “salience“, “neglecting work“, “neglecting social life“, “excessive use“, “anticipation“ and “lack of control”.

Recently, additional comprehensive and multi-dimensional instruments for the diagnosis of internet addiction have surfaced. One of them [88] is based on the four factors “problem behaviour/hard-core internet user“, “utilization of computer technology“, “internet use for sexual gratification/shyness/introversion“, as well as “absence of concern“.

The “Generalized Problematic Internet Use Scale“ (GPIUS) [89] is based on the theoretical concept of the “generalized problematic internet use” [90]. The scale consists of seven subscales: “mood alteration”, “perceived social benefits available online”, “negative outcomes associated with internet use“, “compulsive internet use”, “excessive amounts of time spent online”, “withdrawal symptoms when away from the internet”, as well as “perceived social control available online”. The subscales of GPIUS correlate positively with depression, loneliness as well as shyness and negatively with the extent of self-esteem. According to the authors, the GPIUS is a reliable and valid instrument.

The “Online Cognition Scale“ (OCS) [91] specifically focuses on internet-related cognitions and contains four dimensions: “diminished impulse control“, “loneliness/depression“, “social comfort“, and “distraction“. The OCS appears to be reliable.

The "Sample Questions for a Screening Interview Assessing Problematic Internet Use“ [92] represent a half-standardized instrument for the assessment of problematic internet use. The five main sections of the interviews (presenting problem; biological, psychological and social areas, respectively; relapse prevention) are derived from a biopsychosocial approach [93]. Its reliability and validity have yet to be demonstrated.

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Assessment of sexual addiction

The phenomenon of excessive sexual behaviour has hardly been examined until now and valid instruments in its assessment are scarce. The establishment of the quantity of sexual engagement (e.g., [93]) or the estimation of the frequency of risky sexual activities [94] neglects the complexity of the disorder and does not contribute to obtaining relevant addiction-related aspects, such as loss of control and development of tolerance.

So far, the screening test of sexual addiction [95] is the only available instrument in estimating sexual addiction. This test (like all other screening instruments) is designed to merely provide hints of the existence of the symptom complex and is available as a short (24 items) as well as a long (184 items) version. The short version requires 13 affirmative answers in order to establish the possibility of a sexual addiction. On a critical note it has to be said that the test is limited to being administered to homosexual males. It has not been validated for its use in women.

There are a variety of screening instruments on the internet for the special diagnosis of online sexual addiction. They cannot be discussed in detail here.

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Assessment of various forms of bevavioural addictions

A first approach for the comprehensive and standardized assessment of different forms of behavioural addictions (e.g., pathological gambling, workaholism, compulsive buying) is the German self-assessment questionnaire “Fragebogen zur Differenzierten Anamnese exzessiver Verhaltensweisen“ (FDAV, Questionnaire on Differentiated Assessment of Excessive Behaviours) [96]. The FDAV is based on the criteria of substance-related addictions, pathological gambling and impulse control disorders of the ICD-10 [3] and the DSM-IV-TR [2].

The FDAV is a modified version of the “Fragebogen zur Differenzierten Drogenanamnese“ (FDDA; Questionnaire on Differentiated Assessment of Addiction, QDAA) [97]. Its seven modules obtain “sociodemographic information” (e.g., age, profession, marital status), “history of excessive behaviour” (e.g., diagnostic criteria for addictions and impulse control disorder, individual patterns of behaviour, craving symptoms), “critical life events” (stress caused by traumatic events), “legal situation”, “medical history”, “physical and psychological complaints”, and “emotional state” (triggering psychological conditions, or consequences of the addictive behaviour, respectively). Every module can be administered separately according to the suspected behavioural addiction, thereby making the FDAV an economical tool in assessing behavioural addictions. The FDAV is suitable for diagnostics, evaluation of therapy and follow-up in clinical practice and research. Currently, the FDAV is being validated in clinical and non-clinical samples.

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Characteristics of behavioural addictions

Grüsser and Thalemann [9] described relevant diagnostic characteristics of the different forms of behavioural addictions based on the present state of scientific findings and discussions. The authors view these characteristics as hints for the potential diagnosis of a behavioural addiction. However, they emphasize that in order to work against the inflational use of the term behavioural addiction, each individual case needs to be examined as to whether the suspected behaviour is in fact an addictive or just an excessive one (non-pathological or belonging to other diseases).

Characteristics of behavioural addictions according to Grüsser and Thalemann [9] include:

  1. The behaviour is exhibited over a long period of time (at least 12 months) in an excessive, aberrant form, deviating from the norm or extravagant (e.g., regarding its frequency and intensity)
  2. Loss of control over the excessive behaviour (duration, frequency, intensity, risk) when the behaviour started
  3. Reward effect (the excessive behaviour is instantly considered to be rewarding)
  4. Development of tolerance (the behaviour is conducted longer, more often and more intensively in order to achieve the desired effect; in unvaried form, intensity and frequency the desired effect fails to appear)
  5. The behaviour that was initially perceived as pleasant, positive and rewarding is increasingly considered to be unpleasant in the course of the addiction
  6. Irresistible urge/craving to execute the behaviour
  7. Function (the behaviour is primarily employed as a way to regulate emotions/mood)
  8. Expectancy of effect (expectancy of pleasant/positive effects by carrying out the excessive behaviour)
  9. Limited pattern of behaviour (also applies to build-up and follow-up activities)
  10. Cognitive occupation with the build-up, execution and follow-up activities of the excessive behaviour and possibly the anticipated effects of the excessively executed behaviour
  11. Irrational, contorted perception of different aspects of the excessive behaviour
  12. Withdrawal symptoms (psychological and physical)
  13. Continued execution of the excessive behaviour despite negative consequences (health-related, occupational, social)
  14. Conditioned/learned reactions (resulting from the confrontation with internal and external stimuli associated with the excessive behaviour as well as from cognitive occupation with the excessive behaviour)
  15. Suffering (desire to alleviate perceived suffering)

The clinical perception as well as the increasing amount of scientific investigations emphasize the commonalities of substance-related and non-substance related behavioural addictions, respectively. Therefore, the standardized classifications of mental disorders should classify excessive behaviours meeting the criteria of addictions as an addiction disorder and operationalize them accordingly in the diagnostic criteria. Only then will it be possible to establish accurate diagnoses (by using valid and reliable instruments) and thus to facilitate effective treatment of affected individuals.

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Conflicts of interest

None declared.

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