Following chronic administration of a drug, and feature tolerance and withdrawal, without the

exprience of the negative consequences of addiction. A change in terminology my allow the

focus to shit form subtance use and its adaptation-associated physical consequences to the
harmful effects of addiction on multiple domains of functioning.

There are a number of advantages associated with categorizing certain impluse

control disordes as addictive disorders. Rates of co-occurence are high, there are common
demoghraphic and epidemilogic features, and there are paralellsbetween presenting
symptomatology. Substance abuse treatment programs may be more likely to asses for the
presence of a impluse control disorders in their patient population than general mental health
or primary care settings. By expanding the scope of addiction to include these disordes, it
may increase awareness, extend treatment for these conditions in yhe context of substance
abuse treament, and increase the availability of funding and research into these disordes.

Despite the advantages describded above, several disadvantages to reclassification

exsist. The primary rationale for the separate classification has been the lack of substance use
with the impulse control disorders, resulting in distinct consequences from use, particularly
regarding the lack of significant physical sequelae from impluse control disorders.
Additionally, categorizing impulse control disorders as addictive my increase stigmatization.
Individuals without co-occurring chemical addiction may feel uncomfortable receiving
treatment in a substance abuse treatment setting. Treatment programs that primarily treat
substance abuse may not have a sufficient numbers of a patients with impulse control
disorders to offer groups dedicated to their treatment.

TREATMENT MODELS

Behavioral and chemical adictions can respond positively to the same treatment modalites.
While research continues in this area, there are no currently approved medications for the
treatment of behavioral addictions. Psychosocial therapies play many roles in the treatmnent
of cooccurring chemical and behavioral addictions. They are used to directly target and
reduce problem behaviors in both domains directly as well indirectly through the rationale
that reductions in ope type of behavior are likely to lead to reduced symptom severity and
reducetions in other problematic behavior. Behavioral therapies can also be used to enhance
treatment engagement and promote treatment adherence, and can target other psychosocial
problems that may occur.

Multiple psychosocial approaches have been employed in this treatment. Many

treatments for behavioral addictions were orginally developed for the treatmentof substance
use disorders , and psychosocial treatmnents for both types of disorders often employ a
relapse prevention model, encouraging absitinence through idetification of paterns of abuse,
avoidance, or coping mechanisms for high-risk situations and lifestyle changes. CBT,
motivational approaches , and Twelve-Step approaches are mainstays of substance abuse
treatment that have been successfully used in the treatment of a number of impluse control
disordes, including pathologic gambling, compulsive sexual behavior, kleptomania,
pathologic skin pickin, and compulsive buying. CBT focuses on learning new skills and
strategies to reduce negative thoughts and behaviors, helping individuals to indentify patterns
associated with angoing substance use or other behaviors. Motivational approaches are brief
interventions designed to produce internally motivated change in problematic behaviors.
Contingency management, in which individuals receive incentives or rewards for
demonstrating observable target behaviors (such as negative urine toxicology or treantment
attendace), has been shown to be effective in reducing substance use and may be similarly
effective when used for reducing other problematic behafiors.

Individuals with co-occurring disorders have also been shown to have poorer
treatment outcomes, highlighting the need or effective treatment models to address co-
occurring dosordes. Integrated treatment, in which interventions and serfices are directed at
both disorders by the same treatment team at the same time, is now recommended as the
standard of care for substance use and mental health disorders and may also be the preferred
model for co-occuring behavioral addiction and substance use disorders.