Introduction
Behavioral addictions are patterns of behavior that follow a cycle similar to that of chemical addiction. Persons addicted to certain behaviors, such as gambling, exercising, computer gaming, Internet use, shopping, eating, or sexual activity, crave the activity and engage in that activity at the risk of causing problems in important life areas.
Behavioral addicts often recognize that their actions are causing a problem, but as with any addiction, they find the behavior impossible to control. Behavior addiction can be socially and psychologically damaging, rivaling substance addiction in the ability to cause havoc in family structure. However, behavioral addictions are often overlooked, even though its markers are similar to those of substance addiction.
Many health care professionals believe that addiction in one area is indicative of addictive tendencies in general, and persons who have these tendencies are likely to exhibit addictive behavior in many areas of life. Thus, substance abuse and behavioral abuse often go hand-in-hand, and screening for one type of addiction should include screening for all types.
Risk Assessment Screen
A diagnosis of substance addiction is often fairly clear. However, behavioral addiction is a much harder diagnosis for a professional to make. Often, this type of addiction is overlooked even though it coexists with substance addiction.
Clinical psychologist James Slobodzien introduced a tool called behavior risk assessment screen (BRAS) for professionals to use when they suspect addictive behavior. This tool screens for addictive behavior in seven areas: substance intake (nicotine, alcohol, illicit drugs, caffeine), eating attitude, exercise patterns, sleep patterns, sexual practice, gambling practices, and risky behaviors (impulsive behaviors with negative consequences such as reckless driving and starting fires).
Each of the seven areas includes two or three statements read by the tested subject. The subject then decides which of the statements best describes his or her behavior. Each statement is then given a standardized weighted classification, and the number of points is totaled for a cumulative score called a prognostic assessment gauge score, which ranges from 0 to 100.
This score is further broken into twenty-point categories ranging from excellent (80–100), good (60–80), fair (40–60), poor (20–40), and guarded (0–20). These point categories characterize how well the subject is coping with addictive behavior. The final score represents a person’s overall psychological, social, and occupational function and is comparable to a global assessment of functioning score (part of the
Diagnostic and Statistical Manual of Mental Disorders
).
CAGE Assessment Tool
The CAGE assessment tool screens for alcohol abuse. However, because it attempts to identify addictive behaviors, this simple tool is used by many providers as a basis for any type of addiction, including behavioral addictions, by substituting the type of addictive behavior for the term drinking in the questions.
The screen consists of four questions: Have you felt the need to cut down on your drinking? Do you feel annoyed or angered by others’ criticism of your drinking? Have you ever felt guilty about your drinking? And do you need to drink soon after waking as an eye-opener?
In using this tool to screen for behavioral addiction, two additional questions have been suggested to form the acronym “CAGED”: Do you feel empty when you’re not (for example) eating or gambling? Does (for example) eating or gambling disrupt your life or are you neglecting parts of your life because of it? These two additional questions may help pinpoint and further define behavioral addiction. Addictive tendencies may be a concern if the person being screened answers “yes” to two or more of the questions.
Screening for Specific Behavior Addictions
The BRAS and CAGE or CAGED assessments can give an idea of whether a person has addictive tendencies, including both behavioral and substance addictive tendencies. However, each type of addictive behavior has specific, though similar, screening instruments to determine whether the screening subject has that specific behavior addiction. Some examples follow.
Gambling. The LIE/BET screening for gambling consists of two questions: Have you ever had to lie to people important to you about how much you gambled? Have you ever felt a need to bet more money? A “yes” answer to either question would indicate that a person should be evaluated further. The South Oaks gambling screen is more complex, with sixteen questions (and several subquestions) rating the behavior of the person being screened. The questions are answered with the terms not at all, less than once a week, or once a week or more. This screening tool asks questions about the amounts of money used in gambling, family or friends who gamble, and several more related to gambling behavior. Answers to these questions are then weighted and scored, with a score of 5 or more indicating problem behavior. Gamblers Anonymous also has a twenty-question screening tool; seven or more yes answers means the person is likely to be a compulsive gambler.
Sexual activity. The WASTE Time tool is a quick screening for sex addiction. This tool assesses functional indicators such as withdrawal, adverse consequences, inability to stop, tolerance or intensity, and escape, with time spent on sexual activity being the final element of the screen. Answering “yes” to even one of the screening questions indicates a possible problem; answering “yes” to two or more questions indicates a high probability of sex addiction. Another screening for sexual addiction is the sexual addiction screening test, which consists of forty-five questions. Answering “yes” to more than seven of the first twenty questions indicates a sexual addiction, while the rest of the questions are intended to help pinpoint the problem’s manifestations.
Eating disorders
. EAT-26 is a common screening tool to assess eating behavior addictions such as overeating, anorexia nervosa, or bulimia nervosa. The tool consists of personal-information questions that assess attitudes about ideal weight, with twenty-six yes/no questions, and six behavioral questions. Items are scored on a scale of 1 to 3; if the total score is above 20, further help may be needed. However, even a score of less than 19 may refer a person for further help if binging or purging behavior is indicated by the screening.
Internet use. The Internet addiction test may be used as a screening tool for Internet addiction. The test screens with twenty questions that are rated on a scale using the terms does not apply or rarely to always. Each question is scored, and a total score is assigned (between 0 and 100). These scores are broken into ranges of 0–19 (below average), 20–49 (average), 50–79 (above average), and 80–100 (significantly above average). A score of 80 or above is cause for referral for further help.
Work. The work addiction risk test consists of twenty-five questions pertaining to attitudes toward work and to related behaviors in particular and life in general. The person being screened answers each question on a scale of 1 to 4, with 1 representing “never true” and 4 representing “always true.” The numbers are then added into a total score, in which 25–54 represents “not work addicted,” 55–69 represents “mildly work addicted,” and 70–100 represents “highly work addicted.”
Bibliography
Crozier, Mary K., and Steven R. Sligar. “Behavioral Addiction Screening during the Vocational Evaluation Process.” Vocational Evaluation and Work Adjustment Association Journal 37 (2010): 45–57. Print.
Freimuth, Marilyn. “The ‘New Look’ in Addiction Assessment: Implications for Medical Education.” Annals of Behavioral Science and Medical Education 16.1 (2010): 30–34. Print.
Petry, Nancy M. Behavioral Addictions: DSM-5 and Beyond. New York: Oxford UP, 2016. Print.
Rosenberg, Kenneth Paul, and Laura Curtiss Feder. Behavioral Addictions: Criteria, Evidence, and Treatment. New York: Academic, 2014. Print.
Whitlock, Evelyn, et al. “Evaluating Primary Care Behavioral Counseling Interventions: An Evidence-Based Approach.” American Journal of Preventive Medicine 22.4 (2002): 267–84. Print.
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