Behavioral addictions like internet, sex, and shopping addictions may not be formally recognized as psychiatric conditions, but research shows that treatments can be effective in reducing problematic symptoms.
Key Facts:
- Psychological, pharmacological, and combined treatments all showed robust improvements in global severity and frequency of compulsive behaviors for internet, sex, and shopping addictions.
- Treatment gains were maintained over follow-up periods up to 6 months.
- Cognitive behavioral therapy (CBT) was commonly used and found effective across addictions. But other therapies like mindfulness, family therapy, and motivational interviewing also worked.
- Medications like antidepressants and stimulants improved symptoms, especially when combined with CBT.
- Similar to treatments for substance addictions and gambling, more intensive and longer-duration programs had greater success.
- Improvements were seen across cultures, age groups, and regardless of anxiety/depression.
Source: J Behav Addict.
Treatment for Addiction: Reviewing the Research
Researchers conducted a comprehensive meta-analysis reviewing 91 studies on treatments for internet addiction, sex addiction, and compulsive shopping.
The studies included 3,531 total participants.
About half of the studies compared treatments to no treatment or waitlist control groups.
The rest relied on within-group designs comparing patients’ scores before and after treatment.
Follow-up data was limited, with only some studies reporting outcomes 1 to 6 months later.
The analysis looked at two outcome measures – global severity of the compulsive behaviors, and frequency of behaviors.
It compared psychological therapies, medications, and combined approaches across the three behavioral addictions.
Effective Psychological Treatments
For both internet and sex addiction, psychological treatments showed large pre-post improvements in patients’ global severity and behavior frequency.
The gains held up at follow-up periods.
Cognitive behavioral therapy (CBT) was the most common type of therapy used.
But the analysis found other approaches were equally effective, like mindfulness, acceptance and commitment therapy, family therapy, and motivational interviewing.
Therapies delivered face-to-face in individual or group settings worked better than self-guided treatments for internet addiction specifically.
Longer-duration programs led to greater reductions in problematic internet use.
For compulsive shopping, psychological treatments also substantially decreased global symptom severity from pre- to post-treatment and these improvements lasted.
However, only two studies measured shopping frequency, so conclusions are limited.
Results were consistent regardless of age, gender, culture, or comorbid anxiety/depression.
Overall, the benefits seen mirror those from psychological therapies for substance addictions and gambling disorder.
Medications Improve Symptoms
Several classes of medications generated large pre-post improvements in global severity across the three behavioral addictions examined.
But there was minimal follow-up data to determine if gains persisted.
Compared to placebo, medications did not show a consistent advantage in the few controlled trials conducted.
This may be due to additional support like therapy also being provided to placebo groups.
For internet addiction, antidepressants outperformed stimulants in reducing symptoms.
But this seemed to be influenced by factors like patient age and comorbid diagnoses.
Combination Treatments May Enhance Results
For internet addiction, combined medication and CBT led to greater improvements than either treatment alone.
CBT combinations were more effective than integrating other therapeutic approaches.
But more research is needed on combined approaches for sex and shopping addictions.
Overall, internet addiction had the most available studies and data.
But results across the three conditions were fairly similar in terms of psychological and medication treatment effects.
The Outcome Measures Used
The global severity of compulsive behaviors was measured using standardized scales like the Compulsive Internet Use Scale, Sexual Compulsivity Scale, and Yale-Brown Obsessive Compulsive Scale modified for shopping.
For behavior frequency, studies tracked indicators like hours online, pornography viewing, and buying episodes per week.
Reliable and consistent measurement tools are important.
Comparison to Substance Addictions and Gambling
The treatment gains seen mirror results from studies on psychological and pharmacological therapies for substance addictions and gambling disorder.
This supports theories that behavioral addictions share underlying mechanisms with substance-related addictions.
Addictive behaviors may commonly stem from issues like impaired prefrontal functioning and reward pathway disruptions.
Treatments aim to modify faulty thinking patterns, alter maladaptive habits, and address biological disruptions contributing to compulsive behaviors.
Their success provides evidence that formally recognizing conditions like internet and sex addiction as diagnosable disorders warrants further consideration.
Limitations and Need for More Research in Addiction Treatment
There are several limitations to the current research. Most studies had methodological shortcomings like lack of controlled designs and follow-up data.
Diagnostic criteria and comorbid conditions need further validation.
More rigorously designed randomized controlled trials are needed, especially for medication treatments.
Direct head-to-head comparisons of therapies for behavioral versus substance addictions would also be informative.
Conclusion: CBT & Antidepressants may be best for addiction
In sum, psychological and pharmacological therapies can effectively reduce problematic symptoms of internet, sex, and shopping addictions based on the research analyzed.
Cognitive behavioral therapy in particular is beneficial, especially when combined with antidepressants.
The level of improvement seen is on par with results from treatment studies on substance addictions and gambling disorder.
This lends support for considering formally diagnosing and classifying these common behavioral addictions as recognized psychiatric conditions.
More research is still needed, but effective treatment options are available for those struggling with compulsive internet use, sexual behaviors, or shopping.
References
- Study: Treatments for internet addiction, sex addiction, compulsive buying (meta-analysis)
- Authors: Martina Goslar et al. (2020)
