Non-substance related addictions: Their place in DSM-V

A number of potentially new disorders have been proposed for the DSM-V that have some possible overlap with substance use disorders. These include internet or gaming, eating, shopping, work, and sexual “addictions.” In addition, pathological gambling has considerable crossover with substance use disorders. The DSM-5 Substance Use Disorders Workgroup considered the available data regarding these potentially new diagnoses and their associations with substance use disorders. Although case reports and some empirical data exist regarding excessive gaming, eating, shopping, work, and sexual activities, we concluded that sufficient data were not currently available to recommend their inclusion as new diagnoses in DSM-V. In particular, data regarding the reliability and validity of these diagnoses are lacking at this time. However, after reviewing the literature, we propose that pathological gambling, classified as an impulse control disorder in DSM-IV, is better considered as a non-substance “addiction” disorder. Pathological gambling has overlap with substance use disorders with respect to diagnostic criteria symptom similarity. There is also evidence of some shared neural substrates, biomarkers, temperamental antecedents, cognitive and emotional process in abnormalities, and causal environmental risk factors. Further, empirical data suggest high rates of comorbidity between substance use and gambling disorders along with similar genetic risk factors. The course of illness and treatment response also has overlap with those of substance use disorders. The classification of pathological gambling as a non-substance related “addictive” disorder may pave the way for additional research on other behavioral “addictions,” which in turn may ultimately improve their diagnosis, treatment and prevention.