Exercise addiction is a controversial concept including whether excessive exercise is a positive or negative addiction and whether excessive physical activity could be harmful. The purpose of this chapter is to provide clarity to exercise addiction by reviewing the scientific literature examining its definition, measurement, correlates, prevention, and treatment. Exercise addiction is defined as a craving for leisure-time physical activity that results in uncontrollably excessive exercise behavior that manifests itself in physiological and/or psychological symptoms with two principal distinctions of primary and secondary addiction. Measuring exercise addiction involves the assessment of multidimensional characteristics that also consider symptoms of addiction and the ability to distinguish between low- and high-risk individuals for exercise addiction. Several risk factors for exercise addiction will be addressed including high levels of exercise identity, body dissatisfaction, neuroticism, extraversion and low levels of self-esteem and agreeableness. Finally, the scant literature on the prevention and treatment of exercise addiction will be reviewed. Given the lack of awareness in professional and lay communities about exercise addiction, healthcare professionals may not recognize the signs of exercise addiction even when its adverse health consequences are apparent.

This chapter discusses the role culture plays in addictions. First, we discuss the nature of culture and how it interacts with addiction. Then we present addiction-specific information related to the role of culture, including comparisons across ethnicity, nationality, gender and sexual orientation, as well as historical trends. These five aspects of role-of-culture information are nested within the discussion of nine types of addictions: shopping, work, gambling, internet, substance use, exercise, food, sex, and love. Finally, we discuss limitations and future directions of culturally based addiction research.

Mindfulness-based interventions (MBIs), founded on the meditation practices outlined in the Mindfulness-Based Stress Reduction (MBSR) program and historically rooted in contemplative traditions, offer one mental framework to address the unique needs of individuals suffering from the causes and consequences of substance and behavioral addictions. MBIs are considered a third wave of empirically tested psychotherapies following behavioral therapy and cognitive-behavioral therapy, respectively. MBI-proposed targets of change include self-regulation, self-exploration, and self-liberation; together, an important set of mental capacities or skills to break the cycle of addiction. In this chapter, we describe the development of MBIs adapted for a variety of addictions. We focus on MBIs for substance use disorders (SUD) and binge-eating disorder (BED) due to similarities in addictive and neurobiological processes (both may be considered substance addictions, BED as a proxy for food addiction), though other behavioral addictions are also discussed. We then critically review leading experimental trials that test the efficacy of MBIs on mechanisms of addiction and substance use behavior among people diagnosed with SUD and BED. Based on results available to date, treatment effects from MBIs are on par with other clinically accepted treatments. However, several methodological limitations make interpretation of the internal validity and reliability of these results difficult to assess. We discuss strengths and limitations of the state of evidence to date and provide suggestions for future research with an emphasis on treatment fidelity and its role in improving the validity of future study findings. We expect our synthesis to inform the public on the value of applying MBIs to remediate the causes and consequences of addictive behavior.

This chapter reviews current research related to prevention, early interventions, and treatment strategies for "food addiction." However, the paucity of directly relevant investigation resulted in the necessity to broaden the focus to include studies in the area of general addiction disorders, and those targeting compulsive overeating and chronic weight gain. Included are discussions of school-based interventions aimed at reducing caloric intake, such as taxation on sweetened-beverage consumption, and the increased availability of fruits and vegetables in cafeteria menus. Consideration is also extended to discussions about the efficacy of public health policies and regulatory agencies aimed at reducing consumption of highly caloric foods at the population level – based on evidence of their addictive properties. This approach is based on past evidence that increasing prices and decreasing ease of access has reduced use of other addictive substances such as nicotine. Applied to addictive foods, this may indicate that implementing taxes on foods such as sugary candy and soda may aid in reducing consumption. Regarding treatment, although more focused research is still needed, perhaps the most promising evidence-based strategies occur in the field of cognitive interventions, which target hedonic overeating. These approaches are mostly theory driven and mesh with an experimental-medicine approach toward intervention development. It was also concluded that future research should carefully assess possible moderating effects of prevention/intervention and treatment approaches, including individual differences in sex/gender, personality traits such as impulsivity, and varying patterns of compulsive overeating. In addition, it would behoove future researchers to include standardized control groups in order to understand better the theoretical bases on which the interventions and treatments have been developed.

Addiction is characterized by excessive desire for a particular substance or behavioral incentive at the expense of other life rewards. Addictive desire can develop even in absence of any associated increase in pleasure, and also in absence of withdrawal. Here we review evidence that the brain mechanisms underlying desire or ‘wanting’ can operate independently from those mediating pleasure, or "liking." That is, "wanting" and "liking" are mediated by two anatomically and neurochemically distinct brain mechanisms that normally interact together to influence motivation, but can become dissociated in the transition to addiction. Pleasure "liking" is the hedonic impact of a pleasant stimulus and is causally amplified by a brain system of several functionally interactive but anatomically distributed locations referred to as "hedonic hotspots." These hedonic hotspots are localized subregions within larger brain structures, and are relatively sensitive to disruption. By contrast, "wanting" or the subconscious desire for reward or reward-related cues is much more robust, and mediated by a larger brain system. "Wanting" can be generated by dopamine enhancements as well as by opioid enhancements in several broadly defined regions throughout mesocorticolimbic circuitry. In susceptible individuals, mesolimbic circuitry can become hyperreactive or sensitized (e.g., through previous drug experience), so that "rewards" and their related cues evoke even greater dopamine release and "wanting." Sensitized "wanting" becomes harder to resist, which can spur on excessive and compulsive pursuit and relapse in addiction. Importantly, this sensitization of brain "wanting" systems need not be accompanied by an enhancement of brain "liking" (i.e., dopamine manipulations do not appear to effect pleasure). In this chapter, we also highlight possible mechanisms for how some drugs or behaviors become the specific focus of excessive but narrow pursuit, usually involving mesolimbic brain interactions with areas such as the amygdala. Further we demonstrate that behavioral addictions such as food addiction and gambling, like drug addiction, are accompanied by sensitization of mesolimbic brain "wanting" systems in the transition to addiction.

The study of addiction throws up a wide range of philosophical issues, connecting with some of the deepest and longest-running debates in ethics, metaphysics, epistemology, and the philosophy of science, to name but a few subdisciplinary areas. By straddling such a wide range of fields of scientific enquiry, as this Handbook demonstrates, it also throws up numerous conceptual, explanatory, and methodological quandaries between disciplines, of the sort that philosophers have over the years developed many tools to deal with and reconcile. In this chapter, I first summarize some early philosophical treatments of addiction, as well as descriptions of addiction among the ancient philosophers themselves, before considering some of the major philosophical debates with which the study of addiction intersects, and the significance of those debates and intersections for the understanding of addiction in other disciplines.

Several decades of basic research support the neural basis of multiple memory systems. These systems are highly relevant to all health behaviors, since behaviors are learned from experience and require some form of memory process to retain learning and affect subsequent action. Research on the neuroscience of appetitive behaviors has rigorously studied motivational processes involved in behaviors such as drug use, diet, and sex. However, very little of this otherwise stellar research has attempted to integrate its findings with multiple memory system views that acknowledge the wide range of memory effects uncovered in several highly relevant basic research areas. Further, good explanatory theories of multiple memory systems studied mostly in addiction and in animal research have not yet been integrated with the vast knowledge base from human cognitive science. Moreover, most research on the epidemiology, prevention, or treatment of problems in appetitive behavior has not taken into account these basic research findings and has instead focused on theories and methods derived primarily from survey research. Yet, basic research areas from neuroscience and cognitive science are highly relevant to all areas of study of appetitive behavior, and the prevailing focus in prevention science on concepts derived from survey research may be channeled mostly by the training of investigators and disciplinary history. This chapter provides one example of how these disparate literatures from basic research might be integrated to advance our understanding of this class of behavior and derive new possibilities for intervention. It highlights examples of key findings supporting the need for a greater translational effort but also highlights large gaps in knowledge. Future research filling these gaps and others in the void between compelling research domains could substantially change and advance the study of addictions and all appetitive or habit-forming behaviors.

Impulsivity and compulsivity are the defining features of various psychiatric disorders, including attention-deficit/hyperactivity disorder, obsessive–compulsive disorder, and behavioral and substance addictions. Once thought to be diametrically opposed, compulsivity and impulsivity are increasingly recognized as orthogonal symptom dimensions that are linked by shared neurobiological mechanisms. This chapter selectively reviews impulsivity and compulsivity from a transdiagnostic perspective. It begins by discussing the neurobiology of impulsivity and compulsivity and the relationship of these constructs to addictive disorders. The chapter then discusses the clinical features of specific compulsive and impulsive disorders (as well as gambling disorder, a putative behavioral addiction), with a focus on comorbidity and treatment. The complex interrelationships among compulsive, impulsive, and addictive disorders have implications for how these disorders are assessed and treated.

Evidence for the idea that some individuals may experience an addictive-like response to certain foods has grown in the past decade. Food addiction parallels substance use disorders to suggest that highly processed foods (e.g., chocolate, French fries) may exhibit an addictive potential and trigger addictive-like responses in vulnerable individuals. An opposing conceptualization of addictive-like eating was recently developed, suggesting that the behavioral act of eating may be addictive rather than highly processed foods. However, the arguments for a behavioral eating addiction do not consider the central role of behaviors within substance use disorders and are not supported by preliminary research demonstrating that highly processed foods may directly contribute to the addictive-like eating phenotype. The primary goal of this chapter is to argue that a substance-based, food addiction framework is the most appropriate reflection of the current state of the literature and more closely parallels scientific understanding of addictive disorders. Specifically, this chapter will review theoretical debates between the food versus eating addiction perspectives, raise concerns about discrepancies between eating addiction and existing behavioral addictions, and review assessment tools for food and eating addiction. Finally, implications for stigma, intervention, and future research are discussed.

This chapter provides an overview of qualitative research methods in substance and behavioral addictions research and practice. It discusses the nature and importance of qualitative methodologies in iterating how individual perspectives, social meanings, and lived experiences impact the nature of substance and behavioral addictions. Methods addressed include ethnography, participant and nonparticipant observation, qualitative interviews, focus groups, and participatory action research (PAR), and empirical evidence in the context of addictions is provided. Additionally, a brief summary of each method and generally understood advantages and disadvantages of each are given. Data analysis techniques covered include grounded theory, narrative and discourse analysis, and thematic analysis. Lastly, major contributions to the field of addictions regarding research on hard-to-reach and marginalized populations, evaluating treatment and intervention services, measuring risk behaviors, investigating barriers to treatment programs, conceptualizing motivational and emotional components of addiction, and aiding in the formation of diagnostic criterion are reviewed.

The role of appetitive needs in the etiology of addiction is described in this chapter, including consideration of typologies of needs, how appetitive need-satiation cycles may cross over into addiction, and factors that may facilitate dysregulation of appetitive effects. An overview of an Associational Memory-Appetitive System Relations Model (AMASR) is presented. The constituents of this model are described and include neurobiological vulnerability, lifestyle pushes (stresses) and pulls (seductions), associative learning of relations among addiction-related cues with subjective perception of appetitive needs fulfillment, and associative memory for alternative behaviors, all which interact and lead to addictive or nonaddictive behavior.

The landscape of gambling has dramatically changed. In addition to more and more jurisdictions having casinos, electronic gambling machines, lotteries and sports wagering in close proximity to individuals, online gambling has dramatically increased. Gambling has moved from being a negatively perceived activity associated with sin and vice to its current state of being viewed as a socially acceptable recreational pastime. Upwards of 80 percent of individuals report having gambled for money during their lifetime, and governments throughout the world have come to recognize that regulated forms of gambling can be a significant source of revenue. While the vast majority of individuals have no gambling-related issues, an identifiable proportion of both adults and adolescents experience significant gambling-related problems. In spite of the growing body of research which has identified many of the risk and protective factors associated with excessive problematic gambling, a limited number of prevention and treatment programs exist. This chapter examines current knowledge concerning the efficacy of existing harm minimization prevention programs and treatment of gambling disorders.

Substance use disorders affect physicians at a prevalence like the general population, yet they are difficult to detect and are inextricably linked to job dissatisfaction and burnout. Often physicians develop complex denial strategies and rationalizations, and shame and stigma prevent them from seeking help. However, when engaged in treatment and monitored through state-level Physicians Health Programs (PHPs), including long term monitoring and systems of accountability, approximately 80 percent will stay sober for and return to work in five years. This continuing care model with long-term monitoring and follow up, if adopted for the general population, may provide a paradigm shifting approach for the treatment of substance addictions, and might be extended to behavioral addictions.

Anhedonia – a diminished interest in, or ability to experience pleasure from, common rewarding stimuli – is implicated in addictive behaviors. Integrative reviews of extant research on the role of anhedonia in understanding addictive behaviors are dated and overlook nonsubstance addictions. This chapter reviews the anhedonia construct, describes theoretical models of mechanisms linking anhedonia to addiction, summarizes and synthesizes the empirical evidence on anhedonia in addictive behaviors in humans, and proposes future research directions. From the literature review and integration, it is concluded that: (1) anhedonia may be a risk factor and consequence of addictive behaviors, (2) anhedonia may increase motivation to engage in addictive behaviors to offset deficient pleasure, and (3) anhedonia is generally correlated with onset, escalation, persistence, and relapse to a variety of addictive behaviors in prior research. Addictive agents, intervention applications, and other topics overlooked in the study of anhedonia in addictive behaviors warrant further inquiry to advance addiction science and practice.

Approximately 23.5 million people in America need assistance for an alcohol, tobacco, or other drug use (ATOD) disorder, although many do not obtain the help that they need. This disorder is extremely difficult to resolve, as it can be hard to make the necessary lifestyle changes to accommodate sobriety. Sometimes, individuals may recover without formalized treatment, otherwise known as natural recovery. Other times, inpatient or outpatient treatment, or partial-hospitalization, is warranted. Even for individuals taking the proper steps and going to treatment, attrition rates are high, with consistent drop-out rates of 30 percent to 40 percent within three months of treatment initiation. Racial and gender disparities in both treatment participation and outcomes exist, indicating a need for tailoring of treatments and further research on breaking barriers to treatment entrance. Motivation is central in several recovery models proposed to explain stages of change in treatment. Treatment options include initial detoxification and pharmacological options (such as medication-assisted treatment using buprenorphine for opioid use disorder), cognitive-behavioral therapy, motivational interviewing, cue exposure, attentional retraining, twelve-step programs, and group/family therapy. Relapse rates are high, and oftentimes individuals move from one addiction to another. Harm reduction approaches may be beneficial to those that cannot fully quit an addiction, and relapse prevention is an important treatment component, as addiction is a life-long battle.