The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

Passion is defined as a strong inclination toward an activity that people like, that they find important, and in which they invest time and energy Two types of passion are proposed: obsessive and harmonious Obsessive passion (OP) refers to a controlled internalization of an activity in one's identity that creates an internal pressure to engage in the activity that the person likes Harmonious passion (HP) refers to an autonomous internalization that leads individuals to choose to engage in the activity that they like HP promotes healthy adaptation whereas OP thwarts it by causing negative affect and rigid persistence Results from four studies involving more than 900 participants from different populations supported the proposed conceptualization

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Les passions de l'ame: on obsessive and harmonious passion.

Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies

OBJECTIVES: This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years METHODS: A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies This method produced more reliable prevalence rates than were available from any single study RESULTS: Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (eg, 39% vs 16% for lifetime estimates of level 3 gambling) Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years CONCLUSIONS: Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders

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Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.

Context An association between dopamine-replacement therapies and impulse control disorders (ICDs) in Parkinson disease (PD) has been suggested in preliminary studies. Objectives To ascertain point prevalence estimates of 4 ICDs in PD and examine their associations with dopamine-replacement therapies and other clinical characteristics. Design Cross-sectional study using an a priori established sampling procedure for subject recruitment and raters blinded to PD medication status. Patients Three thousand ninety patients with treated idiopathic PD receiving routine clinical care at 46 movement disorder centers in the United States and Canada. Main Outcome Measures The Massachusetts Gambling Screen score for current problem/pathological gambling, the Minnesota Impulsive Disorders Interview score for compulsive sexual behavior and buying, and Diagnostic and Statistical Manual of Mental Disorders research criteria for binge-eating disorder. Results An ICD was identified in 13.6% of patients (gambling in 5.0%, compulsive sexual behavior in 3.5%, compulsive buying in 5.7%, and binge-eating disorder in 4.3%), and 3.9% had 2 or more ICDs. Impulse control disorders were more common in patients treated with a dopamine agonist than in patients not taking a dopamine agonist (17.1% vs 6.9%; odds ratio [OR], 2.72; 95% confidence interval [CI], 2.08-3.54; P P  = .14). Additional variables independently associated with ICDs were levodopa use, living in the United States, younger age, being unmarried, current cigarette smoking, and a family history of gambling problems. Conclusions Dopamine agonist treatment in PD is associated with 2- to 3.5-fold increased odds of having an ICD. This association represents a drug class relationship across ICDs. The association of other demographic and clinical variables with ICDs suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies. Trial Registration clinicaltrials.gov Identifier:NCT00617019

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Impulse Control Disorders in Parkinson Disease: A Cross-Sectional Study of 3090 Patients

Background: This study updates prevalence estimates of gambling-related disorders in the United States and Canada, identifies differences in prevalence estimates among population segments, and identifies changes in prevalence over the past 25 years. Method: A meta-analytic strategy guided the synthesis of 180 estimates derived from 146 prevalence studies. Results: Prevalence estimates among adolescent samples were significantly higher than estimates among adult samples for both clinical (level 3) and sub-clinical (level 2) measures of disordered gambling within both lifetime and past-year time frames. Among adults, level 3 prevalence estimates continue to increase significantly. Conclusions: Membership in youth, treatment, and prison population segments is significantly associated with experiencing gambling-related disorders. Understanding sub-clinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Prospective studies of incidence are necessary to determine whether the prevalence of disordered gambling continues to increase among the adult general population and how adolescent gambling experiences change as this cohort ages.

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Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada

This article reviews the extant published and unpublished studies that estimate the prevalence of adolescent gambling problems in North America. The nine nonduplicative studies identified by our literature search included data collected from more than 7700 adolescents from five different regions of the United States and Canada. In addition to comparing the conceptual and methodological differences that exist among these studies, this article employed a meta-analytic strategy to synthesize prevalence estimates from the existing studies. This analysis revealed that within a 95 percent confidence interval, between 9.9% and 14.2% of adolescents are at risk of developing or returning to serious gambling problems. Similarly, between 4.4% and 7.4% of adolescents exhibit seriously adverse compulsive or pathological patterns of gambling activity. Finally, the discussion proposes a generic multi-level classification scheme to reconcile the divergent classification methods and data reporting strategies. This new multi-level approach to reporting gambling prevalence will facilitate interstudy comparisons among existing estimates of gambling prevalence and help to provide a general data reporting system for future research.

Estimating the prevalence of adolescent gambling disorders: A quantitative synthesis and guide toward standard gambling nomenclature.

This project was funded by a grant from the National Center for Responsible Gaming (NCRG), Kansas City, Missouri. The National Center for Responsible Gaming is the first national organization devoted exclusively to funding independent research on problem gambling and underage gambling. The NCRG funds basic and applied research projects selected through a rigorous peer review process. The authors accept full responsibility for the content and conclusions of this report.

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Título: Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Meta-analysis

Problems related to intemperate Internet use are examined within the conceptual framework of addiction. It is argued that empirical support for the construct validity of computer addiction has yet to emerge, that defining the construct as a unique psychiatric disorder is therefore premature, and that, in most cases, excessive computer use may be symptomatic of other, more primary disorders. Greater caution and rigor are urged in investigating and treating problems related to intemperate computer use.

Matthew N. Hall

Papers

Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.

Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada

Estimating the prevalence of adolescent gambling disorders: A quantitative synthesis and guide toward standard gambling nomenclature.

Título: Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Meta-analysis

"Computer addiction": a critical consideration.