1. Behavioral Addictions: Are they Really Addictions? Thomas E. Legere, Ph.D.

2. How do we Decide?

3. Old School: DSM

4. We Need a NEW Model! From THREE Sources…

5. Source #1: The DSM

6. Source #2: What Those Who Suffer From the Disease Say

7. Source #3: Neurobiology

8. Three TYPES of Addictions

9. I. HARD Addictions: Alcohol & Drugs

10. II. SOFT Addictions: Nicotine & Caffeine

11. III. BEHAVIORAL Addictions

12. Three Levels of Addiction: Mild Mild Moderate Moderate Severe Severe

13. Soft Addictions: Soft for a Reason

14. Proposed Behavioral Addictions: Sex Sex Love Love Gambling Gambling Exercise Exercise Eating Eating

15. What Makes them Real Addictions (or not)?

16. Need Common Criteria for Hard Addictions & Behavioral Addictions

17. Honestly: The DSM is Not Buying Behavioral Addictions

18. DSM: Compulsive Disorders Compulsive Disorders Pathological Behavior Pathological Behavior Eating Disorders Eating Disorders

19. Twelve Integrated Criteria (DSM, Experience, Neurobiology)

20. 1. Pleasure Pathway In the Brain

21. 2. Same Brain Chemicals Involved Dopamine Gaba Dopamine Gaba Serotonin Glutamate Serotonin Glutamate Endorphins Cortisone Endorphins Cortisone Norepinephrine Corticotrophin Norepinephrine Corticotrophin Epinephrine Histamine Epinephrine Histamine Enkephalins Anandamide Enkephalins Anandamide Acetylcholine Acetylcholine

22. 3. Tolerance

23. 4. Use to Intoxication: I Cant Stop!

24. 5. Obsessive Dimension

25. 6. Denial

26. 7. Continued Use Despite Adverse Consequences

27. 8. Progressive Escalation of Intake and Problems

28. 9. Repeated Attempts To Control Use

29. 10. Withdrawal

30. 11. Incurable (Only Remission)

31. 12. Effectiveness of 12 Step Program