Behavioural addictions: common features and treatment implications

Marks' editorial is welcome in that is suggests common treatment approaches for chemical and behavioural addictions, namely, exposure and relapse prevention. There are other common features of addictive substances or activities which may explain their addictive potential: they act as operant reinforcers and as Pavlovian unconditioned stimuli, tolerance develops, an initial positive mood is followed by dysphoria and addictions are stimulated by common states (arousal, stress, pain). Most of Marks' features are not unique to addictions but apply to primary drive states (normal eating, sleeping, elimination, sex) and many apply to normal goal-orientated behaviour. Normal repetitive behaviour is more flexible than addictive behaviour, in allowing satisfactory substitution of alternatives. The restrictive range of activities which are satisfactory for the addict suggest that building up the behavioural repertoire may help in prevention and rehabilitation. Tics and Tourette's syndrome should not be regarded as addictions, since they involve simple, involuntary and non-goal-directed behavioural sequences. Considering addictions as goal-directed is important: addicts are often ambivalent about whether they want to give up or continue. This often underlies dropout and relapse. Treatment must address this issue.