Substance and behavioral addictions-Two sides of the same coin: Commentary on Grubbs and Boness (2025)

Comments on the article by J. B. Grubbs and C. L. Boness (see record 2025-66167-001). We read the correspondence with interest and agree that the label "behavioral addictions" (BA) should be applied with care to avoid trivializing genuine addictions. However, in arguing that we should move past substance use disorder (SUD) paradigms the authors highlight known concerns that BA researchers appreciate, and we contend there are at least seven flaws in their viewpoint article. First, we are unaware of BA researchers claiming that the frequency of engagement in a behavior equates with dysfunction. Second, SUDs also vary in "boundaries" of when the use is a "passion" versus when it is an "addiction." Third, one might note that SUDs involve both a substance component and a behavioral component (preparation to engage in substance intake), both of which may alter neurobiological function. Fourth, researchers do engage in qualitative work eliciting self-reports and lived experiences of BA. Fifth, the authors do not discuss the neurobiological underpinnings of BAs. Sixth, the authors fail to note statements made expanding the concept of SUD beyond physiological tolerance and withdrawal (e.g., Leshner, 1997). Finally, the criteria now used to apply to substances are acknowledged to apply to behaviors (American Psychiatric Association, 2013). While insurance companies may not want to pay for treatment for BAs due to the increased prevalence of disordered behavior needing assistance, that does not mean that negatively consequential addictive behaviors do not exist or that they cannot be treated in the absence of established diagnostic criteria (Sussman & Sinclair, 2023). Frankly, the evidence for the existence of BAs is overwhelming at this point. (PsycInfo Database Record (c) 2025 APA, all rights reserved).