When Behavior Becomes Addiction: What Clinicians Need to Know

In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. Emily Brunner explore behavioral addictions—including gaming, gambling, sex, and social media. They discuss how these behaviors impact the brain, how they present clinically, and how to recognize and treat them using evidence-based approaches. The episode emphasizes the importance of validating these conditions and offering appropriate care. 

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Peter Selby, MBBS, CCFP(AM), FCFP, FASAM 

Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.

Expert

Emily Brunner, MD, DFASAM 

Dr. Emily Brunner is board-certified in family medicine and a distinguished fellow in addiction medicine. She has experience treating addiction in both inpatient and outpatient settings. She specializes in trauma-informed clinical treatment of substance use disorders with a comprehensive and compassionate approach. Dr. Brunner has been involved in leadership of the Minnesota Society of Addiction Medicine and is now on the national board of the American Society of Addiction. She is a passionate advocate for improving the care of patients with substance use disorder across the healthcare system, specifically in advocating for increased utilization of medications for opioid use disorder across all levels of care. Minnesota Magazine recognized her as a Top Doctor for Addiction Medicine in 2020 and 2021. She is the medical director of Gateway Recovery and Recovering Hope and does training on behalf of the Hazelden Betty Ford Foundation. 

📖 Show Segments

• 00:05 - Introduction 
• 02:03 -  How Behavioral Addictions Compare to Substance Use Disorders
• 04:18 - Clinical Presentation and Initial Screening
• 06:19 - Emerging Neuroscience and Research
• 09:15 - Diagnostic and Screening Tools
• 12:56 - Patient Experience in the Healthcare System
• 14:13 - Evidence-based Interventions
• 19:11 - Co-occurring Conditions and Risk Factors
• 21:14 - Advice to Clinicians
• 23:40 - Regulation and Future Directions
• 25:53 - Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Behavioral Addictions are Real Diseases: Behavioral addictions such as gaming, gambling, and social media are increasingly recognized as legitimate disorders. They share similar brain mechanisms and clinical presentations with substance use disorders, including loss of control, impaired functioning, and continued use despite harm. 
• Emerging Neuroscience: Studies using fMRI have shown changes in brain structures in gaming and gambling disorders similar to those in substance addiction. 
• Screening and Diagnosis: Various validated screening tools exist for different behavioral addictions; it is crucial to familiarize oneself with and integrate them into clinical practice. 
• Treatment Approaches: Evidence-based treatments include cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management. Additionally, certain medications, such as naltrexone and bupropion, have also shown some evidence of effectiveness. GLP-1 agonists may be another option in the future.  
• Co-Occurring Conditions: Individuals with behavioral addictions often have co-occurring mental health issues such as anxiety, depression, and other substance use disorders. 
• Regulatory Needs: There is a need for better regulation to protect young people from addictive technologies and predatory behaviors. 
• The Importance of