Search

Background: Recently, the concept of addiction has expanded to include many types of problematic repetitive behaviors beyond those related to substance misuse. This trend may have implications for the way lay people think about addictions and persons struggling with addictive disorders. The aim of this study was to provide a better understanding of how the public understands a variety of substance-related and behavioral addictions. Methods: A representative sample of 4,000 individuals from Alberta, Canada completed an online survey. Participants were randomly assigned to answer questions about perceived addiction liability, etiology, and prevalence of problems with four substances (alcohol, tobacco, marijuana, and cocaine) and six behaviors (problematic gambling, eating, shopping, sexual behavior, video gaming, and work). Results: Bivariate analyses revealed that respondents considered substances to have greater addiction liability than behaviors and that most risk factors (moral, biological, or psychosocial) were considered as more important in the etiology of behavioral versus substance addictions. A discriminant function analysis demonstrated that perceived addiction liability and character flaws were the two most important features differentiating judgments of substance-related versus behavioral addictions. Perceived addiction liability was judged to be greater for substances. Conversely, character flaws were viewed as more associated with behavioral addictions. Conclusions: The general public appreciates the complex bio-psycho-social etiology underlying addictions, but perceives substance-related and behavioral addictions differently. These attitudes, in turn, may shape a variety of important outcomes, including the extent to which people believed to manifest behavioral addictions feel stigmatized, seek treatment, or initiate behavior changes on their own.

There is currently no well-validated measure that assesses a broad spectrum of substance-related and behavioural addictions in general populations. This study aimed to develop a brief self-attribution Screener for Substance and Behavioural Addictions (SSBA) to screen for four substances and six behaviours, and to compare its performance with established individual-behaviour screening instruments.A small, psychometrically optimal set of items to assess self-attributed indicators of addiction across alcohol, tobacco, cannabis, cocaine, gambling, shopping, videogaming, overeating, sexual activity and overworking were identified from a broader pool that was developed using a lay epidemiology qualitative approach. The suitability of the four-item single-factor solution was tested for each behaviour and scores were compared with those obtained from the sample using individual-behaviour screening instruments.Participants (n = 6000), broadly representative of the Canadian English-speaking adult population, were recruited through the Ipsos Reid Canadian Online Panel.Participants completed an item pool of 15 indicators of addiction for each target behaviour and a validation instrument for one randomly assigned behaviour.A set of four items identified using principal component and confirmatory factor analyses demonstrated good fit and excellent internal consistency (α = 0.87-0.95) across behaviours, and good convergent validity (rs = 0.44-0.8) with extant instruments measuring similar constructs, with only one exception (r = 0.26).The proposed Screener for Substance and Behavioural Addiction is a reliable and valid measure assessing the lay public's self-attributed indicators of addiction across 10 substances and behaviours.

Pre-print version of article deposited according to Informa Healthcare's Resources for Editors and Authors page: http://informahealthcare.com/page/resources/authors, Objectives: To describe absolute and relative prevalence of 10 self-attributed substance-related and behavioural addiction problems among Canadian adults, to describe perceived prevalence of these problems in the general population, and to examine whether estimates varied by survey mode. Methods: Sample 1 included 4000 adults recruited from an online research panel; Sample 2 included 2000 randomly selected adults who completed a computer-assisted telephone interview. Respondents in both samples were asked (1) whether or not they had experienced a problem in the preceding year with each of four substances (alcohol, tobacco, marijuana, and cocaine) and six behaviours (gambling, eating, shopping, sex, video gaming, and work), (2) whether they had ever personally knew someone exhibiting a problem with each behaviour, and (3) perceived prevalence of problems in the general population. Results: About half of the respondents reported experiencing any past-year addiction problems. Tobacco and alcohol were the most common substance-related problems, while the most common behavioural problems were related to eating and work. Respondents consistently overestimated perceived population prevalence relative to self-attributed problems; however, the magnitude of overestimation was significantly greater among those who personally reported a problem with these behaviours. Online survey participants consistently reported higher self-attributed problem rates compared with CATI respondents, but rank-order correlations across self-, acquaintances-, and population-attributed prevalence estimates were very high in both samples. Conclusions: Both survey modes provided accurate relative prevalence estimates, but further research should explore determinants of higher prevalence rates among online participants and respondents’ consistent tendency to overestimate perceived population prevalence.

Publisher Summary This chapter discusses how people experiencing addictions are incapable of making treatment decisions, explaining how treatment provided under mandates is effective. Addiction treatment programs have traditionally adopted the view that clients are sufficiently impaired and concerned by their problems to seek help voluntarily. However, the case-mix has shifted over time, and mandatory treatment pathways are becoming increasingly entrenched in addiction treatment programs and policies around the world. Evidence indicates that at treatment entry, mandated clients often differ from self-referred clients with respect to age, problem severity, personal characteristics, criminality, employment, and motivation for treatment. It is incumbent upon advocates of mandated treatment to address whether treatment under legal, formal, and informal mandates is better than exposure to no treatment at all. Thus, policy makers and treatment providers must take into account the sizeable body of research that has accumulated documenting remission of addictive behaviors without treatment intervention. Additional research is needed to explore how neurocognitive impairments vary in relation to phenotypic heterogeneity with respect to context of drug use, addiction history, treatment history, and time. It will also be important to investigate the shift to a more process-oriented approach of competency assessment and evaluate what impact such an approach might have on the development of client–counselor rapport and client outcomes in treatment.

Publisher Summary People who seek addiction treatment, their friends, and family members, along with professionals who provide treatment services and those who pay for programs and services, all expect that exposure to treatment will reduce alcohol and other drug misuse, reduce the devastating health and social problems that typically accompany addictions, and improve alcohol and drug misusers' quality of life. Every one of these stakeholders can and should demand that the kinds of treatment offered in addiction programs and services and effectiveness, and that ongoing efforts should be made to monitor and improve service delivery and outcomes facilitated by treatment providers. By illuminating the active ingredients that transcend treatment modalities, researchers have an opportunity to substantially improve all substance abuse treatment approaches.