Psychiatrist Jon Grant, AM’87, is helping treat and raise awareness of behavioral addiction.
One more episode of your favorite show, another doughnut, those new shoes you’re dying to have—cravings like these can be hard to resist. But for some, saying no is nearly impossible. Jon Grant, AM’87, is a professor of psychiatry at UChicago who studies and treats behavioral addiction (also called impulse-control disorders), which affects an estimated 10 to 15 percent of the global population annually. For his patients, relatively commonplace activities, such as shopping, eating, or internet surfing, have become all consuming. Many arrive in his office facing financial ruin, legal trouble, or serious marital problems. “These conditions can be difficult for other people to understand,” Grant and his coauthors write in Why Can’t I Stop?: Reclaiming Your Life From a Behavioral Addiction (Johns Hopkins University Press, 2016), a book that examines some of the most prevalent types of impulse-control disorders. While sufferers’ actions may look willful, they “cannot just stop—at some point the behavior has become ingrained, compulsive, and, frequently, beyond their control,” the authors explain. It takes professional intervention (typically therapy and sometimes medication) to bring relief. Grant has published dozens of articles about pathological gambling and directs UChicago’s Addictive, Compulsive, and Impulsive Disorders Research Program. But when he first got interested in gambling addiction as a medical student 20 years ago, doctors didn’t know what to make of the phenomenon. They debated whether it was a symptom of another disorder—or if it was a mental health issue at all. Today doctors have a much better understanding of the problem. It’s now known that compulsive gambling runs in families, for instance. And children of alcoholics have a heightened risk of both alcoholism and compulsive gambling, suggesting a genetic link between the two disorders. Grant’s own research has shown that naltrexone, a drug usually used to treat opioid addiction, can lessen the urge to gamble. Gambling addiction is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), along with compulsive stealing, grooming, and online gaming. But some of the other issues Grant studies, such as compulsive sexual behavior and internet addiction, are not. What’s included in the DSM—the American Psychiatric Association’s official compendium of mental illnesses—can have practical ramifications for patients, like whether their health insurance will cover the cost of treatment. (Providers can often sidestep insurance limitations by using one of the DSM’s “catchall” diagnoses.) Grant says he understands skeptics’ hesitation to classify these behaviors as addictions and include them in the DSM, and the reluctance to “glibly pathologize something that might not merit it.” Still, however it’s labeled by the medical community, his patients’ distress is real. Grant argues that including more impulse-control disorders in the DSM will raise awareness of these afflictions and convince more people to seek treatment. Without a clear set of diagnostic criteria, patients often “feel less legitimate,” he says. In their early stages, behavioral addictions can be hard to spot. Family doctors typically ask patients about drug, alcohol, and tobacco use but almost never about behaviors like gambling. Addicts can easily justify their actions by pointing out that everyone else is shopping and overeating too. This sense of denial is typical of internet addicts—after all, they argue, aren’t we all fixated on our phones? Grant says internet addiction is a growing part of his practice and is especially prevalent in young adults. He’s seen college students who, unable to tear themselves away from their browsers, failed an entire semester, and “now all heck is breaking loose and they really do need help.” Internet and online gaming addictions aren’t well recognized in the United States, but South Korea began taking the issue seriously after several deaths related to internet binges. (In one disturbing case, a three-month-old South Korean girl died of malnutrition; her parents regularly left her alone for 10-hour stretches while they went to internet cafés.) The Korean government has since introduced public education campaigns about the dangers of excessive internet use. Behavioral addictions may be dangerous, but, Grant stresses, they can be overcome. Cognitive behavioral therapy, which focuses on changing patterns of thought and behavior, is especially helpful. And Grant’s lab is currently investigating medications that may ease symptoms of these disorders—making unbearable urges less painful, and a normal life more possible.