Sexual internet and physical exercise addictions as

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sexual, internet and physical exercise addictions, as well as with the Barratt Impulsiveness Scale (BIS-11) and Temperamental and Character Inventory – Revised (TCI-R). The Obsessive Compulsive Drinking Scale (OCDS) and Visual Analogue Scale for craving (VASc) were also administered to the AUD sample. Results. 28.4% (n=27) of AUD subjects had at least one BA, as compared to 15% (n=21) of controls ( χ 2 =6.27; p=.014). In AUD subjects, direct correlations between BIS-11 and Compulsive Buying Scale (CBS), Internet Addiction Disorder test (IAD), Exercise Addiction Inventory (IAD) scores (p<.01), between OCDS obsessive and CBS and VASc and CBS, IAD scores (p<.003), were found. BIS-11 (t= 2.36; p=.020), OCDS obsessive (Z=-4.13; p<.001), OCDS compulsive (Z=-2.12; p=.034) and VASc (Z=-4.94; p<.001) scores were higher in AUD subjects with co-occurring BAs. The occurrence of BAs was associated with higher impulsivity traits (BIS-11 scores; OR=1.08; p=.012) and higher craving levels (VASc scores; OR=2.48; p<.001). Conclusions. Our findings emphasize a significant rate of co-occurrence of BAs in AUD. High levels of impulsivity and craving for alcohol seem to be associated with other addictive behaviors. KEYWORDS : Alcohol Use Disorder; Gambling Disorder; behavioral addictions; impulsivity; craving; internet addiction.
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Page 3 of 35 Accepted Manuscript 3 1. INTRODUCTION Gambling disorder is currently conceptualized as a non-substance-related disorder and has been included in the DSM-5 diagnostic category of ‘Substance-related and Addictive Disorders’ (APA, 2013). Though gambling disorder is the most extensively investigated, several other non- substance behaviors bring about a similar form of behavioral reinforcement, producing short-term reward that may trigger persistent behavioral patterns despite adverse consequences (Grant et al., 2010, 2013). Diagnostic criteria have been proposed for compulsive buying (McElroy et al., 1994; Black, 2001), internet addiction (Young, 1996; Shapira et al., 2000), sexual addiction (Goodman, 1993; Keane, 2004) and physical exercise addiction (Hausenblas and Symons Downs, 2002). Behavioral addictions (BAs) share important features with substance use disorders (SUDs): persistent and maladaptive engagement in the behavior despite possible harm to oneself and/or others, excessive time spent and diminished control over the behavior, increasing sense of tension or excitement before performing the behavior, a sense of pleasure and gratification or relief when performing the behavior or shortly after (Frascella et al., 2010; Marazziti et al., 2014). Also, like SUDs, BAs present the phenomena of tolerance, withdrawal and craving. In particular, craving has re-emerged as a fundamental construct in the pathophysiology of addictive behaviors with its inclusion in DSM-5 as a key clinical symptom of addictive disorders (APA, 2013). Similar predispositions (neurobiological, genetic, environmental) underlie the development and maintenance of both substance and behavioral addictions, so that pathophysiological models for drug addiction may be relevant to BAs as well (Potenza, 2008). Natural rewards and abused substances appear to induce similar activity in reward circuitry (i.e., the mesolimbic dopamine
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