Exploring the prevalence of and risk and protective factors associated with behavioral addictions
among alcohol and substance use disorder treatment populations.

Authors: Eric Shanazari, Steve Sussman, Xiao Zhang, Lizbeth Becerra, Jennifer B. Unger, Artur
Galimov, Deborah L. Sinclair, Leah Meza, Myriam Forster

Background: Approximately 17% of Americans have been diagnosed with a substance use disorder (SUD) and 10% with an alcohol use disorder (AUD). While research is scant, it is estimated that as many as half of the SUD/AUD treatment-seeking population has a comorbid behavioral addiction (BA). Because BAs (e.g., sex, food, gambling) can increase risk for relapse and decrease quality of life, research is needed to identify risk and protective factors for BAs among adults receiving SUD/AUD treatment. This study explored the prevalence of comorbid BAs among adults within the first 90 days of treatment and the associations among adverse childhood experiences (ACE), recovery capital (internal/external resources necessary to initiate
and sustain recovery from addiction) and BAs.

Methods: Data are online survey responses from adults (N=274) in 11 AUD/SUD treatment centers located in four states. Respondents reported past 6-month BAs, ACE, and recovery capital (BARC), using valid and reliable instruments. Regression models tested the hypothesized association between ACE, recovery capital, and BAs.

Results: The sample was 51% male, on average 36 (SD=4.13) years old, and ethnically diverse- Non-Hispanic White (47%), Hispanic (35%), African American (10%), Multiethnic (5%), and Asian/Pacific Islander (3%). Over one-fourth (28%) reported one BA, while nearly half (44%) acknowledged multiple BAs. The most common BAs were exercise (27%), internet (26%) food (22%), sex (20%), and gambling (20%). Every additional ACE was associated with higher incidence rates of BAs (IRR:3.36, 95% CI:2.39,4.72) whereas higher recovery capital scores
were associated with lower incidence of BAs (IRR:0.98, 95% CI: 0.97, 0.99).

Conclusion: Comorbid BAs among this SUD/AUD treatment population were common, especially among respondents with a history of ACE. Promising treatment approaches may nclude having providers consider the role and remediation of BAs in AUD/SUD treatment best practices, and foster building recovery capital by addressing childhood trauma.