Taking out your mobile to compulsively swipe between one application and another while waiting for the subway is not the same as having an anxiety attack when you run out of battery or internet connection. Nor can you compare playing video games late with eating and taking a shower due to the impossibility of leaving a game unfinished. In one case, these are people who have developed an intense bond with activities that give them pleasure and which they do not want to give up. In the other, we talk about pure addiction: it’s not that they don’t want to quit, it’s that they can’t.
“The problem is that today people call anything ‘addiction’, but it is much more complex. If you take out your mobile and start looking at the screen while you talk to another person, you are not addicted, you are simply rude”, says Francisco Ferre Navarrete, director of the AdCom clinic, the first public center for prevention, treatment and research in behavioral addictions at the Institute of Psychiatry and Mental Health of the Gregorio Marañón Hospital, which opened its doors on July 26. After its first week of activity, it already has 15 patients —75% of the people who participated in the first screening—, who are going to start treatment against addictions to sex and online gambling, and compulsive shopping.
Understanding the difference between abuse and dependency is essential to avoid minimizing a problem that affects between 3% and 4% of Spaniards. For this reason, the first objective of the Ferre team ―made up of an adult psychiatrist, a child and adolescent psychiatrist, a clinical psychologist, a mental health specialist nurse and a social worker― is to clarify whether a behavior, which in some cases it can be perceived as annoying or problematic, it represents a symptom of an addiction. From dependence on gambling in bookmakers, to compulsive purchases, through addiction to sex and new technologies such as social networks. In short, all addictions that do not include the consumption of substances – such as drugs and alcohol – and that, however, have exactly the same consequences in the life of those who suffer from them.
In addition to offering immediate help to people from Madrid who suffer from addiction, the AdCom center aspires to become an international reference in the field of research. “Once we start operating at full capacity, we are talking about being able to screen about 100 people a week,” says Ferre. “A year from now we will have data on more than 4,000 patients. It is an exceptional sample to advance in a field that remains difficult to investigate”.
The first step is problem detection. People from Madrid who believe they have an addiction or a mental disorder can make an appointment to access the screening directly from the website or the Virtual Health Card application, without going through the filter of the family doctor or the health center. “In this way there is no stigma, many times it is embarrassing to admit to another person that you suffer from an addiction. From a psychological point of view, it is very important that it is the patient himself who decides to take a step forward. Recognizing that help is needed is essential for treatment,” explains Mercedes Peña, the center’s nursing supervisor.
During the first week of AdCom’s life, 20 potential patients have already gone through the screening phase. They are mostly adults: only one of them was a minor, a circumstance that does not surprise specialists. “The children are on vacation and live much more relaxed. Surely after the summer we are going to have many cases of video game addictions”, clarifies Ricardo Miguel Hodann, the clinical psychologist.
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Once summoned, the screening process is carried out in person in a room of the hospital’s Institute of Psychiatry. Adults fill in the questionnaires directly from their mobile with the Madrid health service application, while children are provided with a tablet. The questions – to which one answers with a “yes” or “no”, or marking values that go from “never” to “very often” – identify whether the potential patient suffers not only from some type of behavioral addiction, but also to substances or mental health disorders, such as anxiety or depression.
Red lines between abuse and addiction
“Clearly, not all screenings are going to end up in a diagnosis of addiction,” emphasizes Ferre, who insists that the percentage of the population that suffers from a dependency does not usually exceed 4%, although it rises to 5% in the case of video game addictions among the youngest. “If the first screening has resulted in such a high percentage of addictions, it is probably because the clinic has just opened and these patients have seen hope in it.”
On a psychological level, there are four signs that indicate the transition to addiction. It begins with an excessive dedication to a behavior, until tolerance is reached ―that is, it is necessary to increase more and more the time dedicated to the addiction to achieve stimulation. If for some reason the addict is deprived of that behavior, he begins to suffer great physical and psychological discomfort, which is known as withdrawal.
The last sign is the negative consequences that this behavior has on the patient’s life. “Spoiling the family, having problems at work or losing it… you don’t have to have an alcohol dependency to get that far. Those who have a shopping addiction can end up spending their entire salary on objects that they accumulate at home without being worn, get into debt up to their necks and fall into depression”, explains psychiatrist Marisol Roncero Rodríguez, who during her career has treated many cases of compulsive purchases , an addiction that mainly affects women.
In case of detecting a problematic use, “the yellow card of addictions”, the social workers of the center will provide information on support groups to be able to control the risk of dependency. If the yellow card becomes red, the patient is summoned to the center for a more exhaustive evaluation and to start treating the addiction he suffers. “From the first evaluation, the patient is offered a therapeutic plan that goes from 12 to 24 weeks, with psychiatric treatment and individual or group psychotherapy”, explains Hodann.
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