Social judgments of behavioral versus substance-related addictions: A population-based study

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.