Addictions are primarily diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM, currently DSM-IV)1 according to which substance abuse and dependence are distinct categories—throughout this review, we use the term ‘addiction' to refer to substance abuse or dependence. Proposed changes to the DSM system of nomenclature (DSM-5, http://www.dsm5.org/Pages/Default.aspx) may eliminate the distinction between abuse and dependence, replacing it with a single category of substance use disorder (see Box 1 for diagnostic criteria).4 Also proposed for DSM-5 is the addition of ‘behavioral addictions'.5 A number of candidate behavioral addictions were considered, such as compulsive internet use (for example, gaming), sexual activity or shopping, but the only behavioral addiction that is currently formally codified is disordered gambling. This decision was based, in part, on symptomatic and neurobiological similarities between disordered gambling and substance use disorders6 and the more developed research base for disordered gambling than for the other behavioral addictions.
