7.5 Process Addictions, Technology Use & Their Systemic Impact

What the Outline Requires and What the Manual Recognizes

The content outline requires assessment of "process use disorders (e.g., gambling, internet use, technology use, shopping)." The diagnostic manual is considerably more conservative, and the exam tests the gap.

• Gambling disorder is the sole behavioral addiction placed with substance-related and addictive disorders in DSM-5-TR, on the evidence that it activates reward systems comparably to substances and produces similar tolerance and withdrawal-like phenomena. It requires four or more of nine criteria in a twelve-month period, with severity specified as mild, moderate, or severe by criterion count, and with episodic or persistent and in-early or in-sustained-remission specifiers.
• Internet gaming disorder appears in Section III as a condition for further study, meaning it is not a codable diagnosis.
• Compulsive buying, compulsive sexual behavior, and general problematic internet use are not DSM-5-TR diagnoses. Note that the World Health Organization's ICD-11 does recognize gaming disorder and compulsive sexual behaviour disorder, which is why sources appear to conflict.

The testable rule is straightforward: assess and treat the functional impairment regardless of whether a code exists, and do not assert a diagnosis the manual does not support.

The Nine Gambling Disorder Criteria

Worth knowing because they generalize to the family patterns other process addictions produce: needing to gamble with increasing amounts to achieve excitement; restlessness or irritability when attempting to cut down; repeated unsuccessful efforts to control or stop; preoccupation; gambling when distressed; chasing losses by returning another day to get even; lying to conceal extent of involvement; jeopardizing or losing a significant relationship, job, or opportunity; and relying on others to provide money to relieve desperate financial situations.

Two of those nine — lying to conceal and relying on others for money — are explicitly relational, which is why the exam treats gambling as a family disorder rather than an individual one.

Systemic Patterns Process Addictions Produce

Financial devastation with delayed detection. Unlike substance use, gambling and compulsive shopping often produce no visible physical signs. Families frequently discover the problem only through a foreclosure notice, a repossessed vehicle, a drained retirement account, or a call from a creditor. The discovery is experienced as a betrayal event structurally similar to infidelity, and it is often treated that way clinically: the injury is to trust and to the couple's shared reality, not merely to the balance sheet.

Accommodation that maintains the behavior. Families reduce their own distress by paying debts, covering absences, taking over the household's finances entirely, or lying to extended family. Each of these relieves the immediate crisis and removes the natural consequence that would otherwise create pressure to change. Reducing accommodation is a core intervention target and must be done in a planned, negotiated way rather than as an abrupt withdrawal of support.

Role reorganization. A partner becomes financial controller, an adult child becomes creditor, and the person with the disorder occupies a dependent position that further erodes standing in the family.

Concealment and the erosion of shared reality. Sustained lying about money produces the disorienting experience of having doubted one's own perception. Recovery work commonly requires transparency structures — joint account access, spending disclosure, and third-party financial oversight — that function like the transparency agreements used after infidelity.

Technology Use in Families

Task 02.12 and knowledge area 62 both point at technology. The exam's stance is that conflict about technology is rarely about hours.

Assess four dimensions rather than duration alone:

1. Displacement. What has the use replaced — sleep, meals, homework, sex, conversation, exercise?
2. Boundary function. Is the device being used to regulate distance in a relationship, to avoid conflict, or to maintain a secret channel?
3. Content and risk. Gambling applications, sports betting, harassment, contact with a person outside the relationship, or exposure to extremist or self-harm content.
4. Impairment. Job, school, financial, health, and relational consequences.

Family interventions that work are structural rather than numerical: device-free zones and times that apply to every member including the parents, shared charging locations outside bedrooms, and negotiated agreements about which channels are private and which are transparent. Parent-imposed limits that exempt the parents predictably fail and generate additional conflict, and the exam rewards options that place the rule at the level of the family system.

Two specific risks recur in vignettes. Legalized sports betting and in-app purchasing have compressed the timeline from first use to significant financial harm, particularly for adolescents and young adults, so financial screening belongs in adolescent assessment. And secret digital channels — a hidden messaging account, a dating profile, a private financial account — function as boundary violations whether or not any physical contact occurs.

Assessment and Treatment

Screen directly and without euphemism. For gambling, the two-item Lie/Bet screen — have you ever had to lie to people important to you about how much you gambled, and have you ever felt the need to bet more and more money — is a widely used brief screen, with the South Oaks Gambling Screen and the Problem Gambling Severity Index available for fuller assessment.

Treatment integrates individual and systemic components:

• Cognitive-behavioral work targeting the cognitive distortions specific to gambling: the gambler's fallacy, illusion of control, near-miss effects, and chasing.
• Motivational interviewing given the ambivalence characteristic of behavioral addictions.
• Financial containment through restricted account access, third-party oversight, and formal debt counseling. Note that a therapist provides referral to debt counseling rather than financial advice, which falls outside scope of competence under AAMFT Standard 3.10.
• Self-help and family mutual aid such as Gamblers Anonymous and Gam-Anon.
• Systemic work on accommodation, transparency, betrayal repair, and the redistribution of financial roles.

Comorbidity is high and must be screened: substance use disorders, mood and anxiety disorders, and attention-deficit/hyperactivity disorder all co-occur with gambling disorder at elevated rates. Suicide risk is meaningfully elevated in gambling disorder, particularly following a large loss or a disclosure event, and task 02.03 makes that screening mandatory rather than optional.