Behavioral Addictions Clinic

Behavioral addiction is a form of addiction that involves a compulsion to engage in a rewarding non-drug related behavior despite negative consequences to the person's physical, mental, social, or financial well-being. Types of behavioral addictions addressed in the behavioral addictions clinic (BAC) include gambling, compulsive sexual behavior (e.g., frequent sexual partners, problematic use of pornography), binge eating disorder, excessive internet use, (e.g., online shopping, playing video games), and compulsive buying. Rates of gambling disorder and compulsive sexual behavior (i.e., dysregulated sexual behaviors; e.g., excessive use of pornography, frequent casual sexual partners) are higher among Veterans than non-Veterans. There is growing demand for behavioral addiction treatment services within VHA, particularly among returning combat Veterans. The BAC provides cutting-edge training to the addictions postdoctoral resident on the assessment and treatment of behavioral addictions which commonly co-occur with conditions such as PTSD, sexual trauma, substance use, and anxiety among Veterans. The BAC operates on a short-term treatment model where the focus of the individual and group treatment services is on assisting Veterans to obtain mastery over the problematic behaviors for which they have been referred. After successful completion of the BAC treatment services, the Veterans are then referred to their main treatment providers to address other remaining mental health service needs as appropriate. The BAC is the only specialty outpatient clinic in VHA that focuses the training for residents on best practices for assessing and treating problem gambling, compulsive sexual behavior disorder, and binge eating disorder, and it has been recognized as a leader in VHA for assessing and treating behavioral addictions. Residents have the opportunity to be trained in effective brief treatments for behavioral addictions, including acceptance commitment therapy, cognitive behavioral therapy, and mindfulness-based relapse prevention. Residents will also gain experience conducting intakes and assessments, engaging in differential diagnosis pertaining to behavioral addictions, providing clinical consultations to providers, and providing brief individual and group psychotherapies as well as psychoeducation for Veterans. The BAC is staffed by psychologists, licensed independent clinical social workers, and an addictions psychiatrist.

• Demonstrate an understanding of screening, assessment, diagnosis, and recommended treatment approaches for behavioral addictions including gambling disorder, binge eating disorder, compulsive sexual behavior, compulsive shopping, and gaming disorder. 
• Complete initial diagnostic evaluations for patients referred to clinic and provide clinically appropriate treatment recommendations. 
• Provide individual psychotherapy to a panel of Veterans with behavioral addictions and possible comorbid mental health conditions. 

• Demonstrate an understanding of ACT, CBT, and mindfulness-based approaches for behavioral addictions. 
• Successfully recruit for and lead at least one psychotherapy group related to behavioral addictions. 
• Present case conceptualizations to interdisciplinary team and/or present on role of medication management and emerging research related to specific behavioral addictions. 
• Effectively evaluate and understand risk in the context of behavioral addiction 
• Gain a deeper understanding of differential diagnoses among impulse, obsessional, and addictive disorders.