The COVID-19 pandemic is having far-reaching effects on global health, economy, and ways of life. The virus has now infected more than 4 million people worldwide, killed hundreds of thousands, and led to shutdowns and other major initiatives to limit the disease spread. Half of the world’s population is living under restrictions more like quarantine than life beforehand. International border crossings have been closed, and legitimate and illicit drug-related economic activity has declined drastically .
Social isolation, fear, and anxiety make existing psychiatric and addiction problems worse, cause new cases, and relapse of cases in remission. Drug trafficking relies heavily on growing, harvest, preparation, trans-shipment, and smuggling across borders to regional and local dealers. All have been disrupted by the current crisis.
Prescription drugs that are also abused utilize M.D.s and other providers for supplies and then re-sellers. Counter-narcotics efforts are being more successful as borders have closed, farm supply has decreased, and generally, drug flows into the U.S. have fallen. The supply chain from U.S. borders to the user has been disrupted.
Governmental initiatives to counter the COVID-19 pandemic have affected the production and trafficking of illicit drugs to consumers. Heroin, cocaine, and other drug shortages, as well as the loss of disposable funds to spend on drugs, have been reported by the U.N.
Following on this disruptive trend, we have seen increases in synthetic drug use, alcohol use, high fat, junk, and sugar-filled foods. We have also seen increases in compulsive gaming, internet gambling, and pornography use.
As the coronavirus shutdowns continue, less money is being spent on fresh or organic foods. A big trend in healthy living and eating has been reversed in a few weeks. Americans are choosing fat-dense and comfort foods, sugary cereals, junk food, frozen pizza, and other unhealthy items to help them emotionally get through the epidemic .
Not only overeating sugar and junk foods, but also drinking and behavioral addictions are increasing at alarming rates. Stay-at-home quarantines related to the coronavirus (COVID-19) pandemic have led to significantly raised alcohol and cigarette consumption hand and hand with junk foods, online pornography, gambling and gaming in what has been called the perfect storm . New data is supporting these early observations.
The best new work in this area of behavioral addictions research is the work being done by Yale University School of Medicine’s Dr. Marc Potenza. I will review this new work and put it into context.
Behavioral Addiction & Gambling
Gaming and gambling disorders are common. Outlets for live gambling have disappeared as COVID-19 related shutdown of casinos across the United States, and most live horse racing has stopped . These shutdowns have been only part of the problem for gamblers as professional sporting events have been put on hold.
Gambling and also sports betting have been online for years, in the right place and time when COVID 19 forced the closure of physical gambling locations. With casinos closed across the country and sports betting drying up, online casino-style gambling is proving to be a winner for the industry .
Casinos have remained closed as have most venues for live gambling. Thus far, increased online gaming has escaped scrutiny as a problem. There are so many problems associated with isolating and spatial distancing that gambling online is just not on the radar.
Internet gambling revenues in New Jersey alone, rose 66%, to $65 million in March. New Jersey, a leader in internet gambling, offers typical online gambling, including slots as well as table games like blackjack.
Experts have blamed the absence of opportunities to bet on live sports as the trigger for online gambling to expand. This change to online casino games and slot machines are of great concern because they are more likely to trigger compulsive users and carry higher rates of addiction.
Online gambling, is one of the biggest winners of the shutdown, alongside services such as food delivery. Internet gambling has soared in New Jersey. The Golden Nugget, New Jersey’s leader in internet gambling revenue, brought in over $177 million last year.
Just last year, Atlantic City casinos won nearly $483 million online , an increase of almost 62% over 2018 levels. Including in-person casino games and sports betting money, the casinos won $3.46 billion last year .
Hard Rock Atlantic City recently added remote-controlled slot machines that players can activate and play from home. It also offers traditional internet gambling. Morgan Stanley  analyst says the impact of Covid-19 could spur more states to legalize online casino and sports betting.
Even among occasional gamblers, more than half of respondents said they had sustained or increased their level of gambling. Gambling disorder is increasing. It is the only behavioral addiction (as opposed to substance use) identified in DSM-5.
Alcohol relapses have increased among those in recovery but also in the general population. Drinking has grown as a self-medication for stress, anxiety, and despair, but also, alcohol use may increase gambling in gamblers.” . Protracted periods of social isolation and technology-based activity pose the danger of solidifying unhealthy lifestyle patterns, leading to difficulties in readaptation when the COVID-19 crisis has passed.
A growing field with audiences in the millions, and over $1 billion in revenue as of 2019, is e-gaming sports. In these events, people play video games online competitively. No audience or venue is needed, and people can watch and participate with a smartphone or laptop.
These gaming events can grow in an environment of quarantines. Experts have concluded that increased consumption of digital entertainment, particularly online gaming and related activities (e.g., esports viewing and videogame streaming) , has accompanied this pandemic.
For example, Verizon, a US-based telecommunications provider, reported a 75% increase in online gaming activity coinciding with initial stay-at-home directives. In Italy, a 70% increase in Fortnite-gaming-related internet traffic was reported.
Steam, a leading gaming distributor, reported more than 20 million concurrent active users, the most in its 16-year history, and live-streaming platforms YouTube Gaming and Twitch reported a 10% increase in viewership. The World Health Organization (WHO) has expressed support for the gaming industry’s online social media campaign that incorporates WHO messaging about coronavirus prevention guidelines in conjunction with encouraging online gaming. However, recent WHO mental health information (#HealthyAtHome – Mental Health) recommends balanced screen time and gaming .
We are starting to open up slowly, but the current national coronavirus quarantine has meant different things to different people. Fear and stress are linked to addictive behaviors. According to Potenza, there can be little question that the social distancing around coronavirus or COVID-19 has been a very stressful interruption of the daily routine for many . “For patients with substance use disorders, compulsive gambling, pornography use, or problematic internet gaming disorder, the quarantine is anything but safe. It is fraught with danger. ”
Recent data suggest that half of the current online gamblers have just opened a new online account during the pandemic. Regular online gamblers are gambling more during this coronavirus crisis. More than a third of regular gamblers describe gambling too much or developing an addiction.
The Swedish government is introducing limits on how much bettors are allowed to spend at online casinos. The Swedes plan to keep those restrictions in place for the remainder of the COVID-19 pandemic. According to government officials, the limits are a response to a dramatic increase in online gambling during the coronavirus shutdowns .
A recent study by the Australian  credit bureau reports a 67% increase in online gambling in the week after COVID-19shutdown. 250,000 Australian consumers studied show that people who gamble regularly online are doing so more frequently during the coronavirus lockdown.
The findings, in a Survation poll , will fuel concerns that betting among problem gamblers and increased use of riskier products, such as online casino games has been seen during this crisis. Addiction to gaming is described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . However, they felt that there was not sufficient evidence to determine whether the condition is a unique mental disorder but recognized internet gaming disorder in the section recommending requirements for further research.
The American Psychiatric Association’s DSM-5 proposed symptoms of internet gaming  — include:
- Continuing to the game despite problems
- Withdrawal symptoms when gaming is taken away or not possible (sadness, anxiety, irritability)
- Tolerance, the need to spend more time gaming to satisfy the urge
Inability to reduce playing, unsuccessful attempts to quit gaming
- Giving up other activities, loss of interest in previously enjoyed activities due to gaming
- Deceiving family members or others about the amount of time spent on gaming
- The use of gaming to relieve negative moods
- Risk, having jeopardized or lost a job or relationship due to gaming
Under the proposed criteria, a diagnosis of internet gaming disorder would require experiencing five or more of these symptoms within a year. The condition can include gaming on the internet, or any electronic device, although most people who develop clinically significant gaming problems play primarily on the internet.
In the last few years, there has been considerable interest in behavioral addictions; some of them have a focus on online pornography addiction. Internet pornography addiction fits into the addiction diagnostic framework and the current understanding described by addiction medicine specialists.
Drugs of abuse hijack the brain systems, which are typically utilized to reinforce species survival behaviors such as food and sex. So, many experts believe that pornography and sexual compulsivity share similar underlying mechanisms with substance addiction .
Hypersexual disorder fits this addiction medicine model, but it may be composed of several sexual behaviors, like the problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction, considering the “triple-A” influence (accessibility, affordability, anonymity) .
This problematic use might have adverse effects on sexual development and sexual functioning, especially among the young population. Together with studies on Internet addiction and Internet Gaming Disorder, we see strong evidence for considering addictive internet behaviors as a behavioral addiction.
Not only has online gambling increased during the COVID 19 pandemic, but also Pornography use and pornography-related high-risk behaviors are also growing. Pornography  has had a perfect pandemic. It is not clear if sexual compulsivity, or what Carnes has called sexual addiction, has increased as well .
The pornography industry itself is already changed and adapted to a world in lockdown. It already moved online, and users often self-isolate. It is hard to know exactly how good the pornography business is.
Gene Munster, a managing partner at Loup Ventures, an American investment firm, estimates that since the pandemic began, spending on porn worldwide has nearly doubled. Concurrently, Pornhub, one of the largest pornography sites, has reported increased pornography use in multiple countries, with global traffic increasing in one month over 11% from late February to March 17, 2020.
Social-distancing rules are accelerating change across the porn industry. Traffic on premium sites is soaring. Studios are sending professional cameras and lighting rigs to actors who live together and can, therefore, film themselves at home.
To help performers shoot and edit, the FSC produces online tutorials. The approach is catching on. Ella Hughes, a British porn star, says she has quit performing for traditional producers because so many admirers now pay $12.99 a month to watch videos that she shoots of herself at home and uploads to a premium site.
Some subscribers pay an additional $40 to $500 for short bespoke videos of Ms. Hughes that only they can view. Almost all porn performers, she says, now sell homemade sexually explicit material on premium websites.
Generally, pornographic materials, like drugs or alcohol, distract individuals from loneliness, distress, boredom, or other pandemic-related negative emotions . Sex, Gambling, Sugary, and Fatty Fast Foods have effects on the brain, like drugs of abuse .
Growing, shipping, and distributing illicit drugs have been disrupted during the COVID pandemic. In addition, public health measures to reduce exposure to and impact of COVID 19 include social distancing. While it is essential to our pandemic response, it has precipitated a change in eating toward foods that produce calming mood effects  and increased alcohol consumption.
Sitting at home anxious and fearful or quarantined has increased access and utilization of digital gaming, gambling, and sex platforms. In those with pre-existing illnesses like depression, eating disorders, or substance use disorder, social isolation can be even more harmful.
Patients in recovery, those who have delayed treatment, and new cases are going untreated. They are all at high risk. Overdose response has been compromised as has patient access to EMTs, Emergency Rooms, and non-COVID providers.
Many programs and A.A. groups have complied with the social distancing guidelines and group gathering admonitions and simply closed real-time and real-life meetings. Relapses, suicides, overdoses, and deaths of despair are feared to have increased .
Psychiatrists, counselors, and addiction programs have had to close offices and programs, but many have offered telemedicine options. Still, these are not evidence-based and proven in clinical trials to be equal to CBT or Alcoholics Anonymous or other treatments for Behavioral Addictions, Alcohol, and Substance Use Disorders (SUDs).
School, professional meetings, and shopping have turned online as we hunker down at home. At the same time, online platforms have proliferated and successfully have exploited the crisis by switching from live to compelling online platforms promoting gaming, gambling, and pornography.
Marc Potenza, M.D., Ph.D. Behavioral Addiction References :
King DL, Delfabbro PH, Billieux J, Potenza MN. Problematic online gaming and the COVID-19 pandemic. J Behav Addict. 2020 Apr 29. doi: 10.1556/2006.2020.00016
GEMMA MESTRE-BACH, GRETCHEN R. BLYCKER, and MARC N. POTENZA Pornography use in the setting of the COVID-19 pandemic. http://dx.doi.org/10.1556/2006.2020.00015
19. Love T, Laier C, Brand M, Hatch L, Hajela R..Neuroscience of Internet Pornography Addiction: A Review and Update. Behav Sci (Basel). 2015 Sep 18;5(3):388-433. doi: 10.3390/bs5030388.
20. de Alarcón, R.; de la Iglesia, J.I.; Casado, N.M.; Montejo, A.L. Online Porn Addiction: What We Know and What We Don’t—A Systematic Review. J. Clin. Med. 2019, 8, 91.
22. Carnes, P. J., Green, B. A., Merlo, L. J., Polles, A., Carnes, S., & Gold, M. S. (2012). PATHOS: a brief screening application for assessing sexual addiction. Journal of addiction medicine, 6(1), 29–34. https://doi.org/10.1097/ADM.0b013e3182251a28
24. Kenneth Blum, Tonia Werner, Stefanie Carnes, Patrick Carnes, Abdalla Bowirrat, John Giordano, Marlene-Oscar-Berman, Mark Gold Sex, Drugs, and Rock ‘N’ Roll: Hypothesizing Common Mesolimbic Activation as a Function of Reward Gene Polymorphisms. J Psychoactive Drugs. Author manuscript; available in PMC 2014 Jun 2. Published in final edited form as: J Psychoactive Drugs. 2012 Jan-Mar; 44(1): 38–55
25. Kenneth Blum, Panayotis K. Thanos, Mark S. Gold Dopamine and glucose, obesity, and reward deficiency syndrome Front Psychol. 2014; 5: 919. Pre-published online 2014 Jun 23. Published online 2014 Sep 17. doi: 10.3389/fpsyg.2014.00919
About the Author:
Mark S. Gold, M.D. served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014.
Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from multiple physical, emotional, environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Published on May 25, 2020
Reviewed by Jacquelyn Ekern, MS, LPC on May 25, 2020
Published on AddictionHope.com