Harm Reduction for Behavioral Addiction in the Digital Age

Hector Colon-Rivera, MD, discussed the clinical assessment and management of behavioral addictions, with emphasis on digital and exercise addiction.

Colon-Rivera framed behavioral addiction as a rapidly evolving clinical domain driven by the proliferation of digital technology, encompassing gaming disorder, gambling disorder, internet addiction, and emerging presentations related to AI dependency and social media use.¹ He situated exercise addiction within this landscape, characterizing it not as a primary disorder but as one that consistently presents with psychiatric comorbidities—most commonly anxiety disorders, body image concerns, and depressive episodes—frequently precipitated by injury or driven by social media-related performance pressures.²

A central clinical challenge Colon-Rivera identified was the social embedding of digital addiction; for many patients, online communities constitute their primary social ecosystem, encompassing romantic partners, family, and peer networks. He noted that abrupt disconnection therefore carries significant collateral consequences—"I'm taking away family, I'm taking away friends, I'm taking away a girlfriend"—and advocated instead for graduated, harm-reduction-oriented interventions aimed at restoring control and self-efficacy. Strategies might include limiting AI platform usage to a fixed daily credit allocation, or setting social media application time limits.

On exercise addiction, Colon-Rivera described a withdrawal syndrome that emerges during periods of enforced rest, manifesting as depression, anxiety, and compulsive urges to resume exercise despite injury or medical contraindication. He cited serious complications including malnutrition, sleep disturbance, fibromyalgia, and rhabdomyolysis, particularly among competitive athletes facing performance decline. He also addressed the neurobiology underlying behavioral addiction, cautioning against an oversimplified dopamine-pleasure model and invoking the liking versus wanting distinction for understanding compulsive behavior.

Dr Colon-Rivera is medical director for the Asociación Puertorriqueños en Marcha and is president-elect of the American Society for Adolescent Psychiatry.

References

1. Schmitt K. As online betting surges, so does risk of addiction. Hopkins Bloomberg Public Health. December 19, 2025. Accessed May 21, 2026. https://magazine.publichealth.jhu.edu/2025/online-betting-surges-so-does-risk-addiction

2. Minutillo A, Di Trana A, Aquilina V, et al. Recent insights in the correlation between social media use, personality traits and exercise addiction: a literature review. Front Psychiatry. 2024;15:1392317.