RESEARCH STARTER

Screening for behavioral addiction

Screening for behavioral addiction involves assessing whether an individual engages in compulsive behaviors that mirror the patterns of substance addiction. This process is crucial as behavioral addictions, such as gambling, internet use, shopping, and sexual activity, can significantly disrupt personal and social functioning, similar to chemical dependencies. Professionals utilize various tools for screening, including the Behavior Risk Assessment Screen (BRAS), which evaluates addictive tendencies across multiple areas such as substance intake and gambling practices, and the CAGE assessment adapted for broader behavioral addictions. Each tool generates a score that helps gauge a person's coping abilities and potential need for further evaluation.

Specific screening instruments also exist for particular behaviors; for instance, the LIE/BET tool for gambling and the EAT-26 for eating disorders. These assessments are designed to identify the severity of the behavior and guide the individual towards appropriate interventions. Despite the growing recognition of behavioral addictions, they are often overlooked in clinical settings, emphasizing the importance of comprehensive screening that considers both substance and behavior-related addictions. Understanding and addressing these behaviors is essential for promoting overall well-being and preventing further psychological harm.

Full Article

DEFINITION: Screening for behavioral addiction is a process in which mental health professionals determine whether a person is likely to engage in or does engage in problem behaviors to the point of addiction. Screening shows if a person may need further help for addictive behavior problems.

Introduction

Behavioral addictions are patterns of behavior that follow a cycle similar to that of chemical addiction. Persons addicted to certain behaviors, such as gambling, exercising, computer gaming, Internet use, shopping, eating, or sexual activity, crave the activity and engage in that activity at the risk of causing problems in important life areas. Notably, the only behavioral addiction recognized in the American Psychiatric Association's 2022 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is gambling disorder; others are listed as conditions for further study, and some experts argue that these are problematic behaviors rather than true addictions.

Individuals with behavioral addictions often recognize that their actions are causing a problem, but as with any addiction, they find the behavior impossible to control. Behavior addiction can be socially and psychologically damaging, rivaling substance addiction in the ability to cause havoc in family structure. However, behavioral addictions are often overlooked, even though their markers are similar to those of substance addiction.

Many healthcare professionals believe that addiction in one area is indicative of addictive tendencies in general, and persons who have these tendencies are likely to exhibit addictive behavior in many areas of life. Thus, substance abuse and behavioral abuse often go hand-in-hand, and screening for one type of addiction should include screening for all types.

Risk Assessment Screen

Compared to substance addiction, behavioral addiction is a much more complex diagnosis for a professional to make. Often, this type of addiction is overlooked even though it coexists with substance addiction.

Clinical psychologist James Slobodzien introduced a tool called the behavior risk assessment screen (BRAS) for professionals to use when they suspect addictive behavior. This tool screens for addictive behavior in seven areas: substance intake (nicotine, alcohol, illicit drugs, caffeine), eating attitude, exercise patterns, sleep patterns, sexual practice, gambling practices, and risky behaviors (impulsive behaviors with negative consequences such as reckless driving and starting fires).

Each of the seven areas includes two or three statements read by the tested subject. The subject then decides which statement best describes their behavior. Each statement is then assigned a standardized weighted classification, and the points are totaled to yield a cumulative score called a prognostic assessment gauge score, which ranges from 0 to 100.

This score is further broken into twenty-point categories ranging from excellent (80–100), good (60–80), fair (40–60), poor (20–40), and guarded (0–20). These point categories characterize how well the subject is coping with addictive behavior. The final score represents a person’s overall psychological, social, and occupational function and is comparable to a global assessment of functioning score (part of the DSM-5-TR).

CAGE Assessment Tool

The CAGE (Cut, Annoyed, Guilty, and Eye) assessment tool, sometimes called the CAGE Questionnaire, screens for alcohol abuse. However, because it attempts to identify addictive behaviors, this simple tool is used by many providers as a basis for any type of addiction, including behavioral addictions, by substituting the type of addictive behavior for the term drinking in the questions.

The screen consists of four questions: Have you felt the need to cut down on your drinking? Do you feel annoyed or angered by others’ criticism of your drinking? Have you ever felt guilty about your drinking? And do you need to drink soon after waking as an eye-opener?

In using this tool to screen for behavioral addiction, two additional questions have been suggested to form the acronym “CAGED”: Do you feel empty when you are not (for example) eating or gambling? Does (for example) eating or gambling disrupt your life, or are you neglecting parts of your life because of it? These two additional questions may help pinpoint and further define behavioral addiction. Addictive tendencies may be a concern if the person being screened answers “yes” to two or more of the questions.

Screening for Specific Behavior Addictions

The BRAS and CAGE or CAGED assessments can give an idea of whether a person has addictive tendencies, including both behavioral and substance-addictive tendencies. However, each type of addictive behavior has specific, though similar, screening instruments to determine whether the screening subject has that specific behavior addiction. Some examples follow.

Gambling. The DSM-5-TR's diagnostic criteria for gambling disorder provide professionals with a framework for identifying problematic gambling behaviors. However, many other screening tools exist. The LIE/BET screening for gambling consists of two questions: Have you ever had to lie to people important to you about how much you gambled? Have you ever felt a need to bet more money? A “yes” answer to either question would indicate that a person should be evaluated further. The South Oaks Gambling Screen (SOGS) is more complex, with sixteen questions (and several subquestions) rating the behavior of the person being screened. The questions are answered with the terms not at all, less than once a week, or once a week or more. This screening tool asks questions about the amounts of money used in gambling, family or friends who gamble, and several other related to gambling behavior. Answers to these questions are weighted and scored; a score of 5 or more indicates problem behavior. Gamblers Anonymous also has a twenty-question screening tool; seven or more yes answers may indicate the person engages in problematic gambling. Other screening tools are produced and updated by the Center for Gambling Studies (CGS) at Rutgers School of Social Work, like the Rutgers Gambling Screening Protocol and the Gambling Pathways Questionnaire (GPQ). The Problem Gambling Severity Index (PGSI), a nine-item screening tool, can help professionals properly apply useful interventions based on the individual's existing circumstances.

Sexual activity. The WASTE Time tool is a quick screening for sex addiction. This tool assesses functional indicators such as withdrawal, adverse consequences, inability to stop, tolerance or intensity, and escape, with time spent on sexual activity being the final element of the screen. Answering “yes” to even one of the screening questions indicates a possible problem; answering “yes” to two or more questions indicates a high probability of sex addiction. Another screening for sexual addiction is the sexual addiction screening test, which consists of forty-five questions. Answering “yes” to more than seven of the first twenty questions indicates a sexual addiction, while the rest of the questions are intended to help pinpoint the problem’s manifestations.

Eating disorders. The Eating Attitudes Test (EAT-26) is a common screening tool to assess the risk of developing behavior addictions such as overeating, anorexia nervosa, or bulimia nervosa. The tool consists of personal information questions that assess attitudes about ideal weight, with twenty-six yes/no questions and six behavioral questions. Items are scored on a scale of 1 to 3; if the total score is above 20, further help may be needed. However, even a score of less than 19 may refer a person for further help if binging or purging behavior is indicated by the screening. Another common screening and diagnostic tool for eating disorders is the five-question Sick, Control, One, Fat, Food (SCOFF) Questionnaire.

Internet use. The Internet Addiction Test (IAT) may be used as a screening tool for Internet addiction. The test screens with twenty questions that are rated on a scale using the terms does not apply or rarely to always. Each question is scored, and a total score is assigned (between 0 and 100). These scores are broken into ranges of 0–19 (below average), 20–49 (average), 50–79 (above average), and 80–100 (significantly above average). A score of 80 or above is cause for referral for further help. Other screening tests include the Internet Addiction Test-Adolescence (IAT-A) and the Internet Addiction Assessment (IAA).

Work. The Work Addiction Risk Test (WART) consists of twenty-five questions pertaining to attitudes toward work and related behaviors in particular and life in general. The person being screened answers each question on a scale of 1 to 4, with 1 representing “never true” and 4 representing “always true.” The numbers are then added into a total score, in which 25–54 represents “not work addicted,” 55–69 represents “mildly work addicted,” and 70–100 represents “highly work addicted.” The Bergen Work Addiction Scale is also sometimes used to diagnose work addictions, and an updated version of the Screener for Substance and Behavioral Addictions (SSBA-G) incorporated criteria to evaluate excessive work behaviors (as well as self-harm and skin picking).

Exercise. Peer-reviewed evidence is lacking in exercise addiction research, but individuals who compulsively exercise to a degree that harms their health require treatment. Understanding the addiction and its severity is critical in treatment and remission. Screening tools such as the Expanded Exercise Addiction Inventory (EAI-3) and its original version, the Exercise Addiction Inventory (EAI), can help healthcare professionals develop care plans for these individuals.


Bibliography

Freimuth, Marilyn. “The ‘New Look’ in Addiction Assessment: Implications for Medical Education.” Annals of Behavioral Science and Medical Education, vol. 16, no. 1, 2010, pp. 30–34, www.researchgate.net/profile/Marilyn-Freimuth/publication/230867684_The_New_Look_in_Addiction_Assessment_Implications_for_Medical_Education/links/0fcfd5058bd25be80b000000/The-New-Look-in-Addiction-Assessment-Implications-for-Medical-Education.pdf. Accessed 22 Oct. 2025.

Konkolÿ Thege, Barna, et al. “Psychometric Properties of the Generalised Version of the Screener for Substance and Behavioural Addictions (SSBA-G): A Comprehensive Screening Tool for Substance-Related and Behavioural Addictions.” Psychiatry Research, vol. 328, 2023, doi:10.1016/j.psychres.2023.115459. Accessed 22 Oct. 2025.

Mastropietro, S., et al. "Behavioral Addictions Questionnaire (BAQ): Validation of a New Tool for the Screening of Multiple Addictive Behaviors in the Italian Population." International Journal of Mental Health and Addiction, vol. 22, 2024, pp. 965–78, doi:10.1007/s11469-022-00906-x. Accessed 22 Oct. 2025.

Melnyk, Bernadette Mazurek, and Pamela Lusk. A Practical Guide to Child and Adolescent Mental Health Screening, Evidence-Based Assessment, Intervention, and Health Promotion. 3rd ed., Springer, 2022.

Mitchell, Kristin. "What’s the CAGE Assessment?" WebMD, 26 Sept. 2025, www.webmd.com/mental-health/addiction/whats-the-cage-assessment. Accessed 22 Oct. 2025.

"OASAS Approved Gambling Screening/Assessment Tools." Office of Addiction Services and Supports, oasas.ny.gov/system/files/documents/2024/01/approved-gambling-screening-and-assessment-tools.pdf. Accessed 22 Oct. 2025.

Pautrat, Maxime, et al. “Identifying Available Addictive Disorder Screening Tests Validated in Primary Care: A Systematic Review.” Addictive Behaviors, vol. 126, 2022, p. 107180, doi:10.1016/j.addbeh.2021.107180. Accessed 22 Oct. 2025.

Petry, Nancy M. Behavioral Addictions: DSM-5 and Beyond. Oxford UP, 2016.

"Screening and Assessment Tools Chart." National Institute on Drug Abuse, 6 Jan. 2023, nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/chart-screening-tools. Accessed 22 Oct. 2025.

Full Article

DEFINITION: Screening for behavioral addiction is a process in which mental health professionals determine whether a person is likely to engage in or does engage in problem behaviors to the point of addiction. Screening shows if a person may need further help for addictive behavior problems.

Introduction

Behavioral addictions are patterns of behavior that follow a cycle similar to that of chemical addiction. Persons addicted to certain behaviors, such as gambling, exercising, computer gaming, Internet use, shopping, eating, or sexual activity, crave the activity and engage in that activity at the risk of causing problems in important life areas. Notably, the only behavioral addiction recognized in the American Psychiatric Association's 2022 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is gambling disorder; others are listed as conditions for further study, and some experts argue that these are problematic behaviors rather than true addictions.

Individuals with behavioral addictions often recognize that their actions are causing a problem, but as with any addiction, they find the behavior impossible to control. Behavior addiction can be socially and psychologically damaging, rivaling substance addiction in the ability to cause havoc in family structure. However, behavioral addictions are often overlooked, even though their markers are similar to those of substance addiction.

Many healthcare professionals believe that addiction in one area is indicative of addictive tendencies in general, and persons who have these tendencies are likely to exhibit addictive behavior in many areas of life. Thus, substance abuse and behavioral abuse often go hand-in-hand, and screening for one type of addiction should include screening for all types.

Risk Assessment Screen

Compared to substance addiction, behavioral addiction is a much more complex diagnosis for a professional to make. Often, this type of addiction is overlooked even though it coexists with substance addiction.

Clinical psychologist James Slobodzien introduced a tool called the behavior risk assessment screen (BRAS) for professionals to use when they suspect addictive behavior. This tool screens for addictive behavior in seven areas: substance intake (nicotine, alcohol, illicit drugs, caffeine), eating attitude, exercise patterns, sleep patterns, sexual practice, gambling practices, and risky behaviors (impulsive behaviors with negative consequences such as reckless driving and starting fires).

Each of the seven areas includes two or three statements read by the tested subject. The subject then decides which statement best describes their behavior. Each statement is then assigned a standardized weighted classification, and the points are totaled to yield a cumulative score called a prognostic assessment gauge score, which ranges from 0 to 100.

This score is further broken into twenty-point categories ranging from excellent (80–100), good (60–80), fair (40–60), poor (20–40), and guarded (0–20). These point categories characterize how well the subject is coping with addictive behavior. The final score represents a person’s overall psychological, social, and occupational function and is comparable to a global assessment of functioning score (part of the DSM-5-TR).

CAGE Assessment Tool

The CAGE (Cut, Annoyed, Guilty, and Eye) assessment tool, sometimes called the CAGE Questionnaire, screens for alcohol abuse. However, because it attempts to identify addictive behaviors, this simple tool is used by many providers as a basis for any type of addiction, including behavioral addictions, by substituting the type of addictive behavior for the term drinking in the questions.

The screen consists of four questions: Have you felt the need to cut down on your drinking? Do you feel annoyed or angered by others’ criticism of your drinking? Have you ever felt guilty about your drinking? And do you need to drink soon after waking as an eye-opener?

In using this tool to screen for behavioral addiction, two additional questions have been suggested to form the acronym “CAGED”: Do you feel empty when you are not (for example) eating or gambling? Does (for example) eating or gambling disrupt your life, or are you neglecting parts of your life because of it? These two additional questions may help pinpoint and further define behavioral addiction. Addictive tendencies may be a concern if the person being screened answers “yes” to two or more of the questions.

Screening for Specific Behavior Addictions

The BRAS and CAGE or CAGED assessments can give an idea of whether a person has addictive tendencies, including both behavioral and substance-addictive tendencies. However, each type of addictive behavior has specific, though similar, screening instruments to determine whether the screening subject has that specific behavior addiction. Some examples follow.

Gambling. The DSM-5-TR's diagnostic criteria for gambling disorder provide professionals with a framework for identifying problematic gambling behaviors. However, many other screening tools exist. The LIE/BET screening for gambling consists of two questions: Have you ever had to lie to people important to you about how much you gambled? Have you ever felt a need to bet more money? A “yes” answer to either question would indicate that a person should be evaluated further. The South Oaks Gambling Screen (SOGS) is more complex, with sixteen questions (and several subquestions) rating the behavior of the person being screened. The questions are answered with the terms not at all, less than once a week, or once a week or more. This screening tool asks questions about the amounts of money used in gambling, family or friends who gamble, and several other related to gambling behavior. Answers to these questions are weighted and scored; a score of 5 or more indicates problem behavior. Gamblers Anonymous also has a twenty-question screening tool; seven or more yes answers may indicate the person engages in problematic gambling. Other screening tools are produced and updated by the Center for Gambling Studies (CGS) at Rutgers School of Social Work, like the Rutgers Gambling Screening Protocol and the Gambling Pathways Questionnaire (GPQ). The Problem Gambling Severity Index (PGSI), a nine-item screening tool, can help professionals properly apply useful interventions based on the individual's existing circumstances.

Sexual activity. The WASTE Time tool is a quick screening for sex addiction. This tool assesses functional indicators such as withdrawal, adverse consequences, inability to stop, tolerance or intensity, and escape, with time spent on sexual activity being the final element of the screen. Answering “yes” to even one of the screening questions indicates a possible problem; answering “yes” to two or more questions indicates a high probability of sex addiction. Another screening for sexual addiction is the sexual addiction screening test, which consists of forty-five questions. Answering “yes” to more than seven of the first twenty questions indicates a sexual addiction, while the rest of the questions are intended to help pinpoint the problem’s manifestations.

Eating disorders. The Eating Attitudes Test (EAT-26) is a common screening tool to assess the risk of developing behavior addictions such as overeating, anorexia nervosa, or bulimia nervosa. The tool consists of personal information questions that assess attitudes about ideal weight, with twenty-six yes/no questions and six behavioral questions. Items are scored on a scale of 1 to 3; if the total score is above 20, further help may be needed. However, even a score of less than 19 may refer a person for further help if binging or purging behavior is indicated by the screening. Another common screening and diagnostic tool for eating disorders is the five-question Sick, Control, One, Fat, Food (SCOFF) Questionnaire.

Internet use. The Internet Addiction Test (IAT) may be used as a screening tool for Internet addiction. The test screens with twenty questions that are rated on a scale using the terms does not apply or rarely to always. Each question is scored, and a total score is assigned (between 0 and 100). These scores are broken into ranges of 0–19 (below average), 20–49 (average), 50–79 (above average), and 80–100 (significantly above average). A score of 80 or above is cause for referral for further help. Other screening tests include the Internet Addiction Test-Adolescence (IAT-A) and the Internet Addiction Assessment (IAA).

Work. The Work Addiction Risk Test (WART) consists of twenty-five questions pertaining to attitudes toward work and related behaviors in particular and life in general. The person being screened answers each question on a scale of 1 to 4, with 1 representing “never true” and 4 representing “always true.” The numbers are then added into a total score, in which 25–54 represents “not work addicted,” 55–69 represents “mildly work addicted,” and 70–100 represents “highly work addicted.” The Bergen Work Addiction Scale is also sometimes used to diagnose work addictions, and an updated version of the Screener for Substance and Behavioral Addictions (SSBA-G) incorporated criteria to evaluate excessive work behaviors (as well as self-harm and skin picking).

Exercise. Peer-reviewed evidence is lacking in exercise addiction research, but individuals who compulsively exercise to a degree that harms their health require treatment. Understanding the addiction and its severity is critical in treatment and remission. Screening tools such as the Expanded Exercise Addiction Inventory (EAI-3) and its original version, the Exercise Addiction Inventory (EAI), can help healthcare professionals develop care plans for these individuals.


Bibliography

Freimuth, Marilyn. “The ‘New Look’ in Addiction Assessment: Implications for Medical Education.” Annals of Behavioral Science and Medical Education, vol. 16, no. 1, 2010, pp. 30–34, www.researchgate.net/profile/Marilyn-Freimuth/publication/230867684_The_New_Look_in_Addiction_Assessment_Implications_for_Medical_Education/links/0fcfd5058bd25be80b000000/The-New-Look-in-Addiction-Assessment-Implications-for-Medical-Education.pdf. Accessed 22 Oct. 2025.

Konkolÿ Thege, Barna, et al. “Psychometric Properties of the Generalised Version of the Screener for Substance and Behavioural Addictions (SSBA-G): A Comprehensive Screening Tool for Substance-Related and Behavioural Addictions.” Psychiatry Research, vol. 328, 2023, doi:10.1016/j.psychres.2023.115459. Accessed 22 Oct. 2025.

Mastropietro, S., et al. "Behavioral Addictions Questionnaire (BAQ): Validation of a New Tool for the Screening of Multiple Addictive Behaviors in the Italian Population." International Journal of Mental Health and Addiction, vol. 22, 2024, pp. 965–78, doi:10.1007/s11469-022-00906-x. Accessed 22 Oct. 2025.

Melnyk, Bernadette Mazurek, and Pamela Lusk. A Practical Guide to Child and Adolescent Mental Health Screening, Evidence-Based Assessment, Intervention, and Health Promotion. 3rd ed., Springer, 2022.

Mitchell, Kristin. "What’s the CAGE Assessment?" WebMD, 26 Sept. 2025, www.webmd.com/mental-health/addiction/whats-the-cage-assessment. Accessed 22 Oct. 2025.

"OASAS Approved Gambling Screening/Assessment Tools." Office of Addiction Services and Supports, oasas.ny.gov/system/files/documents/2024/01/approved-gambling-screening-and-assessment-tools.pdf. Accessed 22 Oct. 2025.

Pautrat, Maxime, et al. “Identifying Available Addictive Disorder Screening Tests Validated in Primary Care: A Systematic Review.” Addictive Behaviors, vol. 126, 2022, p. 107180, doi:10.1016/j.addbeh.2021.107180. Accessed 22 Oct. 2025.

Petry, Nancy M. Behavioral Addictions: DSM-5 and Beyond. Oxford UP, 2016.

"Screening and Assessment Tools Chart." National Institute on Drug Abuse, 6 Jan. 2023, nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/chart-screening-tools. Accessed 22 Oct. 2025.

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