Certain centrally acting chemicals, such as cocaine or amphetamine, affect the brain’s reward pathways, particularly the nucleus accumbens “reward center” and linked dopamine and opioid systems. Repeated consumption of such substances, for vulnerable individuals, can lead to escalating cycles of intake and functional impairment, termed addiction. Addiction encompasses a number of core features, as highlighted in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), including impaired top-down control (unsuccessful attempts to reduce intake), narrowing of interests, risky use (continued use despite knowledge of damaging consequences) and physiologic aspects (tolerance and withdrawal). As psychoactive substances including alcohol and cocaine have high addictive potential by virtue of their effects on the brain’s reward pathways, so too do certain types of behavior. This has led to the proposal that some mental disorders can be conceptualized as behavioral addictions Most people who engage in these behaviors will not become addicted, but some individuals will. Individuals with behavioral addictions exhibit impaired control, functional impairment and persisting engagement in the behavior despite negative consequences.