Background: DSM-5 mentions autoerotic asphyxia in the paraphilic disorders section, as a specifier for the diagnostic of sexual masochism disorder, “if the individual engages in the practice of achieving sexual arousal related to restriction of breathing”. Strangulation activities have also been observed in the “choking game”, defined as “self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia”. The term “strangulation activity” is consideredas more appropriate than “choking game”. While sharing a same behaviour, autoerotic asphyxia and non auto-erotic strangulation activities might represent a very distinct pattern of disorders. Case description: We report the case of a 25 years old male student practicing manually self-strangulation up to 40 times a day since adolescence. He has a concomitant history of both ketamine and cannabis use disorders, and reports urges to self-strangulate, sometimes specifically avoiding contact with friends to do it. He reports never really tried to stop this behavior. Neuropsychological assessment found a cognitive functioning below the level expected given his educational level. Our intervention consists on a 3-weeks cognitive and motivational therapy program in addiction unit. This intervention was associated with abstinence. Conclusions: Autoerotic asphyxia is a behaviour observed not only in the context of sexual masochism disorder, but also as a specific behavioral addiction to selfstrangulation in absence of sexual arousal.