Category Archives: Addiction

A night on the tiles: A brief look at addiction to ‘Scrabble’

In previous blogs I have covered some arguably frivolous (and alleged) addictions including addictions to cryptic crosswords and Sudoku. Today’s blog looks at an equally frivolous topic in the same vein – Scrabble addiction. I have to be honest and say that I love playing Scrabble and have been playing a lot against the computer over the last few weeks (and is one of the reasons I decided to write an article on the topic). According to a 2004 article ‘Scrabble addicts’ in The Independent by John Walsh, there are numerous celebrity Scrabble lovers including Robbie Williams, Kylie Minogue, Nigella Lawson, Christina Aguilera, Sting, Avril Lavigne and Alison Steadman. He also  asserted that the secret of Scrabble’s success is threefold.

“First, it’s a game of skill (like chess) that depends on the luck of the tiles you get (like cards). Second, it deploys a commodity common to every human being, namely words. Third, anyone can play it”.

Back in 2000, I published a paper on the psychology of games in Psychology Review and what makes a good game. These are all applicable to Scrabble. I noted in that article that:

  • All good games are relatively easy to play but can take a lifetime to become truly adept. In short, there will always room for improvement.
  • For games of any complexity there must be a bibliography that people can reference and consult. Without books and magazines to instruct and provide information there will be no development and the activity will die.
  • There needs to be competitions and tournaments. Without somewhere to play (and likeminded people to play with) there will be little development within the field over long periods of time.
  • Finally – and very much a sign of the times – no leisure activity can succeed today without corporate sponsorship of some kind.

But is there any evidence to suggest Scrabble can be addictive? Jan Kern published a book in 2009 called Eyes on Line: Eyes on Life – A Journey Out of Online Addictions. She noted the case of Tom who started out his story by saying: “Hi, my name is Tom, and I’m an addict. I don’t have a problem with the bottle or with any kind of pharmaceutical product, legal or illegal. No, my problem is with games. I’m addicted to them…And now the Internet has made this potential to get hooked all too easy. My particular poison these days is online Scrabble”. I then came across these examples:

  • Extract 1: “[I] have struggled with Scrabble addiction. When I play Scrabble on the Internet, I lose all track of time. I promise myself I’ll just play one game, and the next thing I know, the sun is coming up and my eyes are a shade of crimson. I’m just glad to know that I’m not the only one” (Raphael Pope-Sussman, New York Times, 2007).
  • Extract 2: “I read ‘Addicted to L-U-V’ while I was in the midst of a Scrabble game…Whenever I encounter a new word, I calculate the number of letters, roots, prefixes and suffixes. I’ve got it bad. My Scrabble buddies both live out of state…When we are together, we have cut-throat marathon games…When we’re apart, we practice our addiction online” (Cheryl Beatty, New York Times, 2007).
  • Extract 3: “Phew! I am not the only one! Scrabble with my friends and daughter was my addiction for years. These days I play it on my computer when I take a break from work…O.K., that’s enough writing; time to get back to another game of Scrabble” (Beth Rosen, New York Times, 2007).

These extracts were all published in response to American journalist and film director Nora Ephron’s 2007 article ‘Addicted to L-U-V’ in the New York Times about her addiction to the word game Scrabble. In her article, Ephron admitted that:

“I stumbled onto something called Scrabble Blitz. It was a four-minute version of Scrabble solitaire, on a Web site called Games.com, and I began playing it without a clue that within 24 hours – I am not exaggerating – it would fry my brain…I began having Scrabble dreams in which people turned into letter tiles that danced madly about. I tuned out on conversations and instead thought about how many letters there were in the name of the person I wasn’t listening to. I fell asleep memorizing the two- and three-letter words that distinguish those of us who are hooked on Scrabble from those of you who aren’t…My brain turned to cheese. I could feel it happening. It was clear that I was becoming more and more scattered, more distracted, more unfocused…I instantly became an expert on how the Internet could alter your brain in a permanent way”.

Ephron went on to report comments from other people in the online Scrabble games (“I’m an addict, lol”, “I can’t stop playing this, ha ha”). Ephron concluded she was no different from the other players. She then went onto say:

“The game of Scrabble Blitz eventually became too much for the Web site. Lag was a huge problem. From time to time, the Scrabble Blitz area would shut down for days, and when it returned, so did all the addicts, full of comments about how they had barely withstood life without the game. I began to get carpal tunnel syndrome from playing. I’m not kidding. I realized I was going to have to kick the habit…I was saved by what’s known in the insurance business as an act of God: Games.com shut down Scrabble Blitz. And that was that. It was gone”.

Obviously I’m sceptical about whether there are genuine cases of addiction to Scrabble (particularly as there is nothing in the psychological literature whatsoever). There have also been other lengthy first-person journalistic accounts of Scrabble addiction such as the 2011 article by James Brown in the Sabotage Times (who also did some interesting background research for his article). According to Brown, the recent upsurge in Scrabble began in 2007 when Indian brothers Rajat and Jayant Agarwalla developed a Scrabble application for Facebook (‘Scrabulous’). It quickly became the most popular game on Facebook (but was then removed due to a legal dispute with the original developers of Scrabble – Hasbro and Mattel. The game later returned as Lexulous). Brown then confessed:

Hello, my name’s James and I am a Scrabble addict. I have been playing it all day everyday from last Christmas until my summer holiday when two weeks without a computer allowed me to crack the habit. I am not alone, there are over a hundred thousand Scrabble players on Facebook. We play each other at any time of day or night because we are situated all over the world and timezones are helpful like that. We decide how long we will allow for each move to take, how many people can play, and what standard we play at…On an hourly basis day after day I played people in Australia, Britain, South Africa, India, the West Indies and pretty much anywhere else where the Scrabble application could work. Eventually I spent more time talking and playing with these new Scrabble partners than I did the people I lived with. It was madness. A genuine obsession, I would go as far as to say addiction. I was late to pick my son up from school, late to sports matches I was playing in, I ignored writing work I had to do, I took the computer to bed with me and played last thing at night until my eyes hurt and then started again as soon as I woke up… For me it eventually became too much. One day I looked at the 18 consecutive games I had going on at once, many of them with just two minutes at a time to play my word, and realised what that would look like if I actually had 18 people with 18 boards in the room with me. This moment of clarity gave me some perspective on how it had consumed my life”.

I have to admit that this case account is quite compelling and does at least suggest Scrabble could be potentially addictive. Finally, as a Professor of Gambling Studies I was also interested in Brown’s analogy between Scrabble and gambling as he noted:

“Not knowing what letters would appear next had that random appeal that watching a horse race has.  The excitement at using all seven letters and scoring a bingo, or taking a game to the very last tile to reach a conclusion was immense, there was always just one more game, one more opponent, maybe the same one you’d already played five times that day and you wanted to take another victory from or avenge an earlier defeat. The international 24 hour pull of the game is relentless, for some it over-comes loneliness for others it fuels addictive personalities”.

Playing with what you get given is almost an outlook on life itself. However, unlike life, I seriously doubt whether excessive and/or addictive playing of Scrabble will ever become the topic of scientific study.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Brown, J. (2011). Scrabble addict. Sabotage Times, May 16. Located at: http://sabotagetimes.com/life/scrabble-addict/

Ephron, N. (2007). Addicted to L-U-V. New York Times, May 13. Located at: http://www.nytimes.com/2007/05/13/opinion/13ephron.html

Griffiths, M.D. (2000). The psychology of games. Psychology Review, 7(2), 24-26.

Hayward, A. (2014). Can New Words With Friends reignite your competitive pseudo-Scrabble addiction? MacWorld, October 14. Located at: http://www.macworld.com/article/2825932/can-new-words-with-friends-reignite-your-competitive-pseudo-scrabble-addiction.html

Kern, J. (2009). Eyes on Line: Eyes on Life – A Journey Out of Online Addictions. Accessible Publishing Systems PTY, Ltd.

Walsh, J. (2004). Scrabble addicts. The Independent, October 9. Located at: http://www.independent.co.uk/news/uk/this-britain/scrabble-addicts-535160.html

I love view: Can Google Glass be addictive?

Last week, The Guardian (and news media all over the world) reported the story of a man being treated for internet addiction disorder brought on by his excessive use of Google Glass. According to The Guardian’s report:

“The man had been using the technology for around 18 hours a day – removing it only to sleep and wash – and complained of feeling irritable and argumentative without the device. In the two months since he bought the device, he had also begun experiencing his dreams as if viewed through the device’s small grey window…[The patient] had checked into the Sarp [Substance Addiction Recovery Program] in September 2013 for alcoholism treatment. The facility requires patients to steer clear of addictive behaviours for 35 days – no alcohol, drugs, or cigarettes – but it also takes away all electronic devices. Doctors noticed the patient repeatedly tapped his right temple with his index finger. He said the movement was an involuntary mimic of the motion regularly used to switch on the heads-up display on his Google Glass”.

The story was based on a case study that has just been published in the journal Addictive Behaviors by Dr. Kathryn Yung and her colleagues from the Department of Mental Health, Naval Medical Center in San Diego (United States). The authors claim that the paper (i) reported the first ever case of internet addiction disorder involving the problematic use of Google Glass, (ii) showed that excessive and problematic uses of Google Glass can be associated with involuntary movements to the temple area and short-term memory problems, and (iii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass. For those reading this who have not yet come across what Google Glass is, the authors provided a brief description: 

Google Glass™ was named as one of the best inventions of the year by Time Magazine in 2012. The device is a wearable mobile computing device with Bluetooth connectivity to internet-ready devices. Google Glass™ has an optical head-mounted display, resembling eyeglasses; it displays information in a Smartphone-like, but hands-free format that is controlled via voice commands and touch”.

The man that came in for treatment was a 31-year old enlisted service member who had served seven months in Afghanistan. Although he did not suffer any kind of post-traumatic stress disorder (PTSD) he was reported by the authors as having a mood disorder, most consistent with a substance-induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia, obsessive–compulsive disorder, and severe alcohol and tobacco use disorders”. His referral to the substance use program was because he had resumed problematic alcohol drinking following a previous eight-week intensive outpatient treatment. It was only after re-entering the program that staff noticed other behaviours that were nothing to do with his alcohol problem. More specifically, they reported that:

“The patient had been wearing the Google Glass™ device each day for up to 18 h for two months prior to admission, removing the device during sleep and bathing. He was given permission by his superiors to use the device at work, as the device allowed him to function at a high level by accessing detailed and complicated information quickly. The patient shared that the Google Glass™ increased his confidence with social situations, as the device frequently became an initial topic of discussion. All electronic devices and mobile computing devices are customarily removed from patients during substance rehabilitation treatment. The patient noted significant frustration and irritability related to not being able to use the device during treatment. He stated, ‘The withdrawal from this is much worse than the withdrawal I went through from alcohol’, He noted that when he dreamed during his residential treatment, he envisioned the dream through the device. He would experience the dream through a small gray window, which was consistent with what he saw when wearing the device while awake. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative. When asked questions by the examiner, the patient was noted on exam to reach his right hand up to his temple area and tap it with his forefinger. He explained that this felt almost involuntary, in that it was the familiar motion he would make in order to turn on the device in order to access information and answer questions. He found that he almost ‘craved’ using the device, especially when trying to recall information”.

Even though my primary area of research interest in behavioural addictions, the thing that caught my attention in the description above was the observation that his dreams were experienced in the way he viewed things through Google Glass while he was awake. On first reading this I thought this sounding very much like some research I have been doing with my colleague Angelica Ortiz de Gortari on Game Transfer Phenomena (GTP) in which gamers transfer aspects of their game playing into real life situations. Our work is an extension of the so-called Tetris Effect where Tetris players see falling blocks before their eyes even when they are not playing the game. It appears the authors of this case study has also made the same connection as they reported:

The patient’s experiences of viewing his dreams through the device appear to be best explained solely by his heavy use of the device and may be consistent with what is referred to as the ‘Tetris Effect’. When individuals play the game Tetris for long periods of time, they report seeing invasive imagery of the game in their sleep (Stickgold, Malia, Maguire, Roddenberry, & O’Connor, 2000). Interestingly, Stickgold et al. noted that patients with amnesia due to traumatic brain injury, who had trouble with short-term memory recall, reported invasive imagery of the game during sleep even though they did not recall playing the game (Stickgold et al., 2000). Technology-assisted learning devices and video gaming appear to be powerful methods to aid in the acquisition of new information. Further studies in the field of traumatic brain injury utilizing gaming and technology-assisted learning are needed”.

At the end of the 35-day inpatient stay, the outcome was reported as being good. The patient reported he felt less irritable, and he was making far fewer compulsive movements to his temple. However, no further follow-up was reported by Yung and her colleagues. There are, of course, wider questions about whether addiction to the internet even exists although the article in The Guardian did provide a link to a comprehensive and systematic review of internet addiction that I co-authored with Dr. Kuss and others in the journal Current Pharmaceutical Design. As regular readers of my blog will be aware, I believe that there is a fundamental difference between addictions on the internet and addictions to the internet. The vast majority of people appear to have addictions on the internet (such as gambling addiction, gaming addiction, sex addiction, shopping addiction, etc.) where the internet facilitates other addictive behaviours. However, there is growing evidence of internet-only addictive behaviour (with social networking addiction being the most common).

In relation to this case study, there have been some that have said that the study doesn’t have face validity because the battery life of Google Glass is so small that it is impossible to spend up to 18 hours a day wearing it. (For instance, check out an interesting article written by Taylor Hatmaker published by the Daily Dot). I ought to add that one of the study’s co-authors, Dr. Andrew Doan did say to various news outlets that:

“A wearable device is constantly there – so the neurological reward associated with using it is constantly accessible. There’s nothing inherently bad about Google Glass. It’s just that there is very little time between these rushes. So for an individual who’s looking to escape, for an individual who has underlying mental dysregulation, for people with a predisposition for addiction, technology provides a very convenient way to access these rushes. And the danger with wearable technology is that you’re allowed to be almost constantly in the closet, while appearing like you’re present in the moment”.

Based on the two-page paper that was published, I don’t think there was enough evidence presented to say whether the man in question was addicted to the internet via Google Glass. There were certainly elements associated with addiction but that doesn’t mean somebody is genuinely addicted. Furthermore, most addictive behaviours have to have been present for at least six months before being diagnosed as a genuine addiction. In this case, the man had only been using Google Glass for two months before entering the treatment program.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ghorayshi, A. (2014). Google glass user treated for internet addiction caused by device. The Guardian, October 14. Located at: http://www.theguardian.com/science/2014/oct/14/google-glass-user-treated-addiction-withdrawal-symptoms

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Worplace Learning, 7, 463-472.

Hatmaker, T. (2014). There is no such thing as Google Glass addiction. The Daily Dot, October 15. Located at: https://www.dailydot.com/technology/google-glass-internet-addiction/

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., Shorter, G.W., van Rooij, A.J., Griffiths, M.D., & Schoenmakers, T.M. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12, 351-366.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

Ortiz de Gotari, A., Aronnson, K. & Griffiths, M.D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning, 1(3), 15-33.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Hauppauge, NY: Nova Science.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Stickgold, R., Malia, A., Maguire, D., Roddenberry, D., & O’Connor, M. (2000). Replaying the game: Hypnagogic images in normals and amnesics. Science, 290, 350–353.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors, http://dx.doi.org/10.1016/j.addbeh.2014.09.024.

Joystick junkies: A brief overview of online gaming addiction

Over the last 15 years, research into various online addictions have greatly increased. Prior to the 2013 publication of the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there had been some debate as to whether ‘internet addiction’ should be introduced into the text as a separate disorder. Alongside this, there has also been debate as to whether those researching in the online addiction field should be researching generalized internet use and/or the potentially addictive activities that can be engaged on the internet (e.g., gambling, video gaming, sex, shopping, etc.).

It should also be noted that given the lack of consensus as to whether video game addiction exists and/or whether the term ‘addiction’ is the most appropriate to use, some researchers have instead used terminology such as ‘excessive’ or ‘problematic’ to denote the harmful use of video games. Terminology for what appears to be for the same disorder and/or its consequences include problem video game playing, problematic online game use, video game addiction, online gaming addiction, internet gaming addiction, and compulsive Internet use.

Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic internet use (i.e., internet gaming disorder [IGD]) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. According to Dr. Nancy Petry and Dr. Charles O’Brien, IGD will not be included as a separate mental disorder until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features have been evaluated.

Although there is now a rapidly growing literature on pathological video gaming, one of the key reasons that IGD was not included in the main text of the DSM-5 was that the SUDWG concluded that no standard diagnostic criteria were used to assess gaming addiction across these many studies. In 2013, some of my colleagues and I published a paper in Clinical Psychology Review examining all instruments assessing problematic, pathological and/or addictive gaming. We reported that 18 different screening instruments had been developed, and that these had been used in 63 quantitative studies comprising 58,415 participants. The prevalence rates for problematic gaming were highly variable depending on age (e.g., children, adolescents, young adults, older adults) and sample (e.g., college students, internet users, gamers, etc.). Most studies’ prevalence rates of problematic gaming ranged between 1% and 10% but higher figures have been reported (particularly amongst self-selected samples of video gamers). In our review, we also identified both strengths and weaknesses of these instruments.

The main strengths of the instrumentation included the: (i) the brevity and ease of scoring, (ii) excellent psychometric properties such as convergent validity and internal consistency, and (iii) robust data that will aid the development of standardized norms for adolescent populations. However, the main weaknesses identified in the instrumentation included: (i) core addiction indicators being inconsistent across studies, (iii) a general lack of any temporal dimension, (iii) inconsistent cut-off scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or dimensionality.

It has also been noted by many researchers (including me) that the criteria for IGD assessment tools are theoretically based on a variety of different potentially problematic activities including substance use disorders, pathological gambling, and/or other behavioural addiction criteria. There are also issues surrounding the settings in which diagnostic screens are used as those used in clinical practice settings may require a different emphasis that those used in epidemiological, experimental, and neurobiological research settings.

Video gaming that is problematic, pathological and/or addictive lacks a widely accepted definition. Some researchers in the field consider video games as the starting point for examining the characteristics of this specific disorder, while others consider the internet as the main platform that unites different addictive internet activities, including online games. My colleagues and I have begun to make an effort to integrate both approaches, i.e., classifying online gaming addiction as a sub-type of video game addiction but acknowledging that some situational and structural characteristics of the internet may facilitate addictive tendencies (e.g., accessibility, anonymity, affordability, disinhibition, etc.).

Throughout my career I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflects a common etiology of addictive behaviour. When I started research internet addiction in the mid-1990s, I came to the view that there is a fundamental difference between addiction to the internet, and addictions on the internet. However many online games (such as Massively Multiplayer Online Role Playing Games) differ from traditional stand-alone video games as there are social and/or role-playing dimension that allow interaction with other gamers.

Irrespective of approach or model, the components and dimensions that comprise online gaming addiction outlined above are very similar to the IGD criteria in Section 3 of the DSM-5. For instance, my six addiction components directly map onto the nine proposed criteria for IGD (of which five or more need to be endorsed and resulting in clinically significant impairment). More specifically: (1) preoccupation with internet games [salience]; (2) withdrawal symptoms when internet gaming is taken away [withdrawal]; (3) the need to spend increasing amounts of time engaged in internet gaming [tolerance], (4) unsuccessful attempts to control participation in internet gaming [relapse/loss of control]; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming [conflict]; (6) continued excessive use of internet games despite knowledge of psychosocial problems [conflict]; (7) deception of family members, therapists, or others regarding the amount of internet gaming [conflict]; (8) use of the internet gaming to escape or relieve a negative mood [mood modification];  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games [conflict].

The fact that IGD was included in Section 3 of the DSM-5 appears to have been well received by researchers and clinicians in the gaming addiction field (and by those individuals that have sought treatment for such disorders and had their experiences psychiatrically validated and feel less stigmatized). However, for IGD to be included in the section on ‘Substance-Related and Addictive Disorders’ along with ‘Gambling Disorder’, the gaming addiction field must unite and start using the same assessment measures so that comparisons can be made across different demographic groups and different cultures.

For epidemiological purposes, my research colleagues and I have asserted that the most appropriate measures in assessing problematic online use (including internet gaming) should meet six requirements. Such an instrument should have: (i) brevity (to make surveys as short as possible and help overcome question fatigue); (ii) comprehensiveness (to examine all core aspects of problematic gaming as possible); (iii) reliability and validity across age groups (e.g., adolescents vs. adults); (iv) reliability and validity across data collection methods (e.g., online, face-to-face interview, paper-and-pencil); (v) cross-cultural reliability and validity; and (vi) clinical validation. We aso reached the conclusion that an ideal assessment instrument should serve as the basis for defining adequate cut-off scores in terms of both specificity and sensitivity.

The good news is that research in the gaming addiction field does appear to be reaching an emerging consensus. There have also been over 20 studies using neuroimaging techniques (such as functional magnetic resonance imaging) indicating that generalized internet addiction and online gaming addiction share neurobiological similarities with more traditional addictions. However, it is critical that a unified approach to assessment of IGD is urgently needed as this is the only way that there will be a strong empirical and scientific basis for IGD to be included in the next DSM.

Note: A version of this article was first published on Rehabs.com

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders – Text Revision (Fifth Edition). Washington, D.C.: Author.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M. D., Pápay, O., . . . Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5), e36417.

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, under review.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Kim, M. G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

King, D. L., Delfabbro, P. H., Griffiths, M. D., & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

King, D. L., Delfabbro, P. H., & Griffiths, M. D. (2012). Cognitive-behavioral approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

King, D.L., Haagsma, M.C., Delfabbro, P.H., Gradisar, M.S., Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., Paksi, B., Papp, K., Kun, B., . . . Demetrovics, Z. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2013).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, in press.

Pápay, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment. New York: Elsevier.

Petry, N.M., & O’Brien, C.P. (2013). Internet gaming disorder and the DSM-5. Addiction, 108, 1186–1187.

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder. Cyberpsychology and Behavior, 1, 237-244.

The weighting game: Gambling with the nation’s health (revisited)

A couple of weeks ago I wrote a blog on why problem gambling should be considered a health issue. Earlier this week, I came across an interesting study carried out by jackpot.co.uk who surveyed 2,131 online gamblers (58% males and 42% female) about their health. After the self-reported data had been collected, the gamblers were classed into one of nine categories based on the casino game type that the gambler played most often (i.e., slot machines, video poker, blackjack, roulette, dice/craps, baccarat, poker, pai gow, and ‘other’). The data were then tabulated so that all the health variables (including obesity) corresponded to the gambler’s preferred casino game.

I was interested in the findings not only because I am a Professor of Gambling Studies, but also because I was a member of the Department of Health’s Expert Working Group on Sedentary Behaviour, Screen Time and Obesity’ (a reference to our final report to the British government can be found in the ‘Further Reading’ section below). The study took an objective measurement of physical condition by asking each gambler their height (centimetres) and their weight (kilograms) to calculate each person’s Body Mass Index (BMI) by dividing the gamblers’ weight by height (metres) and dividing by height again (for example, someone who weighs 80kg and is 180cm tall, the BMI is 24.1 as this is 80/1.80)/1.80). The survey then asked s few general health and lifestyle questions (similar to ones that we have used in the last few British Gambling Prevalence Surveys:

  • Do you normally drink more than the recommended limit for weekly alcohol consumption (21 units of alcohol for men and 14 for women)? (Yes/No)
  • Do you smoke regularly? (Yes/No)
  • Do you normally engage in at least 30 minutes of physical activity, 5 times per week? (Yes/No)

Overall, the survey found that British casino gamblers as a group were no less healthy than the rest of the British population, with an average Body Mass index (BMI) of 27 (which is the same as the UK national average). However, the survey also reported that the average BMIs, health, and lifestyle choices (such as smoking cigarettes, engaging in exercise, and drinking alcohol varied considerably depending on the casino games that the respondents played. Here are some of the main findings:

  • Slots players were the least healthy. They took less exercise and had an average BMI of 31, pushing them into the category of obese (which is linked to increased chance of developing illnesses such as Type 2 diabetes and reduced life expectancy)
  • Roulette, blackjack, video poker and craps/dice players were not far behind slots players, each having BMI levels higher than the national average.
  • Those that played poker, baccarat and Pai Gow had an average BMI of 25 or under (well within the normal range recommended by the World Health Organisation.
  • Whilst drinking levels might be reasonably high among poker players, they were very exercise conscious, with 58% engaging in physical activity for at least 30 minutes, five times a week. For slots players the figure was 27% meeting this government recommended target.
  • Overall slots players drink the most, with 24.1% drinking over the recommended weekly limit. Poker players are not far behind on 23%. Female slots players were the biggest drinking subgroup, closely followed by male poker players.
  • Slots players also smoked more, with 24% being regular smokers (compared to the UK national average of 20%). Blackjack and roulette players smoked slightly more than average, on 21% and 22% respectively, while poker players smoked slightly less than average, on 19.5%.

None of these results is overly surprising as there are many studies (including my own) showing comorbidity between gambling and other potentially addictive behaviours. However, very few academic studies have ever looked at these health variables by game type. Although this was not an academic study, the results will likely be of interest to those in the gambling studies field.

The survey also examined the most common platform on which the gamblers played casino games. The most common was the desktop computer (65%), followed by mobiles and tablets (20%) and land-based casinos (14%). This is not surprising given the survey was completed by online gamblers. Interestingly, desktop use was linked to higher levels of obesity, drinking and smoking. This is something that I would expect given that online gambling is the most sedentary of these activities.

There are (of course) some limitations with the data collected particularly as it comprised a self-selected sample of online gamblers that played via jackpot.co.uk websites. We have no idea as to whether the sample is representative of all online gamblers but as I noted above, it is no surprise that online gamblers preferred playing casino games online compared to offline (i.e., land-based casinos). The data were also self-report and are therefore open to any number of individual biases including recall biases and social desirability biases. Also, we have no geographical breakdown of the sample as the internet (by definition) is global. However, the sample size is good in comparison to many published studies on gambling and the sample included individuals that were actually gamblers (as opposed to university undergraduates or members of the general public). According to Sam Marsden (editor of jackpot.co.uk and author of the report):

“There’s an undeniable link connecting passive games like slots and video poker to unhealthy, sedentary lifestyles. On the other hand, games that require concentration, strategy and some physical stamina like poker and blackjack seem to fare much better in the health stakes. It seems it’s less a case of ‘you are what you eat’ and more ‘you are what you play’.”  

Although such a conclusion could be argued to be PR spin on the findings, the results suggest that more rigorous studies could be carried out in the area including secondary analyses of the robust datasets that already exist including the British Gambling Prevalence Surveys, the English Health Surveys, and the Scottish health Surveys.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Biddle, S., Cavill, N., Ekelund, U., Gorely, T., Griffiths, M.D., Jago, R., et al. (2010). Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health/Department For Children, Schools and Families (126pp).

Griffiths, M.D. (2001). Gambling – An emerging area of concern for health psychologists. Journal of Health Psychology, 6, 477-479.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association (ISBN 1-905545-11-8).

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Marsden, S. (2014). Booze, bets, and BMI. Jackpot.co.uk, October 6. Located at: http://www.jackpot.co.uk/online-casino-articles/booze-bets-bmi

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Wardle, H., Griffiths, M.D., Orford, J., Moody, A. & Volberg, R. (2012). Gambling in Britain: A time of change? Health implications from the British Gambling Prevalence Survey 2010. International Journal of Mental Health and Addiction, 10, 273-277.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M. D., Constantine, R., & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: National Centre for Social Research.

The national wealth service: Problem gambling is a health issue

Over the last decade, the United Kingdom has undergone major changes of gambling legislation (most notably, the 2005 Gambling Act that came into force on September 1, 2007). The Gambling Act has provided the British public with increased opportunities and access to gambling like they have never seen before. Gambling legislation was revolutionized and many of the tight restrictions on gambling dating back to the 1968 Gaming Act were relaxed (particularly in relation to the advertising of gambling). The deregulation of gambling has also been coupled with the many new media in which people can gamble (internet gambling, mobile phone gambling, interactive television gambling, gambling via social networking sites). Given the expected explosion in gambling opportunities, is this something that the health and medical professions should be concerned about?

Gambling has not been traditionally viewed as a public health matter although research into the health, social and economic impacts of gambling has grown considerably since the 1990s. In August 1995, the British Medical Journal published an editorial called ‘Gambling with the nation’s health?’ which argued that gambling was a health issue because it widened the inequalities of income and that there was an association between inequality of income in industrialized countries and lower life expectancy. However, there are many other more specific reasons why gambling should be viewed as an issue for the medical profession.

According to the last British Gambling Prevalence Survey (BGPS) published in 2011, just under 1% of the British population have a severe gambling problem although the rate is approximately twice as high in adolescents, particularly as a result of problematic slot machine gambling. Disordered gambling is characterized by unrealistic optimism on the gambler’s part. All bets are made in an effort to recoup their losses. The result is that instead of “cutting their losses”, gamblers get deeper into debt pre-occupying themselves with gambling, determined that a big win will repay their loans and solve all their problems.

It is clear that the social and health costs of problem gambling can be large on both an individual and societal level. Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, family neglect, and bankruptcy. I have also reported in a number of my papers (including a 2007 report I wrote for the British Medical Association) that there can also be adverse health consequences for both the gambler and their partner including depression, insomnia, intestinal disorders, migraines, and other stress-related disorders. In the UK, preliminary analysis of the calls to the national gambling helpline also indicated that a significant minority of the callers reported health-related consequences as a result of their problem gambling. These include depression, anxiety, stomach problems, other stress-related disorders and suicidal ideation.

There are also other issues relating to problem gambling that may have medical consequences. One US study published in the Journal of Emergency Medicine by Dr. Robert Muellman and his colleagues found that intimate partner violence (IPV) was predicted by pathological gambling in the perpetrator. In a sample of 286 women admitted to the emergency department at a University Hospital in Nebraska, findings revealed that a woman whose partner was a problem gambler was 10.5 times more likely to be a victim of IPV than partners of a non-problem gambler.

Health-related problems due to problem gambling can also result from withdrawal effects. In a study published in the American Journal of the Addictions, Dr. Richard Rosenthal and Dr. Henry Lesieur found that at least 65% of pathological gamblers reported at least one physical side-effect during withdrawal including insomnia, headaches, upset stomach, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty and/or chills. Their results were also compared to the withdrawal effects from a substance-dependent control group. They concluded that pathological gamblers experienced more physical withdrawal effects when attempting to stop than the substance-dependent group. I also found similar things in a small study that I published in the Social Psychological Review (with Michael Smeaton).

Pathological gambling is very much the ‘hidden’ addiction. Unlike (say) alcoholism, there is no slurred speech and no stumbling into work. Furthermore, overt signs of problems often don’t occur until late in the pathological gambler’s career. If problem gambling is an addiction that can destroy families and have medical consequences, it becomes clear that medical professionals should be aware of the effects of gambling in just the same way that they are with other potentially addictive activities like drinking (alcohol) and smoking (nicotine).

However, gambling addiction is an activity that is not (at present) being treated via the British National Health Service (NHS). This was shown in a paper that I published with Dr. Jane Rigbye in a paper we published in a 2011 issue of the International Journal of Mental Health and Addiction. We sent a total of 327 letters were sent to all Primary Care Trusts, Foundation Trusts and Mental Health Trusts in the UK requesting information about problem gambling service provision and past year treatment of gambling problems within their Trust under the Freedom of Information Act. Our findings showed that 97% of the NHS Trusts did not provide any service (specialist or otherwise) for treating those with gambling problems (i.e., only nine Trusts provided evidence of how they deal with problem gambling). Only one Trust offered dedicated specialist help for problem gambling. Our study showed there was some evidence that problem gamblers may get treatment via the NHS if that person has other co-morbid disorders as the primary referral problem.

Problem gambling is very much a health issue that needs to be taken seriously by all within the health and medical professions. General practitioners routinely ask patients about smoking and drinking but gambling is something that is not generally discussed. Problem gambling may be perceived as a somewhat ‘grey area’ in the field of health and it is therefore very easy to deny that those in the medical profession should be playing a role. If the main aim of practitioners is to ensure the health of their patients, then it is quite clear that an awareness of gambling and the issues surrounding it should be an important part of basic knowledge.

As briefly outlined above, opportunities to gamble and access to gambling have increased because of deregulation and technology. What has been demonstrated from research evidence in other countries is that – in general – where accessibility of gambling is increased there is an increase not only in the number of regular gamblers but also an increase in the number of problem gamblers – although this may not be proportional. This obviously means that not everyone is susceptible to developing gambling addictions but it does mean that at a societal (rather than individual) level, in general, the more gambling opportunities, the more problems. Other countries such as Australia, Canada and New Zealand have seen increases in problem gambling as a result of gambling liberalization. In the UK, the last BGPS showed that problem gambling in Great Britain had increased by 50% compared to the previous BGPS published in 2007. (However, the latest data from the combined Health Survey for England and the Scottish Health Survey in 2014 reported that problem gambling had fallen to about 0.5%).

Gambling is without doubt a health and issue and there is an urgent need to enhance awareness within the medical and health professions about gambling-related problems and to develop effective strategies to prevent and treat problem gambling. The rapid expansion of gambling represents a significant public health concern and health/medical practitioners also need to research into the impact of gambling on vulnerable, at-risk, and special populations. It is inevitable that a small minority of people will become casualties of gambling in the UK, and therefore help should be provided for the problem gamblers. Since gambling is here to stay and is effectively state-sponsored, the Government should consider giving priority funding (out of taxes raised from gambling revenue) to organizations and practitioners who provide advice, counselling and treatment for people with severe gambling problems.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association.

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D., Scarfe, A. & Bellringer, P. (1999). The UK National telephone Helpline – Results on the first year of operation. Journal of Gambling Studies, 15, 83-90.

McKee, M. & Sassi, F. (1995). Gambling with the nation’s health. British Medical Journal, 311, 521-522.

Muelleman, R. L., DenOtter, T., Wadman, M. C., Tran, T. P., & Anderson, J. (2002). Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. Journal of Emergency Medicine, 23, 307-312.

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Rosenthal, R. & Lesieur, H (1992). Self-reported withdrawal symptoms and pathological gambling. American Journal of the Addictions, 1, 150-154.

Setness, P.A. (1997). Pathological gambling: When do social issues become medical issues? Postgraduate Medicine, 102, 13-18.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Net losses: What are the downsides of online therapy for problem gamblers and clinicians?

In my last blog, I briefly looked at the advantages of online therapy. However, the growth of online therapy is not without its critics. I may have given the impression in my previous blog that online therapy has nothing but positive implications. However, this blog briefly examines some of the main criticisms that have been levelled against online therapy. This loist is not exhaustive but hopefully covers the key concerns:

  • Legal and ethical considerations: As Internet counselling services grow, attention will have to be focused on the specialist construction of a legal and ethical code for this type of work. Cyberspace transcends state and international borders, therefore, there are many legal and regulatory concerns. For example, client/doctor confidentiality regulations differ from one jurisdiction to another. It may not be legal for a clinician to provide chat-room services to problem gamblers who are in a jurisdiction in which the clinician is not licensed. Furthermore, some problem gamblers may be excluded from telehealth services because they lack the financial resources to access the Internet. One potential ethical and legal dilemma is the extent to which service quality can be ensured. It is possible that individuals who register to provide counselling services online do not have the qualifications and skills they advertise. They may not even be licensed to practice. There are also issues regarding the conduct of practitioners engaged in all forms of telecommunication therapy. For example: issues of informed consent, the security of electronic medical records, electronic claims submissions and so forth. Therapy provided over the Internet holds promise but there is a need to check that it works and see to it that, if it is done then it is done well. Underlying guidelines that are applicable to all forms of counselling are that: (i) the therapist must be trained, supervised and accountable with qualifications that can be checked against a list held by a mainstream organisation, and (ii) the nature of the contract between client and practitioner must be spelled out so clients understand the boundaries of what they are receiving for what they are paying.
  • Effectiveness of online therapy: There are a growing number of evaluation studies that have examined whether online therapy is an effective treatment approach. With specific regard to problem gambling, my research colleague Dr. Gerry Cooper reported that about 70% spoke of how they benefited from their exposure to and involvement with GAweb, an online peer support group. An evaluation that I carried out with Dr. Richard Wood of Gam-Aid also showed that participants derived great benefit from using the online service and was particularly attractive for problem online gamblers (that are already comfortable with interacting online).
  • Confidentiality: Online therapy may compromise privacy and confidentiality, particularly if a skilled computer ‘hacker’ is determined to locate information about a particular individual. There is also some evidence that as more personal information is required of counselling sites online, the attractiveness of these sites is reduced. On the other hand, one of the things that the Internet is especially helpful with is its ability to afford the consumer the control over self-disclosure. In this way, individuals may overestimate the degree to which their information is safe and secure from computer hackers.
  • Encryption: No online therapist can confidently promise a problem gamblers confidentiality given the limitations of the medium. That being said, there are some sites that now offer secure messaging systems that offer the same level of protection as banking institutions. To protect confidentiality, care will have to be taken to prevent inappropriate and deliberate hacking into counselling sessions on the Internet. There will need to be a continuous upgrading of technology to stay ahead of hackers’ ability to breach security.
  • Complicated payment structures: Given the cross-national nature of the Internet, there may be complicated pay structures for problem gamblers to overcome when selecting a therapist. While universally-accepted credit cards might actually make payment easier (since one can use their credit card online and the credit card company will automatically calculate the currency exchange for the transaction), one may not immediately understand how much the online counselling has cost in their own currency. They may not know this until their credit card invoice arrives at a later date.
  • Cost-effectiveness to the therapist: For the therapist, there is the problem that online counselling may be as time consuming as face-to-face therapy with substantially less financial remuneration.
  • Identity problems: One of the major potential problems is that online problem gamblers may not be who they say they are, i.e., counsellors may not always know the true identity of their online clients (although identity is an issue only applicable to those services that are not anonymous). This is clearly a major issue since some assumptions (rightly or wrongly) are made by the clinician depending on what the problem gambler presents (including age and other demographics). However, to some extent, these issues also apply to telephone and face-to-face counselling as the therapist has to accept what is said at face value. Additionally, some might argue that merely responding to the words that a problem gambler chooses to use necessitates more focus on the part of the therapist. As a result, this may lead to a more democratic counselling environment. In other words, the role of therapist and problem gambler becomes more equal in this situation. Some therapists may have difficulty adapting to these new roles.
  • Severity of client problems: Some clients’ problems may be just too severe to be dealt with over the Internet. To some extent, there can always be contingencies, but because people can come from anywhere in the world and have a multitude of circumstances, online clinicians may be hard-pressed to meet everyone’s needs. It is important to acknowledge that this is not a panacea; that online help will not solve everybody’s problems (to be sure, those who are illiterate will likely have a difficult time of it without some additional support nearby). On the other hand, it is likely to go a long way in helping a great many more people than otherwise would have been the case.
  • Client referral problems: One obvious difficulty for the counsellor is how to go about making a referral for someone in a faraway town or another country. Once again, one would need to establish basic contingencies. Over time, it could be expected there would be many more international-regional clearinghouses regarding where to get immediate assistance, but to date it is very difficult to know what services are available for many parts of the world.
  • Establishing client rapport: It could perhaps be argued that there might be difficulty in establishing rapport with someone that the therapist has never seen. This is an interesting area where clearly more information is needed. One might also argue that because the problem gambler is in a more equal relationship with the therapist, they will feel more comfort. That is, since the problem gambler controls all of the personal disclosure levers, rapport might be established much more easily.
  • No face-to-face contact: Online therapy leads to a loss of non-verbal communication cues such as particular body language, voice volume and tone of voice. Furthermore, the lack of face-to-face interaction between problem gambler and therapist could result in a wrong referral or diagnosis. What is known about online communication where cues are filtered out, is that it typically takes more work to accomplish a task where more than one person is involved. It may be the case that with time and experience, therapists who work online will develop skills that will help them compensate for the absence of visual cues. For example, they might become much more skilled and precise with the words they choose to use.
  • Incomplete information: The written information provided in online therapy may be incomplete. Online therapy (via e-mail) may not allow the opportunity for immediate follow-up questions. Making a provisional recommendation or diagnosis is fraught with potential problems. For instance, a problem gambler may describe problems that are symptomatic of other more serious underlying disorders. However, diagnostic processes are quite heterogeneous practices even in face-to-face settings. Diagnoses are often provisional and therapists usually require more information to validate initial observations. In fact, clinicians might have better access to their clients through e-mail than trying to track them down face-to-face or exchanging telephone answer messages, should they need further information. Still, the information derived from problem gamblers in online formats may be unverifiable, more so than in face-to-face contexts.
  • Loss of therapist contact: Although perhaps more of a possibility than a reality, therapists can just ‘disappear’ only to re-emerge weeks later saying that their server failed and/or leave a problem gambler mid-therapy with little that the problem gambler can do about it. The same problem could occur with some clinicians in face-to-face settings although being online may be more of a problem in finding out what has happened.
  • Commercial exploitation: Consumers theoretically are not always as anonymous as they might think when they visit health sites because some sites share visitors’ personal health information with advertisers and business partners without consumers’ knowledge or permission. Some sites allow third-party advertisers to collect visitors’ personal information without disclosing this practice. As a result, visitors may get e-mails from advertisers about their products and services. Information can be collected during a variety of tasks including the visiting of chat rooms and bulletin boards, searching for information, subscribing to electronic newsletters, e-mailing articles to friends or filling out health-assessment forms. This allows third parties to build detailed, personally identified profiles of individuals’ health conditions and patterns of Internet use. In relation to gamblers, this is a real issue. By virtue of posting to places where problem gamblers talk to each other online with an accurate e-mail address shown, online gambling operators have the potential to collect such information in order to later send junk e-mail promoting their gambling websites. Other questionable and fraudulent marketing practices by online operators have also been outlined in my previous blogs.
  • Emergency situations: Being online and geographically distant has the potential to cause problems in an acute situation. For instance, if a clinician does not know where a problem gambler lives or can be located, they cannot call for help in the case of an emergency such as a suicidal threat.
  • Convenience: Although convenience was outlined as an advantage in the previous section, it can also have a downside. For instance, it may mean that the problem gambler is less likely to draw on their own existing coping strategies and use the online therapist as a convenient crutch (something which is actively discouraged in face-to-face therapy).

Hopefully this blog has redressed the balance of my previous blog on the positive benefits of online therapy. Anyone that seeks online advice, help, and/or treatment needs to carefully do their own cost-benefit analysis as to whether such an online service will be of direct benefit to them after taking into account some of the disadvantages outlined here.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bloom, W. J. (1998). The ethical practice of Web Counseling. British Journal of Guidance and Counselling, 26 (1), 53-59.

Connall, J. (2000). At your fingertips: Five online options. Psychology Today, May/June, 40.

Griffiths, M.D. (2001). Online therapy: A cause for concern? The Psychologist: Bulletin of the British Psychological Society, 14, 244-248.

Griffiths, M.D. (2005). Online therapy for addictive behaviors. CyberPsychology and Behavior, 8, 555-561.

Griffiths, M.D. (2010). Online advice, guidance and counseling for problem gamblers. In M. Manuela Cunha, António Tavares & Ricardo Simões (Eds.), Handbook of Research on Developments in e-Health and Telemedicine: Technological and Social Perspectives (pp. 1116-1132). Hershey, Pennsylvania: Idea Publishing.

Griffiths, M.D. & Cooper, G. (2003). Online therapy: Implications for problem gamblers and clinicians, British Journal of Guidance and Counselling, 13, 113-135.

Rabasca, L. (2000). Self-help sites: A blessing or a bane? APA Monitor on Psychology, 31(4), 28-30.

Segall, R. (2000). Online shrinks: The inside story. Psychology Today, May/June, 38-43.

Wood, R.T.A. & Griffiths, M.D. (2007). Online guidance, advice, and support for problem gamblers and concerned relatives and friends: An evaluation of the Gam-Aid pilot service. British Journal of Guidance and Counselling, 35, 373-389.

Wood, R. T., & Wood, S. A. (2009). An evaluation of two United Kingdom online support forums designed to help people with gambling issues. Journal of Gambling Issues, 23, 5-30.

Net gains: What are the benefits of online therapy for problem gamblers and clinicians?

“A 35-year old man comes home very late from a night out at the casino having lost all his savings at the roulette wheel. Unable to sleep, he logs onto the Internet and locates a self-help site for problem gambling and fills out a 20-item gambling checklist. Within a few hours he receives an E-mail which suggests he may have an undiagnosed gambling disorder. He is invited to revisit the site to learn more about his possible gambling disorder, seek further advice from an online gambling counsellor and join an online gambling self-help group” (from Griffiths and Cooper, 2003)

On initial examination, this fictitious scenario appears of little concern until a number of questions raise serious concerns. For instance, who scored the gambling test? Who will monitor the gambling self-help group? Who will give online counselling advice for the gambling problem? Does the counsellor have legitimate qualifications and experience regarding gambling problems? Who sponsors the gambling website? What influence do the sponsors have over content of the site? Do the sponsors have access to visitor data collected by the website? These are all questions that may not be raised by a problem gambler in crisis seeking help but they are important questions that require answers. Of course, these are also questions that should apply to any comparable face-to-face interventions.

The Internet could be viewed as just a further extension of technology being used to transmit and receive communications between the helper and the helped. If gambling practitioners shun the new technologies, others who might have questionable ethics will likely come in to fill the clinical vacuum. Online therapy is growing. Furthermore, its growth appears to outstrip any efforts to organize, limit and regulate it. It has been claimed that online therapy is a viable alternative source of help when traditional psychotherapy is not accessible. Proponents claim it is effective, private and conducted by skilled, qualified, ethical professionals. It is further claimed that for some people, it is the only way they either can or will get help (from professional therapists and/or self-help groups).

Psychological services provided on the Internet range from basic information sites about specific disorders, to self-help sites that assess a person’s problem, to comprehensive psychotherapy services offering assessment, diagnosis and intervention. Most experts agree that online therapy currently available is not traditional psychotherapy. For many, it appears to be an alternative for those who are either unable or reluctant to seek face-to-face treatment. There have been many reasons put forward as to why online assistance is advantageous. Here are the main ones:

  • Online therapy is convenient: Online therapy is convenient to deliver, and can provide a way to seek instant advice or get quick and discreet information. In the case of counselling by E-mail, one needs to keep in mind that therapy per se can occur either via professionally delivered formats or via peer-delivered self-help groups. In addition, the counselling might not necessarily be restricted to E-mail; some might augment face-to-face counselling with E-mail ‘booster’ sessions. In this way, correspondence happens at the convenience of both the client and the counsellor. Online therapy avoids the need for scheduling and the setting of appointments, although for those who want them, appointments can be scheduled over a potential 24-hour period. For problem gamblers who might have a sense of increased risk or vulnerability, they can take immediate action via online interventions, as these are available on demand and at any time. Crisis workers often report that personal crises occur beyond normal office hours, making it difficult for people to obtain help from mental health clinicians and the like. If a problem gambler has lost track of time at the casino only to depart depressed, broke, and suicidal at 4am in the morning, they can perhaps reach someone at that hour who will be understanding, empathic and knowledgeable. They likely have a better chance of finding someone at an online peer-support site like GamTalk (gamtalk.org) than they would at their local mental health centre.
  • Online therapy is cost-effective for clients: Compared with traditional face-to-face therapies, online therapy is cheaper. This is a big selling point often used by those selling their services online (for instance, some sites advertise their online services as ‘less than the customary cost of a private therapy session’ or ‘help and therapy at a reasonable fee’). This is obviously an advantage to those who may have low financial resources. It may also allow practitioners to provide services to more clients because less time is spent travelling to see them. Since there are financial consequences for a gambler, cheaper forms of therapy such as online therapy may be a preferred option out of necessity rather than choice. The cost factor is particularly important in countries where people are often forced to pay for health care (for example, in the United States). With the Internet, quality information and support (even if treatment is not yet freely available online) is available without cost. Arguably, one needs Internet access, but this too is becoming more freely available, and conceivably, even those who are homeless would be able to utilize such services through places like public libraries (although, literacy would continue to be an important requirement).
  • Online therapy overcomes barriers that otherwise may prevent people from seeking face-to-face help: There are many different groups of people who might benefit from online therapy. For example, those who are (i) physically disabled, (ii) agoraphobic, (iii) geographically isolated and/or do not have access to a nearby therapist (military personnel, prison inmates, housebound individuals etc.), (iv) linguistically isolated, and (v) embarrassed, anxious and/or too nervous to talk about their problems face-to-face with someone, and/or those who have never been to a therapist before might benefit from online therapy. Some like those with agoraphobia and/or the geographically isolated, might be more susceptible to activities like online gambling because they either tend not to leave home much or they do not have access to more traditional gambling facilities (like casinos, bingo halls, racetracks and so forth). It is clear that those that are most in need of help (whether it is for mental health problems, substance abuse or problem gambling often do not receive it).
  • Online therapy helps to overcome social stigma: The social stigma of seeing a therapist can be the source of profound anxiety for some people. However, online psychotherapists offer clients a degree of anonymity that reduces the potential stigma. Gambling may be particularly stigmatic for some because they may find it is a self-initiated problem. Others have found that the issue of stigma has caused some problem gamblers to avoid seeking treatment. Furthermore, in an exploratory study, my research colleague Dr. Gerry Cooper found that there was a correlation between higher levels of concerns about stigma and the absence of treatment utilization, and that lurking (i.e., visiting but not registering presence to other users) at a problem gambling support group website made it easier for many to seek help including face-to-face help. It should also be noted that there is strong emerging evidence for the power and effectiveness of narrative therapies. For example, there is some evidence to suggest that a person’s use of positive emotion words in their written articulations of difficult or problematic experiences lead to improved health changes.
  • Online therapy allows therapists to reach an exponential amount of people: Given the truly international cross-border nature of the Internet, therapists have a potential global clientele. Furthermore, gambling itself has been described as the ‘international language’ and has spread almost everywhere within international arenas.

From the brief outline presented here, it would appear that in some situations, online therapy can be helpful – at least to some specific sub-groups of society, some of which may include problem gamblers. Furthermore, online therapists will argue that there are responsible, competent, ethical mental health professionals forming effective helping relationships via the Internet, and that these relationships help and heal. However, online therapy is not appropriate for everyone. As with any new frontier, there are some issues to consider before trying it. In my next blog I will look at some of the downsides of online therapy.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bloom, W. J. (1998). The ethical practice of Web Counseling. British Journal of Guidance and Counselling, 26 (1), 53-59.

Connall, J. (2000). At your fingertips: Five online options. Psychology Today, May/June, 40.

Griffiths, M.D. (2001). Online therapy: A cause for concern? The Psychologist: Bulletin of the British Psychological Society, 14, 244-248.

Griffiths, M.D. (2005). Online therapy for addictive behaviors. CyberPsychology and Behavior, 8, 555-561.

Griffiths, M.D. (2010). Online advice, guidance and counseling for problem gamblers. In M. Manuela Cunha, António Tavares & Ricardo Simões (Eds.), Handbook of Research on Developments in e-Health and Telemedicine: Technological and Social Perspectives (pp. 1116-1132). Hershey, Pennsylvania: Idea Publishing.

Griffiths, M.D. & Cooper, G. (2003). Online therapy: Implications for problem gamblers and clinicians, British Journal of Guidance and Counselling, 13, 113-135.

Rabasca, L. (2000). Self-help sites: A blessing or a bane? APA Monitor on Psychology, 31(4), 28-30.

Segall, R. (2000). Online shrinks: The inside story. Psychology Today, May/June, 38-43.

Wood, R.T.A. & Griffiths, M.D. (2007). Online guidance, advice, and support for problem gamblers and concerned relatives and friends: An evaluation of the Gam-Aid pilot service. British Journal of Guidance and Counselling, 35, 373-389.

Wood, R. T., & Wood, S. A. (2009). An evaluation of two United Kingdom online support forums designed to help people with gambling issues. Journal of Gambling Issues, 23, 5-30.

Period pain: A brief look at ‘binge gambling’

Most of you reading this will have probably heard of ‘binge drinking’ and ‘binge eating’. These behaviours are well known in the psychological literature. However, there has been very little research into the phenomenon of binge gambling. Binge gambling shares many similarities with other binge behaviours including loss of control, salience, mood modification, conflict, withdrawal symptoms, denial, etc. However, there are also clear differences between some binge behaviours. For instance, amounts of alcohol and food can be quantified and measured in terms of physical factors (e.g., organ capacity, weight, metabolic rate), and are therefore subject to physical limitation. The amount of money spent gambling can be highly individual, related to the gambler’s income and access to money, and is limited by few external controls aside from time, fatigue, and lack of funds.

In 2003, Dr. Lia Nower and Dr. Alex Blaszczynski published a case study of a binge gambler in the journal International Gambling Studies. They hypothesized the existence of a unique typology of adult gamblers that are distinctly different from traditional pathological gamblers. They hypothesized that gambling binges are characterized by six factors including:

  • Sudden onset of irregular or intermittent periods of sustained gambling
  • Excessive expenditures relative to income
  • Rapidly spent money over a discrete interval of time
  • Sense of urgency and impaired control
  • Marked intra-and inter-personal distress
  • Absence between bouts of any rumination, preoccupation or cravings to resume gambling participation.

More recently I also published a case study of a binge gambler in the International Journal of Mental Health and Addiction – a male slot machine addict that I called ‘Trevor’ (and aged 31 years when I published my study). I met Trevor in my capacity as an expert witness in a court trial. Trevor was charged with criminal offences related to his gambling behaviour.

Trevor’s initial gambling involvement started in the summer of 1990 when he was 16 years of age. At the time, Trevor had just begun working on a Youth Training Scheme in a West Midland town in the UK. His place of work was situated right next to an amusement arcade that housed many slot machines. Trevor’s normal routine was to go to the arcade every Friday (on his ‘pay day’). At this stage, Trevor rarely spent more than £3 at any one time on the machines and they were clearly unproblematic at that point.

Over the following years (1993–1996), Trevor’s slot machine gambling became progressively worse (at least in the amount he was spending on them) although not necessarily problematic. From 1995 onwards, Trevor had a good job as a support worker for people with disabilities. He was 21-years old and “making good money” (£250 a week), but about half of his salary was used to fund his slot machine gambling. Trevor recalled very vividly one Friday evening at the end of 1995 when he lost £200 of his weekly wage playing a slot machine. This he said was “devastating” to him. It was after this single incident that Trevor admitted to himself that he may have a problem with his gambling. Trevor is what would best be described as a binge gambler and did not gamble daily. His typical pattern would be to gamble only once or twice a week (most Fridays and the occasional Sunday). However, these binges often resulted in the losing of substantial sums of money — at least substantial to Trevor.

The real “crunch” in Trevor’s life came in the latter half of 1997 (aged 23 years) when because of his excessive gambling he failed to pay any rent or bills and was evicted from the flat he was living in at the time. In February 1998, Trevor started attending Gamblers Anonymous (GA) even though there was not a local group to attend. This meant he had to travel to Birmingham, which was three-quarters of an hour away from where he lived. Trevor attended GA for just over a year and eventually left in March 1999. While drop out rates for GA tend to be high (over 90% in the first few weeks of attendance), Trevor gained immense benefit from this group by the fact he attended for a significant period of his life. The weekly GA meeting provided a supportive network that helped Trevor’s gambling problem subside. He also knew he wasn’t alone in experiencing these types of problem.

During the following five-year period (early 1999 to early 2004), Trevor didn’t gamble at all, took control of his own earnings, and appeared to have his slot machine gambling under control. During this period, his gambling problem almost totally subsided. He began a relationship in 2000, and in 2002, they had a baby son. Trevor gambled small amounts (approximately £2 to £3) very occasionally on slot machines and always in the company of his partner who would be “keeping an eye on him” to make sure he didn’t overspend. During this period of over three years, Trevor claimed he was in control of his gambling and that because his life had some stability.

In February 2004, Trevor and his partner split up and Trevor’s gambling once again “spiralled out of control”. Most of the time Trevor would be gambling on his favourite slot machine in his local pub because it served as an escape from the breakdown of his relationship. Trevor claimed that only a quarter of his wages at this point was spent on gambling because he needed to keep money back to buy things for when he got periodic access to his young son (such as nappies, food, etc.).

On the surface, this type of behaviour does not appear to be indicative of someone totally out of control with their gambling, as most problem gamblers do not think about the consequences of their actions before they gamble. It could be the case that Trevor was either lying about how much money he spent or — like many gamblers — was not accurately recalling how much money he was spending during this period. Alternatively, and perhaps more likely, he only gambled excessively when there was nothing else to focus on his life. If Trevor’s self-report is to be believed, his son appeared to act as a barrier to the worst excesses of his gambling as his son came first when he had access to him. On the occasions where Trevor was totally responsible for his son, it forced Trevor’s problem gambling into the background somewhat.

The research literature (including my own work) certainly shows that major life events often cause spontaneous remission in gambling addictions (e.g., getting married, birth of first child, getting a job etc.). During this period in 1994, Trevor didn’t feel he had enough to support his gambling from his wages as he resorted to criminal acts, (i.e., opening mail at the postal depot where he worked in an attempt to get money to gamble on slot machines). Being caught stealing money to feed his gambling habit clearly indicated to Trevor that he needed help with his gambling again. He once again attended GA in the latter half of 2004.

Trevor believed his gambling problems were related to low self-esteem coupled with feeling depressed and having nothing else to do. Such feelings are typically found in problem gamblers who use gambling as a way of modifying their mood. Trevor claimed that his excessive gambling was integrally linked with his mood state and that when he was feeling down and/or agitated he sought solace in gambling that made him (temporarily) feel better. However, when he lost money, he would feel even worse. Trevor’s gambling problems were usually linked to other underlying problems. When these were dealt with, his problem gambling all but disappeared. It became obvious that Trevor’s gambling binges were typically caused by very specific ‘trigger’ incidents and that Trevor used gambling as a way of making himself feel better. The break-up of his last relationship was such a clear trigger incident.

Compared to other problem gamblers I have known, Trevor’s gambling was much less problematic. The gambling was usually symptomatic of other problems in Trevor’s life. In short, problem gambling only occurred at two very specific periods in Trevor’s life (1997 and 2004) and that these binges were triggered by very specific incidents. It is also worth noting that Trevor’s gambling problem was very specific (i.e., slot machines) and that no other types of gambling caused him any problems. Trevor’s case appears to adhere to the six characteristics of binge gambling outlined above by Dr. Nower and Dr. Blaszczynski in that there was irregular or intermittent periods of sustained gambling, excessive expenditures relative to income, rapidly spent money over a discrete interval of time, a sense of urgency and impaired control (at least at the times of problem gambling), marked intra- and inter-personal distress, and absence between bouts of any rumination, preoccupation or cravings to resume gambling participation.

It is not uncommon for problem gamblers to gamble excessively on ‘pay days’, lose their money, and wait for the next cycle. What really distinguishes Trevor as a binge gambler is that there is clear evidence that Trevor has had long periods of trouble-free gambling in his life (e.g., 1990 to 1995; 2000 to 2004). When things were going well for Trevor, gambling was simply not an issue. When given access and responsibility for his son, Trevor clearly puts him before anything else. Being totally responsible for his son appears be a major protective barrier in preventing him gamble.

It is also interesting to note that between his two major binges of problem gambling (1997 and 2004), Trevor appeared to have phases of both abstinent and controlled gambling. This shares some similarities with the literature on controlled drinking (particularly the pioneering research of Dr. Linda Sobell and Dr. Mark Sobell) which suggests that alcoholics who had sustained periods of non-problematic social drinking may be more likely to be able return to controlled drinking. Trevor’s case also supports other case studies in the gambling literature showing that controlled gambling after periods of problem gambling is possible.

The concept of problem binge gambling is still a much overlooked area. It appears to be less serious than chronic problem gambling but can still cause significant problems in the lives of people it affects. More research should be carried out along the lines of the types of research that are currently being carried out into binge drinking.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Dickerson, M. G., & Weeks, D. (1979). Controlled gambling as a therapeutic technique for compulsive gamblers. Journal of Behavioural Therapy and Experimental Psychiatry, 10, 139–141.

Griffiths, M.D. (1994). The role of cognitive bias and skill in fruit machine gambling. British Journal of Psychology, 85, 351–369.

Griffiths, M.D. (1995). Adolescent gambling. London: Routledge.

Griffiths, M.D. (2002). Gambling and gaming addictions in adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055–1056.

Griffiths, M.D. (2006). A case study of binge problem gambling. International Journal of Mental Health and Addiction, 4, 369-376.

Nower, L., & Blaszczynski, A. (2003). Binge gambling: A neglected concept. International Gambling Studies, 3, 23–35.

Rankin, H. (1982). Control rather than abstinence as a goal in the treatment of excessive gambling. Behavioural Research Therapy, 20, 185–187.

Sobell, L. C., Sobell, M. B., & Ward, E. (Eds.) (1980). Evaluating alcohol and drug abuse treatment effectiveness. Elmsford, New York: Pergamon.

Token gestures: A brief look at ‘sexual trophy collecting’

Back in 2002, I had a little piece published on excessive collecting behaviour in the Guardian newspaper (‘Addicted to hoarding’). In it I wrote:

“I have always been interested in why we have what seems like an innate ability to collect. I would almost go as far as to say that we are ‘natural born hoarders’. Furthermore, there has been surprisingly little research in this area and Freud’s theories on the topic are unfortunately almost empirically untestable. I would also add that for some people, collecting is at the pathological end of the behavioural continuum. There are some that are (for want of a better word) ‘addicted’ to collecting and there are some with obsessive-compulsive disorders who simply cannot throw away anything”.

Since then I’ve published a few articles on the psychology of collecting in this blog and is probably one of the reasons that I have had a few approaches over the last couple months from journalists asking me about the psychology behind various forms of collecting. (In fact, I’ve also been approached to write an academic chapter on the phenomenon too). Two of the most recent media requests included journalists writing articles on why people collect retro video games (which I hope to write about in a future blog) and another on why people collect ‘sexual trophies’.

I have to admit that I am no expert on sexual trophies so I did a little reading on the topic. According to one definition I came across, a sexual trophy is “any item or piece of clothing gained from a sexual encounter as proof of a successful sexual conquest”. To tie in with the release of US comedy I Just Want My Pants Back, MTV conducted a [non-academic] survey and reported that one in three young British people (aged between 18 and 34 years) admitted to owning some sort of sex trophy with one in six of them (16%) claiming they had two or more sex-based trophies (a group that MTV termed ‘Sexual Magpies’).

However, when it comes to the collecting ‘sexual trophies’, I would argue that most academic research that I have come across on the topic relates to more criminal sexual deviance rather than day-to-day sexual encounters. For instance, in the 2010 book Serial Murderers and Their Victims, Dr. Eric Hickey described the case of man – who was a voyeur – from Georgia (US) that used to break into houses and steal women’s underwear. On his eventual arrest they found over 400 pairs of knickers that he had stolen. More disturbing are cases such as this excerpt from a story in the Daily Telegraph. This is arguably more typical of what I perceive to be sexual trophy hunters:

“A company manager and ‘pillar of the community’ has been exposed after 20 years as a serial sex attacker known as the Shoe Rapist. James Lloyd, 49, a long-standing Freemason who took the footwear of his victims as trophies, was finally caught through advances in DNA techniques. Police later found more than 100 pairs of stiletto shoes hidden behind a trap door at the printing works where he was employed… As well as taking their shoes, he often stole jewellery from the women, mainly in their teens and early 20s, between 1983 and 1986” (Daily Telegraph, July 18, 2006).

However, Dr. Hickey’s book describes even worse acts of sexual trophy collecting. He noted that many serial killers are “known for their habits of collecting trophies or souvenirs. Others have collected lingerie, shoes, hats, and other apparel”. A sizeable section of the book concentrates on the types of serial killers that are popular in the media (such as those that commit ‘lust murders‘) and are the subject of many Hollywood films such as the series of films with (my favourite fictional psychopath) Hannibal Lecter. As Hickey notes:

“These are the rapists who enjoy killing and, often, indulging in acts of sadism and perversion. These are the men who have engaged in necrophilia, cannibalism, and the drinking of victims’ blood. Some like to bite their victims; others enjoy trophy collecting – shoes, underwear, and body parts, such as hair clippings, feet, heads, fingers, breasts, and sexual organs…[and] evoke our disgust, horror, and fascination”.

One of the cases discussed is 1950s US serial killer Harvey Glatman (known in the media as ‘The Lonely Hearts Killer’) who used to take photographs of the women he murdered. Citing the work of Dr. Robert Keppel (another expert in serial murder cases and author of Serial Murder: Future Implications for Police Investigations), Dr. Hickey wrote:

“His photos were more than souvenirs, because in Glatman’s mind, they actually carried the power of his need for bondage and control. They showed the women in various poses: sitting up or lying down, hands always bound behind their backs, innocent looks on their faces, but with eyes wide with terror because they had guessed what was to come”.

Other murderers described by Dr. Hickey included a man that liked to surgically remove (and keep) the eyeballs from his sexual victims (most probably 1990s’ serial killer Charles Allbright) and another that skinned his victims and made lampshades, eating utensils, and clothing. In his overview of necrophilic homicide (i.e., those individuals that kill others in order to engage in sexual activity), Hickey also mentions that such necrosadistic murderers often engage in other paraphilias related to necrophilia “including partialism or the desire to collect specific body parts that the offenders finds sexually arousing. This may include feet, hands, hair, and heads, among others”. Hickey also noted that:

“Another important characteristic of these lust killers was the ‘perversion factor’. This subgroup was often prone to carry out bizarre sexual acts. These acts most commonly included necrophilia and trophy collection. Jerry Brudos severed the breasts of some of his victims and made epoxy molds. Brudos, like others, also photographed his victims in various poses, dressed and disrobed. The photos served as trophies and a stimulus to act out again”.

Later in the book, Dr. Hickey examines the case of Jerry Brudos in more detail (please be warned that some of the things written here may offend those of a sensitive nature):

“At an early age, Jerry Brudos developed a particular interest in women’s shoes, especially black, spike-heeled shoes. As he matured, his shoe fetish increasingly provided sexual arousal. At 17, he used a knife to assault a girl and force her to disrobe while he took pictures of her. For his crime he was incarcerated in a mental hospital for 9 months. His therapy uncovered his sexual fantasy for revenge against women, fantasies that included placing kidnapped girls into freezers so he could later arrange their stiff bodies in sexually explicit poses. He was evaluated as possessing a personality disorder but was not considered to be psychotic…He continued to collect women’s undergarments and shoes. Prior to his first murder, he had already assaulted four women and raped one of them. At age 28, Jerry was ready to start killing…He took [his first victim] to his garage, where he smashed her skull with a two-by-four. Before disposing of the body in a nearby river, he severed her left foot and placed it in his freezer. He often would amuse himself by dressing the foot in a spiked-heel shoe. His fantasy for greater sexual pleasure led him…to strangle [another victim] with a postal strap. After killing her, he had sexual intercourse with the corpse, then cut off the right breast and made an epoxy mold of the organ. Before dumping her body in the river, he took pictures of the corpse. Unable to satisfy his sexual fantasies and still in the grasp of violent urges, he found his third victim…After sexually assaulting her, he strangled her in his garage, amputated both breasts, again took pictures, and tossed her body into the river”.

Arguably the most infamous ‘sexual trophy collector’ was 1980s US serial killer Jeffrey Dahmer, the so-called ‘Milwaukee Cannibal’. In Dr. Hickey’s account he noted that:

“Restraining Dahmer, the officers looked around the apartment and counted at least 11 skulls (7 of them carefully boiled and cleaned) and a collection of bones, decomposed hands, and genitals. Three of the cleaned skulls had been spray-painted black and silver. These were to be part of the shrine fantasized by Dahmer. A complete skeleton suspended from a shower spigot and three skulls with holes drilled into them were found throughout the apartment…Chemicals, including muriatic acid, ethyl alcohol, chloroform, and formaldehyde, were also discovered, along with several Polaroid photographs of recently dismembered young men. A complete human head sat in the refrigerator”.

Another infamous case from the early 1970s (that I admit I had never heard of until I read Dr. Hickey’s book) was Ed Kemper, a cannibalistic killer who also collected human trophies and keepsakes of his victims. Citing the book Hunting Humans by Dr. Elliot Leyton, it was reported that:

“At the age of 23, Ed started killing again, a task that would last nearly a year and entail eight more victims. He shot, stabbed, and strangled them. All were strangers to him, and all were hitchhikers. He cannibalized at least two of his victims, slicing off parts of their legs and cooking the flesh in a macaroni casserole. He decapitated all of his victims and dissected most of them, saving body parts for sexual pleasure, sometimes storing heads in the refrigerator. Ed collected ‘keepsakes’ including teeth, skin, and hair from the victims. After killing a victim, he often engaged in sex with the corpse, even after it had been decapitated. In his confession Kemper stated five different reasons for his crimes. His themes centered on sexual urges, wanting to possess his victims, trophy hunting, a hatred for his mother, and revenge against an unjust society (Leyton, 1986)”.

The most obvious question related to these depraved acts is why such people do it in the first place. Writing in the Encyclopedia of Murder and Violent Crime, Nicole Mott provides an answer:

“A trophy is in essence a souvenir. In the context of violent behavior or murder, keeping a part of the victim as a trophy represents power over that individual. When the offender keeps this kind of souvenir, it serves as a way to preserve the memory of the victim and the experience of his or her death. The most common trophies for violent offenders are body parts but also include photographs of the crime scene and jewelry or clothing from the victim. Offenders use the trophies as memorabilia, but also to reenact their fantasies. They often masturbate or use the trophies as props in sexual acts. Their exaggerated fear of rejection is quelled in front of inanimate trophies. Ritualistic trophy taking, as is found with serial offenders, acts as a signature. A signature is similar to a modus operandi (a similar act ritualistically performed in virtually all crimes of one offender), yet it is an act that is not necessary to complete the crime”

In one of my previous blogs on the psychology of collecting more generally, I referred to a paper by Dr. Ruth Formanek in the Journal of Social Behavior and Personality. She suggested five common motivations for collecting: (i) extension of the self (e.g., acquiring knowledge, or in controlling one’s collection); (ii) social (finding, relating to, and sharing with, like-minded others); (iii) preserving history and creating a sense of continuity; (iv) financial investment; and (v), an addiction or compulsion. She also claimed that the commonality to all motivations to collect was a passion for the particular things collected. Personally, I think that the acquisition of sexual trophies – even in the most deranged individuals – can be placed within this motivational typology in that such individuals clearly have a passion for what they do and I would argue that the behaviour is an extension of the self that to some individuals may be a compulsion or addiction.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Branagh, N. (2012). Third of UK owns sex trophy. March 26. Located at: http://www.studentbeans.com/mag/en/sex-relationships/third-of-uk-owns-sex-trophy

Du Clos, B. (1993). Fair Game. New York: St. Martin’s Paperbacks.

Griffiths, M.D. (2002). Addicted to hoarding. The Guardian (Review Section), August 10, p.19.

Formanek, R. (1991). Why they collect: Collectors reveal their motivations. Journal of Social Behavior and Personality, 6(6), 275-286.

Hickey, E. W. (Ed.). (2003). Encyclopedia of Murder and Violent Crime. London: Sage Publications

Hickey, E. W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Keppel, R. D. (1989). Serial Murder: Future Implications for Police Investigations. Cincinnati, OH: Anderson.

Leyton, E. (1986a). Hunting Humans. Toronto: McClelland and Stewart.

Leyton, E. (1986b). Compulsive Killers: The Story of Modern Multiple Murder. New York: New York University Press.

War of the Words: Campaign for Fairer Gambling still gambling with people’s reputations

The Campaign for Fairer Gambling (CFFG) yesterday responded to my article in which I outlined the potentially libellous comments made by CFFG spokesperson Adrian Parkinson. Here’s my brief response to what was said and alleged in yesterday’s CFFG’s article.

“Supposed academic”: In my previous blog I noted that Parkinson had claimed that I was only a “supposed academic” and that I believed this to be false and deliberately malicious. The CFFG now concedes in their article that I am not only an academic but a “decorated” one. However, no apology was given. They then go onto claim:

“Using the term ‘supposed’ does not impact that general point. However, when conducting certain industry funded projects, it is right to question whether these are being conducted on an academic, commercial or egotistical basis. It is supposed that they are conducted on an academic basis”

Firstly, Parkinson clearly used the word “supposed” in an attempt to slur and denigrate my research and reputation. Parkinson could have written the same tweet without the word “supposed” and the meaning and emphasis of what he said would have been different. I found Parkinson’s use of the word both offensive and demeaning. If someone claimed in an article that Parkinson was a “supposed campaign consultant”, anyone reading that would probably assume that the person writing it was trying to make a point that he is not worthy of being a campaign consultant. (For the record, I am well aware that Parkinson is the CFFG’s campaign consultant and would not sink to the level of calling him a “supposed campaign consultant”). The CFFG says the use of the word “supposed” does not impact on their general points made about me. That is irrelevant. The word “supposed” in and of itself was used in a potentially libellous way. It doesn’t take away from my point that the use of the word “supposed” in this context was hurtful, malicious, and without foundation. Secondly – and for the record – all of my work is conducted for academic reasons. Any insinuation otherwise is again untrue and potentially libellous.

“Defender of FOBTs”: In my response to Parkinson’s claim that I am “industry funded defender of FOBTs” I pointed out in my previous article that I’ve only ever written one public article on the topic (a blog I wrote in 2013). The CFFG response to this was to separate out the “funded” and the “defender of FOBTs” in an attempt to justify the claims made. If not being anti-FOBTs in my one blog on this issue counts as being a defender of FOBTs, then so be it. However, my objection was the use of the combined term “industry funded defender of FOBTs” because I am not. There is a world of difference between an academic having independently carried out a few consultancy projects for the gaming industry and being industry funded. Using the CFFG’s criterion why haven’t they called me Gambling Commission-funded or British Academy-funded or ESRC-funded?  The reason is that it doesn’t suit the picture they are trying to paint.

My personal views are not (and never have been) funded by anyone. In my previous article I provided a detailed account showing that my research is not industry-funded and that out of the 1500+ articles and papers I have published not a single one of those had been about FOBTs. I have now published over 500 blogs in addition to those 1500+ other articles and only one of these is on the topic of FOBTs. Not a single one these articles has been funded by the industry. One of the reasons I am not anti-FOBTs is because we now live in a society that anyone with internet access via computer, laptop, tablet or mobile phone has access to FOBT-type games at their fingertips. Basically, if you own a smart phone, you are walking around with a potential bookmaker in your pocket. On this basis, singling out FOBTs in licenced bookmakers to be banned has no equity at all.

“Industry funded”: Again, I will make the point that having ever received money from the gaming industry for independent consutancy and being “industry-funded” are two very different things. Being ‘industry funded’ suggests everything someone does is paid for by the industry. Based on the article published yesterday, one of the CFFG’s main concerns about my academic activity appears to be that one of my consultancies was a social responsibility assessment for Paddy Power. As I mentioned in my article about Parkinson’s potentially libellous tweets, I’ve written around 150 consultancy reports on social responsibility and responsible gambling and I can indeed confirm that one of my consultancy clients has been Paddy Power. The report I wrote for them covered a number of areas (most notably, crime and gambling, social responsibility in gambling, and underage gambling). Paddy Power paid my university for my time spent writing this independent report (as all monies are paid to them and not me personally) and for my appearance as an expert witness. As an independent expert witness, I have to follow all judicial protocol. In all expert witness work I follow the protocol outlined by the Civil Justice Council. The most relevant extracts are in Sections 4.1 and 4.3:

“Experts always owe a duty to exercise reasonable skill and care to those instructing them, and to comply with any relevant professional code of ethics. However when they are instructed to give or prepare evidence for the purpose of civil proceedings in England and Wales they have an overriding duty to help the court on matters within their expertise…This duty overrides any obligation to the person instructing or paying them. Experts must not serve the exclusive interest of those who retain them…Experts should provide opinions which are independent, regardless of the pressures of litigation. In this context, a useful test of ‘independence’ is that the expert would express the same opinion if given the same instructions by an opposing party. Experts should not take it upon themselves to promote the point of view of the party instructing them or engage in the role of advocates”.

Again, there is nothing in the independent report I wrote for Paddy Power that I am an “industry funded defender of FOBTs” (as there was little in my report on FOBTs). In the article published yesterday, the CFFG also claimed

“Griffiths produced a flawed critique of a paper by Steve Sharman on the strong link between problem gamblers and the homeless. Westminster Council used the Sharman paper to support the refusal of a Paddy Power license. Griffiths did not contact Sharman prior to publishing his criticism, which is against academic etiquette. He also did not identify that he has a commercial relationship with Paddy Power in his attack on Sharman”.

I’m not sure in what way the CFFG thinks my critique of the study carried out by Sharman and his colleagues was “flawed” (they didn’t say) but for the record (i) the critique I wrote has been published in the Journal of Gambling Studies (JGS), (ii) I did email Sharman (and his colleagues) about my critique, and (iii) I sent Sharman and his colleagues a copy of my published critique (so that they could pen a response to the JGS if they so wished). I am not sure what the CFFG mean when they say I have a “commercial relationship with Paddy Power”. If they mean that Paddy Power paid my university for my time spent writing my independent consultancy report, then that is true. If they mean that Paddy Power (and any of my clients) are paying me personally then that is false (as all consultancy money is paid to my employer – Nottingham Trent University – and not me personally).

“Dirty work for the ABB”: In Parkinson’s original tweets he said I was carrying out “dirty work” for the Association of British Bookmakers. Nothing in the response article by the CFFG actually defended their use of the term “dirty”. The CFFG may have the view that is morally wrong for someone like myself to do consultancy on social responsibility and responsible gambling with any organization connected with the gaming industry. They may simply not like the fact that a “decorated academic” like myself should have any working association with the gaming industry at all. But none of this is “dirty” or “dirty work”. The work I do is legitimate, legal, independent, and in accordance with all consultancy protocols. The assertion that the work I do is “dirty” is simply a slur on my reputation and was used in a context to again demean the work that I do. Again, taking the word “dirty” out of the tweet would have entirely changed the meaning. The CFFG then go on to assert: 

“Griffiths is evaluating a code of conduct which he has helped author in conjunction with the ABB – so he is evaluating his own work, which is again, against academic etiquette. A formal evaluation of the code of conduct is being conducted by Nat Cen. The Campaign for Fairer Gambling anticipate that this evaluation will be more critical of the – code of conduct than the Griffiths ‘self”-evaluation’.”

There are a number of issues here that are simply wrong. While I did input into the ABB code (and was proud to do so), it is in no way ‘my’ code or my “own work”. The ABB introduced some of the things into the new code that I wanted to see in it (most notably time and money setting tools, pop-up reminders, and mandatory breaks – based on our empirical research published in the Journal of Gambling Studies and the Journal of Gambling Issue – see ‘Further Reading below). My consultancy report on the how the new social responsibility tools were used by FOBT players in the first 15 weeks of operation is a commentary on the data and an evaluation in the loosest sense (i.e., the dictionary definition of the making of a judgement about the amount, number, or value of something”). The CFFG also state that “self-evaluation” is “against academic etiquette”. This is simply not true. Many (if not most) evaluations of anything published in the academic literature are self-evaluations of one description or another. For instance, gambling treatment interventions, gambling education programs, and gambling prevention programs are typically evaluated by the researcher or the research team that designed them.

“Doing what the industry tells me to do”: In Parkinson’s tweets, he claimed I simply do what the industry tells me to do. I said this was a ludicrous claim and the CFFG’s ‘evidence’ that I do has absolutely no foundation whatsoever. They say:

“In respect of FOBTs: through the misleading FOBT blog, the code of conduct, his appearance at court with Paddy Power, a willingness to attack an academic paper used by a council to act against Paddy Power, the Campaign Killer blog, and his willingness to attend an invitation only ABB event to promote the code of conduct, Griffiths is supporting the commercial interests of bookmakers. It is understandable that others believe he is sympathetic to the position of the bookmakers on FOBTs. After all, Griffiths knows all about the importance to his career of being able to attract funded research as he acknowledges in his ‘Campaign Killer’ blog”.

Absolutely nothing mentioned in the above paragraph provides any evidence that I “do what the industry tells me to do”. The writing of independent consultancy reports is not doing what the gaming industry tells me to do. My FOBT blog is not misleading. My critique of the gambling homelessness study is in the public domain and published in the world’s leading academic gambling journal (Journal of Gambling Studies). All the above paragraph demonstrates is that of the thousands of projects and activities that I have done in my career, a small minority have involved independent consultancy for a gaming company.

Further points: The CFFG article also makes some further points that I am happy to respond to. They claim that:

“In the last paragraph of his ‘Campaign Killer’ blog, Griffiths contradicts his previous FOBT blog in which he stated that banning FOBTs would result in an increase in remote gambling. He now states it would drive problem gambling underground. This change of FOBT defence is exactly the same change of FOBT defence used by the bookmakers. But there is no evidence to support either a switch to remote gambling or underground gambling through banning FOBTs or merely a FOBT stake reduction”

I haven’t changed or switched defence as the things I highlighted are not mutually exclusive. All I have dne is speculate that if gamblers cannot gamble on FOBTs because of a ban they would probably gamble elsewhere (e.g., illegal underground FOBT gambling, remote gambling, etc.). The CFFG then goes onto say:

“Most amazingly, Griffiths also claims that the principle of social responsibility includes “maximising fun for those who enjoy gambling”. This alleged component is not referred to in the 2005 Gambling Act and does not form part of the official remit of any of the relevant bodies – Department of Culture Media and Sport, the Gambling Commission, the Responsible Gambling Trust nor the Responsible Gambling Strategy Board. It is truly remarkable that Griffiths thinks he has the authority to advocate this definition”

The CFFG appear not to have realized that I have been writing about social responsibility in gambling for many years prior to the 2005 Gaming Act and to the formation of the Gambling Commission and the Gambling Strategy Board. My claim that social responsibility is about maximizing the fun for those that enjoy gambling and minimizing harm for those that are vulnerable comes from an article on social responsibility in gambling that I wrote in 2001 (you can download a copy from here where I mention this in the second paragraph). The Gambling Commission is under no obligation to use my views of what social responsibility is about. For me, one of the most important things about social responsibility is about getting the balance right. At its simplest level, my own view (in many of my social resposibility writings since 2001) has always tried to think how the non-problem gambler would react to having a prohibitions or restrictions placed upon them in an attempt to protect the most vulnerable. Finally, the CFFG talk about libel. They assert:

“The current standard of libel law relates to ‘substantial harm’ to a reputation whereas the prior standard related to a lesser standard of ‘harm’. Griffiths refers to being ‘previously vilified and criticized by the gaming industry’. It would be interesting to learn if Griffiths threatened the gambling industry with legal action under the lesser harm standard for that vilification”

In response to this question, I have only ever had to threaten legal action once as the majority of criticism I have received has been said without being libellous. This does not change my view that the tweets made by Parkinson are still potentially libellous.

I realize that the CFFG are likely to come back with yet another point-by-point retaliation but I am probably going to stop responding. I have done nothing wrong and I will simply have to accept that the CFFG will continue to smear my work. I have avoided the temptation of attacking their campaign philosophy and where they get their funding from as this has been written up by others. (If you are really interested in who funds the CFFG and why they do what they do, I suggest you check out this article by Mark Davies and the legal threats he then received – and this other article).

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Auer, M. & Griffiths, M.D. (2013). Limit setting and player choice in most intense online gamblers: An empirical study of online gambling behaviour. Journal of Gambling Studies, 29, 647-660.

Auer, M. & Griffiths, M.D. (2014). Personalised feedback in the promotion of responsible gambling: A brief overview. Responsible Gambling Review, 1, 27-36.

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Auer, M., Malischnig, D. & Griffiths, M.D. (2014). Is ‘pop-up’ messaging in online slot machine gambling effective? An empirical research note. Journal of Gambling Issues, 29, 1-10.

Griffiths, M.D. (2001). Good practice in the gaming industry: Some thoughts and recommendations. Panorama (European State Lotteries and Toto Association), 7, 10-11.

Griffiths, M.D. (2012). Internet gambling, player protection and social responsibility. In R. Williams, R. Wood & J. Parke (Ed.), Routledge Handbook of Internet Gambling (pp.227-249). London: Routledge.

Griffiths, M.D. (2014). The relationship between gambling and homelessness: A commentary on Sharman et al (2014). Journal of Gambling Studies, DOI 10.1007/s10899-014-9491-0

Griffiths, M.D. & Wood, R.T.A. (2008). Responsible gaming and best practice: How can academics help? Casino and Gaming International, 4(1), 107-112.

Griffiths, M.D., Wood, R.T.A., Parke, J. & Parke, A. (2007). Gaming research and best practice: Gaming industry, social responsibility and academia. Casino and Gaming International, 3(3), 97-103.

Sharman, S., Dreyer, J., Aitken, M., Clark, L., & Bowden-Jones, H. (2014). Rates of problematic gambling in a British homeless sample: A preliminary study. Journal of Gambling Studies, DOI 10.1007/s10899-014-9444-7.

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