Category Archives: Drug use
Like many others around the world, last week I was genuinely shocked when I heard about the death of Oscar-winning actor Philip Seymour Hoffman on February 2 (2014). One of my regular blog readers emailed me a couple of days ago asking if I would be writing a blog on him because of all his well publicized past drug and alcohol addiction. As the Wikipedia entry on his personal life noted:
“In a 2006 interview, Hoffman revealed he had suffered from drug and alcohol abuse and that after graduating from college at age 22, he went to rehab for drug and alcohol addiction. He said he had abused ‘anything I could get my hands on. I liked it all’. Hoffman relapsed more than 20 years later with heroin and addiction to prescription medications. He subsequently checked himself into a drug rehab for about ten days in May 2013”.
I had already decided I would do a belated tribute to Seymour Hoffman but not in relation to his chemical addictions – but in relation to his portrayal of gambling addiction in the 2003 film Owning Mahowny. Although my all-time favourite gambling film is the 1974 movie The Gambler starring James Caan (a film on which I’ve written academically – see ‘Further Reading’ below), Owning Mahowny runs a close second. One of the key strengths of Owning Mahowny was that it was based on a real person. Seymour Hoffman played ‘Dan Mahowny’ (whereas the real life person was Brian Molony).
Brian Malony worked as a Toronto-based bank clerk at the Canadian Imperial Bank of Commerce (CIBC). Over a one-and-a-half year period – and to fund his gambling addiction – Molony embezzled over $10million from the bank. His story was later the subject of a best-selling book by Gary Ross (called Stung: The Incredible Obsession of Brian Molony, and on which the screenplay to Owning Mahowny was based). Ross wrote his book following 4-5 hours of interviewing Molony every day for a month. Ross was asked what made Molony’s story so interesting:
“I was senior editor at ‘Saturday Night’ magazine at the time the fraud was discovered, right across the street from the Bay and Richmond (Toronto) branch of the CIBC. I assumed it was some sophisticated computer scam – how else could you liberate $10.2-million from a big bank? [I] was intrigued to learn from Eddie Greenspan, Brian Molony’s lawyer, that Molony was a compulsive gambler and that the frauds had been acts of improvised desperation rather than an elegant criminal scheme…Gambling addiction can be every bit as devastating, and as hard to treat, as a drug or alcohol dependency. It’s all the more insidious for being invisible, and it’s far more widespread than most people understand. A lot of social security checks, pay checks, and even liquidated homes end up on the casino’s bottom line”.
Additionally, and according to Molony’s Wikipedia entry:
“Molony, who had developed a passion for the race-track and gambling from the age of ten years, and acted as a bookie for his school-mates, graduated from the University of Western Ontario in London with a degree in journalism. Initially planning to be a financial writer, he did so well in a Canadian Imperial Bank of Commerce aptitude test that he was put in their management-training program and hired right out of university. Molony spent a few weeks as a teller before working in savings, current accounts, foreign exchange and loan accounting, then ‘floating’ among some of the Bank’s huge network of some 1,600 branches, which gave him a further broad exposure to the bank’s highly regimented workings and familiarity with its systems and internal weaknesses. On a modest annual salary of about $10,000, Molony led an unassuming lifestyle in Toronto, wearing inexpensive, ill-fitting clothes and leaving carefully calculated seven per cent tips in restaurants, at the same time he was embezzling $10.2 million from CIBC to feed his gambling habit, writing loans in the names of both real and fictitious companies. Molony was then able to transfer millions of dollars out of the bank through a company called California Clearing Corp., a wholly owned subsidiary of Desert Palace, a Las Vegas casino. This corporation’s only purpose was to let people deposit sums of money into the casino without detection”.
After 18 months of spending his employer’s money (including $4,732,000 lost at Caesars between February 7, 1981 to April 23, 1982), Molony lost half a million dollars at the Caesars casino playing table games in Atlantic City (AC). Molony had led the life of a ‘high roller, and was being heavily ‘comped’ with free luxury hotel rooms and access to a Lear jet to fly between AC and Vegas. Molony was eventually arrested (April 27, 1982), the day after he lost the money at Caesars. Later in the year (November 1983), Molony admitted during his trial that he had embezzled all the money from CICB and served 30 months in jail. One of his activities since leaving prison has been to lecture publicly on gambling addiction. At the same time that Molony went to jail, CIBC filed a federal lawsuit claiming that Caesars’ staff members should have realized that the money Molony was gambling with was not his own. The case was eventually settled out of court with the terms of the settlement remaining private.
Seymour Hoffman’s portrayal of Molony was excellent and provides true insight into life as a problem gambler. Obviously there is some artistic license in the dramatization of Molony’s life but all the key elements in the film were true. The film is noteworthy because (like The Gambler) the story concerns the effects of gambling addiction on the gambler and those around him rather than the glitz and glamour of gambling in Vegas and AC. Gary Ross, author of Stung was asked whether Seymour Hoffman’s portrayal bore similarity with Brian Molony. He replied:
“Remarkably so. They have the same stocky build, bushy moustache, glasses, slightly unkempt look, and earnestness. And Philip somehow managed to assimilate the psychic essence of Molony – a yawning emptiness that nothing except gambling was able to fill…It’s remarkably faithful to what actually happened. I assumed a great many liberties would be taken in the transition from page to screen, and I’m pleased that the changes were minor and inconsequential. The pathos and grimness of what happened is there in the movie”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Griffiths, M. (2004). An empirical analysis of the film ‘The Gambler’. International Journal of Mental Health and Addiction, 1(2), 39-43.
Ross, G. (1987). Stung: The Incredible Obsession of Brian Molony. London: Stoddart.
Wikipedia (2014). Brian Molony. Located at: http://en.wikipedia.org/wiki/Brian_Molony
Wikipedia (2014). Owning Mahowny. Located at: http://en.wikipedia.org/wiki/Owning_Mahowny
Wikipedia (2014). Philip Seymour Hoffman. Located at: http://en.wikipedia.org/wiki/Philip_Seymour_Hoffman
Back in 1996, I published a paper on behavioural addictions in the Journal of Workplace Learning. One of my introductory paragraphs in that paper noted:
“There is now a growing movement (e.g. Miller, 1980; Orford, 1985) which views a number of behaviours as potentially addictive, including many behaviours which do not involve the ingestion of a drug. These include behaviours diverse as gambling (Griffiths, 1995), overeating (Orford, 1985), sex (Carnes, 1983), exercise (Glasser, 1976), computer game playing (Griffiths, 1993a), pair bonding (Peele and Brodsky, 1975), wealth acquisition (Slater, 1980) and even Rubik’s Cube (Alexander, 1981)! Such diversity has led to new all encompassing definitions of what constitutes addictive behaviour”.
The reason I mention this is that I was recently asked to comment on a story about ‘wealth addiction’ and I vaguely remembered that I had mentioned (in passing) Philip Slater’s 1980 book (also entitled Wealth Addiction). Slater’s book was written from a sociological standpoint and was both controversial and provocative. Slater claimed on the book cover that: ““Money is America’s most powerful drug. Here’s how it weakens us and how we can free ourselves”. I also came across an interesting 2012 article by journalist Scott Burns (on ‘wealth addiction revisited’) who noted that:
“One of the hallmarks of wealth addiction is very simple: more possessions but less use. We become so interested in possessing the thing that we lose the experience it provides. This can be as vast as owning homes all around the world, as some of the very rich do, as simple as Bernie Madoff’s shoe collection, or as obsessive as a collection of rare watches. Whatever it is, the wealth addict confuses possession with experience”.
Slater argued that our increasing reliance on money and all of the things that it can buy has the potential to become an obsession that can destroy individual lives. According to short article by Dr. Paul Hokemeyer, wealth addiction has three key characteristics:
- Tolerance: More and more money is needed to attain a baseline level of satisfaction.
- Withdrawal: The thought of losing money or not making it fills a person with fear, anxiety and stress.
- Negative consequences: In their pursuit of money, the person forgoes emotional fulfillment, intimate relationships and peace of mind.
These are actually three of the six criteria that I personally believe comprise genuine addictive behaviour (although I use the word ‘conflict’ rather than ‘negative consequences’; the other three criteria are salience, mood modification and relapse – see my previous blog on behavioural addiction for further details).
The reason why wealth addiction has made a re-appearance over the last month is because of an article published in the New York Times by Sam Polk, a former hedge fund trader that worked on Wall Street (and who since the article has been published has been compared to Jordan Belfort, the person that Leonardo DiCaprio portrayed in the true story film The Wolf of Wall Street).
Polk’s article is an interesting read (whether you think wealth addiction exists or not) and I thought I would pick out some of the text and relate it to my own views about what constitutes addictive behaviour.
- Extract 1: “In my last year on Wall Street my bonus was $3.6 million – and I was angry because it wasn’t big enough. I was 30 years old, had no children to raise, no debts to pay, no philanthropic goal in mind. I wanted more money for exactly the same reason an alcoholic needs another drink: I was addicted”
Here, Polk refers to his work bonuses becoming bigger and bigger and that they were never enough. To me, this sounds like some kind of tolerance effect with more and more money needed to achieve the desired (presumably mood modifying effect). Polk also claims – after the fact – that he had become addicted.
- Extract 2: “I was also a daily drinker and pot smoker and a regular user of cocaine, Ritalin and ecstasy. I had a propensity for self-destruction that had resulted in my getting suspended from Columbia for burglary, arrested twice and fired from an Internet company for fist fighting”.
Polk openly discusses his previous use of potentially addictive substances and made the comparisons himself between his self-confessed behavioural (wealth) addiction and his previous self-destructive chemical abuse. Some readers may jump to the conclusion that Polk had (or has) an ‘addictive personality’ but this is not something that I personally believe in. To me, Polk is displaying ‘reciprocity’ (swapping one potential addiction with another) rather than being a function of an underlying personality trait. Giving up one addiction often leaves a large void and sometimes the only way to fill it is by engaging in other behaviours that provide similar feelings and sensations.
- Extract 3: “My counselor didn’t share my elation [at earning more and more money]. She said I might be using money the same way I’d used drugs and alcohol – to make myself feel powerful — and that maybe it would benefit me to stop focusing on accumulating more and instead focus on healing my inner wound”.
Here, Polk’s therapist appears to hit the nail on the head in relation to what money represented for Polk. I would describe the feeling that Polk gained from both drugs and money was omnipotence (something that I have also written about in relation to my research on gambling).
- Extract 4: “I was terrified of running out of money and of forgoing future bonuses. More than anything, I was afraid that five or 10 years down the road, I’d feel like an idiot for walking away from my one chance to be really important. What made it harder was that people thought I was crazy for thinking about leaving. In 2010, in a final paroxysm of my withering addiction, I demanded $8 million instead of $3.6 million. My bosses said they’d raise my bonus if I agreed to stay several more years. Instead, I walked away”.
Polk’s language here is very much rooted in what addicts say about their drug or behaviour of choice (“terrified” of being without the thing they love doing). The weighing up of the costs clearly led to a decision for Polk to quit his “withering addiction” and there are obviously signs both here (and the rest of the article if you read it) that leaving behind the wealth left him with some feelings of regret.
- Extract 7: “The first year was really hard. I went through what I can only describe as withdrawal — waking up at nights panicked about running out of money, scouring the headlines to see which of my old co-workers had gotten promoted. Over time it got easier — I started to realize that I had enough money, and if I needed to make more, I could. But my wealth addiction still hasn’t gone completely away. Sometimes I still buy lottery tickets”.
Here, Polk uses addictive terminology (i.e., withdrawal) to describe giving up the activity that led to him gaining wealth. Again, the fear of running out of money appears psychologically similar to the fear that other more traditional addicts have about running out of their drug of choice. It could also be argued that he has given up one form of gambling (financial trading) with partially doing another (buying lottery tickets).
- Extract 8: “I was lucky. My experience with drugs and alcohol allowed me to recognize my pursuit of wealth as an addiction. The years of work I did with my counselor helped me heal the parts of myself that felt damaged and inadequate, so that I had enough of a core sense of self to walk away”
Polk uses his experiences in giving up drugs with the help of his therapist as a way of helping him give up wealth acquisition. Knowing you have managed to give up one addiction shows that you have the mental strength to give up another.
Obviously I have never met Polk and I can only go on how he described his experiences during his time on Wall Street, However, the insights shared do seem to suggest that some of the wealth acquisition behaviour had addictive elements and that there was at least some evidence that Polk – at least on some occasions – experienced salience, tolerance, withdrawal, conflict and mood modification. Whether he was genuinely addicted to money in the same way as drug addicts are addicted to psychoactive substances is debatable. However, theoretically, I can see how someone might be become addicted to wealth. There are also interesting questions as to whether wealth acquisition may be an underlying motivation for those addicted to work.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Alexander, R. (1981). A cube popular in all circles. New York Times, 21 July, p. C6.
Burns, S. (2012). Beyond envy: Wealth addiction revisited. Dallas News, December 15: Located at: http://www.dallasnews.com/business/columnists/scott-burns/20121215-beyond-envy-wealth-addiction-revisited.ece?nclick_check=1
Carnes, P. (1983). Out of the Shadows: Understanding Sexual Addiction. CompCare, New York, NY.
Glasser, W. (1976). Positive Addictions. Harper & Row, New York, NY.
Griffiths, M.D. (1993). Are computer games bad for children? The Psychologist: Bulletin of the British Psychological Society, 6, 401-407.
Griffiths, M.D. (1995). Adolescent Gambling, Routledge: London.
Orford, J. (1985). Excessive Appetites: A Psychological View of the Addictions. Wiley: Chichester.
Peele, S. and Brodsky, A. (1975). Love and Addiction. Taplinger: New York, NY.
Polk, S. (2013). For the love of money. New York Times, January 29. Located at: http://www.nytimes.com/2014/01/19/opinion/sunday/for-the-love-of-money.html?_r=1
Slater, P. (1980). Wealth Addiction. E.P. Dutton: New York, NY.
In 1984, Dr. Milton Burglass and Dr. Howard Shaffer published a paper in the journal Addictive Behaviors and claimed that arguably the important questions in the addiction field are ‘why do people become addicted to some things and not others?’ and ‘why some people become addicted and not others?’ Answers to these questions have been hindered by two common misconceptions about addiction, which to some extent have underpinned the ‘hard core’ disease concept of addiction. These are that addiction somehow resides within: (i) particular types of people or (ii) particular substances, and/or particular kinds of activity. That is, either some people are already ‘diseased,’ or else some substances/ activities cause this disease, or both.
There is a belief that some people are destined to become addicted. Typically this is explained in one (or both) of two ways. That some people (i.e., ‘addicts’) have an addictive personality, and that there is a genetic basis for addiction. The evidence for ‘addictive personality’ rests to a certain extent upon one’s faith in the validity of psychometric testing. Setting aside this major hurdle, the evidence in this area (as I argued with my colleagues Dr. Michael Larkin and Dr. Richard Wood in a 2006 issue of Addiction Research and Theory [ART]) is still inconclusive and contradictory.
First, psychologists have yet to determine which particular personality traits are linked to addiction. Studies have claimed that ‘the addictive personality’ may be characterized by a wide range of factors (e.g., sensation-seeking, novelty-seeking, extroversion, locus-of-control preferences, major traumatic life events, learned behaviours, etc.). The extent of this range stretches not only the notion of an ‘addictive personality’ but also the concept of ‘personality’ itself. Inevitably, much of this work relies on correlation analysis, and so the interpretation of results is not easily framed in terms of cause and effect. The approach is overly simplistic and is underpinned by a simple proposition that if we can divide people up into the right groups, then the explanation will emerge. However, addiction is far more complex than this. Of course, the relationship between individual bodies, minds, contexts, and life histories is complex and important – but it requires that we approach the matter from a more sophisticated and integrative position.
The search for a genetic basis for addiction rests upon the notion that some types of individuals are somehow ‘biologically wired’ to become addicts. In our 2006 ART paper, we argued that we must set aside any doubts about the limited conceptualization of ‘the environment’ that often typifies this kind of research, and its combination with epidemiological designs that are largely descriptive. Meta-analytic reviews have concluded that the heritability of addictive behaviour is likely to be controlled by many genes each contributing a small fraction of the overall risk. Furthermore, some of these same genes appear to be risk factors for other problems, some of them conceptually unrelated to addiction. We argued that the main point here is that while these findings do contribute something to our understanding of ‘why some people and not others,’ they do not adequately or independently explain the range of variation. Therefore the most we can say is that some people are more likely to develop problems under certain conditions, and that given the right conditions most people could probably develop an addiction. Emphasis needs to be placed on identifying those ‘conditions,’ rather than on searching for the narrowest of reductionist explanations.
We also argued in our 2006 ART paper that substances and activities cannot be described as intrinsically addictive in themselves (unless one chooses to define ‘addictive’ in terms of a substance or behaviour’s ability to produce tolerance and/or withdrawal, and to ignore the range of human experience that is excluded by this). Biologists may be able to tell us very valuable things about the psychopharmacological nature of the rewards that particular substances and behaviours provide, and the different kinds of neuroadaptation that they may or may not produce in order to effect tolerance and/or withdrawal. But we argue that this on its own, is not an adequate explanation for addiction. In 1975, Dr. Lee Robins’ classic study (in the Archives of General Psychiatry) of heroin-users returning from the Vietnam war is one example of the evidence that refutes this oversimplification. This study clearly highlighted the importance of context (i.e., that in a war zone environment individuals were addicted to heroin but on return to civilian life the addiction ceased to exist), and the framework provided by such contexts for making sense of addiction. In a hostile and threatening environment, opiates clearly provided something not usually required by most people; and given a cultural environment in which opiate use is a commonplace, and opiates are available, then opiate use ‘makes sense’. This study provides support for the assertion that some people are more likely to become addicted under some conditions, and that given the right conditions perhaps many people could understand what it means to be an addict.
So, with regard to the question, ‘why some individuals/addictions and not others?’ the rewards associated with various activities may be qualitatively very different, and may not necessarily be inherent or unique to a particular activity or substance, either. Many rewarding activities are rewarding because they present individuals with opportunities to ‘shift’ their own subjective experience of themselves (for example, see the research on Ecstasy use and bungee jumping that I published with Dr. Michael Larkin in a 2004 issue of the Journal of Community and Applied Social Psychology).
Frequently, a range of such opportunities is offered to the experienced user. Dr. Howard Shaffer (in a 1996 paper in the Journal of Gambling Studies) has pointed out that those activities that can be most relied upon to shift self-experience in a robust manner are likely to be the most popular – and (as a consequence) to be the most frequent basis of problems. So, obviously, our understanding of the available resources for mood modification must play a major part in understanding addiction. However, we must make a careful distinction between describing some substances as being more ‘robust shifters of experience’ than others (as we advocated in our 2006 ART paper) and describing some substances as ‘more addictive’ than others (which we argued against).
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Burglass, M.E. & Shaffer, H.J. (1984). Diagnosis in the addictions I: Conceptual problems. Addictive Behaviors, 3, 19-34.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Transgressive Culture, 1(1), 7-28.
Griffiths, M.D. & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account. Addiction Research and Theory, 12, 99-102.
Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.
Orford, J. (2001). Excessive Appetites: A Psychological View of the Addictions (Second Edition). Chichester: Wiley.
Robins, L.N, Helzer, J.E, & Davis, D.H (1975) Narcotic use in Southeast Asia and afterward. Archives of General Psychiatry, 32, 955-961.
Shaffer, H. J. (1996). Understanding the means and objects of addiction: Technology, the Internet, and gambling. Journal of Gambling Studies, 12, 461–469.
Tyndale, R.F. (2003). Genetics of alcohol use and tobacco use in humans. Annals of Medicine, 35(2), 94–121.
Walters, G. D. (2002). The heritability of alcohol use and dependence: A meta-analysis of behavior genetic research. American Journal of Drug and Alcohol Abuse, 28, 557–584.
Cigarette smoking among adults (i.e., those aged 18 years and over) has been a highly prevalent behaviour in Great Britain for decades but overall rates have significantly declined in recent times. Figures show that the highest recorded level of nicotine smoking among British males was in 1948 when four-fifths smoked (82%) although at that time only two-thirds smoked manufactured cigarettes (as the rest smoked pipes and/or cigars). The highest recorded level of nicotine smoking among British females was in the mid-1960s (45%) slightly higher than the prevalence rate of 41% in 1948.
A 2003 study by Dr. M. Jarvis in the journal Addiction reported that since 2000 the overall adult smoking rates in Great Britain had been declining by around 0.4% per year. More recently, the British prevalence rates of smoking remained constant at 21% between 2007 and 2009 (according to a 2013 report by Action on Smoking and Health [ASH]). According to the 2013 Office for National Statistics report, the most recent prevalence rate is 20% (21% of men and 19% of women). This equates to around 10 million British adult cigarette smokers. Smoking prevalence rates are highest in young adults. More specifically, in the 20-24 year age group, the prevalence rate of nicotine smoking is 30% in males and 28% in females. Only 1% of children are nicotine smokers at the age of 11 years. By the age of 15 years, 11% of children are regular smokers. As the 2013 ASH report noted:
“Since the mid 1970s cigarette consumption has fallen among both men and women. The overall reported number of cigarettes smoked per male and female smoker has changed little since the mid 1980s, averaging 13 cigarettes per smoker per day. As in previous years, men smoked slightly more per day on average than women and there was an association between consumption and socio-economic group. In 2011, smokers in manual occupations smoked an average of 14 cigarettes a day compared with 11 a day for those in managerial or professional groups… In 2011, 63% of smokers said they would like to stop smoking altogether. Other ways of measuring dependence include how difficult people would find it to go for a whole day without smoking and how soon they smoke after waking… In 2011, 60% of smokers said they would find it hard to go for a whole day without smoking. Eighty-one per cent of heavier smokers (20 or more a day) said they would find it difficult, compared to 32% of those smoking fewer than 10 cigarettes per day”.
Like drug addictions more generally, nicotine addiction is a complex combination of influences including genetic, pharmacological, psychological, social and environmental factors. In 2010, the US Surgeon General asserted that “there is no established consensus on criteria for diagnosing nicotine addiction” but that there are a number of symptoms can be viewed as addiction indicators such as:
- Drug use that is highly controlled or compulsive with psychoactive effects
- Stereotypical patterns of use
- Continued use despite harmful effects
- Relapse following abstinence accompanied by recurrent cravings.
A 2000 report by the Royal College of Physicians also noted that nicotine fulfils criteria for defining an addiction and states that:
“It is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration…Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.”
One of the key characteristics of drug addiction or dependence on a substance is the degree of compulsion experienced by the user. Since 1992, the British General Lifestyle Survey (which typically surveys around 15,000 adults from over 9000 households annually) has asked three questions relevant to nicotine dependence and addiction. The first is whether the person would like to stop smoking, the second is whether person would find it easy or difficult not to smoke for a whole day, and the third is how soon after waking up they smoke their first cigarette. Since 1992, there has been almost no change in any of the three measures.
The latest 2013 survey reported that 63% of smokers said they would like to stop smoking altogether and 60% felt it would be difficult for them to go a day without smoking. Four-fifths (81%) of heavy smokers (i.e., those smoking 20 or more cigarettes a day) said they would find it difficult to give up smoking compared to one-third (32%) of lighter smokers (i.e., those smoking less than 10 cigarettes a day). The average number of cigarettes smoked per day is 13, and 14% smoke a cigarette within five minutes of getting up in the morning, a figure that rises to 35% among heavy smokers who smoke more than 20 cigarettes a day. Research consistently shows that approximately two-thirds of smokers want to quit the behaviour yet the majority are unable to do so, which is also suggestive of a genuine addiction. Those that do try to quit smoking typically experience a wide range of withdrawal symptoms including craving for nicotine, irritability, anxiety, difficulty concentrating, restlessness, sleep disturbances, decreased heart rate, and increased appetite or weight gain.
Outside of Great Britain, tobacco and other drug use prevalence have been examined extensively among youth and adults. For example, by the Monitoring the Future research group in the U.S. (http://monitoringthefuture.org). They reported that daily (20 or more days in last 30 days) cigarette smoking varied from 11.4% among 18 year olds to 17% among 50 year olds. One may infer that daily cigarette smoking is addictive use, though several studies measure tobacco (nicotine) addiction specifically. Tobacco addiction (dependence) among older teenagers has been found to vary between 6% and 8%. Studies have found a prevalence rates of between 1.7% to 9.6% for tobacco addiction among college students.
In a 2004 issue of the Archives of General Psychiatry, Dr. Jon Grant and colleagues found a prevalence of 12.8% for tobacco addiction among a U.S. national sample of adults. A few years later in a 2009 issue of the American Journal of Public Health, Dr. R.D. Goodwin and colleagues found a prevalence of 21.6% and 17.8% for tobacco addiction among a U.S. national sample of male and female adults, respectively. It appears that daily smoking demonstrates about the same level of prevalence as direct measures of dependence, particularly among adults.
In a 2011 study that I carried out with Dr. Steve Sussman and Nadra Lisha, we estimated that past year nicotine dependence prevalence in the general adult population of the U.S. as being approximately 15%. A different summary of research on the epidemiology of drug dependence has shown that of all people who initiate cigarette use, almost one-third become addicted smokers (32%), a figure that is much higher addiction rate than for users of heroin (23%), cocaine (17%), alcohol (15%) or cannabis (9%).
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Action on Smoking and Health (2012). Nicotine and addiction. London: Action on Smoking and Health.
Action on Smoking and Health (2013). Smoking statistics: Who smokes and how much. London: Action on Smoking and Health.
Benowitz, N. (2010). Nicotine addiction. New England Journal of Medicine, 362, 2295–2303,
Carpenter C.M., Wayne, G.F., & Connolly, G.N. (2007). The role of sensory perception in the development and targeting of tobacco products. Addiction, 102, 136-147.
Goodwin, R.D., Keyes, K.M., & Hasin, D.S. (2009). Changes in cigarette use and nicotine dependence in the United States: Evidence from the 2001-2002 wave of the National Epidemiologic Survey of Alcoholism and Related Conditions. American Journal of Public Health, 99, 1471-1477.
Grant, B.F., Hasin, D.S., Chou, P., Stinson, F.S., & Dawson, D.A. (2004a). Nicotine dependence and psychiatric disorders in the United States. Archives of General Psychiatry, 61, 1107-1115.
Information Centre for Health and Social Care (2011). Smoking drinking and drug use among young people in England in 2011. London: Information Centre for Health and Social Care.
Jarvis, M. (2003). Monitoring cigarette smoking prevalence in Britain in a timely fashion. Addiction, 98, 1569-1574.
Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.
Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.
Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
Wald, N. & Nicolaides-Bouman, A. (1991). UK Smoking Statistics (2nd edition). Oxford: Oxford University Press.
One of the recurring questions I am often asked to comment on by the media is whether celebrities are more prone to addiction than other groups of people. One of the problems in trying to answer what looks like an easy question is that the definition of ‘celebrity’ is different to different people. Most people would argue that celebrities are famous people, but are all famous people celebrities? Are well-known sportspeople and politicians ‘celebrities’? Are high profile criminals celebrities? While all of us would say that Hollywood A-Listers such as Tom Cruise, Johnny Depp, Angelina Jolie, Brad Pitt and Julia Roberts are ‘celebrities’, many of the people that end up on ‘celebrity’ reality shows are far from what I would call a celebrity. Being the girlfriend or relative of someone famous does not necessarily famous.
Another problem in trying to answer this question is what kinds of addiction are the media actually referring to? Implicitly, the question might be referring to alcohol and/or illicit drug addictions but why should other addictions such as nicotine addiction or addiction to prescription drugs not be included? In addition to this, I have often been asked to comment on celebrities that are addicted to sex or gambling. However, if we include behavioural addictions in this definition of addiction, then why not include addictions to shopping, eating, or exercise? If we take this to an extreme, how many celebrities are addicted to work?
Now that I’ve aired these problematic definitional issues (without necessarily trying to answer them), I will return to the question of whether celebrities are more prone to addiction. To me, when I think about what a celebrity is, I think of someone who is widely known by most people, is usually in the world of entertainment (actor, singer, musician, television presenter), and may have more financial income than most other people I know. When I think about these types of people, I’ve always said to the media that it doesn’t surprise me when such people develop addictions. Given these situations, I would argue that high profile celebrities may have greater access to some kinds of addictive substances.
Given that there is a general relationship between accessibility and addiction, it shouldn’t be a surprise if a higher proportion of celebrities succumbs to addictive behaviours compared with a member of the general public. The ‘availability hypothesis’ may also hold true for various behavioural addictions that celebrities have admitted having – most notably addictions to gambling and/or sex. It could perhaps be argued that high profile celebrities are richer than most of us (and could therefore afford to gamble more than you or I) or they have greater access to sexual partners because they are seen as more desirable (because of their perceived wealth and/or notoriety).
Firstly, when I think about celebrities that have ‘gone off the rails’ and admitted to having addiction problems (Charlie Sheen, Robert Downey Jr, Alec Baldwin) and those that have died from their addiction (Whitney Houston, Jim Morrison, Amy Winehouse) I would argue that these types of high profile celebrity have the financial means to afford a drug habit like cocaine or heroin. For many in the entertainment business such as being the lead singer in a famous rock band, taking drugs may also be viewed as one of the defining behaviours of the stereotypical ‘rock ‘n’ roll’ lifestyle. In short, it’s almost expected. In an interview with an online magazine The Fix, Dr. Scott Teitelbaum, an American psychiatrist based at the University of Florida:
“Some people who become famous and get put on a pedestal begin to think of themselves differently and lose their sense of humility. And this is something you can see with addicts, too. Famous or not, people in the midst of their addiction will behave in a narcissistic, selfish way: they’ll be anti-social and have a disregard for rules and regulations. But that is part of who they as an addict – not necessarily who they would be as a sober person. Then there are some people who are narcissists outside of their disease, who don’t need a drug or alcohol addiction to make them feel like the rules don’t apply to them – and yes, I have seen in this in many athletes and actors. Of course, you also have non-famous people who struggle with both…People with addiction and people with narcissism share a similar emptiness inside. Those who are famous might fill it with achievement or with drugs and alcohol. That’s certainly not the case for everyone. But when you see people who are both famous and narcisstic – people who struggle with staying right-sized or they don’t have a real sense of who they are without the fame – you know that they’re in trouble… People with addiction and people with narcissism both seek outside sources for inside happiness. And ultimately neither the fame nor the drugs nor the drinking will work”.
The same article also pointed out that there is an increase in the number of people who (usually through reality television) are becoming (in)famous but have no discernable talent whatsoever. In my own writings on the psychology of fame, I have made the point that (historically) fame was a by-product of a particular role (e.g., country president, news anchorman) or talent (e.g., captain of the national sports team, a great actor). While the Andy Warhol maxim that everyone will be famous for 15 minutes will never be truly fulfilled, the large increase in the number of media outlets and number of reality television shows suggests that more people than ever are getting their 15 minutes of fame. In short, the intersection between fame and addiction is on the increase. US psychiatrist Dr. Dale Archer was also interviewed for The Fix article and was quoted as saying:
“Fame and addiction are definitely related. Those who are prone to addiction get a much higher high from things – whether it’s food, shopping, gambling or fame – which means it [the behavior or situation] will trigger cravings. When we get an addictive rush, we are getting a dopamine spike. If you talk to anyone who performs at all, they will talk about the ‘high’ of performing. And many people who experience that high report that when they’re not performing, they don’t feel as well. All of which is a good setup for addiction. People also get high from all the trappings that come with fame. The special treatment, the publicity, the ego. Fame has the potential to be incredibly addicting”.
I argued some of these same points in a previous blog on whether fame can be addictive in and of itself. Another related factor I am asked about is the effect of having fame from an early age and whether this can be a pre-cursor or risk factor for later addiction. Dr. Archer was also asked about this and claimed:
“The younger you are when you get famous, the greater the likelihood that you’re going to suffer consequences down the road. If you grow up as a child star, you realize that you can get away with things other people can’t. There is a loss of self and a loss of emotional growth and a loss of thinking that you need to work in relationship with other people”.
I’m broadly in agreement with this although my guess is that this only applies to a minority of child stars rather than being a general truism. However, trying to carry out scientific research examining early childhood experiences of fame amongst people that are now adult is difficult (to say the least). There also seems to be a lot of children and teenagers who’s only desire when young is “to be famous” when they are older. As most who have this aim will ultimately fail, there is always the concern that to cope with this failure, they will turn to addictive substances and/or behaviours.
Griffiths, M.D. & Joinson, A. (1998). Max-imum impact: The psychology of fame. Psychology Post, 6, 8-9.
Halpern, J. (2007). Fame Junkies. New York: Houghton Mifflin Harcourt
McGuinness, K. (2012). Are Celebrities More Prone to Addiction? The Fix, January, 18. Located at: http://www.thefix.com/content/fame-and-drug-addiction-celebrity-addicts100001
Rockwell, D. & Giles, D.C. (2009). Being a celebrity: A phenomenology of fame. Journal of Phenomenological Psychology, 40, 178-210.
(The following blog is based on an article I published last year in the Nottingham Post on why I was actively supporting the Stoptober smoking campaign to get people to stop smoking for 28 days during October. I also published a blog last year outlining my 10 top tips for giving up smoking. Since that blog, my ten tips have been slightly changed and adapted in co-operation with the Department of Health running the Stoptober campaign. I make no apologies for repetition between today’s blog and that published last year, as my only aim is to help people give up smoking).
Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol and nicotine addiction (see ‘Further reading’ below). Last year I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.
This October, the Department of Health (DoH) are re-launching the ‘Stoptober’ campaign for the second time, urging as many nicotine smokers as possible to give up smoking for 28 days from October 1. The DoH website claims that “people who stop smoking for 28 days are five times more likely to stay smoke free” compared to those that don’t give up for such a long period. Like last year, those that decide to try and stop for the month will be given a lot of encouragement during the campaign including access to the Smokefree Facebook page and the downloadable Stoptober app. People will also be sent daily emails providing additional encouragement.
In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects. Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:
- (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
- (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
- (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
- (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0800-1690169) or visit the smokefree website and click on the ‘ways to quit’ tab.
- (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
- (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
- (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
- (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
- (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
- (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).
Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.
Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.
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.
Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.
Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.
Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.
Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.
“Aaaaaaaggggggghhhhhhh” – or something like it – was the sound I made as I jumped from 300 foot above the River Thames with a piece of elastic tied round my ankles in my one and only bungee-jump. Was I brave? No. Insane? No (although others may take issue). Stupid? Possibly. Was I doing it for a bet? No. To raise money for a charity? No. To have a story to tell the grandchildren? No (but I will have). At the end of the day, I really don’t know what possessed me to take that jump. But I did it. I have about a hundred eyewitnesses, the certificate, the photos, and of course the video of my jump (“Drastic Elastic”).
So how did it all come about? Well, it was one of those spur of the moment things. I was with my partner and some of her friends all of whom had congregated at Battersea Power Station to see one of their long-standing friends do a bungee-jump. The bungee-jump at Battersea as I later found out is the highest in the UK but as I sat drinking bottled lager on the riverside boat bar all I was wondering was why the bloody hell is he going to do it? He had a few weeks to think about it. Thankfully when it came to my jump, I had about half an hour for it to sink in. The only bottle I really had was the one I had been holding full of lager.
Before I went on my jump, a couple of radio journalists went up to do a report. A couple of my colleagues have suggested that it was only the presence of the broadcast media that got me to jump. One jumper who came down while I was waiting described it as the worst experience of his life. What a time to tell me! What’s more, the person before me chickened out when she got to the top. I must admit than when I was finally hoisted up to that birds-eye view over London, I did momentarily think there was still time to change my mind. The forms that I signed before going up were certainly food for thought. There is a phrase in the small print that basically says that in the event of my death or serious injury that I do not hold the UK Bungee Club personally responsible.
As the crane slowly ascended to the jump point my heart got a little faster but I was still looking forward to it. The crane suddenly stopped. The door of the cage opened and there I was standing over the Thames. In three seconds time I would be making my oscillating descent downwards. One of the guys in the crane said he would count to three and then tap me on the shoulder which was my cue to jump. The other guy was holding the camcorder recording my every grimace.
“One. Two. Three. Jump”. I dived off the cage’s platform and hurtled towards my friends in the boat below. I bounced up and down for about half a minute before I realised it was nearly over. The rush I got from the whole experience hit me straight after the jump rather than during it. The term “adrenaline junkie” has now passed into everyday usage and although my main research area concentrates on very specific types of risky behaviour (e.g., gambling) and others perceive me to be someone who generally takes risks, I would be the first to admit that bungee jumping is not something that has ever been one of my lifelong desires.
It is therefore something of an irony that one of my ex-PhD students (Dr. Michael Larkin) did his research on the relationship between addiction and identity and interviewed bungee-jumpers about their experiences and whether they view their high-risk behaviour as addictive (research that we eventually published in the Journal of Community and Applied Social Psychology). I also realize that if I was interviewing myself about my experiences of bungee jumping I’d be hard pressed to give any kind of rational explanation of why I did it.
Large-scale research in the area of young people and risk-taking has tended to focus on ‘risk-takers’. This term clearly situates the ‘risky-ness’ within a particular kind of person, and captures only the negative aspect of such behaviours (i.e., risk). In our published research, Dr. Larkin and I purposefully used the term ‘risky-but-rewarding activities’ for two reasons. Firstly, the term situates ‘risky-ness’ within activities, rather than the persons engaging in them, and secondly, it captures both the positive and negative aspects of such activities (i.e., risk and reward).
In one of our studies, we used semi-structured interviews to explore the experiences and understandings of two small groups of participants engaging in either dangerous sports (i.e., bungee jumpers) or recreational drug use (i.e., Ecstasy users). We chose these two particular activities because they provided an opportunity to explore an interesting psychological question – how do individuals evaluate and understand the relationship between risk and pleasure?
All participants had what can best be described as ‘non-problematic’ relationships with their respective activities (i.e. they did not consider themselves as ‘addicted’. Furthermore, all of the participants in our study claimed they made informed and educated decisions about the risks involved in their respective activities – even though there were variations in each individual’s appraisal of how great this risk might actually be, and of how well-informed they were.
We found both similarities and differences between the bungee-jumpers and the Ecstasy users. Initiation into bungee jumping was presented as the consequence of an active, rational decision. Perhaps this was possible for the bungee-jumpers, in contrast to the ecstasy users, because they had fewer reservations to overcome. We also reported that there seemed to be no expectation of unknown, long-term risk associated with bungee jumping (as opposed to Ecstasy use). Secondly, bungee jumping does not represent an analogous ‘boundary point’ between relatively minor involvement, and more serious involvement, in dangerous sports, in the way that Ecstasy use and amphetamine use may do within general drug-taking activities. Thus, we can see that ‘contextual decisions’ may have a psychological function for the user, as a means of overcoming reservations (through denial of agency), and a discursive function for the speaker, as a means of rationalizing a ‘risky shift.’ However, even though bungee jumpers did not utilize this strategy, they still presented their activities as participatory, and acknowledged that social elements contributed to the rewards of the activity, and carried out a considerable amount of identity work in the interviews, which collectively suggests that (like Ecstasy-use) participation grants access to an identity, and gives the user a voice within a particular sub-culture.
We also found that first experiences of bungee jumping and Ecstasy-use were often ambivalent, and sometimes even unpleasant. This ambivalence was generally reported as leading to a stage of ‘learning to like it.’ This might be considered a key process in moving from initiation to maintaining use. Our analysis of the data sought to illuminate something of what it means to take risks for pleasure in our culture. From this process, a number of insights have emerged.
Firstly, it seemed that initiation into a risk-taking activity may require numerous strategies in order to overcome one’s own reservations, and also to accommodate perceived disapproval from others. These strategies include momentary denials of agency (such as the construction of ‘contextual decisions’ rather than ‘rational decisions’), emphasis on the value of ‘inclusion’ for maintaining friendship and cultural identity, the use of anticipated regret as a rationale for accepting possible consequences, and emphasis on the intrinsic value of collecting a broad range of experiences.
Secondly, while initiation may involve some denial of agency, once the person is initiated, and it perhaps becomes evident that the activity can be maintained relatively safely (costs; managing risks) and satisfactorily (learning to like it; learning to control it), then engagement in the activity becomes more rationalized. This involves the acquisition of information about the risks involved, espousing certain practices in response to those risks, and explaining accidents in terms of inappropriate engagement in the activity. In these ways, short-term risks can be managed and accepted as appropriate to the pleasure received.
One interesting feature of the accounts we collected is their positive, appetitive and wilful orientation toward risk. Our participants articulated a relationship with risk that allowed us to see it as a source of pleasure and reward, cultural identity and social participation, but also perhaps as a means of expressing resistance to conventional constraints. Risk-taking was not exactly ‘normal’ for our participants. Its very abnormality was part of its transgressive allure, but at the same time it was mediated by attempts to adopt safe practices, and as such it cannot be understood simply as negativistic action either. Instead, it makes more sense to understand the value of these transgressive acts in terms of access granted to both desirable identities and modified mood states. Whatever future research uncovers, I will always have my bungee jumping certificate that takes pride of place in my office and reads:
“This certifies that in a brief moment of bravado, Dr. Mark Griffiths being of sound mind did of their own choice leap from a 300ft platform. When they launched themselves into space their only touch with reality was a bungee cord attached to their ankles. This courageous person has hereby encountered “The Ultimate Adrenalin Experience”. Lesser beings should now show the respect and admiration due to the intrepid Bungee Jumper, who has undertaken to accept their fame with some restraint and modesty”
Beck, U. (1992). The risk society: Towards a new modernity. London: Sage.
Douglas, M. (1994). Risk and blame. London: Routledge.
Griffiths, M.D. (2006). Bungee jumping madness: A personal case study. Psy-PAG Quarterly, 61, 34-36.
Larkin, M. (2002). Understandings and experiences: A post-constructionist cultural psychology of addiction and recovery in the 12-step tradition. Unpublished PhD. thesis, Nottingham Trent University.
Larkin, M., & Griffiths, M.D. (2002). Experiences of addiction and recovery: The case for subjective accounts. Addiction Research and Theory, 10, 281–311.
Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.
Plant, M., & Plant, M. (1992). Risk-takers: Alcohol, drugs, sex and youth. London: Routledge.