Thigh high: A brief look at thigh fetishism

Thigh fetishism might appear a somewhat obvious topic to write a blog on given all the previous body part fetishes I have looked at (including foot fetishism, shoulder fetishism). However, there is no academic research on the topic and most non-academic articles that I have read tend to concentrate on thigh-boot fetishism rather than thigh fetishism in, and of, itself. According to the Kinkly website:

“Thigh fetish refers to a sexual arousal by or sexual interest in thighs. Typically, it is a male interest in female thighs. However, it can apply to a woman’s interest in female thighs, a woman’s interest in male thighs, or a male’s interest in male thighs. Usually the fetishist is attracted to the naked thighs. The thighs don’t even need to be extremely sexualized for the fetishist. Often it is the gap between a high boot and edge of skirt, or knee high socks and edge of skirt that arouse the fetishist more than sexualized images of thighs”.

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The Self-Help Sexuality website adds that “some men have a thigh fetish where they are turned on by the glimpse of woman’s inner thigh or when a woman opens her thigh. Some men enjoy kissing and licking woman’s inner thigh”. Both of these descriptions are fairly commonsense and arguably don’t need empirical research to back up the claims made.

Thee one piece of empirical research I found with some reference to thigh sexuality was a paper published in a 2014 issue of the journal Cortex by Dr. Oliver Turnbull and colleagues who examined which erogenous zones are the most sensitive in males and females. They surveyed 800 participants (mainly British and Sub-Saharan Africans) and were asked to rate 41 body parts for erogenous intensity on a 10-point scale. Unsurprisingly, the highest rated body parts for sensitivity were the clitoris among women (mean rating 9.17 out of 10) and the penis among men (mean rating 9.0 out of 10). Inner thighs were rated as the fourth most erogenous zone by men (mean rating 5.84 out of 10; back of thigh 2.48 out 10; outer thigh 1.91 out of 10), and the seventh most erogenous zone by women (mean rating 6.7 out of 10; back of thigh 2.6 out 10; outer thigh 1.96 out of 10).

I also found details of a non-academic online survey among Japanese businessmen (mainly those in their thirties and forties) carried out by the marketing research company Goo via an article on the Japanator website. The focus of the survey was favourite “secret fetishes”. Top of the 20 listed fetishes was zettai ryouiki (which translates as “absolute territory”) and refers to the “leg exposure located between the hem of a skirt and the top of thigh-high socks”. The second-placed ‘secret fetish’ was also thigh-related and was being held in the vice-like grip of “athletic thighs”.

Regular readers of my blog will know that I’m fascinated by the sexual culture in Japan and have written many blogs on various aspects of Japanese sexuality. An article about thigh fetishes on the Venus O’Hara website specifically examined zettai ryouiki:

In other words, they fantasize most frequently about that piece of exposed flesh between the top of a girl’s thigh-high socks and the bottom of a short skirt. This description fulfils the fetish principle in that no nudity is involved. Zettai ryouiki describes an otherwise mundane detail which, when used as a primer for arousal, assumes a sexual significance that is almost impossible to explain for non thigh-fetishists. The same principle applies to Western men and the expression of their own thigh fetishism when it comes to lingerie and hosiery. Stockings and suspenders make these men’s enjoyment of thighs and their understanding of thigh fetishism that much easier. The combination of panties, a suspender belt and stockings isolates the area of exposed thigh and almost draws a border around it. This focuses the attention on the naked skin as oppose to the erogenous zones that are covered, albeit by material that is often sheer. A garter belt is another magnet for thigh fetishists, as are knee-high socks, thigh-high boots and self-support stockings”.

My own view is that thigh fetishism and other thigh-related fetishes (for thigh boots, thigh socks, etc.) while overlapping, are not the same. The article on the Venus O’Hara website then goes onto talk about another variant of thigh fetishism:

“Thigh fetishism has produced a new variation of itself recently and social media has had a lot to do with it. The trend for promoting and desiring a permanent clearance between the tops of the legs has become a social phenomenon and a modern yardstick for feminine health and beauty. This ‘thigh gap’ is more common, anatomically, in women who are naturally much taller and whose body mass index is lower than the average. The physiques displayed by contemporary fashion models are an obvious ideal where the ‘thigh gap’ is concerned. A much more democratic trend in relation to thigh fetishism has also arisen on social media almost in response to the ‘thigh gap’.  ‘Thighbrow’ describes the naturally-occurring crease between the thigh and the hip that appears when you sit or kneel down. Two of these, when observed together, have been said to resemble eyebrows. Whereas the ultimate ‘thigh gap’ seems to be exclusive to young women who wear size 6 jeans, the ‘thighbrow’ is a fetish highlight that everyone can flaunt”.

There was also a recent exhibition in Japan devoted purely to thigh fetishism. A short online article about the exhibition noted that:

“In Japanese Culture there are so many different fetishes that are popular: Swimsuit Fetish, Doorknob Licking Fetish (it’s not a joke), Teeth Fetish…Amongst these Fetishes, there is also Thigh Fetish, and Todays Gallery Studio decided to dedicate an entire photo exhibition about it…More than 500 works and 1000 pair of thighs shot by artist Yuria will be exposed”.

In my own research for this blog I was unable to find any dedicated online discussion forum for thigh fetishism. This could either be because it’s so rare or be because it’s so common that it’s not worth creating a dedicated website to discuss such matters. I found very few first-hand accounts of self-admitted thigh fetishism, in fact I only located two individuals:

  • Extract 1: “This is going to sound weird, but I sort of have a thing for women who have strong looking thighs. Size isn’t just what it’s about, but with a muscular tone along with it. It’s not like I get off on it, but I do find it very sexy and is a big turn on for me. It started when I seen a women at this gym who was wearing these spandex looking short pants and I couldn’t help but notice her thighs in them, and they were rather muscular. I don’t have a fetish for female bodybuilders, though I do find spandex sexy…but it wasn’t that, it was her thighs, and I just started noticing things like this more and more afterward”.
  • Extract 2Even before I hit puberty, I always had these strange, excited feeling in me…[When] I was 11, I would imagine these pretty girls getting out of their pants and revealing their legs…One night, I had an extremely arousing dream. It was odd, yet intense. I was hanging out in the park in my neighborhood. A bunch of ladies were hanging out…With no warning, all the ladies in the park started screaming. Their pants were undoing themselves. Afterward, all the ladies’ pants were being pulled off by something invisible and sex crazed. Something that wanted a bunch of ladies have no pants on. Now these scared ladies were in their underwear. The idea of these beautiful ladies going from having their pants on to being taken off them excited me to no end…My women’s thigh fetish was getting more intense…By the time I was 14, I imagined the sex crazed invisible creature taking off random women’s pants and making them cross their naked thighs together, like they were making out…When I was 14, I finally had found a girl…I told her all about my sexy dreams. About my women’s thigh fetish…I kept asking her really warped questions, like how she would feel if something took her pants off in school. How would she feel if her and another girl lost their pants together…[I] finally ejaculated and [was] happy that her legs were the reason…Even now…my women’s thigh fetish dreams were always my favorites to think about”.

I have no idea if these accounts are in any way representative of those who have a thigh fetish but both appear to be heterosexual males, and both can pinpoint where their interests in women’s thighs originated. As with many fetishes I have examined, I can’t see thigh fetishism being the topic of any in-depth empirical research simply because it has the ‘so what?’ factor. Who would be interested in such research and why?

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Scorolli, C., Ghirlanda, S., Enquist, M., Zattoni, S. & Jannini, E.A. (2007). Relative prevalence of different fetishes. International Journal of Impotence Research, 19, 432-437.

Taktak, S., Yılmaz, E., Karamustafalıoglu, O., & Unsal, A. (2016). Characteristics of paraphilics in Turkey: A retrospective study – 20years. International Journal of Law and Psychiatry. doi.org/10.1016/j.ijlp.2016.05.004.

Turnbull, O.H., Lovett, V.E., Chaldecott, J., & Lucas, M.D. (2014). Reports of intimate touch: Erogenous zones and somatosensory cortical organization. Cortex, 53, 146-154.

Art in the right place: Cosey Fanni Tutti’s ‘Art Sex Music’

Five years ago I wrote a blog about one of my favourite bands, Throbbing Gristle (TG; Yorkshire slang for a penile erection). In that article, I noted that TG were arguably one of “the most extreme bands of all time” and “highly confrontational”. They were also the pioneers of ‘industrial music’ and in terms of their ‘songs’, no topic was seen as taboo or off-limits. In short, they explored the dark and obsessive side of the human condition. Their ‘music’ featured highly provocative and disturbing imagery including hard-core pornography, sexual manipulation, school bullying, ultra-violence, sado-masochism, masturbation, ejaculation, castration, cannibalism, Nazism, burns victims, suicide, and serial killers (Myra Hindley and Ian Brady).

I mention all this because I have just spent the last few days reading the autobiography (‘Art Sex Music‘) of Cosey Fanni Tutti (born Christine Newbie), one of the four founding members of TG. It was a fascinating (and in places a harrowing) read. As someone who is a record-collecting completist and having amassed almost everything that TG ever recorded, I found Cosey’s book gripping and read the last 350 pages (out of 500) in a single eight-hour sitting into the small hours of Sunday morning earlier today.

cosey_fanni_tutti_paperback_signed

TG grew out of the ‘performance art’ group COUM Transmissions in the mid-1970s comprising Genesis P-Orridge (‘Gen’, born Neil Megson in 1950) and Cosey. At the time, Cosey and Gen were a ‘couple’ (although after reading Cosey’s book, it was an unconventional relationship to say the least). TG officially formed in 1975 when Chris Carter (born 1953) and Peter ‘Sleazy’ Christopherson (1955-2010). Conservative MP Sir Nicholas Fairburn famously called the group “wreckers of civilisation” (which eventually became the title of their 1999 biography by Simon Ford).

As I noted in my previous article, TG are – psychologically – one of the most interesting groups I have ever come across and Cosey’s book pulled no punches. To some extent, Cosey’s book attempted to put the record straight in response to Simon Ford’s book which was arguably a more Gen-oriented account of TG. Anyone reading Cosey’s book will know within a few pages who she sees as the villain of the TG story. Gen is portrayed as an egomaniacal tyrant who manipulated her. Furthermore, she was psychologically and physically abused by Gen throughout their long relationship in the 1970s. Thankfully, Cosey fell in love with fellow band member Chris Carter and he is still the “heartbeat” of the relationship and to who her book is dedicated.

Like many of my favourite groups (The Beatles, The Smiths, The Velvet Underground, Depeche Mode), TG were (in Gestaltian terms) more than the sum of their parts and all four members were critical in them becoming a cult phenomenon. The story of their break up in the early 1980s and their reformation years later had many parallels with that of the Velvet Underground’s split and reformation – particularly the similarities between Gen and Lou Reed who both believed they were leaders of “their” band and who both walked out during their second incarnations.

Cosey is clearly a woman of many talents and after reading her book I would describe her as an artist (and not just a ‘performance artist’), musician (or maybe ‘anti-musician in the Brian Eno sense of the word), writer, and lecturer, as well as former pornographic actress, model, and stripper. It is perhaps her vivid descriptions of her life in the porn industry and as a stripper that (in addition to her accounts of physical and psychological abuse by Gen) were the most difficult to read. For someone as intelligent as Cosey (after leaving school with few academic qualifications but eventually gaining a first-class degree via the Open University), I wasn’t overly convinced by her arguments that her time working in the porn industry both as a model and actress was little more than an art project that she engaged in on her own terms. But that was Cosey’s justification and I have no right to challenge her on it.

What I found even more interesting was how she little connection between her ‘pornographic’ acting and modelling work and her time as a stripper (the latter she did purely for money and to help make ends meet during the 1980s). Her work as a porn model and actress was covert, private, seemingly enjoyable, and done behind closed doors without knowing who the paying end-users were seeing her naked. Her work as a stripper was overt, public, not so enjoyable, and played out on stage directly in front of those paying to see her naked. Two very different types of work and two very different psychologies (at least in the way that Cosey described it).

Obviously both jobs involved getting naked but for Cosey, that appeared to be the only similarity. She never ever had sex for money with any of the clientele that paid to see her strip yet she willingly made money for sex within the porn industry. For Cosey, there was a moral sexual code that she worked within, and that sex as a stripper was a complete no-no. The relationship with Gen was (as I said above) ‘unconventional’ and Gen often urged her and wanted her to have sex with other men (and although she never mentioned it in her book, I could speculate that Gen had some kind of ‘cuckold fetish’ that I examined in a previous blog as well as some kind of voyeur). There were a number of times in the book when Cosey appeared to see herself as some kind of magnet for unwanted attention (particularly exhibitionists – so-called ‘flashers’ – who would non-consensually expose their genitalia in front of Cosey from a young age through to adulthood). Other parts of the book describe emotionally painful experiences (and not just those caused by Gen) including both her parents disowning her and a heartfelt account of a miscarriage (and the hospital that kept her foetus without her knowledge or consent). There are other sections in the book that some readers may find troubling including her menstruation art projects (something that I perhaps should have mentioned in my blog  on artists who use their bodily fluids for artistic purposes).

Cosey’s book is a real ‘warts and all’ account of her life including her many health problems, many of which surprisingly matched my own (arrhythmic heart condition, herniated spinal discs, repeated breaking of feet across the lifespan). Another unexpected connection was that her son with Chris Carter (Nick) studied (and almost died of peritonitis) as an undergraduate studying at art at Nottingham University or Nottingham Trent University. I say ‘or’ because at one stage in the book it says that Nick studied at Nottingham University and in another extract it says they were proud parents attending his final degree art show at Nottingham Trent University. I hope it was the latter.

Anyone reading the book would be interested in many of the psychological topics that make an appearance in the book including alcoholism, depression, claustrophobia, egomania, and suicide to name just a few. In previous blogs I’ve looked at whether celebrities are more prone to some psychological conditions including addictions and egomania and the book provides some interesting case study evidence. As a psychologist and a TG fan I loved reading the book.

 Dr Mark Griffiths, Professor of Behavioural Addictions, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Cooper, D. (2012). Sypha presents … Music from the Death Factory: A Throbbing Gristle primer. Located at: http://denniscooper-theweaklings.blogspot.co.uk/2012/02/sypha-presents-music-from-death-factory.html?zx=c19a3a826c3170a7

Fanni Tutti, C. (2017). Art Sex Music. Faber & Faber: London.

Ford, S. (1999). Wreckers of Civilization: The Story of Coum Transmissions and Throbbing Gristle. London: Black Dog Publishing.

Kirby, D. (2011). Transgressive representations: Satanic ritual abuse, Thee Temple ov Psychick Youth, and First Transmission. Literature and Aesthetics, 21, 134-149.

Kromhout, M. (2007). ‘The Impossible Real Transpires’ – The Concept of Noise in the Twentieth Century: a Kittlerian Analysis. Located at: http://www.mellekromhout.nl/wp-content/uploads/The-Impossible-Real-Transpires.pdf

Reynolds, S. (2006). Rip It Up and Start Again: Postpunk, 1978–1984. New York: Penguin.

Sarig, R. (1998). The Secret History of Rock: The Most Influential Bands You’ve Never Heard Of. New York: Watson-Guptill Publications.

Walker, J.A. (2009). Cosey Fanni Tutti & Genesis P-Orridge in 1976: Media frenzy, Prostitution-style, Art Design Café, August 10. Located at: http://www.artdesigncafe.com/cosey-fanni-tutti-genesis-p-orridge-1-2009

Wells, S. (2007). A Throbbing Gristle primer. The Guardian, May 27. Located at: http://www.guardian.co.uk/music/musicblog/2007/may/29/athrobbinggristleprimer

Selling hope: A brief look at the advertising of online sports betting

(Please note that this article was co-written with Dr. Hibai Lopez-Gonzalez).

Marketing strategies are essential in a market environment such as online sports betting wherein product differentiation is minimal and price inelasticity robust. Business insiders widely accept that product innovation is instantly replicated across competitors, which are permanently seeking to generate, so far unfruitfully, a disruptive competitive edge. In a context where the number of licensed bookmakers is constantly growing, advertising plays a big part in luring customers who cannot tell the difference between companies. Advertising and marketing spend on sports betting has increased exponentially over the last five years in Europe and that is mirrored on the exposure to betting commercial messages of sports fans.

For instance, a 2014 report published by the Victorian Responsible Gambling Foundation estimated that viewers of the Australian Football League and the National Rugby League – the two most followed sport codes in Australia – are exposed to 10 to 15 minutes of gambling advertisements per game. Similarly, Dr. Sophie Lindsay and colleagues in a 2013 issue of BMC Public Health looked further into the environmental impact of gambling advertising in sport events. They calculated that in three rugby league matches the public had been exposed to ‘322 episodes’ of betting marketing – for example, considering an episode every time an electronic banner advertised a gambling site – which is somewhat paradoxical given in-play betting is illegal in Australia (as of mid-2016).

Online_Sports_Betting_Australia

One of the marketing tricks is the use of the psychological bias known as the ‘representativeness heuristic’ (coined by Dr. Amos Tversky and Dr. Daniel Kahneman). Imagine the following two betting propositions concerning a soccer game: (a) FC Barcelona will lose the next match against the bottom team in the league (an extremely unlikely event, say 0.01 probability); (b) FC Barcelona will lose the next match against the bottom team in the league but (i.e. AND) Leo Messi will score at least one goal (this one an extremely likely event, for the sake of the argument, 0.99 probability). Mathematically speaking, proposition B can never be a better choice than proposition A, since P(A)=0.01 as opposed to P(B)=0.01×0.99= 0.0099. However, bookmakers understand that Messi scoring a goal is a highly representative event that can be effortlessly be retrieved from memory, transferring the representativeness to the whole betting proposition. In addition, it is plausible that representative heuristics work in conjunction with wishful thinking, overestimating the likelihood of an event based on one’s own preferences, as anecdotal evidence from betting advertisements concerning national teams participating in international competitions appear to suggest.

In a recent paper in the Journal of Sport and Social Issues, I and my colleagues (Dr. Hibai Lopez-Gonzalez and Dr. Ana Estevez) discussed two of most utilized master narratives in online betting promotions are discussed, namely skill-enhancing narratives – in which there is an overemphasis on the capacities and knowledge of the bettor – and, at the other end of the spectrum, risk-lowering narratives – which underemphasise the risks involved in betting and typically overestimate the probability of winning.

Skill-enhancing narratives: In a 2016 issue of iGaming Business magazine, Vahe Baloulian, CEO of the betting software company BetConstruct, declared that new features were there to give customers ‘a chance to feel more in control by engaging more often and making decisions’ with ‘feel’ and ‘control’ being the keywords here. The ‘feel’ component refers to a perceived non-factual sensation that lies at the heart of the advertising endeavour. The perception of control over the betting activity has been found to be a common attribute of gambling narratives in Swedish research by Dr. Per Binde, in which elements of skill have been exaggerated, as well as in televised commercials from Canada (in a 2008 paper by John McMullan and Delthia Miller in the Journal of Gambling Issues), wherein betting has been associated with the imagery of media sport communication, skills, and long-meditated strategies, while luck was downplayed.

Many betting features newly added to online platforms are said by commercials to enhance the control of the user over the outcome of the event bet upon, including more gamified experiences (where passive bettors supposedly become players), immersive betting experiences, and fantasy sports (where the player actively recruits a team). In these examples, the betting experience demands a higher involvement from the bettor, arguably resulting in a psychological transference between the active role of a bettor executing actions and the actual influence a bettor’s actions may have on the outcome of an external event. In essence, betting advertising contributes to the myth of gambling as a sport, an activity that is healthy, harmless, and that can be mastered with practice and talent.

Among the most used selling points that enhance the self-efficacy and control of the sports bettor are the narratives of masculinity. Attributes such as loyalty to the team, being a real man, and being brave enough to prove sporting knowledge have been implicit in some sports betting messages, including stereotyped gender depictions and sexualized imagery. According to recent research by Dr. Nerilee Hing and colleagues (in the International Journal of Mental Health and Addiction), the prototype sports bettor is male, young, tech-savvy, and professional, which aligns with the target audience of betting advertising. This reinforces the idea of male providers that sublimates in gambling their manly instincts for aggression, competition, and combat, as was observed in the behaviour of horserace bettors as identified in early studies.

Risk-lowering advertising: In parallel to the skill-enhancing strategies, advertising diminishes the harmful consequences of excessive betting by representing it as a risk-free activity. The combined narrative would be that of a safe environment where intelligent people possess the tools to succeed. In an attempt to lower the perceived risk inherently embedded in any betting activity, three major messages have been emphasized by advertisers: (i) betting is a perfectly normal activity; (ii) errors in betting predictions are not fatal; and (iii) betting is a social activity.

Advertising has been frequently proposed as a significant mechanism of gambling normalisation including new social media channels (see Dr. Sally Gainsbury and colleagues 2016 research in the Journal of Gambling Studies). The portrayal of gambling attitudes and behaviours in media representations as well as in real life environments promotes the idea of gambling as an intrinsic form of entertainment. This is true for all forms of gambling but sports betting presents some singular intensifiers. Unlike any other gambling form, sport instils in betting its health and sanitization attributes. Attributes such as fair competition, success through talent and perseverance, equal opportunities and big rewards, respect for nature, green and healthy habits are transmitted to betting behaviour. Celebrities deepen that connection as they have been proven to reduce the perceived risk by the public of the products they endorse. Sportspeople tell the story of young, talented risk-takers who challenged the odds but emerged successful in the end, arguably a perfect incarnation of the bettor’s own aspirational narrative.

Another marketing technique broadly employed by betting operators concerns the provision of risk-free bets. Advertisements typically offer welcome bonuses for new customers, free bonuses for loyal clientele, and money-back exceptions in multiple complex accumulated bets. All of these free offers pose a dual threat. On the one hand, the so-called free money requires bettors to engage in further betting in order to reclaim their benefits (leading to money losses in the process). On the other hand, even if it is a bona fide free bonus, problem gamblers might conceptualise betting as a riskless activity that entails no responsibilities even when done excessively.

A third main risk-lowering technique used in commercials is the representation of betting as a social form of entertainment to be conducted alongside other people. Solitary gambling, like solitary drinking, has been thought to be a determinant and/or consequence of problem gambling. However, some studies have raised the alarm about the misconception that gambling, when done in group, cannot be problematic (see the recent work of Emily Deans and her colleagues in ‘Further reading’ below). In fact, peer facilitation has been identified as a fundamental contributing factor to impulse betting, with excessive betting being more plausible when sport matches are viewed in the company of others (as shown by Mattew Lamont and colleagues in a 2016 qualitative study in Sport Management Review). Sport is a cultural product, socially consumed (watched, practiced, discussed, and bet upon). The social stigma attached to gambling habits might be shifting towards its naturalisation, a long-term process that advertising cannot carry out on its own but can certainly facilitate.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Binde, P. (2009). ‘You could become a millionaire’: Truth, deception, and imagination in gambling advertising. In: Kingma S (ed.), Global Gambling: Cultural Perspectives on Gambling Organizations, (pp. 171-194). London: Routledge.

Deans, E.G., Thomas, S.L,. Derevensky, J. & Daube, M. (2017) The influence of marketing on the sports betting attitudes and consumption behaviours of young men: implications for harm reduction and prevention strategies. Harm Reduction Journal, 14(5). doi:10.1186/s12954-017-0131-8.

Deans, E.G., Thomas, S.L,. Daube, M., Derevensky, J., et al. (2016) Creating symbolic cultures of consumption: an analysis of the content of sports wagering advertisements in Australia. BMC Public Health, 16(1), 208.

Deans, E.G., Thomas, S.L,. Daube, M. & Derevensky J (2016) The role of peer influences on the normalisation of sports wagering: a qualitative study of Australian men. Addiction Research & Theory. doi: 10.1080/16066359.2016.1205042.

Gainsbury, S.M., Delfabbro, P., King, D.L., et al. (2016) An exploratory study of gambling operators’ use of social media and the latent messages conveyed. Journal of Gambling Studies, 32, 125–141.

Gordon, R. & Chapman, M. (2014). Brand community and sports betting in Australia. Victoria, Australia: Victorian Responsible Gambling Foundation.

Guerrero-Solé, F., Lopez-Gonzalez, H., Griffiths, M.D. (2017). Online gambling advertising and the Third-Person Effect: A pilot study. International Journal of Cyber Behavior, Psychology and Learning, 7(2), 15-30.

Hing, N. (2014). Sports betting and advertising (AGRC Discussion Paper No. 4). Melbourne: Australian Gambling Research Centre.

Hing, N., Lamont, M., Vitartas, P., et al. (2015). Sports-embedded gambling promotions: A study of exposure, sports betting intention and problem gambling amongst adults. International Journal of Mental Health and Addiction, 13(1), 115–135.

Lamont, M., Hing, N. & Vitartas, P. (2016). Affective response to gambling promotions during televised sport: A qualitative analysis. Sport Management Review, 19(3), 319-331.

Lindsay, S., Thomas, S., Lewis, S., et al. (2013) Eat, drink and gamble: marketing messages about ‘risky’ products in an Australian major sporting series. BMC Public Health 13(1), 719.

Lopez-Gonzalez, H., Estevez, A. & Griffiths, M.D. (2017). Marketing and advertising online sports betting: A problem gambling perspective. Journal of Sport and Social Issues, 41, 256-272.

Lopez-Gonzalez, H. Estevez, A., Jimenez-Murcia, S. & Griffiths, M.D. (2017). Alcohol drinking and low nutritional value food eating behaviour of sports bettors in gambling adverts. International Journal of Mental Health and Addiction, in press.

Lopez-Gonzalez, H. & Griffiths, M.D. (2016). Is European online gambling regulation adequately addressing in-play betting advertising? Gaming Law Review and Economics, 20, 495-503.

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). Understanding the convergence of online sports betting markets. International Review for the Sociology of Sport, in press.

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). ‘Cashing out’ in sports betting: Implications for problem gambling and regulation. Gaming Law Review and Economics, in press.

Lopez-Gonzalez, H.. & Griffiths, M.D. (2017). Betting, forex trading, and fantasy gaming sponsorships – A responsible marketing inquiry into the ‘gamblification’ of English football. International Journal of Mental Health and Addiction, in press.

McMullan, J.L. & Miller, D. (2008). All in! The commercial advertising of offshore gambling on television. Journal of Gambling Issues, 22, 230-251.

Tversky, A. & Kahneman, D. (1983) Extensional versus intuitive reasoning: The conjunction fallacy in probability judgment. Psychological Review, 90(4), 293–315.

Dream lovers: Can lucid dreaming be addictive?

Last week I watched the South Korean film Lucid Dream (a 2017 Netflix original that premiered on June 2), the directorial debut by Kim Joon-sung. For those who don’t know, lucid dreams are those in “which the dreamer is aware of dreaming. During lucid dreaming, the dreamer may be able to exert some degree of control over the dream characters, narrative, and environment” (Wikipedia). The reason I mention this is because one of the characters in the film claims he is ‘addicted’ to lucid dreams. Obviously the use of the word ‘addicted’ in this context piqued my interest (in what must be said was a mediocre film).

Unknown

I’ve been fascinated by lucid dreams even before I knew what they were. Although I’ve suffered from insomnia for most of my life, I’m also someone that has very vivid dreams when I sleep. I learned a lot more about lucid dreaming during my PhD at the University of Exeter because one of my best friends (Rob Rooksby) was carrying out research into the area. Over the course of a few years, I had many conversations with Rob about the topic (both professional and personal) because I had experienced lucid dreams myself (and still do).

One of the academics that Rob mentioned many times to me was the psychologist Dr. Jayne Gackenbach who at the time was editor of a journal called Lucidity Letter (and in which Rob had a couple of papers published in, see ‘Further reading’ below. By co-incidence, I came to know Dr. Gackenbach professionally in the 1990s and since then I have written three chapters in some of her edited books – two on internet addiction and one on Game Transfer Phenomena – also see ‘Further reading’ below). In a short 1987 paper in Lucidity Letter, Dr. Gackenbach claimed that lucid dreaming could be potentially addictive:

“I would caution against taking an attitude toward the lucid dream state of it being unrelated to waking life. This could result in undue absorption in lucid dreaming, leading potentially to addiction (see the letter by Barroso in [the December, 1987] issue of Lucidity Letter for an excellent example)…After hearing about Tholey’s training of an Olympic athlete with dream lucidity, a colleague spontaneously remarked, “Dream lucidity is really the ultimate drug!” Yes, the state has that potential. But so too comes the potentiality of abuse through ignorance of proper use and possibly addiction”.

Consequently, I managed to track down a copy of Mark Barroso’s 1987 published letter where he asserted that:

“I would like to comment on how lucid dreaming became counterproductive. Like most everything else I’ve enjoyed, too much of it could be very destructive. Living in the dream world became preferable to reality. I would lay in bed, miss work, and wrap myself in a catatonic state in which to spin dreams, dreams, dreams. I would sleep in public places to use various stimuli for my lucid dreams: a park, a downtown bench, the beach, park the car near a school yard of children playing. If you have mastered lucid dreaming, you should try this, it really is incredible. Real and random sounds factor in the dream. Basically, all I did was lucid dream and nothing else. With a life like that it could be hard to pay the rent. So I just stopped. Over time I lost the ability to lucid dream…Although I never regarded myself as having a special ability, it never occurred to me that others did this as well. I finally “O.D.’d” on lucid dreaming when I stayed in bed for 4 or 5 days, only rising to drink and use the bathroom. I was a hermit with no other ambition. I got a job where people were counting on me to show up and found within me the motivation to shake the cobwebs from my eyes”.

Although I am highly sceptical that lucid dreaming can be potentially addictive, Barroso’s letter does contain anecdotal evidence at least suggestive of addiction-like symptoms where lucid dreaming completely took over his life and impacted negatively on every area of his life. These aren’t the only references to ‘lucid dreaming addiction’ in the academic literature. In a 1990 book by Dr. Stephen LaBerge and Dr. Howard Rheingold entitled Exploring The World of Lucid Dreaming, one chapter (‘Preparing for learning lucid dreaming’) featured a ‘Q&A’ section including the following question and answer:

“Q. Lucid dreams are so exciting and feel so good that real life pales by comparison. Isn’t it possible to get addicted to them and not wish to do anything else? 

A. It may be possible for the die-hard escapist whose life is otherwise dull to become obsessed with lucid dreaming. Whether or not this deserves to be called addiction is another question. In any case, some advice for those who find the idea of “sleeping their life away” for the sake of lucid dreaming is to consider applying what they have learned in lucid dreams to their waking lives. If lucid dreams seem so much more real and exciting, then this should inspire you to make your life more like your dreams – more vivid, intense, pleasurable, and rewarding. In both worlds your behavior strongly influences your experience”.

Another similar Q&A featured on the World of Lucid Dreaming (WLD) website founded by Rebecca Turner. One of the WLD readers (‘Nikki’) asked Turner: Is lucid dreaming addictive? I really want to have lucid dreams but I read that lucid dreaming is really addictive and this worries me. Would you compare this need to taking drugs? How do you keep control over it?” Turner responded by saying: “I [too] have read in the media that “lucid dreaming is addictive” but this is a poor use of language. They are trying to say that it’s highly enjoyable and you’ll want to do it more”.

As far as I am aware, no empirical study has ever examined addiction to lucid dreaming although there are plenty of individuals on various lucid dreaming online forums who have claimed that such activity can be addictive from either their own experiences or by those known to them. Here are a few of the more detailed examples I have come across:

  • Extract 1: “I first lucid dreamed purposely about 5-6 years ago. For the past year and a half. I’ve lucid dreamed every single night, except when I’m really drunk, I don’t seem to dream then. I have a bit of an addictive personality, I smoke weed every day. I have a sex in my dreams very often, a few times a week, and they almost always end up with an orgasm and a wet awakening later. I always just have the greatest times and see the greatest things while I’m dreaming. But it is getting harder and harder to get up in the morning. I will sleep an extra 2-3 hours after I want to wake up because I don’t want to leave the dream world, and I find if I go to sleep while the dream is fresh in my mind still I can continue it with ease. I have lost many jobs, and fucked up many opportunities because I couldn’t get out of bed in the morning…Now I am on welfare, get money from the government every month, and I sleep all the time, I have no set sleep schedule, I sleep in the day, I sleep at night, I sleep whenever I feel like it. I feel like the second my head hits the pillow I’m sucked into another world in my head. I daydream whenever I’m not sleeping, I’ve lost track of time. My whole world feels like a lucid dream now” (Steezy 233).
  • Extract 2: I think I spend at least half of my nights lucid dreaming. I never get tired of it…I love the world my mind creates every night…I have a really long history with lucid dreaming and hallucinations, but if I were to go that in-depth this post would end up being a novel or something. Long story short, I used to have hypnagogic hallucinations and sleep paralysis every night when I was young (4-10, I think)…Then one night I had my first lucid dream, and did some investigating…I became better and better at lucid dreaming, and somehow parts of my dream world have become consistent (architecture, people, holidays even). I love living in the dream world. It’s fun, and horrifying at times, but either way it’s exciting. But in the day, everything is drab. Living feels so dull and dead and repetitive and stressful…I love dreaming. I’m depressed when I’m not dreaming. Sometimes I wish I could dream and never wake up. I’m not suicidal or anything dangerous like thatI don’t really want people I know to know I have this addiction to dreaming” (‘JDBar’).
  • Extract 3: “When I first learned how to induce lucid dreams as a teenager, and then program the dream I wanted to have, it was intoxicating! Every night before I went to sleep I would have to decide if I wanted to do something romantic with a hunky male movie star, or save the world as Storm from the X-Men, or work on astral projection, or try to contact my friends who were also lucid dreaming, etc. I was practically living a double life because my night life was vastly different than my waking life.  I was becoming addicted to the pleasures of lucid dreaming. That habit led to some unfortunate experiences, however.  The more I explored the dream world and different planes of existence, the less connected I was to my waking life.  This was not at all healthy. It would take too long to explain everything that happened…but suffice it to say, it nearly destroyed my sanity. I eventually decided I had to plug back into my “real” life and leave some of the other world behind.  It took a couple of years to reconnect with the living instead of the astral” (Erin).
  • Extract 4: Well, I’ll admit that I went through a bad stage last year. I had high levels of anxiety and depression and I saw lucid dreaming as a way to escape from everything that was going on at school and in my life. I would even fake sick just to stay home and sleep all day to lucid dream. But something just changed lately and I’m no longer depressed…I don’t rely on lucid dreaming like I used to, instead I just see it as some fun. I wouldn’t say there’s any real reason not to lucid dream, though. It’s a lot of fun and can help with night terrors and nightmares” (Daydreamer14).

Most accounts I have come across online see the benefits of lucid dreaming as far outweighing any negatives. In fact, I came across a few websites claiming that lucid dreaming can be used as a method of overcoming more traditional addictions (similar to the idea of Dr. Bill Glasser’s positive addictions that I examined in a previous blog). For instance, at the Lucid Dream Leaf website it was claimed that:

“Lucid dreaming has a seemingly endless list of benefits attached to it. It can help people who are struggling with emotional pain, end recurring dreams and nightmares, expand consciousness, and so on. In addition to all of this, regular lucid dreaming practice can also be a useful tool to those in recovery (or moving toward recovery) from addictions”.

Other websites (such as the Remedy Free website) provide advice on how to overcome addiction to lucid dreaming or how to overcome problems with lucid dreaming (‘7 nasty side effects of lucid dreaming and how to fix them’ and ‘Lucid dreaming dangers – Obsession [Addiction]’). Although I’ve argued that any activity can be potentially addictive as long as there are constant rewards from the activity, lucid dreaming can only occur when an individual is asleep, so unless someone is constantly sleeping, it doesn’t appear it could be an addiction by my own criteria – but as ever, I am happy to be proved wrong. I ought to add that some online articles (such as one on the Dreaming Life blogsite) claim that lucid dreaming can be a consequence of ‘sleeping addiction’ (but I’ll leave that for another blog).

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Barroso, M., (1987). Letter to the Editor. Lucidity Letter, 6(2). Retrieved from https://journals.macewan.ca/lucidity/article/view/763/704

Gackenbach, J. (1987). Clinical and transpersonal concerns with lucid dreaming voiced. Lucidity Letter, 6(2), 1-4.

Glasser, W. (1976), Positive Addictions. Harper & Row, New York, NY.

Griffiths, M.D. (1998). Internet addiction: Does it really exist? In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (pp. 61-75). New York: Academic Press.

LaBerge, S., & Rheingold, H. (1990). Exploring The World of Lucid Dreaming. New York: Ballantine Books.

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.

Rooksby, R. (1989). Problems in the historical research of lucid dreaming. Lucidity Letter, 8(2), 75-80.

Rooksby, B., & Terwee, S. (1990). Freud, van Eeden and lucid dreaming. Lucidity Letter, 9(2), 1-10.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: Does it really exist? (Revisited). In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (2nd Edition), (pp.141-163). New York: Academic Press.

Wikipedia (2017). Lucid dream. Located at: https://en.wikipedia.org/wiki/Lucid_dream

Tub zero: A brief look at bath-related illnesses and fatalities

Regular readers of my blog will know that I have an interest in all things bizarre and out of the ordinary. In previous blogs I have examined coital cephalagia (people that get headaches from having sex) and masturbatory cephalagia (people that get headaches from masturbation). It was while researching those articles that I came across a 2005 paper on ‘bath-related headaches’ (BRHs) by Dr. Mak and colleagues in the journal Cephalagia.

BRH is rare headache syndrome. They reported 13 case studies (six from their own case files collected over a seven-year period and seven from other reports in the medical literature). They reported that all the cases involved “Oriental women” aged 32 to 67 years (with an average age of 51 years). The cases were reported in females from Hong Kong (n=6), Taiwan (n=4) and Japan (n=3). All of the women reported severe headaches (lasting from 30 minutes to 30 hours) that were triggered by bathing or other activities involving contact with water. Typically, the onset of the headaches were “hyperacute” and were like ‘thunderclap’ headaches (a severe headache that takes seconds to minutes to reach maximum intensity). The paper reported that no underlying secondary causes were identified and that drug treatment was generally unsatisfactory (although use of the drug Nimodipine was reported to shorten the length of the headache in some cases). Unfortunately, the only way that such headaches could be prevented was to avoid bathing.

After reading this paper I looked for other papers relating to bath-related illnesses. A 2000 paper by Dr. S. Cerovac and Dr. A. Roberts reported on 57 cases of burns sustained by hot bath and shower water (in the journal Burns) over an eight-year period. None of the 57 cases died as a result of the burns. The authors worked at Stoke Mandeville Hospital (in the UK) and they divided the cases into child (below the age of 16 years) and adult groups. Most of the children (n=39) were under the age of three years (83%), with two-fifths having superficial burns (41%). Most of these cases occurred due to what the authors described as “inadequate supervision” by the child’s parents (85%). Among the adult group, 83% of the adults were over 60 years of age with around 65% of them having “some form of psycho-motor disorder that predisposed to an accident which should have been anticipated”. The adult group had more extensive burns which resulted in eight deaths (out of 18 cases; 44%). They reported that the number of cases had been declining over the eight-year period but the study highlighted that fatal incidents could be caused by something as simple as bathing.

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A 1995 study by Dr. J. Lavelle in the Annals of Emergency Medicine evaluated the risk factors associated with bathtub submersion injury and their relationship to child abuse and neglect over a 10-year period (1982-1992). They reported that there had been 21 patients treated for bathtub near-drownings (nine of which had subsequently died). Of these, two-thirds of the children (67%) had “historic and/or physical findings suspicious for abuse or neglect, including incompatible history for the injury, other physical injuries, previous child abuse reports, psychiatric history of the caretaker, and/or psychosocial concerns noted in the chart”. The mortality rate of 42% was significant. However, findings showed that no demographic characteristics identified at-risk children.

Perhaps the most common form of bathtub deaths are infant drownings. A paper by Dr. John Pearn and Dr. James Nixon examined the socio-demographic factors surrounding drowning accidents among children aged 0-15 years in a 1978 issue of Social Science & Medicine. Obviously this paper examined all drownings but did note that those that involved bathtub drownings occur “almost exclusively in lower social class homes” In a follow-up study specifically on bathtub drownings, Dr. Pearn and his colleagues reported the cases of seven bathtub drownings in the journal Pediatrics. All of the seven cases were infants in the US state of Hawaii. As with the previous paper, the authors reported that the families of the infant were typically of lower socioeconomic status but also added that the deaths had occurred when the father “had immediate care of the infant at the time of the accident”. In five of the cases, the drowned infant was being looked after by older sibling.

In 1985, Dr. Lawrence Budnick and Dr. D. Ross published a study on bathtub-related drownings in the USA in the American Journal of Public Health. They analysed information (1979-1981) on such deaths using data from the (i) National Center for Health Statistics and (ii) Consumer Product Safety Commission data. They reported 710 individuals had drowned in the bath during this period with an estimated mortality rate of 1.6 per million individuals per year. They reported an excess of deaths in the spring but this was not statistically significant. However, they did note that individuals “at the extremes of age were at greatest risk of death, with mortality rates of 5-6 per million per year”. Unsurprisingly, there was a frequent history of children below the age of five years being left unattended by parents. Amongst young to middle-aged adults, there was a frequent history of seizures or history of alcohol or drug use. Among more elderly individuals there was frequent evidence of having fallen in the bath.

Similarly, in 2006, Dr. G. Somers and colleagues carried out a 20-year review of bathtub drownings published in the American Journal of Forensic Medicine and Pathology. The authors retrospectively retrospective reviewed US autopsy records over a 20-year period (1984–2003). They identified 18 cases of bathtub drownings (8 boys and 10 girls) aged 6 months to 70 months (average of 17 months) almost three-quarters aged under one year (72%). The factors leading to the death were reported as inadequate adult supervision (89%), cobathing (39%), the use of infant bath seats (17%), and coexistent medical disorders predisposing the child to the drowning episode (17%).

A paper by Dr. R. Rauchschwalbe and colleagues in a 1997 issue of Pediatrics examined the role of bathtub seats and rings as a primary cause of death in US infant drowning deaths (1983-1995). The paper reported 32 deaths by drowning involving bath seats/rings with the victims’ ages at the time of the death ranging from 5 to 15 months (average 8 months old). Nine in ten deaths was due to a “reported lapse in adult supervision”. The authors concluded that infant drownings associated with bath seats/rings are increasing in the US and that very young children “should never be left in the bathtub unsupervised, even for brief moments”.

A more recent 2004 study by Dr. R. Byard and Dr. T. Donald in the Journal of Paediatrics and Child Health examined the possible role of infant bathtub seats in drowning and near-drowning (1998-2003). The authors used files from the Forensic Science Centre and Child Protection Unit, Women’s and Children’s Hospital in Adelaide (Australia). In the six-year period, there were six cases of drowning in children aged under two years. They noted:

“One of these cases, a 7-month-old boy, had been left unattended for some time in an adult bath in a bathtub seat. He was found drowned, having submerged after slipping down and becoming trapped in the seat. Three near-drowning episodes occurred in children under the age of 2 years, including two boys aged 7 and 8 months, both of whom had been left for some time in adult baths in bath seats. Both were successfully resuscitated and treated in hospital…These cases demonstrate the vulnerability of infants to immersion incidents when left unattended in bathtubs”.

In a 1984 paper in the Journal of the American Medical Association, Dr. Lawrence Budnick examined bathtub-related electrocutions in the USA (1979 to 1982). He reported that at least 95 Americans had been electrocuted in the bath and that the use of hair dryers in the bathroom had caused 60% of the deaths. It was also noted that two-thirds of the deaths had occurred during spring and winter, and that those under five years of age had the highest mortality rate.

A 2003 paper by Dr. N. Yoshioka and his colleagues in the journal Legal Medicine examined bathtub deaths in Japan. The authors claimed that approximately 100–120 cases of “sudden death in bathroom” are reported there every year and accounts for around “8–10% of the total number of what is considered unnatural deaths”. Most of the deaths occur in winter and 80% of cases involve the elderly and the authors described the deaths as “baffling” as the autopsies rarely locate the exact cause of death. By testing physiological changes 54 volunteers in both winter and summer, the authors reported that many heart conditions occurred during the winter months in their volunteers (e.g., cardiac arrhythmia including ventricular tachycardia, ventricular extrasystole, supraventricular extrasystole, and bradycardia) and that these conditions might lead to an increased risk for cardiac arrest while bathing.

Another possible reason for bathtub-related drownings is epileptic seizures while bathing. A paper by Dr. C. Ryan and Dr. G. examined drowning deaths among epileptics in a 1993 issue of the Canadian Medical Association Journal. The authors retrospectively reviewed deaths from drowning in Alberta (Canada) from 1981 to 1990. Of these drownings in Alberta (n=482), 5% (n=25) were directly related to epileptic seizures of which 60% (n=15) occurred while the individual was taking an unsupervised bath. The authors advised that all people with epilepsy should take showers (while sitting) instead of baths.

While most of these bath-related health issues and fatalities are rare, they do highlight the issue that accidents can happen anywhere and that in the bath can be a vulnerable location for infants left unattended or those with medical conditions that cause immobility.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Budnick, L.D. (1984). Bathtub-related electrocutions in the United States, 1979 to 1982. JAMA, 252(7), 918-920.

Budnick, L.D., & Ross, D.A. (1985). Bathtub-related drownings in the United States, 1979-81. American Journal of Public Health, 75(6), 630-633.

Byard, R. W., & Donald, T. (2004). Infant bath seats, drowning and near‐drowning. Journal of Paediatrics and Child Health, 40(5‐6), 305-307.

Cerovac, S., & Roberts, A.H. (2000). Burns sustained by hot bath and shower water. Burns, 26(3), 251-259.

Lavelle, J. M., Shaw, K. N., Seidl, T., & Ludwig, S. (1995). Ten-year review of pediatric bathtub near-drownings: evaluation for child abuse and neglect. Annals of Emergency Medicine, 25(3), 344-348.

Mak, W., Tsang, K.L., Tsoi, T.H., Au Yeung, K.M., Chan, K.H., Cheng, T. S., … & Ho, S.L. (2005). Bath‐related headache. Cephalalgia, 25(3), 191-198.

Pearn, J. H., Brown, J., Wong, R., & Bart, R. (1979). Bathtub drownings: Report of seven cases. Pediatrics, 64(1), 68-70.

Nixon, J., & Pearn, J. (1978). An investigation of socio-demographic factors surrounding childhood drowning accidents. Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 12, 387-390.

Rauchschwalbe, R., Brenner, R.A., & Smith, G.S. (1997). The role of bathtub seats and rings in infant drowning deaths. Pediatrics, 100(4), e1.

Ryan, C. A., & Dowling, G. (1993). Drowning deaths in people with epilepsy. CMAJ: Canadian Medical Association Journal, 148(5), 781-784.

Somers, G. R., Chiasson, D. A., & Smith, C. R. (2006). Pediatric drowning: A 20-year review of autopsied cases: III. Bathtub drownings. American Journal of Forensic Medicine and Pathology, 27(2), 113-116.

Yoshioka, N., Chiba, T., Yamauchi, M., Monma, T., & Yoshizaki, K. (2003). Forensic consideration of death in the bathtub. Legal Medicine, 5, S375-S381.

Tubular hells: A brief look at ‘addiction’ to watching YouTube videos

 

A few days ago, I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). As Gaita reported:

“The story profiles a middle school student whose obsessive viewing of YouTube content led to extreme behavior changes and eventually, depression and a suicide attempt. The student finds support through therapy at an addiction recovery center…The student in question is a young girl named Olivia who felt at odds with the ‘popular’ kids at her Oakland area school. She began watching YouTube videos after hearing that it was a socially acceptable thing to do… Her viewing habits soon took the place of sleep, which impacted her energy and mood. Her grades began to falter, and external problems within her house – arguments between her parents and the death of her grandmother – led to depression and an admission of wanting to hang herself. Her parents took her to a psychiatric hospital, where she stayed for a week under suicide watch, but her self-harming compulsion continued after her release. She began viewing videos about how to commit suicide, which led to an attempt to overdose on Tylenol[Note: The name of the woman – Olivia – was a pseudonym].

McClurg interviewed Olivia’s mother for the PBS article and it was reported that Olivia went from being a “bubbly daughter…hanging out with a few close friends after school” to “isolating in her room for hours at a time”. Olivia’s mother also claimed that her daughter had always been kind of a nerd, a straight. A student who sang in a competitive choir. But she desperately wanted to be popular, and the cool kids talked a lot about their latest YouTube favorites”. According to news reports, all Olivia would do was to watch video after video for hours and hours on end and developed sleeping problems. Over time, the videos being watched focused on fighting girls and other videos featuring violence.

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The news story claimed that Olivia was “diagnosed with depression that led to compulsive internet use”. When Olivia went back home she was still feeling suicidal and then spent hours watching YouTube videos on how to commit suicide (and it’s where she got the idea for overdosing on Tylenol tablets).

After a couple of spells in hospital, Olivia’s parents took her to a Californian centre specialising in addiction recovery (called ‘Paradigm’ in San Rafael). The psychologist running the Paradigm clinic (Jeff Nalin) claimed Olivia’s problem was “not uncommon” among clients attending the clinic. Nalin believes (as I do and have pointed out in my own writings) that treating online addictions is not about abstinence but about getting the behaviour under control but developing skills to deal with the problematic behaviour. He was quoted as saying:

“I describe a lot of the kids that we see as having just stuck a cork in the volcano. Underneath there’s this rumbling going on, but it just rumbles and rumbles until it blows. And it blows with the emergence of a depression or it emerges with a suicide attempt…The best analogy is when you have something like an eating disorder. You cannot be clean and sober from food. So, you have to learn the skills to deal with it”.

The story by Gaita asked the question of whether compulsive use of watching YouTube could be called a genuine addiction (and that’s where my views based on my own research were used). I noted that addiction to the internet may be a symptom of another addiction, rather than an addiction unto itself. For instance, people addicted to online gambling are gambling addicts, not internet addicts. An individual addicted to online gaming or online shopping are addicted to gaming or shopping not to the internet.

An individual may be addicted to the activities one can do online and is not unlike saying that an alcoholic is not addicted to a bottle, but to what’s in it. I have gone on record many times saying that I believe anything can be addictive as long there are continuous rewards in place (i.e., constant reinforcement). Therefore, it’s not impossible for someone to become addicted to watching YouTube videos but the number of genuine cases of addiction are likely to be few and far between. Watching video after video is conceptually no different from binge watching specific television series or television addiction itself (topics that I have examined in previous blogs).

I ought to end by saying that some of my own research studies on internet addiction (particularly those co-written with Dr. Attila Szabo and Dr. Halley Pontes and published in the Journal of Behavioral Addictions and Addictive Behaviors Reports – see ‘Further reading’ below) have examined the preferred applications by those addicted to the internet, and that the watching of videos online is one of the activities that has a high association with internet addiction (along with such activities such as social networking and online gaming). Although we never asked participants to specify which channel they watched the videos, it’s fair to assume that many of our participants will have watched them on YouTube), and (as the Camelot lottery advert once said) maybe, just maybe, a few of those participants may have had an addiction to watching YouTube videos.

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

Further reading

Gaita, P. (2017). Does compulsive YouTube viewing qualify as addiction? The Fix, May 19. Located at: https://www.thefix.com/does-compulsive-youtube-viewing-qualify-addiction

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

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Griffiths M.D. & Szabo, A. (2014). Is excessive online usage a function of medium or activity? An empirical pilot study. Journal of Behavioral Addictions, 3, 74-77.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

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., 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.

McClurg, L. (2017). After compulsively watching YouTube, teenage girl lands in rehab for ‘digital addiction’. PBS Newshour, May 16. Located at: http://www.pbs.org/newshour/rundown/compulsively-watching-youtube-teenage-girl-lands-rehab-digital-addiction/

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

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

Doctor, doctor: What can British GPs do about problem gambling?

A study published in the British Journal of General Practice in March 2017 reported that of 1,058 individuals surveyed in GP waiting rooms in Bristol (UK), 0.9% were problem gamblers and that a further 4.3% reported gambling problems that “were low to medium severity”. This is in line with other British studies carried out over the last decade which have reported problem gambling prevalence rates of between 0.5% and 0.9%.

I have long argued that problem gambling is a health issue and that GPs should routinely screen for gambling problems. Back in 2004, I published an article in the British Medical Journal about why problem gambling is a health issue. I argued that the social and health costs of problem gambling were (and still are) large at both individual and societal levels.

uk-gambling-trade-bodies-unite-to-improve-responsible-gaming

Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy. Adverse health consequences for problem gamblers and their partners include depression, insomnia, intestinal disorders, migraine, and other stress related disorders. In my BMJ article I also noted that analysis of calls to the GamCare national gambling helpline indicated that a small minority of callers reported health-related consequences as a result of their problematic gambling. These included depression, anxiety, stomach problems, and suicidal ideation. Obviously many of these medical problems arise through the stress of financial problems but that doesn’t make it any less of a health issue for those suffering from severe gambling problems.

Research published in the American Journal of Addictions has also shown that health-related problems can occur as a result of withdrawal effects. For instance, one study by 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, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty, and chills.

Based on these findings, problem gambling is very much a health issue that needs to be taken seriously by all in the medical profession. GPs routinely ask patients about smoking cigarettes and drinking, but gambling is something that is not generally discussed. Problem gambling may be perceived as a grey area in the field of health, and it is therefore very easy for those in the medical profession not to have the issue on their wellbeing radar. If the main aim of GPs is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge and should be taught in the curriculum while prospective doctors are at medical school. One of the reasons that GPs don’t routinely screen for problem gambling is because they are not taught about it during their medical training and therefore do not even think about screening for it in the first place. As I recommended in a report commissioned by the British Medical Association, the need for education and training in the diagnosis, appropriate referral and effective treatment of gambling problems must be addressed within GP training. More specifically, GPs should be aware of the types of gambling and problem gambling, demographic and cultural differences, and the problems and common co-morbidities associated with problem gambling. GPs should also understand the importance of screening patients perceived to be at increased risk of gambling addiction, and should be aware of the referral and support services available locally.

I also recommended that treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded by gambling-derived profit revenue.

Back in 2011, Dr. Jane Rigbye and myself published a study using Freedom of Information requests to ask NHS trusts if they had ever treated pathological gamblers. Only 3% of the trusts had ever treated a problem gambler and only one trust said they offered dedicated help and support. I’m sure if we repeated the study today, little will have changed.

It is evident that problem gambling is not, as yet, on the public health agenda in the UK. NHS services – including GP surgeries – need to be encouraged to see gambling problems as a primary reason for referral and a valid treatment option. Information about gambling addiction services, in particular services in the local area, should be readily available to gamblers and GP surgeries are a good outlet to advertise such services. Although some gambling services (such as GamCare, the gambling charity I co-founded) provide information to problem gamblers about local services, such information is provided to problem gamblers who have already been proactive in seeking gambling help and/or information. Given that very few GPs could probably treat a problem gambler, what they must have is the knowledge of who they can refer their patients to.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Calado, F. & Griffiths, M.D. (2016). Problem gambling worldwide: An update of empirical research (2000-2015). Journal of Behavioral Addictions, 5, 592–613.

Cowlishaw, S., Gale, L., Gregory, A., McCambridge, J., & Kessler, D. (2017). Gambling problems among patients in primary care: a cross-sectional study of general practices. British Journal of General Practice, doi: bjgp17X689905

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. & Smeaton, M. (2002). Withdrawal in pathological gamblers: A small qualitative study. Social Psychology Review, 4, 4-13.

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.

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., Sproston, K., Orford, J., Erens, B., Griffiths, M.D., Constantine, R. & Pigott, S. (2007). The British Gambling Prevalence Survey. London: The Stationery Office.

Dispensing wisdom: ATMs on the gaming floor

The gambling industry has long been trying to perfect techniques that keep players on their premises and gambling on their games longer. In short, their aim is to introduce facilities that maximize their bottom line profits. In super-casinos around the world, restaurants are often positioned in the centre so that customers have to pass the gaming areas before and after they have eaten. Live entertainment areas for music or sporting events (e.g., boxing matches) are also positioned similarly.

This strategy is often combined with the deliberate use of circuitous paths to keep customers in the casino longer, the psychology being that if the patrons are in the casino longer they will spend more money. Large US casinos have got this down to a fine art. A number of years ago I remember going to a live music concert at the MGM Grand in Las Vegas and on entering the casino it took me a 20- to 25-minute walk past thousands of slot machines and gaming tables before I even arrived at the auditorium! Although I didn’t gamble during the 45 minutes I was exposed to the slot machines to and from the casino entrance, I did wonder how many of the thousands in the audience had succumbed at some point.

Massachusetts-casinos-ATM-banking-law

UK gambling venues are now increasingly offering other non-gambling services (such as snack facilities and live entertainment) in a bid to either attract new customers or to keep those already in the venue as long as possible. The 2005 Gambling Act allowed even more of this diversification. It is also worth noting that some forms of gambling (such as slot machines) are far more profitable than other forms (such as table games). What’s more, slot machines don’t need a croupier to deal or spin the roulette ball. This means that most casinos worldwide are now dominated by slot machines in preference to other forms of gambling (although there are places like Macao where table games are preferred over slot machines).

Two of the biggest changes that have occurred in casinos worldwide over the last 20 years that appear to aid such a ‘maximisation’ strategy are the introduction of cash machines onto the gaming floors and the introduction of note acceptors to electronic gaming machines. At a very simplistic level, facilities like these create and enhance convenience gambling.

Note acceptors are very popular in countries like US, Canada and Australia. The gaming industry argues that note acceptors are popular with customers and enhance the playing experience in that they make life a little bit easier for the punter when standing in front of a slot machine not to have to keep going to the cashier for change. However, there is a very fine line between customer enhancement and customer exploitation. Note acceptors have the capacity to increase spending in a number of direct and indirect ways. Firstly, note acceptors increase privacy for the punter. More specifically for the punter, it avoids the potential embarrassment of letting gaming staff, friends, family or even other customers know how much they are spending. Secondly, note acceptors can aid in suspending judgment whereby more cash is transferred to credit in one go. Thirdly, note acceptors minimise breaks as players do not need to leave the machine to get change. Not taking breaks minimises ‘time out’ periods where punters can think more rationally about the money they have spent. A study carried out in Canadian casinos showed that the amount initially put into a slot machine by punters was twice as high on machines that had note acceptors. Although this is only one study, it does seem to suggest that gamblers spend more when a note acceptor is present. 

Like note acceptors, the introduction of automated cash dispensers onto the casino floor also increases privacy for the punter. Although studies have found that only a relatively small proportion of casino patrons seldom use cash dispensers at gambling venues, a significantly high proportion of problem gamblers do so. One study in New Zealand carried out by Professor Max Abbott found that only 2% of all adults interviewed in a national survey considered that greater access to these facilities led to an increase in their gambling. Among problem gamblers, this figure was over eight times as high at 17%.

In Australia, a study led by Professor Jan McMillen also found much greater cash dispenser usage at gambling venues by problem gamblers when compared to non-problem gamblers. They also found that problem gamblers withdrew larger amounts.  Money accessed in this way was most often for the purchase of both alcohol and gambling. They concluded that convenient access to cash dispenders in gambling venues contributed to greater expenditure and was a contributory factor in the development and persistence of gambling problems.

A number of other studies have reported similar findings. Problem gamblers frequently mention that adjacent access to cash dispensers is one of the most frequently mentioned reasons for gambler’s exceeding their planned spending limit. Research has also shown that both problem and non-problem gamblers would prefer cash dispensers to be located away from gambling venues. It would seem that the only people who want cash dispensers on gambling premises are the operators themselves, mainly because they know it increases revenue.

Dr Mark Griffiths, Professor of Behavioural Addictions, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abbott, M.W.  (2007). Situational factors that affect gambling behavior. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.251-278. New York: Elsevier.

Friedman, B. (2000). Designing Casinos to Dominate the Competition. Reno, NV: Institute for the Study of Gambling and Commercial Gaming, University of Nevada.

Griffiths, M.D. (2009). Casino design: Understanding gaming floor influences on player behaviour. Casino and Gaming International, 5(1), 21-26.

Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed.), Gambling: Who wins? Who Loses? pp. 277-292. New York: Prometheus Books.

Lam, L.W., Chan, K.W., Fong, D. & Lo, F. (2011). Does the look matter? The impact of casino servicescape on gaming customer satisfaction, intention to revisit, and desire to stay. International Journal of Hospitality Management, 30, 558-567.

McCormack, A. & Griffiths, M.D. (2013). A scoping study of the structural and situational characteristics of internet gambling. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 29-49.

McMillen, J., Marshall, D., and Murphy, L. (2004). The Use of ATMs in ACT Gaming Venues: An Empirical Study. ANU Centre for Gambling Research, Canberra.

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling.  In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies (pp.211-243). New York: Elsevier.

Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.

Search of the poisoned mind? A brief look at ‘internet search dependence’

Despite being a controversial topic, research into a wide variety of online addictions has grown substantially over the last decade. My own research into online addictions has been wide ranging and has included online social networking, online sex addiction, online gaming addiction, online shopping addiction, and online gambling addiction. As early as the late 1990s/early 2000s, I constantly argued that when it came to online addictions, most of those displaying problematic behaviour had addictions on the internet rather than addictions to the internet (i.e., they were not addicted to the medium of the internet but addicted to applications and activities that could be engaged in via the internet).

A recent 2016 paper by Dr. Yifan Wang and colleagues in the journal Frontiers in Public Health described the development of the Questionnaire of Internet Search Dependence (QISD), a tool developed to assess individuals who may be displaying a dependence on using online search engines (such as Google and Baidu). The notion of individuals being addicted to using search engines is not new and was one of five types of internet addiction outlined in a 1999 typology in a paper in the Student British Medical Journal by Dr. Kimberley Young (and what she termed ‘information overload’ and referred to compulsive database searching). Although I criticized the typology on the grounds that most of the types of online addict were not actually internet addicts but were individuals using the medium of the internet to fuel other addictive behaviours (e.g., gambling, gaming, day trading, etc.), I did implicitly acknowledge that activities such as internet database searching could theoretically exist, even if I did not think it was a type of internet addiction.

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As far as I am aware, the new scale developed by Wang et al. (2016) is the first to create and psychometrically evaluate an instrument to assess ‘internet search dependence’. As noted by the authors:

Subsequently, we compiled 16 items to represent psychological characteristics associated with Internet search dependence, based on the literature review and a follow-up interview with 50 randomly selected university students…We adopted the six criteria for behavioral addiction formulated by Griffiths (i.e., salience, mood modification, tolerance, withdrawal, conflict, and relapse) [Griffiths, 1999b]”.

Given the authors claimed they used an early version of my addiction components model (i.e., one from 1999 rather than my most recent 2005 formulation) to help inform item construction, I was obviously interested to see the scale’s formulated items. I have to admit that I had a lot of misgivings about the paper so I wrote a commentary on it that has just been published in the same journal (Frontiers in Public Health). More specifically, I noted in my paper that if an individual was genuinely addicted to searching online databases I would have expected to see all of my six criteria applied as follows:

  • Salience – This occurs when searching internet databases becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialized behaviour). For instance, even if the person is not actually searching the internet they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with internet database searching).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of internet database searching and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’ when searching internet databases).
  • Tolerance – This is the process whereby increasing amounts of time searching internet databases are required to achieve the former mood modifying effects. This basically means that for someone engaged in internet database searching, they gradually build up the amount of the time they spend searching internet databases every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.), that occur when an individual is unable to search internet databases because they are ill, the internet is unavailable, or there is no Wi-Fi on holiday, etc.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time searching internet databases.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive internet database searching to recur and for even the most extreme patterns typical of the height of excessive internet database searching to be quickly restored after periods of control.

Of the 12 QISD items constructed in the new scale, very few appeared to have anything to do with addiction and/or dependence but this is most likely due to the fact that the authors also used data collected from 50 participants to inform their items and not just the criteria in the addiction components model. However, relying heavily on input from their participants resulted in a number of key features in addiction/dependence not even being assessed (i.e., no assessment of salience, mood modification, conflict, relapse or tolerance). A couple of items may peripherally assess withdrawal symptoms (e.g., ‘I will be upset if I cannot find an answer to a complex question through Internet search’) but not in any way that is directly associated with addiction or dependence. This may be because the authors’ conceptualization of ‘dependence’ was more akin to ‘over-reliance’ rather than traditional definitions of dependence.

While the QISD may be psychometrically robust I argued that it appears to have little face validity and does not appear to assess problematic engagement in internet database searching (irrespective of how addiction or dependence is defined). Based on the addiction components model, I concluded my paper by creating my own scale to assess internet search dependence based directly on the addiction components model and which I argued would have much greater face validity than any item currently found in the QISD:

  • Internet database searching is the most important thing in my life.
  • Conflicts have arisen between me and my family and/or my partner about the amount of time I spend searching internet databases.
  • I engage in internet database searching as a way of changing my mood.
  • Over time I have increased the amount of internet database searching I do in a day.
  • If I am unable to engage in internet database searching I feel moody and irritable.
  • If I cut down the amount of internet database searching I do, and then start again, I always end up searching internet databases as often as I did before.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

Andreassen, C.S., Pallesen, S., Griffiths, M.D. (2017). The relationship between excessive online social networking, narcissism, and self-esteem: Findings from a large national survey. Addictive Behaviors, 64, 287-293.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Griffiths, M.D. (1998). Internet addiction: Does it really exist? In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (pp. 61-75). New York: Academic Press.

Griffiths, M.D. (1999a). Internet addiction: Internet fuels other addictions. Student British Medical Journal, 7, 428-429.

Griffiths, M.D. (1999b). Internet addiction: Fact or fiction? The Psychologist: Bulletin of the British Psychological Society, 12, 246-250.

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, 191-197.

Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, in press.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

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.

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

Wang, Y., Wu, L., Zhou, H., Xu, J. & Dong, G. (2016). Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 4, 274. doi: 10.3389/fpubh.2016.00274

Young, K. S. (1999). Internet addiction: evaluation and treatment. Student British Medical Journal, 7, 351-352.