In dependence days: A brief overview of behavioural addictions

Please note: A version of this blog first appeared on addiction.com

Conceptualizing addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. Therefore it is perhaps unsurprising that most official definitions concentrate on drug ingestion. Despite such definitions, there is now a growing movement that views a number of behaviours as potentially addictive including those that do not involve the ingestion of a drug. These include behaviours diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioural – comprise six components (i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse). More specifically:

• Salience – This occurs when the activity 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 engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
• Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity 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’).
• Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
• Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
• Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

In May 2013, the new criteria for problem gambling (now called ‘Gambling Disorder’) were published in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), and for the very first time, problem gambling was included in the section ‘Substance-related and Addiction Disorders’ (rather than in the section on impulse control disorders as had been the case since 1980 when it was first included in the DSM-III). Although most of us in the field had been conceptualizing extreme problem gambling as an addiction for many years, this was arguably the first time that an established medical body had described it as such.

There had also been debates about whether or not ‘Internet Addiction Disorder’ should have been included in the DSM-5. As a result of these debates, the Substance Use Disorder Work Group recommended that the DSM-5 include ‘Internet Gaming Disorder’ [IGD] in Section III (“Emerging Measures and Models”) as an area that required further research before possible inclusion in future editions of the DSM. To be included in its own right in the next edition, research will have to establish the defining features of IGD, obtain cross-cultural data on reliability and validity of specific diagnostic criteria, determine prevalence rates in representative epidemiological samples in countries around the world, and examine its associated biological features. Other than gambling and gaming, no other behaviour (e.g., sex, work, exercise, etc.) has yet to be classified as a genuine addiction by established medical and/or psychiatric organizations.

In one of the most comprehensive reviews of chemical and behavioural addictions, Dr. Steve Sussman, Nadra Lisha and myself examined all the prevalence literature relating to 11 different potentially addictive behaviours. We reported overall prevalence rates of addictions to cigarette smoking (15%), drinking alcohol (10%), illicit drug taking (5%), eating (2%), gambling (2%), internet use (2%), love (3%), sex (3%), exercise (3%), work (10%), and shopping (6%). However, most of the prevalence data relating to behavioural addictions (with the exception of gambling) did not have prevalence data from nationally representative samples and therefore relied on small and/or self-selected samples.

Addiction is an incredibly complex behaviour and always result from an interaction and interplay between many factors including the person’s biological and/or genetic predisposition, their psychological constitution (personality factors, unconscious motivations, attitudes, expectations, beliefs, etc.), their social environment (i.e. situational characteristics such as accessibility and availability of the activity, the advertising of the activity) and the nature of the activity itself (i.e. structural characteristics such as the size of the stake or jackpot in gambling). This ‘global’ view of addiction highlights the interconnected processes and integration between individual differences (i.e. personal vulnerability factors), situational characteristics, structural characteristics, and the resulting addictive behaviour.

There are many individual (personal vulnerability) factors that may be involved in the acquisition, development and maintenance of behavioural addictions (e.g. personality traits, biological and genetic predispositions, unconscious motivations, learning and conditioning effects, thoughts, beliefs, and attitudes), although some factors are more personal (e.g. financial motivation and economic pressures in the case of gambling addiction). However, there are also some key risk factors that are highly associated with developing almost any (chemical or behavioural) addiction such as having a family history of addiction, having co-morbid psychological problems, and having a lack of family involvement and supervision. Psychosocial factors such as low self-esteem, loneliness, depression, high anxiety, and stress all appear to be common among those with behavioural addictions.

This article briefly demonstrates that behavioural addictions are a part of a biopsychosocial process and not just restricted to drug-ingested (chemical) behaviours. Evidence is growing that excessive behaviours of all types do seem to have many commonalities and this may reflect a common etiology of addictive behaviour. Such commonalities may have implications not only for treatment of such behaviours but also for how the general public perceive such behaviours.

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

Further reading

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (2009). Gambling addictions. In A. Browne-Miller (Ed.), The Praeger International Collection on Addictions: Behavioral Addictions from Concept to Compulsion (pp. 235-257). Westport, CT: Praeger.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Transgressive Culture, 1(1), 7-28.

Griffiths, M.D. (2011). Workaholism: A 21^st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, M.D., Kuss, D.J. & Demetrovics, Z. (2014). Social networking addiction: An overview of preliminary findings. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.119-141). New York: Elsevier.

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

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

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.

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.

Bowling a maiden over: A very brief look at ‘damsel in distress’ fetishes

“I have a fetish for damsels in distress.” “Don’t be sexist.” “Not at all. My services are also available to gentlemen in distress. It’s an equal opportunity fetish.” (From the 2009 book City of Glass, the third book in the Mortal Instruments six-part series of books written by Cassandra Clare)

While researching various other blogs including ones on sexual sadism, sexual masochism, and knismolagnia, I kept coming across references to ‘damsel in distress’ [DiD] fetishes, all of which involve the basic concept of a helpless female victim who may (but sometimes may not) need rescuing from a captor and/or some kind of perilous situation.

“The subject of the damsel in distress or persecuted maiden is a classic theme in world literature, art and film. She is almost inevitably a young, nubile woman, who has been placed in a dire predicament by a villain or a monster and who requires a hero to dash to her rescue. She has became a stock character of fiction, particularly of melodrama. Some claim the popularity of the damsel in distress is perhaps in large measure because her predicaments sometimes contain hints of BDSM fantasy” (Nation Master encyclopedia entry on ‘Damsel in distress’).

“The figure of the damsel in distress is a feature of certain established fetishes within the field of BDSM. In particular, actresses playing damsels in distress in mainstream movies and television shows are often shown bound or restrained, resulting in images that appeal to some bondage fetishists” (Wikipedia entry on ‘Damsel in distress’).

“One specific paraphilia involving a gag relates to video depictions in which the captor gags the damsel in distress to stop her screaming for help. Some people are sexually aroused by such imagery, even if there is no nudity or sexual act present, or even if the victim is only gagged but not restrained in any way” (Wikipedia entry on ‘Gag [BDSM]’).

It is mostly males who have DiD fetishes and can be very specific including (but not restricted to) such things as (i) ‘kidnap and rescue’ fetishes (sexual pleasure from watching or engaging in women being kidnapped and/or rescued from potentially life-threatening scenarios where they are cuffed, bound and/or controlled by another person or persons), (ii) tickle bondage fetishes (sexual pleasure from watching or tickling women while they are tied up), (iii) quicksand fetishes (sexual pleasure from watching women sink in quicksand), and (iv) ‘pedal pumping’ and ‘cranking’ fetishes (sexual pleasure from watching women stranded in their cars with repeated pressing of the gas pedal and revving up – which also has elements of foot fetishism – while turning the key in an attempt to get the engine to start). According to an Everthing2.com article on the topic, such fetishists prefer the ‘raw’ and natural ‘non-stylized’ DiD scenarios rather than the ‘glossy’ role-playing type DiD scenarios. The same article also stresses that:

“Sexual menacing or assault is not necessary to create an appealing DiD scene. In fact, in judging DiD scenes in movies and television, violence against the damsel is often a detraction. Blood or bruises make the scene less pretty. More often, it is the idea of a woman being helpless and begging for release. A woman crying, pleading, or trying to speak through a gag, referred to in DiD discussions as “mmphing” is also attractive”.

A quick internet search reveals there is a dedicated DiD fan community that host a range of online forums and discussion groups (such as the Staked Damsels website “for anyone
who finds burning at the stake, bondage and damsels in distress erotic” or the Danger Island website where “you’ll find all your ‘damsel in distress’ fetish needs met”) as well as a wide range of YouTube video clips (type ’pedal pumping cranking’ into Google and you’ll see what I mean). There are also websites that provide lists of films and television shows that feature DiD scenarios (such as the 1981 made-for-television film Terror Among Us which according to Wikipedia has become a cult film among the DiD fan community because of its lengthy portrayal of bound and gagged women), and links to YouTube clips just showing the relevant DiD video capture (‘vidcap’) scenes from films (called ‘Didcaps’ among the DiD fan community). The Wikipedia entry also notes:

“Outside the mainstream, the fetishistic subculture of specialized bondage magazines and videos that has thrived since the late 1970s is a variation on the damsel in distress of literature, but with one major difference. Here, the helplessness of the bound and gagged victim is eroticized and celebrated as an end in itself, occasionally with no rescuing hero or hope of escape”.

Unsurprisingly, and given the ‘underground’ status of the DiD fetish community, there is no academic research on the topic. I did manage to track down a small (non-scientific) survey carried out on the Deviant Art website where 226 DiD enthusiasts responded to a question relating to their favourite DiD scenario. The results (in order of preference) were cheerleader or schoolgirl in uniform (24%), princess/medieval/dragons (13%), vampire (13%), kidnapped by thugs (13%), ancient mythology (8%), sci-fi alien attack (8%), mad scientist (6%), prisoner of war (4%), monster/troll/ogre (3%), and (non-specific) other (7%). Obviously this was a based on a self-selected sample of DiD enthusiasts who could be bothered to respond so we have no way of knowing if the respondents were representative of all DiD fans. It remains to be seen whether any academic or clinical research ever gets carried out on this particular sub-domain of sadomasochism but I won’t be holding my breath.

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

Further reading

Everything 2 (2002). Damsels in distress bondage. June 25. Located at: http://everything2.com/title/damsels+in+distress+bondage

Nation Master (2012). Damsel in distress. Located at: http://www.statemaster.com/encyclopedia/Damsel-in-distress

Pop Crunch (2010). Quicksand, Pedal Pumping, Tickle Bondage, Women in Distress in general. May 11. Located at: http://www.popcrunch.com/the-17-most-wtf-fetishes-imaginable/

Wikipedia (2015). Damsel in distress. Located at: http://en.wikipedia.org/wiki/Damsel_in_distress

Prophet share: A case study of ‘addiction to fortune telling’

In the latest issue of the Journal of Behavioral Addictions, there are two papers that I co-authored on muscle dysmorphia as an addiction (see ‘Further reading’ below). The reason I mention this is because in the same issue there was a case study report by Dr. Marie Grall-Bronnec and her colleagues of a woman (Helen) that was ‘addicted’ to fortune tellers. As noted in their paper:

“Clairvoyance consulting, also known as fortune teller consulting, is a behavior that may seem harmless, but can also become excessive. Fortune telling is defined as the practice of predicting information about a person’s life, using for example…astrology, cartomancy or crystallomancy”.

As I have noted in a number of my previous blogs, I subscribe to the view that if there are clinical criteria for addiction and a behaviour fulfils the criteria, it should be classed as an addiction (irrespective of the behaviour). This has led to accusations of me “watering down the concept of addiction” because such criteria have been applied to behaviours as diverse as gardening and chewing gum. According to the authors of the ‘fortune telling addiction’ paper:

“Helen is a 45-year-old woman who declares early on suffering from ‘a clairvoyance addiction’…She has no particular medical history, except for two major depression episodes after romantic breakups, and does not take any medication. She regularly sees a psychiatrist for support psychotherapy because of negative life events (sexual abuse and death in her family). She is divorced and does not have any children. Her career as a manager seems to fully satisfy her. She decides to seek treatment on account of her excessive financial expenditures due to the consultation of fortune tellers. Another motivation that explains her decision is her age. Indeed, she says she is entering a new phase in her life, after renouncing to the idea of becoming a mother one day”.

According to the paper, Helen had been consulting fortune tellers since she was 19 years old. She started using such people for educational and career advice as she claimed that she was poor at reaching important decisions herself and thought the life choices she made would be wrong. The authors noted that her first meeting with a clairvoyant was an event that gave her a feeling of reassurance. In her mid-twenties, her visits to clairvoyants escalated significantly and ended up “losing control of her use of fortune telling”. At that particular time, she was visiting clairvoyants to get relationship advice from them (e.g., “Does he really love me?” and “How long will our relationship last?”). Her current ‘addiction to clairvoyants’ dates back to her mid- to late-30s when she got divorced after the failure of her marriage:

“She repeatedly returned to fortune telling to reassure herself about the future of her relationship, and increasingly so as it deteriorated. The breakup worsened the disorder. Since her divorce, she consults fortune tellers – not always the same person – on the phone or online, in a compulsive way, more and more often (up to every day), for longer and longer periods of time (up to 8 hours a day) and spends each time more and more money (up to 200 euros per session). As she is never satisfied with the fortune tellers’ predictions, she will consult again very soon after the latest call or connection. Every choice she has to make, from the most trivial (going to the movies) to the most important (making relationship decisions), leads her to irrationally consult a fortune teller”

Before each consultation she said he got very excited at the prospect and that the experience relieved all of her psychological discomfort (at least in the short-term). However, not long after consultations she would feel incredibly guilty. The paper also reported that during consultations with the fortune tellers, she was totally convinced that they could see her future and that their predictions would come true. He authors went on to report:

“This excessive behavior gives her some kind of reassurance and allows her to make up for her lack of self-confidence. In that sense, the excessive behavior could be considered as an attempt at self-medication or as a way to cope with negative emotions. However, Helen knows that her belief in the fortune tellers’ ability to predict the future is completely irrational. This brings major adverse consequences, particularly in financial terms: despite a comfortable income, she is indebted. She also says having low self-esteem, due to her in- ability to resist her strong urge to consult fortune tellers, and due to her being isolated from the others because of the time spent consulting fortune tellers. Helen succeeds in limiting the consultation of fortune tellers during short periods of time, when her financial situation becomes too critical”.

The authors of the report also used different sets of addiction criteria to determine whether Helen was truly addicted to consulting clairvoyants. They also used my own six criteria (salience, mood modification, tolerance, withdrawal, conflict, and relapse). Here are the authors own description of the behaviour using my components model:

• Salience: “Consulting fortune tellers becomes the most important activity in Helen’s life and dominates her thinking (preoccupation and cognitive distortions), feelings (cravings) and behavior (she has progressively quit all her leisure activities, particularly going out with friends)”.
• Mood modification: “Helen says feeling excitement before each consultation, but also feels nervous tension and anxiety. This excessive behavior gives her some kind of reassurance and the excessive behavior could be considered as an attempt at self-medication or a way to cope with negative emotions”.
• Tolerance: “Over time, Helen has been feeling a growing need to consult fortune tellers, and the consultations have to last longer to obtain the same effect of relief”.
• Withdrawal: “When she attempts to resist the urge to consult or has to refrain from consulting fortune tellers (in the case of her financial situation being too critical, for example), she feels tense and nervous”.
• Conflict: “Helen knows that her use of fortune telling is problematic, and that it brings very negative consequences. However, she cannot refrain from consulting fortune tellers, leading to an intra-psychic conflict and guilt”.
• Relapse: “Over the years, Helen has made repeated efforts to reduce and stop this problematic behavior. Her clinical course is characterized by relapses and remissions”.

Based on the evidence presented, there is clear evidence that Helen’s behaviour was problematic. Whether it was genuinely addictive is debatable but the authors provided some evidence that (in this case at least) the behaviour appeared to include some addictive aspects. The authors conclude that in addition to individual risk factors, other situational and structural characteristics may have played a role in the development of problematic behaviour concerning Helen’s ‘addiction’:

“Regarding the risk factors related to the object of addiction (i.e. fortune telling use), one might mention, inter alia, the possibility to consult online, which guarantees anonymity. Furthermore, the Internet increases both accessibility and availability. Finally, the money spent during fortune telling sessions seems virtual, which makes it all the more easy to spend. Increased risks related to the Internet have already been described on gambling (Griffiths, Wardle, Orford, Sproston & Erens, 2009). Regarding socio-environmental risk factors, today’s society encourages the need for control and does not give way to uncertainty. In Helen’s case, all the conditions were met for the fortune telling use to become excessive, and we are tempted to conclude that it is an addictive-like phenomenon”.

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

Further reading

Foster, A.C., Shorter, G.W. & Griffiths, M.D. (2015). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, 4, 1-5.

Grall-bronnec, M. Bulteau, S., Victorri-Vigneau, C., Bouju, G. & Sauvaget, A. (2015). Fortune telling addiction: Unfortunately a serious topic about a case report. Journal of Behavioral Addiction, 4, 27-31.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M. (2005). A “components” model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191–197.

Griffiths, M.D., Foster, A.C. & Shorter, G.W. (2015). Muscle dysmorphia as an addiction: A response to Nieuwoudt (2015) and Grant (2015). Journal of Behavioral Addictions, 4, 11-13.

Griffiths, M., Wardle, H., Orford, J., Sproston, K. & Erens, B. (2009). Sociodemographic correlates of internet gambling: Findings from the 2007 British gambling prevalence survey. CyberPsychology and Behavior, 12, 199–202.

Hughes, M., Behanna, R. & Signorella, M. L. (2001). Perceived ac- curacy of fortune telling and belief in the paranormal. Journal of Social Psychology, 141(1), 159–160.

Shein, P. P., Li, Y. Y. & Huang, T. C. (2014). Relationship between scientific knowledge and fortune-telling. Public Understanding of Science, 23(7), 780–796.

Bottling it up: A brief look at penile strangulation

While I was researching a blog on urethral manipulation I came across a paper entitled ‘Penile strangulation by a hard plastic bottle’ by Dr. Satish Jain and his colleagues published in a 2004 issue of the Indian Journal of Surgery. As the paper explains:

“Penile strangulation is a rare injury and most require only removal of the constriction and conservative management. Penile strangulating objects are usually rings, nuts, bottles, bushes, wedding rings etc. in an adult, while in children they tend to be rubber bands threads or hair coils. In adults these constricting penile bands, whether expandable or non-expandable, are placed deliberately by the person himself for masturbation or by the female counterpart to prolong erection. In children these are used to prevent enuresis and incontinence or as an innocent childish experiment. Because these bands occlude penile venous flow, most patients present to the emergency with penile edema” [an edema is a swelling caused by fluid in body tissue].

They reported the case of a 27-year old man who turned up at hospital needing emergency treatment for an extremely swollen penis and unable to urinate. This occurred as a result of placing his penis inside a hard plastic bottle as a masturbatory aid. In short, the neck of the bottle got stuck, constricting the penis base. The paper then described how the bottle was removed:

“The hospital carpenter was called to assist in cutting open that bottle. With the use of iron cutting saw…first the bottle was cut near the neck and then the bottle neck was cut open slowly and diagonally. The penis was held slightly bent downwards. Once one end of the bottle neck was cut open, the plaster spreader (used by orthopaedician) was use to hold the cut ends open and the whole bottle neck was cut opened and removed after 15 minutes of struggle…Penile edema subsided completely in a week and patient had an uneventful recovery. There was no erectile dysfunction or decreased uroflow”.

This case was relatively easy to treat and on the less serious side. Later in the paper, the authors note that more serious medical complaints can arise including ulceration (skin inflammation and/or lesion), necrosis (death of body tissue), urinary fistula (abnormal opening of the urethra) or even gangrene (death and decay of body tissue due to loss of blood supply). Unsurprisingly, these latter conditions most often occur because the patient is too shy or embarrassed to seek medical help.

It was after reading this paper that I went searching for other cases and found many papers on the topic (far too many to outline here). However, I thought I would pick out some that caught my eye. Penises stuck inside bottles seemed (somewhat predictably) to feature quite heavily. For instance, Dr. C.K. Ooi and colleagues reported two cases of “unusual” penile strangulation in a 2009 issue of the Singapore Medical Journal. One of the cases was a 77-year old man who got his penis stuck in a bottle. Although the bottle was successfully removed in the emergency ward the patient subsequently developed post-obstructive diuresis (i.e., excessive urination). The second case was a 60-year old man who got his penis stuck inside a metallic ring. An orthopaedic cutter was used to remove the ring and there were no long-term complications. Another paper by Dr. Matthias May and colleagues in a 2006 issue of the International Urology and Nephrology reported the case of a 49-year old man who got his penis stuck in a polyethylene terephthalate (PET) bottle. (Ethylene terephthalate is a light plastic material that is – according to various papers I read – “nearly indestructible”). After trying to cut the bottle off with a scalpel and then a glass saw, the bottle was finally removed by cutting it longitudinally with an oscillating saw (that was normally used for cutting off patient plaster casts).

A more recent case in a 2011 issue of the International Journal of Biological and Medical Research by Dr. Uday Shamrao Kumbhar and colleagues reported the case of a 46-year old man who got a plastic bottle neck stuck on the base of his penis following attempted masturbation. More specifically, they reported that:

“The man came after 14 [hours] with gross penile edema and impaired penile sensation distal to the constriction…The nature of the plastic bottle neck was such that an attempt at cutting the device was difficult. We retrieved the constructing device by cutting it by soldering gun (used for electrical soldering by electrician). Cuts were taken at two places – 3 and 9 o’clock positions. The only hurdle was heat generated during the soldering, which was overcome by intermittent soldering and pouring cold normal saline in between”.

The patient recovered fully and following removal had a normal erection, could masturbate and have sex without problems. The most recent case I came across was published in a 2014 issue of Case Reports in Urology. The authors (Dr. Avinash Chennamsetty, Dr. David Wenzler and Dr. Melissa Fischer) reported the case of a 49-year-old man that turned up at the Emergency Department complaining that his penis was swollen and painful. The authors reported that nine days prior to coming into hospital the man had placed a metallic constriction device over his penis for an “autoerotic motive” but then found that he couldn’t remove it. The authors noted that:

“He was able to urinate but had a decreased force of stream. Physical exam revealed a tightly encircling metallic ring with peripheral cogs placed on the mid shaft of the penis causing severe penile engorgement and edema. The metal appeared to be a very hard alloy with thickness measuring 5–7mm depending on the location. The penile skin under the ring was excoriated and necrotic. Due to the incarceration time, degree of necrosis, and significant distal edema, simple lubrication, compression, and manual removal were not an option for fear of amputation. Manual and electric ring cutters were used, but after several attempts, we were unable to do more than scratch the surface of the metal ring. The patient was given procedural sedation and a tongue depressor was placed beneath the metal ring to provide soft tissue protection. Using the pin cutter, enough force was generated in one attempt to snap the ring into two separate pieces”.

Another different kind of penile strangulation – with more serious consequences – was reported by Dr. A. Nuhu and his colleagues in a 2009 issue of the West African Journal of Medicine. In this instance, a middle-aged Nigerian managed to get a round metallic nut stuck on his penis. For five days the man had delayed coming into hospital for treatment even though he was unable to urinate properly (in fact he had trouble urinating at all). By the time he went for medical help, his penis had developed gangrene. Unfortunately, the only treatment option available was a complete amputation of his penis.

It is also worth mentioning that a number of papers I came across purely describe the methods that can be used in the “extrication of penile entrapment” such as a detailed report by Dr. Guang-Ming Liu and colleagues in a 2012 issue of the International Urology and Nephrology that described the “technique of suture traction in conjunction with Dundee…performed for the management of penile entrapment in polyethylene terephthalate bottle neck” that they claim can be performed “without any special tools required in the management of penile entrapment involving PET bottles [and can] be applied safely for the low-grade penile injury”.

Within two weeks of removal, the man’s penis had fully recovered and he was able to resume sexual activity. Another earlier 2001 paper by Dr. Mark Detweiler in the Scandinavian Journal of Urology and Nephrology outlined treatment guidelines “according to level of penile trauma for penile incarceration by metal devices”. Detweiler analysed all previous cases of penile strangulation (aka penile incarceration) and divided treatment interventions into four groups going from the safest to the most dangerous to perform: (i) string techniques with and without aspiration [removal] of blood from the glans; (ii) pure aspiration techniques; (iii) cutting devices; and (iv) surgical techniques.

Finally, the most tragic case of penile strangulation I came across was one published in 2011 by Dr. Benito Morentin and colleagues in the American Journal of Forensic Medicine and Pathology. They reported that a 58-year old man was found dead at a guesthouse by a flatmate living in the house. The paper reported: 

“According to the flatmate, the deceased had not been out of his room in the last 2 weeks. Two days before the death the flatmate phoned the emergency services asking for help due to the strange behavior of the subject. When the emergency staff arrived the man refused any kind of help claiming that he did not have any medical problems at all. Clinical antecedents included paresis of the left leg due to stroke, smoking, alcoholism, and social behavior disorder. At autopsy, physical examination showed that the penis was engorged and swollen, with dark black color and evident gangrene. A plastic bottle neck was found over the base of the penis. Between the bottle neck and the penis there was a piece of condom…Histologic examination of the penis revealed severe necrosis, intense hemorrhage of the tissue due to stagnated blood, and thrombosis… Death was attributed to multi-organ failure secondary to septic shock”.

This last case is clearly an extreme and tragic case. The authors speculated that the man was simply too ashamed to seek treatment. They also believed that this is the only ever death recorded as arising from penile strangulation.

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

Further reading

Chennamsetty, A., Wenzler, D. & Fischer, M. (2014). Removal of a penile constriction device with a large orthopedic pin cutter. Case Reports in Urology, Volume 2014, http://dx.doi.org/10.1155/2014/347285

Detweiler, M. B. (2001). Penile incarceration with Metal objects a review of procedure choice based on penile trauma grade. Scandinavian Journal of Urology and Nephrology, 35(3), 212-217.

Ivanovski, O., Stankov, O., Kuzmanoski, M., Saidi, S., Banev, S., Filipovski, V., Lekovski, L. & Popov, Z. (2007). Penile strangulation: two case reports and review of the literature. Journal of Sexual Medicine, 4(6), 1775-1780.

Jain S., Gupta A., Singh T., Aggarwal N., Sharma, S. & Jain S. (2004). Penile strangulation by a hard plastic bottle: A case report, Indian Journal of Surgery, 66(3), 173-175.

Liu, G. M., Sun, G., & Ma, H. S. (2012). Extrication of penile entrapment in a polyethylene terephthalate (PET) bottle: A technique of suture traction and Dundee and literature review. International Urology and Nephrology, 44(5), 1335-1340.

May, M., Gunia, S., Helke, C., Kheyri, R., & Hoschke, B. (2006). Penile entrapment in a plastic bottle – A case for using an oscillating splint saw. International Urology and Nephrology, 38(1), 93-95.

Morentin B., Biritxinaga B. & Crespo L. (2011). Penile strangulation: Report of a fatal case. American Journal of Forensic Medicine and Pathology, 32, 344-346.

Nuhu, A., Edino, S. T., Agbese, G. O., & Kallamu, M. (2009). Penile gangrene due to strangulation by a metallic nut: a case report. West African Journal of Medicine, 28(5), 340-242.

Ooi, C. K., Goh, H. K., Chong, K. T., & Lim, G. H. (2009). Penile strangulation: report of two unusual cases. Singapore Medical Journal, 50(2), e50-52.

Shamrao Kumbhar U., Dasharathimurumu, D. & Bhargavpak, D. (2011). Acute penile incarceration injury caused by a plastic bottle neck. International Journal of Biological and Medical Research, 2(4), 1184-1185.

Mourning sickness? A brief look at disaster tourism

Last week I did an interview with the Daily Mail about disaster tourism and why people flock to see disaster areas. I briefly mentioned the topic in a previous blog that I wrote on people that collect murder memorabilia (‘murderabilia’) and argued that the psychology behind disaster tourism and murderabilia were very similar. According to the Wikipedia entry:

“Disaster tourism is the act of travelling to a disaster area as a matter of curiosity. Disaster tourism took hold in the Greater New Orleans Area in the aftermath of Hurricane Katrina. There are now guided bus tours to neighbourhoods that were severely damaged and/or totally destroyed by the flooding”.

The same article also highlights the March and April 2010 eruptions of the Eyjafjallajökull volcano in Iceland. The article noted that disaster tourism quickly sprang up following the first eruption, with tour companies offering trips to see the volcano. Academically, disaster tourism is closely associated with ‘Dark Tourism’ and also has its own Wikipedia page:

“Dark tourism (also black tourism or grief tourism) has been defined as tourism involving travel to sites historically associated with death and tragedy. More recently it was suggested that the concept should also include reasons tourists visit that site, since the site’s attributes alone may not make a visitor a ‘dark tourist’. Thanatourism, derived from the ancient Greek word thanatos for the personification of death, refers more specifically to violent death; it is used in fewer contexts than the terms ‘dark tourism’ and ‘grief tourism’. The main draw to dark locations is their historical value rather than their associations with death and suffering”.

When I started researching this blog I was quite surprised by the amount of academic writing on the topic (although the vast majority of it is theorizing rather than the collection of empirical data). The academic field appears to have been kick-started by the publication of Malcolm Foley and John Lennon’s 2000 book Dark tourism: The attraction of death and disasters. Most of the papers I read speculated on the many motivations that people have for visiting places associated with death along with typologies of different kinds of dark tourism and what dark tourism means in a wider social and cultural context. In 2012, Dr. Maximiliano Korstanje speculated that “dark tourism could be a mechanism of resiliency helping society to recover after a disaster or catastrophe, a form of domesticating death in a secularized world”. However, many academics have different views and/or explanations. Before looking at some of the academic theorizing, I wanted to share some of the pros and cons of disaster tourism from an article on the WiseGeek site (‘What is disaster tourism?’) as non-academic articles seem to get straight to the point without the caveats and psychosocial babble:

“Disaster tourism is the practice of traveling to areas that have recently experienced natural or man-made disasters. Individuals who participate in this type of travel are typically curious to see the results of the disaster and often travel as part of an organized group. Many people have criticized disaster tourism as exploitation of human misery and a practice that demeans and humiliates local residents. Others argue that tourism to devastated areas can offer a boost to the local economy and raise awareness of the incident, both of which are often needed after a tragedy. When a geographical region suffers a major incident, the media may spend a great deal of time reporting on the situation and the plight of local residents…As a result, some people will actually visit the affected areas so they can experience the situation firsthand. These individuals are typically motivated by curiosity and do not necessarily plan to participate in relief efforts…In some cases, those who participate in disaster tourism will simply travel to an area on their own, while others will purchase a package tour from a travel business”.

Many of the more populist articles on disaster tourism and dark tourism would have readers believe that the phenomenon is new, but it isn’t. Throughout human history there are dozens of examples of people visiting places associated with death and destruction. As I argued in my interview with the Daily Mail, people are intrigued by death and the macabre (and was the subject of a previous blog I wrote on people’s fascination with death).

As a child I remember going on school trips to battlefields, visiting graveyards and cemeteries, and making brass rubbings from burial places in churches and cathedrals. As an adult I have visited Ground Zero in New York and Alcatraz prison island off San Francisco. Is this really that far removed from dark tourism? Many academic writers such as Dr. Philip Stone (who has written paper after paper on dark tourism and has his own ‘Institute for Dark Tourism Research at the University of Central Lancashire, UK) note that war-tourism is a small subset “of the totality of tourist sites associated with death and suffering”. He makes reference to people visiting assassination sites (e.g., the building where President John F. Kennedy was shot in Dallas), Holocaust sites (such as the Auschwitz concentration camp), celebrity death sites (of Elvis Presley, James Dean, Buddy Holly, etc.), terrorism sites, major disaster sites (e.g., plane crash sites, tsunami sites), slavery heritage attractions, and ‘entertainment’ locations (such as Vienna’s Funeral Museum, Whitby’s ‘Dracula Experience’, the Tower of London). In short, he argues that a full categorisation of dark tourism is extremely complex. He also goes on to say that:

“Despite the diverse range of sites and tourist experiences, Tarlow (2005) identifies dark tourism as ‘visitations to places where tragedies or historically noteworthy death has occurred and that continue to impact our lives’ – a characterisation that aligns dark tourism somewhat narrowly to certain sites and that, perhaps, hints at particular motives. However, it excludes many shades of dark sites and attractions related to, but not necessarily the site of, death and disaster…Consequently, Cohen (2011) addresses location aspects of dark tourism through a paradigm of geographical authenticity and sense of victimhood. Meanwhile, Biran, Poria, and Oren (2011) examine sought benefits of dark tourism within a framework of dialogic meaning making…Jamal and Lelo (2011) also explore the conceptual and analytical framing of dark tourism, and suggest notions of darkness in dark tourism are socially constructed, rather than objective fact….dark tourism may be referred to more generally as the ‘act of travel to tourist sites associated with death, suffering or the seemingly macabre’ (Stone, 2006)”

I was also surprised to learn from Dr. Stone and other papers that dark tourism has been given lots of other names in the academic literature including ‘morbid tourism’, ‘fright tourism’, ‘horror tourism’, ‘black spot tourism’, ‘hardship tourism’, ‘grief tourism’, ‘tragedy tourism’, ‘[extreme] thanatourism’, ‘warfare tourism’ and ‘genocide tourism’ all of which concern “milking the macabre” and “dicing with death”.

Dr. Jeffrey Podoshen (2013) has noted that an interest in death is general, and not person-specific and leads to the conclusion that there are a wide variety of potential manifestations related to dark tourism consumption motivations. Various academics have speculated that the motivations for dark tourism include sensation seeking and voyeurism. Citing the work of Dr. Richard Sharpley, he notes that “schadenfreude sparks dark tourism interest and likens these tourists to rubber-neckers who gaze at the tragedy of others”. However, as Philip Stone and Richard Sharpley note in a 2008 issue of the Annals of Tourism:

“The question of why tourists seek out such dark sites has attracted limited attention. Generally, visitors are seen to be driven by differing intensities of interest or fascination in death, in the extreme hinting at tasteless, ghoulish motivations. More specific reasons vary from morbid fascination or ‘rubber-necking’, through empathy with the victims, to the need for a sense of survival/continuation, untested factors which, arguably, demand verification within a psychology context”.

A recent study by Dr Takalani Mudzanani published in a 2014 issue of the Mediterranean Journal of Social Sciences examined why people visited the Hector Peterson Memorial and Museum in South Africa (named after one of the pupils who died during the Soweto riots). Via 15 in-depth interviews his study highlighted factors such as novelty, escapism, enhancement of kinship relations, nostalgia, education and the media played an important role in motivating visitors to visit the site. Finally, it’s worth noting that there are also those in the field that believe there are levels of dark tourism (such as Dr. William Miles in a 2002 issue of the Annals of Tourism Research) who talk of dark, darker, darkest tourism. Furthermore, most academics in the area would agree that dark tourism is not a single concept (something that with just a brief dip into this fascinating literature I totally agree with).

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

Further reading

Dann, G. M., & Seaton, A. V. (2001). Slavery, contested heritage and thanatourism. International Journal of Hospitality & Tourism Administration, 2(3-4), 1-29.

Foley, M., & Lennon, J. (2000). Dark tourism. Annals of Tourism Research, 19(1), 68-78.

Lennon, J. & Foley, M. (2000). Dark tourism: The attraction of death and disasters. London: Thomson Learning.

Miles, W. F. (2002). Auschwitz: Museum interpretation and darker tourism. Annals of Tourism Research, 29(4), 1175-1178.

Mudzanani, T. (2014). Why is Death so Attractive? An Analysis of Tourists’ Motives for Visiting the Hector Peterson Memorial and Museum in South Africa. Mediterranean Journal of Social Sciences, 5(15), 570-574.

Podoshen, J. S. (2013). Dark tourism motivations: Simulation, emotional contagion and topographic comparison. Tourism Management, 35, 263-271.

Sharpley, R., & Stone, P.R. (Eds.). (2009). The darker side of travel. Channel View Publications.

Stone, P. (2005). Dark tourism consumption: a call for research. E-Review of Tourism Research (eRTR), 3(5), 109-117.

Stone, P. (2006). A dark tourism spectrum: Towards a typology of death and macabre related tourist sites, attractions and exhibitions. Tourism: An Interdisciplinary International Journal, 54(2), 145-160.

Stone, P. R. (2011). Dark tourism and the cadaveric carnival: mediating life and death narratives at Gunther von Hagens’ Body Worlds. Current Issues in Tourism, 14(7), 685-701.

Stone, P. & Sharpley, R (2008). Consuming dark-tourism a thanatological perspective. Annals of Tourism Research, 35, 574–595.

Korstanje, M. & Ivanov, S. (2012). Tourism as a form of new psychological resilience: The inception of dark tourism. Cultur: Revista de Cultura e Turismo, 6(4), 56-71.

Miles, W. F. (2002). Auschwitz: Museum interpretation and darker tourism. Annals of Tourism Research, 29(4), 1175-1178

Strange, C., & Kempa, M. (2003). Shades of dark tourism: Alcatraz and Robben Island. Annals of Tourism Research, 30(2), 386-405.

The beast inside: What does your favourite animal say about you?

Every couple of months I get calls from the media asking me to comment on what some particular aspect or preference of human behaviour says about someone’s personality and/or demeanour. Most recently, I appeared on my local radio station (BBC Radio Nottingham) being interviewed about men’s and women’s favourite animals. The ‘hook’ of the story was a survey carried out by the polling organization YouGov on 190,000 people. The story appeared in the Daily Telegraph with the headline ‘Men identify with lobsters, women with miniature pigs’:

“Asked to pick the most stereotypically ‘manly’ of animals, we might opt for a shark, bear or bull. But a new poll by YouGov has found that lobsters may be the manliest animal of them all. The survey of 190,000 people asked respondents to name their favourite animal. The results were then broken down along gender lines. The animal which was most favoured by men compared to women was the lobster, followed by the alligator and stickleback fish. Meanwhile, miniature pigs, cats and ponies were disproportionately favoured by women. Completing the ‘masculine’ top ten were sharks, eagles, octopuses, ants, narwhals, scorpions and spiders. The next most ‘feminine’ animals were donkeys, chinchillas, pandas, rabbits, guinea pigs, zebras and – perhaps the most bizarre feature of this already bizarre survey – African pygmy hedgehogs. ‘In general, men are more likely to have sympathy for heroic, aggressive or creepy animals while women are more likely to prefer the cute, beautiful and exotic types,’ a researcher from YouGov wrote. He also noted that there were no mammals in the most typically male animals, while every animal in the women’s top 20 was a mammal, apart from the penguin and butterfly. The results were deemed ‘statistically significant’, with the full breakdown of preferred animals by gender available here”. 

The DJ that interviewed me hadn’t realised that the poll wasn’t about male and female ‘top 10’ favourite animals but was actually about the top differences between men and women’s favourite animals. Although the interview was enjoyable it had no scientific value whatsoever – so why did I do it? Well, I think the main reason was to please my university’s Press Office, but also in the back of my mind was a little exercise that one of my psychology lecturers made us do in a tutorial 30 years ago.

We were asked to name our three favourite animals and then to write three adjectives to describe the animals we had chosen. I chose the coelacanth* (rare, long-living, unchanging), the South American condor (high-flying, distinctive, endangered), and the duck-billed platypus (unique, nature-defying, electro-sensitive) – thankfully I was able to check my 1985 diary to check what adjectives I had used all those years ago. We were then told by our lecturer that: (i) our first choice represented how we think we are, (ii) the second choice represented how we think other people perceive us, and (iii) the third represented how we really are. Given that I am sharing it here, gives you an indication that I wasn’t overly unhappy with the outcome (and I’d like to think there is some truth in the insight given the adjectives I chose at the time – but that’s more to do with wishful thinking than science).

At best, these kinds of ‘personality insights’ are little more than pop psychology (although arguably fun to do). Arguably the most well-known ‘animal personality test’ can be found in Roy Feinson’s 1998 book The Animal In You: Discover Your Animal Type and Unlock the Secrets of Your Personality (and you can also check out the Animal In You website). According to the website:

“Are you a wolf, rugged and misunderstood, or more like the introspective mole? Take the Animal In You personality test and find out! To identify the animal that best matches you simply answer the questions as honestly as you can. For even more accurate results, you might want to get ratings from people that know you well or have them take the test for you! This test is based on the best selling book The Animal in You by Roy Feinson, which explores how biological and social pressure conspire to form our personalities. If you find it to be uncannily accurate, it’s due to the test’s sophisticated algorithms. When you’ve entered your personal data, the test will build a mathematical model that corresponds to your unique personality, match it to our database of animal profiles and choose the ones closest to you. Though you may have one or two other possible results, remember that each person properly matches only one animal personality”.

I have to admit that I have not personally taken the test myself, but I don’t see that much difference between this type of test and those that you find in astrology books. I have a little more faith in the Myers-Briggs Test (MBT; developed by Katharine Briggs and her daughter Isabel Myers) that is not a test of animal personality per se but has been extrapolated into animal personality types. The MBT draws on the theories of Carl Jung who theorized that there are four principal psychological functions by which humans experience the world: sensation, intuition, feeling, and thinking. In the MBT, these dichotomies (as outlined by the online article ‘What’s your animal personality type?’) are:

• Worldview: Extroversion (E) or Introversion (I) 
- i.e. would you rather play with your pals or hang out at home with a book?
• Information: Sensing (S) or Intuition (N) 
- i.e. when taking in something new, do you prefer to take it simply, at face value or interpret / add meaning based on your gut?
• Decisions: Thinking (T) or Feeling (F)
 – i.e. when making up your mind about something, do you primarily rely on logic and structure, or do you gravitate towards emotion and empathy?
• Structure: Judging (J) or Perceiving (P)
 – i.e. would you rather things in your life to be decided and set, or do you like to stay open to whatever options might come along?

Based on your scores on these four dimensions, your personality can (supposedly) be mapped onto one of the following animals: owl (INTP; ‘wise and clam’), fox (ESTP; ‘subtle and opportunistic’), sloth (ISFP; ‘harmless and sensitive’), lion (ENTJ; ‘king of the jungle’), deer (ISFJ; ‘territorial and protective’), octopus (INTJ; ‘solitary hunter’), cat (ISTP; ‘secret and unpredictable’), otter (ESFP; ‘fun and entertaining’), wolf (INFJ; ‘rare and fascinating’), dolphin (ENFP; ‘spontaneous and creative’), honey bee (ESTJ; ‘strict and aggressive’), beaver (ISTJ; ‘slow but tough’), dog (ENFJ; ‘loyal and affectionate’), meerkat (INFP; ‘free spirited and kind’), parrot (ENTP; ‘charming and clever’), and elephant (ESFJ; ‘gentle and caring’). Finally, if you are interested in taking the test, you can do so here.

 

*The Wikipedia entry on coelacanths note they “constitute a now rare order of fish…They follow the oldest known living lineage of Sarcopterygii (lobe-finned fish and tetrapods), which means they are more closely related to lungfish, reptiles, and mammals, than to the common ray-finned fishes…Since there are only two species of coelacanth and both are threatened, it is the most endangered order of animals in the world. The West Indian Ocean coelacanth is a critically endangered species. Coelacanths were thought to have undergone extinction 66 million years ago…The first recorded coelacanth fossil, found in Australia, was of a jaw that dated back 360 million years…The fossil record is unique because coelacanth fossils were found 100 years before the first live specimen was identified. In 1938, Courtenay-Latimer rediscovered the first live specimen…caught off the coast of East London, South Africa. In 1997, a marine biologist on honeymoon discovered the second live species…in an Indonesian market”.

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

Further reading

Barton, S.A. (2012). What’s your animal personality type? BuzzFeed, June 20. Located at: http://www.buzzfeed.com/summeranne/whats-your-animal-personality-type#.wtJJblrrQ

Dahlgreen, W. (2015). Lobsters for men, miniature pigs for women. YouGov UK, March 1. Located at: https://yougov.co.uk/news/2015/03/01/animals-gender/

Feinson, R. (1998). The Animal In You: Discover Your Animal Type and Unlock the Secrets of Your Personality. London: St. Martin’s Griffin.

Healthy Living Editors (2012). What animal matches your personality? Care2.com, October 21. Located at: http://www.care2.com/greenliving/whats-your-animal-personality.html

Merz, T. (2015). Men identify with lobsters, women with miniature pigs. Daily Telegraph, March 2. Located at: http://www.telegraph.co.uk/men/relationships/11444854/Men-identify-with-lobsters-women-with-miniature-pigs.html

Wikipedia (2015). Coelacanth. Located at: http://en.wikipedia.org/wiki/Coelacanth

Wikipedia (2015). Myers-Briggs Type Indicator. Located at: http://en.wikipedia.org/wiki/Myers–Briggs_Type_Indicator

Coining it in: Neologisms and ‘New Syndrome’ Syndrome

One of things I am very proud of in my academic career is the coining of the term ‘technological addiction’ back in 1995 (an umbrella term that I invented to describe a number of different person-machine addictions including slot machine addictions, video game addiction, television addiction, etc.). I’m also proud of coining the term ‘aca-media’ (relating to academics like myself that use the media to disseminate our research). A neologism (i.e., the name for a newly coined term) is often (according to Wikipedia) directly attributable to a specific event, person, publication, or period.

In the 1980s and early 1990s, there seemed to be a real upsurge is the naming of ‘new syndromes’ in the medical literature including many relating to excessive use of technology (such as ‘Space Invader’s Wrist’) and other leisure activities (such as ‘Cuber’s Thumb’ relating to excessive use of the Rubik’s Cube) – both of which made their appearance in 1981 issues of the New England Journal of Medicine. Other videogame medical complaints include ‘Pseudovideoma’ (in a 1984 issue of the Journal of Hand Surgery), ‘Pac-Man Phalanx’ (in a 1983 issue of Arthritis and Rheumatism) and ‘Joystick Digit’ (in a 1987 issue of the Journal of the American Medical Association). Another videogame-related medical complaint (in this case an infection), was reported in a 1987 issue of the Western Journal of Medicine by Dr. G.B. Soe and colleagues:

“We wish to focus WJM readers’ attention on another complication associated with video games-one that originally presented as an “infected spider bite. A 17-year-old right-handed boy noted progressive swelling and redness of his left hand seven days before admission. Two days before admission he was given penicillin intramuscularly and oral cephalexin to take at home. The swelling did not subside and the hand became very painful, so he came to the medical center for treatment. On admission his mother reported that she had seen many spiders around the house with a violin pattern on their backs, and that her son had probably been bitten by a spider…After seven days of parenteral antibiotic therapy, the edema, erythema and fever had disappeared and the patient was discharged home. Further questioning revealed that the young man was spending almost all of his time playing his favorite video game, which involved a fighting kung fu character. The patient used his left hand in manipulating a ball-shaped joystick to move the figure up, down, left and right, and his right in operating buttons to kick and jab. Extensive use of the joystick resulted in blisters on his left palm. He rubbed the blisters off, and an infection resulted that progressed to abscess formation. Neuromuscular complications of video games (‘pseudovideoma’, ‘Pac-Man phalanx’, ‘firing-finger syndrome’ and ‘Space Invaders wrist’) have been reported, as well as video game-induced seizures, but we have not come across any reports of an infectious complication of video games. Perhaps video game players should wear gloves to protect their palms, similar to ones worn by golfers and baseball players, who also need to get a firm grip on their respective sticks”.

Another one that I’d never heard of is ‘Nurd Knuckles’ coined by Dr. J.B. Martin in the Canadian Medical Association Journal in 1982:

“I wish to describe a case of painful knuckles associated with the use and manipulation of a new, allegedly therapeutic product, a Nurd. A Nurd is a head 10 cm across with a smiling face and large ears, reminiscent of the character Yoda of ‘Star Wars’. It is made of malleable material that can be stretched, twisted or deformed in any direction, yet with release of tension quickly resumes its original shape without a trace of distortion. A 32-year-old public school teacher presented with painful knuckles of his right hand. His students, perhaps feeling that their teacher was under increased stress during the marking of exams, had given him a Nurd for Christmas, and during a particularly trying day he had found occasion to use it. He repeatedly stretched its ears and twisted its neck without ill effect; however, on punching it he suffered sharp pain of his fourth and fifth metacarpophalangeal joints. On examination the joints were found to be reddened, with point tenderness over the fifth metacarpal head; there was no evidence of deformity. He was advised to stop beating his Nurd, and the pain subsided. While the Nurd is very plastic, yielding to the linear tension of stretching and twisting, it is very resistant to compression. Punching a Nurd does not cause the surface to give way, and, since the force of the blow is returned to the fist, it is conceivable that a fracture might result. Therefore, although stretching and twisting Nurds does not cause any harm, users should be cautioned against punching their Nurd. The Nurd is advertised as being a ‘punchable, stretchable, pushable and likeable alternative to tension, migraine headaches, drug abuse, alcoholism and manic depression’, but these claims are unsubstantiated. A MEDLINE search of the medical literature shows that no retrospective or prospective case control studies or controlled double blind crossover studies have been undertaken. Before the clinical efficacy of the Nurd can be taken seriously in the treatment of this broad spectrum of disease, full clinical trials must be completed. Subjects entering into trials must, however, be duly informed of the hazards of punching Nurds”.

Another one that caught my attention was a new affliction (‘Breaker’s Neck’) caused by the craze of ‘break dancing’ reported by Dr. Bertha Ramirez and her colleagues in a 1984 issue of the Journal of the American Medical Association. (The reason why I say it caught my eye is that I am currently involved in some research on ‘dancing addiction’ with some of my Hungarian colleagues and we have just had a new paper accepted in the journal PLoS ONE concerning the development of our ‘Dancing Motives Inventory’ – see ‘Further Reading’ below).

“To be added to the rapidly growing list of socially acquired injuries, we report a case of traumatic cervical subluxation caused by a new dance technique. This technique, labeled ‘breaking’ by its devotees, involves a modified head stand, in which the dancer, using his arms and hands for balance, spins rapidly on his head, neck, or shoulders to the rhythm of disco music. He then lowers his body to the floor and performs a series of rotational motions using his arms as a fulcrum…A 15-year-old boy was seen in our pediatric emergency room complaining that, on awakening two days previously, he felt a ‘snap’ in his neck, followed by persistent neck stiffness. He reported having ‘danced on his head’ the night prior to this incident. On physical examination, his head was tilted to the left with an inability to flex”.

Engaging in excessive sporting activity has given rise to a number of medical syndromes. One such consequence is ‘Rower’s Rump’ reported by Drs. K Tomecki and J. Mikesell in a 1987 issue of the Journal of the American Academy of Dermatology. In a previous blog I examined addiction to cycling. In the 1980s there were many medical complaints reported as a result of excessive cycling. One such complaint (given the name of ‘Bicycling nipples’) was highlighted by Dr. B. Powell in a 1983 issue of the Journal of the American Medical Association:

“Bicyclists are likely to suffer from a number of maladies, including dysuria, numb penises, and more. During cool or cold weather, another problem, bicyclist’s nipples, may occur. This condition is similar to jogger’s nipples, but it is primarily a thermal injury instead of an irritation secondary to friction, as with the jogger’s complaint. Often the rider is out in the cold weather for some time, and his or her undershirt, jersey, and jacket can become moist from perspiration. Evaporation and the chill of the wind lower the temperature of the nipples. They get downright cold, and they hurt. The pain continues after the ride is over. Indeed, it can continue for several days. The nipples are sore, sensitive to both temperature change and touch”.

After reading this I found out that Dr. Fred Levit had reported a case of ‘Jogger’s Nipples’ in a 1977 issue of the New England Journal of Medicine. All of these related nipple conditions are all examples of fissure of the nipple as they are all caused by friction resulting in soreness, dryness or irritation to, or bleeding of, one or both nipples. The Wikipedia entry also notes that “the condition is also experienced by women who breastfeed, and by surfers who do not wear rash guards”. The article also noted that:

“Jogger’s nipple is caused by friction from the repeated rubbing of a t-shirt or other upper body clothing against the nipples during a prolonged period of exercise. The condition is suffered mainly by runners. Long-distance runners are especially prone, because they are exposed to the friction on the nipple for the greatest period of time. However, it is not only suffered by athletes; the inside of a badge, a logo on normal items of clothing, or breastfeeding can also cause the friction which results in this condition”.

Outside of the leisure sphere, there were two case study reports of ‘Diaper Doer’s Hand’ in a 1987 issue of the journal Clinical Rehabilitation by Dr. J.L. Cosgrove and colleagues:

“Three cases of stenosing tenosynovitis occurred three to six months postpartum. Childcare activities aggravated the symptoms of pain and swelling in both patients. In two cases, a specific method of carrying the child was implicated as the mechanism of injury. Although there was no evidence of generalized inflammatory arthritis, all patients had very low positive titres of anti-nuclear antibodies. While it is likely that tenosynovitis was caused by mechanical factors, the possibility of increased susceptibility to inflammatory disease in the postpartum period cannot be discounted. The patients were successfully treated with a low temperature plastic splint, superficial heat and gentle mobilization”.

All of these new syndromes lead to why I put this article together in the first place. I found this letter in the British Medical Journal by Dr. E.P. Hoare entitled ‘New Syndrome Syndrome’ that I found both funny and poignant:

“Your readers will be familiar with tennis elbow, brazier’s ague, and soap packer’s jig not to mention Achilles’ heel. More recently we have heard of Space Invader’s wrist, jogger’s nipples, and the ultimate futility of Cuber’s thumb. May I point out another occupational disease which I have noticed among patrons of the reading room medical journal correspondence column reader’s neck or, more succinctly, the new syndrome syndrome. Symptoms usually begin with muscular contraction of the eyebrows, hyperventilation, and involuntary utterances, which in severe cases can lead to coprolalia. These may be followed by drowsiness, disorientation, hysterical amblyopia, and double vision (of the deja vu variety). If untreated the condition can result in a chronic pain in the neck. Treatment is 200 ml of gin and tonic stat by mouth and complete rest; music can also be helpful. The long-term prognosis is poor, however, unless journal editors can be persuaded to ban further reports of occupational afflictions or at least print a health warning at the head of their correspondence columns”.

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

Further reading

Behr, J.T. (1984). Pseudovideoma. Journal of Hand Surgery, 9(4), 613.

Cosgrove, J. L., Welch, D. A., Richardson, G. S., & Nicholas, J. J. (1987). Diaper doer’s hand: stenosing tenosynovitis in the postpartum period. Clinical Rehabilitation, 1(3), 219-223.

Gibofsky, A. (1983). Pac‐Man phalanx. Arthritis and Rheumatism, 26(1), 120.

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Griffiths, M.D. (1995). Pop psychology and “aca-media”: A reply to Mitchell. The Psychologist: Bulletin of the British Psychological Society, 8, 537-538.

Griffiths, M.D. (2001). A moral obligation in aca-media? The Psychologist: Bulletin of the British Psychological Society, 14, 460.

Hite, P. R., Greene, K. A., Levy, D. I., & Jackimczyk, K. (1993). Injuries resulting from bungee-cord jumping. Annals of emergency medicine, 22(6), 1060-1063.

Hoare, E.P. (1982). Points: New syndrome syndrome. British Medical Journal, 285(6352), 1429.

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Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, in press.

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Torre, P. R., Williams, G. G., Blackwell, T., & Davis, C. P. (1993). Bungee jumper’s foot drop peroneal nerve palsy caused by bungee cord jumping. Annals of emergency medicine, 22(11), 1766-1767.

Waugh, D. (1981). Cuber’s thumb. New England Journal of Medicine, 305, 768.

Displeasures of the flesh: A brief look at anthropophagolagnia and paraphilic behaviour in serial killers

In previous blogs I have examined the psychology of sexual cannibalism and erotophonophilia (aka ‘lust murder’) as well as an article that I wrote on serial killers that collect their victims’ body parts as ‘trophies’. One very rare sub-type of both sexual cannibalism and erotophonophilia is anthropophagolagnia. This particular type of sexual paraphilia has been defined by Dr Anil Aggrawal as the paraphilia of “rape with cannibalism” and by the Right Diagnosis website as “sexual urges, preferences or fantasies involving raping and then cannibalizing the victim”.

The Listaholic website goes as far to say that anthropophagolagnia is one of the ten “most bizarre sexual fetishes on earth” claiming that serial killer is the “poster boy” for these “twisted” individuals. Other serial killers that might be classed as anthropophagolagniacs include Albert Fish, Peter Kirsten, Ottis Toole and Ed Gein. However, there also appear to be cases of what I would call ‘systematic anthropophagolagnia’ if the extract I found online is true:

“While it is easy to dismiss one case as stemming from some sort of neurological aberrations in the participants, we also see sexualized cannibalism in modern day Africa. In the early 2000s in Congo, rape and cannibalism were reported to coincide sporadically across the region. The claims are backed by a UN investigation into the phenomena…Rebels would go into villages and rape the women and children, then dismember them alive while eating their flesh. There are many reports of family members being forced to eat the flesh of other murdered family members after being raped…The men committing these atrocities do not have any neurological aberrations, they simply have the power to exercise this behavior. While cannibalism has been practiced in Africa as part of spiritual traditions for centuries, sadistic sexualized torture is not part of that tradition. So why add it in? Presumably the rebels didn’t all happen to be born child rapists either, yet raping children is part of their terror campaign and they must be able to achieve an erection to carry out the task, and so it must be assumed they learned to like it”.

Last year, I also read about 40-year old preacher Stephen Tari, the leader of a 6,000-strong cannibal rape cult in Papua New Guinea. He was in prison following his conviction for a brutal rape but escaped (only to be killed by people from his village in retaliation for the cannibalistic rape murders he had committed). As a report in The Independent noted:

“[Tari] had previously been accused of raping, murdering and eating three girls in front of their traumatised mothers…The charismatic cult leader, who wore white robes and is said to have regularly drunk the blood of his ‘flower girls’, quickly returned to his home village of Gal after [a prison] escape, but could only manage six months before killing yet again…It has not yet been established if the murdered woman was killed as part of a blood sacrifice, but it is considered likely as Tari was said to have been attempting to resurrect his cult following the spell in prison”.

Dr. Eric Hickey (in his book Serial Murderers and Their Victims) notes that paraphilic behaviour is very common among those that commit sexual crimes (and that more than one is often present) but that the two activities (sex offending and paraphilias) may be two independent constructs and that one does not necessarily affect the other. In fact he notes that:

“Rather than paraphilia being caused by sexual pathology, they may be better understood as one of many forms of general social deviance…For the male serial killer, the paraphilia engaged in usually has escalated from softer forms to those that are considered not only criminal but violent as well. They range from unusual to incredibly bizarre and disgusting. As paraphilia develop, men affected by them often engage in several over a period of time. Most men who engage in paraphilia often exhibit three or four different forms, some of them simultaneously. For those with violent tendencies, soft paraphilia can quickly lead to experimentation with hardcore paraphilia that often involves the harming of others in sexual ways. For example, some paraphilic offenders prefer to stalk and sexually assault their victims in stores and other public places without getting caught. The thrill of hunting an unsuspecting victim contributes to sexually arousing the offender”.

Hickey asserts that anthropophagolagnia is one of the so-called ‘attack paraphilias’ (as opposed to the ‘preparatory paraphilias’). Attack paraphilias are described by Hickey as being sexually violent (towards other individuals including children in extreme circumstances). Preparatory paraphilias are defined by Hickey as those “that have been found as part of the lust killer’s sexual fantasies and activities” (including those that display anthropophagolagnia). However, Hickey notes that individuals that engage in preparatory paraphilias do not necessarily go on to become serial killers. He then goes on to say:

“The process of sexual fantasy development may include stealing items from victims. Burglary, although generally considered to be a property crime, also is sometimes a property crime for sexual purposes. Stealing underwear, toiletries, hair clippings, photographs, and other personal items provides the offender with souvenirs for him to fantasize over”.

Some of the examples Hickey cites are both revealing and psychologically interesting:

“One offender noted how he would climax each time he entered a victim’s home through a window. The thought of being alone with people sleeping in the house had become deeply eroticized. Another offender likes to break into homes and watch victims sleep. He eventually will touch the victim and will only leave when she begins to scream. He ‘began’ his sexual acting out as a voyeur. This paraphilic process was also examined by Purcell and Arrigo (2001), who note that the process consists of mutually interactive elements: paraphilic stimuli and fantasy; orgasmic conditioning process; and facilitators (drugs, alcohol, and pornography). The probability of the offender harming a victim is extremely high given the progressive nature of his sexual fantasies”.

Along with anthropophagolagnia, other ‘attack paraphilias’ that have been associated with serial killers include amokoscisia (sexual arousal or sexual frenzy from a desire to slash or mutilate other individuals [typically women]), anophelorastia (sexual arousal from defiling or ravaging another individual), biastophilia (sexual arousal from violently raping other individuals; also called raptophilia), dippoldism (sexual arousal from abusing children, typically in the form of spanking and corporal punishment), necrophilia (sexual arousal from having sex with acts with dead individuals), paedophilia (sexual arousal from having sex with minors typically via manipulation and grooming), and sexual sadism (empowerment and sexual arousal derived from inflicting pain and/or injuring other individuals).

The ‘preparatory paraphilias’ that typically precede serial killing and attack paraphilias such as anthropophagolagnia include agonophilia (sexual arousal caused by a sexual partner pretending to struggle), altocalciphilia (sexual arousal from high-heeled shoes), autonecrophilia (sexual arousal by imagining oneself as a dead person), exhibitionism (exposing genitals to inappropriate and/or non-consenting people for sexual arousal), frottage (sexual arousal from rubbing up against the body against a sexual partner or object), gerontophilia (sexual arousal from someone whose age is older and that of a different generation), hebephilia (men that are sexually aroused by aroused by teenagers), kleptolagnia (sexual arousal from stealing), retifism (sexual arousal from shoes), scatophilia (sexual arousal via making telephone calls, using vulgar language, and/or trying to elicit a reaction from the other party), scoptophilia (sexual arousal by watching others [typically engaged in sexual behaviour] without their consent, and more usually referred to as voyeurism), and somnophilia (sexual arousal from fondling strangers in their sleep). The multiplicity of co-existent paraphilias (including anthropophagolagnia) is highlighted by the Wikipedia entry on Jeffrey Dahmer:

“Dahmer readily admitted to having engaged in a number of paraphilic behaviors, including necrophilia, exhibitionism, hebephilia, fetishism, pygmalionism, and erotophonophilia. He is also known to have several partialisms, including anthropophagy (also known as cannibalism). One particular focus of Dahmer’s partialism was the victim’s chest area. By his own admission, what caught his attention to Steven Hicks hitchhiking in 1978 was the fact the youth was bare-chested; he also conceded it was possible that his viewing the exposed chest of Steven Tuomi in 1987 while in a drunken stupor may have led him to unsuccessfully attempt to tear Tuomi’s heart from his chest. Moreover, almost all the murders Dahmer committed from 1990 onwards involved a ritual of posing the victims’ bodies in suggestive positions – many pictures taken prior to dismemberment depict the victims’ bodies with the chest thrust outwards. Dahmer also derived sexual pleasure from the viscera of his victims; he would often masturbate and ejaculate into the body cavity and at other times, literally used the internal organs as a masturbatory aid”.

Almost nothing is known empirically about anthropophagolagnia except that it is very rare and that almost all information about it comes from serial killers that have been caught. Explanations for the development of anthropophagolagnia can only be speculated but are likely to be no different from the development of other paraphilic behaviour. Hickey (citing Irwin Sarason and Barbara Sarason’s Abnormal Psychology textbook) notes five key explanations for the development of paraphilias (reproduced below verbatim):

• Psychodynamic – paraphilic behavior as a manifestation of unresolved conflicts during psychosexual development;
• Behavioral – paraphilia is developed through conditioning, modeling, reinforcement, punishment, and rewards, the same process that normal sexual activity is learned;
• Cognitive – paraphilia become substitutes for appropriate social and sexual functioning or the inability to develop satisfying marital relationships;
• Biological – heredity, prenatal hormone environment, and factors contributing to gender identity can facilitate paraphilic interests. Other explanations are linked to brain malfunctioning and chromosomal abnormalities;
• Interactional – that development of paraphilia is a process that results from psychodynamic, behavioral, cognitive, and biological factors.

As an eclectic, I favour the interactional explanation for the existence of anthropophagolagnia but also believe that the most important influences are the behavioural aspects via classical and operant conditioning processes.

Dr. Mark Griffiths, Professor of Gambling Studies, 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.

Hall, J. (2013). ‘Black Jesus’ murder: Leader of 6,000-strong cannibal rape cult hacked to death by villagers in Papua New Guinea jungle after killing yet again. The Independent, August 30. Located at: http://www.independent.co.uk/news/world/asia/black-jesus-murder-leader-of-6000strong-cannibal-rape-cult-hacked-to-death-by-villagers-in-papua-new-guinea-jungle-after-killing-yet-again-8791967.html

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

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

Purcell, C., and B. Arrigo. (2001). Explaining paraphilias and lust murder: Toward an integrated model. International Journal of Offender Therapy and Comparative Criminology, 45(1), 6–31.

Sarason, I. G. and B. R. Sarason. (2004). Abnormal Psychology, 11th Edition. Upper Saddle River, N.J.: Prentice Hall.

Wikipedia (2014). Jeffrey Dahmer. Located at: http://en.wikipedia.org/wiki/Jeffrey_Dahmer

Booze news: What are the simplest ways to reduce your alcohol intake?

Last week I did an interview with the Daily Mail about how to cut down alcohol intake. The hook of the story was from a 2012 Finnish study published in the journal Addiction. The longitudinal study examined whether how close a person lives to a pub or bar and whether it had any effect on risky drinking behaviour (‘Living in proximity of a bar and risky alcohol behaviours: a longitudinal study’). The study was briefly summarized in Medical News Today:

“People who live close to an on-site alcohol outlet, such as a bar, are more likely to engage in risky alcohol behavior, while people who live further away have a lower chance of dangerous drinking. The researchers analyzed data consisting of the locations of licensed on-site alcohol outlets between 2000 and 2008, which was taken from the alcohol licence register, maintained by Valvira (National Supervisory Authority for Welfare and Health). They then reviewed data on alcohol consumption from surveys taken from the Finnish Institute of Occupational Health’s (FIOH) Public Sector study from 2000 to 2009. More than 78,000 people filled out at least one survey and over 55,000 took at least two surveys. The team found that people who lived less than a kilometer away from a bar or other on-site alcohol outlet had a 13% higher chance of heavy alcohol use compared to those who lived more than a kilometer away. When a people changed the location of their house between the two study surveys, the likelihood changed. [More specifically] (i) a shorter distance raised the likelihood of risky drinking by 17%, [and] (ii) a longer distance decreased the likelihood by 17%…The authors concluded that people have a higher chance of consuming alcohol if they live close to an on-site alcohol outlet”.

This is an example of the ‘availability hypothesis’ that is well known in most areas of addictive behaviour. In my own field of gambling studies, there is a general rule of thumb that where the opportunities and access to gambling are increased, more people engage in gambling (although this is not necessarily proportional to the level of problem gambling). The relationship between accessibility and engagement in addictive behaviour is complex as many other factors come into play. However, the Finnish study on risky drinking and proximity to alcohol outlets provides empirical support for the availability hypothesis.

There are also likely to be cultural differences. A lot of my consultancy work is for Scandinavian companies and I have been fortunate to visit Finland, Norway, Sweden and Denmark many times. One thing that is very noticeable in these countries is that alcohol is highly taxed and it is very expensive to drink alcohol in bars. On one of my first visits to Norway in the mid-1990s, I insisted on buying a round of drinks for the six people I was with (even though they were pleading with me not to). When I was charged 350 Krone (about £35) I began to understand why. My experience is that buying rounds of drinks appears to be very rare and I noticed that many people would make their pint of lager last hours in the bar.

Moving to countries like Norway as a way of cutting down on alcohol intake is a drastic option as there are many other simple ways that we can cut down on drinking alcohol. Unfortunately, as a result of a chronic medical condition I was told to stop drinking alcohol last September (2014). In the last six months I have drank only 8 units of alcohol (and 6 of those units were on New Year’s Eve). My own reduction in alcohol intake was forced upon me. I can obviously choose to ignore my doctor’s advice but I decided not to. Any woman has to make a similar decision about whether they consume alcohol and/or nicotine during pregnancy.

The remainder of today’s blog provides some tips on the simplest ways to cut down on alcohol intake. They are not aimed at problem drinkers as they require extra external support and interventions from family, friends, doctors and/or therapists. The tips below come from a variety of sources (listed in ‘Further reading’). I don’t claim to be an expert on alcohol addiction (although I have published more than a few papers on alcohol problems over the years – again, see some of these in ‘Further reading’ below) but most of these tips are practical and common sense:

• Don’t go it alone: If you really want to cut down your alcohol intake, try do it with your friends and family together. Doing it with others rather than on your own means you will have others around you going through the same thing as yourself as well as having a ready made support group.
• Don’t buy rounds of drinks in pubs and clubs: If you’ve ever been out on a pub crawl with friends, you will know that you tend to drink at the pace of the quickest drinker in the group (and this may be at a quicker rate than you would ideally prefer). If you do want to drink in rounds, then try opting out every other round and/or try to drink with a smaller group of friends (as larger groups typically lead to more alcohol being drunk over the course of an evening).
• Spread out your drinking and drink more slowly: Sounds obvious but it’s true. (As I noted above, in places where alcohol is very expensive this becomes a natural option). A related option is to have one alcoholic drink followed by one non-alcoholic drink throughout the evening.
• Don’t buy pints, doubles or large glass drinks: When you do drink in pubs and clubs, order smaller measures (wine in a small glass rather than a large one, halves instead of pints, a bottle of lager rather than a pint of lager). All of these smaller options mean a reduced ‘alcohol by volume’ ratio (i.e., less alcohol actually consumed). If you are the kind of person who says to yourself ‘I never have more than two glasses of wine a night’, then changing to a smaller glass will have an immediate and appreciable effect in lowering overall alcohol intake.
• Where possible choose non–alcoholic drinks: When you eat out or dine at home, have a soft drink, juice or water rather than wine or beer with your meal.
• Dilute alcoholic drinks: If the option of a non-alcoholic drink isn’t always possible or simple doesn’t appeal, then dilute your drinks. Have a lager shandy or a white wine spritzer.
• Have ‘alcohol-free’ days: If you drink every day, start by trying to drink alcohol every other day. If you drink alcohol a few times a week, try to drink just once a week. Just cutting down on your normal weekly pattern will help you to realise that you can go without alcohol.
• Avoid cocktails: Cocktails often contains a lot more alcohol than people think.
• Drink alcohol free beers and lagers: If you love the taste of lager or beer, there are alcohol free options. There are also an increasing number of fake cocktails (‘mocktails’).
• Reward yourself for not drinking alcohol: Many people drink as a way to alleviate the stresses and strains of every day life (or to do the exact opposite – to celebrate the fact that you’ve done something well or because it is a special occasion). The money not spent on alcohol could go towards giving yourself another kind of treat or reward (a massage, the new CD you wanted, watching a film at the cinema, etc.).
• Tell everyone in your social circle you’re cutting down alcohol intake: By telling everyone you know including family, friends and work colleagues, you will be more committed to not drinking alcohol than if you told no-one.
• Avoid temptation: One of the key factors in any potentially addictive activity is knowing what the ‘triggers’ are (e.g., walking past a pub, watching television, having an argument with your loved one, etc.). Knowing what the triggers are can be a strategy for avoiding temptation (e.g., changing the routes on your way back home to avoid walking past your favourite pub, doing something else instead of watching television, etc.).
• Get a new hobby: Changing one aspect of your routine life can also help change other aspects. Sometimes, changing one aspect of your life (such as introducing daily exercise) goes hand-in-hand with other areas of your life (drinking less alcohol, eating more healthily).
• Think of the benefits of not drinking alcohol: Not drinking alcohol can bring lots of positives. In six months without alcohol I’ve lost about 6.35kg in weight because alcohol is high in calories (and that’s without exercise!). Other benefits include more money for other things, better quality sleep, less stress (because alcohol is a depressant), and better health.
• Use alcohol tracking tools: Many apps are now available to help you keep track of your alcohol intake. For instance, the MyDrinkaware tool allows you to see how alcohol is affecting you on a number of different dimensions including your health (how many units you are consuming over time), weight (how many calories you are consuming over time), and finances (how much money you are spending on alcohol over time).

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

Further reading

Drinkaware (2015). Tips for cutting down when out. Located at: https://www.drinkaware.co.uk/make-a-change/how-to-cut-down/cutting-down-when-out-and-about/tips-for-cutting-down-when-out

Drinkaware (2015). Track your drinking. Located at: https://www.drinkaware.co.uk/unitcalculator#unitcalculator

Griffiths, M.D. (2014). I drink, therefore I am: The UK’s alcohol dependence. Intervene, April, 20-23.

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.

Halonen, J. I., Kivimäki, M., Virtanen, M., Pentti, J., Subramanian, S. V., Kawachi, I., & Vahtera, J. (2013). Living in proximity of a bar and risky alcohol behaviours: a longitudinal study. Addiction, 108(2), 320-328.

Glynn, S. (2012). Living close to a bar increases chance of risky drinking. Medical News Today, November 7. Located at: http://www.medicalnewstoday.com/articles/252462.php

NHS Choices (2015). Tips on cutting down [alcohol]. Located at: http://www.nhs.uk/Livewell/alcohol/Pages/Tipsoncuttingdown.aspx

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.