Category Archives: Addiction

Ringing the changes: Can disordered mobile phone use be considered a behavioural addiction?

Over the last decade, I have published various papers on excessive mobile phone use both in general and related to particular aspects of mobile phone use (such as gambling and gaming via mobile phones (see ‘Further reading’ below). Recently, some colleagues and I (and led by Dr. Joël Billieux) published a new review in the journal Current Addiction Reports examining disordered mobile phone use.

I don’t think many people would say that their lives are worse because of mobile phones as the positives appear to greatly outweigh the negatives. However, in the scientific literature, excessive mobile phone use has been linked with self-reported dependence and addiction-like symptoms, sleep interference, financial problems, dangerous use (phoning while driving), prohibited use (phoning in banned areas), and mobile phone-based aggressive behaviours (e.g., cyberbullying).

Despite accumulating evidence that mobile phone use can become problematic and lead to negative consequences, its incidence, prevalence, and symptomatology remain a matter of much debate. For instance, our recent review noted that prevalence studies conducted within the last decade have reported highly variable rates of problematic use ranging from just above 0% to more than 35%. This is mainly due to the fact most studies in the field have been conducted in the absence of a theoretical rationale.

Too often, excessive mobile phone use has simply been conceptualized as a behavioural addiction and subsequently develop screening tools using items adapted from the substance use and pathological gambling literature, without taking into account either the specificities of mobile phone “addiction” (e.g., dysfunctional mobile phone use may often be related to interpersonal processes) or the fact that the most recent generation of mobile phones (i.e., smartphones) are tools that – like the internet – allow the involvement in a wide range of activities going far beyond traditional oral and written (SMS) communication between individuals (e.g., gaming, gambling, social networking, shopping, etc.).

The first scientific studies examining problematic mobile phone use (PMPU) were published a decade ago. Since then, the number of published studies on the topic has grown substantially. At present, several terms are frequently used to describe the phenomenon, the more popular being ‘mobile phone (or smartphone) addiction’, ‘mobile phone (or smartphone) dependence’ or ‘nomophobia’ (that refers to the fear of not being able to use the mobile phone).

PMPU is generally conceptualized as a behavioural addiction including the core components of addictive behaviours, such as cognitive salience, loss of control, mood modification, tolerance, withdrawal, conflict and relapse. Accordingly, the criteria (and screening tools developed using such criteria) that have been proposed to diagnose an addiction to the mobile phone have been directly transposed from those classifying and diagnosing other addictive behaviours, i.e., the criteria for substance use and pathological gambling. For example, in a recent study published in the Journal of Behavioral Addictions, Dr. Peter Smetaniuk reported a prevalence of PMPU around 20% in U.S. undergraduate students using adapted survey items that were initially developed to diagnose disordered gambling.

Although many scholars believe that PMPU is a behavioural addiction, evidence is still lacking that either confirms or rejects such conceptualization. Indeed, the fact that this condition can be considered as an addiction is to date only supported by exploratory studies relying on self-report data collected via convenience samples. More specifically, there is a crucial lack of evidence that similar neurobiological and psychological mechanisms are involved in the aetiology of mobile phone addiction compared to other chemical and behavioural addictions. Such types of evidence played a major role in the recent recognition of Gambling Disorder and Internet Gaming Disorder as addictive disorders in the latest (fifth) addiction of the DSM (i.e., DSM-5) In particular, three key features of addictive behaviours, namely loss of control, tolerance and withdrawal, have – to date – received very limited empirical support in the field of mobile phone addiction research.

Given these concerns, it appears that the empirical evidence supporting the conceptualization of PMPU as a genuine addictive behaviour is currently scarce. However, this does not mean that PMPU is not a genuine addictive behaviour (at least for a subgroup of individuals displaying PMPU symptoms), but rather that the nature and amount of the available data at the present time are not sufficient to draw definitive and valid conclusions. Therefore, further studies are required. In particular, longitudinal and experimental research is needed to obtain behavioural and neurobiological correlates of PMPU. In the absence of such types of data, all attempts to consider PMPU within the framework of behavioural addictions will remain tentative. It is worth noting here that it took decades of empirical research before disordered gambling was officially recognized as an addiction (as opposed to a disorder of impulse control) in the DSM-5.

The current conceptual chaos surrounding PMPU research can also be related to the fact that while the number of empirical studies is growing quickly, these studies have (to date) primarily been based on concepts borrowed from other disorders (e.g., problematic Internet use, pathological gambling, substance abuse, etc.). This approach is atheoretical and lacks specificity with regard to the phenomenon under investigation. In fact, by adopting such a ‘confirmatory approach’ relying on deductive quantitative studies, important findings that are unique to the experience of PMPU have been neglected. As an illustration, no qualitative analyses of PMPU exist, and only a few models have been proposed. This implies that most studies have been conducted without a theoretical rationale that goes beyond transposing what is known about addictions in the analysis of PMPU.

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

Additional input: Joël Billieux, Pierre Maurage, Olatz Lopez-Fernandez and Daria J. Kuss

Further reading

Bianchi, A. & Phillips, J.G. (2005). Psychological predictors of problem mobile phone use. Cyberpsychology and Behavior, 8, 39–51.

Billieux, J. (2012). Problematic use of the mobile phone: A literature review and a pathways model. Current Psychiatry Reviews, 8, 299–307.

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

Carbonell, X., Chamarro, A., Beranuy, M., Griffiths, M.D. Obert, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Chóliz M. (2010). Mobile phone addiction: a point of issue. Addiction. 105, 373-374.

Griffiths, M.D. (2007). Mobile phone gambling. In D. Taniar (Ed.), Encyclopedia of Mobile Computing and Commerce (pp.553-556). Pennsylvania: Information Science Reference.

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Lopez-Fernandez, O., Honrubia-Serrano, L., Freixa-Blanxart, M., & Gibson, W. (2014). Prevalence of problematic mobile phone use in British adolescents. Cyberpsychology, Behavior and Social Networking, 17, 91-98.

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (2015). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3) (pp. 591-606). Hershey, PA: IGI Global.

Smetaniuk, P. (2014). A preliminary investigation into the prevalence and prediction of problematic cell phone use. Journal of Behavioral Addictions, 3(1), 41-53.

Needles and the damage done: A brief look at ‘knitting addiction’

In a previous blog, I briefly looked at ‘quilting addiction’. It was while I was researching that blog that I also came across a number of academic papers on the sociology of knitting and various references in the academic (and non-academic) literature to ‘knitting addiction’. In previous blogs I have written about the work of Dr. Bill Glasser who introduced the concept of ‘positive addiction’ in a 1976 book of the same name.

In a more recent 2012 paper on the topic in the Canadian Journal of Counselling and Psychotherapy, Glasser claimed that he had heard numerous stories from many different individuals claiming they were ‘positively addicted “to a variety of activities such as swimming, hiking, bike riding, yoga, Zen, knitting, crocheting, hunting, fishing, skiing, rowing, playing a musical instrument, singing, dancing, and many more”. Glasser (1976) argued that activities such as jogging and transcendental meditation were positive addictions and were the kinds of activity that could be deliberately cultivated to wean addicts away from more harmful and sinister preoccupations. He also asserted that positive addictions must be new rewarding activities that produce increased feelings of self-efficacy.

This idea has actually been put into practice with knitting. Dr. Kathryn Duffy published a paper in a 2007 issue of the Journal of Groups in Addiction and Recovery about knitting as an experiential teaching method for affect management for females in addiction group therapy at a drug and alcohol rehabilitation centre. Duffy claimed her knitting program had been successful in facilitating discussions and beneficial in providing a skill for moderating stress and emotions, both for female inpatient and outpatient drug and alcohol addicts.

A more recent paper by Dr. Betsan Corkhill and colleagues examined knitting and wellbeing (in a 2014 issue of Textile: The Journal of Cloth and Culture), using the World Health Organisation’s definition of wellbeing as “an ability to realize personal potential, cope with daily stresses, and contribute productively to society”. Their paper argued that knitting contributes to human wellbeing and has therapeutic benefits for those that engage in it because it is a behaviour (like many others) that can be used as a coping mechanism that can help overcome the daily pressures of life. One of the more interesting papers that I read on knitting was one published in a 2011 issue of Utopian Studies by Dr. Jack Bratich and Dr. Heidi Brush about “fabriculture” and “craftivism”:

“When we speak of ‘fabriculture’ or craft culture, we are referring to a whole range of practices usually defined as the ‘domestic arts’: knitting, crocheting, scrapbooking, quilting, embroidery, sewing, doll-making. More than the actual handicraft, we are referring to the recent popularization and resurgence of interest in these crafts, especially among young women. We are taking into account the mainstream forms found in Martha Stewart Living as well as the more explicitly activist (or craftivist) versions such as Cast Off, Anarchist Knitting Circle, MicroRevolt, Anarchist Knitting Mob, Revolutionary Knitting Circle, and Craftivism…When we use the term craft-work, we are specifically referring to the laboring practices involved in crafting, while fabriculture speaks to the broader practices (meaning-making, communicative, community-building) intertwined with this (im)material labor”.

The paper also outlined how women who knit in public (such as during a lecture or a conference) are often castigated and/or ridiculed for their behaviour. They even cited Sigmund Freud in relation to why knitting in public causes discomfort for onlookers:

“Freud institutionalized a concept denoting the jarring and disorienting effect of being spatially out of phase: unheimlich. The queasiness of the unheimlich occurs also when interiors become exteriorized (especially the home, as it also means unhomely). Knitting in public turns the interiority of the domestic outward, exposing that which exists within enclosures, through invisibility and through unpaid labor: the production of home life. Knitting in public also inevitably makes this question of space an explicitly gendered one. One commentator observes that knitting in public today is analogous to the outcry against breast-feeding in public twenty years ago (Higgins 2005). Both acts rip open the enclosure of the domestic space to public consumption. Both acts are also intensely productive and have generally contributed to women’s heretofore invisible and unpaid labor. But could such an innocuous activity as knitting have such social ramifications? How disruptive can fabriculture be when crafting women are more in the public eye than ever before? Many of us may know that Julia Roberts, Gwyneth Paltrow, Madonna, and other celebs knit”.

The paper goes on to say that there are various knitting blogs (such as Etherknitter) that “expose the dark side of knitting” including excessive consumption and addiction. I then went onto the Etherknitter website and located an article specifically written on knitting addiction (‘Etherknitter’ turned out to be the pseudonym of the individual that runs the site). Here are some extracts from the article which also notes some of the shared terminology between drug addiction and knitting addiction:

“It’s been a revealing several days. I have discovered that I am incapable of not knitting. The only thing that would have stopped me would have been pain… In college, when I flirted with smoking cigarettes for six weeks…Alcohol has never appealed…In my profession, an uncomfortable number of practitioners succumb to the siren song of drug addiction…Then we get to knitting. I can’t not knit. Well, I can, but it hurts too much to be worth it. (I wonder if that’s why addicts stay addicted.) I was talking to a [fabric store] owner recently…She commented that the staff in the store sees a lot of people at the store who act out their neediness through yarn. She saw it as uncontrolled buying. Since we were talking about obesity in America at the time, she was tying it into alcohol/drug and food addiction. [The Too Much Wool website] pointed out our knitterly use of the word ‘stash’, and its clear crossover to the drug culture. Blogworld is full of knitters describing uncontrolled stash acquistions [such as ‘majorknitter’]. And trying to hide the size of the stash from significant others. And selling parts of their stash to others. The addiction to fiber and knitting is probably more benign, except for the financial aspects, and the time constraints. I really do have to beat myself to fulfill the more boring paperwork obligations in my life since I started knitting. The needles (aha! Another crossover analogy) are more fun. I don’t plan to do anything about my knit-addiction quite yet. But it does bother me”. 

In researching this article I came across a number of online accounts of people claiming to be genuinely addicted to knitting. This extract was particularly revealing as this short account seems to highlight many of the core components of addiction such as salience, conflict, and withdrawal symptoms:

“So, I’m 22 and I go through all that typical 22-year old stuff. Sometimes, my life gets rough and I have trouble coping. Rather than going out with friends and drinking till I puke, or going and smoking a few cigarettes or a joint, or having sex with random boys, I turn to my knitting in times of crisis. This might sound like a constructive thing. After all, I’m creating rather than destroying, right? Wrong. I say that I’m addicted because I am. I can’t function on a normal level without my knitting bag at my side. I can’t sit still in class or on a break if I’m not knitting. My head hurts, I sweat, I get jittery if my hands are doing nothing. And it gets worse. I skip classes to go to yarn stores. I come back late from breaks at work because I needed to finish just one more row. I already have one knitting tattoo and another planned. I pay my rent late because I spent my entire paycheck on yarn. My boyfriend’s half of the apartment is slowly being taken over by my stash. My life isn’t complete without knitting. I bought two spinning wheels so I could spin my own yarn. I think that if I ever lost a hand or arm due to an accident I would probably kill myself because I couldn’t knit…I’ve admitted to myself that I have a problem, but most people see knitting as simply my hobby. It goes so much deeper than that and I feel like I finally needed to say something”.

Academically, there is little on knitting addiction. In an unpublished thesis by Christiana Croghan, she noted in one paragraph that:

“Baird (2009) supports the theory that knitting alters brain chemistry, lowering stress hormones and boosting the production of serotonin and dopamine. Dittrich (2001) argues while there are many health benefits associated with knitting there is also a health risk of the possible development of carpal tunnel syndrome. Research suggests knitting may also have an addictive quality that Corkhill (2008) considers to be a constructive addiction that may replace other more severe harmful addictions. Marer (2002) interviewed professional women who knit during lunch hours, and found a consistent theme of relief from anxiety and a sense of clear headedness at work. Marer (2002) also found patients with severe illnesses such as cancer experience a greater sense of coping when they knit”.

More specifically on addiction, a 2011 issue of Asian Culture and History, Hye Young Shin and Dr. Ji Soo Ha examined knitting practice in Korea. Their qualitative research revealed that:

“Immersion in knitting projects can become so intense as to create anxiety for some knitters after the completion of a knitting project. They confess a sense of emptiness or feeling lost after a period of deep mental and physical engagement. This suggests that knitting can become an activity that does not arise out of necessity or has a clear purpose. However, knitters who have a lot of experience with knitting practice tend to say that long experience with knitting has enabled them to handle this urge to indulge in knitting, a typical symptom in the early stage of one’s knitting career”.

Their paper includes the following quotes from knitters that they interviewed:

  • Extract 1: “Knitting is a kind of addiction or drug. I feel so bored and empty and a sense of being lost when I’m done with one project.”
  • Extract 2: “For example, I check the time when a TV drama begins and I can stop knitting when the drama starts. When I first started knitting, I couldn’t control my urge to keep knitting on and on, but now I can; otherwise I can’t enjoy it as a pleasurable and long-term hobby. I still want to carry on when I sit for knitting, not wanting to stand up to wash the dishes, but now I can control myself.”

I have always argued that is theoretically possible for an individual to become addicted to anything if there are constant reinforcements (i.e., rewards). The anecdotal reports in this article suggest that a few individuals appear to experience addiction-like symptoms but there is too little detail to say one way or another whether knitting addiction genuinely exists.

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

Further reading

Baird, M., (2009). Fighting the stress with knitting needles. Located at: http://heal-all.org/art/18/human-body/1999/fighting-the-stress-with-knitting-needles

Bratich, J. Z., & Brush, H. M. (2011). Fabricating activism: Craft-work, popular culture, gender. Utopian Studies, 22(2), 233-260.

Corkhill, B. (2008) Therapeutic knitting. retrieved from www.knitonthenet.com/issue4/features/therapeutic knitting/

Corkhill, B., Hemmings, J., Maddock, A., & Riley, J. (2014). Knitting and Well-being. Textile: The Journal of Cloth and Culture, 12(1), 34-57.

Croghan, C. (2013). Knitting is the new yoga? Comparing techniques; physiological and psychological indicators of the relaxation response. Unpublished manuscript. Located at: http://esource.dbs.ie/handle/10788/1586

Dittrich, L. R. (2001) Knitting. Academic Medicine, 76(7), 671. Retrieved from: http://knittingbrain.com/results.php

Duffy, K. (2007). Knitting through recovery one stitch at a time: Knitting as an experiential teaching method for affect management in group therapy. Journal of Groups in Addiction and Recovery, 2(1), 67-83.

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

Glasser, W. (2012). Promoting client strength through positive addiction. Canadian Journal of Counselling and Psychotherapy, 11(4), 173-175.

Etherknitter (2006). Public displays of knitting. Etherknitter Blog. Accessed April 19, 2006, http://etherknitter.typepad.com/etherknitter/2006/03/please_picture_.html

Marer, E. (2002). Knitting: the new yoga. Health, 16(2), 76-78.

Shin, H. Y., & Ha, J. S. (2011). Knitting practice in Korea: A geography of everyday experiences. Asian Culture and History, 3(1), 105-114.

Sound conclusions: The psychology of musical preferences

Last week I was invited to give a keynote talk at an Italian conference on community psychology in Padova. The reason I mention this is because it was at this conference I met another academic – Dr. Tom Ter Bogt – that has a job that I would love to have. Dr. Ter Bogt is a Professor in Popular Music and Youth Culture at the Department of Interdisciplinary Social Sciences of Utrecht University. Regular readers of my blog will know that I have an obsessive love of music and have written about the psychology many of my musical heroes in previous blogs.

It all started when Dr. Ter Bogt innocently asked me what I thought of Noel Gallagher’s latest album (Chasing Yesterday). When I told him that I thought it was great, it sparked a long conversation where we discussed our eclectic love of music taking in a shared appreciation of Oasis, The Beatles, Throbbing Gristle, The Velvet UndergroundLou Reed, Iggy Pop, David Bowie, Roxy Music, Brian Eno, Grace Jones, Johnny Cash, and Chic (to name but a few). I also learned that he used to be a club DJ and that he had authored a best selling book on the history of pop music in his home country. In further email conversations, he also shared with me that his most played artists were Television and the Comsat Angels (something I would never have predicted based on out initial conversation but something that I found endearing).

In the nicest way possible, I am envious of Dr. Ter Bogt’s job. He has managed to become a professor through his love of music, and now carries out scientific research on the topic. Our respective research backgrounds – while very different – occasionally intersect. For instance, Dr. Ter Bogt and his colleagues published a paper in a 2002 issue of Contemporary Drug Problems on ‘Dancestasy’ (dance and MDMA use) in Dutch youth culture and I have published papers on both dance as an addiction, and young people’s use of ecstasy as a ‘risky but rewarding behaviour’ (see ‘Further reading below).

As an avid music fan I was interested to read Dr. Ter Bogt’s typology of music listeners in a 2010 paper in the journal Psychology of Music. In this study, Dr. Ter Bogt and his colleagues constructed a typology of music listeners based on the of importance attributed to music and four types of music use (among a sample of nearly a thousand Dutch participants): (i) mood enhancement (e.g., “Music helps me to relax and stop thinking about things”), (ii) coping with problems (e.g., “I always play music when I feel sad”), (iii) defining personal identity (e.g., “Lyrics of my music often express how I feel”), and (iv) social identity (e.g., “I can’t be friends with someone who dislikes my music”).

Using latent class analysis, the study’s participants were classed into three listener groups – High-Involved Listeners (HILs; 19.7% of the sample), Medium-Involved Listeners (MILs; 74.2%), and Low-Involved Listeners (LILs; 6.1%). HILs listened to music most often for mood enhancement, coping with distress, identity construction and social identity formation. MILs and LILs formed predictably attached less importance to music in their lives. HILs liked a wide range of musical genres (e.g., pop, rock, urban, dance, etc.) and experienced the most positive affects when listening to music. Interestingly, both HILs and MILs (when compared to LILs) reported more negative affects (such as anger and sadness) when listening to music. The study also reported that even LILs listened to music frequently and used it as a mood enhancer.

In a 2010 study in the Journal of Adolescence, Dr. Ter Bogt and his colleagues examined the association between music preferences and adolescent substance use. In a nationally representative sample of 7324 Dutch adolescents (aged 12–16 years), the study collected data concerning music preferences, substance use behaviors, and the perceived number of peers using substances. Adolescent music preferences for eight different music genres clustered into four distinct styles labeled as pop (chart music, Dutch pop), adult (classical music, jazz), urban (rap/hip-hop, soul/R&B) and hard (punk/hardcore, techno/hard-house). Adolescent substance use among the participants comprised smoking, drinking, and cannabis use. The results showed that music preference and substance use was either wholly or partially mediated by perceived peer use.

Using the same dataset, a study published in a 2009 issue of Substance Use and Misuse reported that when all other factors were controlled for, higher levels of substance use was more likely among those who liked punk/hardcore, techno/hard-house, and reggae while lower levels of substance use was more likely among those who preferred pop and classical music. According to Ter Bogt and his colleagues, prior empirical research had demonstrated that liking heavy metal and rap predicted substance use. The Dutch data in this study found that “a preference for rap/hip-hop only indicated elevated smoking among girls, whereas heavy metal was associated with less smoking among boys and less drinking among girls”. Consequently, it was concluded that the music genres associated with increased substance use “may vary historically and cross-culturally, but, in general, preferences for nonmainstream music are associated positively with substance use, and preferences for mainstream pop and types of music preferred by adults (classical music) mark less substance use among adolescents”. The authors also noted that the data were correlational therefore the direction of causation of the music–substance use link cannot be drawn.

In a more recent (2013) study published in the journal Pediatrics, Dr. Ter Bogt and colleagues examined the relationship between early adolescents’ musical preferences and minor delinquency. Following 309 adolescents (149 boys, 160 girls) from the age of 12 years over a four-year period, the study found that that early fans of different types of rock (e.g., rock, heavy metal, gothic, punk), African American music (rhythm and blues, hip-hop), and electronic dance music (trance, techno/hard-house) showed elevated minor delinquency both concurrently and longitudinally. Conversely, preferring conventional pop (chart pop) or highbrow music (classic music, jazz) was negatively related to minor delinquency. The study concluded that “early music preferences emerged as more powerful indicators of later delinquency rather than early delinquency, indicating that music choice is a strong marker of later problem behavior”.

On a personal level, I know how important music is in my on life and as a source of my own identity. The many studies carried out by Dr. Ter Bogt and his research colleagues further our understanding of music across the lifespan (particularly its role in adolescence) and I look forward to reading their future work.

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

Further reading

Delsing, M. J., Ter Bogt, T. F., Engels, R. C., & Meeus, W. H. (2008). Adolescents’ music preferences and personality characteristics. European Journal of Personality, 22(2), 109-130.

Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.

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, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Mulder, J., Ter Bogt, T. F., Raaijmakers, Q. A., Gabhainn, S. N., Monshouwer, K., & Vollebergh, W. A. (2009). The soundtrack of substance use: music preference and adolescent smoking and drinking. Substance Use and Misuse, 44(4), 514-531.

Mulder, J., Ter Bogt, T. F., Raaijmakers, Q. A., Gabhainn, S. N., Monshouwer, K., & Vollebergh, W. A. (2010). Is it the music? Peer substance use as a mediator of the link between music preferences and adolescent substance use. Journal of Adolescence, 33, 387-394.

Mulder, J., Ter Bogt, T., Raaijmakers, Q., & Vollebergh, W. (2007). Music taste groups and problem behavior. Journal of Youth and Adolescence, 36(3), 313-324.

Selfhout, M. H., Branje, S. J., ter Bogt, T. F., & Meeus, W. H. (2009). The role of music preferences in early adolescents’ friendship formation and stability. Journal of Adolescence, 32(1), 95-107.

Ter Bogt, T., Engels, R., Hibbel, B., Van Wel, F., & Verhagen, S. (2002). ‘Dancestasy’: Dance and MDMA use in Dutch youth culture. Contemporary Drug Problems, 29, 157–181.

Ter Bogt, T. F., Keijsers, L., & Meeus, W. H. (2013). Early adolescent music preferences and minor delinquency. Pediatrics, 131(2), e380-e389.

Ter Bogt, T.F., Mulder, J., Raaijmakers, Q.A., & Gabhainn, S.N. (2010). Moved by music: A typology of music listeners. Psychology of Music, 39, 147-163.

Sell division: Responsible marketing and advertising by the gambling industry

Over the last few years there has been a great deal of speculation over the role of advertising as a possible stimulus to increased gambling, and as a contributor to problem gambling (including underage gambling). Various lobby groups (e.g., anti-gambling coalitions, religious groups, etc.) claim advertising has played a role in the widespread cultural acceptance of gambling. These groups also claim casino advertising tends to use glamorous images and beautiful people to sell gambling, while other advertisements for lottery tickets and slot machines depict ordinary people winning loads of money or millions from a single coin in the slot.

Around the world, various lobby groups claim that advertisements used by the gambling industry often border on misrepresentations and distortion. There are further claims that adverts are seductive, appealing to people’s greed and desperation for money. Real examples include: ‘Winning is easy’, ‘Win a truckload of cash’, ‘Win a million, the fewer numbers you choose, the easier it is to win’, ‘It’s easy to win’ and ‘$600,000 giveaway simply by inserting card into the poker machine’. Lobby groups further claim that in amongst the thousands of words and images of encouragement, there is rarely anything about the odds of winning – let alone the odds of losing. It has also been claimed that many gambling adverts feature get-rich-quick slogans that sometimes denigrate the values of hard work, initiative, responsibility, perseverance, optimism, investing for the future, and even education.

Those promoting gambling products typically respond in a number of ways. The most popular arguments used to defend such marketing and advertising is that: (i) the gaming industry is in the business of selling fantasies and dreams, (ii) consumers knows the claims are excessive, (iii) big claims are made to catch people’s attention, (iv) people don’t really believe these advertisements, and (v) business advertising is not there to emphasise ‘negative’ aspects of products.   While some of these industry responses have some merit, a much fairer balance is needed.

Statements such as ‘winning is easy’ are most likely (in a legal sense) be considered to be ‘puffery’. Puffery involves making exaggerated statements of opinion (not fact) to attract attention. Various jurisdictions deem it is not misleading or deceptive to engage in puffery. Whether a statement is puffery will depend on the circumstances. A claim is less likely to be puffery if its accuracy can be assessed. The use of a claim such as ‘winning is easy’ is likely to be considered puffery because it is subjective and cannot be assessed for accuracy. However, a statement like ‘five chances to win a million’ may not be puffery as it likely to be measurable.

Most of us who work in the field of responsible gambling agree that all relevant governmental gambling regulatory agencies should ban aggressive advertising strategies, especially those that target people in impoverished individuals or youth. It is also worth pointing out that there are many examples of good practice. Responsible marketing and advertising needs to think about the content and tone of gambling advertising, including the use of minors in ads, and the inclusion of game information. There has to be a strong commitment to socially responsible behaviour that applies across all product sectors, including sensitive areas like gambling. Socially responsible advertising should form one of the elements of protection afforded to ordinary customers and be reflected in the codes of practice. Children and problem gamblers deserve additional shielding from exposure to gambling products and premises, and their advertising. Many codes that regulate gambling marketing and advertising across the world now typically include special provisions on the protection of such groups.

Gambling advertising also plays an important role in ‘normalizing’ gambling. Content analyses of gambling adverts have reported that gambling is portrayed as a normal, enjoyable form of entertainment involving fun and excitement. Furthermore, they are often centred on friends and social events. The likelihood of large financial gain is often central theme, with gambling also viewed as a way to escape day-to-day pressures (one gaming company’s advertising even had the strapline “Bet to forget”). Research has found that there is a large public awareness of gambling advertising, and that problem gamblers often mention advertising as a trigger to gambling.

An example of good practice is that of Canadian gaming operator Loto-Quebec. They did a thorough review of its advertising code and some of the key aspects in terms of responsible marketing and advertising of gambling included:

  • A marketing policy that (i) prohibits any advertising that is overly aggressive, (ii) rejects concepts liable to incite the interest of children, and (iii) prohibits the use of spokespeople who are popular among youth, and (iv) prohibits placement of advertisements within media programs viewed mainly by minors.
  • The odds of winning are highlighted. This is being done in response to the suggestions expressed so frequently by various groups interested in knowing their chances of winning.
  • Television commercials for new products devote 20% of their airtime to promoting the gambling help line and to presenting warnings about problem gambling.
  • A policy that prohibits the targeting of any particular group or community for the purposes of promoting its products. For example, one of their instant lotteries used a Chinese theme to stimulate interest. However, the Chinese community did not agree with making references to its customs in order to promote the game. Out of respect for this community, the game was immediately suspended.

As various national and international advertising regulation bodies have advocated, socially responsible advertising should form one of the elements of protection afforded to ordinary customers and be reflected in the codes of practice. Personally, I believe that gambling advertising should focus on buying entertainment rather than winning money. Gambling problems often occur when an individual’s primary reason to gamble is to win money.

Many countries have strict codes for gambling advertisements, and good codes (like those in the UK) recommend that gambling advertisements must not: (i) exploit cultural beliefs or traditions about gambling or luck, (ii) condone or encourage criminal or anti-social behaviour, (iii) condone or feature gambling in a working environment (with the exception for licensed gambling premises), (iv) exploit the susceptibilities, aspirations, credulity, inexperience or lack of knowledge of under-18s or other vulnerable persons, (v) be likely to be of particular appeal to under-18s, especially by reflecting or being associated with youth culture, and (vi) feature anyone who is, or seems to be, under 25 years old gambling or playing a significant role.

Quite clearly it is appropriate and necessary for the gaming industry to advertise, market, and promote its facilities and products. However, I believe that all advertising and marketing should be carried out in a socially responsible manner as it is good for long-term repeat business.

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

Further reading

Adams, P. (2004). Minimising the impact of gambling in the subtle degradation of democratic systems, Journal of Gambling Issues, 11. Available at: http://www.camh.net/egambling/issue11/jgi_11_adams.html.

Binde, P. (2007). Selling dreams – causing nightmares? On gambling advertising and problem gambling. Journal of Gambling Issues, 20, 167-191.

Griffiths, M.D. (2005). Does advertising of gambling increase gambling addiction? International Journal of Mental Health and Addiction, 3(2), 15-25.

Griffiths, M.D. (2007). Brand psychology: Social acceptability and familiarity that breeds trust and loyalty. Casino and Gaming International, 3(3), 69-72.

Griffiths, M.D. (2010). Online ads and the promotion of responsible gambling. World Online Gambling Law Report, 9(6), 14.

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

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, in press.

Korn, D, Hurson, T. & Reynolds, J. (2004). Commercial Gambling Advertising: Possible Impact on Youth Knowledge, Attitudes, Beliefs and Behavioural Intentions. Report submitted to the Ontario Gambling Research Centre.

Whirled piece: Dancing as an addiction

In previous blogs I have examined various (admittedly extreme) aspects of dancing including people that are sexually aroused by dancing (choreophilia), dancing as a form of frottuerism, people that are addicted to dancing (in this case, the Argentine tango), and people who have developed medical complaints as a result of dancing (‘breaker’s neck’ caused by break dancing). However, over the last few months I have been a co-author on two dance-related research papers with my research colleagues in Hungary (led by Aniko Maraz). The first one (published in the journal PLoS ONE) was about the development and psychometric validation of the ‘Dancing Motives Inventory’ (DMI). The second one (also published in PLoS ONE) was a study of dance addiction (and which I will describe in more detail below).

I’m sure many of you reading this will think that dancing is a somewhat trivial area to be carrying out scientific research. However, research has shown that dancing can have substantial benefits for physical and mental health such as decreased depression and anxiety, and increased physical and psychological wellbeing. After we developed the DMI, we realised that very little known about the psychological underpinnings of excessive dancing, and whether in extreme cases, dancing could be classed as an addictive behaviour. Given the lack of empirical research in dance addiction, we conceptualized dance addiction to be akin to exercise addiction. For example, a study published in the journal Perceptual and Motor Skills led by Dr. Edgar Pierce reported that dancers scored higher on the Exercise Addiction Scale compared to endurance and non-endurance athletes. Added to this, both exercise and dancing require stamina and physical fitness, and for this reason, dance is often classified as a form of exercise.

Over the last 20 years I have published many papers on exercise addiction (see ‘Further reading’ below) so there is no reason why dance addiction couldn’t theoretically exist (in fact, it could be argued that dance addiction – if it exists – is a sub-type of exercise addiction). There are also a handful of studies that have examined excessive dancing and whether it can be addictive to a small minority. A study by Edgar Pierce and Myra Daleng (again in Perceptual and Motor Skills) conducted a study with 10 elite ballet dancers and found that dancers rated thinner bodies as ideal and significantly more desirable than their actual body image despite being in the ‘ideal’ BMI range. The study also found that dancers often continue to dance despite discomfort, “because of the embedded subculture in dance that embraces injury, pain, and tolerance”. In a more recent study in the Journal of Behavioral Addictions (and which I reported at length in a previous blog), Dr. Remi Targhetta and colleagues assessed addiction to the Argentine tango. They found that almost half of their participants (45%) met the DSM-IV criteria of abuse, although a substantially lower prevalence rate (7%) was found when using more conservative criteria.

In our recently published study, we proposed that excessive social dancing would be associated with detriments to mental health. More specifically, we aimed to (i) identify subgroups of dancers regarding addiction tendencies, (ii) explore which factors account for the elevated risk of dance addiction, and (iii) explore the motivations underlying excessive dancing.

Our sample included 447 salsa and ballroom dancers (32% male and 68% female, with an average age of 33 years) who danced recreationally at least once a week. To assess ‘dance addiction’ we created the ‘Dance Addiction Inventory’ modified from the Exercise Addiction Inventory (that I co-developed back in 2004) in which we simply replaced the word ‘exercise’ with the word ‘dance’. We also assessed the dancers’ general mental health, borderline personality disorder, eating disorder symptoms, and dance motives.

As far as we are aware, our study is the first to explore the psychopathology and motivation behind dance addiction. Based on my criteria of addiction, five distinct types of dancers were identified. Only two of these types danced excessively. About one-quarter of our sample reported high values on all criteria of addiction but they reported no conflict with the social environment. However, 11% of dancers (and what we termed the ‘high risk’ group) scored high on all addiction symptoms and experienced conflict in their life as a consequence of their excessive dancing.

Our study also found that dance addiction was associated with mild psychopathology, especially with elevated number of eating disorder symptoms and (to a lesser extent) borderline personality traits (something which has also been found in research examining exercise addiction). Perhaps unsurprisingly, escapism (and to a lesser extent mood enhancement) was an especially strong indicator of dance addiction. I say ‘unsurprisingly’ because escapism has already been much reported in other types of behavioural addiction such as gambling and video gaming (including a lot of my own research). Here, escapism as a motivational factor refers to dancing in order to avoid feeling empty or as a mechanism to deal with everyday problems. Based on our findings, we believe that to a minority of individuals appear to be addicted to dancing and that it may be being used be a maladaptive coping mechanism.

Based on what we know in the exercise addiction literature, we proposed that future studies should also assess whether eating disorder is primary or secondary to dance addiction (i.e., whether the purpose of excessive dancing is weight-control and/or the motivation to perform leads to disturbances in eating patterns). I should also point out that although we found that distress was correlated with dance addiction, the association disappeared when other measures were added to the regression model. This may indicate that distress is not directly associated with problematic dancing and that it may arise from other problematic factors such as having an eating disorder.

Given the lack of research in the field, other studies are needed to confirm or refute the findings of our study. Given that dancing is a social activity, social conflicts may not arise when the person has only fellow dancers as partners or friends – therefore, the risky behaviour may remain somewhat hidden. Another question that could be examined is whether there is any difference between amateur and professional dancers in terms of addiction tendency (although among professional dancers there may be a debate about whether their behaviour is dancing addiction or ‘workaholism’). Also, we don’t know whether our findings can be extended to other dance genres (as we only surveyed ballroom and salsa dancers)

I would just like to end by saying that dancing is very clearly a healthy activity for the majority of individuals. However, our study does seem to suggest that excessive dancing may have problematic and/or harmful effects for a small minority. Although we couldn’t establish causality, dance addiction appears to have the potential to be associated with mild psychopathology.

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

Additional input: Aniko Maraz, Róbert Urbán and Zsolt Demetrovics.

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory,14, 631-646

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Griffiths, M.D., Szabo, A. & Terry, A. (2005). The Exercise Addiction Inventory: A quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, 30-31.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

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, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Pierce, E.F. & Daleng, M.L. (1998) Distortion of body image among elite female dancers. Perceptual and Motor Skills, 87, 769-770.

Pierce, E.F., Daleng, M.L. & McGowan, R.W. (1993) Scores on exercise dependence among dancers. Perceptual and Motor Skills, 76, 531-535.

Ramirez, B., Masella, P.A., Fiscina, B., Lala, V.R., & Edwards, M. D. (1984). Breaker’s neck. Journal of the American Medical Association, 252(24), 3366-3367.

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, 2, 179-186.

Meditate to medicate: Mindfulness as a treatment for behavioural addiction

Please note: A version of the following article was first published on addiction.com and was co-written with my research colleagues Edo Shonin and William Van Gordon

Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. We have defined mindfulness as the process of engaging a full, direct, and active awareness of experienced phenomena that is spiritual in aspect and that is maintained from one moment to the next. As part of the practice of mindfulness, a ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience.

Throughout the last two decades, Buddhist principles have increasingly been employed in the treatment of a wide range of psychological disorders including mood and anxiety disorders, substance use disorders, bipolar disorder, and schizophrenia-spectrum disorders. The emerging role of Buddhism in clinical settings appears to mirror a growth in research examining the potential effects of Buddhist meditation on brain neurophysiology. Such research forms part of a wider dialogue concerned with the evidence-based applications of specific forms of spiritual practice for improved psychological health.

Within mental health and addiction treatment settings, mindfulness-based interventions (MBIs) are generally delivered in a secular eight-week format and often comprise the following: (i) weekly sessions of 90-180 minutes duration, (ii) a taught psycho-education component, (iii) guided mindfulness exercises, (iv) a CD of guided meditation to facilitate daily self-practice, and (v) varying degrees of one-to-one discussion-based therapy with the program instructor. Examples of MBIs used in behavioural addiction treatment studies include Mindfulness-Based Cognitive Therapy, Mindfulness-Enhanced Cognitive Behaviour Therapy, Mindfulness-Based Relapse Prevention, Mindfulness-Based Stress Reduction, and Meditation Awareness Training.

Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on problem and/or pathological gambling. These studies have shown that levels of dispositional mindfulness in problem gamblers are inversely associated with gambling severity, thought suppression, and psychological distress. Recent clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change in problem gambling individuals. Published case studies include: (i) a male in his sixties addicted to offline roulette playing, (ii) a 61-year old female (with comorbid anxiety and depression) addicted to slot machine gambling (treated with a modified version of Mindfulness-Based Cognitive Therapy), and (iii) a 32-year old female (with co-occurring schizophrenia) addicted to online slot-machine playing (treated with a modified version of Meditation Awareness Training). Also, a recent study showed that problem gamblers that received Mindfulness-Enhanced Cognitive Behaviour Therapy demonstrated significant improvements compared to a control group in levels of gambling severity, gambling urges, and emotional distress.

Outside of gambling addiction, case studies have investigated the applications of mindfulness for treating addiction to work (i.e., workaholism) and sex. In the case of the workaholic, a director of a blue-chip technology company in his late thirties was successfully treated for his workaholism utilizing Meditation Awareness Training. Significant pre-post improvements were also observed for sleep quality, psychological distress, work duration, work involvement during non-work hours, and employer-rated job performance. However, as with any case study, the single-participant nature of the study significantly restricts the generalizability of such findings.

Key treatment mechanisms that have been identified and/or proposed in this respect (several of which overlap with mechanisms identified as part of the mindfulness-based treatment of chemical addictions) include:

  • A perceptual shift in the mode of responding and relating to sensory and cognitive-affective stimuli that permits individuals to objectify their cognitive processes and to apprehend them as passing phenomena.
  • Reductions in relapse and withdrawal symptoms via substituting maladaptive addictive behaviours with a ‘positive addiction’ to mindfulness/meditation (particularly the ‘blissful’ and/or tranquil states associated with certain meditative practices).
  • Transferring the locus of control for stress from external conditions to internal metacognitive and attentional resources.
  • The modulation of dysphoric mood states and addiction-related shameful and self-disparaging schemas via the cultivation of compassion and self-compassion.
  • Reductions in salience and myopic focus on reward (i.e., by undermining the intrinsic value and ‘authenticity’ that individuals assign to the object of addiction) due to a better understanding of the ‘impermanent’ nature of existence (e.g., all that is won must ultimately be lost, an attractive body will age and wither, a senior/lucrative occupational role must one day be relinquished, etc.).
  • Growth in spiritual awareness that broadens perspective and induces a re-evaluation of life priorities.
  • ‘Urge surfing’ (the meditative process of adopting an observatory, non-judgemental, and non-reactive attentional-set towards mental urges) that aids in the regulation of habitual compulsive responses.
  • Reduced autonomic and psychological arousal via conscious-breathing-induced increases in prefrontal functioning and vagal nerve output (breath awareness is a central feature of mindfulness practice).
  • Increased capacity to defer gratitude due to improvements in levels of patience.
  • A greater ability to label and therefore modulate mental urges and faulty thinking patterns.

Although preliminary findings indicate that there are applications for MBIs in the treatment of behavioural addictions, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed. Despite this, both the classical Buddhist meditation literature and recent scientific findings appear to agree that when correctly practised and administered, mindfulness meditation is a safe, non-invasive, and cost-effective tool for treating behavioural addictions and for improving psychological health more generally.

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

Further reading

Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, in press.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Mindfulness as a treatment for behavioural addiction. Journal of Addiction Research and Therapy, 5: e122. doi: 10.4172/2155-6105.1000e122.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Current trends in mindfulness and mental health. International Journal of Mental Health and Addiction, 12, 113-115.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.

Shonin, E., Van Gordon W., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

Net losses: Another look at problematic online gaming

I have examined problematic and/or addictive video gaming in a number of my previous blogs. Despite the increasing amount of empirical research into problematic online gaming, the phenomenon still sadly lacks a consensual definition. Some researchers (including myself, and others such as John Charlton and Ian Danforth) consider video games as the starting point for examining the characteristics of this specific pathology, while other researchers consider the internet as the main platform that unites different addictive internet activities including online games (such as my friends and colleagues Tony Van Rooij and Kimberley Young). There are also recent studies that have made an effort to integrate both approaches (such as some work I carried out with Zsolt Demetrovics and his team of Hungarian researchers in the journal PLoS ONE).

I have noted in a number of my papers on addiction (particularly in a paper I had published in a 2005 issue of the Journal of Substance Use) that although each addiction has several particular and idiosyncratic characteristics, they have more commonalities than differences that may reflect a common etiology of addictive behaviour. Using the ‘components’ model of addiction, within a biopsychosocial framework, I consider online game addiction a specific type of video game addiction that can be categorized as a nonfinancial type of pathological gambling. I developed the components of video game addiction theory by modifying Iain Brown’s earlier addiction criteria. These are:

(1) Salience: This is when video gaming becomes the most important activity in the person’s life and dominates his/her thinking (i.e., preoccupations and cognitive distortions), feelings (i.e., cravings) and behaviour (i.e., deterioration of socialized behaviour);

(2) Mood modification: This is the subjective experience that people report as a consequence of engaging in video game play (i.e. they experience an arousing ‘buzz’ or a ‘high’ or, paradoxically, a tranquillizing and/or distressing feel of ‘escape’ or ‘numbing’).

(3) Tolerance: This is the process whereby increasing amounts of video game play are required to achieve the former effects, meaning that for persons engaged in video game playing, they gradually build up the amount of the time they spend online engaged in the behaviour.

(4) Withdrawal symptoms: These are the unpleasant feeling states or physical effects that occur when video gaming is discontinued or suddenly reduced, for example, the shakes, moodiness, irritability, etc.

(5) Conflict: This refers to the conflicts between the video game player and those around them (i.e., interpersonal conflict), conflicts with other activities (e.g., job, schoolwork, social life, hobbies and interests) or from within the individual themselves (i.e., intrapsychic conflict and/or subjective feelings of loss of control) which are concerned with spending too much time engaged in video game play.

(6) Relapse: This is the tendency for repeated reversions to earlier patterns of video game play to recur and for even the most extreme patterns typical at the height of excessive video game play to be quickly restored after periods of abstinence or control.

John Charlton and Ian Danforth analyzed these six criteria and found that tolerance, mood modification and cognitive salience were indicators of high engagement, while the other components – withdrawal symptoms, conflict, relapse and behavioural salience – played a central role in the development of addiction.

Researchers such as Guy Porter and Vladan Starcevic don’t differentiate between problematic video game use and problematic online game use. They conceptualized problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. Their criteria for problematic video game use didn’t include other features usually associated with dependence or addiction, such as tolerance and physical symptoms of withdrawal, because in their opinion there is no clear evidence that problem video game use is associated with these phenomena.

Arguably the most well known representative of the internet-based approach is Kimberley Young who developed her theoretical framework for problematic online gaming based on her internet addiction criteria which were based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – (Fourth Edition, DSM-IV) criteria for pathological gambling. Her theory states that online game addicts gradually lose control over their game play, that is, they are unable to decrease the amount of time spent playing while immersing themselves increasingly in this particular recreational activity, and eventually develop problems in their real life. The idea that internet/online video game addiction can be assessed by the combination of an internet addiction score and the amount of time spent gaming are also reflective of the internet-based approach.

Integrative approaches try to take into consideration both aforementioned approaches. For instance, a 2010 paper by M.G. Kim and J. Kim in Computers in Human Behavior claimed that neither the first nor the second approach can adequately capture the unique features of online games such as Massively Multiplayer Online Role-Playing Games (MMORPGs), therefore it’s absolutely necessary to create an integrated approach. They argued that “internet users are no more addicted to the internet than alcoholics are addicted to bottles” which means that the internet is just one channel through which people may access whatever content they want (e.g., gambling, shopping, chatting, sex, etc.) and therefore users of the internet may be addicted to the particular content or services that the Internet provides, rather than the channel itself. On the other hand, online games differ from traditional stand-alone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players.

Their multidimensional Problematic Online Game Use (POGU) model reflects this integrated approach fairly well. It was theoretically developed on the basis of several studies and theories (such as those by Iain Brown, John Charlton, Ian Danforth, Kimberley Young and myself), and resulted in five underlying dimensions: euphoria, health problems, conflict, failure of self-control, and preference of virtual relationship. A 2012 study I carried out with Zsolt Demetrovics and his team also support the integrative approach and stresses the need to include all types of online games in addiction models in order to make comparisons between genres and gamer populations possible (such as those who play online Real-Time Strategy (RTS) games and online First Person Shooter (FPS) games in addition to the widely researched MMORPG players). According to this model, six dimensions cover the phenomenon of problematic online gaming – preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal. Personally, I believe that online game addiction can be defined as one type of behavioural addiction. In fact ‘internet gaming disorder’ has just been included in the appendices of the new DSM-5 in order to encourage research to determine whether this particular condition should be added to the manual as a disorder in the future.

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

Additional input: Orsolya Pápay, Katalin Nagygyörgy and Zsolt Demetrovics

Further reading

Charlton, J. P., & Danforth, I.D.W. (2007). Distinguishing addiction and high engagement in the context of online game playing. Computers in Human Behavior, 23(3), 1531-1548.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.

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

Han, D. H., Hwang, J. W., & Renshaw, P. F. (2010). Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Experimental and Clinical Psychopharmacology, 18, 297-304.

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

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

Peters, C. S., & Malesky, L. A. (2008). Problematic usage among highly-engaged players of massively multiplayer online role playing games. Cyberpsychology & Behavior, 11(4), 480-483.

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

Pontes, H., Király, O. Demetrovics, Z. & Griffiths, M.D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

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

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

Van Rooij, A. J., Schoenmakers, T. M., Vermulst, A. A., Van den Eijnden, R. J., & Van de Mheen, D. (2011). Online video game addiction: identification of addicted adolescent gamers. Addiction, 106(1), 205-212.

Young, K. S. (1998a). Caught in the Net: How to recognize the signs of Internet addiction and a winning strategy for recovery. New York: Wiley.

Young, K. S. (1999). Internet addiction: Symptoms, evaluation, and treatment. In L. Vande Creek & T. Jackson (Eds.), Innovations in clinical practice: A source book (pp. 17, 19–31). Sarasota, FL: Professional Resource Press.

Water feature: A brief look at psychogenic polydipsia, hyponatraemia, and ‘aquaholism’

Over the weekend I went to the cinema with my oldest son to watch Mad Max: Fury Road. The reason I mention this is because King Immortan Joe in the film (who live in a world where water is a scarce commodity) tells his thirsty subjects “Do not become addicted to water, it will take hold of you”. As soon as I got home after the film, I was straight onto Google and Google Scholar to see whether there had been anything written on ‘water addiction’. Unsurprisingly, there were lots of newspaper reports of individuals being ‘addicted’ to water but little in the academic literature. For instance, one American online article told the story of Sasha Kennedy:

“[Sasha] is addicted to water, drinking 25 liters of the stuff a day, far exceeding the USDA Recommended Daily Water Intake of 2.7 liters…What surprised me most was that the condition had a name: Psychogenic polydipsia. It is ‘an uncommon clinical disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink’ and is typically found among mental patients on phenothiazine medications. Kennedy appears to be completely sane, although she does experience the dry mouth sensation characteristic of the condition…You’d think drinking so much water would do something to her health, but medical experts confirmed that there is nothing wrong with her. She doesn’t even have hypoatremia, where cells swell due to too much water in the blood. She’s perfectly healthy and her blood isn’t diluted. Then again, her habit started when she was two years old, so maybe her body acclimatized. Her lifestyle, however, is drastically affected by her addiction. She has to go to the toilet 40 times a day and can only get about an hour of sleep every night before having to wake up to drink some water or go to the loo. She carries large bottles of water with her everywhere she goes, and once quit her job because the tap water quality wasn’t up to par”.

Another case was reported by the UK’s Daily Mail who recounted the story of 22-year old “aquaholic” Sarah Schapira who (at the time the article was written) drank seven litres of water every day, and like Sasha above spent a lot of time in the toilet. Schapira stated:

“My argument has always been that water is good for you and helps you to detox. We’ve all been told about the benefits of water, so I drink lots and lots of it, from the minute I wake up to the minute I go to bed. If I don’t have my bottle of water I feel paranoid. And if I try not to drink for an hour, I start to feel dehydrated and I get throbbing headaches. But it has got to the stage where I don’t know how to give it up. It used to make me feel really good and healthy but not any more. I know I ought to cut down but I’m not sure how I can”.

Polydipsia (which in practical terms means drinking more than three litres of water a day) often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. The low levels of sodium causes the brain to swell which in turn constricts the blood supply to the brain when the brain compresses against the skull’s inner surface. Another person interviewed for the Daily Mail story was 26-year-old Rachel Bennett, a marketing agent from North London who drank also drank seven litres of water a day which led to headaches and dizziness. She said:

“My friends used to tease me about the amount I drank, but I dismissed their fears because I always thought it was so good for me. It got to the stage where I felt I couldn’t function without it. If I woke without a bottle of water by my bed, I would feel really paranoid. I couldn’t drink tap water – that tasted awful – instead I drank Evian by the gallon. It’s expensive, too – I could spend over £30 a week on water – but I had got to the stage where I got a huge buzz from drinking so much”.

In researching this article, I was surprised to find dozens and dozens of academic papers on psychogenic polydipsia (PPD). For instance, a paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. They also noted that:

“The underlying pathophysiology of this syndrome is unclear, and multiple factors have been implicated, including a hypothalamic defect and adverse medication effects. Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death. Evaluation of psychiatric patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria, hyponatremia”.

A 2000 study in European Psychiatry by Dr. E. Mercier-Guidez and Dr. G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. The study reported that 38 of the psychiatric patients (11%) suffered from polydipsia with one-third of them at risk of water intoxication. They also reported that being polydipsic was significantly associated with being male, a cigarette smoker and celibate. Those with polydipsia were highly prevalent among those with schizophrenia, mental retardation, pervasive developmental disorders and somatic disorders.

A comprehensive review by Dr. Victor Vieweg and Dr. Robert Leadbetter in the journal CNS Drugs examined the polydipsia-hyponatraemia syndrome (PHS). They reported that PHS occurs in approximately 5%-10% of institutionalised, chronically psychotic patients, of which four-fifths have schizophrenia. Major clinical features are polydipsia and dilutional hyponatraemia. Patents with PHS can experience delirium, generalised seizures, coma and death. The main ways to treat such individuals are fluid restriction, daily bodyweight monitoring, behavioural approaches, and supplemental oral sodium chloride administration. However, these interventions can be expensive as they require experienced and dedicated multidisciplinary staff. They also report that:

“A number of pharmacological treatments have been assessed for PHS including the combination of lithium and phenytoin, demeclocycline, propranolol, ACE inhibitors, selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, typical antipsychotic drugs, clozapine and risperidone. Of these agents, the most promising are the combination of lithium and phenytoin, and clozapine…Long term strategies include behavioural interventions and the combination of lithium and phenytoin, and clozapine”.

Unsurprisingly, I found almost nothing on being addicted to water. A 2010 review article on PPD by Dr. D. Hutcheon and Dr. M. Bevilacqua in the Annals of the American Psychotherapy Association claimed:

“One way to assess a patient’s ability to limit polydipsia is to examine their objective reasons why polydipsia is so important in their lives. This can be initiated during psychosocial rehabilitation group meetings held semi-weekly (e.g., two 15-minute sessions per week). In these meetings, many patients have described a euphoric quality associated with polydipsia, although others have admitted to increased irritability. Most patients have noted a desire for stimulation, similar to other substances of abuse such as alcohol or street drugs. Developing an understanding of what influences a patient to develop an addiction for polydipsia can improve management of this dysregulation of fluid intake…During the treatment period in a structured inpatient setting, many patients diagnosed with psychogenic polydipsia, whether falling in the range of mild, moderate, or severe addiction, are unable to sustain a comfortable discharge to an open ward…psychogenic polydipsia can become an addiction with no demonstrable cure if left untreated… Due to the nature of the addiction and potential for self-injurious behavior, treatment requires a milieu that balances maximizing the patients’ dignity with their safety, which demands close scrutiny by the multidisciplinary team”.

I also found an old case study from a 1973 issue of the British Journal of Addiction on ‘water dependence’. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. A couple of papers by Dr. Bennett Foddy and Dr. Julian Savulescu have cited this case study in their own writings on addiction. In a 2010 issue of Philosophy, Psychiatry and Psychology, they noted:

“Of course, it can be claimed that a person who is addicted to sugar or water is diseased, and that their brain has changed in such a way as to make their sugar- or water-seeking behavior involuntary. Yet we know how sugar interacts with the brain to form a sensitization effect, and it is identical to how drugs – and sugar – interact with the brain of a non-addicted person. If addictions are formed through a pharmacological process, it is the exact same process that forms a person’s likes and dislikes of any pleasurable stimulus. Terms like ‘addiction’ and ‘dependence’ can reasonably be employed when a person’s likes become particularly strong, but it should be understood that these terms denote a difference in degree, not a difference in kind…The only relevant difference between drugs and sugar is that drugs produce a higher level of brain reward relative to the volume of the dose. It is easier to get addicted to heroin than to sugar, because you can do it by taking a quarter gram at a time. It is very hard to get addicted to water, because you must force down liters of it every day”.

This interesting extract argues that it is theoretically possible for someone to become addicted to water and that there is no real difference to drug addictions in terms of conceptualization and mechanism – just that the sheer amount of water that needs to be drunk to have a negative effect is large and highly unlikely.

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

Further reading

Daily Mail (2005). Aquaholics: Addicted to drinking water. May 16. Located at: http://www.dailymail.co.uk/health/article-348917/Aquaholics-Addicted-drinking-water.html

de Leon, J., Verghese, C., Tracy, J. I., Josiassen, R. C., & Simpson, G. M. (1994). Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biological Psychiatry, 35(6), 408-419.

Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia review: etiology, differential, and treatment. Current Psychiatry Reports, 9(3), 236-241.

Edelstein, E.L. (1973). A case of water dependence. British Journal of Addiction to Alcohol and Other Drugs, 68, 365–367.

Foddy, B., & Savulescu, J. (2007). Addiction is not an affliction: Addictive desires are merely pleasure-oriented desires. American Journal of Bioethics, 7(1), 29-32

Foddy, B., & Savulescu, J. (2010). A liberal account of addiction. Philosophy, Psychiatry, and Psychology, 17(1), 1-22.

Hutcheon, D., & Bevilacqua, M. (2010). Psychogenic polydipsia: A review of past and current interventions for treating psychiatric inpatients diagnosed with psychogenic polydipsia (PPD). Annals of the American Psychotherapy Association, 13(1). Located at: http://www.biomedsearch.com/article/Psychogenic-polydipsia-review-past-current/222558218.html

Teoh, S.Y. (2012). Woman addicted to water drinks 100 glasses a day. The Mary Sue, July 12. Located at: http://www.themarysue.com/woman-addicted-to-water/#geekosystem

Vieweg, W.V.R., & Leadbetter, R.A. (1997). Polydipsia-Hyponatraemia Syndrome. CNS Drugs, 7(2), 121-138.

Verghese, C., de Leon, J., & Josiassen, R. C. (1996). Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia. Schizophrenia Bulletin, 22(3), 455-464.

Place your bets: Has problem gambling in Great Britain decreased?

In the summer of 2014 I was commissioned to review problem gambling in Great Britain (the fall out of which I wrote about in detail in a previous blog). Earlier last year, a detailed report by Heather Wardle and her colleagues examined gambling behaviour in England and Scotland by combining the 2012 data from the Health Survey for England (HSE; n=8,291 aged 16 years and over) and the 2012 Scottish Health Survey (SHeS; n=4,815). To be included in the final data analysis, participants had to have completed at least one of the gambling participation questions. This resulted in a total sample of 11,774 participants. So what did the research find? Here is a brief summary of the main results:

  • Two-thirds of the sample (65%) had gambled in the past year, with men (68%) gambling more than women (62%). As with the British Gambling Prevalence Survey (BGPS), past year participation was greatly influenced by the playing of the bi-weekly National Lottery (lotto) game. Removal of those individuals that only played the National Lottery meant that 43% had gambled during the past year (46% males and 40% females).
  • Gambling was more likely to be carried out by younger people (50% among those aged 16-24 years and 52% among those aged 25-34 years).
  • The findings were similar to the previous BGPS reports and showed that the most popular forms of gambling were playing the National Lottery (52%; 56% males and 49% females), scratchcards (19%; 19% males and 20% females), other lottery games (14%; 14% both males and females), horse race betting (10%; 12% males and 8% females), machines in a bookmaker (3%; 5% males and 1% females), slot machines (7%; 10% males and 4% females), online betting with a bookmaker (5%; 8% males and 2% females), offline sports betting (5%; 8% males and 1% females), private betting (5%; 8% males and 2% females), casino table games (3%; 5% males and 1% females), offline dog race betting (3%; 4% males and 2% females), online casino, slots and/or bing (3%; 4% males and 2% females), betting exchanges (1%; males 2% and females 0%), poker in pubs and clubs (1%; 2% males and 0% females), spread betting (1%; 1% males and 0% females).
  • The only form of gambling (excluding lottery games) where females were more likely to gamble was playing bingo (5%; 7% females and 3% males).
  • Most participants gambled on one or two different activities a year (1.7 mean average across the total sample).
  • Problem gambling assessed using the Problem Gambling Severity (PGSI) criteria was reported to be 0.4%, with males (0.7%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 180,200 British adults aged 16 years and over.
  • Problem gambling assessed using the criteria of the fourth Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was reported to be 0.5%, with males (0.8%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 224,100 British adults aged 16 years and over.
  • Using the PGSI screen, problem gambling rates were highest among young men aged 16-24 years (1.7%) and lowest among men aged 65-74 years (0.4%). Using the DSM-IV screen, problem gambling rates were highest among young men aged 16-24 years (2.1%) and lowest among men aged over 74 years (0.4%).
  • Problem gambling rates were also examined by type of gambling activity. Results showed that among past year gamblers, problem gambling was highest among spread betting (20.9%), played poker in pubs or clubs (13.2%), bet on other events with a bookmaker (12.9%), bet with a betting exchange (10.6%) and played machines in bookmakers (7.2%).
  • The activities with the lowest rates of problem gambling were playing the National Lottery (0.9%) and scratchcards (1.7%).
  • Problem gambling rates were highest among individuals that had participated in seven or more activities in the past year (8.6%) and lowest among those that had participated in a single activity (0.1%).

The authors also carried out a latent class analysis and identified seven different types of gambler among both males and females. The male groups comprised:

  • Cluster A: non-gamblers (33%)
  • Cluster B: National Lottery only gamblers (22%)
  • Cluster C: National Lottery and scratchcard gamblers only (20%)
  • Cluster D: Minimal, no National Lottery [gambling on 1-2 activities] (9%)
  • Cluster E: Moderate [gambling on 3-6 activities] (12%)
  • Cluster F: Multiple [gambling on 6-10 activities] (3%)
  • Cluster G: multiple, high [gambling on at least 11 activities] (1%).

The female groups comprised:

  • Cluster A: non-gamblers (40%)
  • Cluster B: National Lottery only gamblers (21%)
  • Cluster C: National Lottery and scratchcard gamblers only (7%)
  • Cluster D: Minimal, no National Lottery (8%)
  • Cluster E: moderate, less varied [2-3 gambling activities, mainly lottery-related] (8%)
  • Cluster F: moderate, more varied [2-3 gambling activities but wider range of activities] (6%)
  • Cluster G: multiple [gambling on at least four activities] (6%)

Using these groupings, the prevalence of male problem gambling was highest among those in Cluster G: multiple high group (25.0%) followed by Cluster F: multiple group (3.3%) and Cluster E: moderate group (2.6%). The prevalence of problem gambling was lowest among those in the Cluster B; National Lottery Draw only group (0.1%) followed by Cluster C: minimal – lotteries and scratchcards group (0.7%). The prevalence of female problem gambling was highest among those in the Cluster G: multiple group (1.8%) followed by those in Cluster F: moderate – more varied group (0.6%). The number of female gamblers was too low to carry out any further analysis. The report also examined problem gambling (either DSM-IV or PGSI) by gambling activity type.

  • The prevalence of problem gambling was highest among spread-bettors (20.9%), poker players in pubs or clubs (13.2%), bettors on events other than sports or horse/dog races (12.9%), betting exchange users (10.6%) and those that played machines in bookmakers (7.2%).
  • The lowest problem gambling prevalence rates were among those that played the National Lottery (0.9%) and scratchcards (1.7%).
  • These figures are very similar to those found in the 2010 BGPS study although problem gambling among those that played machines in bookmakers was lower (7.2%) than in the 2010 BGPS study (8.8%).
  • As with the BGPS 2010 study, the prevalence of problem gambling was highest among those who had participated in seven or more activities in the past year (8.6%) and lowest among those who had taken part in just one activity (0.1%). Furthermore, problem gamblers participated in an average 6.6 activities in the past year.

Given that the same instruments were used to assess problem gambling, the results of the most recent surveys using data combined from the Health Survey for England (HSE) and Scottish Health Survey (SHeS) compared with the most recent British Gambling Prevalence Survey (BGPS) do seem to suggest that problem gambling in Great Britain has decreased over the last few years (from 0.9% to 0.5%). However, Seabury and Wardle again urged caution and noted:

“Comparisons of the combined HSE/SHeS data with the BGPS estimates should be made with caution. While the methods and questions used in each survey were the same, the survey vehicle was not. HSE and SHeS are general population health surveys, whereas the BGPS series was specifically designed to understand gambling behaviour and attitudes to gambling in greater detail. It is widely acknowledged that different survey vehicles can generate different estimates using the same measures because they can appeal to different types of people, with varying patterns of behaviour…Overall, problem gambling rates in Britain appear to be relatively stable, though we caution readers against viewing the combined health survey results as a continuation of the BGPS time series”.

There are other important caveats to take into account including the differences between the two screen tools used in the BGPS, HSE and SHeS studies. Although highly correlated, evidence from all the British surveys suggests that the PGSI and DSM-IV screens capture slightly different groups of problem gamblers. For instance, a 2010 study that I co-authored with Jim Orford, Heather Wardle, and others (in the journal International Gambling Studies) using data from the 2007 BGPS showed that the PGSI may under-estimate certain forms of gambling-related harm (particularly by women) that are more likely to be picked up by some of the DSM-IV items. Our analysis also suggested that the DSM-IV appears to measure two different factors (i.e., gambling-related harm and gambling dependence) rather than a single one. Another important distinction is that the two screens were developed for very different purposes (even though they are attempting to assess the same construct). The PGSI was specifically developed for use in population surveys whereas the DSM-IV was developed with clinical populations in mind. Given these differences, it is therefore unsurprising that national surveys that utilize the screens end up with slightly different results comprising slightly different groups of people.

It also needs stressing (as noted by the authors of most of the national gambling surveys in Great Britain) that the absolute number of problem gamblers identified in any of the surveys published to date has equated to approximately 60 people. To detect any significant differences statistically between any of the studies carried out to date requires very large sample sizes. Given the very low numbers of problem gamblers and the tiny number of pathological gamblers, it is hard to assess with complete accuracy whether there have been any significant changes in problem and pathological gambling between all the published studies over time. Wardle and her colleagues concluded that:

“Overall, based on this evidence, it appears that problem gambling rates in England and Scotland are broadly stable. Whilst problem gambling rates according to either the DSM-IV or the PGSI were higher in 2010, the estimate between 2007 and the health surveys data were similar. Likewise, problem gambling rates according to the DSM-IV and the PGSI individually did not vary statistically between surveys, meaning that they were relatively similar” (p.130).

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

Further reading

Griffiths, M.D. (2014). Problem gambling in Great Britain: A brief review. London: Association of British Bookmakers.

Orford, J., Wardle, H., Griffiths, M.D., Sproston, K. & Erens, B. (2010). PGSI and DSM-IV in the 2007 British Gambling Prevalence Survey: Reliability, item response, factor structure and inter-scale agreement. International Gambling Studies, 10, 31-44.

Seabury, C. & Wardle, H. (2014). Gambling behaviour in England and Scotland. Birmingham: Gambling Commission.

Wardle, H. (2013). Gambling Behaviour. In Rutherford, L., Hinchliffe S., Sharp, C. (Eds.), The Scottish Health Survey: Vol 1: Main report. Edinburgh.

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

Wardle, H., & Seabury, C. (2013). Gambling Behaviour. In Craig, R., Mindell, J. (Eds.) Health Survey for England 2012 [Vol 1]. Health, social care and lifestyles. Leeds: Health and Social Care Information Centre.

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

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

Wardle, H., Sutton, R., Philo, D., Hussey, D. & Nass, L. (2013). Examining Machine Gambling in the British Gambling Prevalence Survey. Report by NatCen to the Gambling Commission, Birmingham.

Unfruitful approaches: Why are slot machine players so hard to study?

Anyone that researches in the area of slot machine gambling will know how difficult to can be to collect data from this group of gamblers. Over a decade ago, Dr. Jonathan Parke and I published a paper in the Journal of Gambling Issues on why slot machine players are so hard to study. Almost all of the things we wrote in that paper are still highly relevant today, so this blog briefly examines some of the issues we raised. The following explanations represented our experiences of several research efforts in attempting to examine the psychology of slot machine gamblers in the UK, Canada and the United States. Our explanations are roughly divided into three categories. More specifically, these relate to what we called (i) player-specific factors, (ii) researcher-specific factors, and (iii) miscellaneous external factors.

Player-specific factors: There are a number of player-specific factors that can impede the collection of reliable and valid data. These include factors such as activity engrossment, dishonesty/social desirability, motivational distortion, fear of ignorance, guilt/embarrassment, infringement of player anonymity, unconscious motivation/lack of self-understanding, chasing, and lack of incentive. These are explained in more detail below:

  • Activity engrossment – Slot machine gamblers can become fixated on their playing almost to the point where they ‘tune out’ to everything else around them. We have observed that many gamblers will often miss meals and/or utilise devices (such as catheters) so that they do not have to take toilet breaks. Given these observations, there is sometimes little chance that we as researchers can persuade them to participate in research studies – especially when they are gambling on the machine when approached.
  • Dishonesty/Social desirability – It is well known that some gamblers will lie and be dishonest about their gambling behaviour. Social and problem gamblers alike are subject to social desirability factors and will be dishonest about the extent of their gambling activities to researchers (in addition to those close to them). This obviously has implications for the reliability and validity of any data collected.
  • Motivational distortion – Many slot machine gamblers experience low self-esteem and when participating in research may provide ego-boosting responses that lead to motivational distortion. For this reason, many report that they win more (or lose less) than they actually do. Again, this self-report data has implications for reliability and validity of the data.
  • Fear of ignorance – We have observed that many slot machine gamblers report to understand how the slot machine works when in fact they know very little. This appears to be a ‘face-saving’ mechanism so that they do not appear to be stupid and/or ignorant to the researchers.
  • Guilt/embarrassment – Slot machine gamblers can often be guilty and/or embarrassed to be in the gambling environment in the first place. They like to convince themselves that they are not ‘gamblers’ but simply ‘social players’ who visit gambling environments infrequently. We have found that gamblers will often cite their infrequency of gambling as a reason or excuse not participate in an interview or fill out a questionnaire. Connected with this, some gamblers just simply do not want to face up to the fact that they gamble.
  • Infringement of player anonymity – Some slot machine gamblers clearly play on machines as a means of escape. Many gamblers will perceive the gaming establishment in which they are gambling as a ‘private’ (rather than public) arena. As such, researchers who approach them may be viewed as people who are infringing on their anonymity.
  • Unconscious motivation and lack of self-understanding – Unfortunately, many slot machine gamblers do not understand why they gamble themselves. Therefore, articulating this accurately to researchers can be very difficult. Furthermore, many gamblers experience the ‘pull’ of the slot machine where they feel compelled to play despite their better judgment but cannot articulate why.
  • Chasing – When trying to carry out research in the playing environments (e.g., arcades, casinos, bingo halls, etc.), many regular gamblers do not want to leave ‘their’ slot machine in case someone “snipes” their machine while they are elsewhere. Understandably, gamblers are more concerned with chasing losses than participating in an interview or filling out a questionnaire for a researcher.
  • Lack of incentive – Some slot machine gamblers simply refuse to take part in research because they feel that there is “nothing in it for them” (i.e., a lack of incentive). Furthermore, very few gamblers take the view that their gambling habits and experiences can be helpful to others.

Researcher-specific factors: In addition to player-specific factors, there are also some researcher-specific factors that can impede the collection of data from slot machine gamblers. Most of these factors concern research issues relating to participant and non-participant observational techniques (i.e., blending in, subjective sampling and interpretation, and lack of gambling knowledge). These are expanded on further below:

  • Blending in – The most important aspect of non-participant observation work while monitoring fruit machine players is the art of being inconspicuous. If the researcher fails to ‘blend in’, slot machine gamblers soon realise they are being watched. As a result, they are increasingly likely to change their behaviour in some way. For instance, some players will get nervous and/or agitated and stop playing immediately whereas others will do the exact opposite and try to show off by exaggerating their playing ritual. Furthermore, these gamblers will discourage spectators as they are often considered to be “skimmers” (individuals trying to make profits by playing “other peoples machines”). Blending into the setting depends upon a number of factors. If the gambling establishment is crowded, it is very easy to just wander around without looking too suspicious. The researcher’s experience, age and sex can also affect the situation. In the UK, amusement arcades are generally frequented by young men and elderly women. The general rule is that the older the researcher gets, the harder it will be for them to mingle in successfully. If the arcade is not too crowded then there is little choice but to be one of the ‘punters’. The researcher will probably need to stay in the arcade for lengthy periods of time, therefore spending money is unavoidable unless the researcher has a job there – an approach that Dr. Parke took to collect data.
  • Subjective sampling and interpretation – When the researcher is in the gambling environment, they cannot possibly study everyone at all times, in all places. Therefore it is a matter of personal choice as to what data are recorded, collected and observed. This obviously impacts on the reliability and validity of the findings. Furthermore, many of the data collected during observation will be qualitative in nature and therefore will not lend themselves to quantitative data analysis.
  • Lack of gambling knowledge – Lack of ‘street knowledge’ about slot machine gamblers and the environments they frequent (e.g., terminology that players use, knowledge of the machine features, gambling etiquette, etc.) can lead to misguided assumptions. For instance, non-participant observation may lead to the recording of irrelevant data and/or an idiosyncratic interpretation of something that is widely known amongst gamblers. As above, this can lead to subjective interpretation issues.

External factors: In addition to player-specific and researcher-specific factors, there are also some external factors that can impede the collection of data from slot machine gamblers. Most of these factors concern the gaming industry’s reactions to researchers being in their establishments although there are other factors too. These are briefly outlined below:

  • Gaming establishment design It is clear from many of the arcades and casinos that we have done research in over the years that many are not ideally designed for doing covert research in. Non-participant observation is often very difficult in small establishments or in places where the clientele numbers are low.
  • “Gatekeeper” issues and beaurocratic obstacles – The questions of ‘how?’ and ‘where?’ to access to the research situation can be gained raise ethical questions. Access is often determined by “informants” (quite often an acquaintance of the researcher) or “gatekeepers” (usually the manager of the organisation etc.). Getting permission to carry out research in a gambling establishment can be very difficult and is often the hardest obstacle that a researcher has to overcome to collect the data required. Many establishments do not have the power to make devolved decisions and have to seek the permission of their head office. The prevention of access by the industry can be for many reasons but the main ones are highlighted next.
  • Management concerns – From the perspective of arcade or casino managers, the last thing they want are researchers that disturb their clientele (i.e., their players), by taking them away from their gambling and/or out of the establishment. Furthermore, they do not want us to give their customers any chance to make gamblers feel guilty about their gambling. In our experience, this is something that researchers are perceived by management to do. This obviously impacts on whether permission to carry out research is given in the first place.
  • Industry perceptions – From the many years we have spent researching (and gambling on) slot machines, it has become evident that there are some people in the gaming industry that view researchers such as ourselves as ‘anti-gambling’ and/or that any research will report negatively about their clientele or establishment/organization. As with management concerns, this again impacts on whether permission to carry out research is given in the first place.

Dr. Parke and I envisaged that our explanations might enhance future research in this area by providing researchers with an understanding of some of the difficulties with data collection. Unfortunately, identification of slot machine gamblers is often limited to a “search and seek” method of trawling local gambling establishments (e.g., amusement arcades, casinos etc.). Therefore, researchers are often limited to collecting data during play rather than outside of it. Obviously data facilitation would be better if gamblers were not occupied by their machine gambling.

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

Further reading

Griffiths, M.D. (1991). The observational study of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1994). The observational analysis of marketing methods in UK amusement arcades. Society for the Study of Gambling Newsletter, 24, 17-24.

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

Griffiths, M.D. (1996). Observing the social world of fruit-machine playing. Sociology Review, 6(1), 17-18.

Parke, A., & Griffiths, M.D. (2004). Aggressive behavior in slot machine gamblers: A preliminary observational study. Psychological Reports, 95, 109-114.

Parke, A. & Griffiths, M.D. (2005). Aggressive behaviour in adult slot machine gamblers: A qualitative observational study. International Journal of Mental Health and Addiction, 2, 50-58.

Parke, J. & Griffiths, M.D. (2002). Slot machine gamblers – Why are they so hard to study? Journal of Gambling Issues, 6. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2002.6.7

Parke, J. & Griffiths. M.D. (2008). Participant and non-participant observation in gambling environments. ENQUIRE, 1, 1-18.

Griffiths, M.D. (2011). A typology of UK slot machine gamblers: A longitudinal observational and interview study. International Journal of Mental Health and Addiction, 9, 606-626.

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