Category Archives: Addiction

Net calls: Is online gambling regulation a help or hindrance?

Online gambling regulation is a hot topic and many online gambling operators are wondering what the effect of increased (and arguably stricter) legislative measures will have on the online gambling market. Based on the studies that our research unit has carried out, I would guess that overall it is good news for the industry as I believe this will lead to an increased uptake by those people who are somewhat sceptical or agnostic about online gaming. So why do I think this?

Despite the increase in online gambling research over the last ten years, there has been very little empirical research examining why people gamble online or – just as importantly – why they don’t gamble online. Because there is so little research in this area, Dr Abby McCormack and I published a study in the International Journal of Mental Health and Addiction with adult online and offline gamblers examining the motivating and inhibiting factors in online gambling.

Our findings on the inhibiting factors of online gambling identified one major overarching theme as to what people don’t like about gambling online. In a nutshell, gamblers said that the authenticity of gambling was reduced when gambling online. However, many online gaming operators have now introduced more ‘realistic’ live gaming experiences (e.g., via webcams) so this may diminish over time. However, we also identified other online gaming inhibitors (i.e., the asocial nature and characteristics of the internet, the reduced psychological value of gambling with virtual money, and concerns about the safety of online gambling websites and their trustworthiness). These factors all contributed to the reduced authenticity of the online gambling experience.

Issues around website security, safety and trust, were all major inhibitors that decreased the likelihood of punters gambling online. Predictably, we found that online gamblers were much more likely than the offline gamblers and non-gamblers to believe that the gambling websites were secure. However, there was a perception that some websites were considered more trustworthy than others, and consequently the gamblers generally played on well known sites (e.g., companies that were well established offline).

So what are the implications of these findings for stricter online gaming regulation? From a psychological perspective, research on how and why people access commercial websites indicates that one of the most important factors is trust. If people know and trust the name, they are more likely to use that service. Reliability of the service provider is also a related key factor. Stricter regulation is likely to increase consumer confidence if they feel more protected when they perceive the service to be unfair and/or goes wrong. It is likely to change sceptical gamblers’ perceptions about the reliability and trustworthiness of online gaming operators for the better (no pun intended!).

Even with increased protective legislation, research shows that some punters will always have concerns about Internet security and may never be happy about putting their personal details online. But this mistrust will diminish over the long-term as the ‘screenagers’ of today (the so-called ‘digital natives’) are the potential gamblers of tomorrow. Digital natives generally have more positive attitudes towards online commercial operations. Today’s children and younger adolescents have never known a world without the Internet, mobile phones and interactive television, and are therefore tech-savvy, have no techno-phobia, and are very trusting of these new technologies. For many ‘screenagers’, their first gambling experiences may come not in a traditional offline environment but via the Internet, mobile phone or interactive television. Stricter regulation may not even be an issue for tomorrow’s gamblers as they are already accessing a myriad of online services and are highly trusting of such services.

Despite the lack of trust by some players, the online gaming industry shouldn’t be too worried about stricter regulation. The prevalence of online gambling is steadily increasing and there are lots of reasons why some punters prefer online to offline gambling. Our research findings indicate that those who prefer online (to offline) gambling like the increased convenience, the greater value for money, the greater variety of games, and the anonymity.

Furthermore, online gambling has many advantages for punters as it saves time because they don’t have to travel anywhere, they are not restricted by opening hours, and they can gamble from the comfort of their own home. The removal of unnecessary time consumption (e.g., travelling to a gambling venue) through online gambling is another barrier to gambling participation that had been removed. Increased regulation is highly unlikely to change any of these important motivating factors for gambling online.

Finally, compared to offline gamblers, our research also indicates that online gamblers are more likely to be male, young adults, single, have good qualifications, and in professional and managerial employment. Given this particular demographic profile, this group appears to be highly educated, and are likely to make well informed decisions to gamble online based on due consideration of the facts at hand. Again, stricter regulation is something that is likely to strengthen the decision to gamble rather than inhibit it.

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

Further reading

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2009). Socio-demographic correlates of internet gambling: findings from the 2007 British Gambling Prevalence Survey. CyberPsychology and Behavior, 12, 199-202.

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

McCormack. A. & Griffiths, M.D. (2012). Motivating and inhibiting factors in online gambling behaviour: A grounded theory study. International Journal of Mental Health and Addiction, 10, 39-53.

McCormack. A. & Griffiths, M.D. (2012). What differentiates professional poker players from recreational poker players? A qualitative interview study. International Journal of Mental Health and Addiction, 10, 243-257.

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

McCormack, A., Shorter, G. & Griffiths, M.D. (2013). An examination of participation in online gambling activities and the relationship with problem gambling. Journal of Behavioral Addictions, 2(1), 31-41.

McCormack, A., Shorter, G. & Griffiths, M.D. (2013). Characteristics and predictors of problem gambling on the internet. International Journal of Mental Health and Addiction, 11, 634-657.

Parke, A. & Griffiths, M.D. (2011). Poker gambling virtual communities: The use of Computer-Mediated Communication to develop cognitive poker gambling skills. International Journal of Cyber Behavior, Psychology and Learning, 1(2), 31-44.

Parke, A. & Griffiths, M.D. (2011). Effects on gambling behaviour of developments in information technology: A grounded theoretical framework. International Journal of Cyber Behaviour, Psychology and Learning, 1(4), 36-48.

Parke, A. & Griffiths, M.D. (2012). Beyond illusion of control: An interpretative phenomenological analysis of gambling in the context of information technology. Addiction Research and Theory, 20, 250-260.

Wardle, H., Moody, A., Griffiths, M.D., Orford, J. & and Volberg, R. (2011). Defining the online gambler and patterns of behaviour integration: Evidence from the British Gambling Prevalence Survey 2010. International Gambling Studies, 11, 339-356.

It’s no fabrication: A brief look at ‘quilting addiction’

“I am addicted to quilting enjoying the color, texture and patterns. This [Pinterest] board inspires me in color, quilts, designs and quilting!” (Kim Hazlett)

“My name is Laura and I’m addicted to quilting. I know there could be worse addictions, so all things considered, quilting is a harmless addiction. Unless that is, you are running out of time to do it all!. I did 4 [square blocks] over the past week and a half. I jumped ahead. I couldn’t help it. The more I make, the more I want to keep on making them! At this rate I’ll surely have all 111 blocks finished by 2012. Not that there’s a deadline)” (Laura)

“Addiction to quilting? Are you being serious?” I hear you say. Obviously there is no scientific research on ‘quilting addiction’ (although there is academic research on quilting that I’ll talk about later in this article) but a quick Google search shows there are numerous websites devoted to the topic (for example, Addicted to Quilts, My Quilting Addiction, Sew Addicted To Quilting, My Quilt Place, Quilt Addicts Anonymous, Addicted to Fabric, etc.). None of these sites are really about addiction but more about people’s overwhelming love of quilting (either professionally or personally). There are even books on the topic such as Get Addicted To Free-Motion Quilting (by Sheila Sinclair Snyder) and dedicated webpages such as ‘Addicted To Scraps’ on the Quiltmaker website or ’15 reasons to get addicted to Kantha quilts’ on the Houzz website.

Renelda Peldunas-Harter (RPH), author of From Ensign’s Bars to Colonel’s Stars: Making Quilts to Honor Those Who Serve and author of the online article ‘Are you addicted to quilting?’ asserted:

“Quilting is habit-forming and I’m going to try and break down certain aspects of the addiction. I’m going to throw a disclaimer in right here – I am not trained to diagnose or explain anything, I am merely an observer and chronicler of the quilting animal and want to share my observations. Quilters can display many ‘habit-forming’ behaviors”.

RPH breaks quilting into three categories – the fabrics, the tools used, and stash building (more of which later in the blog). More specifically, quilting addiction depends upon the type of fabrics chosen to make quilts, the number of different tools the quilter owns to make quilts, and (probably the most obvious indicators of an addiction) the accumulating of quilting paraphernalia. For RPH, stash building encompasses many things:

“It can mean an obsession to make quilt related gifts, compulsion to collect quilt magazines, quilt gadgets, quilt patterns, fabric/items with a certain theme, machines, patterns, or buying large/medium/small amounts of fabric in general with no earthly idea of what to do with it – otherwise known as stash building!”

With tongue firmly in cheek, the article outlines ‘The Quilting Commandments, which if adhered to could certainly indicative of addiction: “(1) Always buy new fabric no matter how much you already have; (2) Sew all day and night – absolutely no cooking permitted; (3) Always start a new quilt before the last one is finished; (4) Repeat Step 1”.

While researching this article, I was surprised to find that there had been quite a bit of research on quilting. In a 2001 paper in the World Leisure Journal, Dr. Faye King examined the social dynamics of quilting (based on her own 1997 PhD thesis). Based on her research, Faye reached three main conclusions: (i) quilting expresses powerful rhetorical statements about the maker’s values and social concerns (in which Faye provides a number of examples of where quilts were created to make political statements); (ii) quilting can have a social impact on society as well as their individual maker (those donated to charities and hospitals for sick children); and (iii) quilting provides meaning for the maker and as a leisure activity can help help reduce stress in one’s life (which indirectly provides a reason as to why some people might theoretically develop an ‘addiction’).

A qualitative study by Dr. Rhiannon Gainor of 25 quilters that run their own quilting websites and/or blogs examined motivations for quilting and their expressions of personal creativity. One of the salient themes that emerged was ‘quilting as passion’ and described by some as an addiction. More specifically, Gainor noted that:

“Quilters also wrote about quilting being a passion, an addiction, and a lifelong interest. These kinds of comments on the sites made it clear that quilting for many is more avocation than pastime, supporting Stebbins’ (2004) definition of the serious leisure enthusiast as one finding gratification and fulfillment, rather than mere fun, in their chosen activity”.

Dr. Marybeth Stalp has written a few papers on quilting. In one of them published in a 2008 issue of the journal Home Cultures, she examined the “stash” of those that engaged in domestic handicraft (including quilters). She makes a reference to addiction:

“Those who create domestic arts and handcrafts are quite familiar with the term ‘stash’ and may even have one (or more). While it is not a reference to addictive drugs (or is it?), questions regarding the stash illuminate the themes that exist within the stash and the ‘lifeworlds’ of the collectors of the stash”.

Via participant observation and interviews, the paper examined the meaning and role of the stash in the lives of knitters, quilters, and crocheters. Arguably, the findings use the language of addictions in various places:

“Handcrafters collectively refer to their collections as ‘stash,’ hoard whatever they collect over time, find un/official support groups to support their habits, and together strategize hiding places and storage. Collecting, hoarding, and hiding stash is quite normal for crafters, yet such acts are often deviant to others, particularly those who share their living space. Often the stash is portrayed negatively by non-crafting family members and friends, as well as the popular media, and sometimes even by handcrafters themselves…The handcrafter continues to acquire and stash fabric, yarn, floss, etc. despite how much space the stash demands, or how the stash influences relationships with others. The larger social structures of family, work and friends shape how we think about our stashes”.

In an earlier paper published in a 2006 issue of the journal Textile: The Journal of Cloth and Culture, Stalp presented her results of a four-year ethnographic study of 70 US amateur quilters. She examined the “guilty pleasures surrounding quilting practices, including the deviant acts of hiding both identity and fabric from family members and friends”. The paper describes how quilters slowly build up their stash of fabric, purchasing more fabric than they need than necessary, and both hoarding and strategically hiding it from their families. She then goes on to say that:

“Women’s anxieties surrounding acquiring, hoarding, and hiding their fabric stashes highlight their diminished ability, relative to their spouses and their children, to pursue leisure activities without a stigma. Collecting and hiding the fabric stash become symbolic of women’s attempts to carve out time and space for themselves amid the multiple demands placed on them by such greedy institutions such as family and the workplace”. 

Another academic who has written a few papers on quilting is Dr. Rosemary Wilkinson. Her first paper on the topic in the International Journal of the Humanities examined the rhetoric of obsession, addiction, guilt, and subterfuge in two Australian quilters’ magazines (Down Under Quilts and Quilters Companion) over a five-year period. She reported that while some of the quilting publications describe the benefits of quilting to individuals and communities, she also noted the ways in which the magazines integrate the “rhetotic of addiction” in constructing of the identity of quilters. She concludes that:

“[This] ploy seemingly at odds with the overall positive and promotional tone of the magazines…[the findings] demonstrate that the concept of addiction is exploited within the magazines to reinforce the quilter’s creative drive, her communal belonging and her vocation”.

In a more recent 2014 paper in the journal TEXT, Dr. Williamson reprised the same findings:

Both the turning towards and the intensity of commitment to quilts may be expressed through metaphors of addiction, illness or affliction. The rhetoric of addiction is well established among quilters generally, and has occurred in [Australian quilting magazines] since their inception…Profiles from 2010 to 2013 contain references to, for example, catching ‘the quilting bug’…or other phrases that translate commitment into popular clichés of addiction (‘Jenny began a creative journey that soon became an addiction, as is so often the case’)…Frequent references in profiles to quilters’ passion for what they do, even if expressed in clichés of addiction, connote personal commitment and satisfaction as driving forces for career development that is organic and responsive to, and accommodating of, personal circumstances”.

In reading the academic papers on quilting, I got the sense that the word ‘addiction’ was being used in a non-clinical sense and as a metaphor for justifying the amount of time that quilters engaged in their passion and pastime. There was little evidence of negative detriment although some quilters clearly feel they need to lie about or hide away aspects of their hobby.

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

Further reading

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

Gainor, R. (2011). Hobby quilting websites and voluntary provision of information. New Directions in Folklore, 9(1/2), 41-67.

King, F.L. (2001). Social dynamics of quilting. World Leisure Journal, 43(2), 26-29.

Peldunas-Harter, R. (2014). Are you addicted to quilting? Take the quiz. Schiffer Publishing, December 15. Located at: http://schifferpublishing.tumblr.com/post/105289542106/are-you-addicted-to-quilting-take-the-quiz

Sayasane, J.H. (2011). My quilting addiction explained. Quilters Newsletter, March 2. Located at: http://www.quiltersnewsletter.com/blogs/insideqn/2011/03/02/my-quilting-addiction-explained/

Stalp, M. C. (2006). Hiding the (fabric) stash: Collecting, hoarding, and hiding strategies of contemporary US quilters. Textile: The Journal of Cloth and Culture, 4(1), 104-124.

Stalp, M. C., & Winge, T. M. (2008). My collection is bigger than yours: Tales from the handcrafter’s stash. Home Cultures, 5(2), 197-218.

Stebbins, R. (2007). Serious Leisure: A Perspective for Our Time. New Brunswick, NJ: Transaction Publishers.

Williamson, R. (2008). Obsession, guilt, subterfuge and penury: The rhetoric of addiction and the construction of creative identity in Australian quilters’ magazines. The International Journal of the Humanities, 5(11), 163-70.

Williamson, R. (2014). Modelling the creative and professional self: The magazine profile as narrative of transition and transformation. TEXT, Special Issue 25. Australasian magazines: new perspectives on writing and publishing. http://www.textjournal.com.au/speciss/issue25/Williamson.pdf

Distraction plans: Excessive smartphone use and pain perception

In a previous blog I outlined many physical syndromes that had been reported in the 1980s medical literature, a number of which related to excessive video game playing. This included ‘Space Invader’s Wrist’ (published in the New England Journal of Medicine), ‘Pseudovideoma’ (Journal of Hand Surgery), ‘Pac-Man Phalanx’ (Arthritis and Rheumatism) and ‘Joystick Digit’ (Journal of the American Medical Association). More recently, other new medical complaints have been reported related to excessive mobile phone use including a report of ‘Blackberry thumb’ in a 2013 issue of the Canadian Medical Association Journal. 

Earlier this month saw the publication of a case report involving a tendon rupture in a man excessively playing a video game on his smartphone. The report appeared in JAMA Internal Medicine by Dr. Andrew Doan and his colleagues (the same Dr. Doan that reported a case study of someone “addicted” to Google Glass that I examined in a previous blog). The authors of the latest report wrote:

“We describe a patient with rupture of the extensor pollicis longus tendon associated with excessive video game play on his smartphone. A 29-year-old, right hand–dominant man presented with chronic left thumb pain and loss of active motion. Before the onset of symptoms, he reported playing a video game on his smartphone all day for 6 to 8 weeks. He played with his left hand while using his right hand for other tasks, stating that ‘playing was a kind of secondary thing, but it was constantly on.’ When playing the video game, the patient reported that he felt no pain. He reported no injuries or prior operations to either hand. He denied a history of inflammatory arthritis, quinolone use, or other predisposing medical condition for ten-don rupture. On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. The thumb metacarpophalangeal range of motion was 10° to 80°, and thumb interphalangeal range of motion was 30° to 70°. The findings on physical examination of the patient’s right hand were unremarkable. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. A magnetic resonance imaging study of his left hand revealed tendon attenuation and rupture of the tendon. Radiographic studies of the wrist found no bone spurs or prior or current fractures. The patient subsequently underwent an extensor indicis proprius (1 of 2 tendons that extend the index finger) to extensor pollicis longus tendon transfer. During surgery, rupture of the extensor pollicis longus tendon was seen between the metacarpophalangeal and wrist joints”

One of the things that I found interesting was that despite the tendon rupture, when the man was actually playing the game, he felt no pain. This is something I know only too well from personal experience. Unfortunately, I have a chronic and degenerative spinal complaint (herniated discs in my neck) but I feel no pain whatsoever when I am cognitively distracted. I find that work is a much better analgesic than dihydrocodeine (i.e., when I am working I feel no pain whatsoever). However, playing video games come a close second as when I am engaged in video game playing (even on simple casual games), the fact that it takes up all my cognitive resources means that I don’t feel any pain. This is nothing new and many medics are aware of the therapeutic benefits of gaming. There are now many studies showing that children undergoing chemotherapy need much less pain relief if they play video games after their treatment compared to children that don’t play video games. (In fact I’ve written a number of papers and book chapters on ‘video game therapy’ – see ‘Further reading’ below). This case report then went on to say:

“Video games suppress pain perception in pediatric patients and during burn treatments. Visual distraction and neuroendocrine hypothalamic-pituitary-adrenal arousal provide a plausible explanation for why the patient did not feel pain from his injury. Without the expected physiologic negative pain feedback, excessive gaming may have led to tendon attenuation and subsequent attritional rupture of the tendon. Attritional rupture at the midtendon differs from high- energy ruptures that occur where the tendon is thinnest or be- tween tendon and bone. Although this is only a single case report, research might consider whether video games have a role in clinical pain management and as nonpharmacologic alternatives during uncomfortable or painful medical procedures. They may also have a role in reducing stress. It may be interesting to ascertain whether various games differ in their ability to reduce the perception of pain…Research might also consider whether pain reduction is a reason some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming”.

This conclusion does appear to suggest that the authors are unaware of the many hundreds of studies that have examined the therapeutic benefits of gaming (in fact there’s even an academic journal dedicated to such studies appropriately called the Games For Health Journal). As I have noted in a number of my writings about video gaming as a medical intervention for children:

  • Videogames are likely to engage much of a person’s individual active attention because of the cognitive and motor activity required.
  • Videogames allow the possibility to achieve sustained achievement because of the level of difficulty (i.e., challenge) of most games during extended play.
  • Videogames appear to appeal most to adolescents.

Consequently, videogames have also been used in a number of studies as ‘distractor tasks’. This latest case report highlights the simultaneous potential positive and negatives of gaming within a single individual but also highlights the fact that video gaming is both mobile and spreading to many more types of hardware. I’m now wondering which medical team will be the first to write about a new medical syndrome relating to the new Apple Watch.

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

Further reading

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

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

Gilman, L., Cage, D.N., Horn, A. Bishop, F., Klam, W.P. & Doan, A.P. (2015). Tendon rupture associated with excessive smartphone gaming. JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.0753

Griffiths, M.D. (2003). The therapeutic use of videogames in childhood and adolescence. Clinical Child Psychology and Psychiatry, 8, 547-554.

Griffiths, M.D. (2005). Video games and health. British Medical Journal, 331, 122-123.

Griffiths, M.D. (2005). The therapeutic value of videogames. In J. Goldstein & J. Raessens (Eds.), Handbook of Computer Game Studies (pp. 161-171). Boston: MIT Press.

Griffiths, M. D., Kuss, D.J., & Ortiz de Gortari, A. (2013). Videogames as therapy: A review of the medical and psychological literature. In I. M. Miranda & M. M. Cruz-Cunha (Eds.), Handbook of research on ICTs for healthcare and social services: Developments and applications (pp.43-68). Pennsylvania: IGI Global.

McCowan, T.C. (1981). Space Invader’s wrist. New England Journal of Medicine, 304,1368.

Osterman, A. L., Weinberg, P., & Miller, G. (1987). Joystick digit. Journal of the American Medical Association, 257(6), 782.

O’Sullivan, B. (2013). Beyond BlackBerry thumb. CMAJ, 185, 185-186.

Soe, G.B., Gersten, L. M., Wilkins, J., Patzakis, M. J., & Harvey, J.P. (1987). Infection associated with joystick mimicking a spider bite. Western Journal of Medicine, 146(6), 748.

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

Net advantage: Another brief look at the psychology of online poker

From everything that I’ve observed over the last decade in the gambling world, the one thing that has caught my eye more than anything else is the number of online gambling stories – particularly about the rise of online poker. Clearly, online poker and traditional poker are not synonymous. As I outlined in one of my previous blogs, a very useful psychological tool in poker is to ‘read’ a player through their body language and their verbalisations. When playing online poker, a gambler is denied this advantage. Poker players must therefore seek to manipulate their poker-playing opponents by using the psychological tools at their disposal. One of my colleagues who has researched this area (Dr. Adrian Parke), believes that in a ‘SunTzu’-type way, an online poker player must take their weakness (in this case, not being able to physically see other players) and turn it into a positive strength. Put simply, a player must use the non-transparency inherent in the situation to their advantage.

Online poker permits players to create a false identity. As a player you could portray the façade of being a young attractive novice female player when in fact you are actually a very experienced recognised pro. On a psychological level, the key to a ‘hustle’ or manipulating other players in poker is by projecting a character and hiding your identity. Essentially it is about representing a façade, whether it is for one hand or the whole of the game. While playing poker online, a player can adapt any ‘character’ they wish to suit any game in which they engage in. For instance, if you are playing with novices it may be profitable to portray an experienced professional in order to intimidate players into submission.

Using the messaging systems provided, it is easier for online poker players to develop their persona(s). The tone and pitch of what a player “says” is not revealed in the text on the screen. At a fundamental level all players are acting with their most unemotional ‘poker face’. In these situations, players can exude confidence as they go all in on a psychological bluff, when in reality they may have shaking hands and be sweating like a pig. The key to winning on a psychological level is by inducing emotional reactions from other players, so with knowledge of the opponent, it is possible to ‘tailor’ interactions to induce the desired response.

Social interaction at the online poker table is not confined to adversarial chastising. It is also possible to develop amiable relationships between players. Online poker – particularly at low stakes tables – is often more about entertainment than making profits. In poker it is not necessary to reveal your hand if nobody calls (i.e., pays to see it). Without seeing cards it is more difficult to understand player behaviour. However, at more sociable tables, players will reveal what they had to opposing players, if nothing else but to indulge the observers. Creating false ‘alliances’ is a way of ascertaining more information about your opponents and improving your ability to ‘read’ them.

From a psychological perspective, there are also some things to be aware of in the online gambling world. At a basic level, what separates professional gamblers and novice (or problem) gamblers is the factor of self-control. The rule of thumb is to avoid becoming emotionally involved in the game. Inducing emotional rather than logical reactions from gamblers is what makes the gambling industry so profitable. By remaining unemotional gamblers can protect themselves from recklessly chasing losses and avoid going on ‘tilt’. People gambling online are particularly at risk from engaging in chasing losses for the simple reason that they have 24-hour convenient access from their home or workplace and have the potential to be constantly subjected to temptation. What’s more, in this asocial world, they often lack friends acting as a “social safety net” to give objective appraisals of the player’s behaviour.

The best ways of avoiding becoming emotionally engaged online is to have (i) reflective time outs and (ii) an objective attribution of outcomes. Having reflective time-outs simply refers to playing slowly, making gambling decisions with accrued knowledge (for example, knowledge of probability and of opponents). It is advisable after a ‘bad beat’ to be disciplined enough sit out one or two hands to regain composure before playing again. Determining objective attributions of outcomes occurs at a psychological level and concerns the gambler’s locus of control. For the gambler, this means having an external locus of control when assessing the cards they have and an internal locus of control regarding what they do with the cards available.

The mantra of poker players is that ‘You can only play the hand you were dealt’. All players will experience streaks of both desirable and poor hands, and it is how a player responds to these streaks that will determine their success. It is very easy to become frustrated while in a negative streak. Likewise, it is easy in a positive streak to become narcissistic and complacent. It is the knowledgeable player that understands probability and who realises that over a continuous playing period, positive and negative streaks are inevitable and transient.

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

Further reading

Biolcati, R., Passini, S. & Griffiths, M.D. (2015). All-in and bad beat: Professional poker players and pathological gambling. International Journal of Mental Health and Addiction, in press.

Griffiths, M.D., Parke, J., Wood, R.T.A. & Rigbye, J. (2010). Online poker gambling in university students: Further findings from an online survey. International Journal of Mental Health and Addiction, 8, 82-89.

McCormack. A. & Griffiths, M.D. (2012). What differentiates professional poker players from recreational poker players? A qualitative interview study. International Journal of Mental Health and Addiction, 10, 243-257.

Parke, A. & Griffiths, M.D. (2011). Poker gambling virtual communities: The use of Computer-Mediated Communication to develop cognitive poker gambling skills. International Journal of Cyber Behavior, Psychology and Learning, 1(2), 31-44.

Parke, A., Griffiths, M., & Parke, J. (2005) Can playing poker be good for you? Poker as a transferable skill. Journal of Gambling Issues, 14.

Recher, J. & Griffiths, M.D. (2012). An exploratory qualitative study of online poker professional players. Social Psychological Review, 14(2), 13-25.

Wood, R.T.A., Griffiths, M.D. & Parke, J. (2007). The acquisition, development, and maintenance of online poker playing in a student sample. CyberPsychology and Behavior, 10, 354-361.

Wood, R.T.A. & Griffiths. M.D. (2008). Why Swedish people play online poker and factors that can increase or decrease trust in poker websites: A qualitative investigation. Journal of Gambling Issues, 21, 80-97.

The must of lust discussed: Why isn’t sex addiction in the DSM-5?

Please note: A shorter and slightly different version of this blog first appeared on addiction.com

Sex addiction appears to be a highly controversial area among both the general public and those who work in the addiction field. Some psychologists adhere to the position that unless the behaviour involves the ingestion of a psychoactive substance (e.g., alcohol, nicotine, cocaine heroin), then it can’t really be considered an addiction. But I’m not one of them. If it were up to me, I would have given serious consideration to including sex addiction in the latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Given that ‘gambling disorder’ was reclassified from a disorder of impulse control to a behavioural addiction in the DSM-5, there is now no theoretical reason why other behavioural addictions can’t be added in the years to come. So why wasn’t sex addiction included in the latest DSM-5? Here are some possible reasons.

Some researchers think that sex addiction just doesn’t exist (for moral and theoretical reasons): Many scholars have attacked the whole concept of sex addiction saying it is a complete myth. It’s not hard to see why, as many of the claims appear to have good face validity. Many sociologists would argue that ‘sex addiction’ is little more than a label for sexual behaviour that significantly deviates from society’s norms. The most conventional attack on sex addiction is a variation on the position outlined in my introduction (i.e., that ‘addiction’ is a physiological condition caused by ingestion of physiological substances, and must therefore be defined physiologically). There are also attacks on more moral grounds with people saying that if excessive sexual behaviour is classed as an addiction it undermines individuals’ responsibility for their behaviour (although this argument could be said of almost any addiction).

The word ‘addiction’ has become meaningless: There are also those researchers within the social sciences who claim that the every day use of the word ‘addiction’ has rendered the term meaningless (such as people saying that their favorite television show is ‘addictive viewing’ or that certain books are ‘addictive reading’). Related to this is that those that work in the field don’t agree on what the disorder (e.g. ‘sex addiction’, ‘sexual addiction’, ‘hypersexuality disorder’, ‘compulsive sexual behaviour’, ‘pornography addiction’, etc.) should be called and whether it is a syndrome (i.e., a group of symptoms that consistently occur together, or a condition characterized by a set of associated symptoms) or whether there are many different sub-types (pathological promiscuity, compulsive masturbation, etc.). 

There is a lack of empirical evidence about sex addiction: One of the main reasons that sex addiction is not yet included in the DSM-5 is that the empirical research in the area is relatively weak. Although there has been a lot of research, there has never been any nationally representative prevalence surveys of sex addiction using validated addiction criteria, and a lot of research studies are based upon those people who turn up for treatment. Like Internet Gaming Disorder (which is now in the appendix of the DSM-5), sex addiction (or more likely ‘Hypersexual Disorder’) will not be included as a separate mental disorder until the (i) defining features of sex addiction have been identified, (ii) reliability and validity of specific sex addiction criteria have been obtained cross-culturally, (iii) prevalence rates of sex addiction have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features of sex addiction have been evaluated.

The term ‘sex addiction’ is used an excuse to justify infidelity: One of the reasons why sex addiction may not be taken seriously is that the term is often used by high profile celebrities as an excuse by those individuals who have been sexually unfaithful to their partners (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand). In some of these cases, sex addiction is used to justify the individual’s serial infidelity. This is what social psychologists refer to as a ‘functional attribution’. For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position where they were bombarded with sexual advances from other individuals and succumbed. But how many people wouldn’t do the same thing if they had the opportunity? It becomes a problem only when you’re discovered, when it’s in danger of harming the celebrity’s brand image.

The evidence for sex addiction is inflated by those with a vested interest: One of the real issues in the field of sex addiction is that we really have no idea of how many people genuinely experience sex addiction. Sex addiction specialists like Patrick Carnes claims that up to 6% of all adults are addicted to sex. If this was really the case I would expect there to be sex addiction clinics and self-help support groups in every major city across the world – but that isn’t the case. However, that doesn’t mean sex addiction doesn’t exist, only that the size of the problem isn’t on the scale that Carnes suggests. Coupled with this is that those therapists that treat sex addiction have a vested interest. Out simply, there are many therapists worldwide who make a living out of treating the disorder. Getting the disorder recognized by leading psychological and psychiatric organizations (e.g., American Psychiatric Association, World Health Organization) legitimizes the work of sex addiction counselors and therapists so it is not surprising when such individuals claim how widespread the disorder is.

There may of course be other reasons why sex addiction is not considered a genuine disorder. Compared to behavioural addictions like gambling disorder, the empirical evidence base is weak. There is little in the way of neurobiological research (increasingly seen as ‘gold standard’ research when it comes to legitimizing addictions as genuine). But carrying out research on those who claim to have sex addiction can face ethical problems. For instance, is it ethical to show hardcore pornography to a self-admitted pornography addict while participating in a brain neuroimaging experiment? Is the viewing of such material likely to stimulate and enhance the individual’s sexual urges and result in a relapse following the experiment? There are also issues surrounding cultural norms. The normality and abnormality of sexual behaviour lies on a continuum but what is considered normal and appropriate in one culture may not be viewed similarly in another (what is often referred to by sociologists as ‘normative ambiguity’). Personally, I believe that sex addiction is a reality but that it affects a small minority of individuals. However, many sex therapists claim it is on the increase, particularly because the Internet has made sexual material so easy to access. Maybe if sex addiction does eventually make it into future editions of the DSM, it will be one of the sub-categories of Internet Addiction Disorder rather than a standalone category.

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

Further reading

Dhuffar, M. & Griffiths, M.D. (2014). Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study. Journal of Behavioural Addictions, 3, 231–237.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, DOI 10.1007/s40429-015-0055-x

Goodman, A. (1992). Sexual addiction: Designation and treatment. Journal of Sex and Marital Therapy, 18, 303-314.

Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D. (2001). Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2001). Addicted to love: The psychology of sex addiction. Psychology Review, 8, 20-23.

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

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

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400.

Orford, J. (2001). Excessive sexuality. In J. Orford, Excessive Appetites: A Psychological View of the Addictions. Chichester: Wiley.

Deal love: Bargain hunting as an addiction

“Bargain hunting may save money, but for some people, looking for the next ‘great deal’ becomes an addiction. The call of the clearance rack wins out over practical matters – like whether you need or want what you found, or even have a place to put it” (Tesh Media, ‘Are You Addicted To Bargain Hunting?’)

A couple of weeks ago, I did some background research for a newspaper interview on the psychology of bargain hunting (only for the journalist then to interview somebody else about it). Instead of wasting all the material collected, I decided to use it for this article. Most of the material in this article borders on ‘pop psychology’ but I found it interesting nonetheless. For instance, in a recent article on the BBC News website, the (anonymous) author provided some basic rules on how to be a more savvy shopper and bargain hunter (which I am quoting verbatim):

  • “Try to avoid stores that are too busy with loud music. This can confuse and distract you from judging what is a genuine offer.
  • Ask the sales rep to repeat the sales details in a clear and slow manner and if possible ask him/her to write them down.
  • Before you make a decision take a break, count from one to ten and think again about the benefits and perils of the offer.
  • Can you shop alone? Peer pressure has been proven to be a key indicator for individuals buying products that they do not need.
  • Never shop when you are feeling emotionally upset. Purchasing to overcome any mood or behavioural troubles is not beneficial in the long term.
  • Go shopping after a meal or when in a good and clear mood. There is evidence that shopping when you feel peckish can make you spend more than intended”.

As soon as we enter any shop (online or offline) we are being bombarded with psychological tactics in an attempt to get us to buy more products (such as selling products that have a price ending in 99p). The BBC article interviewed consumer psychologist Dr. Dimitri Tsivrikos who said:

“These prices are obviously used to convince you that you are spending less than you actually are. A price reduction makes it even more tempting. The bargain price is appealing to you because it challenges the status quo. The retailer appears not to be in complete control of the final price of the product, and this makes you feel that you are now in control. And because of that you feel you can negotiate the final price that you have to pay – whether that is the sale price or even a buy one get one free deal…Brain studies have shown that when we are excited by a bargain, this interferes with your ability to clearly judge whether it is actually a good offer or not”.

When I started researching online, I came across a number of articles claiming that for a small minority, bargain hunting was addictive (as the opening quote demonstrates). In another article on the Tesh Media website, reference was made to April Lane Benson’s edited book I Shop, Therefore I Am. According to that article (which merges bargain hunting addiction with shopping addiction more generally):

“[Benson] says that when it comes to bargain-hunting addictions, what people buy isn’t as important as how big the price reduction is. In fact, the bigger the price cut, the more tempting a purchase is. After all, if something’s 80% off the original price – you’re saving 80 percent! What you may not consider is that by not buying, you’ll save 100%. Bargain addicts also make illogical purchases, like grabbing up sale-price auto parts for cars they don’t own, or bargain kid’s clothes for children they don’t have…So, why is a bargain-hunting addiction so common? Tim Kasser, a professor of psychology at Knox College in Illinois, says it’s a way for people to ease insecurities, and feel more competent and in control. In fact, shopping addicts often don’t realize they have a problem, even when the bags and bills start stacking up. It usually takes a big event to bring it to their attention, like divorce, a new baby, unemployment, or retirement. Or they simply max out their credit cards, and have no more spending power”

In the same article published on the Tech Media website, it claimed the five signs of being ‘addicted’ to bargain hunter were:

  • “You hit sales and clearance racks when you feel angry or blue. Or you feel guilty after shopping and hide your purchases.
  • You spend more money than you can afford.
  • You see sales as opportunities you can’t pass up.
  • Another clue you’re a bargain addict: You spend so much time tracking down deals that it intrudes on your time with family and friends.
  • You often forget what you bought, and find things in your closets you’ve never used”.

Obviously some of these ‘warning signs’ tap into what I believe are the core components of addiction (such as the fourth bullet point that taps into ‘conflict’), however, most of the criteria have nothing to do with ‘addiction’ whatsoever. Using bargain-hunting as a way of making oneself feel better mirrors what is found in other addictions, but characteristics such as not being able to pass up a bargain, and forgetting what has been bought are not core signs of addiction but are idiosyncratic consequences that specifically relate to bargain hunting. Another online article also noted:

“According to new survey findings from Consumer Reports, 23% of women say they sometimes buy things they don’t need just because they’re on sale. For most of us, getting a discount is enough of a reward: 80% say they would hunt for a bargain even if money weren’t an issue for them. In general, the survey found bargain shopping has increased significantly, from 76% in 2011 to 83% today. That shift may be due in part to the growing use of smartphone coupons, which has increased from 11% in 2011 to 24% today. Human psychology may help explain the irresistible allure of a discount. Research suggests that people tend to enjoy bargains, regardless of whether any financial gain is involved. You might even be able to blame your bargain hunting on Mom and Dad, because some experts say genetic differences make certain people predisposed to finding pleasure in raiding the sale rack”.

This paragraph provided a hyperlink to some genuine academic research carried out by Dr. Peter Darke and his colleagues (published in a 2006 issue of the Journal of Applied Social Psychology). They carried out a couple of experiments examining both the financial and non-financial motivations underlying bargain hunting. They reported that:

“Subjects read scenarios that described the purchase of a television set. Scenarios differed in terms of whether a bargain was received, whether there was personal financial gain, and whether the sale was acquired through skill or luck. The results suggest that subjects generally enjoyed bargains regardless of any financial gain, thereby implying that nonfinancial motives might also be involved. Surprisingly, bargains acquired skillfully were not enjoyed more than lucky bargains. Thus, achievement motives could not explain why subjects enjoyed bargains when there was no associated financial gain. Instead, it seemed that acquiring a bargain was primarily considered a matter of luck”.

I was also interested in the claims that bargain hunting might be underpinned by genetic influences. These claims were made by Mark Ellwood in his 2013 book Bargain fever: How to shop in a discounted world. Ellwood summarized his book in an article for Time magazine and wrote:

“As it turns out, a passion for finding bargains is genetically preprogrammed in all humans, although it’s activated much more in some than others. Spotting special offers triggers a release of dopamine, the feel-good neurotransmitter that I like to think of as ‘buyagra’. Dopamine is such a powerful chemical that our brains have developed a built-in system to clean it up as quickly as possible. One in four Caucasians has an otherwise harmless flaw in what’s known as the COMT gene. While the rest of us can flush our brains free of dopamine with the efficiency of a Dyson, those with an iffy COMT gene can brandish only a hand broom. It takes more time and effort to flush their brains clean of buyagra – and so they are physiologically more prone to splurge, especially on bargains”.

Ellwood claimed that as soon as “bargain addicts sees one ‘Sale’ sign – cue a jolt of dopamine – they’re hooked”. More specifically, he goes on to argue that:

“Of course, a propensity for bargain hunting isn’t purely genetic…Many hardcore coupon cutters I’ve interviewed cite hardscrabble childhoods or food-bank visits as the foundation of their frugality. Certainly, in the past decade, deal hunting has gone from a sign of indigence to one of intelligence; thanks to the roiling economy and an uncertain future, more people have migrated to the markdown section than ever before…Internet-equipped smartphones turned price comparison into a one-step process in your palm — the practice known as showrooming that’s so detested by retailers. But in our search for bargains, we would do well to ask ourselves whether we are really trying to economize or whether we’re being driven by an even stronger impulse: the chemical drive to get a good price”.

Given that I believe shopping can be an addiction in a minority of individuals, it doesn’t take too much of a leap to suggest bargain hunting could be an addiction (or even a sub-type of shopping addiction). However, as far as I am aware, there has never been any empirical research examining ‘bargain hunting addiction’ more specifically. Based on the few online articles that I read, it certainly appears that we are living in a time and an age where such research would be worth carrying out.

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

Further reading

BBC News (2015). The psychology of shopping for bargains. Located at: http://www.bbc.co.uk/consumer/23818336

Benson, A.L. (2000). I Shop Therefore I Am: Compulsive Buying and the Search for Self. Jason Aronson Inc. Publishers.

Consumer Reports (2014). America’s bargain-hunting habits. What shoppers will and won’t do to save a buck. April 30. Located at: http://www.consumerreports.org/cro/news/2014/04/america-s-bargain-hunting-habits/index.htm

Darke, P. R., & Freedman, J. L. (1995). Nonfinancial Motives and Bargain Hunting1. Journal of Applied Social Psychology, 25(18), 1597-1610.

Davenport, K., Houston, J. & Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, 10, 474-489.

Ellwood, M. (2013). The genetics of bargain hunting. Time, October 21. Located at: http://ideas.time.com/2013/10/21/the-genetics-of-bargain-hunting/

Ellwood, M. (2013). Bargain fever: How to shop in a discounted world. London: Portfolio.

Lebowitz, S. (2014). Extreme bargain hunters: How far would you go for a deal. LearnVest, May 2. Located at: http://www.learnvest.com/2014/05/extreme-bargain-hunters-how-far-would-you-go-for-a-deal-123/

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

Tesh Media Group (2015). Are you addicted to bargain hunting? Located at: http://www.tesh.com/story/money-and-finance-category/are-you-addicted-to-bargain-hunting/cc/12/id/9141

Williams, A. (2013). Bargain fever: The new secrets of shopping in a discounted world. The Week, November 5. Located at: http://theweek.com/articles/457383/bargain-fever-new-secrets-shopping-discounted-world

In dependence days: A brief overview of behavioural addictions

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

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

  • Salience – This occurs when the activity becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialized behaviour). For instance, even if the person is not actually engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).
  • Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

Coining it in: Neologisms and ‘New Syndrome’ Syndrome

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

Levit, F. (1977). Jogger’s nipples. New England Journal of Medicine, 297(20), 1127.

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

Martyn, J. B. (1983). Nurd knuckles. Canadian Medical Association Journal, 129(3), 228.

McCowan, T.C. (1981). Space Invader’s wrist. New England Journal of Medicine, 304,1368.

Osterman, A. L., Weinberg, P., & Miller, G. (1987). Joystick digit. Journal of the American Medical Association, 257(6), 782.

Powell, B. (1983). Bicyclist’s nipples. Journal of the American Medical Association, 249(18), 2457-2457.

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.

Soe, G.B., Gersten, L. M., Wilkins, J., Patzakis, M. J., & Harvey, J.P. (1987). Infection associated with joystick mimicking a spider bite. Western Journal of Medicine, 146(6), 748.

Tomecki, K. J., & Mikesell, J. F. (1987). Rower’s rump. Journal of the American Academy of Dermatology, 16(4), 890-891.

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

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