Category Archives: Addiction

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.

Disarray of light: A brief look at ‘chaos addiction’

A few weeks ago, three independent things happened that has led me to writing this article. Firstly, I received an email from one of my blog readers who wrote:

“I’m a recovering addict. I still find that hard to admit even after time in therapy and the support of my loved ones, but to say it out loud can sometimes be a help. One part of my therapy, which really did strike a chord was something called ‘Chaos Addiction’. It was suggested to me that my addictive behaviors were fueled by a need to constantly have things in my life that were ‘in flux’ – to experience the ‘predictably unpredictable’. Looking back over my life, it hit home…I’d love it if you might think about sharing this with your site’s readership”.

Secondly, a couple of days later I was given a CD-R by one of my friends that included the song ‘Addicted to Chaos’ by the group Megadeth (from their 1994 album Youthanasia). Thirdly, a couple of days after that I was watching the film Chasing Lanes where the lead character in the film Doyle Gipson (played by Samuel L Jackson) is told by his Alcoholics Anonymous sponsor (played by William Hurt) that he was ‘addicted to chaos’ rather than alcohol.

I have never come across the term ‘chaos addiction’ prior to the email I was sent. As far as I am aware, there has never been any empirical research on the topic although Dr. Keith Lee did write a 2007 book (Addicted to chaos: The journey from extreme to serene) of his own experiences on the topic. Using case studies, the book examines individuals that have become “addicted to intensity out of the chaos and toward mind/body harmony, higher consciousness, and a deeply spiritual transformation”. More specifically:

“In a culture where the ‘extreme theme’ has become the norm, people are increasingly seduced into believing that intensity equals being alive. When that happens, the mind becomes wired for drama and the soul is starved of meaningful purpose. This type of life may produce heart-pounding excitement, but the absence of this addictive energy can bring about withdrawal, fear, and restlessness that is unbearable”.

In researching this article I came across a number of online articles dealing with ‘addiction to chaos’. The term has been applied to the actress Lindsay Lohan following a television interview with Oprah Winfrey (and the many articles that followed that honed in on her ‘addiction to chaos).

A short piece in Business Week by Clate Mask claimed that it is entrepreneurs that are frequently addicted to chaos (based on his “experiences and observations working with thousands and thousands of entrepreneurs over the years” along with his top three signs he sees as being addicted to chaos: (i) their business life revolves around the in-box, (ii) they can’t step away from the business, (ii) they are strangely proud they have so little free time. Clate then goes on to claim that:

“If you find yourself experiencing these symptoms, you are probably addicted to chaos. Get help. Business ownership should bring you more time, money, and control. If you’re not getting that, make some changes to your mindset and your business systems so you can find the freedom you were looking for when you started your business in the first place”.

However, to me, this appears to be more like addiction to work rather than addiction to chaos (see ‘Further reading’ below for my papers on workaholism).

An online article by Silvia Mordini discussed about her personal experiences and how she now uses yoga to provide grounding and stability in her life. (In fact, there are quite a few papers on treating addictions with yoga including a recent systematic review of randomized control trials by Paul Posadski and his colleagues in the journal Focus on Alternative and Complementary Therapies – see ‘Further reading’ below). As Mordini confessed:

“My past addiction to chaos simply hurt me too much. I got sick of the constant mental tug-o-war with myself.  I’m not interested in feeling impatient with one thought and having to pull or push at the next one. Impatience promotes chaos and doesn’t feel good. The antidote to this is patience. Patience feels good. It feels like a return to mental stability no matter the chaos around us or what other people are thinking or doing…[The grounding that yoga brings] serves us as a simplifying force in order to stabilize our minds. When grounded, we plug back into our best selves and become fully present and balanced. Our energy stabilizes. Once centered, we are able to clearly see the circumstances of our lives. We no longer over-respond or over-worry because the static noise of chaos doesn’t pull us apart”.

She then goes on to provide her readers with five practical ways to promote stability and overcome addiction to chaos: (i) practice yoga, (ii) meditate, (iii) use a mantra (she suggests “I will let go of the need to be needed/I will let go of the need to be accepted/I will let go of the need to be accomplished), unplug from technology, and (v) get your hands and feet dirty (do some gardening, go for a walk on the beach, etc.). Obviously there is no clinical research confirming that these strategies would help overcome ‘chaos addiction’ but engaging in them certainly won’t do anyone any harm.

Another online article (‘Addicted to Chaos’) by addiction counselor Rita Barsky notes that many addicts grew up within dysfunctional families and noted:

“We never felt safe in our family of origin and the only thing we knew for sure was that nothing was for sure. Life was totally unpredictable and we became conditioned to living in chaos. When I talk about chaos in our lives, it was often not the kind that can be seen. In fact, many alcoholic/addict mothers were also super controllers and on the surface, our lives appeared to be perfect. The unsafe and chaotic living conditions of our lives were not visible or obvious to the outside world. Despite the appearance of everything being under control, we experienced continued chaos, developed a tolerance for chaos and I believe became addicted to chaos. I think it is important to say I have never done a scientific experiment to investigate this theory. It is based on observation of numerous alcoholic/addicts and their behavior”.

This was clearly written from experience and appears to have some face validity. Interestingly, Barsky then goes on to say:

“During the recovery process life becomes more manageable and less chaotic. The alcoholic/addict begins to feel a sense of autonomy and safety. A feeling of calm settles over their life. The paradox for the alcoholic/addict is that feeling calm is so unfamiliar it induces anxiety. There is a sense of waiting for the other shoe to drop. When there is a crisis, whether real or perceived, we actually experience a physical exhilaration and it feels remarkably like being active. From there it can be a very short distance to a relapse. Even if we don’t pick up we are not in a sober frame of mind. Addiction to chaos can be very damaging. Once engaged in someone else’s crisis we abandon ourselves and often develop resentments, especially if it is someone we love or are close to. Family chaos is the ‘best’ because it’s so familiar and we can really get off on it. When there is a crisis with family or friends we feel compelled to listen to every sordid detail and/or take action. We are unable to let go, we need to be in the mix even though it is painful and upsetting. It requires tremendous effort to detach and not jump in with both feet to the detriment to our well being”.

I find this account compelling because it’s written by someone that appears to have gone through this herself, and has now applied her therapeutic expertise retrospectively to understand the underlying psychology of what was occurring at the height of the addiction. Another compelling account is at Molly Field’s Yoga Blog.

“My object of desire is Chaos. My therapist told me at the end of my first session ever that I have a Chaos addiction…I’m not kidding: this stuff’s insidious. If it weren’t for my awareness of my ability to lose my temper over little-seeming things (aka scars from my past), I’d never know about the Addiction to Chaos. It’s because I grew up with it, was surrounded by it and trained by some of the world’s finest Chaos foments that I became one myself…My relationship with Chaos had become so much a part of my fabric of being that if I didn’t sense it, I would make it”.

Finally, I’ll leave you with the only tool that I have come across that claims to provide a diagnostic indication of whether someone is addicted to chaos. I need to point out that this came from the website of former psychologist Phil McGraw, the US television host of Dr. Phil. I have reproduced everything below verbatim (so when it says that “you are addicted to chaos” if you endorsed five or more of the ten items, that is the view of Dr. Phil – whenever I have co-developed a scale, I at least add the words “You may have a problem” rather than “You have got a problem”).

“While most people try to avoid drama, research shows that others have figured out how to trigger the body’s stress response, just for the rush. Take the test and find out if you’re creating chaos in your everyday life!

Directions: Answer the following questions ‘True’ or ‘False’

  • Do you usually yell and scream to make your point?
  • Do you ramp things up to win every argument? 

  • If you get sick, do you feel that EVERYONE should know about it?
  • 
When you argue, do you ever break things or knock them over? 

  • Does being calm or bored sound like the worst thing to you? 

  • Do you ever yell at strangers if you feel that they are in your way? 

  • Do you hate it when you are not the center of attention? 

  • Is there usually a crisis to solve in your life? 

  • Do you break up or threaten a break up with a mate often? 

  • Are you usually the one who starts fights?

Results: If you answered ‘True’ to five or more of the questions above, you are addicted to chaos”

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

Further reading

Barsky, R. (2007). Addicted to Chaos. A Sober Mind, December 2. Located at: http://asobermind.blogspot.co.uk/2007/12/addicted-to-chaos.html

Field, M. (2012). Recovering from an addiction to chaos. The Yoga Blog, April 7. Located at: http://www.theyogablog.com/recovering-from-addiction/

Griffiths, M.D. (2005). Workaholism is still a useful construct Addiction Research and Theory, 13, 97-100.

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

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Jakub, L. Addicted to chaos: Oprah’s interview with Lindsay Lohan. Hello Giggles, August 19. Located at: http://hellogiggles.com/addicted-to-chaos-oprahs-interview-with-lindsay-lohan

Kramer, L. (2015). Are you addicted to chaos? Recovery.org, January, 15. Located at: http://www.recovery.org/pro/articles/are-you-addicted-to-chaos/

Lee, J.K. (2007). Addicted to chaos: The journey from extreme to serene. Transformational Life Coaching and Consultancy.

Mask, C. (2011). Three signs you’re addicted to chaos. Business Week, March 18. Located at: http://www.businessweek.com/smallbiz/tips/archives/2011/03/three_signs_you_are_addicted_to_chaos.html

Posadzki, P., Choi, J., Lee, M. S., & Ernst, E. (2014). Yoga for addictions: a systematic review of randomised clinical trials. Focus on Alternative and Complementary Therapies, 19(1), 1-8.

Mordini, S. (2013). Are you addicted to chaos and drama? Mind Body Green, January 15. Located at: http://www.mindbodygreen.com/0-7395/are-you-addicted-to-chaos-and-drama.html

Brain humour: The Ig Nobels are coming to Nottingham Trent (again)

I apologise in advance, but today’s blog is (i) a not-so thinly disguised plug (well, a blatant plug) for a national event that is being hosted by my university on Wednesday 18th March (2015) and (ii) a just a slight updating of a blog I published a couple of years ago when the Ig Nobels last came to NTU. The new blurb I was sent by our local organizer Phil Banyard proclaims:

“The Ig Nobel Prizes honour achievements that first make people laugh, and then make them think. The prizes are intended to celebrate the unusual, honour the imaginative — and spur people’s interest in science, medicine, and technology. The awards are held each year at Harvard University and each award is presented by a Nobel laureate such is the esteem of this event. Over the past few years Marc Abrahams has brought an Ig Nobels tour to the UK in the spring. The tours highlights some of the key awards from the Ig Nobels’ back catalogue and provides a great opportunity to promote science to a wider audience. This year’s programme will feature Marc Abrahams, organiser of the Ig Nobel Prizes, editor of the Annals of Improbable Research, and Guardian columnist, together with a gaggle of Ig Nobel Prize winners and other improbable researchers. The programme will include: Chris McManus (Ig Nobel winner, Scrotal asymmetry in ancient Sculpture and man); Richard Stephens (Ig Nobel winner, The effect of swearing on pain); Richard Webb (Tribute to John Hoyland, the father of Nominative Determinism)”.

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If that’s not enough to get you going, I would also like to add that science’s top journal Nature says: “The Ig Nobel awards are arguably the highlight of the scientific calendar” (and who am I to argue?). For those of you who know nothing about the Ig Nobels, they were initiated by one of my favourite journalists, Guardian columnist Marc Abrams. Abrams writes a weekly column for the Guardian called Improbable Research and he is also the editor of the Annals of Improbable Research.

Back in February 2010, I was delighted when Abrams did a whole column on my research into gambling entitled ‘Slot-machine gamblers are hard to pin down: Why are gamblers such a difficult subject for academic study?’ Secretly, I’m very proud that he dedicated a whole column to my research. (In fact, I found out while I was researching the original blog on this topic, is that my research also features in his 2012 book This is Improbable: Cheese String Theory, Magnetic Chickens, and Other WTF Research. Here are some of the things he wrote about my research into gambling:

It’s hard to get good payoffs from slot machines, yes. But it’s also hard to get good information from slot machine gamblers, and that made things awkward for psychologists Mark Griffiths, of Nottingham Trent University, and Jonathan Parke, of Salford University. They explained how, in a monograph called Slot Machine Gamblers – Why Are They So Hard to Study? Griffiths and Parke published it a few years ago in the Journal of Gambling Issues. ‘We have both spent over 10 years playing in and researching this area,’ they wrote, ‘and we can offer some explanations on why it is so hard to gather reliable and valid data. Here are three from their long list.

  • First, gamblers become engrossed in gambling. ‘We have observed that many gamblers will often miss meals and even utilise devices (such as catheters) so that they do not have to take toilet breaks. Given these observations, there is sometimes little chance that we as researchers can persuade them to participate in research’ 
  • Second, gamblers like their privacy. They ‘may be dishonest about the extent of their gambling activities to researchers as well as to those close to them. This obviously has implications for the reliability and validity of any data collected.’
  • Third, gamblers sometimes notice when a person is spying on them. “The most important aspect of non-participant observation research while monitoring fruit-machine players is the art of being inconspicuous. If the researcher fails to blend in, then slot-machine gamblers soon realise they are being watched and are therefore highly likely to change their behaviour.’

The gambling machines go by many names, ‘fruit machine’ and ‘one-armed bandit’ also being popular. But Griffiths and Parke don’t obsess about nomenclature. The two are giants in their chosen profession. The International Journal of Mental Health and Addiction ran a paean from a researcher who said: ‘In the problem gambling field we don’t exhibit the same adulation as music fans for their idols, but we have our superstars and, for me, Mark Griffiths is one.’

Professor Griffiths is one of the world’s most published scholars on matters relating to the psychology of fruit-machine gamblers, with at least 27 published studies that mention fruit machines in their title. These range from 1994’s appreciative Beating the Fruit Machine: Systems and Ploys Both Legal And Illegal to 1998’s admonitory Fruit Machine Gambling and Criminal Behaviour: Issues for the Judiciary*. Women get special attention (Fruit Machine Addiction in Females: a Case Study), as do youths (Adolescent Gambling on Fruit Machines and several other monographs). There is the humanist perspective (Observing the Social World of Fruit-Machine Playing) as well as that of the biomedical specialist (The Psychobiology of the Near Miss in Fruit Machine Gambling). Griffiths and Parke collaborate often. Strangers to their work might wish to begin by reading the classic The Psychology of the Fruit Machine. Their fruitful publication record reminds every scholar that, even when a subject is difficult to study, persistence and determination can yield a rewarding payoff”.

All I can say is that after re-reading this, I wonder how I can still get my head through the door.

More recently, one of my papers was actually reported by Marc Abrams on his Improbable Research website. More specifically, my case study published in the Archives of Sexual Behavior about eproctophilia (i.e., sexual arousal from flatulence), was given press coverage in over 100 newspaper and magazine stories around the world including those in the UK, Ireland, US, Greece, Italy, Holland, China, and Ghana (e.g., New York Daily News, Huffington Post, Daily Telegraph, Daily Mirror, The Sun, Metro, Times of Malta, Irish Examiner, Asian Image, and Cosmopolitan). However, it was actually Abrams who first reported the story under the headline Academic Study of a Young Man’s Sexual Attraction to Human Gas”. For those who don’t know, the underlying philosophy of the IR website is to feature “research that makes people laugh and then think”. More specifically, Abrams wrote:

“Professor Mark D Griffiths of Nottingham Trent University has published a remarkable new study. Here’s how we know this study is remarkable:  The university’s press office sent copies of it to many prominent science journalists, remarking that (1) ‘It’s the world’s first paper on eproctophilia – sexual arousal from flatulence’ and (2) ‘Professor Griffiths would be more than happy to talk to you in more detail’. A remarkable number of those journalists immediately sent it on to us at the Annals of Improbable Research. We are, in this blog entry you are reading right now, remarking upon that study. There is more. Lots more. In other respects, too, Professor Griffiths is an expert. So renowned is he that Wikipedia devoted an entire web page to him. One of the many things on which he is an expert is the academic study of gamblers. We have celebrated some of his abundant work on that subject. (We express our thanks, and other emotions, to the many journalists who instinctively decided that they should alert us to the existence of Professor Griffiths’s new line of research.) BONUS (unrelated): The 1998 Ig Nobel Prize for literature was awarded to Dr. Mara Sidoli of Washington, DC, for her illuminating report, ‘Farting as a Defence Against Unspeakable Dread’ [Journal of Analytical Psychology, vol. 41, no. 2, 1996, pp. 165-78.]”

Anyway, if you’d like to go see Marc Abrams in person, here are the further details:

Event: The Ig Nobels: A celebration of Science

Time and date: 6.30 pm, Wednesday 18th March

Location: The Newton Building on the City Campus of the University.

Booking details: The event is free but booking is essential.

Book at: www.ntu.ac.uk/ignobles2015 (direct link here)

Details of their UK events and more information about the Ig Nobels can be found on their website: http://www.improbable.com/improbable-research-shows/complete-schedule/

* I’ve never actually written a paper with this title but I think it’s an inadvertent mix of two or three papers I’ve written with similar titles

 

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

Further reading (i.e., the papers cited by Marc Abrams above)

Griffiths, M.D. (1991). The psychobiology of the near miss in fruit machine gambling. Journal of Psychology, 125, 347-357.

Griffiths, M.D. (1994). Beating the fruit machine: Systems and ploys both legal and illegal. Journal of Gambling Studies, 10, 287-292.

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

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

Griffiths, M.D. (2003). Fruit machine addiction in females: A case study. Journal of Gambling Issues, 8. Located at: http://www.camh.net/egambling/issue8/clinic/griffiths/index.html.

Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, 42, 1383-1386.

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

Parke, J. & Griffiths, M.D. (2006). The psychology of the fruit machine: The role of structural characteristics (revisited). International Journal of Mental Health and Addiction, 4, 151-179.

Yeoman, T. & Griffiths, M.D. (1996). Adolescent machine gambling and crime (I). Journal of Adolescence, 19, 99-104.

Griffiths, M.D. & Sparrow, P. (1998). Fruit machine addiction and crime. Police Journal, 71, 327-334.

Griffiths, M.D. (2001). Cybercrime: Areas of concern for the judiciary. Justice of the Peace, 165, 296-298.

Flying ‘high’: A brief look at ‘binge flying’ and ‘flying addiction’

As part of my job I do a lot of travel. It’s an occupational necessity. Last year alone I did over 20 work trips abroad that comprised over 50 flights (such as the six flights that I had to take to get to a conference in Uruguay and then back to the UK). One of my research colleagues at a conference in Taiwan jokingly accused me of being ‘addicted’ to flying. Nothing could be further from the truth. For me, flying is little more than a way to get from A to B. However, I have tried to turn my experiences into something more positive and have written a number of short articles providing tips about flying and travelling abroad for outlets such as the British Medical Journal and the PsyPAG Quarterly (see ‘Further Reading’ below).

However, there are a few papers in the academic literature that have proposed the idea of ‘binge flying’ and ‘flying addiction’ in the Annals of Tourism Research. One British research team (Drs. Scott Cohen, James Higham and Christina Cavaliere) have written various papers on flying, particularly the dilemma that many business travellers face in wanting to be ‘green’ and ‘eco-friendly’ but knowing that the amount of flying they are doing is contributing to climate change and leaving a ‘carbon footprint’.

One of the papers published by Cohen and his colleagues was entitled ‘Binge flying: Behavioural addiction and climate change’. In their introduction to the topic, the authors referenced my 1996 paper in the Journal of Workplace Learning on behavioural addictions to argue there was now evidence that many behaviours could be potentially addictive even without the ingestion of a psychoactive substance. They then went on to say:

“[Two] articles in the popular press have further implicated frequent tourist air travel as a practice that may constitute behavioural addiction (Hill, 2007; Rosenthal, 2010). In stark contrast to most behavioural addictions, which are characterised by severe negative consequences for individuals directly, the destructive outcome attributable to excessive flying is premised upon air travel’s growing contribution to global climate change. Both Burns and Bibbings (2009) and Randles and Mander (2009) cite Hill’s (2007) interview in ‘The Observer’ with ‘Rough Guides’ founder Mark Ellingham, who coins the term ‘binge flying’ in critiquing the public’s growing appetite for holidays accessed through air travel”.

They also used my 1996 paper to make a number of points to support their premise that excessive flying can be conceptualized as an addiction. More specifically, they noted:

“Griffiths (1996) notes that behavioural addictions may have ‘normative ambiguity’, in that moderate use is accepted but stigma can result from over-enactment of the behaviour, or compulsive consumption (Hirschman, 1992)…Even though addictions are typically conceptualised as purely negative, Griffiths (1996) distinguishes a number of possible addiction benefits that individuals may perceive, such as changes of mood and feelings of escape, positive experiences of pleasure, excitement, relaxation, disinhibition of behaviour and the activity as a source of identity and/or meaning in life…Not only does excessive tourist air travel meet this basic criterion of behavioural addiction where longer-term outlooks are sacrificed for immediate gratification, but tourist experiences also supply many of the psychological benefits that Griffiths (1996) uses to characterise sites of potential behavioural addiction. These include feelings of escape, heightened experiences of pleasure and excitement (a ‘buzz’ or ‘rush’), relaxation, disinhibition of behaviour and the activity as an arena for identity work and searching for meaning in life”.

To support their argument that flying can be an addiction, they assert there are three key characteristics that can be found in addictive behavior that can be applied to flying: (i) a drive or urge to engage in the behaviour, (ii) a denial of the harmful consequences of the behaviour, and (iii) a failure in attempts to modify the behaviour. As regular readers of my blog will know, I operationally define addictive behaviour as comprising six components (salience, mood modification, tolerance, withdrawal, conflict and relapse), and as such, flying would be unlikely to be classed as an addiction by my own criteria. The authors interviewed 30 participants as part of their research but little of the qualitative data presented made any reference to addiction or elements of addictive behaviour. They somehow concluded that:

“Continued movement in consumer discourses towards a mainstream negative perception of the practice of holiday frequent flying may eventually find tourism consumption the further subject of query as an addictive phenomenon. Frequent air travel may then join gambling, smoking, shopping, video games and Internet use, (Clark & Calleja, 2008), amongst others, as ‘pathologised’ sites of behavioural addiction that reflect society’s (re)positioning of certain types of behaviour as socially dysfunctional”.

The concept of ‘binge flying’ and ‘flying addiction’ were more recently critiqued by Dr. Martin Young and colleagues in a 2014 issue of the Annals of Tourism Research. Their view closely matches my own view (and they also cite my 1996 paper on behavioural addictions) when they asserted:

“We take issue with the application of a behavioural addiction framework in the context of consumption generally, and frequent flying specifically. We argue that while the conceptual lens of behavioural addiction may be seductive to some (cf. Hill, 2007), it is, in contrast to the position of Cohen et al. (2011), ultimately counterproductive to the development of a meaningful critical response to the question of frequent flying and environmental damage… There is, of course, a deep irony in even trying to view frequent flying through the lens of addiction. Tourism, traditionally the realm of freedom, unconstraint and abandon (Crompton, 1979; Sharpley, 2003) is now recast as a pathology, associated with the pernicious tendencies of the human psyche.

Dr. Young and colleagues’ paper asserts that the idea that flying in extreme cases could be classed as a behavioural addiction is “unconvincing” (and again is something that I agree with). The paper also adapts the 2013 DSM-5 criteria for gambling disorder (substituting the word ‘gambling’ with ‘flying’) to highlight that while it is theoretically possible for someone to have an addiction to flying, it is highly unlikely even amongst the most frequent of flyers. As they note:

“A diagnosed flying addict (and some may exist) would appear to differ from the frequent flyer who is feeling guilty about the environmental consequences of flying. Indeed, the latter would appear to be entirely rational. Flying may be associated with feelings of guilt and suppression, but so are many other activities, like driving to work, using plastic bags, and using electricity from coal-powered generators. This does not make flying an addiction as defined by the DSM-5. In addition, a flying addict would be addicted to the act of flying when, in reality, people fly as part of a broader tourism or business journey or experience. Flying may be incidental to the motivations for travel, merely an unavoidable part of attaining a particular experience. In other words, the focus of flying addiction is likely to be complicated and shifting, unlike, for instance, gambling addiction, that is more clear-cut”.

Pathologizing a behaviour like flying may be stretching the addiction analogy a little too far, but I don’t see a theoretical reason why someone could not become addicted. However, it’s unknown as to what the actual object of flying addiction might be. Is it the actual flying and being in the air? The thrill of take-offs and landings? Is it the feeling of being attended and catered for (especially when flying business class) by the airline staff? Is it the anticipation associated of visiting somewhere new? All of these suggestions could be empirically tested but probably from a purely motivational view rather than from an addiction perspective.

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

Further reading

Burns, P., & Bibbings, L. (2009). The end of tourism? Climate change and societal challenges. 21st Century Society, 4(1), 31-51.

Clark, M., & Calleja, K. (2008). Shopping addiction: A preliminary investigation among Maltese university students. Addiction Research and Theory, 16(6), 633-649.

Cohen, S. A., Higham, J. E., & Cavaliere, C. T. (2011). Binge flying: Behavioural addiction and climate change. Annals of Tourism Research, 38(3), 1070-1089.

Crompton, J. (1979). Motivations for pleasure vacation. Annals of Tourism Research, 6(4), 408–424.

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

Griffiths, M.D. (2003). Tips on…Business travel abroad, British Medical Journal, 327, S38.

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

Griffiths, M.D. (2012). Tips on…Conference travel abroad. Psy-PAG Quarterly, 83, 4-6.

Higham, J. Cohen, S. & Cavaliere, C. (2013). ‘Climate breakdown’ and the ‘flyer’s dilemma': Insights from three European societies. In: Fountain, J. & Moore, K. (Eds.). CAUTHE 2013: Tourism and Global Change: On the Edge of Something Big (pp. 321-324). Christchurch, N.Z.: Lincoln University.

Hill, A. (2007). Travel: The new tobacco. The Observer, May 6. Located at: http://www.guardian.co.uk/travel/2007/may/06/travelnews.climatechange

Hirschman, E. C. (1992). The consciousness of addiction: Toward a general theory of compulsive consumption. Journal of Consumer Research, 19(2), 155-179.

Randles, S., & Mander, S. (2009a). Practice(s) and ratchet(s): A sociological examination of frequent flying. In S. Gössling & P. Upham (Eds.), Climate change and aviation: Issues, challenges and solutions (pp. 245-271). London: Earthscan.

Rosenthal, E. (2010, 24 May). Can we kick our addiction to flying? Guardian, May 24. Located at: http://www.guardian.co.uk/environment/2010/may/24/kick- addiction-flying

Sharpley, R. (2003). Tourism, tourists and society. Huntingdon: Elm Publications.

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