Category Archives: Adolescence

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

Distraction plans: Excessive smartphone use and pain perception

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

Played to death: What turns online gaming into a health risk?

Please note that the following article is a slightly extended version of an article that was first published by CNN International

Last month, a 32-year old male gamer was found dead at a Taiwanese Internet café following a non-stop three-day gaming session. This followed the death of another male gamer who died in Taipei at the start of the year following a five-day gaming binge.

While these cases are extremely rare, it does beg the question of why gaming can lead to such excessive behaviour. I have spent nearly three decades studying videogame addiction and there are many studies published in both the medical and psychological literature showing that very excessive gaming can lead to a variety of health problems that range from repetitive strain injuries and obesity, through to auditory and visual hallucinations and addiction. I have to stress that there is lots of scientific research showing the many educational and therapeutic benefits of playing but there is definitely a small minority of gamers that develop problems as a result of gaming overuse.

But what is it that makes gaming so compulsive and addictive for the small minority? For me, addiction boils down to constant reinforcement, or put more simply, being constantly rewarded while playing the game. Gaming rewards can be physiological (such as feeling ‘high’ or getting a ‘buzz’ while playing or beating your personal high score), psychological (such as feeling you have complete control in a specific situation or knowing that your strategic play helped you win), social (such as being congratulated by fellow gamers when doing something well in the game) and, in some cases, financial (such as winning a gaming tournament). Most of these rewards are – at least to some extent – unpredictable. Not knowing when the next reward will come keeps some players in the game. In short, they carry on gaming even though they may not have received an immediate reward. They simply hope that another reward is ‘just around the corner’ and keep on playing.

Added to this is the shift over the last decade from standalone console gaming to massively multiplayer online games where games never end and gamers have to compete and/or collaborate with other gamers in real time (instead of being able to pause the game and come back and play from the point at which the player left it). Many excessive gamers report that they hate logging off and leaving such games. They don’t like it as they don’t know what is going on in the game when they are not online.

The last five years has seen large increase in the number of scientific studies on problematic gaming. In May 2013, the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). For the first time, the DSM-5 included ‘internet gaming disorder’ (IGD) as a psychological condition that warrants future research. Throughout my research career I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences such as total preoccupation, mood modification, cravings, tolerance, withdrawal symptoms, conflict with work, education and other people, and loss of control. These similarities likely reflect a common etiology of addictive behaviour.

So when does a healthy enthusiasm turn into an addiction? At the simplest level, healthy enthusiams add to life and addictions take away from it. But how much is too much? This is difficult to answer as I know many gamers who play many hours every day without any detrimental effects. The DSM-5 lists nine criteria for IGD. If any gamer endorses five or more of the following criteria they would likely be diagnosed as having IGD: (1) preoccupation with internet games; (2) withdrawal symptoms when internet gaming is taken away; (3) the need to spend increasing amounts of time engaged in internet gaming, (4) unsuccessful attempts to control participation in internet gaming; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming; (6) continued excessive use of internet games despite knowledge of psychosocial problems; (7) deception of family members, therapists, or others regarding the amount of internet gaming; (8) use of the internet gaming to escape or relieve a negative mood;  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games.

The good news is that only a small minority of gamers suffer form IGD. Most online games are fun and exciting to play. But like any activity that is taken to excess, in a minority of cases the activity can become addictive. Any activity if done for days on end could lead to severe health problems and even death – and gaming is no exception. Instead of demonizing games, we need to educate gamers about the potential dangers of very excessive use.

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

Further reading

Griffiths, M.D. (2014). Gaming addiction in adolescence (revisited). Education and Health, 32, 125-129.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, 4(1), 1-4.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

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

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

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.

Lopez-Fernandez, O., Honrubia-Serrano, M.L., Baguley, T. & Griffiths, M.D. (2014). Pathological video game playing in Spanish and British adolescents: Towards the Internet Gaming Disorder symptomatology. Computers in Human Behavior, 41, 304–312.

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

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

Spekman, M.L.C., Konijn, E.A, Roelofsma, P.H.M.P. & Griffiths, M.D. (2013). Gaming addiction, definition, and measurement: A large-scale empirical study, Computers in Human Behavior, 29, 2150-2155.

Primal suspects: The psychology of Tears for Fears

Because I am both a psychologist and self-confessed music obsessive, one of the questions I am often asked by my friends is ‘Who is the most psychologically influenced band?’ Based on my own musical tastes, I would have to say Tears for Fears (one of many bands named after something psychological – other contenders based on name alone include Pavlov’s Dog, Therapy?, Primal Scream, Madness, and The Mindbenders, to name a few).

Tears For Fears (TFF) were one of my favourite bands as a teenager and (if my memory serves me) I saw them support The Thompson Twins just as their third single (‘Mad World’) became their first British hit single. TFF were formed in 1981 by Roland Orzabal and Curt Smith after they left the Bath-based band Graduate (mostly remembered for their single ‘Elvis Should Play Ska’ from their debut – and only – LP Acting My Age). They briefly called the band ‘History of Headaches’ but eventually settled on TFF.

TFF’s name was inspired by primal therapy (as was the band Primal Scream). Even from a young age I was well aware of primal therapy as I was – and still am – a massive fan of The Beatles and John Lennon. Lennon underwent primal therapy in 1970 with its’ developer (US psychotherapist Dr. Arthur Janov). In fact, one of the reasons I chose to study psychology at university was because I had read Janov’s first book (The Primal Scream) just because of my love of Lennon’s work. As the Wikipedia entry on primal therapy notes:

“Primal therapy is a trauma-based psychotherapy trauma-based created by Arthur Janov, who argues that neurosis is caused by the repressed pain of childhood trauma. Janov argues that repressed pain can be sequentially brought to conscious awareness and resolved through re-experiencing the incident and fully expressing the resulting pain during therapy. Primal therapy was developed as a means of eliciting the repressed pain; the term Pain is capitalized in discussions of primal therapy when referring to any repressed emotional distress and its purported long-lasting psychological effects. Janov criticizes the talking therapies as they deal primarily with the cerebral cortex and higher-reasoning areas and do not access the source of Pain within the more basic parts of the central nervous system. Primal therapy is used to re-experience childhood pain – i.e., felt rather than conceptual memories – in an attempt to resolve the pain through complete processing and integration, becoming ‘real’. An intended objective of the therapy is to lessen or eliminate the hold early trauma exerts on adult life”.

The Primal Scream book recounts the primal therapy experiences that Janov had with 63 clients during a year-and-a-half period in the late 1960s (and who he claimed were all successfully ‘cured’ using his newly developed therapy). Unlike John Lennon, TFF never underwent primal therapy themselves (but read Janov’s work). It was actually Dr. Janov’s 1980 book Prisoners of Pain (Unlocking The Power Of The Mind To End Suffering) where he claimed “tears as a replacement for fears” (and hence the band’s chosen name). In a 2004 television interview, both Smith and Orzabal said they were disillusioned when they met Janov in the mid-1980s (claiming Janov had become quite “Hollywood” and asking TFF to write a musical based on his work).

Both Smith and Orzabal claimed to have had unhappy childhoods that led them to the work of Dr. Janov (they were too poor – unlike Lennon – to actually have primal therapy and described having such therapy as “an aspiration”). Most of their songs directly or indirectly referenced primal therapy. In fact, I would go as far as to say that the whole of their first album The Hurting was a concept LP. Orzabal claimed that “writing the title track was a strange piece of psychic osmosis…I had an acoustic guitar in my hand at the time and played [Curt] what he was describing: that’s how ‘The Hurting’ was written, and we knew for a long time it was the right name for our first album”.

A quick look at the album’s song titles shows how influenced they had been by primal therapy (such as the title track, ‘The Prisoner’, ‘Mad World’, Ideas As Opiates’, ‘Watch Me Bleed’, ‘Memories Fade’, ‘Start Of The Breakdown’, ‘Pale Shelter (You Don’t Give Me Love’, and ‘Change’). As Paul Sinclair notes in his sleeve notes for the latest box-set reissue:

“Like all great art, ‘The Hurting’ connects. The emotion grabs hold of your heart and gives it a squeeze. The Primal Therapy and Janov influence provide a satisfying consistency, and the band are comfortable in using the ‘C’ word [concept] in reference to ‘The Hurting’…[Orzabal adds] It’s a very consistent album with its own personality. There’s a strong message running through it and some of the song titles were taken from Janov’s writing”.

A number of commentators (including Sinclair) have made the observation that the whole album is about the transition between childhood and adulthood. Maybe that’s why I bought it as a teenager. In contrast to lyrics in The Smiths’ ‘Panic’ (“It says nothing to me about my life”), The Hurting “said something to me about my life”. Sinclair also notes:

“Deep analysis of the songs and navel gazing is not a condition of entry. The genius of ‘The Hurting’ is that on one level, it is just an album of great, melodic, hook-filled pop songs…In the end. ‘The Hurting’ was the album that the band needed to make. There was never going to be an alternative debut. The basic idea behind Janov’s Primal Therapy – the impact that the trauma of childhood had on your character as an adult – was the blood running through the veins of the record”.

Of course, TFF haven’t been the only band to have songs and/or an album influenced by psychologists and/or psychological theory (and of course Carl Jung and Sigmund Freud were both on the cover of The Beatles Sgt. Pepper’s Lonely Hearts Club Band). Arguably the most well known LP inspired by Dr. Janov’s therapy was John Lennon’s first ‘proper’ 1970 solo LP (John Lennon/Plastic Ono Band). Other artists have had direct inspiration from Freud (Freudiana by the Alan Parsons Project, the song ‘Psychotherapy’ by Melanie), Jung (Synchronicity by The Police) and Wilhelm Reich (Kate Bush’s single ‘Cloudbusting’ and Patti Smith’s ‘Birdland’). However, I would still contend that TFF were more psychologically influenced as primal therapy was their life philosophy (at least for a number of years).

Most people would probably argue that it was only The Hurting LP that was influenced by Dr. Janov but their later singles off their second LP Songs From The Big Chair are arguably primal therapy-related including ‘Mother’s Talk’ and ‘Shout’ (“Shout, shout, let it all out” could be the mission statement of primal therapy). However, Roland Orzabal claimed that neither were rooted in primal therapy:

“A lot of people think that ‘Shout’ is just another song about primal scream theory continuing the themes of the first album. It is actually more concerned with political protest. It came out in 1984 when a lot of people were still worried about the aftermath of The Cold War and it was basically an encouragement to protest…The song [Mothers Talk] stems from two ideas. One is something that mothers say to their children about pulling faces. They say the child will stay like that when the wind changes. The other idea is inspired by the anti-nuclear cartoon book ‘When The Wind Blows‘ by Raymond Briggs”.

However, ‘The Big Chair’ (B-side to ‘Shout’ and the inspiration for the title of the band’s second LP Songs From The Big Chair) has undeniable psychological roots. The song was inspired by the 1976 film Sybil (based on the 1973 non-fiction book by of the same name by Flora Rheta Schreiber). Sybil is about US psychiatric patient Sybil Dorsett (actually a pseudonym for Shirley Ardell Mason) who was treated for multiple personality disorder (now known as dissociative identity disorder) by her psychoanalyst (Dr. Cornelia Wilbur). ‘The Big Chair’ was in the therapist’s office where Sybil was treated and where she felt safest when talking about her traumatic childhood. Other songs hidden away on TFF B-sides cover aspects of traumatic psychology (‘My Life In The Suicide Ranks’) as well as ‘anti-science’ songs (‘Schrodinger’s Cat’ and ‘Déjà Vu & The Sins of Science’). However, like Christian historian Nathan Albright, I too believe the second LP and later 1986 single ‘Laid So Low’ are psychologically-based:

“Nor did the interest in psychology stop [with ‘The Hurting’]. Tears For Fears’ second album, “Songs From The Big Chair,” are a self-aware “multiple personality” exploration, a conceptual connection that is often forgotten because the hit singles from the album were so successful…Clearly, the musings about power and anger and memory that inform the work of Tears For Fears, the melancholy underpinnings of songs like ‘Watch Me Bleed’ and ‘Laid So Low (Tears Roll Down)’ are fairly easy to recognize, and draw greater meaning the more one knows about the band and its personal histories”.

As the years have passed, TFF’s songs have been less psychological but we are a product of our pasts and I would argue that the band’s output is still likely to be shaped by both their conscious and unconscious ideology. Smith was recently interviewed and he admitted that he still had an interest in various psychologies but that he no longer believed in primal therapy:

“Primal theory blames everything on your parents. So that teenage angst we were going through at the time. Since then, I think I’ve moved on to various different psychologies, but it’s something we’re both interested in. Since then, certainly, I’m not a huge believer in primal theory anymore, but I think that comes from having children”.

Maybe their most recent album (Everybody Loves A Happy Ending) has at last brought the band’s traumatic past to rest. Maybe the music itself became a kind of psychological therapy. As Nathan Albright concluded:

“The fact that [Tears For Fears] have a popular and critically acclaimed body of musical work is itself remarkable, but the fact that their work is heavily influenced by psychology, serving as therapy, serves as an inspiration. Rather than self-medication through drugs or alcohol, the two chose music as therapy, turning their lives into the inspiration for hauntingly beautiful songs in their debut concept album, ‘The Hurting’…And that is the most powerful legacy of Tears For Fears, in providing a way for both commercial viability as well as personal therapy. Many creative people [use] creativity as a way to wrestle with our own demons, and the fact that Tears For Fears were able to do it openly and honestly and sincerely, and successfully gives hope to the rest of us who have chosen to deal with our issues in the light, rather than engaging in false pretense”.

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

Further reading

Albright, N. (2012). Suffer the children: Tears For Fears and musical therapy. Edge Induced Cohesion, May 2. Located at: https://edgeinducedcohesion.wordpress.com/2012/05/02/suffer-the-children-tears-for-fears-and-musical-therapy/

Comaretta, L. (2014). Tears For Fears’ Curt Smith: Back in The Big Chair. Consequence of Sound, November 6. Located at: http://consequenceofsound.net/2014/11/tears-for-fears-curt-smith-back-in-the-big-chair/

Janov, A. (1970). The Primal Scream. New York: Dell Books.

Janov A (1977). Towards a new consciousness. Journal of Psychosomatic Research, 21, 333–339.

Janov, A. (1980). Prisoners of Pain: Unlocking The Power Of The Mind To End Suffering. New York: Anchor Books.

Sinclair, P. (2013). Tears For Fears: The Hurting. (Booklet in the Deluxe Reissue of ‘The Hurting’).

Wikipedia (2015). Arthur Janov. Located at: http://en.wikipedia.org/wiki/Arthur_Janov

Wikipedia (2015). Primal therapy. Located at: http://en.wikipedia.org/wiki/Primal_therapy

Wikipedia (2015). Tears For Fears. Located at: http://en.wikipedia.org/wiki/Tears_for_Fears

The junkie generation? Teenage “addiction” to social media

Earlier today I appeared live on my local radio station (BBC Radio Nottingham) commenting on a study released by the Allen Carr Addiction Clinics (ACAC) concerning teenage addiction (and more specifically addiction to social media). The study was a survey of 1,000 British teenagers aged 12 to 18 years old and the press release went with the heading “INFO UK BREEDING A GENERATION OF TEENAGE ADDICTS SAYS NEW STUDY” (their capital letters, not mine) with the sub-headline that “83% of UK teenagers would struggle to go ‘cold turkey’ from social media and their other vices for a month”.

As someone that has spent almost 30 years studying ‘technological addictions’ I was interested in the survey’s findings. I tried to get hold of the actual report by contacting the ACAC Press Office. They were very helpful and sent me a copy of the Excel file containing the raw data (entitled ‘Addicted Britain’). They also informed me that the data were collected for ACAC by the market research company OnePoll, and that the teenagers filled out the survey online (with parents’ permission). However, there is no actual published report with the findings (and more importantly, no methodological details). I asked ACAC if they knew the response rate (for instance, was the online survey sent to 10,000 teenagers to get their 1,000 responses that would give a response rate of 10%), and how were the teenagers recruited in the first place. Also, as the survey was carried out online, those teenagers who are the most tech-savvy and feel confident online, would be more likely to participate than those who don’t like (or rarely use) online applications. Before I comment on the survey itself, I would just like to provide some excerpts from the press release that was sent out:

“The explosion of social media, selfies and mobile devices is priming a generation of UK teenagers for a lifelong struggle with addiction…83% of UK teenagers admit they would struggle to give up their vices for a whole month. [The study] unveiled a worrying trend of growing numbers of young people constantly striving to find the next thrill, mostly via technology and social media. When asked which behaviours they could abstain from, UK teens said they would most struggle living without texting (66%), followed by social networking (58%), junk food (28%) and alcohol (6%). The report found that the average teen checks social media 11 times a days, sends 17 text messages and takes a ‘selfie’ picture every four days. This constant pursuit of stimulation, peer approval, instant gratification, and elements of narcissism are all potential indicators of addictive behaviour. The study highlights that parents across the UK are inadvertently becoming ‘co-dependents’ enabling their child’s addictions by providing them with cash albeit with the best of intentions”.

The first thing that struck me reading this text was the use of the word “vice”. Most dictionary definitions of a vice is “immoral or wicked behaviour” or criminal activities involving prostitution, pornography, or drugs”. As far as I am concerned, social networking, junk food, and alcohol are not vices (especially social networking). The whole wording of the press release is written in a way to pathologise normal behaviours such as engaging in social media use. Also, asking teenagers about which behaviours they could not abstain from for a month tells us almost nothing about addiction. All it tells us is that the activities that teenagers most engage in are the ones they would find hardest not to do. This is just common sense. My main hobbies are listening to music on my i-Pod and reading. I would really have difficulty in not listening to my favourite music or reading for a whole month but I’m not addicted to music or reading.

The ACAC kindly sent me all the questions that were asked in the survey and there was no kind of addiction scale embedded in any of the questions asked. Basically, the survey does not investigate teenagers’ potential addictions, as no screening instrument for any behaviour asked about was included in the survey. There were some attitude questions asking whether activities like social networking could be addictive, but as I have argued in previous blogs, almost any activity that is constantly rewarding can be potentially addictive.

That’s not so say we shouldn’t be concerned about teenagers’ excessive use of technology as my own research has shown that a small minority of teenagers do appear to have problems and/or be addicted to various online activities. However, as my research has shown, doing something excessively doesn’t mean that it is addictive. As I have noted in a number of my academic papers, the difference between a healthy enthusiasm and an addiction is that healthy enthusiasm add to life and addictions take away from it. The perceived overuse of technology by the vast majority of teenagers is quite clearly something that is life-enhancing and positive with no detrimental effects whatsover.

Given that the vast majority of teenagers use the social media to communicate and interact with friends, I was surprised that ACAC’s findings were not closer to 100% saying that they couldn’t abstain for one month. Which teenagers would find it easy not to use social media for a month given how important it is in their day-to-day social lives? The findings in the press release also quote John Dicey (Global Managing Director and Senior Therapist of ACAC) who said:

“The findings of this report are cause for concern and highlight a generation of young people exhibiting many of the hallmarks of addictive behaviour. The explosion of technology we have seen since the late 90’s offers incredible opportunities to our youth – the constant stimulation provided by access to the internet for example can be a good or a bad thing. There’s a price to pay. This study indicates that huge numbers of young people are developing compulsions and behaviours that they’re not entirely in control of and cannot financially support. Unless we educate our young people as to the dangers of constant stimulation and consumption, we are sleepwalking towards an epidemic of adulthood addiction in the future”.

While my own research shows that a small minority of teenagers experience problems concerning various online activities, there was almost nothing in the ACAC report “huge numbers of young people are developing compulsions and behaviours that they’re not entirely in control of”. The use of the word “huge” is what we psychologists call a ‘fuzzy quantifier’ (as what is ‘huge’ to one person may not be ‘huge’ to another). Mr. Dicey’s conclusions simply cannot be made from the data collected. He says that the report shows that many teenagers are displaying the “hallmarks of addictive behaviour” but given no addiction screening instruments were used, the data do not show this. The press release uses the following findings to make the claim that “the abundance of technology that UK teens can access seems to be creating a generation of ‘tech addicts’!”

“One-third of UK teens (32%) admit they check social media more than 10 times a day. The report also found that the average teen checks social media 11 times day, which equals once every 1.5 hours they are awake. UK teens are also avid takers of ‘selfies’, with over a quarter taking more than 10 a month. The average teen takes 7.4 selfies a month, equalling one every four days on average…The plethora of technology available to teens is also having a worrying impact on their attention spans. 1 in 4 teens have over 20 apps on their smartphones, with the average teen having 13 apps on their device. The constant search for the ‘next thing’ is evidenced in how they use apps – 46% admitted that they stop using or delete an app less than a week after using it, freeing up storage space for a new app”.

Anyone that has teenagers (I have three screenagers myself) will tell you that the above statistics indicate adolescent normality not addiction. Checking social media 10 times a day does not indicate addiction in the slightest. Although I have never taken a selfie, I check my social media far more than 10 times a day. Deleting apps to make way for other apps is no different from me removing songs on my i-Pod every week to make way for other songs I want to listen to. Again, there is absolutely nothing in these statistics that provides evidence of adolescent addiction.

Anyone that is aware of my work will know that I take the issue of teenage technology use seriously and that I firmly believe that a small minority of adolescents experience addiction to various online applications. However, studies like the one done for ACAC do little for the area as the rhetoric of the claims are unsupported by their data.

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

Further reading

Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.

Griffiths, M.D., King, D.L. & Delfabbro, P.H. (2014). The technological convergence of gambling and gaming practices. In Richard, D.C.S., Blaszczynski, A. & Nower, L. (Eds.). The Wiley-Blackwell Handbook of Disordered Gambling (pp. 327-346). Chichester: Wiley.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, 4(1), 1-4.

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., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

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

Kuss, D.J. & Griffiths, M.D. (2011). Addiction to social networks on the internet: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552.

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

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

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

The highs of the prize: Are instant-win products a form of gambling?

A nine-year old boy walks into a shop and buys a packet of potato chips. An eight-year old girl walks into the same shop and buys a chocolate bar. Nothing particularly unusual except this particular packet of potato chips poses the question “Is there a spicy £100,000 inside?” in big letters on the front of the packet with the added rider “1000’s of real £5 notes to be won!” The bar of chocolate offers “£1 million in cash prizes – win instantly. Look inside to see if your a winner!!”. The boy opens up the bag of crisps but it contains nothing but crisps. He is very disappointed. The little girl opens up the chocolate bar and sees the all to familiar phrase “Sorry. You haven’t won this time but keep trying. Remember there’s £1 million in cash prizes to be won”. She too is very disappointed. Both of them decide to buy the product again to see if their luck will change. It doesn’t. This time a different chocolate bar says “Sorry this is not a winning bar. Better luck next time!” The most they are likely to win is another packet of crisps or some more chocolates.

This scenario describes a typical instant win product (whereby a consumer buys a particular product with the chance of instantly winning something else of financial value). This type of instant-win marketing has been around for some time and is not particularly new but it is the younger generation that is being targeted. In a different environment, it could be argued that these two children are “chasing” their losses in the same way a gambler chases theirs. All over the world, this type of marketing is becoming more prevalent with big multi-national companies also employing its use to increase sales (e.g., MacDonalds).

In gambling situations after losing money, gamblers often gamble again straight away or return another day in order to get even. This is commonly referred to as “chasing” losses. Chasing is symptomatic of problem gambling and is often characterized by unrealistic optimism on the gambler’s part. All bets are made in an effort to recoup their losses. The result is that instead of “cutting their losses” gamblers get deeper into debt pre-occupying themselves with gambling, determined that a big win will repay their loans and solve all their problems. Although not on this scale, the scenario outlined above appears to be a chasing-like experience akin to that found in gambling. To children, this type of behaviour appears to be a gambling-type experience and is similar to other gambling pre-cursors that I have highlighted in some of my papers such as the playing of marbles, card flipping, and sports card playing. For instance, in sports card playing, it is not uncommon for adolescents to keep buying packs of cards to get their favorite baseball or football star. Products like crisps and chocolate are popular and appeal not only to the young but to adults too. However, the fact that such promotions are often coupled with the appearance of teenage idols (e.g., famous pop groups or top soccer sporting heroes) suggests that it is younger people that are being aimed for.

Manufacturers of instant-win products claim that people buy their products because customers want them. They further claim that the appeal of a promotion is secondary to the appeal of the product. This may well be true with most people but instant-win promotions obviously increase sales otherwise so many companies would not resort to it in the first place. It would appear that most people have no problem on moral (or other) grounds with companies who use this type of promotion. However, there are those (such as those who work in the area of youth gambling) who wonder whether this type of promotion exploits the vulnerable in some way (i.e., children and adolescents). The question to ask is whether young children and adolescents are actually engaging in a form of gambling by buying these types of products.

Gambling is normally defined as the staking of money (or something of financial value) on the uncertain outcome of a future event. Technically, instant-win promotions are not a form of gambling. This is because (by law) manufacturers are required to state that “no purchase is necessary”. This whole practice it is little more than a lottery except that in very small letters at the bottom of the packet there is the added phrase “No purchase necessary – see back for details”. However, very few people would know this unless they bought the product in the first place, and secondly, the likelihood is that a vast majority will not do this anyway – particularly children and adolescents.

The small print usually reads “No purchase necessary. Should you wish to enter this promotion without purchasing a promotional pack, please send your name and address clearly printed on a plain piece of paper. If you are under 18, please ask a parent or guardian to sign your entry. An independently supervised draw will be made on your behalf, and should you be a winner, a prize will be sent to you within 28 days”. I have tried writing to companies to ascertain how many people utilize this route but (to date) I have been unsuccessful in gaining any further information. It is highly likely that very few people write to the companies concerned. There is a high likelihood that the companies in question have the empirical evidence but unfortunately it is not in the public domain. If it is assumed that the number of people who actually write to the companies for their names to be put into an independently supervised draw is very low, it can be argued that to all intents and purposes that people who buy such products are engaged in a form of gambling.

Since the introduction of the UK National Lottery and instant scratchcards in the mid-1990s, a “something-for-nothing” culture appears to have developed where people want to win big prizes on lots of different things. Children themselves are growing up in an environment where gambling is endemic. Having examined a variety of instant-win promotions, I am in little doubt that they should be viewed as gambling pre-cursors in that they are gambling-like experiences without being a form of gambling with which anyone can identify. It is unlikely that great numbers of children will develop a problem with this activity, but there is the potential concern that a small minority will. Research has consistently shown that the earlier that a child starts to gamble the more likely they are to develop a gambling problem.

Evidence that instant-win products are problematic to young children is mostly anecdotal. For instance, a number of years ago, I appeared on a UK daytime television programme with a mother and her two children (aged nine and ten years of age) who literally spent all their disposable income on instant-win promotions. These two children had spent hundreds of pounds of their pocket money in the hope of winning the elusive prizes offered but never won more than another bag of potato chips. The mother claimed they had “the gambling bug” and was “terrified they will have problems when they grow up”. She claimed she had done her utmost to stop them using their pocket money in this way but as soon as her back was turned they were off to the local corner shop to buy instant-win products. This wasn’t just restricted to products they enjoyed anyway. For instance, when they went to the supermarket to shop the children just fill up the shopping trolley with anything that has an instant-win promotion including tins of cat food – even though they didn’t have a cat!

Harsh critics of instant-win promotions might advocate a complete banning of these types of marketing endeavors. However, this is impractical if not somewhat over the top. What is more, there is no empirical evidence (to date) that there is a problem. However, this does not mean that such practices should not be monitored. Instant-win marketing appears to be on the increase and it may be that young children are particularly vulnerable to this type of promotion if anecdotal case study accounts are anything to go by.

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

Further reading

Griffiths, M.D. (1989). Gambling in children and adolescents. Journal of Gambling Behavior, 5, 66-83.

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

Griffiths, M.D. (1997). Instant-win promotions: Part of the gambling environment? Education and Health, 15, 62-63.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2003). Instant-win products and prize draws: Are these forms of gambling? Journal of Gambling Issues, 9. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2003.9.5

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

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D. (2013). Responsible marketing and advertising of gambling. i-Gaming Business Affiliate, August/September, 50.

Griffiths, M.D., King, D.L. & Delfabbro, P.H. (2009). Adolescent gambling-like experiences: Are they a cause for concern? Education and Health, 27, 27-30.

Hayer, T. & Griffiths, M.D. (2015). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment (Second Edition) (pp. 539-558). New York: Kluwer.

Zangeneh, M., Griffiths, M.D. & Parke, J. (2008). The marketing of gambling. In Zangeneh, M., Blaszczynski, A., and Turner, N. (Eds.), In The Pursuit Of Winning (pp. 135-153). New York: Springer.

Slots of fun: What should parents and teachers know about adolescent gambling? (Part 2)

Today’s blog is the second part of a two-part article (the first of which can be found here). The previous blog briefly examined risk factors in adolescent gamblers and signs of problem gambling in adolescents. The three lists below highlight some early warning signs of a possible gambling problem, some definite signs and a thumbnail profile of a problem gambler. This is followed by some (hopefully) helpful tips and hints.

Early warning signs of a gambling addiction

  • Unexplained absences from home
  • Continual lying about day-to-day movements
  • Constant shortage of money
  • General increase in secretiveness
  • Neglect of studies, family, friends, health and appearance
  • Agitation (if unable to gamble)
  • Mood swings
  • Loss of friends and social life
  • Gambling seen as a legitimate way of making money

Signs of a definite gambling problem

  • Large debts (which are always explained away)
  • Trouble at school or college about non-attendance
  • Unexplained borrowing from family and friends
  • Unwillingness to repay borrowed money
  • Total preoccupation with gambling and spending money on gambling
  • Gambling alone for long periods
  • Constantly chasing losses in an attempt to win money back
  • Constantly gambling until all money is gone
  • Complete alienation and rejection from family and friends
  • Lying about the extent of their gambling to family and friends
  • Committing crimes as a way of getting money for gambling or paying off debts
  • Gambling overriding all other interests and obligations

Profile of the problem adolescent gambler

  • Unwilling to accept reality and has a lack of responsibility for gambling
  • Gambles to escape deeper problems (and the gambling environment may even be a substitute for parental affection)
  • Insecure and feels inferior to parents and elders
  • Wants good things without making an effort and loves games of chance
  • Likes to be a ‘big shot’ and feels it’s important to win (gambling offers them status and a way of defining achievement)
  • Likes to compete
  • Feels guilty with losses acting as a punishing behaviour
  • May be depressed
  • Low self-esteem and confidence
  • Other compulsive and/or addictive traits

Finally it is worth noting some of the ‘trigger’ situations and circumstances that a gambling problem might first come to light. Paul Bellringer has highlighted an array of situations that provide an opportunity to help the gambler focus on their need to change. These are:

  • Acceptance by the gambler that control has been lost: This is the step before they ask for help.
  • Asking for help: Having realised for themselves that gambling has taken control over their life, they may reach out to those closest to them
  • Observation of too much time spent in a gambling environment: Such observations by friends or family may provoke discussion as to how this is affecting the life of a gambler.
  • Getting in to financial trouble/Accumulation of debts: This might be a crisis point at which problem gambling might raise its head for the first time.
  • Uncovered lies: Realization that the gambler has been caught lying may lead to admissions about their gambling problems
  • Dwindling social circles/Losing close relationships: These observation may again lead to problem gambling being discovered by family or friends.
  • Discovered crime: This is usually a real crisis point that the family may discover the truth for the first time.
  • Homelessness: Being thrown out of the family home may be the trigger for problem gamblers to be honest for the first time about the mess they are in. 

Discovering that you are the parent of an adolescent problem gambler can be highly stressful – particularly as it is often a problem that parents feel they have to face on their own. Before getting involved with their children parents have to understand the problem as well as the process of problem gambling. By the time a young gambler acknowledges they have a problem, the family may have already gone through a lot of emotional turmoil including feelings of anger, sadness, puzzlement and guilt. Parents should try and get in touch with a helping agency as soon as possible. The following points are appropriate for parents either during or as a follow-up to their initial contact with a helping agency.

  • Remember that you are not the only family facing this problem.
  • You may be able to help your child by talking the problem through but it is probably better if a skilled person outside the family is also involved.
  • Keep in mind that it is a serious matter and that the gambler cannot “just give up”.
  • Take a firm stand; whilst it might feel easier to give in to demands and to believe everything they say, this allows your child to avoid facing the problem.
  • Remember that your child likes to gamble and is getting something from the activity quite apart from money.
  • Do not forget that gamblers are good at lying – to themselves as well as you
  • Let your child know that you believe it is a problem even though they may not admit it.
  • Encourage your child all the time as they have to be motivated to change
  • Be prepared to accept that your child may not be motivated to change until they are faced with an acute crisis.
  • Leave the responsibility for gambling and its consequences with the gambler, but also help them to face up to it and to work at overcoming the dependency.
  • Do not condemn them, as it is likely to be unhelpful and may drive them further into gambling.
  • Setting firm and fair boundaries for your child’s behaviour is appropriate and is likely to be constructive in providing a framework with which to address the dependency.
  • Despite what your child may have done it is important to let them know that you still love them. This should be done even if you have to make a ‘tough love’ decision such as asking them to leave home.
  • Do not trust them with money until the dependency has been broken. If they are agreeable it is a helpful strategy for a defined short period of time to manage their money for them. In addition, help develop their financial management skills.
  • Encourage other alternative activities. Try to identify other activities that the child is good at and encourage them in that.
  • Give praise for any achievements (however small) although don’t go over the top.
  • Provide opportunities to contribute to the family or the running of the house to develop responsibility.
  • Try to listen with understanding and look at them with pleasure. Communication channels between child and parent can easily be blocked so simple measures can pay big dividends.
  • Bear in mind that as a parent you will need support too through this long process of helping the child. You will need the support of your family and may also need additional support from a helping agency.

Having successfully broken a dependency on gambling, it is important to put in place measures that will help prevent gambling relapses. Useful strategies include the following:

  • Place a limit on future gambling, or avoid gambling altogether.
  • Internalise learning and avoid reverting to ingrained reactions to difficult or stressful situations.
  • Watch for situations and circumstances that trigger the urge to gamble and be ready to face them.
  • Nurture self-esteem – work at feeling good about yourself.
  • Develop a range of interests that, preferably, meet similar needs to those that were previously being met by gambling.
  • Spend time and energy working at building good human relationships.
  • Reassess the significance of money and endeavour to reduce its importance in your life.
  • Continue to explore, on occasion, reasons why gambling became so significant in your life.

Other more general steps that gamblers should be encouraged to do include:

  • Be honest with themselves and others
  • Deal with all outstanding debts
  • Accept responsibility for their gambling
  • Abstain from gambling while trying to break the dependency
  • Talk about how gambling makes them feel
  • Take one day at a time
  • Keep a record of ‘gambling-free’ days
  • Be positive and not give up after a ‘slip’ or a ‘lapse’
  • Reward themselves after a gambling-free period
  • Develop alternative interests

Parents and practitioners should also be aware that problems are likely to be avoided when the young gambler keeps in control of the situation and ensures that their gambling remains a social activity. The following brief guide is aimed particularly for working with young gamblers but applicable to everyone. It will help ensure that gambling remains an enjoyable and problem-free experience. It is wise to remember that:

  • When you are gambling you are buying entertainment, not investing money
  • You are unlikely to make money from gambling
  • The gaming industry and the government are the real winners
  • You should only gamble with money that you can afford to lose
  • You should set strict limits on how much you will gamble
  • To make profit from gambling you should quit when ahead
  • Gambling should only take up a small amount of your time and interest
  • Problems will arise if you become preoccupied with gambling
  • Gambling within your means is a fun and exciting activity
  • Gambling outside your means is likely to create serious problems
  • You should not gamble to escape from worries or pressures
  • The feeling of being powerful and in control when gambling is a delusion
  • A gambling dependency is as damaging as other addictions
  • Always gamble responsibly

Hopefully the two parts of this blog have highlighted a potential danger among children and adolescence. It covered risk factors, warning signs to look for, and strategies to help those with a problem. Through education and awareness, it is hoped that gambling problems will be viewed no differently from other potentially addictive substances and that schools will take the issue seriously.

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

Further reading

Bellringer, P. (1999). Understanding Problem Gamblers. London : Free Association Books.

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

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2003). Adolescent gambling: Risk factors and implications for prevention, intervention, and treatment. In D. Romer (Ed.), Reducing Adolescent Risk: Toward An Integrated Approach (pp. 223-238). London: Sage.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Griffiths, M.D. & Wood, R.T.A. (2000). Risk factors in adolescence: The case of gambling, video-game playing and the internet. Journal of Gambling Studies, 16, 199-225.

Slots of fun: What should parents and teachers know about adolescent gambling? (Part 1)

Research has consistently shown that a small but significant minority of adolescents have a gambling problem. It has also been noted that adolescents may be more susceptible to problem gambling than adults. In Great Britain, the most recent statistics suggest that around 2% of adolescents have a gambling problem. This figure is two to three times higher than that identified in the adult population. On this evidence, young people are clearly more vulnerable to the negative consequences of gambling than adults.

A typical finding of many adolescent gambling studies has been that problem gambling appears to be a primarily male phenomenon. It also appears that adults may to some extent be fostering adolescent gambling. For example, a strong correlation has been found between adolescent gambling and parental gambling. Similarly, many studies have indicated a strong link between adult problem gamblers and later problem gambling amongst their children. Other factors that have been linked with adolescent problem gambling include working class youth culture, delinquency, alcohol and substance abuse, poor school performance, theft and truancy.

One consequence of the research into adolescent gambling is that we can now start to put together a ‘risk factor model’ of those individuals who might be at the most risk of developing problem gambling tendencies. Based on summaries of empirical research, a number of clear risk factors in the development of problem adolescent gambling emerge. Adolescent problem gamblers are more likely to:

  • Be male (16-25 years)
  • Have begun gambling at an early age (as young as 8 years of age)
  • Have had a big win earlier in their gambling careers
  • Consistently chase losses
  • Gamble on their own
  • Have parents who gamble
  • Feel depressed before a gambling session
  • Have low self-esteem
  • Use gambling to cultivate status among peers
  • Be excited and aroused during gambling
  • Be irrational (i.e. have erroneous perceptions) during gambling
  • Use gambling as a means of escape
  • Have bad grades at school
  • Engage in other addictive behaviours (smoking, drinking alcohol, illegal drug use)
  • Come from the lower social classes
  • Have parents who have a gambling (or other addiction) problem
  • Have a history of delinquency
  • Steal money to fund their gambling
  • Truant from school to go gambling

There are also some general background factors that might increase the risk of becoming a problem gambler. Common factors include:

  • Broken, disruptive or very poor family
  • Difficult and stressful situations within the home
  • Heavy emphasis on money within the family
  • The death of a parent or parental figure in their childhood
  • Serious injury or illness in the family or themselves
  • Infidelity by parents
  • High incidence of abuse (verbal, physical and/or sexual)
  • Feeling of rejection as a child
  • Feelings of belittlement and disempowerment

This list is probably not exhaustive but incorporates what is known empirically and anecdotally about adolescent problem gambling. As research into the area grows, new items to such a list will be added while factors, signs and symptoms already on these lists will be adapted and modified. Gambling has often been termed the ‘hidden addiction’. The main reasons for this arise from the problem with the identification. This is because:

  • There are no observable signs or symptoms like other addictions (e.g. alcoholism, heroin addiction etc.)
  • Money shortages and debts can be explained away with ease in a materialistic society
  • Adolescent gamblers do not believe they have a problem or wish to hide the fact
  • Adolescent gamblers are exceedingly plausible and become adept at lying to mask the truth
  • Adolescent gambling may be only one of several excessive behaviours

Although there have been some reports of a personality change in young gamblers many parents may attribute the change to adolescence itself (i.e., evasive behaviour, mood swings etc. are commonly associated with adolescence). It is quite often the case that many parents do not even realize they have a problem until their son or daughter is in trouble with the police. I have noted there are a number of possible warning signs to look for although individually, many of these signs could be put down to adolescence. However, if several of them apply to a child or adolescent it could be that they will have a gambling problem. The signs include:

  • No interest in school highlighted by a sudden drop in the standard of schoolwork
  • Unexplained free time such as going out each evening and being evasive about where they have been
  • Coming home later than expected from school each day and not being able to account for it
  • A marked change in overall behaviour (that perhaps only a parent would notice). Such personality changes could include becoming sullen, irritable, restless, moody, touchy, bad-tempered or constantly on the defensive
  • Constant shortage of money
  • Constant borrowing of money
  • Money missing from home (e.g., from mother’s purse or father’s wallet)
  • Selling personal possessions and not being able to account for the money
  • Criminal activity (e.g., shoplifting in order to sell things to get money for gambling)
  • Coming home hungry each afternoon after school (because lunch money has been spent on gambling)
  • Loss of interest in activities they used to enjoy
  • Lack of concentration
  • A “couldn’t care less” attitude
  • Lack of friends and/or falling out with friends
  • Not taking care of their appearance or personal hygiene
  • Constantly telling lies (particularly over money)

However, many of these ‘warning signs’ are not necessarily unique to gambling addictions and can also be indicative of other addictions (e.g. alcohol and other drugs). Confirming that gambling is indeed the problem may prove equally as difficult as spotting the problem in the first place. Directly asking an individual if they have a problem is likely to lead to an outright denial. Talking with them about their use of leisure time, money and spending preferences, and their view about gambling in general is likely to be more effective. Part 2 to follow in my next blog!

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

Further reading

Bellringer, P. (1999). Understanding Problem Gamblers. London : Free Association Books.

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

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2003). Adolescent gambling: Risk factors and implications for prevention, intervention, and treatment. In D. Romer (Ed.), Reducing Adolescent Risk: Toward An Integrated Approach (pp. 223-238). London: Sage.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Griffiths, M.D. & Wood, R.T.A. (2000). Risk factors in adolescence: The case of gambling, video-game playing and the internet. Journal of Gambling Studies, 16, 199-225.

Joystick junkies: A brief overview of online gaming addiction

Over the last 15 years, research into various online addictions have greatly increased. Prior to the 2013 publication of the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there had been some debate as to whether ‘internet addiction’ should be introduced into the text as a separate disorder. Alongside this, there has also been debate as to whether those researching in the online addiction field should be researching generalized internet use and/or the potentially addictive activities that can be engaged on the internet (e.g., gambling, video gaming, sex, shopping, etc.).

It should also be noted that given the lack of consensus as to whether video game addiction exists and/or whether the term ‘addiction’ is the most appropriate to use, some researchers have instead used terminology such as ‘excessive’ or ‘problematic’ to denote the harmful use of video games. Terminology for what appears to be for the same disorder and/or its consequences include problem video game playing, problematic online game use, video game addiction, online gaming addiction, internet gaming addiction, and compulsive Internet use.

Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic internet use (i.e., internet gaming disorder [IGD]) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. According to Dr. Nancy Petry and Dr. Charles O’Brien, IGD will not be included as a separate mental disorder until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features have been evaluated.

Although there is now a rapidly growing literature on pathological video gaming, one of the key reasons that IGD was not included in the main text of the DSM-5 was that the SUDWG concluded that no standard diagnostic criteria were used to assess gaming addiction across these many studies. In 2013, some of my colleagues and I published a paper in Clinical Psychology Review examining all instruments assessing problematic, pathological and/or addictive gaming. We reported that 18 different screening instruments had been developed, and that these had been used in 63 quantitative studies comprising 58,415 participants. The prevalence rates for problematic gaming were highly variable depending on age (e.g., children, adolescents, young adults, older adults) and sample (e.g., college students, internet users, gamers, etc.). Most studies’ prevalence rates of problematic gaming ranged between 1% and 10% but higher figures have been reported (particularly amongst self-selected samples of video gamers). In our review, we also identified both strengths and weaknesses of these instruments.

The main strengths of the instrumentation included the: (i) the brevity and ease of scoring, (ii) excellent psychometric properties such as convergent validity and internal consistency, and (iii) robust data that will aid the development of standardized norms for adolescent populations. However, the main weaknesses identified in the instrumentation included: (i) core addiction indicators being inconsistent across studies, (iii) a general lack of any temporal dimension, (iii) inconsistent cut-off scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or dimensionality.

It has also been noted by many researchers (including me) that the criteria for IGD assessment tools are theoretically based on a variety of different potentially problematic activities including substance use disorders, pathological gambling, and/or other behavioural addiction criteria. There are also issues surrounding the settings in which diagnostic screens are used as those used in clinical practice settings may require a different emphasis that those used in epidemiological, experimental, and neurobiological research settings.

Video gaming that is problematic, pathological and/or addictive lacks a widely accepted definition. Some researchers in the field consider video games as the starting point for examining the characteristics of this specific disorder, while others consider the internet as the main platform that unites different addictive internet activities, including online games. My colleagues and I have begun to make an effort to integrate both approaches, i.e., classifying online gaming addiction as a sub-type of video game addiction but acknowledging that some situational and structural characteristics of the internet may facilitate addictive tendencies (e.g., accessibility, anonymity, affordability, disinhibition, etc.).

Throughout my career I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflects a common etiology of addictive behaviour. When I started research internet addiction in the mid-1990s, I came to the view that there is a fundamental difference between addiction to the internet, and addictions on the internet. However many online games (such as Massively Multiplayer Online Role Playing Games) differ from traditional stand-alone video games as there are social and/or role-playing dimension that allow interaction with other gamers.

Irrespective of approach or model, the components and dimensions that comprise online gaming addiction outlined above are very similar to the IGD criteria in Section 3 of the DSM-5. For instance, my six addiction components directly map onto the nine proposed criteria for IGD (of which five or more need to be endorsed and resulting in clinically significant impairment). More specifically: (1) preoccupation with internet games [salience]; (2) withdrawal symptoms when internet gaming is taken away [withdrawal]; (3) the need to spend increasing amounts of time engaged in internet gaming [tolerance], (4) unsuccessful attempts to control participation in internet gaming [relapse/loss of control]; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming [conflict]; (6) continued excessive use of internet games despite knowledge of psychosocial problems [conflict]; (7) deception of family members, therapists, or others regarding the amount of internet gaming [conflict]; (8) use of the internet gaming to escape or relieve a negative mood [mood modification];  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games [conflict].

The fact that IGD was included in Section 3 of the DSM-5 appears to have been well received by researchers and clinicians in the gaming addiction field (and by those individuals that have sought treatment for such disorders and had their experiences psychiatrically validated and feel less stigmatized). However, for IGD to be included in the section on ‘Substance-Related and Addictive Disorders’ along with ‘Gambling Disorder’, the gaming addiction field must unite and start using the same assessment measures so that comparisons can be made across different demographic groups and different cultures.

For epidemiological purposes, my research colleagues and I have asserted that the most appropriate measures in assessing problematic online use (including internet gaming) should meet six requirements. Such an instrument should have: (i) brevity (to make surveys as short as possible and help overcome question fatigue); (ii) comprehensiveness (to examine all core aspects of problematic gaming as possible); (iii) reliability and validity across age groups (e.g., adolescents vs. adults); (iv) reliability and validity across data collection methods (e.g., online, face-to-face interview, paper-and-pencil); (v) cross-cultural reliability and validity; and (vi) clinical validation. We aso reached the conclusion that an ideal assessment instrument should serve as the basis for defining adequate cut-off scores in terms of both specificity and sensitivity.

The good news is that research in the gaming addiction field does appear to be reaching an emerging consensus. There have also been over 20 studies using neuroimaging techniques (such as functional magnetic resonance imaging) indicating that generalized internet addiction and online gaming addiction share neurobiological similarities with more traditional addictions. However, it is critical that a unified approach to assessment of IGD is urgently needed as this is the only way that there will be a strong empirical and scientific basis for IGD to be included in the next DSM.

Note: A version of this article was first published on Rehabs.com

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

Further reading

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders – Text Revision (Fifth Edition). Washington, D.C.: Author.

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

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

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, under review.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

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

King, D. L., Delfabbro, P. H., Griffiths, M. D., & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

King, D. L., Delfabbro, P. H., & Griffiths, M. D. (2012). Cognitive-behavioral approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

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

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