Category Archives: Adolescence
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
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 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.