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.

Koronczai, B., Urban, R., Kokonyei, G., Paksi, B., Papp, K., Kun, B., . . . Demetrovics, Z. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

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., Karila, L. & Billieux, J. (2013).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, in press.

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

Petry, N.M., & O’Brien, C.P. (2013). Internet gaming disorder and the DSM-5. Addiction, 108, 1186–1187.

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

Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder. Cyberpsychology and Behavior, 1, 237-244.

Method factors: The cognitive psychology of gambling (revisited)

One of the proudest moments of my academic career was when my 1994 study on the role of cognitive bias in slot machine gambling published in the British Journal of Psychology was introduced as a compulsory study that all ‘A’ Level students on the OCR syllabus have to learn about here in the UK. Today’s blog looks at that 1994 study in context.

I began a PhD on the psychology of slot machines back in 1987 and spent the first three or four months reading everything I could about how psychological research methods had been used to study this relatively new area of research. As a PhD student, the paper that really inspired me was a pioneering study by George Anderson and Iain Brown (also published in the British Journal of Psychology in 1984). Up until the mid-1980s almost all of the experimental work on the psychology of gambling had been done in laboratory settings and the question of ecological validity was something that I had great concerns about. I didn’t want to study gamblers in a psychology laboratory, I wanted to examine them in the gambling environments themselves. Anderson and Brown studied the role of arousal in gambling and used heart rate measures as an indicator of arousal. They found that regular gamblers’ heart rates increased significantly by around 23 beats per minute (compared to baseline resting levels) when they were gambling in a casino but when doing the same activity in a laboratory setting there was no significant increase in heart rate. To me, this perhaps explained why previous studies on arousal during laboratory gambling had failed to find significant heart rate increases above baseline levels.

Anderson and Brown claimed that Skinnerian reinforcement theory couldn’t account for the phenomenology of addictive gambling (especially relapse after abstinence). As a result of their ecologically valid experimental study, Anderson and Brown postulated a theoretical model centred upon individual differences in cortical and autonomic arousal in combination with irregular reinforcement schedules. They argued for a neo-Pavlovian model in which arousal played a central role in the addiction process. According to Anderson and Brown this model accounts for reinstatement after abstinence and allows for the maintenance of the behaviour by internal mood/state/arousal cues in addition to external situation cues. I found this theoretical perspective too restrictive and believed that gambling addiction was a more complex process and was the consequence of a combination of a person’s biological/genetic predisposition, their psychological make-up (personality, attitudes, beliefs, expectations, etc.), and the environment they were brought up in. This is what most people would now recognize as a biopsychosocial perspective that runs through much of my subsequent writing and research. Added to this, I passionately believed there were other important factors at play including the situational factors of where the activity took place such as the design of the gambling environment, and the structural features of the activity itself such as the speed of play and ambient factors like lights, colour, noise and music.

My 1994 study found that regular gamblers produced significantly more irrational verbalisations that non-regular gamblers. (The ethics committee wouldn’t let me use non-gamblers as they didn’t want participants to be introduced to gambling via a university research study!). One of the most observations in my study was that regular gamblers personified the machine and often treated the machine as if it was a person. They attributed thought processes to it and would talk to it as if it could actually hear them. Another of the more interesting observations concerned ‘the psychology of the near miss’ (or more accurately. ‘the near win’). I noticed that when I used the ‘thinking aloud method’ as a way of gaining direct cognitive access to what gamblers were thinking as they played a slot machine, regular gamblers often explained away their losses and changed clear losing situations into near winning ones. On a cognitive level gamblers weren’t constantly losing, they were constantly nearly winning, and this, I argued, was both psychologically and physiologically rewarding for them. (I also did a study where I measured gamblers’ heart rates in an amusement arcade where, like Anderson and Brown I found regular gamblers had significantly increased heart rates when compared to baseline resting levels).

Anyone reading my 1994 paper will instantly spot what appears to be a major limitation of the study – the fact that there was no inter-rater reliability in the coding of the verbalisations that I transcribed. Could this be (as some have argued) the Achilles Heel of the study? I have argued that in the context of this study having a second rater might have added a confounding variable in itself. Another rater wouldn’t have had the time with the data that I had and wouldn’t have been there at the time of the experiment. In short, ‘not being there’ would have been a great disadvantage to a second coder as they would not have understood the context in which various verbalizations were made. I transcribed each tape straight after each trial so that I could remember the context of everything that was said by each player. I would also add that this was one study that was done in conjunction with lots of others simultaneously (the details of which are provided below).

The work of Dr. Paul Delfabbro in Australia built on my idea of analysing gamblers within session and postulated that gambling is maintained by winning and losing sequences within the operant conditioning paradigm (i.e., that the only rewards and reinforcers in gambling are purely monetary). I then argued in response to that paper (in a 1999 issue of the British Journal of Psychology) that Delfabbro’s contribution was too narrow in its focus in that they had taken no account of the ‘near miss’ in relation to operant conditioning theory and that there may be other reinforcers that play a role in the maintenance process (such as physiological rewards, psychological rewards, and social rewards). I also argued that gambling was biopsychosocial behaviour and should therefore be explained by a biopsychosocial account.

My 1994 study showed that gamblers could be studied in real-life contexts and that useful data could be collected. It also showed the complexity of gambling and that gamblers could turn apparently objective outcomes (i.e., losing) into ones that were highly subjective (i.e., near winning ones). I also showed that this had implications for treatment and that maybe these cognitive biases could be used by psychologists as a way of ‘re-educating’ gamblers through some kind of ‘cognitive correction’ technique. I should also point out that this one experimental study was one small part of a much bigger jigsaw. What I mean by this is that my 1994 shouldn’t be seen in isolation but read along with my simultaneous observational studies of arcade gamblers, my other experimental studies, my semi-structured interview studies, surveys, and my case studies. All of these studies as a whole were featured in my first book (Adolescent Gambling, published in1995).

My work into the role of cognitive bias in gambling and gambling addiction also led to me studying behavioural addictions more generally. Since I finished my PhD I have branched out and carried out research into videogame addiction, Internet addiction, sex addiction, work addiction, and exercise addiction. Many psychologists don’t view excessive behaviour as an addiction, but for me gambling is the ‘breakthrough’ addiction. I have argued that when gambling is taken to excess it can be comparable to other more recognised addictions like alcoholism. If you accept that gambling can be a genuine addiction, there is no theoretical reason why other behaviours when taken to excess cannot be considered potentially addictive if ‘gambling addiction’ exists.

A key difference between excessive use and addiction is the detrimental effects (or lack of) that arise as a result of that behaviour. When people are addicted to a behaviour that becomes the single most important thing in their life, they compromise everything else in their life to do it. A person’s job/work, personal relationships and hobbies are severely compromised. The basic difference between an excessive healthy enthusiasm and an addiction is that healthy enthusiasms add to life – addictions take away from it. This is very much a (non-psychological) lay view, but there is a lot of truth in it.

I am the first to admit that my 1994 study when taken in isolation is hardly up there with the ‘classic’ studies of Freud, Watson, Skinner or Milgram. However, as part of two decades of other research into gambling and other potentially excessive behaviours I would like to think I have had an influence in my field. Only time will tell.

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

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

Anderson, G. and Brown, R.I.F. (1984). Real and laboratory gambling, sensation seeking and arousal. British Journal of Psychology, 75, 401-410.

Delfabbro, P. & Winefield, A.H. (1999). Poker machine gambling: An analysis of within-session characteristics. British Journal of Psychology, 90, 425-439.

Griffiths, M.D. (1990). The acquisition, development and maintenance of fruit machine gambling. Journal of Gambling Studies, 6, 193-204.

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

Griffiths, M.D. (1991b). Fruit machine addiction: Two brief case studies. British Journal of Addiction, 85, 465.

Griffiths, M.D. (1993a). Fruit machine gambling: The importance of structural characteristics. Journal of Gambling Studies, 9, 101-120.

Griffiths, M.D. (1993b). Tolerance in gambling: An objective measure using the psychophysiological analysis of male fruit machine gamblers. Addictive Behaviors, 18, 365-372.

Griffiths, M.D. (1993c). Pathological gambling: Possible treatment using an audio playback technique. Journal of Gambling Studies, 9, 295-297.

Griffiths, M.D. (1993d). Factors in problem adolescent fruit machine gambling: Results of a small postal survey. Journal of Gambling Studies, 9, 31-45.

Griffiths, M.D. (1993e). Fruit machine addiction in adolescence: A case study. Journal of Gambling Studies, 9, 387-399.

Griffiths, M.D. (1994). The role of cognitive bias and skill in fruit machine gambling. British Journal of Psychology, 85, 351-369.

Griffiths, M.D. (1995a). The role of subjective mood states in the maintenence of gambling behaviour, Journal of Gambling Studies, 11, 123-135.

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

Griffiths, M.D. (1999). The psychology of the near miss (revisited): A comment on Delfabbro and Winefield. British Journal of Psychology, 90, 441-445.

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

Griffiths, M.D. (2008). Diagnosis and management of video game addiction. New Directions in Addiction Treatment and Prevention, 12, 27-41.

Griffiths, M.D. & Delfabbro, P. (2001). The biopsychosocial approach to gambling: Contextual factors in research and clinical interventions. Journal of Gambling Issues, 5, 1-33.

Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed.), Gambling: Who wins? Who Loses? pp. 277-292. New York: Prometheus Books.

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

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

The national wealth service: Problem gambling is a health issue

Over the last decade, the United Kingdom has undergone major changes of gambling legislation (most notably, the 2005 Gambling Act that came into force on September 1, 2007). The Gambling Act has provided the British public with increased opportunities and access to gambling like they have never seen before. Gambling legislation was revolutionized and many of the tight restrictions on gambling dating back to the 1968 Gaming Act were relaxed (particularly in relation to the advertising of gambling). The deregulation of gambling has also been coupled with the many new media in which people can gamble (internet gambling, mobile phone gambling, interactive television gambling, gambling via social networking sites). Given the expected explosion in gambling opportunities, is this something that the health and medical professions should be concerned about?

Gambling has not been traditionally viewed as a public health matter although research into the health, social and economic impacts of gambling has grown considerably since the 1990s. In August 1995, the British Medical Journal published an editorial called ‘Gambling with the nation’s health?’ which argued that gambling was a health issue because it widened the inequalities of income and that there was an association between inequality of income in industrialized countries and lower life expectancy. However, there are many other more specific reasons why gambling should be viewed as an issue for the medical profession.

According to the last British Gambling Prevalence Survey (BGPS) published in 2011, just under 1% of the British population have a severe gambling problem although the rate is approximately twice as high in adolescents, particularly as a result of problematic slot machine gambling. Disordered gambling is 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.

It is clear that the social and health costs of problem gambling can be large on both an individual and societal level. Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, family neglect, and bankruptcy. I have also reported in a number of my papers (including a 2007 report I wrote for the British Medical Association) that there can also be adverse health consequences for both the gambler and their partner including depression, insomnia, intestinal disorders, migraines, and other stress-related disorders. In the UK, preliminary analysis of the calls to the national gambling helpline also indicated that a significant minority of the callers reported health-related consequences as a result of their problem gambling. These include depression, anxiety, stomach problems, other stress-related disorders and suicidal ideation.

There are also other issues relating to problem gambling that may have medical consequences. One US study published in the Journal of Emergency Medicine by Dr. Robert Muellman and his colleagues found that intimate partner violence (IPV) was predicted by pathological gambling in the perpetrator. In a sample of 286 women admitted to the emergency department at a University Hospital in Nebraska, findings revealed that a woman whose partner was a problem gambler was 10.5 times more likely to be a victim of IPV than partners of a non-problem gambler.

Health-related problems due to problem gambling can also result from withdrawal effects. In a study published in the American Journal of the Addictions, Dr. Richard Rosenthal and Dr. Henry Lesieur found that at least 65% of pathological gamblers reported at least one physical side-effect during withdrawal including insomnia, headaches, upset stomach, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty and/or chills. Their results were also compared to the withdrawal effects from a substance-dependent control group. They concluded that pathological gamblers experienced more physical withdrawal effects when attempting to stop than the substance-dependent group. I also found similar things in a small study that I published in the Social Psychological Review (with Michael Smeaton).

Pathological gambling is very much the ‘hidden’ addiction. Unlike (say) alcoholism, there is no slurred speech and no stumbling into work. Furthermore, overt signs of problems often don’t occur until late in the pathological gambler’s career. If problem gambling is an addiction that can destroy families and have medical consequences, it becomes clear that medical professionals should be aware of the effects of gambling in just the same way that they are with other potentially addictive activities like drinking (alcohol) and smoking (nicotine).

However, gambling addiction is an activity that is not (at present) being treated via the British National Health Service (NHS). This was shown in a paper that I published with Dr. Jane Rigbye in a paper we published in a 2011 issue of the International Journal of Mental Health and Addiction. We sent a total of 327 letters were sent to all Primary Care Trusts, Foundation Trusts and Mental Health Trusts in the UK requesting information about problem gambling service provision and past year treatment of gambling problems within their Trust under the Freedom of Information Act. Our findings showed that 97% of the NHS Trusts did not provide any service (specialist or otherwise) for treating those with gambling problems (i.e., only nine Trusts provided evidence of how they deal with problem gambling). Only one Trust offered dedicated specialist help for problem gambling. Our study showed there was some evidence that problem gamblers may get treatment via the NHS if that person has other co-morbid disorders as the primary referral problem.

Problem gambling is very much a health issue that needs to be taken seriously by all within the health and medical professions. General practitioners routinely ask patients about smoking and drinking but gambling is something that is not generally discussed. Problem gambling may be perceived as a somewhat ‘grey area’ in the field of health and it is therefore very easy to deny that those in the medical profession should be playing a role. If the main aim of practitioners is to ensure the health of their patients, then it is quite clear that an awareness of gambling and the issues surrounding it should be an important part of basic knowledge.

As briefly outlined above, opportunities to gamble and access to gambling have increased because of deregulation and technology. What has been demonstrated from research evidence in other countries is that – in general – where accessibility of gambling is increased there is an increase not only in the number of regular gamblers but also an increase in the number of problem gamblers – although this may not be proportional. This obviously means that not everyone is susceptible to developing gambling addictions but it does mean that at a societal (rather than individual) level, in general, the more gambling opportunities, the more problems. Other countries such as Australia, Canada and New Zealand have seen increases in problem gambling as a result of gambling liberalization. In the UK, the last BGPS showed that problem gambling in Great Britain had increased by 50% compared to the previous BGPS published in 2007. (However, the latest data from the combined Health Survey for England and the Scottish Health Survey in 2014 reported that problem gambling had fallen to about 0.5%).

Gambling is without doubt a health and issue and there is an urgent need to enhance awareness within the medical and health professions about gambling-related problems and to develop effective strategies to prevent and treat problem gambling. The rapid expansion of gambling represents a significant public health concern and health/medical practitioners also need to research into the impact of gambling on vulnerable, at-risk, and special populations. It is inevitable that a small minority of people will become casualties of gambling in the UK, and therefore help should be provided for the problem gamblers. Since gambling is here to stay and is effectively state-sponsored, the Government should consider giving priority funding (out of taxes raised from gambling revenue) to organizations and practitioners who provide advice, counselling and treatment for people with severe gambling problems.

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

Further reading

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association.

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., Scarfe, A. & Bellringer, P. (1999). The UK National telephone Helpline – Results on the first year of operation. Journal of Gambling Studies, 15, 83-90.

McKee, M. & Sassi, F. (1995). Gambling with the nation’s health. British Medical Journal, 311, 521-522.

Muelleman, R. L., DenOtter, T., Wadman, M. C., Tran, T. P., & Anderson, J. (2002). Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. Journal of Emergency Medicine, 23, 307-312.

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Rosenthal, R. & Lesieur, H (1992). Self-reported withdrawal symptoms and pathological gambling. American Journal of the Addictions, 1, 150-154.

Setness, P.A. (1997). Pathological gambling: When do social issues become medical issues? Postgraduate Medicine, 102, 13-18.

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

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

Bog standard: A brief look at toilet tissue eating

In previous blogs I have looked at pica (i.e., the eating of non-nutritive items or substances) and subtypes of pica such as geophagia (eating of soil, mud, clay, etc.), pagophagia (eating of ice), acuphagia (eating of metal), and coprophagia (eating of faeces). It wasn’t until I started to research on specific sub-types of pica, that I discovered how many different types of non-food substances had been identified in the academic and clinical literature. For instance, Dr. V.J. Louw and colleagues provided a long list in a 2007 issue of the South African Medical Journal including cravings for the heads of burnt matches (cautopyreiophagia), cigarettes and cigarette ashes, paper, starch (amylophagia), crayons, cardboard, stones (lithophagia), mothballs, hair (trichophagia), egg shells, foam rubber, aspirin, coins, vinyl gloves, popcorn (arabositophagia), and baking powder. Most of these are generally thought to be harmless but as Louw and colleagues note, a wide range of medical problems have been documented:

“These include abdominal problems (sometimes necessitating surgery), hypokalaemia, hyperkalaemia, dental injury, napthalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in pica for burnt matches), peritoneal mesothelioma (geophagia of asbestos-rich soil), mercury poisoning (in paper pica), lead poisoning (in dried paint pica and geophagia), and a pre-eclampsia-like syndrome (baking powder pica)”.

In the clinical literature, the eating of paper has been occasionally documented (although anecdotal evidence suggests this is fairly common and I remember doing it myself as a child). A recent review paper on pica by Dr. Silvestre Frenk and colleagues in the Mexican journal Boletín Médico del Hospital Infantil de México highlighted dozens of pica-subtypes and created many new names for various pica sub-types. They proposed that people who eat paper display ‘papirophagia’ (in fact if you type ‘papirphagia’ into Google, you only get one hit – the paper by Silvestre and colleagues – although this blog may make it two!). Eating paper is not thought to be particularly harmful although I did find a case of mercury poisoning because of ‘paper pica’ (as the authors – Dr. F. Olynk and Dr. D. Sharpe – called it) in a 1982 issue of the New England Journal of Medicine.

One sub-type of papirophagia is the eating of toilet paper. As far as I am aware, there is only one case study in the literature and this was published back in 1981, Dr. J. Chisholm Jr. and Dr. H. Martín in the Journal of the National Medical Association. They described the case of a 37-year old black woman with an “unusually bizarre craving” for toilet tissue paper. The authors reported that:

“[The] woman was referred for evaluation of disturbed smell and loss of taste for over one year. These were associated with chronic fatigue and listlessness. During this same period of time, she rather embarrassedly admitted to an overwhelming desire to eat toilet tissue. Frequently, she would awaken at night and dash to her bathroom to eat toilet tissue. No other type(s) of pica were admitted. In addition, she gave a long history of menorrhagia and frequently passed vaginal blood clots during her menses. Her libido was normal and there was no history of poor wound healing, skin or mucous membrane lesions, or intestinal symptoms. Her dietary history suggested a high carbohydrate diet, and due to a mild exogenous obesity she intermittently resorted to a vegan-like diet that included beans and various seeds”

A variety of medical tests were carried out and she was diagnosed with combined iron and zinc deficiency. She was treated with iron and zinc tablets and within a week, both her taste and smell had returned, and her energy levels greatly improved. Zinc deficiencies can lead to a wide variety of clinical disorders including loss of small and taste, anorexia, dwarfism (i.e., growth retardation), impaired wound healing, and geophagia. The woman’s (sometimes) vegan diet may have been to blame for her zinc deficiency as the authors noted that:

“Although vegetables contain zinc, vegans should be made aware that zinc from plant sources is not readily absorbed because naturally occurring phytates, particularly high in beans and seeds, reduce zinc gastrointestinal absorption. Carbohydrates are very poor sources of zinc. Chronic iron deficiency secondary to chronic menorrhagia accounts well for the anemia, fatigue, and unusual pica for toilet tissue noted in this patient”.

Paper pica has occasionally been mentioned in other academic papers although details have typically been limited. For instance, a 1995 paper in the journal Birth by Dr. N.R. Cooksey on three cases of pica in pregnancy reported that one of the women chewed non-perfumed blue toilet paper during the first trimester of her pregnancy (and was forced by her mother to stop). There was also a 2003 paper published by Dr. Dumaguing in the Journal of Geriatric Psychiatry and Neurology examining pica in mentally ill geriatrics. One of the cases mentioned was a 76-year old patient that not only ingested their medication (an emollient cream for arthritis) but was also recorded eating toilet paper, napkins, Styrofoam cups, crayons, and other patients’ medications.

A more recent 2008 paper by Dr. Sera Young and her colleagues in the journal PLoS ONE, critically reviewed procedures and guidelines for interviews and sample collection in relation to pica substances. In describing the protocols involved, they referred to paper pica in the questions that should be asked:

“What is the local name, brand name, or type of pica substance desired or consumed? This will help others to know if this substance has already been studied and assist interested researchers in obtaining subsequent samples at a later date. Furthermore, different manufactured products may contain different materials, e.g. Crayola chalkboard chalk contains slightly different ingredients from other brands. Similarly, the consequences of toilet tissue paper consumption are different from those of eating pages of a novel; information would be lost if the substance was simply described as paper. For these reasons, the substance consumed should be described in as much detail and as accurately as possible”.

Personally (and based on anecdotal evidence), I think that papirophagia is not overly rare (especially among children – although I admit this may be more out of curiosity that craving) but the clinical literature suggests that it is a fairly rare disorder found amongst distinct sub-groups (pregnant women, the mentally ill). Given the fact that for most people eating paper would not cause any problems, this would provide the main reason why so few cases end up seeking medical, clinical, and/or psychological help.

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

Further reading

Chisholm Jr, J. C., & Martín, H. I. (1981). Hypozincemia, ageusia, dysosmia, and toilet tissue pica. Journal of the National Medical Association, 73(2), 163-164.

Cooksey, N.R. (1995). Pica and olfactory craving of pregnancy: How deep are the secrets? Birth, 22, 129-137.

Dumaguing, N.I., Singh, I., Sethi, M., & Devanand, D.P. (2003). Pica in the geriatric mentally ill: unrelenting and potentially fatal. Journal of Geriatric Psychiatry and Neurology, 16, 189-191.

Frenk, S., Faure, M.A., Nieto, S. & Olivares, Z. (2013). Pica. Boletín Médico del Hospital Infantil de México, 70(1), 55-61

Louw, V.J., Du Preez, P., Malan, A., Van Deventer, L., Van Wyk, D., & Joubert, G. (2007). Pica and food craving in adults with iron deficiency in Bloemfontein, South Africa. South African Medical Journal, 97, 1069-1071.

Olynyk, F., & Sharpe, D. H. (1982). Mercury poisoning in paper pica. The New England Journal of Medicine, 306, 1056 -1057.

Young, S.L., Wilson, M.J., Miller, D., Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS ONE, 3(9), e3147. doi:10.1371/journal.pone.0003147

No lady luck: A case study of adolescent female slot machine addiction

Based on research into adolescent slot machine playing, all British research has found that most adolescent slot machine players are male and that very few female adolescent slot machine addicts have ever been identified in the literature. The main findings relating to adolescent female slot machine players were published in papers by Dr. Sue Fisher and myself (mostly in the 1990s). In 1993, Dr. Fisher reported the existence of teenage females with no playing skills and little interest in acquiring them, and who gamble on slot machines primarily to gain access to the arcade venue where they can socialize with their friends (calling them ‘Rent-a-Spacers’). Their preferred role is one of ‘spectator’. In an earlier published (1991) study in the Journal of Applied and Community Psychology, I observed that arcades were a meeting place for adolescent social groups in which playing activity was predominantly male-oriented with girls looking on in ‘cheerleader’ roles. In 2003, I published a rare case study of an adolescent female slot machine addict (who I called ‘Jo’) and thought I would share some of the things I found from that study in today’s blog

During a nine-month period, I interviewed Jo three times formally and also maintained regular contact with her on an informal basis. She was confirmed as a probable pathological gambler using the American Psychiatric Association’s DSM-IV criteria for pathological gambling.

Jo was brought up as an only child in a seaside town in the South West of England. She described her parents as “comfortable, middle class and loving”. However, she also made reference to the fact that there were reasonably strict rules in the house. Her father was an insurance salesman and her mother was a schoolteacher. She went to a mixed school, and up to the age of 13 years she had good school reports and was in the top 10% of her class academically. She was also very good at sports (and was an active member of the school athletics club) and described herself as “physically stronger” than most of her peers. Jo claims she did not really relate to the other girls in her school and often got into playground fights with them. During her early adolescence she made a few good friends although these were mostly boys of her own age or a little older. She herself described her adolescent years as a “tomboy”. Educationally, she left school when she was 16 years old and got an office job working as an administrative assistant.

Jo started playing slot machines at a young age because they were so abundant in the town where she lived. She described them as “being part of the wallpaper”. To some extent, her parents encouraged her gambling. Like a lot of “seaside parents”, they often took Jo to the amusement arcades as a child for “a weekend treat”. Like many families, they did not see anything wrong with going to the seaside arcade because they felt it was “harmless fun and didn’t cost much.” However, these early experiences coupled with exposure to slot machines in her peer group were instrumental factors in Jo’s acquisition of slot machine playing. Living in a seaside town, access to the machines was widespread, and the main place for “hanging out” was at the local arcades. There were four or five of them because the town was a popular tourist attraction. Arcades provided a meeting point for her friends. She was part of a gang in which hanging around the arcades was one of the few activities that the group could engage in.

At 13 years old, she mainly used to just watch her male friends play on the slot machines and video games. However, within a year, she was playing on slot machines as much as her peers. The arcade was where Jo “felt safe and protected”. She liked it that everyone who worked there knew who she was. In the arcade she was a ‘somebody’ rather than a ‘nobody’. In essence, the arcade provided a medium where Jo’s self-esteem was raised.

Jo gave a number of insights into her motivations for slot machine playing. Skill did not appear to be a motivating factor for continued play. She played to win money (to further her playing rather than fuel any winning fantasies) and did not see the machines as particularly skilful. Although most of Jo’s (male) friends claimed that slot machine playing was very skillful if you were good at it, Jo always believed that slot machines were not like video games and that “winning big” had a lot of luck to it. Knowing her way round a slot machine while helpful, didn’t make her feel as though she was especially skilful except when complete novices would play. Also, being female, the older age women who played on the simple machines would talk to her (unlike the adolescent males who would be shunned by this clientele). This made her feel wanted and needed. However, between the ages of 14 and 15 years, Jo’s slot machine playing became all encompassing. As she explains:

“There was a period in my life between the ages of 15 and 17 where the machines became the most important thing in my life. I didn’t worry about money. I just believed I would win it back or that money would come from somewhere because it always had. I was forever chasing my losses. I would always tell myself that after a bad loss, the arcade was only ‘borrowing’ my money and that they would have to ‘pay it back’ next time I was in there. Of course, that rarely happened but once I was playing again, money worries and losses went out of the window. Gambling became my primary means of escape. On the positive side, at least it helped me to give up smoking and drinking. I simply couldn’t afford to buy nicotine or alcohol – or anything else for that matter. I never believed that gambling would make me rich – I just thought it would help me clear my debts.”

Jo didn’t acknowledge that she had a problem – even when she started to go down to the arcade on her own and using all her disposable income to fund her slot machine playing. However, in retrospect, she realized a problem was developing.

“I used to spend every penny I had on the (slot) machines. It was a good job I wasn’t into clothes like the other girls at school. I couldn’t have afforded to buy anything as I lost everything I had in the long run. I used to wear the same pair of jeans for months. I don’t even think I washed them”.

When Jo was 15 years old, a telephone call from the school headmaster alerted Jo’s mother that her daughter might be having some problems in her life. The headmaster phoned to say that Jo’s attendance had been very poor during the previous three months and that she had stopped attending athletics practice. When confronted, Jo admitted that she had not been attending school but said that all the girls in her class hated her. To some extent this was true (she didn’t get on with any of the girls at her school) but was not the reason she was truanting. Instead of going to school she had been spending her time in the local arcades. For a few weeks she tried to stop her gambling. Now that her parents knew there were problems, she thought this would be the ideal time to give up. However, after 17 days without gambling, her boyfriend split up with her and she relapsed by gambling again. This then carried on for almost two years.

Jo’s parents were very understanding and looked for alternatives to help their daughter. They considered moving classes within the school and moving schools completely. Jo simply said she would try to integrate more. At no stage did Jo’s parents ever suspect that her erratic behaviour was linked to anything other than the problems of adolescent mixing. Jo managed to successfully hide her problem for a further two years before everything came out into the open.

As an only child it was difficult for Jo’s parents to know whether their experience was normal. They hardly saw Jo. At the age of 16 years, Jo upset her parents not only by leaving school but also by leaving home. They knew there was little that they could do. When Jo left home, she assumed that all her problems would disappear. However, she got into more and more trouble and was unable to make ends meet. She lived from hand to mouth. She began to steal from friends, from work and from anyone she met. On two occasions she met males she had never met before that moment, went back to their houses, and then stole their money and/or valuables.

Over this period of nearly two years Jo became more and more withdrawn, lost her friends and ended up resorting to stealing from her place of work. Eventually she was sacked (for taking the petty cash) although her employers were unaware that her problem was gambling (or that she even had a problem). They assumed she wanted more money to supplement her very modest wages. Although she lost her job, the company did not instigate criminal charges.

The first major turning point was being sacked from her first job for theft of the petty cash. She had nowhere else to go but back home. Her parents were a tremendous support although were surprised that slot machines were the heart of the problem. Jo claimed her mother didn’t believe her at first. They wondered how someone could get addicted to a machine. Jo claimed it would have been easier for her mother to accept if she had a drug or alcohol problem rather than a gambling problem.

The cessation of her gambling began when Jo (with her parents’ help) got another job in a remote village in Cornwall (in South West England). There was no arcade, no slot machines in the local pub, and no slot machine within a four-mile radius. She did not drive a car and it was too far to walk to the nearest town. In essence, the lack of access to a slot machine forced her to stop playing. She still got the cravings but there was nothing she could do. She also claimed to have a number of serious self-reported withdrawal symptoms. At work she was short-tempered, irritable with colleagues, and constantly moody. Physically, she had trouble sleeping, and occasionally had stomach cramps, and felt nauseous through lack of play.

Jo eventually joined a local Gamblers Anonymous (GA) that her parents drove her to every week. She only attended a handful of times and stopped attending because she was the only female in the group, the only slot machine player, and also the youngest. Despite the opportunity to share her experiences with eleven or twelve people in a similar position to herself, she felt psychologically isolated. Being able to talk about the problem with people she could trust (i.e., her parents) was a great help. In addition, with her desire to stop and with no access to slot machines, Jo managed to curtail her gambling. She claims she “wasted four years of her adolescence” due to slot machine playing – and she doesn’t want to waste any more of her life. However, there is no certainty that Jo is ‘cured’ – Jo feels a number of triggers could set her off again (like rejection of someone close to her). Talking to people has been Jo’s “salvation” as she calls it. She had always thought that slot machine playing couldn’t be a problem and therefore found it hard that people would accept the “addiction” she had. Other people’s acceptance that she suffered something akin to alcoholism or drug addiction has helped her recovery.

From my own personal research experience, Jo’ account is fairly typical of slot machine addicts. This is an individual who began playing slot machines socially, steadily gambled more and more over time, spent every last penny on gambling and resorted to the cycle of using their own money, borrowing money, and then finally stealing money, just to fund their gambling habit. Criminal proceedings could have occurred but fortunately (for Jo), she was punished by losing her job. The one major difference between this and all other accounts is that Jo happens to be female.

The major limitation of a study such as this is that it relied totally on retrospective self-report. Not only do I have to take Jo’s account as true but it is also subject to the fallibility of human memory. There is also the major limitation that the findings here are based on one person only and there is little that can be said about generalizability.

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

Further reading

Fisher, S. E. (1992). Measuring pathological gambling in children: The case of fruit machines in the U.K. Journal of Gambling Studies, 8, 263-285.

Fisher, S. (1993). The pull of the fruit machine: A sociological typology of young players. Sociological Review, 41, 446-474.

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

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). Fruit machine addiction in females: A case study. Journal of Gambling Issues, 8. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2003.8.6

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

Term warfare: ‘Problem gambling’ and ‘gambling addiction’ are not the same

Throughout my career, I have constantly pointed out that I met very few people that are genuinely addicted to playing weekly or bi-weekly Lotto games. When stating this, some people counter my assertion that they know people who spend far too much money on buying Lotto tickets and that it is areal problem in their life. However, this is a classic instance of confusing ‘problem gambling’ with ‘gambling addiction’. These two terms are not inter-changeable. When I give lectures on gambling addiction I always point out that “all gambling addicts are problem gamblers but not all problem gamblers are gambling addicts”.

Nowhere is this more relevant than in the print and broadcast media. For instance, I have been one of the co-authors on the last two British Gambling Prevalence Surveys (published in 2007 and 2011). In these surveys we assessed the rate of problem gambling using two different problem gambling screens. Neither of these screens assesses ‘gambling addiction’ and problem gambling is operationally defined according to the number of criteria endorsed on each screen. For instance, in both studies we used the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to estimate the prevalence of problem gambling. Anyone that endorsed three or more items (out of ten) was classed as a problem gambler. Anyone that endorsed five or more items was classed as a pathological gambler. Pathological gambling is more akin to gambling addiction but we found only a tiny percentage of our national participants could be classed as such. What we did report was that 0.9% of our sample were problem gamblers (i.e., they scored three or more on the DSM-IV criteria).

What we didn’t say (and never have said) was that 0.9% of British adults (approximately 500,000 people) are addicted to gambling. However, many stories in the British media when they talk about problem gambling will claim ‘half a million adults in Great Britain are gambling addicts’ (or words to that effect). I am not trying to downplay the issue of gambling addiction. I know only too well the pain and suffering it can bring to individuals and their families. Also, just because I may not define a problem gambler as being genuinely addicted (by my own criteria as outlined in a previous blog), that doesn’t mean that their problem gambling might not be impacting in major negatively detrimental ways on their life (e.g., relationship problems, financial problems, work problems, etc.).

However, returning to the issue of being ‘addicted’ to Lotto games I have always stated in many of my published papers on both addiction and (more specifically) gambling addiction, that addictions rely on constant rewards. A person cannot be genuinely addicted unless they are receiving constant rewards (i.e., their behaviour being reinforced). Playing a Lotto game in which the result of the gamble is only given once or twice a week is not something that can provide constant rewards. A person can only be rewarded (i.e., reinforced) once or twice a week. Basically, Lotto games are discontinuous and have a very low event frequency (once or twice a week). Continuous gambling activities (like the playing of a slot machine) have very high event frequencies (e.g., a typical pub slot machine in the UK has an event frequency of 10-12 times a minute). Gambling activities with high event frequencies tend to have higher associations with problem gambling, and are more likely to be associated with genuine gambling addictions.

That doesn’t mean people can’t spend too much money buying lottery tickets. Buying ticket after ticket can indeed lead people to have a gambling problem with Lotto. However, I know of no addiction criterion that relates to the amount of money spent engaging in an activity. Obviously the lack of money can lead to some signs of problematic and/or addictive behaviour (such as committing criminal activity in order to get money the person hasn’t got to gamble) but this is a consequence of the behaviour not a criterion in itself. In most of the behavioural addictions that I carry out research into (exercise addiction, sex addiction, video game addiction, etc.), there is little money spent but some of these behaviours for a small minority of people are genuinely addictions.

One of the reasons I felt the need to write this article was a press release I saw the other day from the Salvation Army in New Zealand. The story basically said that for some people, playing Lotto was an addictive activity. Here are some of the things the press release said:

“The Salvation Army Problem Gambling service is seeing an increase in the number of clients for whom Lotto products has become a problem for them and their families. ‘When it becomes an addiction, gambling creates havoc in people’s lives’, says Commissioner Alistair Herring, National Director of Addiction Services. ‘The gambling of some of our clients has led to criminal offending, domestic violence, loss of the family home, and – most commonly – children going without food and other basic needs. Regrettably, some people are unable to buy a simple product like a Lotto ticket without it leading to harm for themselves and others. A Lotto ticket can seem harmless but once their purchase becomes an addiction the results can be devastating’…In the past year, The Salvation Army problem gambling programme assisted over 1400 clients most of whom used Lotto. Fifty-seven clients said Lotto was the most significant aspect of their gambling problem. ‘This sort of sales promotion without fully understanding the damage the product can have on an individual and their family is irresponsible. New Zealand is moving toward food labelling that identifies additives dangerous to health. Yet Lotto tickets are sold without any warning that they can lead to health dangers through addiction’. One of the results of Lotteries Commission activity is that Countdown supermarkets recently started selling Lotto tickets at the checkout”.

Many of you reading this may think I am being a little pedantic but while I don’t doubt that buying too many Lotto tickets can be problematic if the person buying them simply can’t afford it, the resulting behaviour is ‘problem gambling’ not ‘gambling addiction’. In relation to my own criteria for addiction, the only way someone could be addicted to Lotto was if they were actually addicted to the buying of the tickets rather than the outcome of the gamble itself. This is not as bizarre as it sounds as some research that I carried out in the late 1990s and early 2000s with Dr. Richard Wood appeared to show that a small proportion of adolescents (aged 11 to 15 years) were addicted to playing both Lotto and scratchcard lottery games.

While it is theoretically possible for kids to be hooked on lottery scratchcards (as you can play again and again and again if you have the time, money, and opportunity), we found it strange that adolescents should have ‘addiction’ problems with Lotto. However, in follow-up qualitative focus groups, some adolescents reported that they actually got a buzz from the buying of Lotto tickets and scratchcards because it was an illegal activity for them (i.e., only those aged 16 years or older can play lottery games in the UK so the buying of tickets below this age is a criminal offence). Basically, there was a small minority of kids that were getting a buzz or high from the illegality of buying a lottery ticket rather than the gambling itself.

Along with Michael Auer, I published a paper in the journal Frontiers in Psychology where we argued game type was actually irrelevant in the development of gambling problems. We provided two examples that demonstrate that it is the structural characteristics rather than the game type that is critical in the acquisition, development and maintenance of problem and pathological gambling for those who are vulnerable and/or susceptible. A ‘safe’ slot machine could be designed in which no-one would ever develop a gambling problem. The simplest way to do this would be to ensure that whoever was playing the machine could not press the ‘play button’ or pull the lever more than once a week. An enforced structural characteristic of an event frequency of once a week would almost guarantee that players could not develop a gambling problem. Alternatively, a risky form of lottery game could be designed where instead of the draw taking place weekly, bi-weekly or daily, it would be designed to take place once every few minutes. Such an example is not hypothetical and resembles lottery games that already exist in the form of rapid-draw lottery games like keno.

Although many people (including those that work in the print media) may still use the terms ‘problem gambling’ and ‘gambling addiction’ interchangeably, hopefully I have demonstrated in this article that there is a need to think of these terms as being on a continuum in which ‘gambling addiction’ is at the extreme end of the scale and that ‘problem gambling’ (while still of major concern) doesn’t necessarily lead to problems in every area of a person’s life.

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

Further reading

Griffiths, M.D. & Auer, M. (2013). The irrelevancy of game-type in the acquisition, development and maintenance of problem gambling. Frontiers in Psychology, 3, 621. doi: 10.3389/fpsyg.2012.00621.

Griffiths, M.D. & Wood, R.T.A. (2001). The psychology of lottery gambling. International Gambling Studies, 1, 27-44.

Leino, T., Torsheim, T., Blaszczynski, A., Griffiths, M.D., Mentzoni, R., Pallesen, S. & Molde, H. (2014). The relationship between structural characteristics and gambling behavior: A population based study. Journal of Gambling Studies, in press.

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

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

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies (pp.211-243). New York: Elsevier.

Salvation Army (2014). Buying Lotto…Winning a gambling addiction. July 2. Located at: http://www.scoop.co.nz/stories/CU1407/S00032/buying-lotto-winning-a-gambling-addiction.htm

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

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

Wood, R.T.A. & Griffiths, M.D. (1998). The acquisition, development and maintenance of lottery and scratchcard gambling in adolescence. Journal of Adolescence, 21, 265-273.

Wood, R.T.A. & Griffiths, M.D. (2002). Adolescent perceptions of the National Lottery and scratchcards: A qualitative study using group interviews. Journal of Adolescence, 25/6, 655 – 668.

Wood, R.T.A. & Griffiths, M.D. (2004). Adolescent lottery and scratchcard players: Do their attitudes influence their gambling behaviour? Journal of Adolescence, 27, 467-475.

Looming large: A brief look at toy crazes and addiction

A few days ago my friend and colleague Dr. Andrew Dunn asked me “Have you written anything about loom band addiction? It’s a hot trend right now and it’s not just for the kids”. If you are not a parent of a tweenager, some of you reading this may have no idea of what a ‘loom band’ even is. Basically, it is a bracelet made from coloured rubber bands using a toy loom (such as the Rainbow Loom or the Cra-Z-Loom Ultimate Bracelet Maker).

Although I have never written on the topic, it just so happened that the day before he asked me the question, one of my regular blog readers sent me an article from the online BBC News Magazine examining the ‘loom band craze’ that is apparently sweeping the UK. Earlier in the year, I also got sent an article by Mark O’Sullivan in The Guardian newspaper on the same topic (“Loom bands: tweens are obsessed with it, and it’s a welcome sight’). Just so we are all clear, the definition of a ‘craze’ as defined by the Oxford Dictionary is “an enthusiasm for a particular activity or object which appears suddenly and achieves widespread but short-lived popularity”.

The BBC article – written by Justin Parkinson – began by noting that in this age of the screenager, it’s “curious to find that rubber bands are a big thing”. One of the reasons they have been in the British press is that some schools have banned them (because some children have been using them as weapons rather than as decorative wrist wear. There are also news reports of schools in New York banning them because they were alleged to be the cause of playground fights. Other countries (e.g., the Philippines) have complained that the bands are dangerous to pets as they eat the discarded bands and end up being lodged in animal intestines. Parkinson reported that:

“The Rainbow Loom…has sold more than three million units worldwide. The sheer scale of the craze can be seen in the stats for Amazon UK. All 30 of the best-selling toys are either looms or loom-related. The products top the sales list for every age group except the under-twos…Children use the looms, or their own fingers, to weave coloured bands into items such as bracelets, necklaces and charms. They use dozens of different designs, recommended on YouTube and by word of mouth, including the ‘fishtail’, the ‘dragon scale’ and the ‘inverted hexafish’. In an age when the toy market is dominated by more complicated toys and expensive computer games, backed by marketing campaigns, how did they become so popular?”

It wasn’t so long ago that a similar rubber band craze (i.e., Silly Bandz) swept across a number of countries. Silly Bandz are silicone rubber bands that are shaped into everyday objects, letters, numbers, musical instruments, and animals. However, Silly Bandz were to be collected rather than to be created. In relation to loom bands, the US writer Hallie Sawyer alluded to an addictive quality by describing loom bands as “Silly Bandz on crack [that will] someday clog up every landfill in America”. All I can remember as a kid was using rubber bands to make cheap catapults. For his BBC article, Parkinson interviewed Esther Lutman [assistant curator at the Museum of Childhood] about why loom bands were so popular:

“It’s part of the charm of these crazes that the kids find something they can do at school until they are banned. They keep pushing new stuff, particularly in the summer, when they spend more time in the playground together…I would bracket loom bands] with marbles in the Victorian era, yo-yos in the 1930s and hula-hoops in the 1950s. They are quite cheap, which helps explain their spread around playgrounds. They are at their absolute peak now. Who knows what will be next?”

Although we have no idea what will be next, there will be something else that comes along and captures the time and imaginations of children. Loom bands are clearly the latest in a long line of toy crazes. In my own lifetime I have personally witnessed (as both a teenager and parent) Rubik’s Cube (1980), Cabbage Patch Kids (1983), Slap Bracelets [also known as ‘snap bands’ and described as “Venetian blinds with attitude” by the New York Times) (1990), Tamagotchis (1996), Furbies (1998), Beanie Babies (1995), POGs (1995), and Bratz Dolls (2001).

I am no stranger to writing about crazes (and particularly ‘toy crazes’) and over the last 20 years whenever any new craze comes to the fore I am invariably asked by the media to what extent any of them are addictive and/or problematic. Arguably the most noteworthy (and in hindsight the most embarrassing for me personally) was the rise of the Tamagotchis and Furbies in the mid- to late-1990s. I was quoted in many national newspapers at the time as I had begun to do a bit of research into the psychological effects on children of virtual pets (and even published papers and articles on them – see ‘Further reading below’). For instance, the snippet below appeared in many newspapers:

“Dr. Mark Griffiths of Nottingham Trent University has researched what he calls ‘electronic friendship’, and is an authority on technological addictions. His latest subject is the Tamagotchi phenomenon. ‘Children make a massive psychological investment in these things. There have been reports of children going through a bereavement process when their Tamagotchi dies. That has its good points. The whole thing about simulations, whether it’s a pet or an aeroplane, is they help you in real life. I personally feel, the earlier people learn to cope with bereavement the better it is later in life’. He adds: ‘People do actually have attachments with their computer games and favourite fruit machine games. With virtual pets, I can understand it totally. People like to be needed’”.

Every Christmas for the last few years, UK television’s Channel 4 has repeatedly shown the programme 100 Greatest Toys with Jonathan Ross. The Tamagotchi was voted in at No.54 and I am featured in the show – being interviewed by Andrew Harvey on BBC 1’s Breakfast News – talking about the bereavement like reactions by children to the death of their Tamagotchi.

The good news with all of the crazes that I have ever been asked about is that none of them features a documented case of any child being genuinely addicted to any of the toys that I have been asked to comment on. While some of the children may have engaged excessively in the playing of the toys, there was never any evidence of the children experiencing detrimental effects as a result of being addicted.

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

Further reading

Cruz, G. (2010). From Tickle Me Elmo to Squinkies: Top 10 toy crazes. Time, December 23. Located at: http://content.time.com/time/specials/packages/article/0,28804,1947621_1947626_1993018,00.html

Conradt, S. (2010). The quick 10: 10 Toy crazes. Mental Floss, December 18. Located at: http://mentalfloss.com/article/23547/quick-10-10-toy-crazes

Griffiths, M.D. (1997). Are virtual pets more demanding than the real thing? Education and Health, 15, 37-38.

Griffiths, M.D. (1998). The side effects of Furby fever. Nottingham Evening Post, December 18, p.15.

Griffiths, M.D. & Gray, F. (1998). The rise of the Tamagotchi: An issue for educational psychology? BPS Division of Educational and Child Psychology Newsletter, 82, 37-40.

Parkinson, J. (2014). A craze for ‘loom bands’. BBC News Magazine, June 25. Located at: http://www.bbc.co.uk/news/magazine-27974401

O’Sullivan, M. (2014). Loom bands: tweens are obsessed with it, and it’s a welcome sight. The Guardian, April 21. Located at: http://www.theguardian.com/commentisfree/2014/apr/21/loom-bands-tweens-are-obsessed-with-it-and-its-a-welcome-sight

The teen screen scene: How does media and advertising influence youth addiction?

When we are looking for factors that change behaviour we can look inside the individual for personal characteristics that make people vulnerable to addiction and we can look outside the individual for features of the environment that encourage addictive behaviours. Addiction is a multi-faceted behaviour that is strongly influenced by contextual factors that cannot be encompassed by any single theoretical perspective.

The media (television, radio, newspapers, etc.) are an important channel for portraying information and channelling communication. Knowledge about how the mass media work may influence both the promotion of potentially addictive behaviour (as in advertising), and for the promotion of health education (such as promoting abstinence or moderation). Much of the research done on advertising is done by the companies themselves and thus remains confidential. The media, especially television and film, often portray addictions (e.g., heroin addiction in the film Trainspotting, marijuana use in the TV show Weeds, gambling addiction in the TV show Sunshine, etc.). Because of this constant portrayal of various addictions, television and film dramas often create controversy because of claims that they glorify addictive behaviour. The popularity of media drama depicting various addictions requires an examination of their themes and the potential impact on the public.

A 2005 study in the Journal of the Royal Society of Medicine by Dr. H. Gunasekera and colleagues analysed the portrayal of sex and drug use in the most popular movies of the last 20 years using the Internet Movie Database list of the top 200 movies of all time. The researchers excluded a number of films including those released or set prior to the HIV era (pre-1983), animated films, films not about humans, and family films aimed at children. The top 200 films following the exclusions were reviewed by one of two teams of two observers using a data extraction sheet tested for inter-rater reliability. Sexual activity, sexually transmitted disease (STD) prevention, birth control measures, drug use and any consequences discussed or depicted were recorded.

The study reported that there were 53 sex episodes in 28 (32%) of the 87 movies reviewed. There was only one suggestion of condom use, which was the only reference to any form of birth control. There were no depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs. Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%) but tended to portray their use positively and without negative consequences. There were no episodes of injected drug use. The researchers concluded that sex depictions in popular movies of the last two decades lacked safe sex messages. Drug use, though infrequent, tended to be depicted positively. They also concluded that the social norm being presented in films was of great concern given the HIV and illicit drug pandemics.

Drug use in this context could be argued to illustrate a form of observational learning akin to advertisement through product placement. A similar 2002 study by Dr. D. Roberts and colleagues examined drug use within popular music videos. Whilst depictions of illicit drugs or drug use were relatively rare in pop videos, when they did appear they were depicted on a purely neutral level, as common elements of everyday activity.

The makers of such drama argue that presenting such material reflects the fact that addictions are everywhere and cut across political, ethnic, and religious lines. Addiction is certainly an issue that impacts all communities. However, it is important to consider possible impacts that it might have on society. Empirical research suggests that the mass media can potentially influence behaviours. For example, research indicates that the more adolescents are exposed to movies with smoking the more likely they are to start smoking. Furthermore, research has shown that the likeability of film actors and actresses who smoke (both on-screen and off-screen) relates to their adolescent fans’ decisions to smoke. Perhaps unsurprisingly, films tend to stigmatise drinking and smoking less than other forms of drug taking. However, the media transmit numerous positive messages about drug use and other potential addictions, and it is plausible that such favourable portrayals lead to more use by those that watch them. Anecdotally, some things may be changing. For instance, there appears to be more emphasis on the media’s portrayal of alcohol as socially desirable and positive as opposed to smoking that is increasingly being regarded as anti-social and dangerous.

Back in 1993, the British Psychological Society (1993) called for a ban on the advertising of all tobacco products. This call was backed up by the UK government’s own research which suggested a relationship between advertising and sales. Also, in four countries that had banned advertising (New Zealand, Canada, Finland and Norway) there was been a significant drop in tobacco consumption.

However, public policy is not always driven by research findings, and the powerful commercial lobby for tobacco has considerable influence. In her reply to the British Psychological Society, the Secretary of State for Health (at the time) rejected a ban saying that the evidence was unclear on this issue and efforts should be concentrated elsewhere. This debate highlights how issues of addictive behaviours cannot be discussed just within the context of health. There are also political, economic, social and moral contexts to consider as well. The British government and European Community made commitments to ban tobacco advertising though they found it difficult to bring it in as quickly as they hoped. It is now rare to see smoking advertised anywhere in the UK but there is a new trend in television drama and films to set the action in a time or location where smoking is part of the way of life (for example the US television programme Mad Men).

Just as the British Government have banned cigarette advertising and banned smoking in public places, they have also deregulated gambling through the introduction of the 2005 Gambling Act. This Act came into effect on September 1st 2007 and allowed all forms of gambling to be advertised in the mass media for the first time. This has led to a large number of nightly television adverts for betting shops, online poker, and online bingo. Whether this large increase in gambling advertising will impact on gambling participation and gambling addiction remains to be seen. There have been very few studies that have examined gambling advertising and those that have been done are usually small scale and lack representativeness.

In an article I wrote in 2010 looking at these issues, I reached a number of conclusions that I don’t think have changed in the past few years since I wrote that article. My conclusions were:

• Glamorisation versus reality is complicated: The issue of glamorisation versus reality is of course complicated. Although the drama producers hope to accurately depict various addictions, they still need to keep ratings up. Clearly, positive portrayals are more likely to increase ratings and programmes might favour acceptance of drug use over depictions of potential harms.
• Research on the role of media effects is inconclusive: More research on how the media influence drug use is needed in order to evaluate the impact of such drama. With media and addiction, it is important to walk with caution, as the line between reality and glamorisation is easy to cross. More research is needed that investigates direct, indirect, and interactive effects of media portrayals on addictive behaviour.
• Relationship between advertising and addictive behaviour is mostly correlational: The literature examining the relationship between advertising on the uptake of addictive behaviour is not clear cut and mostly correlational in nature hence it is not possible to make causal connections.
• There could be different media effects for different addictions: Although there appears to be some relationship between tobacco advertising and tobacco uptake, this does not necessarily hold for all addictive behaviours. For instance, some academics claim that econometric studies of alcohol advertising expenditures come to the conclusion that advertising has little or no effect on market wide alcohol demand.
• Research done to date may not be suitable: Survey research studies have failed to measure the magnitude of the effect of advertising on youth intentions or behaviour in a manner that is suitable for policy analysis. As a consequence, policy makers may introduce and/or change policy that is ineffective or not needed on the basis of research that was unsuitable in answering a particular question.

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

Further reading

Cape, G. S. (2003). Addiction, stigma, and movies. Acta Psychiatrica Scandinavica, 107, 163-169.

Dalton, M.A., Sargent, J.D., Beach, M.L., Titus-Ernstoff, L., Gibson, J.J., Aherns, M.B., & Heatherton, T.F. (2003). Effect of viewing smoking in movies on adolescent smoking initiation: A cohort study. Lancet, 362, 281-285.

Distefan, J. M., E. A. Gilpin, et al. (1999). Do movie stars encourage adolescents to start smoking? Evidence from California. Preventive Medicine, 28, 1-11.

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. (2010). Media and advertising influences on adolescent risk behaviour. Education and Health, 28(1), 2-5.

Gunasekera, H. Chapman, S. Campbell, S. (2005). Sex and drugs in popular movies: An analysis of the top 200 Films. Journal of the Royal Society of Medicine, 98, 464-470.

Nelson, J.P. (2001). Alcohol advertising and advertising bans: A survey of research methods, results, and policy implications. In M.R. Baye & J.P. Nelson (Eds.), Advances in Applied Microeconomics, Volume 10: Advertising and Differentiated Products (Chapter 11). Amsterdam: Elsevier Science.

Roberts, D.F., Christenson, P.G. Henriksen, L. & Bandy, E. (2002). Substance Use in Popular Music Videos. Office Of National Drug Control Policy. Located at: http://www.mediacampaign.org/pdf/mediascope.pdf

Wilde, G.J.S. (1993). Effects of mass media communications on health and safety habits: An overview of issues and evidence. Addiction, 88, 983-996.

Will, K. E., B. E. Porter, et al. (2005). Is television a healthy and safety hazard? A cross-sectional analysis of at-risk behavior on primetime television. Journal of Applied Social Psychology, 35, 198-22

Velvet gold mind: Psychopathy, addiction, ECT, and the psychology of Lou Reed

Regular readers of my blog will have no doubt picked up that one of my all time favourite bands is the Velvet Underground (VU) – often referred to as “The Psychopath’s Rolling Stones“. I bought my first VU album on vinyl back in 1980 as a 14-year old adolescent (a 12-track compilation that I still have simply called ‘The Velvet Underground’). When I bought it I had heard very few VU songs on the radio and one of the main reasons I bought it was because a number of my musical heroes at the time (Ian McCulloch the lead singer of the Echo and the Bunnymen being the one I seem to remember) kept listing VU songs in their ‘Top 10 Tracks’ in Smash Hits magazine.

Over time I have steadily accumulated a massive collection of VU and VU-related albums (mainly solo LPs of VU band members, most notably Lou Reed, John Cale, and Nico, as well as dozens and dozens of bootleg LPs). As much as I love the recorded solo outputs of Cale and Nico, it is Lou Reed that I have always found the most psychologically fascinating on both a musical and personal level (even though Cale was admittedly the better musician) – and because of his autobiographical lyrics (many of which were collated in his 1992 book Between Thought and Expression). Reed (along with a few other musicians such as John Lennon, Morrissey, David Bowie, Adam Ant, and Gary Numan) is someone I would love to have interviewed, as he was a psychological paradox and appeared to have so many different facets to his personality. During is early career, Reed was a self-confessed drug addict and wrote songs about both heroin (‘I’m Waiting For The Man‘ and admitting in his song ‘Heroin‘ that it was “my wife and it’s my life”) and amphetamines (‘White Light, White Heat‘). I would also argue that in later life he replaced these negative addictions with what Bill Glasser defined as a ‘positive addiction‘ in the form of t’ai chi ch’uan (i.e., tai chi).

In the 1960s and early 1970s, Reed’s lyrics covered topics that shocked many people. His song lyrics recounted life’s misfits and those that lived on the fringes (particularly of the life he had himself experienced in New York and as part of pop artist Andy Warhol’s entourage). His world was one of drug addiction, transvestite drag queens, bisexuality, and sado-masochism. Like many of the best and most literary writers, he wrote about what he knew and had experienced. As Reed himself pointed out many times, the subject matter of his songs were no different from his literary heroes such as Edgar Allen Poe, Hubert Selby Jr., William Burroughs, and Delmore Schwartz. Sex and drugs were common themes in novels and poetry. Reed wondered why listeners and rock critics alike were so horrified by the content of his songs when the same content could be found in books from the 1950s and early 1960s.

Reed was a much feared interviewee by music journalists and often poured vitriol on many rock critics (Lester Bangs and Robert Christgau being the most high profile). Just listen to his 1978 live LP Take No Prisoners that is remembered more for the acerbic monologues in between the songs than for the music. Although I would have loved to interview him, his experiences with psychologists and psychiatrists arguably left him emotionally scarred for life (or at the very least a deep mistrust of therapists). His affluent parents sent him for weekly sessions of electroconvulsive therapy (ECT) as a young teenager to “cure” him of his homosexual desires and urges. It had such a negative impression on him that he documented the experiences on his song ‘Kill Your Sons’ (from his 1974 LP Sally Can’t Dance). As he was quoted as saying in Legs McNeil and Gillian McCain’s 1996 book Please Kill Me:

“They put the thing down your throat so you don’t swallow your tongue, and they put electrodes on your head. That’s what was recommended in Rockland State Hospital to discourage homosexual feelings. The effect is that you lose your memory and become a vegetable”

Up until the ECT session, Reed appeared to have lead a relatively trouble-free childhood (although there were admittedly some juvenile delinquent activities). The ECT sessions may have been the catalyst that far from ‘curing’ him of his sexual urges confused the issue even more. Reed was more explicit in the lyrics to ‘Kill Your Sons’ about the whole experience of ECT and what he thought about it:

“All your two-bit psychiatrists are giving you electro shock/They say, they let you live at home, with mom and dad/Instead of mental hospital/But every time you tried to read a book/You couldn’t get to page 17/’Cause you forgot, where you were/So you couldn’t even read/Don’t you know, they’re gonna kill your sons”.

I have read almost every biography that has ever been published on Reed and there appears to be an almost unconscious pathological need to subvert the traditional rock cycle treadmill of fame and success. There is no doubt that Reed wanted to be respected and remembered for his literary writing – but many of his decisions and actions were self-defeating. In my own field of gambling, the psychologist Edmund Bergler speculated that addicted gamblers have an ‘unconscious desire to lose’ – a form of psychic masochism. If Reed was on Bergler’s couch, he may have come to the same conclusion about Reed.

There are so many points in Reed’s life where he appeared to deliberately sabotage his own career and commit what others have described ‘artistic suicide’. For instance, after David Bowie had befriended him in the early 1970s and produced his first hit LP (Transformer) and biggest hit (‘Walk On The Wild Side’), he fell out with Bowie and recorded what a number of rock critics have described as “the most depressing album of all time” (the 1973 LP Berlin). He then seemed to get his career back on course with his one and only top 10 US album (1974 LP Sally Can’t Dance) only to follow it up with the album consisting of four tracks of guitar feedback each 16 minutes in length (1975 album Metal Machine Music). James Wolcott writing for the Village Voice went as far as to say that  Metal Machine Music “crowned Reed’s reputation as a master of psychopathic insolence”. Although both “career killing” LPs have since been hailed as masterpieces in their own way, both releases provide an argument that Reed was a masochist on some level even if the original pain didn’t become pleasure until 30 years later.

The arguably self-inflicted pain didn’t end with his musical output. Almost every important person he looked up to in his life between 1964 and the early 1990s were cast aside and verbally and/or physically abused by Reed at some point. This included his managers (e.g., Andy Warhol, Steve Sesnick, Dennis Katz), his admirers and benefactors (e.g., David Bowie), his record company senior executives (e.g., Clive Davis), his lovers (e.g., Shelly Albin, Nico, Bettye Kronstad, Sylvia Morales, “Rachel” [Tommy] Humphries), and his musical collaborators (e.g., John Cale, Doug Yule, Robert Quine).

Some people have claimed Reed was almost psychopathic in some of his actions. The criminal psychologist Professor Robert Hare developed the Revised Hare Psychopathy Checklist (PCL-R), a psychological assessment that determines whether someone is a psychopath.

“At heart, Hare’s test is simple: a list of 20 criteria, each given a score of 0 (if it doesn’t apply to the person), 1 (if it partially applies) or 2 (if it fully applies). The list in full is: glibness and superficial charm, grandiose sense of self-worth, pathological lying, cunning/manipulative, lack of remorse, emotional shallowness, callousness and lack of empathy, unwillingness to accept responsibility for actions, a tendency to boredom, a parasitic lifestyle, a lack of realistic long-term goals, impulsivity, irresponsibility, lack of behavioural control, behavioural problems in early life, juvenile delinquency, criminal versatility, a history of ‘revocation of conditional release’ (i.e., broken parole), multiple marriages, and promiscuous sexual behaviour. A pure, prototypical psychopath would score 40. A score of 30 or more qualifies for a diagnosis of psychopathy”

Personally, I think there are psychopathic traits in almost any person with a successful career, and Reed (from the many biographies I have read) would certainly endorse some of the indicators in the list above. However, as he (i) became older, (ii) became teetotal and drug-free, (iii) studied Buddhist philosophy (including meditation and tai chi), and (iv) settled down and married performance artist and musician Laurie Anderson, he arguably became happier and produced some of the best music of his career.

The trio of ‘concept’ albums including his ‘warts ‘n’ all’ tribute to his home city (New York, 1989), his moving tribute to Andy Warhol (Songs for Drella, 1990, with John Cale), and his lyrical musings on illness, death and dying (1992, Magic and Loss) were all critically lauded (and among my own personal favourites). Songs for Drella (the VU’s nickname for Andy Warhol – a contraction of the names Cinderella and Dracula) is not just one of Reed’s best albums but it’s one of the best LP’s ever. The fact that the songs were heartfelt and full of remorse for the way Reed had treated Warhol in the latter years of his life, suggest that the characterization of Reed as a psychopath is unfair.

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

Further reading

Bockris, V. (1994). Lou Reed: The Biography. London: Hutchinson.

Bockris, V. & Malanga, G. (1995). Up-tight – The Velvet Underground Story.London:Omnibus Press.

Doggett, P. (1991). Lou reed – Growing Up in Public
. London: 
Omnibus Press.

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

Henry, T. (1989), Break All Rules! Punk Rock and the Making of a Style, Ann Arbour MI: UMI Research Press.

Hare, R. D., & Vertommen, H. (2003). The Hare Psychopathy Checklist-Revised. Multi-Health Systems, Incorporated.

Heylin, C. (2005). All Yesterday’s Parties – The Velvet Underground In Print 1966-1971. Cambridge, MA: Da Capo Press.

Hogan, P. (2007). The Rough Guide To The Velvet Underground. London: Penguin.

Jovanovich, R. (2010). The Velvet Underground – Peeled. Aurum Press.

Kostek, M.C. (1992). The Velvet Underground Handbook
. London: 
Black Spring Press.

McNeil, Legs; McCain, G. (1996). Please Kill Me: The Uncensored Oral History of Punk. London: Grove Press.

Muggleton, D. & Weinzierl, R. (2003). The Post-subcultures Reader. Oxford: Berg.

Reed, L. (1992). Between Thought and Expression. 
London: Penguin Books.

Wall, M. (2013). Lou Reed: The Life. Croydon: Orion Books.

Trends reunited: How has gambling changed? (Part 2)

Most of the changes outlined in my previous blog were things that I predicted would happen in various papers that I wrote in the 1990s. However, there are many things that I did not predict would be areas of growing interest and change. The most interesting (to me at least) include (i) the rise of online poker and betting exchanges, (ii) gender swapping online and the rise of female Internet gambling, (iii) emergence of new type(s) of problem gambling, (iv) increase in use of behavioural tracking data, and (v) technological help for problem gamblers.

Online poker and betting exchanges: Two of the fastest growing forms of online gambling are in the areas of online poker and online betting exchanges. I have speculated there are three main reasons for the growth in these two particular sectors. Firstly, they provide excellent financial value for the gambler. There is no casino house edge or bookmakers’ mark-up on odds. Secondly, gamblers have the potential to win because there is an element of skill in making their bets. Thirdly, gamblers are able to compete directly with and against other gamblers instead of gambling on a pre-programmed slot machine or making a bet on a roulette wheel with fixed odds. However, one of the potential downsides to increased competition is recent research highlighting that problem gamblers are significantly more likely to be competitive when compared to non-problem gamblers. My research unit has also speculated other factors that have aided the popularity of online poker. These include (i) social acceptability of this type of gambling, (ii) promotion through televised tournaments often with celebrity players, (iii) 24/7 availability, (iv) the relative inexpensiveness of playing, and (v) the belief that this is predominantly a game of skill that can be mastered.

Gender swapping and the rise in female Internet gambling: One study by my research unitreported the phenomenon of gender swapping in online poker players. More female players (20%) in our study reported swapping gender when playing compared to males (12%). Typical reasons that female participants gave as to why they did this were that they believed other males would not take them so seriously if they knew they were playing against a woman. It also gave them a greater sense of security as a lone woman in a predominantly male arena. Males and females clearly had different motivations for gender swapping. For males it was a tactical move to give them a strategic advantage. For females it was more about acceptance or privacy in what they perceived to be a male dominated environment. Similar findings have been reported in relation to online computer game playing. In more general terms, the apparent rise in female Internet gambling is most likely because the Internet is a gender-neutral environment. The Internet is seen as less alienating and stigmatising medium when compared to male-dominated environments such as casinos and betting shops. The most obvious example is online bingo where online gaming companies have targeted females to get online, socialise, and gamble.

Emergence of new type(s) of problem gambling: The emergence of new technologies has brought with it new media in which to gamble. As noted above, the rise of online poker has been one of the success stories for the online gaming industry. This rise has also led to more research in this area including some that suggests a different way of viewing problem gambling. For instance, research has suggested that online poker may be producing a new type of problem gambler where the main negative consequence is loss of time (rather than loss of money). This research has identified a group of problem gamblers who (on the whole) win more money than they lose. However, they may be spending excessive amounts of time (e.g., 12 to 14 hours a day) to do this. This could have implications for problem gambling criteria in the future (i.e., there may be more criteria relating to the consequences of time conflicts as opposed to financial consequences).

Increase in use of behavioural tracking data: Over the past few years, innovative social responsibility tools that track player behaviour with the aim of preventing problem gambling have been developed including (e.g., mentor, PlayScan). These new tools are providing insights about problematic gambling behaviour that in turn may lead to new avenues for future research in the area. The companies who have developed these tools claim that they can detect problematic gambling behaviour through analysis of behavioural tracking data. If problem gambling can be detected online via observational tracking data, it suggests that there are identifiable behaviours associated with online problem gambling. Given that almost all of the current validated problem gambling screens diagnose problem gambling based on many of the consequences of problem gambling (e.g., compromising job, education, hobbies and/or relationship because of gambling; committing criminal acts to fund gambling behaviour; lying to family and friends about the extent of gambling, etc.), behavioural tracking data appears to suggest that problem gambling can be identified without the need to assess the negative psychosocial consequences of problem gambling.

Technological help for problem gamblers: Much of this article has discussed the potential downside of technological innovation. However, one area that was not predicted a decade ago is the use of technology in the prevention, intervention, and treatment of problem gambling. For instance, technology is now being used for health promotion using the Web, video games, and/or CD-ROMs. Internet gambling sites are beginning to feature links to relevant gambling awareness sites. For those sites that analyze their online behavioural tracking data, it may be the case that such data could be used to identify problem gamblers and help them rather than exploit them. Finally, help in the form of online therapy (such as online counselling) may be an option for some problem gamblers. For instance, an evaluation that we carried out of an online advice service for problem gamblers showed that clients were very positive about the service and that Internet gamblers were more likely to access the service than non- Internet gamblers.

Obviously the changes I have listed here are the ones that have been most important to me personally and have formed the backbone of my research. In writing these blogs, part of me finds it hard to believe that I am still actively researching in the gambling studies field and that there is always something new to learn and discover.

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

Further reading

Auer, M. & Griffiths, M.D. (2013).Limit setting and player choice in most intense online gamblers: An empirical study of online gambling behaviour. Journal of Gambling Studies, in press.

Griffiths, M.D. (1999). Gambling technologies: Prospects for problem gambling. Journal of Gambling Studies, 15, 265-283.

Griffiths, M.D. (2003). Internet gambling: Issues, concerns and recommendations. CyberPsychology and Behavior, 6, 557-568.

Griffiths, M.D. (2005). Online betting exchanges: A brief overview. Youth Gambling International, 5(2), 1-2.

Griffiths, M.D. (2006). Impact of gambling technologies in a multi-media world. Casino and Gaming International, 2(2), 15-18.

Griffiths, M.D. (2007). Interactive television quizzes as gambling: A cause for concern? Journal of Gambling Issues, 20, 269-276.

Griffiths, M.D. (2009). Internet gambling in the workplace. Journal of Workplace Learning, 21, 658-670.

Griffiths, M.D. (2011). Technological trends and the psychosocial impact on gambling. Casino and Gaming International, 7(1), 77-80.

Griffiths, M.D. (2013). Social gambling via Facebook: Further observations and concerns. Gaming Law Review and Economics, 17, 104-106.

Griffiths, M.D. & Cooper, G. (2003). Online therapy: Implications for problem gamblers and clinicians. British Journal of Guidance and Counselling, 13, 113-135.

Griffiths, M.D. & Whitty, M.W. (2010). Online behavioural tracking in Internet gambling research: Ethical and methodological issues. International Journal of Internet Research Ethics, 3, 104-117.

Griffiths, M.D., Wood, R.T.A. & Parke, J. (2009). Social responsibility tools in online gambling: A survey of attitudes and behaviour among Internet gamblers. CyberPsychology and Behavior, 12, 413-421.

Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gaming in Europe: Challenges, Prevention, and Interventions. New York: Springer.

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

Wood, R.T.A. & Griffiths, M.D. (2007). Online guidance, advice, and support for problem gamblers and concerned relatives and friends: An evaluation of the Gam-Aid pilot service. British Journal of Guidance and Counselling, 35, 373-389.

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