Category Archives: Compulsion

Tubular hells: A brief look at ‘addiction’ to watching YouTube videos

 

A few days ago, I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). As Gaita reported:

“The story profiles a middle school student whose obsessive viewing of YouTube content led to extreme behavior changes and eventually, depression and a suicide attempt. The student finds support through therapy at an addiction recovery center…The student in question is a young girl named Olivia who felt at odds with the ‘popular’ kids at her Oakland area school. She began watching YouTube videos after hearing that it was a socially acceptable thing to do… Her viewing habits soon took the place of sleep, which impacted her energy and mood. Her grades began to falter, and external problems within her house – arguments between her parents and the death of her grandmother – led to depression and an admission of wanting to hang herself. Her parents took her to a psychiatric hospital, where she stayed for a week under suicide watch, but her self-harming compulsion continued after her release. She began viewing videos about how to commit suicide, which led to an attempt to overdose on Tylenol[Note: The name of the woman – Olivia – was a pseudonym].

McClurg interviewed Olivia’s mother for the PBS article and it was reported that Olivia went from being a “bubbly daughter…hanging out with a few close friends after school” to “isolating in her room for hours at a time”. Olivia’s mother also claimed that her daughter had always been kind of a nerd, a straight. A student who sang in a competitive choir. But she desperately wanted to be popular, and the cool kids talked a lot about their latest YouTube favorites”. According to news reports, all Olivia would do was to watch video after video for hours and hours on end and developed sleeping problems. Over time, the videos being watched focused on fighting girls and other videos featuring violence.

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The news story claimed that Olivia was “diagnosed with depression that led to compulsive internet use”. When Olivia went back home she was still feeling suicidal and then spent hours watching YouTube videos on how to commit suicide (and it’s where she got the idea for overdosing on Tylenol tablets).

After a couple of spells in hospital, Olivia’s parents took her to a Californian centre specialising in addiction recovery (called ‘Paradigm’ in San Rafael). The psychologist running the Paradigm clinic (Jeff Nalin) claimed Olivia’s problem was “not uncommon” among clients attending the clinic. Nalin believes (as I do and have pointed out in my own writings) that treating online addictions is not about abstinence but about getting the behaviour under control but developing skills to deal with the problematic behaviour. He was quoted as saying:

“I describe a lot of the kids that we see as having just stuck a cork in the volcano. Underneath there’s this rumbling going on, but it just rumbles and rumbles until it blows. And it blows with the emergence of a depression or it emerges with a suicide attempt…The best analogy is when you have something like an eating disorder. You cannot be clean and sober from food. So, you have to learn the skills to deal with it”.

The story by Gaita asked the question of whether compulsive use of watching YouTube could be called a genuine addiction (and that’s where my views based on my own research were used). I noted that addiction to the internet may be a symptom of another addiction, rather than an addiction unto itself. For instance, people addicted to online gambling are gambling addicts, not internet addicts. An individual addicted to online gaming or online shopping are addicted to gaming or shopping not to the internet.

An individual may be addicted to the activities one can do online and is not unlike saying that an alcoholic is not addicted to a bottle, but to what’s in it. I have gone on record many times saying that I believe anything can be addictive as long there are continuous rewards in place (i.e., constant reinforcement). Therefore, it’s not impossible for someone to become addicted to watching YouTube videos but the number of genuine cases of addiction are likely to be few and far between. Watching video after video is conceptually no different from binge watching specific television series or television addiction itself (topics that I have examined in previous blogs).

I ought to end by saying that some of my own research studies on internet addiction (particularly those co-written with Dr. Attila Szabo and Dr. Halley Pontes and published in the Journal of Behavioral Addictions and Addictive Behaviors Reports – see ‘Further reading’ below) have examined the preferred applications by those addicted to the internet, and that the watching of videos online is one of the activities that has a high association with internet addiction (along with such activities such as social networking and online gaming). Although we never asked participants to specify which channel they watched the videos, it’s fair to assume that many of our participants will have watched them on YouTube), and (as the Camelot lottery advert once said) maybe, just maybe, a few of those participants may have had an addiction to watching YouTube videos.

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

Further reading

Gaita, P. (2017). Does compulsive YouTube viewing qualify as addiction? The Fix, May 19. Located at: https://www.thefix.com/does-compulsive-youtube-viewing-qualify-addiction

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

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

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

Griffiths M.D. & Szabo, A. (2014). Is excessive online usage a function of medium or activity? An empirical pilot study. Journal of Behavioral Addictions, 3, 74-77.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

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

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

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

McClurg, L. (2017). After compulsively watching YouTube, teenage girl lands in rehab for ‘digital addiction’. PBS Newshour, May 16. Located at: http://www.pbs.org/newshour/rundown/compulsively-watching-youtube-teenage-girl-lands-rehab-digital-addiction/

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

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

Doctor, doctor: What can British GPs do about problem gambling?

A study published in the British Journal of General Practice in March 2017 reported that of 1,058 individuals surveyed in GP waiting rooms in Bristol (UK), 0.9% were problem gamblers and that a further 4.3% reported gambling problems that “were low to medium severity”. This is in line with other British studies carried out over the last decade which have reported problem gambling prevalence rates of between 0.5% and 0.9%.

I have long argued that problem gambling is a health issue and that GPs should routinely screen for gambling problems. Back in 2004, I published an article in the British Medical Journal about why problem gambling is a health issue. I argued that the social and health costs of problem gambling were (and still are) large at both individual and societal levels.

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Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy. Adverse health consequences for problem gamblers and their partners include depression, insomnia, intestinal disorders, migraine, and other stress related disorders. In my BMJ article I also noted that analysis of calls to the GamCare national gambling helpline indicated that a small minority of callers reported health-related consequences as a result of their problematic gambling. These included depression, anxiety, stomach problems, and suicidal ideation. Obviously many of these medical problems arise through the stress of financial problems but that doesn’t make it any less of a health issue for those suffering from severe gambling problems.

Research published in the American Journal of Addictions has also shown that health-related problems can occur as a result of withdrawal effects. For instance, one study by 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, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty, and chills.

Based on these findings, problem gambling is very much a health issue that needs to be taken seriously by all in the medical profession. GPs routinely ask patients about smoking cigarettes and drinking, but gambling is something that is not generally discussed. Problem gambling may be perceived as a grey area in the field of health, and it is therefore very easy for those in the medical profession not to have the issue on their wellbeing radar. If the main aim of GPs is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge and should be taught in the curriculum while prospective doctors are at medical school. One of the reasons that GPs don’t routinely screen for problem gambling is because they are not taught about it during their medical training and therefore do not even think about screening for it in the first place. As I recommended in a report commissioned by the British Medical Association, the need for education and training in the diagnosis, appropriate referral and effective treatment of gambling problems must be addressed within GP training. More specifically, GPs should be aware of the types of gambling and problem gambling, demographic and cultural differences, and the problems and common co-morbidities associated with problem gambling. GPs should also understand the importance of screening patients perceived to be at increased risk of gambling addiction, and should be aware of the referral and support services available locally.

I also recommended that treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded by gambling-derived profit revenue.

Back in 2011, Dr. Jane Rigbye and myself published a study using Freedom of Information requests to ask NHS trusts if they had ever treated pathological gamblers. Only 3% of the trusts had ever treated a problem gambler and only one trust said they offered dedicated help and support. I’m sure if we repeated the study today, little will have changed.

It is evident that problem gambling is not, as yet, on the public health agenda in the UK. NHS services – including GP surgeries – need to be encouraged to see gambling problems as a primary reason for referral and a valid treatment option. Information about gambling addiction services, in particular services in the local area, should be readily available to gamblers and GP surgeries are a good outlet to advertise such services. Although some gambling services (such as GamCare, the gambling charity I co-founded) provide information to problem gamblers about local services, such information is provided to problem gamblers who have already been proactive in seeking gambling help and/or information. Given that very few GPs could probably treat a problem gambler, what they must have is the knowledge of who they can refer their patients to.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Calado, F. & Griffiths, M.D. (2016). Problem gambling worldwide: An update of empirical research (2000-2015). Journal of Behavioral Addictions, 5, 592–613.

Cowlishaw, S., Gale, L., Gregory, A., McCambridge, J., & Kessler, D. (2017). Gambling problems among patients in primary care: a cross-sectional study of general practices. British Journal of General Practice, doi: bjgp17X689905

Griffiths, M.D. (2001). Gambling – An emerging area of concern for health psychologists. Journal of Health Psychology, 6, 477-479.

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 (ISBN 1-905545-11-8).

Griffiths, M.D. & Smeaton, M. (2002). Withdrawal in pathological gamblers: A small qualitative study. Social Psychology Review, 4, 4-13.

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.

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. London: The Stationery Office.

Search of the poisoned mind? A brief look at ‘internet search dependence’

Despite being a controversial topic, research into a wide variety of online addictions has grown substantially over the last decade. My own research into online addictions has been wide ranging and has included online social networking, online sex addiction, online gaming addiction, online shopping addiction, and online gambling addiction. As early as the late 1990s/early 2000s, I constantly argued that when it came to online addictions, most of those displaying problematic behaviour had addictions on the internet rather than addictions to the internet (i.e., they were not addicted to the medium of the internet but addicted to applications and activities that could be engaged in via the internet).

A recent 2016 paper by Dr. Yifan Wang and colleagues in the journal Frontiers in Public Health described the development of the Questionnaire of Internet Search Dependence (QISD), a tool developed to assess individuals who may be displaying a dependence on using online search engines (such as Google and Baidu). The notion of individuals being addicted to using search engines is not new and was one of five types of internet addiction outlined in a 1999 typology in a paper in the Student British Medical Journal by Dr. Kimberley Young (and what she termed ‘information overload’ and referred to compulsive database searching). Although I criticized the typology on the grounds that most of the types of online addict were not actually internet addicts but were individuals using the medium of the internet to fuel other addictive behaviours (e.g., gambling, gaming, day trading, etc.), I did implicitly acknowledge that activities such as internet database searching could theoretically exist, even if I did not think it was a type of internet addiction.

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As far as I am aware, the new scale developed by Wang et al. (2016) is the first to create and psychometrically evaluate an instrument to assess ‘internet search dependence’. As noted by the authors:

Subsequently, we compiled 16 items to represent psychological characteristics associated with Internet search dependence, based on the literature review and a follow-up interview with 50 randomly selected university students…We adopted the six criteria for behavioral addiction formulated by Griffiths (i.e., salience, mood modification, tolerance, withdrawal, conflict, and relapse) [Griffiths, 1999b]”.

Given the authors claimed they used an early version of my addiction components model (i.e., one from 1999 rather than my most recent 2005 formulation) to help inform item construction, I was obviously interested to see the scale’s formulated items. I have to admit that I had a lot of misgivings about the paper so I wrote a commentary on it that has just been published in the same journal (Frontiers in Public Health). More specifically, I noted in my paper that if an individual was genuinely addicted to searching online databases I would have expected to see all of my six criteria applied as follows:

  • Salience – This occurs when searching internet databases becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialized behaviour). For instance, even if the person is not actually searching the internet they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with internet database searching).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of internet database searching and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’ when searching internet databases).
  • Tolerance – This is the process whereby increasing amounts of time searching internet databases are required to achieve the former mood modifying effects. This basically means that for someone engaged in internet database searching, they gradually build up the amount of the time they spend searching internet databases every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.), that occur when an individual is unable to search internet databases because they are ill, the internet is unavailable, or there is no Wi-Fi on holiday, etc.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time searching internet databases.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive internet database searching to recur and for even the most extreme patterns typical of the height of excessive internet database searching to be quickly restored after periods of control.

Of the 12 QISD items constructed in the new scale, very few appeared to have anything to do with addiction and/or dependence but this is most likely due to the fact that the authors also used data collected from 50 participants to inform their items and not just the criteria in the addiction components model. However, relying heavily on input from their participants resulted in a number of key features in addiction/dependence not even being assessed (i.e., no assessment of salience, mood modification, conflict, relapse or tolerance). A couple of items may peripherally assess withdrawal symptoms (e.g., ‘I will be upset if I cannot find an answer to a complex question through Internet search’) but not in any way that is directly associated with addiction or dependence. This may be because the authors’ conceptualization of ‘dependence’ was more akin to ‘over-reliance’ rather than traditional definitions of dependence.

While the QISD may be psychometrically robust I argued that it appears to have little face validity and does not appear to assess problematic engagement in internet database searching (irrespective of how addiction or dependence is defined). Based on the addiction components model, I concluded my paper by creating my own scale to assess internet search dependence based directly on the addiction components model and which I argued would have much greater face validity than any item currently found in the QISD:

  • Internet database searching is the most important thing in my life.
  • Conflicts have arisen between me and my family and/or my partner about the amount of time I spend searching internet databases.
  • I engage in internet database searching as a way of changing my mood.
  • Over time I have increased the amount of internet database searching I do in a day.
  • If I am unable to engage in internet database searching I feel moody and irritable.
  • If I cut down the amount of internet database searching I do, and then start again, I always end up searching internet databases as often as I did before.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

Andreassen, C.S., Pallesen, S., Griffiths, M.D. (2017). The relationship between excessive online social networking, narcissism, and self-esteem: Findings from a large national survey. Addictive Behaviors, 64, 287-293.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Griffiths, M.D. (1998). Internet addiction: Does it really exist? In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (pp. 61-75). New York: Academic Press.

Griffiths, M.D. (1999a). Internet addiction: Internet fuels other addictions. Student British Medical Journal, 7, 428-429.

Griffiths, M.D. (1999b). Internet addiction: Fact or fiction? The Psychologist: Bulletin of the British Psychological Society, 12, 246-250.

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, 191-197.

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

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, in press.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

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

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

Wang, Y., Wu, L., Zhou, H., Xu, J. & Dong, G. (2016). Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 4, 274. doi: 10.3389/fpubh.2016.00274

Young, K. S. (1999). Internet addiction: evaluation and treatment. Student British Medical Journal, 7, 351-352.

Digital desires: A brief look at sexual thumb sucking and thumb fetishism

In previous blogs I have examined a number of extreme behaviours involving hands (both sexual and non-sexual) including hand wear fetishism, fingernail fetishism, ‘hands on hip’ fetishism, alien hand syndrome, ‘touch the truck’ endurance television, and thumb sucking as an addiction. However, it was while I was researching a previous blog on belly inflation fetishes that I came across a man who on the Yahoo! Answers website claimed he had a belly inflation fetish and a thumb fetish along with another person who responded saying he also shared the same fetish:

  • Extract 1: “Another weird fetish I have is ‘hitchhiker’s thumb’. Hitchhikers thumb is when the top part of your thumb bends backwards when pushed on or fully extended…The hitchhiker’s thumb fetish developed when I found out that my cousins could do it. I would ALWAYS ask questions about it and I would bend her thumbs back and forth for hours. And I just get turned on by it now…is this weird?” (Male, sexual orientation unknown)
  • Extract 2: “I [also] have a fetish for bendy thumbs hence the profile pic. It’s all good I say whatever turns u on and if not hurting anyone then it’s cool” (Male, sexual orientation unknown)

Although I have read about (i) thumb bondage (mentioned in a 2007 book chapter on themes of sadomasochistic expression by Dr. Charles Moser and Dr. Peggy Kleinplatz) and (ii) thumb sucking by adult babies that are into paraphilic infantilism, I had never read anything on standalone thumb fetishes. (I would also point out that the ‘thumb sucking’ is just one of many baby-like behaviours that paraphilic infantilists enjoy but do not necessarily see as a source of arousal in and of itself). There is also those who say that they engage is ‘thumb sex’ and defined by the online Urban Dictionary as when two people hold hands and run their thumbs around the other persons thumb or twiddle the thumbs”. There are also (for want of a better word) ‘cultural’ references to thumb fetishes such as the instrumental song ‘Mayor Oscar Goodman’s Thumb Fetish’ by US deathcore band Molotov Solution.

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As far as I am aware there has never been any empirical research on thumb fetishism. There are various online websites and forums that feature individuals that claim to have very specific types of thumb fetishes. This is one of the more specific that I found:

  • Extract 3: “I’m a 34 year old men and I have thin thumbs (each ones have the same width as an American/Canadian penny, that’s 0.74 inch or 19 millimeters). I got a fetish that seems to be pretty rare. It consists of being turn on by comparing my thin thumbs with a woman that has larger ones than mine. Also, the younger the woman is with larger thumbs, the better. It’s pretty inoffensive, but rare I think” (Male heterosexual).

There are also whole webpages dedicated to the sexiness of thumb sucking. Here are some of the online accounts I found on the Thumb Sucking Adults website. They begin by noting that adult thumb sucking is “sexy. This fact shouldn’t be too surprising in that it involves the sensual oral center [and] so much of what is human has become sexualized in one way or another that thumb sucking adults is just another part of the total picture”. They then highlight some of their readers’ experiences:

  • Extract 3: “I am a bisexual woman who finds other women sucking their thumbs extremely erotic…First of all, growing up, I had a very close friend who lived down the street from me who also sucked her thumb. Experimenting with sex at a very early age…[she] and I would spend hours together exploring our bodies and touching each other. We learned how to masturbate and although I was so young, I discovered how to reach orgasm. I think perhaps Janice and I shared a certain closeness in our friendship and later in our intimacy because we both sucked our thumbs and felt accepted by each other if not by peers who seemed to ridicule us…I can summarize that my earliest, deepest feelings of sexual desire were connected to both thumb sucking and a female partner. Many years passed and I dated men here and there, but never quite felt emotionally or sexually fulfilled [as with women]…From the e-mails I’ve read on your site, I have also noticed that it is mostly the men who find thumbsucking erotic. Perhaps as a woman who is mostly gay and possesses some traits and attributes more commonly associated with men…I am more turned on by this than other women. And why does it turn me on? I’m sure it has to do with my childhood friend and the feelings associated with that particular behavior”(Bisexual female).
  • Extract 4: “The arousal that naturally occurs when I do it. Thumb in mouth…hand on penis. This goes way back. I had contributed an early ‘embarrassment’ to [another website] saying that I watched a home movie in front of all our relatives and there was this shot of me, around 3 years old, standing by the garage, thumb in mouth, hand holding crotch. I had never seen that before. There was devilish laughter. I laughed along, but was shocked. I do remember a dry climax sucking my thumb when I was about 6 or 7. And my first real emission at age 12 or 13 involved thumb sucking in my bed. So it is very ingrained in me. The physical feeling of doing it brings such erotic pleasure. When I first insert my thumb in my mouth, pressing it against my palate and rubbing it back and forth about 1/2″, the stimulus begins. I don’t suck continuously. I do it for 1-2 minutes and take my thumb out for about 20 seconds and then put it back in. Each time it gets better and better. The key thing is that my thumb gets wetter and softer and SMOOTHER against my palate. I am very curious if anyone else sucks their thumb this way. I don’t actually SUCK it. I rub it. The other important part is that as I rub it, my tongue proceeds to pulsate. It’s involuntary. There’s no stopping it as long as I connect with the right spot on my palate. This enhances the feeling greatly. This dual rubbing, pulsating action. My thumb would have to be cut off to stop me from doing it. The last part of sexuality in thumb sucking is observing others doing it. I have to be honest in saying that watching…is an immense turn-on. Fortunately, I know I can control my desires” (Heterosexual male)
  • Extract 5: “Larry finds many things attractive in a woman. One of these things, apparently, is that she sucks her thumb. It probably is not essential that she does so (if it was, we’d be talking more along the lines of a fetish) but, if she does suck her thumb, he finds that attractive, whatever the underlying psychodynamics. I propose that his preferences aren’t much different than, say, another man’s predilections for big-breasted women, though both allures aren’t necessarily exclusive…There are societal stigmas associated with the habit. Try sucking your thumb whenever you want to and you’ll see that at least an undue amount of attention will be focused your way for a while. The point is, perhaps as adult thumb sucking becomes more widely known, it is natural that some out there will find it an endearing quality in a person…For the adult thumb sucker, this site has been liberating…And, in the case of Larry, the fact that he has felt solitude in his thumb sucking, all his adult life, it’s certainly understandable to me that among all the feelings that are engendered when he sees it in another for the first time…[This website] simply proposes that adult thumb sucking is more common than otherwise assumed and should be accepted since it is, essentially, harmless and, for those that indulge, beneficial. As for thumb sucking being sexually provocative, I suppose that anything human can be sexualized by others eventually. As long as it’s legal, what’s wrong with that?” (Gender and sexual orientation unknown)
  • Extract 6: “I love adult women who still suck on their thumb. Since I was a kid, I felt an attraction for girls sucking their thumbs. My twin sister sucked her thumb till she was 16 years old! When I first started masturbating at age 12, I thought of a girl sucking her thumb. I’ve always looked for women that sucked their thumb and then ask them to suck it for me. When I was 18, I met a girl I suspected of still sucking her thumb. Strangely, I noticed she didn’t have any marks or callus on her thumb. But from time to time, I saw teeth marks and lipstick marks on her thumb…We started to have thumb sucking sex and I loved it. She liked it also. We stayed together four years. It became a habit. She’d suck her thumb for me and then I’d suck her thumb while we made love. I never sucked my thumb but now I suck my thumb while masturbating and thinking about my former girlfriend’s thumb or another girl’s thumb. I always look for women sucking their thumbs in their cars while driving. I have seen three in all the years I have looked. Those times were awesome. I never tried to make contact. I am married now, but my wife never sucks her thumb. She will do it if I ask her, but that isn’t the same. I like it when an adult woman does it naturally…I love a woman with a thumb callus and nice teeth (there are a few). I love to see a wet thumb. I like it when an adult sucks her thumb with the index finger over the nose. I find that very sexy” (Heterosexual male).
  • Extract 7: I find thumb sucking sensual, sexual, erotic, comforting, calming…It’s like catching someone at their most vulnerable. Partly because of its social taboo, it can even be slightly ‘naughty’…But it is an exciting thought to me to perhaps one day ‘catch’ someone else thumb sucking. Thumb sucking provides sensations around the mouth and nose that can be reproduced during sex or loveplay, although thumb sucking is less tiring. It feels nice, smells nice, tickles [the] pleasure centers. It provides the sensations of skin-to-skin warmth that I think everyone of us craves…It’s sensual, it’s intimate. But it’s also sensual and sexual. I find myself sucking my thumb after sex much like I might grab for a cigarette…But I think that thumb sucking is by far more satisfying and truly far less addicting [than smoking]. And definitely far less damaging…Quite honestly I didn’t find out how much I found finger and thumb sucking an exciting part of foreplay and sex until I was 23” (Heterosexual female).
  • Extract 8: I suck my thumb for the usual reasons, tension relief, to go to sleep, it feels good. But, I notice that other contributors here suck their thumb because it also feels erotic, and, I have to say, I agree…When I’m aroused, it enhances the feeling so much more. So it’s obvious that I’ve learned to associate my thumb sucking with something sexual…When I look at the photos of women at this site, sucking away, I just find them so beautiful, so sexually enthralling….First off, there’s the lips. I think most people can understand why lips can be very erotic. I don’t want to get into heavy psychology, but, let’s face it, lips are sexy, especially full lips, parted ever so slightly. They’re like an invitation to something exciting…When I see a woman’s full lips open just a bit, my tongue gets an irresistible urge to explore her sweet mouth…If her teeth were affected by thumb sucking, all the better. The thought that she can’t stop her habit, and the pleasure she derives from it, even if her teeth are affected to the point of obvious buckedness adds that much more to my sensation…She looks like something innocent, childlike but not a child. Her profile, exaggerating her now protrusive lips, wrapped around a phallus-like object that is her compulsion, her requirement, her urgency…I want her thumb to feel comfortable in my mouth as I experience, once again, her essence, her habit as mine” (Heterosexual male).

Obviously this is just a small selection of online accounts of sexual thumb sucking I have come across and I can’t know for sure that they are genuine (but they appear that way to me). Also, I have no idea whether these are typical but I can make a few tentative conclusions. Firstly, both males and females can find thumb sucking sexually stimulating. Secondly, sexual thumb suckers tend to be heterosexual (although one account was from a bisexual woman). Thirdly, most experiences of sexual thumb sucking are rooted in childhood experiences and that the acquisition and development of such behaviour is related with associative pairing (i.e., classical conditioning). Fourthly, no-one pathologizes the behaviour, and as long as the act is consensual, there is absolutely nothing wrong with the behaviour as a sexual preference. Finally, none of the accounts suggest the sexual thumb sucking is fetishistic – just that it is a non-normative sexual expression that fits alongside their other sexual experiences.

While researching this article I also came across the remarkable story of American Rafe Briggs (from Oakland, California) in a 2013 issue of the International Business Times. In 2004, Biggs fell off a roof and broke his neck leaving him paralyzed from the chest down. He obviously thought he would never experience any kind of sexual pleasure again but he was wrong:

“Turns out he can. Biggs, 43, says that his thumb is his ‘surrogate penis’, and that he gets ‘orgasmic sensations’ whenever it’s stimulated. ‘I never thought it would be possible, but massaging and sucking on my thumb, feels a lot like my penis used to feel – it’s really hot” said Biggs, whose girlfriend helped him discover this phenomenon a year after the accident. Sex therapists like Lisa Skye Carle, who works with Biggs, calls it a ‘transfer orgasm – where another place on the body gives the same sensation”. Biggs has made it his mission to helping quadriplegics lead sexually fulfilling lives, working with the group ‘Sexability’ an ‘organization committed to empowering people with disabilities to explore sexuality and creating intimate loving relationships. Since our beginning in 2006, we have been working with individuals, groups and organizations to transform sexuality and disability’. ”

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Huffington Post (2013). Rafe Biggs’ thumb has become his ‘surrogate penis’ after accident left him paralyzed, April 22, Located at: http://www.huffingtonpost.com/2013/04/22/rafe-biggs-thumb_n_3132325.html?utm_hp_ref=weird-news

Moser, C., & Kleinplatz, P. J. (2007). Themes of SM expression. In D. Langdridge & M. Barker (Eds.) Safe, sane & consensual:  Contemporary perspectives on sadomasochism.  (pp. 35-54). Hampshire, UK:  Palgrave Macmillan.

Thumb Sucking Adults (undated). Why [thumb sucking] is sexy. Located at: http://www.thumbsuckingadults.com/mytsingissexypage.htm

Tungol, J.R. (2013). Paralyzed man Rafe Biggs has ‘orgasmic sensations’ through his thumb, ‘surrogate penis’ International Business Times. April 22. Located at: http://www.ibtimes.com/paralyzed-man-rafe-biggs-has-orgasmic-sensations-through-his-thumb-surrogate-penis-1208099

 

Nag, nag, nag: Another look at horse race betting and problem gambling

Literature reviews carried out by myself and others in the gambling studies field have concluded that electronic gaming machines (EGMs such as slot machines, pokie machines, video lottery terminals [VLTs], etc.) tend to have a higher association with problem gambling than other forms of gambling. Although any form of gambling can be potentially problematic, there is surprisingly little in the academically peer-reviewed gambling literature showing that horse race betting has a high association with problem gambling, particularly in comparison to activities such as EGM gambling.

Along with individual susceptibility and risk factors of the individual gambler, the most important determinants in the development and maintenance of problem gambling are structural characteristics, particularly those relating to the speed and frequency of the game (and more specifically event frequency, bet frequency, event duration and payout interval). More specifically, I have argued that researchers in the gambling studies field need to think about game parameters rather than specific game type when it comes to any association with problem and pathological gambling and that event frequency is the single most important determinant.

horse-racing

A study by Dr. Debi LaPlante and colleagues in the European Journal of Public Health examining types of gambling and level of gambling involvement (using data from the 2007 British Gambling Prevalence Survey of which I was one of the co-authors) indicated that when level of gambling is accounted, no specific type of gambling was associated anymore with disordered gambling, and that level of involvement in gambling better characterizes problem gambling than individual forms of gambling. In fact, this paper also concluded that:

“Two games, private betting and betting on horses, had a reversal of association. After controlling for involvement, individuals who engaged in private betting or betting on horses were significantly less likely to have gambling-related problems than people who did not…One interesting, and perhaps unanticipated, finding was that the nature of the relationships between private betting and betting on horses and gambling problems changed when we considered the influence of involvement: engaging in these types of gambling, but not other types, seemed to protect players against developing gambling problems. This finding suggests that the apparent risk between gambling activities and developing gambling-related problems resides, perhaps primarily or even entirely, among individuals who have high rates of involvement. For others who do not have high rates of involvement, playing these types of games might reflect social setting characteristics (e.g. norms) that encourage control and preclude excessive gambling”.

Similar results were also found in an Australian study by Dr. James Phillips and his colleagues in a 2013 issues of the Journal of Gambling Studies. A 2009 study by Dr. Thomas Holtgraves in the journal Psychology of Addictive Behaviors analysed all data from population-based surveys conducted in Canada between 2001 and 2005 comprising 21,374 participants (including 12,229 who had gambled in the past year). Using the Problem Gambling Severity Index to assess problem gambling, the study found that horse race gamblers had the lowest prevalence rates of problem gambling along with those that played bingo and bought raffle tickets (3%). Some types of gambling activity such as sports betting (25%) and playing video lottery terminals (18%) were much higher.

The most recent British Gambling Prevalence Survey [BGPS] published in 2011 reported that the most popular British gambling activity was playing the National Lottery (59%), a slight increase in participation from 2007 (57%). The prevalence of past-year betting on horse races was 16%. Among past year gamblers, problem gambling prevalence rates were highest among those who had played poker at a pub/club (12.8%), online slot machine games (9.1%) and fixed odds betting terminals (8.8%). The lowest problem gambling rates were among those that played the National Lottery (1.3%) and scratchcards (2.5%). Horse race gamblers also had one of the lower prevalence rates for problem gambling (2.7%). However, problem gamblers also gamble on many different activities and problem gambling prevalence was highest among those that gambled on nine or more different activities on a regular basis (28%).

More recently in 2014, Carla Seabury and Heather Wardle published an overview of gambling behaviour in England and Scotland by combining the data from the Health Survey for England and Scottish Health Survey (n=11,774 participants). It was reported that two-thirds of the sample (65%) had gambled in the past year, with men (68%) gambling more than women (62%). The findings were similar to the previous BGPS reports and showed that in terms of past-year gambling, the most popular forms of gambling were playing the National Lottery (52%; 56% males and 49% females) and scratchcards (19%; 19% males and 20% females). One in ten people (10%) had a engaged in horse race betting (12% males and 8% females).

Again, problem gambling rates were also examined by type of gambling activity. Results showed that among past year gamblers, problem gambling was highest among spread betting (20.9%), playing poker in pubs or clubs (13.2%), bet on events other than horse racing with a bookmaker (12.9%), gambling at a betting exchange (10.6%) and playing machines in bookmakers (7.2%). The activities with the lowest rates of problem gambling were playing the National Lottery (0.9%) and scratchcards (1.7%). Problem gambling among horse race gamblers were also among the lowest (2.3%). Problem gambling rates were highest among individuals that had participated in seven or more activities in the past year (8.6%) and lowest among those that had participated in a single activity (0.1%).

Along with Filipa Calado, I recently co-authored two reviews of problem gambling worldwide (one on adult gambling and one of adolescent gambling). None of the studies we reviewed highlighted horse racing to be of particular concern in relation to problem gambling and only two countries (France and Sweden) was horse race betting one of the most preferred and prevalent forms of gambling. Analysis of a 2011 French national prevalence survey by Dr. Jean-Michel Costes reported that horse race betting was fourth in a list of six gambling activities that were most associated with problem gambling (with Rapido [a high event frequency lottery game], sports betting, and poker being the most problematic gambling forms). There is also evidence from gambling treatment service providers that horse race betting is much less of an issue than other forms of gambling. In Finland, the national helpline for problem gamblers, [Peluuri] only 1% of the telephone calls received concern horse betting. In Germany, two studies surveying therapists that treat problem gambling found that the vast majority of treatment was for slot machine gamblers (approximately 75%-80% of clients) whereas treatment for horse race gamblers was 0.6%-1.7% of clients. Unfortunately, the UK problem gambling helpline run by GamCare does not separate horse race betting from any other sports betting in its’ annual helpline statistics. The most recent (2016) GamCare report noted that 11% of their callers concerned betting in a bookmaker’s but this figure included all betting not just horse race betting.

In 2008, I was invited to write a report for the Gambling Commission and reported that internationally, the vast majority of problem gamblers that contact helplines or seek treatment report machine gambling as their primary form of gambling. In Europe many countries report that it is problem EGM gamblers that are most likely to seek treatment and/or contact national gambling helplines (rather than other forms of gambling including horse race betting) including 60% of gamblers seeking help in Belgium, 72% in Denmark, 93% in Estonia, 66% in Finland, 49.5% in France, 83% in Germany, 75% in Spain, and 35% in Sweden.

All data collected in Great Britain and elsewhere in the world demonstrate that horse race betting has a relatively low past-year participation rate. All major literature reviews have concluded that electronic gaming machines tend to have a higher association with problem gambling than other forms of gambling including horse race betting. Although no form of gambling is immune from problem gambling, horse race betting has one of the lowest associations with problem gambling. Furthermore, some analysis of the most recent BGPS data has demonstrated that after controlling for gambling involvement, individuals who engage in horse race betting are significantly less likely to have gambling-related problems than people who did not.

For the vast majority of horse gamblers, the activity is a discontinuous form of gambling in that they make one or a few bets in a small time period but then not bet again for days or weeks. Therefore, the event frequencies for betting on horse racing are much lower than other gambling activities and helps explain why there is a low association with problem gambling compared to activities that have much higher event frequencies (e.g., slot machines, roulette, blackjack, etc.).

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

Further reading

Abbott, M.W.  (2007). Situational factors that affect gambling behavior. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.251-278. New York: Elsevier.

Calado, F., Alexandre, J. & Griffiths, M.D. (2016). Prevalence of adolescent problem gambling: A systematic review of recent research. Journal of Gambling Studies. doi: 10.1007/s10899-016-9627-5

Calado, F. & Griffiths, M.D. (2016). Problem gambling worldwide: An update of empirical research (2000-2015). Journal of Behavioral Addictions, 5, 592–613.

Costes, J. M., Pousset, M., Eroukmanoff, V., Le Nezet, O., Richard, J. B., Guignard, R., … & Arwidson, P. (2011). Les niveaux et pratiques des jeux de hasard et d’argent en 2010. Tendances, 77(1), 8

Costes, J. M, Eroukmanoff V., Richard, J.B, Tovar, M. L. (2015). Les jeux de hasard et d’argent en France en 2014. Les Notes de l’Observatoire des Jeux, 6, 1-9.

Delfabbro, P.H., King, D.L & Griffiths, M.D. (2012). Behavioural profiling of problem gamblers: A critical review. International Gambling Studies, 12, 349-366.

EMPA Pari Mutuel Europe (2012). Common Position On Responsible Gambling. Brussels: EMPA.

GamCare (2016). Annual Statistics 2015/2016. London: GamCare.

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. (2008). Impact of high stake, high prize gaming machines on problem gaming. Birmingham: Gambling Commission.

Griffiths, M.D. (2016). Problem gambling and gambling addiction are not the same. Journal of Addiction and Dependence, 2(1), 1-3.

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.

Holtgraves, T. (2009). Gambling, gambling activities, and problem gambling. Psychology of Addictive Behaviors, 23(2), 295-302.

LaPlante, D.A., Nelson, S.E., LaBrie, R.A., & Shaffer, H.J. (2009). Disordered gambling, type of gambling and gambling involvement in the British Gambling Prevalence Survey 2007. The European Journal of Public Health, 21, 532–537

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

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.

Phillips, J.G., Ogeil, R., Chow, Y.W., & Blaszczynski, A. (2013). Gambling involvement and increased risk of gambling problems. Journal of Gambling Studies, 29(4), 601-611.

Seabury, C. & Wardle, H. (2014). Gambling behaviour in England and Scotland. Birmingham: Gambling Commission.

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

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: National Centre for Social Research.

Fun in the sun? Does ‘tanorexia’ (addiction to sunshine) really exist?

If the many media reports are to be believed, a 2014 study published in the journal Cell claimed that “sunshine can be addictive like heroin”. In an experiment carried out on mice, a research team led by Dr. Gillian Fell at the Harvard Medical School in Boston (US) reported that ultraviolet exposure leads to elevated endorphin levels (endorphins being the body’s own ‘feel good’ endogenous morphine), that mice experience withdrawal effects after exposure to ultraviolet light, and that chronic ultraviolet causes dependency and ‘addiction-like’ behaviour.

Although the study was carried out on animals, the authors speculated that their findings may help to explain why we love lying in the sun and that in addition to topping up our tans, sunbathing may be the most natural way to satisfy our cravings for a ‘sunshine fix’ in the same way that drug addicts yearn for their drug of choice.

Reading the findings of this study took me back to 1998 when I appeared as a ‘behavioural addiction expert’ on Esther Rantzen’s daytime BBC television show that featured people who claimed they were addicted to tanning (and was dubbed by the researchers on the programme as ‘tanorexia’). I have to admit that none of the case studies on the show appeared to be addicted to tanning at least based on my own behavioural addiction criteria (i.e., salience, mood modification, tolerance, withdrawal, conflict, and relapse) but it did at least alert me to the fact that some people thought sunbathing and tanning was addictive (in fact, the people on the show said their excessive tanning was akin to nicotine addiction).

4fa262e602de9.image

There certainly appeared to be some similarities between the people interviewed and nicotine addiction in the sense that the ‘tanorexics’ knew they were significantly increasing their chances of getting skin cancer as a direct result of their risky behaviour but felt they were unable to stop doing it (similar to nicotine addicts who know they are increasing the probability of various cancers but also feel unable to stop despite knowing the health risks).

Since then, tanorexia has become a topic for scientific investigation (and I looked at the topic in a previous blog). For instance, in a 2006 study published in the Journal of the American Academy of Dermatology by Dr. Mandeep Kaur and colleagues reported that frequent tanners (those who tanned 8-15 times a month) that took an endorphin blocker normally used to treat drug addictions (i.e., naltrexone) significantly reduced the amount of tanning compared to a control group of light tanners.

A 2005 study published in the Archives of Dermatology by Dr. Molly Warthan and colleagues claimed that a quarter of the sample of 145 “sun worshippers” would qualify as having a substance-related disorder if ultraviolet light was classed as the substance they crave. Their paper also reported that frequent tanners experienced a “loss of control” over their tanning schedule, and displayed a pattern of addiction similar to smokers and alcoholics.

A 2008 study published in the American Journal of Health Behavior by Dr. Carolyn Heckman and colleagues reported that 27% of 400 students they surveyed were classified as “tanning dependent”. The authors claimed that those classed as being tanning dependent had a number of similarities to substance use, including (i) higher prevalence among youth, (ii) an initial perception that the behaviour is image enhancing, (iii) high health risks and disregard for warnings about those risks, and (iv) the activity being mood enhancing.

Another study by Dr. Heckman and her colleagues in the American Journal of Health Promotion surveyed 306 female students and classed 25% of the respondents as ‘tanning dependent’ based upon a self-devised tanning dependence questionnaire. The problem with this and most of the psychological research on tanorexia to date is that almost all of the research is carried out on relatively small convenience samples using self-report and non-psychometrically validated ‘tanning addiction’ instruments.

Based on my own six criteria of behavioural addiction although some studies suggest some of these criteria appear to have been met, I have yet to be convinced that any of the published studies to date show genuine addiction to tanning (i.e., that there is evidence of all my criteria being endorsed) but that doesn’t mean it’s not theoretically possible. However, I’ve just done a study on tanorexia with my research colleagues at the University of Bergen and when we publish our findings I’ll be sure to let my blog readers know about it.

(Please note: A version of this article first appeared in The Conversation and The Washington Post)

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Fell, G.L., Robinson, K.C., Mao, J., Woolf, C.J., & Fisher, D.E. (2014). Skin β-endorphin mediates addiction to UV light. Cell, 157(7), 1527-1534.

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

Griffiths, M.D. (2014). Sunshine addiction is a hot topic – but does ‘tanorexia’ really exist? The Conversation. June 20. Located at: https://theconversation.com/sunshine-addiction-is-a-hot-topic-but-does-tanorexia-really-exist-28283

Griffiths, M.D. (2014). Sunshine: As addictive as heroin? Washington Post. June 24. Located at http://www.washingtonpost.com/posteverything/wp/2014/06/24/sunshine-as-addictive-as-heroin/

Heckman, C.J., Cohen-Filipic, J., Darlow, S., Kloss, J.D., Manne, S.L., & Munshi, T. (2014). Psychiatric and addictive symptoms of young adult female indoor tanners. American Journal of Health Promotion, 28(3), 168-174.

Heckman, C.J., Darlow, S., Kloss, J.D., Cohen‐Filipic, J., Manne, S.L., Munshi, T., … & Perlis, C. (2014). Measurement of tanning dependence. Journal of the European Academy of Dermatology and Venereology, 28(9), 1179-1185 .

Heckman, C.J., Egleston, B.L., Wilson, D.B., & Ingersoll, K.S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32(5), 451-464.

Kaur, M., Liguori, A., Lang, W., Rapp, S.R., Fleischer, A.B., & Feldman, S.R. (2006). Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. Journal of the American Academy of Dermatology, 54(4), 709-711.

Warthan, M.M., Uchida, T., & Wagner, R.F. (2005). UV light tanning as a type of substance-related disorder. Archives of Dermatology, 141(8), 963-966.

A diction for addiction: A brief overview of our papers at the 2017 International Conference on Behavioral Addictions

This week I attended (and gave one of the keynote papers at) the fourth International Conference on Behavioral Addictions in Haifa (Israel). It was a great conference and I was accompanied by five of my colleagues from Nottingham Trent University all of who were also giving papers. All of the conference abstracts have just been published in the latest issue of the Journal of Behavioral Addictions (reprinted below in today’s blog) and if you would like copies of the presentations then do get in touch with me.

mark-haifa-keynote-2017

Griffiths, M.D. (2017). Behavioural tracking in gambling: Implications for responsible gambling, player protection, and harm minimization. Journal of Behavioral Addictions, 6 (Supplement 1), 2.

  • Social responsibility, responsible gambling, player protection, and harm minimization in gambling have become major issues for both researchers in the gambling studies field and the gaming industry. This has been coupled with the rise of behavioural tracking technologies that allow companies to track every behavioural decision and action made by gamblers on online gambling sites, slot machines, and/or any type of gambling that utilizes player cards. This paper has a number of distinct but related aims including: (i) a brief overview of behavioural tracking technologies accompanied by a critique of both advantages and disadvantages of such technologies for both the gaming industry and researchers; (ii) results from a series of studies carried out using behavioural tracking (particularly in relation to data concerning the use of social responsibility initiatives such as limit setting, pop-up messaging, and behavioural feedback); and (c) a brief overview of the behavioural tracking tool mentor that provides detailed help and feedback to players based on their actual gambling behaviour.

Calado, F., Alexandre, J. & Griffiths, M.D. (2017). Youth problem gambling: A cross-cultural study between Portuguese and English youth. Journal of Behavioral Addictions, 6 (Supplement 1), 7.

  • Background and aims: In spite of age prohibitions, most re- search suggests that a large proportion of adolescents engage in gambling, with a rate of problem gambling significantly higher than adults. There is some evidence suggesting that there are some cultural variables that might explain the development of gambling behaviours among this age group. However, cross­cultural studies on this field are generally lacking. This study aimed to test a model in which individual and family variables are integrated into a single perspective as predictors of youth gambling behaviour, in two different contexts (i.e., Portugal and England). Methods: A total of 1,137 adolescents and young adults (552 Portuguese and 585 English) were surveyed on the measures of problem gambling, gambling frequency, sensation seeking, parental attachment, and cognitive distortions. Results: The results of this study revealed that in both Portuguese and English youth, the most played gambling activities were scratch cards, sports betting, and lotteries. With regard to problem gambling prevalence, English youth showed a higher prevalence of problem gambling. The findings of this study also revealed that sensation seeking was a common predictor in both samples. However, there were some differences on the other predictors be- tween the two samples. Conclusions: The findings of this study suggest that youth problem gambling and its risk factors appear to be influenced by the cultural context and highlights the need to conduct more cross-cultural studies on this field.

Demetrovics, Z., Richman, M., Hende, B., Blum, K., Griffiths,
M.D, Magi, A., Király, O., Barta, C. & Urbán, R. (2017). Reward Deficiency Syndrome Questionnaire (RDSQ):
A new tool to assess the psychological features of reward deficiency. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • ‘Reward Deficiency Syndrome’ (RDS) is a theory assuming that specific individuals do not reach a satisfactory state of reward due to the functioning of their hypodopaminergic reward system. For this reason, these people search for further rewarding stimuli in order to stimulate their central reward system (i.e., extreme sports, hypersexuality, substance use and/or other addictive behaviors such as gambling, gaming, etc.). Beside the growing genetic and neurobiological evidence regarding the existence of RDS little re- search has been done over the past two decades on the psychological processes behind this phenomenon. The aim of the present paper is to provide a psychological description of RDS as well as to present the development of the Reward Deficiency Syndrome Questionnaire (developed using a sample of 1,726 participants), a new four-factor instrument assessing the different aspects of reward deficiency. The results indicate that four specific factors contribute to RDS comprise “lack of satisfaction”, “risk seeking behaviors”, “need for being in action”, and “search for overstimulation”. The paper also provides psychological evidence of the association between reward deficiency and addictive disorders. The findings demonstrate that the concept of RDS provides a meaningful and theoretical useful context to the understanding of behavioral addictions.

Demetrovics, Z., Bothe, B., Diaz, J.R., Rahimi­Movaghar, A., Lukavska, K., Hrabec, O., Miovsky, M., Billieux, J., Deleuze,
J., Nuyens, P. Karila, L., Nagygyörgy, K., Griffiths, M.D. & Király, O. (2017). Ten-Item Internet Gaming Disorder Test (IGDT-10): Psychometric properties across seven language-based samples. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • Background and aims: The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a brief instrument developed to assess Internet Gaming Disorder as proposed in the DSM­5. The first psychometric analyses carried out among a large sample of Hungarian online gamers demonstrated that the IGDT-10 is a valid and reliable instrument. The present study aimed to test the psychometric properties in a large cross-cultural sample. Methods: Data were collected among Hungarian (n = 5222), Iranian (n = 791), Norwegian (n = 195), Czech (n = 503), Peruvian (n = 804), French­speaking (n = 425) and English­ speaking (n = 769) online gamers through gaming­related websites and gaming-related social networking site groups. Results: Confirmatory factor analysis was applied to test the dimensionality of the IGDT-10. Results showed that the theoretically chosen one-factor structure yielded appropriate to the data in all language­based subsamples. In addition, results indicated measurement invariance across all language-based subgroups and across gen- der in the total sample. Reliability indicators (i.e., Cronbach’s alpha, Guttman’s Lambda-2, and composite reliability) were acceptable in all subgroups. The IGDT- 10 had a strong positive association with the Problematic Online Gaming Questionnaire and was positively and moderately related to psychopathological symptoms, impulsivity and weekly game time supporting the construct validity of the instrument. Conclusions: Due to its satisfactory psychometric characteristics, the IGDT-10 appears to be an adequate tool for the assessment of internet gam- ing disorder as proposed in the DSM-5.

Throuvala, M.A., Kuss, D.J., Rennoldson, M. & Griffiths, M.D. (2017). Delivering school-based prevention regarding digital use for adolescents: A systematic review in the UK. Journal of Behavioral Addictions, 6 (Supplement 1), 54.

  • Background: To date, the evidence base for school-delivered prevention programs for positive digital citizenship for adolescents is limited to internet safety programs. Despite the inclusion of Internet Gaming Disorder (IGD) as a pro- visional disorder in the DSM-5, with arguable worrying prevalence rates for problematic gaming across countries, and a growing societal concern over adolescents’ digital use, no scientifically designed digital citizenship programs have been delivered yet, addressing positive internet use among adolescents. Methods: A systematic database search of quantitative and qualitative research evidence followed by a search for governmental initiatives and policies, as well as, non­profit organizations’ websites and reports was conducted to evaluate if any systematic needs assessment and/or evidence-based, school delivered prevention or intervention programs have been conducted in the UK, targeting positive internet use in adolescent populations. Results: Limited evidence was found for school-based digital citizenship awareness programs and those that were identified mainly focused on the areas of internet safety and cyber bullying. To the authors’ knowledge, no systematic needs assessment has been conducted to assess the needs of relevant stakeholders (e.g., students, parents, schools), and no prevention program has taken place within UK school context to address mindful and positive digital consumption, with the exception of few nascent efforts by non­profit organizations that require systematic evaluation. Conclusions: There is a lack of systematic research in the design and delivery of school-delivered, evidence-based prevention and intervention programs in the UK that endorse more mindful, reflective attitudes that will aid adolescents in adopting healthier internet use habits across their lifetime. Research suggests that adolescence is the highest risk group for the development of internet addictions, with the highest internet usage rates of all age groups. Additionally, the inclusion of IGD in the DSM-5 as provisional disorder, the debatable alarming prevalence rates for problematic gaming and the growing societal focus on adolescents’ internet misuse, renders the review of relevant grey and published research timely, contributing to the development of digital citizenship programs that might effectively promote healthy internet use amongst adolescents.

Bányai, F., Zsila, A., Király, O., Maraz, A., Elekes, Z., Griffiths, M.D., Andreassen, C.S. & Demetrovics, Z. (2017). Problematic social networking sites use among adolescents: A national representative study. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Despite being one of the most popular activities among adolescents nowadays, robust measures of Social Media use and representative prevalence estimates are lacking in the field. N = 5961 adolescents (49.2% male; mean age 16.6 years) completed our survey. Results showed that the one-factor Bergen Social Media Addiction Scale (BSMAS) has appropriate psychometric properties. Based on latent pro le analysis, 4.5% of the adolescents belonged to the at-risk group, who reported low self-esteem, high level of depression and the elevated social media use (34+ hours a week). Conclusively, BSMAS is an adequate measure to identify those adolescents who are at risk of problematic Social Media use and should therefore be targeted by school-based prevention and intervention programs.

Bothe, B., Toth-Király, I. Zsila, A., Griffiths, M.D., Demetrovics, Z. & Orosz, G. (2017). The six-component problematic pornography consumption scale. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Background and aims: To our best knowledge, no scale ex- ists with strong psychometric properties assessing problematic pornography consumption which is based on an over- arching theoretical background. The goal of the present study was to develop a short scale (Problematic Pornography Consumption Scale; PPCS) on the basis of Griffiths` (2005) six-component addiction model that can assess problematic pornography consumption. Methods: The sample comprised 772 respondents (390 females; Mage = 22.56, SD = 4.98 years). Items creation was based on the definitions of the components of Griffiths’ model. Results: A confirmatory factor analysis was carried out leading to an 18­item second­order factor structure. The reliability of the PPCS was good and measurement invariance was established. Considering the sensitivity and specificity values, we identified an optimal cut­off to distinguish between problematic and non-problematic pornography users. In the present sample, 3.6% of the pornography consumers be- longed to the at-risk group. Discussion and Conclusion: The PPCS is a multidimensional scale of problematic pornography consumption with strong theoretical background that also has strong psychometric properties.

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

General selection: Is voluntary self-exclusion a good proxy measure for problem gambling?

A couple of months ago, Dr. Michael Auer and I published a short paper in the Journal of Addiction Medicine and Therapy (JAMT) critically addressing a recent approach by researchers that use voluntary self-exclusion (VSE) by gamblers as a proxy measure for problem gambling in their empirical studies. We argued that this approach is flawed and is unlikely to help in developing harm-minimization measures.

For those who don’t know, self-exclusion practices typically refer to the possibility for gamblers to voluntarily ban themselves from playing all (or a selection of) games over a predetermined period. The period of exclusion can typically be chosen by the gambler although some operators have non-negotiable self-exclusion periods. Self-exclusion in both online sites and offline venues has become an important responsible gambling practice that is widely used by socially responsible operators.

There are many reasons why players self-exclude. In a 2011 study in the Journal of Gambling Studies by Dr. Tobias Hayer and Dr. Gerhard Meyer, players frequently reported excluding as a preventive measure and annoyance with the gambling operator as reasons for VSE. Furthermore, only one-fifth of self-excluders reported to be problem gamblers (21.2%). A recent 2016 (conference) paper by Dr. Suzanne Lischer (2016) reported that in a study of three Swiss casinos, 29% of self-excluders were pathological gamblers, 33% were problem gamblers, and 38% were recreational gamblers. Given that many voluntary self-excluders do not exclude themselves for gambling-related problems, Dr. Lischer concluded that self-exclusion is not a good indicator of gambling-related problems. In line with these results, a 2015 study published in International Gambling Studies led by Simo Dragicevic compared self-excluders with other online players and reported no differences in the (i) mean number of gambling hours per month or (ii) minutes per gambling session. The study also reported that 25% of players self-excluded within one day of their registration with the online operator. This could also be due to the fact that online players can self-exclude with just a few mouse-clicks.

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Most studies to date report that the majority of voluntary self-excluders tend to be non-problem gamblers. Additionally, in 2010, the Australian Productivity Commission reported 15,000 active voluntary self-exclusions from 2002 to 2009 and that this represented only 10-20% of the population of problem gamblers. This means that in addition to most self-excluders being non-problem gamblers, that most problem gamblers are not self-excluders. This leads to the conclusion that there is little overlap between problem gambling and self-excluding.

Over the decade, analytical approaches to harm minimization have become popular. This has led to the development of various tracking tools such as PlayScan (developed by Svenska Spel), Observer (developed by 888.com), and mentor (developed by neccton and myself). Furthermore, regulators are increasingly recognizing the importance of early risk detection via behavioural tracking systems. VSE also plays an important role in this context. However, some systems use VSE as a proxy of at-risk or problem gambling.

Based on the findings from empirical research, self-exclusion is a poor proxy measure for categorizing at-risk or problem gamblers and VSE should not be used in early problem gambling detection systems. The reasons for this are evident:

  • There is no evidence of a direct relationship between self-exclusion and problem gambling. As argued above, self-excluders are not necessarily problem gamblers and thus cannot be used for early risk detection.
  • There are various reasons for self-exclusion that have nothing to do with problem gambling. Players exclude for different reasons and one of the most salient appears to be annoyance and frustration with the operator (i.e., VSE is used as a way of venting their unhappiness with the operator). In this case, an early detection model based on self-exclusion would basically identify unhappy players and be more useful to the marketing department than to those interested in harm minimization
  • Problem gamblers who self-exclude are already actively changing their behaviour. The trans-theoretical ‘stages of change’ model (developed by Dr. Carlo DiClemente and Dr. James Prochaska) argues that behavioural change follows stages from pre-contemplation to action and maintenance. One could argue that the segment of players who self-exclude because they believe their gambling to be problematic are the ones who already past the stages where assistance is usually helpful in triggering action to cease gambling. These players are making use of a harm-minimization tool. The ones actually in need of detection and intervention are the ones who have not yet reached this stage of change yet and are not thinking about changing their behaviour at all. This is one more argument for the inappropriateness of self-exclusion as a proxy for problem gambling.

But what could be done to prevent the development of gambling-related problems in the first place? For the reasons outlined above, we would argue that the attempt to identify problem gambling via playing patterns that are derived from self-excluders does not assist harm minimization. Firstly, this approach does not target problem gamblers, and secondly it does not provide any insights into the prevention of such problems.

It is evident that any gambling environment should strive to minimize gambling-related harm and reduce the amount of gambling among vulnerable groups. It is also known that information that is given to individuals to enable behavioural change should encourage reflection because research has shown that self-monitoring can enable behavioural change in the desired direction. Dr. Jim Orford has also stated that attempts to explain such disparate gambling types from a single theoretical perspective are essentially a fool’s errand. This also complements the notion that problem gambling is not a homogenous phenomenon and there is not a single type of problem gambler (as I argued in my first book on gambling back in 1995). This also goes in line with the belief of Dr. Auer and myself that gambling sites have to personalize communication and offer the right player the right assistance based on their individual playing history. Recent research that Dr. Auer and I have carried out supports this line of thinking.

Studies have also shown that dynamic feedback in the form of pop-up messages has a positive effect on gambling behaviour and gambling-related thoughts. For instance, research from Dr. Michael Wohl’s team in Canada have found that animation-based information enhanced the effectiveness of a pop-up message related to gambling time limits. Our own research has found that an enhanced pop-up message (that included self-appraisal and normative feedback) led to significantly greater number of players ending their session than a simple pop-up message. In a real-world study of online gamblers, we also found that personalized feedback had a significant effect in reducing the time and money spent gambling.

Personalized feedback is a player-centric approach and in addition to gambling-specific research, there is evidence from many other areas that shows the beneficial effects on behavioural change. For instance, personalized messages have shown to enable behavioural change in areas such as smoking cessation, diabetes management, and fitness activity. Contrary to the self-exclusion oriented detection approach, we concluded in our recent JAMT paper that personalized feedback aims to prevent and minimize harm in the first place and is a much better approach to the prevention of problem gambling than using data from those that self-exclude from gambling.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

 Further reading

Auer, M. & Griffiths, M. D. (2014). Personalised feedback in the promotion of responsible gambling: A brief overview. Responsible Gambling Review, 1, 27-36.

Auer, M. Griffiths, M.D. (2015). The use of personalized behavioral feedback for online gamblers: an empirical study. Frontiers in Psychology, 6, 1406.  doi:10.3389/fpsyg.2015.01406

Auer, M., Griffiths, M.D. (2015). Testing normative and self-appraisal feedback in an online slot-machine pop-up in a real-world setting. Frontiers in Psychology. 6, 339 doi: 10.3389/fpsyg.2015.00339

Auer, M., Littler, A., Griffiths, M. D. (2015). Legal Aspects of Responsible Gaming Pre-commitment and Personal Feedback Initiatives. Gaming Law Review and Economics. 19, 444-456.

DiClemente, C. C., Prochaska, J. O., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M., & Rossi, J. S. (1991). The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295-304.

Dragicevic, S., Percy, C., Kudic, A., Parke, J. (2015). A descriptive analysis of demographic and behavioral data from Internet gamblers and those who self-exclude from online gambling platforms. Journal of Gambling Studies. 31, 105-132.

Gainsbury, S. (2013). Review of self-exclusion from gambling venues as an intervention for problem gambling. Journal of Gambling Studies, 30, 229-251.

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

Griffiths, M.D. & Auer, M. (2016). Should voluntary self-exclusion by gamblers be used as a proxy measure for problem gambling? Journal of Addiction Medicine and Therapy, 2(2), 00019.

Hayer, T., & Meyer, G. (2011). Self-exclusion as a harm-minimization strategy: Evidence for the casino sector from selected European countries. Journal of Gambling Studies, 27, 685-700

Kim, H. S., Wohl, M. J., Stewart, M. K., Sztainert, T., Gainsbury, S. M. (2014). Limit your time, gamble responsibly: setting a time limit (via pop-up message) on an electronic gaming machine reduces time on device. International Gambling Studies, 14, 266-278.

Lischer, S. (2016, June). Gambling-related problems of self-excluders in Swiss casinos. Paper presented at the 16th International Conference on Gambling & Risk Taking, Las Vegas, USA.

Suurvali, H., Hodgins, D. C., Cunningham, J. A. (2010). Motivators for resolving or seeking help for gambling problems: A review of the empirical literature. Journal of Gambling Studies, 26, 1-33