Category Archives: Cyberpsychology
As a Professor of Behavioural Addiction, one of duties is to profess. Consequently, today’s blog contains content from an interview that I did on problematic gaming as a behavioural addiction for a Spanish magazine. Because the published version was in Spanish I thought my blog readers might be interested in what I had to profess about behavioural addiction in its simplest terms (plus I never like to see things to be left unused or go to waste!).
The focus of your work is mainly behavioural addiction, could you start by giving a brief overview of what behavoural addiction is?
Behavioural addictions are those addictions that do not involve the ingestion of a psychoactive substance such as alcohol, nicotine or heroin. Some people believe that a person cannot become addicted to something in the absence of a psychoactive agent, but it is my passionate belief that people can become addicted to non-chemical behaviours. I have written a number of papers over the past 30 years that have tried to show that some behaviours when taken to excess (e.g., gambling, video gaming) are no different from (say) alcoholism or heroin addiction in terms of the core components of addiction (e.g. salience, tolerance, withdrawal, mood modification, conflict, relapse etc.). If it can be shown that a behaviour like pathological gambling can be a bona fide addiction (and I believe that it can), then there is a precedent that any behaviour that provides continuous rewards (in the absence of a psychoactive substance) can be potentially addictive. Such a precedent ‘opens the floodgates’ for other excessive behaviours to be considered theoretically as potential addictions (e.g. exercise, sex, eating, computer games, the internet) which is what I’ve been examining in some of my research.
Whilst a lot of work is around gambling addictions, you also do work on videogame addiction. What drew you to this area of research?
I suppose the ‘classic’ behavioural addiction is gambling, and it was this type of behavioural addiction that fuelled my interest in other forms of non-chemical addiction such as videogame addiction. Many people might think it’s obvious why a psychologist would be interested in studying behavioural addictions such as videogame addiction. It’s a ‘sexy’ subject, it’s media-friendly, the general public find it interesting, and almost everybody from all walks of life has some kind of view on it, whether it’s rooted in personal experience or in a finely argued theoretical perspective.
Do you feel that online gaming poses more of an issue than offline?
Yes, but in most cases only to those that have a vulnerability or susceptibility in the first place. The key difference is that in offline gaming a player can typically pause and/or save the game and come back to it a point of their choosing. Online games continue even when the player has logged off and that can lead to some people playing excessively because they ‘don’t want to miss anything’ in a 24/7 playing environment (the so-called ‘FOMO’ phenomenon – ‘fear of missing out’). I’ve argued in a lot of my work that the internet can enhance and/or facilitate the acquisition, development and maintenance of online addictions – but the crucial factor is that somebody would have to have some kind of addiction predisposition in the first place.
Are there any potential problems, in your field or otherwise, that could arise from the rapidly expanding user base of video games?
Obviously this depends on the types of game played and their content. Any activity that has the potential to enhance or facilitate excessive play can lead to potential problems. Depending on the types of game played, this could be in the form of medical effects (repetitive strain injuries, headaches, eye-strains, etc.), chronic health conditions (e.g., obesity), psychobiological effects (e.g., addiction), or alleged behavioural effects (e.g., increased aggression). The good news is that most of these potential effects occur in a very small minority of players and that reducing the time spent playing will almost always alleviate or eliminate such problems.
Can a person could spend a great deal of times playing games without being an addict?
For some people, definitely. Any behaviour that is done to excess – even if it is not an addiction – can potentially take away time from other important things such as job, relationships, and other hobbies. This will depend on the duties, constraints and context of the person in question. A 21-year old man with no partner, no children and no job may have time to play 8-10 hours a day without any negative detriment on their life. However, a married man with three children and a full-time job would find it very hard to play 8-10 hours a day without it seriously compromising some other aspect of their life.
Dr. Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Gentile, D.A., Bailey, K., Bavelier, D., Funk Brockmeyer, J., … Griffiths, M.D., … & Young, K. (2017). The state of the science about Internet Gaming Disorder as defined by DSM-5: Implications and perspectives, Pediatrics, 140, S81-S85. doi: 10.1542/peds.2016-1758H
Griffiths, M.D. (2010). Online video gaming: What should educational psychologists know? Educational Psychology in Practice, 26(1), 35-40.
Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.
Griffiths, M.D. (2013). An overview of online gaming addiction. In Quandt, T. & Kröger, S. (Eds.), Multi.player – Social Aspects of Digital Gaming (pp.197-203). London: Routledge.
Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.
Kuss, D.J. & Griffiths, M.D. (2012). Internet gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.
Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.
Griffiths, M.D., Kuss, D.J. & Pontes, H.M. (2016). A brief overview of Internet Gaming Disorder and its treatment. Australian Clinical Psychologist, 2(1), 20108.
Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.
Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2017). Psychometric assessment of Internet Gaming Disorder in neuroimaging studies: A systematic review. In Montag, C. & Reuter, M. (Eds.), Internet Addiction Neuroscientific Approaches and Therapeutical Implications (pp.181-208). New York: Springer.
Pontes, H.M. & Griffiths, M.D. (2017). New concepts, old known issues: The DSM-5 and Internet Gaming Disorder and its assessment. In Gaming and Technology Addiction (pp. 893-898). Hershey, PA: IGI Global.
Torres-Rodriguez, A., Griffiths, M.D., Carbonell, X. Farriols-Hernando, N. & Torres-Jimenez, E. (2019). Internet gaming disorder treatment: A case study evaluation of four adolescent problematic gamers. International Journal of Mental Health and Addiction, 17, 1-12.
Torres-Rodriguez, A., Griffiths, M.D., Carbonell, X. & Oberst, U. (2018). Psychological characteristics of an adolescent clinical sample with Internet Gaming Disorder. Journal of Behavioral Addictions, 7, 707-718.
Today’s blog takes a brief look at some of the stranger addictions that have been written about in the academic literature (or academics that have tried to argue these behaviours can be addictive). Some of these ‘addictions’ listed are not addictions by my own criteria but others have argued they are. The papers or books that have argued the case for the cited behaviour being a type of addiction are found in the ‘Further reading’ section.
- Argentine tango addiction: A French study published in a 2013 issue of the Journal of Behavioral Addictions by Remi Targhetta and colleagues argued that a minority of 1129 Argentine tango dancers they surveyed may be addicted to dancing. In 2015, I and some of my Hungarian colleagues developed the Dance Addiction Inventory (published in PLoS ONE) and also argued that a minority of dancers (more generally) might be addicted to dance and conceptualized the behaviour as a form of exercise addiction.
- Badminton addiction: While there are many behaviours I could have chosen here including addictions to box set television watching (aka ‘box set bingeing), bargain hunting, bungee jumping, blogging, and bodybuilding, a recent 2018 paper published in NeuroQuantology by Minji Kwon and colleagues carried out a neuroimaging study on a sample 45 badminton players. Using the Korean Exercise Addiction Scale, 20% of the sample were defined as being addicted to badminton.
- Carrot eating addiction: Again, there are many behaviours I could have chosen here including alleged addictions to crypto-trading, chaos, collecting, crosswords, and cycling, there are a number of published case studies in the psychological literature highlighting individuals addicted to eating carrots including papers by Ludek Černý and Karel Černý, K. (British Journal of Addiction, 1992), and Robert Kaplan (Australian and New Zealand Journal of Psychiatry, 1996).
- Death addiction: A recent paper by Dr. Marc Reisinger entitled ‘Addiction to death’ in the journal CNS Spectrums attempted to argue that attraction to death be considered an addiction similar to gambling addiction. Reisinger related the concept to individuals who have left Europe to join the jihad in Syria, and outlined the case of 24-year-old French-Algerian Mohamed Merah who committed several attacks in Toulouse in 2012 and who ‘glorified’ death. Te paper claimed that this “addiction to death is taught by Salafist preachers, whose videos, readily accessible on the internet, are kind of advertisements for death, complete with depictions of soothing fountains and beautiful young girls”.
- Entrepreneurship addiction: There are a couple of papers by April Spivack and Alexander McKelvie (a 2014 paper in the Journal of Business Venturing, and a 2018 paper Academy of Management) arguing that entrepreneurship can be addictive. They define ‘entrepreneurship addiction’ as “the excessive or compulsive engagement in entrepreneurial activities that results in a variety of social, emotional, and/or physiological problems and that despite the development of these problems, the entrepreneur is unable to resist the compulsion to engage in entrepreneurial activities”. They also make the case that that entrepreneurship addiction is different from workaholism.
- Fortune telling addiction: Although I could have included addictions to financial trading or fame, a 2015 paper in the Journal of Behavioral Addictions by Marie Grall-Bronnec and her colleagues reported the case study of a woman (Helen) that was ‘addicted’ to fortune tellers. They used my addiction criteria to assess whether Helen was addicted to fortune telling, and argued that she was.
- Google Glass addiction: In previous blogs I have written on addictions to gossip and gardening (although these were based more on non-academic literature). However, a 2015 paper published by Kathryn Yung and her colleagues in the journal Addictive Behaviors, published the first (and to my knowledge) only case of addiction to Google Glass (wearable computer-aided glasses with Bluetooth connectivity to internet-ready devices. The authors claimed that their paper, (i) showed that excessive and problematic uses of Google Glasscan be associated with involuntary movements to the temple area and short-term memory problems, and (ii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass.
- Hacking addiction: Back in the late 1990s and early 2000s I wrote a number of papers on internet addiction and included ‘hacking addiction’ as a type of internet addiction. Given the criminal element of this type of internet addiction I wrote about it in criminological-based journals such as The Probation Journal (1997) and The Police Journal (2000). One of the most infamous cases that I have written about took place in London in 1993, where Paul Bedworth was accused of hacking-related crime causing over £500,000 worth of damage. On the basis of expert witness testimony, he was acquitted on the basis that he was addicted to hacking. Since then, various papers have been published arguing that hacking can be an addiction. For instance, in an in-depth interview study of 62 hackers, Siew Chan and Lee Yao used addiction as a framework to explain their participants’ behaviour (see their paper in the Review of Business Information Systems, 2005).
- Internet search addiction: Although I was tempted to go for IVF addiction, I thought I would go for ‘internet search addiction’ which basically refers to constant ‘googling’ where individuals spend hours and hours every day using online databases to go searching for things. This behaviour was first alluded to by Kimberley Young in her 1999 classification of different types of internet addiction which she called ‘information overload’ and was defined as compulsive web surfing or database searches. More recently, Yifan Wang and her colleagues developed the Questionnaire on Internet Search Dependence (QISD) published in Frontiers in Public Health (FiPH). I criticized the QISD in a response paper published in FiPH, not because I didn’t think internet search addiction didn’t exist (because theoretically it might do, even though I’ve never come across a genuine case) but because the items in the instrument had very little to do with addiction.
- Joyriding addiction: There have been a number of academic papers published on joyriding addiction. Arguably the most well-known study was published by Sue Kellett and Harriet Gross in a 2006 issue of Psychology, Crime and Law. The study comprised semi-structured interviews with 54 joyriders (aged 15 to 21 years of age) all of whom were convicted car thieves (“mainly in custodial care”). The results of the study indicated that all addiction criteria occurred within the joyriders’ accounts of their behaviour particularly ‘‘persistence despite knowledge and concern about the harmful consequences’’, ‘‘tolerance’’, ‘‘persistent desire and/or unsuccessful attempts to stop’’, “large amounts of time being spent thinking about and/or recovering from the behaviour’’ and “loss of control”. The paper also cited examples of ‘withdrawal’ symptoms when not joyriding, the giving up of other important activities so that they could go joyriding instead, and spending more time participating in joyriding than they had originally intended.
- Killing addiction: The idea of serial killing being conceptualized as an addiction in popular culture is not new. For instance, Brian Masters book about British serial killer Dennis Nilsen (who killed at least 12 young men) was entitled Killing for Company: The Story of a Man Addicted to Murder, and Mikaela Sitford’s book about Harold Shipman, the British GP who killed over 200 people, was entitled Addicted to Murder: The True Story of Dr. Harold Shipman. In Eric Hickey’s 2010 book Serial Murderers and Their Victims, Hickey makes reference to an unpublished 1990 monograph by Dr. Victor Cline who outlined a four-factor addiction syndrome in relation to sexual serial killers who (so-called ‘lust murderers’ that I examined in a previous blog). One of the things that I have always argued throughout my career, is that someone cannot become addicted to an activity or a substance unless they are constantly being rewarded (either by continual positive and/or negative reinforcement). Given that serial killing is a discontinuous activity (i.e., it happens relatively infrequently rather than every hour or day) how could killing be an addiction? One answer is that the act of killing is part of the wider behaviour in that the preoccupation with killing can also include the re-enacting of past kills and the keeping of ‘trophies’ from the victims (which I overviewed in a previous blog).
- Love addiction: In the psychological literature, the concept of love addiction has been around for some time dating back to works by Sigmund Freud. Arguably the most cited work in this area is the 1975 book Love and Addiction by Stanton Peele and Archie Brodsky. Their book suggested that some forms of love are actually forms of addiction, and tried to make the case that some forms of love addiction may be potentially more destructive and prevalent than widely recognized opiate drugs. There have also been a number of instruments developed assessing love addiction including the Love Addiction Scale (developed by Hunter, Nitschke, and Hogan, 1981), and the Passionate Love Scale (developed by Hatfield, and Sprecher, 1986).
- Muscle dysmporphia as an addiction: In a paper I published with Andrew Foster and Gillian Shorter in a 2015 issue of the Journal of Behavioral Addictions, we argued that muscle dysmorphia (MD) could be classed as an addiction. MD is a condition characterised by a misconstrued body image in individuals who interpret their body size as both small or weak even though they may look normal or highly muscular. MD has been conceptualized as a body dysmorphic disorder, an eating disorder, and/or part of the obsessive-compulsive disorder symptomatology. Reviewing the most salient literature on MD, we proposed an alternative classification of MD that we termed the ‘Addiction to Body Image’ (ABI) model. We argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating specific foods, taking specific drugs (e.g., anabolic steroids), shopping for specific foods, food supplements, and/or physical exercise accessories, etc.. In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder). Based on empirical evidence, we proposed that MD could be re-classed as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.
- News addiction: Although I could have chosen nasal spray addiction or near death addiction, a recent 2017 paper on ‘news addiction’ was published in the Journal of the Dow University of Health Sciences Karachi by Ghulam Ishaq and colleagues. The authors used some of my papers on behavioural addiction to argue for the construct of ‘news addiction’ as a construct to be empirically investigated. The authors also developed their own 19-item News Addiction Scale (NAS) although the paper didn’t give any examples of any of the items in the NAS. In relation to personality types (and like other addictions), they found news addiction was positively correlated with neuroticism and negatively correlated with conscientiousness. Given that this is the only study on news addiction that I am aware of, I’ll need a lot more research evidence before I am convinced that it really exists.
- Online auction addiction: A number of academics have made the claim that some individuals can become addicted to participating in online auctions. In a 2004 paper on internet addiction published in American Behavioral Scientist, Kimberley Young mentioned online auction [eBay] addiction in passing. The same observation was also made in a later 2009 paper by Tonino Cantelmi and Massimo Talls in the Journal of CyberTherapy and Rehabilitation. Other researchers have carried out empirical studies including a (i) 2007 paper by Cara Peters and Charles Bodkin in the Journal of Retailing and Consumer Services, (ii) 2008 paper by Chih-Chien Wang in the Proceedings of the Asia-Pacific Services Computing Conference, and (iii) 2011 study carried out by Dr. Ofir Turel and colleagues published in the MIS Quarerly. These papers indicated that those with problematic online auction use experienced (i) psychological distress, (ii) habitual usage, (iii) compulsive behaviour, (iv) negative consequences, and/or (v) dependence, withdrawal and self-regulation.
- Pinball addiction: Although I could have listed alleged addictions to plastic surgery and poetry, as far as I am aware, I am the only academic to have published a paper on pinball addiction. Back in 1992, I published a case study in Psychological Reports. My paper featured the case of a young man (aged 25 years) who (based on classic addiction criteria) was totally hooked on pinball. It was the most important thing in his life, used the behaviour to modify his moods, got withdrawal symptoms if he was unable to play pinball, had engaged in repeated efforts to cut down or stop playing pinball, and compromised all other activities in his life (education, occupation and relationships). To me, this individual had a gaming addiction but it was pinball rather than videogame addiction.
- Qat addiction: Qat (sometimes known as khat, kat, cat, and ghat) is a flowering plant traditionally used as a mild stimulant in African and Middle East countries (Somalia, Yemen, Ethiopia). Heavy qat users can experience many side effects including insomnia, anxiety, increased aggression, high blood pressure, and heart problems. There are numerous reports in the medical literature of qat addiction (see papers by Rita Manghi and colleagues in the Journal of Psychoactive Drugs, and Nezar Al-Hebshi and Nils Skuag in Addiction Biology).
- Rock climbing addiction: Over the past two years, a couple of papers by Robert Heirene, David Shearer, and Gareth Roderique-Davies have looked at the addictive properties of rock climbing specifically concentrating on withdrawal symptoms and craving. In the first paper on withdrawal symptoms published in 2016 in the Journal of Behavioral Addictions, the authors highlighted some previous research suggesting that there are similarities in the phenomenology of substance-related addictions and extreme sports (in this case rock climbing). The study concluded that based on self-report, rock climbers experienced genuine withdrawal symptoms during abstinence from climbing and that these were comparable to individuals with substance and other behavioural addictions. In a second investigation just published in Frontiers in Psychology, the same team reported the development of the Rock Climbing Craving Questionnaire comprising three factors (‘positive reinforcement’, ‘negative reinforcement’ and ‘urge to climb’).
- Study addiction: I was spoilt for choice on the letter ‘S’ and could have mentioned addictions to speeding, selfie-taking, shoplifting, Sudoko, and stock market speculation. However, there are now a number of published papers on ‘study addiction’ (individuals addicted to their academic study), three of which I have co-authored (all in the Journal of Behavioral Addictions and led by my colleague Pawel Atroszko). We have conceptualised study addiction as a type of work addiction (or a pre-cursor to work addiction) and in a series of studies (including longitudinal research) we have found empirical evidence of ‘study addiction’. Italian researchers (Yura Loscalzo and Marco Giannini) have also published research on ‘overstudying’ and ‘studyholism’ too (in the journals ARC Journal of Psychiatry, 2017; Social Indicators Research, 2018).
- Tanning addiction: There is now lots of empirical research examining ‘tanorexia’ (individuals who crave tanning and spend every day on sunbeds). However, I along with my colleagues in Norway recently reconceptualised tanorexia as a ‘tanning addiction’ and developed a scale to assess it (which was recently published in a 2018 issue of the British Journal of Dermatology). Our study was the largest over study on tanning (over 23,000 participants) and our newly developed scale (the Bergen Tanning Addiction Scale) had good psychometric properties.
- Upskirting addiction: Upskirting refers to taking a photograph (typically with a smartphone) up someone’s skirt without their permission. In the UK there have been a number of high profile court cases including Paul Appleby who managed to take 9000 upskirting photos in the space of just five weeks (suggesting that he was doing it all day every day to have taken so many photos), and Andrew MacRae who had amassed 49,000 upskirt photos and videos using hidden cameras at his workplace, on trains, and at the beach. Both men avoided a custodial sentence because their lawyers argued they were addicted and/or had a compulsion to upskirting. In a 2017 issue of the Law Gazette, forensic psychologist Julia Lam made countless references to upskirting in an overview of voyeuristic disorder. Dr. Lam also talked about her treatment of upskirting voyeurs and recounted one case which she claimed was a compulsion (and who was successfully treated). The case involved a male university student who was very sport active but who masturbated excessively whenever major sporting events or important exams were imminent as a coping strategy to relieve stress.
- Virtual reality addiction: Back in 1995, in a paper I entitled ‘Technological addictions’ in the journal Clinical Psychology Forum, I asserted that addiction to virtual reality would be something that psychologists would be seeing more of in the future. Although I wrote the paper over 20 years ago, there is still little empirical evidence (as yet) that individuals have become addicted to virtual reality (VR). However, that is probably more to do with the fact that – until very recently – there had been little in the way of affordable VR headsets. (I ought to just add that when I use the term ‘VR addiction’ what I am really talking about is addiction to the applications that can be utilized via VR hardware rather than the VR hardware itself). Of all the behaviours on this list, this is the one where there is less good evidence for its existence. Perhaps of most psychological concern is the use of VR in video gaming. There is a small minority of players out there who are already experiencing genuine addictions to online gaming. VR takes immersive gaming to the next level, and for those that use games as a method of coping and escape from the problems they have in the real world it’s not hard to see how a minority of individuals will prefer to spend a significant amount of their waking time in VR environments rather than their real life.
- Water addiction: In a blog I wrote back in 2015, I recounted some press stories on individuals who claimed they were ‘addicted’ to drinking water. My research into the topic led to a case study of ‘water dependence’ published a 1973 issue of the British Journal of Addiction by E.L. Edelstein. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. This led me to a condition called polydipsia (which in practical terms means drinking more than three litres of water a day) which often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. There are also dozens and dozens of academic papers on psychogenic polydipsia (PPD). A paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. A 2000 study in European Psychiatry by E. Mercier-Guidez and G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. Whether ‘water intoxication’ is a symptom of being ‘addicted’ to water depends upon the definition of addiction being used.
- X-ray addiction: OK, this one’s a little bit of a cheat but what I really wanted to concentrate on what has been unofficially termed factitious disorder (FD). According to Kamil Jaghab and colleagues in a 2006 issue of the Psychiatry journal “FD is sometimes referred to as hospital addiction, pathomimia, or polysurgical addiction”. The primary characteristic of people suffering from FD is that they deliberately pretend to be ill in the absence of external incentives (such as criminal prosecution or financial gain). It is called a factitious because sufferers feign illness, pretend to have a disease, and/or fake psychological trauma typically to gain attention and/or sympathy from other people. Again, whether such behaviours can be viewed as an addiction depends upon the definition of addiction being used.
- YouTube addiction: 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’). The story profiled a student whose obsessive viewing of YouTube content led to extreme behaviour changes and eventually, depression and a suicide attempt. Not long after this, I and my colleague Janarthanan Balakrishnan published what we believe is the only ever study on YouTube addiction in the Journal of Behavioral Addictions. In a study of over 400 YouTube users we found that YouTube addiction was more associated with content creation than watching content
- ‘Zedding’ addiction: OK, I’m using the Urban Dictionary’s synonym here as a way of including ‘sleep addiction’. The term ‘sleep addiction’ is sometimes used to describe the behavior of individuals who sleep too much. Conditions such as hypersomnia (the opposite of insomnia) has been referred to ‘sleeping addiction’ (in the populist literature at least). In a 2010 issue of the Rhode Island Medical Journal, Stanley Aronson wrote a short article entitled “Those esoteric, exoteric and fantabulous diagnoses” and listed clinomania as the compulsion to stay in bed. Given the use of the word ‘compulsive’ in this definition, there is an argument to consider clinomania as an addiction or at least a behaviour with addictive type elements.
Dr Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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Earlier this year, the World Health Organisation announced that ‘Gaming Disorder’ (GD) was to be officially been included in the latest (eleventh) edition of the International Classification of Diseases (ICD-11). The announcement received worldwide media coverage alongside many debates as to whether its inclusion was justified based on the scientific evidence. The extensive media coverage raised many questions but also appeared to give rise to a number of myths. In this blog, I address these myths in the British context but some of these myths also have resonance outside the UK.
Myth 1 – Gaming Disorder equates to gaming addiction. Almost all of the worldwide press coverage for GD in June 2018 was equated with gaming addiction. However, the World Health Organization (WHO) does not describe GD as an addiction and the WHO criteria for GD do not include criteria that I believe are core to being genuine addictions (such as tolerance and withdrawal symptoms). Confusingly, the criteria for Internet Gaming Disorder (IGD) in the latest (fifth) edition of the Diagnostic Manual of Mental Disorders (DSM-5) does include all my core criteria of addiction. However, to be diagnosed with IGD, an individual does not necessarily have to endorse all the core addiction criteria. In short, all genuine gaming addicts are likely to be diagnosed as having GD and/or IGD but not all those with GD and/or IGD are necessarily gaming addicts.
Myth 2 – Gaming has many benefits so should not be classed as a disorder as it will create a ‘moral panic’: Predictably, the videogame industry has not welcomed the WHO’s decision to include GD in the ICD-11 and issued a statement to say gaming has many personal benefits and that GD will create moral panic and ‘abuse of diagnosis’. None of us in the field dispute the fact that gaming has many benefits but many other activities such as work, sex, and exercise can be disordered and addictive for a small minority, and is not a good basis for denying the existence of GD. The videogame industry also claims the empirical basis for GD is highly contested but then ironically uses non-empirical claims (i.e., that the introduction of GD will cause a moral panic and lead to diagnostic abuse by practitioners) as a core argument for why GD should not exist.
Myth 3 – Gaming Disorder is associated with other comorbidities so is not a separate disorder. In coverage concerning GD, those denying the existence of GD sometimes resort to the argument that problematic gaming is typically comorbid with other mental health conditions (e.g., depression, anxiety disorders, etc.) and therefore should not be classed as a separate disorder. However, such an argument is not applied (for instance) to those with alcohol use disorder or gambling disorder which are known to be associated with other comorbidities. In fact, we recently published some case studies in the International Journal of Mental Health and Addiction highlighting those attending treatment for GD included individuals both with and without underlying comorbidities. Consequently, diagnosis of disorders should be based on the external symptomatic behavior and consequences, not on the underlying causes and etiology.
Myth 4 – Gaming Disorder can now be treated for free by the National Health Service: Unlike many other countries, the UK has a National Health Service (NHS) whose treatment services can be accessed free of charge. A number of British newspapers reported that inclusion of GD in the ICD-11 meant that those with GD can now get free treatment. However, this claim is untenable and is unlikely to happen. All health trusts in the UK have a finite budget and allocate resources to those conditions considered a priority. Treating individuals with GD will rarely (if ever) be given priority over treatment for cancer, heart disease, schizophrenia, depression, etc. In countries where private health insurance is the norm, GD is likely to be a condition excluded for treatment on such policies even though it is now in the ICD-11.
Myth 5 – The inclusion of Gaming Disorder as a mental disorder will lead to ‘millions’ of children being stigmatized for their videogame playing: This myth has been propagated by a group of scholars (mainly researchers working in the media studies field) but is completely unsubstantiated. The number of children who would ever be officially be diagnosed as having GD is extremely low and – as noted above – millions of children play videogames for enjoyment without any problems or stigma.
(Please note: This article is based on an editorial that I first published earlier this year: Griffiths, M.D. (2018). Five myths about gaming disorder. Social Health and Behavior Journal, 1, 2-3)
Dr Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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“Cash Out lets you take profit early if your bet is coming in, or get some of your stake back if your bet is going against you – all before the event you’re betting on is over. Cash Out offers are made in real time on your current bets, based on live market prices. Whenever you are ready to Cash Out, simply hit the yellow button. Cash out is available on singles and multiples, on a wide range of sports, including football, tennis, horse racing, and many more! You can Cash Out of bets pre-play, in-play, and between legs” (Definition of ‘cash out’ betting on Betfair website, 2017).
Most European sports betting operators now feature ‘cash out’ functionalities in their online platforms. This means that bettors can withdraw their bets before the event bet upon has concluded, obtaining a smaller but guaranteed return if the outcome of the bet is going their way, or, conversely, cutting down the monetary impact of a foreseeable loss. The ‘cash out’ functionality has rapidly become popular among sports bettors that bet in-play (i.e., during the game on things such as soccer matches and horse races) as a way of maximising value on the bets they have made.
Industry voices such as David O’Reilly, from Colossus Bets, have identified four major benefits of cash out features for bookmakers: (i) reducing the volatility of the operator’s revenue; (ii) increasing the recycling of player returns, with more players banking smaller amounts; (iii) enabling players to avoid their ‘near miss’ frustration; and (iv) improving the player engagement with the platform by introducing a mechanism that promotes constant checking. However, for sports bettors, cashing out strategies might typically involve cutting down the profit while being ahead but rarely reducing the loss when going behind. In this regard, cashing out does not appear to differ greatly from other new internet-based betting forms (e.g. so-called ‘exotic’ or multiple bets), which have been found to possess, in general, higher expected losses for gamblers and greater profit margins for operators.
However, beyond the feature’s financial rationale, cash out affects the nature of sports betting in more meaningful ways. It is, arguably, a game-changer, that leads (along with other features such as ‘edit my acca’ features in which specific bets can be removed from ‘accumulator’ bets) to the transformation of sports betting from a discontinuous to a continuous form of gambling. Here, our contention is that cash out is a key component of the contemporary bettor-bookmaker interaction, and that the widespread adoption by devoted sports bettors merits a closer look into the implications of such an interaction from a problem gambling perspective. Such an examination also suggests that regulators and policymakers need to think about how to protect gambling consumers from the potential harm caused by this new type of betting.
Structural characteristics have been proposed as a determining factor that can influence problem gambling behaviour. Structural characteristics are those associated with the design of a gambling product that shape the way gamblers interact with it. Typical structural characteristics include, but are not limited to, bet frequency, bet duration, event frequency, near misses, stake size, jackpot size, probability of winning, and interface design (e.g., the use of music and colour stimuli in the design of slot machines).
The internet has altered significantly the structural characteristics of gambling and sports betting more specifically. For example, in a number of European countries, the football (soccer) pools used to comprise bets placed during a weekday on the outcome of a game played typically on a Saturday or Sunday (i.e., a once a week wager). This reward delay was a major protective factor against excessive gambling, which on a psychobiological level has been theorised as an imbalance in an individual’s dopamine receptors, and therefore, highly sensitive to shorter bet reward periods. Betting via the internet has reduced such delays in receiving rewards from gambling, thus modifying a major structural characteristic of betting from once a week to (in some instances) every few minutes.
In parallel to the increased uptake of Internet betting in many jurisdictions, a second dynamic, namely globalisation, has further widened the possibilities of betting across countries, sports, and time zones, ultimately transforming sports betting into a 24/7 activity where the bookmaker never closes the shop any day during the year. For the first time, if a gambler has a craving to bet, the market is able to respond to that demand anytime and anywhere via a range of Wi-Fi enabled portable devices (e.g., smartphone, tablets, laptops, etc.). Virtual sports have expanded the availability of betting options even more, eliminating the need to bet on real world sport events.
Although the time between bets (i.e., bet frequency) was effectively reduced to near zero, the time within bets (i.e., bet duration) changed little until cash out functionality was first introduced by the gaming operator William Hill in December 2012. With cash out features, sports betting has become a potentially continuous gambling activity, one that resembles the playing mechanics the stock market. As with investing in stocks, bet values in in-play sports betting are re-calculated seamlessly. The outcome of a sport event might not be as relevant for many bettors as the value their bet will acquire in the next few seconds, even if that bet turns out to be erroneous at the end of the game. As in stock market investing, betting becomes continuous because non-actions also qualify as actions in themselves. Every single second that a bettor decides not to cash out, a new bet takes place. Eventually, cash out features introduce the notion that it is the bet itself the commodity that is being traded in the sports betting market. This new continuous type of sports betting raises questions concerning the gambling-related harm that could be associated with it. It also suggests that the kinds of regulation found widely in the stock market investment sector might have some utility if applied to this new form of gambling.
From a marketing perspective, cash out functionality is often advertised as a control-enhancing mechanism for bettors. Given that cashing out is typically presented in television advertisements as a risk-free operation, the product is likely to be perceived as reimbursable if the client is not happy with it, arguably promoting less planned gambling behaviours. Some gaming operators use the alternative name of “edit my bet” to refer to cash out, focusing on the capacity of bettors to correct later possible errors of judgement. The problem is that (and as happens in stock market investing), cashing out is only possible at the current value of the stock (which may be inferior to the purchasing price). Additionally, and contrary to what happens in stock market investing, betting operators automatically devalue the bet price immediately after the purchase. For example, a bookmaker will typically offer to cash out for $0.95 or similar a $1 bet placed one second ago, a price devaluation unmotivated by any new information or event actually affecting the predicted value of such a bet.
Beyond its most apparent attributes, we have demonstrated that cash out within in-play gambling is a pivotal feature that has been introduced by the sports betting industry to transform sports betting from what was traditionally a discontinuous form of gambling into a continuous one. It is contended that, although cashing out presupposes more engaged gamblers that feel more in control of their bets, the emotionally charged context in which it is often used and the structural attributes of the product itself might actually make some bettors lose control over their gambling wagers. Consequently, gambling policymakers and regulators should be cognizant of the challenges of this transformation of sports betting and consider the implications for the protection of gambling consumers.
[Note: This article was co-written with Dr. Hibai Lopez-Gonzalez]
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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